LONG--Anyone up for a game of Diagnose and Prescribe?

[Spiky Bugger]

Okay, so the new doctor who SOUNDED like he knew about wls is going to be replaced. On December 23rd...cannot do it before then.

He disagreed with our surgeons and us and was SURE, beyond a shadow of a doubt, that once you have the DS your PTH will ALWAYS be out of range, too high, nothing you can do about it. He's an ass. He would, I guess, ignore test results...if he even tested PTH, which he says he won't do...and patients would lose teeth and bones.

Anyway...the current problem. I have a hx of C Diff...so I have not taken antibiotics-except the vancomycin prescribed for C Diff, for over a year. And I'm REALLY afraid of them. But for over a week, I have had, more or less, UTI symptoms. Urgency, frequency, spasms...that kind of thing. BUT, I also have interstitial cystitis, which is, essentially, those symptoms with no bacteria to kill. (So you treat the symptoms and/or live with the pain, which is why that disease has a fairly high suicide rate.)

So, I finally call the Know It All PCP and tell them I have UTI symptoms and I'd like to have a urinalysis. The results came back today, and--I haven't seen them--I'm guessing from what they told me that I don't have the required 100,000 colonies of bacteria needed to call it a UTI, but there are random, unidentified bacteria wandering around in my urinary tract trying to set up housekeeping. Which also means there is no Culture and Sensitivity telling me which drugs to use to combat this possible threat.

So Doctor Genius prescribes 500 mg Cipro, bid x 10 days. I mention that the gastro docs told me to avoid broad spectrum abx, and--insisting that I know nothing about such things--politely ask if this is the best drug to take given those instructions. His response is that the advice I was given only counts while I have active C Diff and I don't need to worry about that now. (Of course, that is NOT the case...the advice to avoid those drugs was given in response to my question about how to avoid future occurrences of C Diff. But I'm not going to argue with this guy...at least not yet.)

So...here I sit with a bunch of Cipro. Which in my mind, is something we are just throwing at the symptoms with no really good reason to choose that drug. But, I'm intermittently in a lot of pain and if the cause is bacterial, then maybe I shouldn't opt to do nothing.

My first thought is that I will take it for THREE days...it is often used to treat cystitis. It might help. And maybe by limiting my exposure to that antibiotic, I won't be killing myself.

My second thought is that if I want to throw random drugs at this, I *DO* have vancomycin and it is safe in regards to C Diff and that might work, too. Although...it may not even work in the urinary tract, I have to go look that up.


Soooo....
•if YOU had been dealing with a spasm-y bladder (and tenderness but not full-blown PAIN in the kidney area) for over a week...and
•you had another disease that could cause those symptoms and, if that's the problem, the only thing possible is to treat the symptoms...and
•you had a shitload of drugs on hand...to include Cipro (ciprofloxacin), Bactrim DS (sulfamethoxazole and trimethoprim), Vancomycin, plus Urispas (flavoxate HCl) to treat the spasm plus a whole shitload of Norco and Vicodin (both hydrocodone) to treat the pain...
•what would YOU do, especially keeping in mind the warning to stay away from broad-spectrum abx? (And I already have an appointment with my Urologist, but he's out of town right now and I'm leaving town before he gets back and it's going to be about a month and until then all I have is the ER and they don't know any more about this mess than anyone else.)

While awaiting your responses, I will go take yet another Norco. Because PAIN.


ETA...also in possession of metric shit tonne of Macrobid and macrodantin (nitrofurantoin or however you spell it.)

 

[KathyF]

What would I do? Drink cranberry juice, take pain pills and call your gastro doctor tomorrow and discuss your best options for treating the symptoms while avoiding the risk of coming down with C-Diff.

 

[DianaCox]

I am not in your shoes of course, but I usually sorta look forward to a course of ABX - my guts are usually less stinky for a while afterwards. But I rarely am prescribed them (other than courses of Flagyl deliberately taken for bacterial overgrowth, I don't think I've been prescribed them more than 3-5 times in the last 11 years (food poisoning, URI that actually was reactive asthma, and I can't recall exactly any others). I don't take them often, and I don't usually get bad effects from them.

BUT - you are a special snowflake, and I am furious on your behalf that your new (and about to be former) doctor doesn't seem to be (1) interested enough to listen to you; (2) respectful of your intelligence; or (3) open minded enough to consider the possibility that what he "knows" might be wrong.

You know you can't let this doctor prescribe for you. You know he is being irresponsible. You know you need a C&S before taking ABX, because any of them can set off your C. diff again.

• Pain meds
• Urgent call to your urologist for him to order a trip back to the lab tomorrow so the C&S is done by Monday
• Ask your urologist to call Dr. Know-It-All to demand that he coordinates your care with him until he's fired.

You shouldn't have to see the urologist with whom you have an established relationship to get prescribed the right meds.

 

[newanatomy]

Sorry that you are going through this again. I hope you get some real relief soon. Sending cyber hugs, not in a stalkerish way though.

 

[kirmy]

What! No. This idiot cannot grasp basic concepts. Change doctors today. Get going. Don't dare take abs not at all. Don't. Get your pain meds right, get your hydration very right and treat your symptoms. Get a referral from your specialist to a mate of his or her for the interim.

Serious fuck wad...PTH...c-diff...all basic !

 

[Spiky Bugger]

What! No. This idiot cannot grasp basic concepts. Change doctors today. Get going. Don't dare take abs not at all. Don't. Get your pain meds right, get your hydration very right and treat your symptoms. Get a referral from your specialist to a mate of his or her for the interim.

Serious fuck wad...PTH...c-diff...all basic !

We belong to a concierge medicine group and the only doctor closer than 15-20 miles, who has openings (they take a max of 600 patients), will not be opening her concierge practice until December 23rd. And if SHE makes sense, we'll sign up again in December.

I can fire this ignorant guy on Monday...even get a refund of my membership fees...but that won't solve my problem, which is apparently, that I have IC and I just have to take lots of drugs. (My other problem is that I can handle ignorance in someone willing to learn, and I can handle arrogance in someone who ranks clearly above the rest of humanity. I just can't tolerate the arrogant ignoramuses of the planet...you know...people who for reasons almost incomprehensible to those who pay attention, suffer from an excess of self-esteem that seems to have grown as exponentially as the colony of Tribbles on the original Starship Enterprise.

It is really strange, too. One minute I am perfectly fine and the next minute I drag along, stumbling in an almost direct route like a hungover bridge troll. And it CAN go away just as quickly.

I can go to urgent care or the Veterans Administration if I want to see a doctor for random reasons. I can go to any ER, including the VA, in an emergency.

The problem in this area is a horrific shortage of physicians. (Kirmy, if you read this, keep in mind that osteopaths here are different than what you are used to. I think your osteopaths equal our chiropractors, but I'm not sure.). That's why the concierge group. At my former local PCP, if I wanted a urinalysis, I had to call and ask for an appointment...that could take a week, just to get someone to write an order for a urinalysis. Then, it was another two or three days to get test results. In the interim, you are expected to assume a fetal position and not complain about the pain. The concierge practice will order a U/A upon receiving your phone request and, if you WANT to see the doctor, get you in today or tomorrow...unless YOU want to wait, say for the third day to be sure the C&S is available. Anyway, if you liked it here, I suspect it would take you one phone call to find a job...and your remodeled bathroom is almost done.
http://www.vegasinc.com/business/2014/apr/27/critical-doctor-shortage/

And...just to compound the felony (as my cop grandfather used to say)...even if I go to Urgent Care today, they won't be able to pull the U/A results, because the lab is having computer problems. So I'm screwed.

I'm going to go numb up my bladder, make it stop spasming, get loaded on hydrocodone and go have a late lunch with friends. ROFLMAO...a late lunch of soft-ish food since my two front teeth are currently plastic replicas of real teeth and I'm not supposed to bite down on anything with them. And if that's the case, my about-to-be-former PCP better wear a nose guard while in my vicinity...'lest I develop an affinity for Imbecile Snout, with a reduction of What's-Left-of-His-Overdeveloped-Sense-of-Self-Worth after I have a word with him.

 

[Sheanie]

@Spiky Bugger , I found a very concentrated cranberry capsule that I take for bladder issues. It knocks the bacteria for a loop very well. It used to be called Cranactin, I think. But now you can find it everywhere, even generic forms. I took ten of them a day. Cranberry juice doesn't do the trick, but the pills do.

I stay the hell away from antibiotics totally.

 

[brooklyngirl]

Agreeing with everyone else! Don't take the antibiotics, take high dose cranberry pills, when I feel a UTI coming on I try to take at least 4 doses per day, with tons of extra water, and it slinks back to wherever it came from. I remember NYB arguing with me that it's not possible to knock out a UTI with cranberry, so either she's the crazy bitch we know her to be, or I'm extra special, but it always works when I do it quickly!

 

[Spiky Bugger]

I hate to agree, in theory, with NYC, but I have seen zero scientific evidence that an EXISTING UTI is changed at all by cranberry anything. (The study I saw said it helped PREVENT UTIs in 19 year olds...but nothing on CURING them.)

However, I bought some and will hope against hope, okay?

And bought some other kidney bladder potion that probably won't work either.

Sincerely,

Little Mary Sunshine

 

[Sheanie]

@brooklyngirl , you and I start taking it at the very first sign of a UTI. Spiky is right, as is NYC, in that taking it once an UTI has gotten bad, the cranberry won't work. Same thing with pounding Vitamin C at the first tickle of a cold. Linus Pauling wrote a paper on the use of C. Old stuff, same principle. Only problem is now with the DS, I can no longer take large doses of C without severe stomach upset and diarrhea, which is Pauling's signal that you've reached your desired maximum C dose, or therapeutic level. I max out before I reach therapeutic C levels. It doesn't happen, however, with cranberry.

Good luck, Spiky.

 

[brooklyngirl]

@brooklyngirl , you and I start taking it at the very first sign of a UTI. Spiky is right, as is NYC, in that taking it once an UTI has gotten bad, the cranberry won't work. Same thing with pounding Vitamin C at the first tickle of a cold. Linus Pauling wrote a paper on the use of C. Old stuff, same principle. Only problem is now with the DS, I can no longer take large doses of C without severe stomach upset and diarrhea, which is Pauling's signal that you've reached your desired maximum C dose, or therapeutic level. I max out before I reach therapeutic C levels. It doesn't happen, however, with cranberry.

Good luck, Spiky.

I guess it's being sensitive to the warning signs before it's gotten to actual infection level? I'd still try that and some other avenues with seeing a doc like mentioned above, rather than take antibiotics. I've never had c diff, but antibiotics have messed me up enough, in various ways, that I'll only take them when I KNOW it's really necessary!

 

[JackieOnLine]

sorry you are going through this, wish I had something helpful to suggest.

 

[hilary1617]

@SpikyBugger, So sorry you are in pain and suffering. I think you should expand the good doctor search radius if that will expose you to some real talent. I share your view about arrogance and incompetence. My tolerance is mutually exclusive - it can only exist in the presence of one or the other - not both. Hang in there!

 

[Spiky Bugger]

@SpikyBugger, So sorry you are in pain and suffering. I think you should expand the good doctor search radius if that will expose you to some real talent. I share your view about arrogance and incompetence. My tolerance is mutually exclusive - it can only exist in the presence of one or the other - not both. Hang in there!

Love how you phrased that...I will use it in getting our $3000 refund.

 

[Spiky Bugger]

@brooklyngirl @Sheanie @KathyF

I know many very smart women who feel that cranberry juice...which in terms of UTI research usually means actual cranberry juice not cranberry juice cocktails...is their savior from UTIs. It is unlikely that I'm right and they--and you--are all wrong.

~But my primary issue with my bladder is Interstitial Cystitis.

"Some of the symptoms of IC/PBS resemble those of bacterial infection, but medical tests reveal no organisms in the urine of people with IC/PBS. Furthermore, people with IC/PBS do not respond to antibiotic therapy. Researchers are working to understand the causes of IC/PBS and to find effective treatments."

And, I'm one of these people...not sixty times day, but when it's bad, it's been up to forty times...which means I was unable to even reach REM sleep, since I had about a 40-minute capacity...got a tad crazy there, I did! (And you cause other problems when you limit fluid intake to reduce frequency.) And this was a large part of an early, disability retirement. There are not a lot of jobs that allow employees to take a break every 40 minutes.

And

"Some people with IC/PBS find that their bladder cannot hold much urine, which increases the frequency of urination. Frequency, however, is not always specifically related to bladder size; many people with severe frequency have normal bladder capacity when measured under anesthesia or during urologic testing. People with severe cases of IC/PBS may urinate as many as 60 times a day, including frequent nighttime urination, also called nocturia.

Source:
http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/


So, my assumption is that my bladder wall is damaged, to some degree, in a lower area of the bladder and when urine hits that area, the unprotected tissue reacts. This also explains why sitting up for long periods...road trips, airline flights, stage performances...causes the pain to start sooner than just lounging my ass around, leaning on one hip, then the other, on the couch does.

~And, my secondary issue is that in this situation, the lab results did not show enough bacteria to call it a UTI. And yet this doctor, aware that I have a hx of C Diff, cavalierly dismissed that concern with a comment which revealed he had no clue about the cause of C Diff.

Essentially, he wants me to take a drug to cure a disease I don't have, even though that drug could set off a chain of events that could kill me.


But anyway, all things considered, I don't mind taking cranberry capsules...even though I'm pretty sure it will make zero difference except to my wallet...because THEY don't cause C Diff.


Now I have to go read up on Ginger (root), Juniper (berry), Marshmallow (root), Parsley (leaf), Uva Ursi (leaf), Cramp Bark (bark), and Goldenseal (root), because they are in the product sold to allegedly promote Kidney/Bladder Health...which, cynic that I am, I don't believe either...but we don't need our kid to inherit too much money, so I bought that, too.

Sue
Firm supporter of Empirical Evidence, skeptic re anything else.