General Medical issues thread

[drron]

@drron it really isn't difficukt to choose an antibiotic. I can cycle through them just as easily as a doctor.

My point was Urology outpatients chose to do absolutely nothing with confirmed bacteria in urine. What do they expect will happen? Body will fight bacteria without assistance? In my mind this is incompetence. You can think what you want.

Our GP showed some concern and called wife but prescribed Keflex which is what is usually prescribed for UTI.

Hospital gave wife 1 dose of intravenous tobramycin followed by Augmentin x 3 per day for 10 days and discharged her.

Had wife listened to me we would not be in this predicament today. Doing something is much better than doing nothing.

Hospital also did ultrasound this morning. Is there a difference between pyelonephritis and tubulo-interstitial nephritis. Both very dangerous if left untreated which is why Urology outpatients lack of action stuns me.

I'm sorry John but you are so wrong. read my previous post gain. You may end up causing problems for your wife.

 

[Katie]

Remember that every MRI on "elderly people" will find a host of issues. Whether they actually cause any physical pain etc or are abnormal is to be debated with a sane specialist who doesn't want to overservice. And I'm not touching the coconut!

Who are you calling elderly??
I’m not even 50! Yet.

But there is pain, I’ve been in pain for about a year (though the cortisone injection into one hip for bursitis has helped with some of the pain, but not the spine pain; the facet joint cortisone injection did bugger all other than give me numbness along my thigh).
I’m just sharing the part of the report that I can have a laugh at due to the language.

I’ve been having to get onto my knees to pick up after our dog on walks, which is annoying.

 

[Aeryn]

How much coffee.?

None at all that day, 1 the day before. I average about 6-7cups a week.

 

[JohnK]

It sounds like your wife is getting recurrent infections.

Have you considered a consult with a urologist and/or a gynaecologist?

We've been seeing Urology outpatients. They don't know what to do. They are the cause of the most recent hospitalisation. She should have been on antibiotics 5 weeks ago.

I'm sorry John but you are so wrong. read my previous post gain. You may end up causing problems for your wife.

I did read your post.

Please tell me you would not neglect a patient that has bacteria in urine sample?

What would you recommend for recurring UTI? Trimethoprim? Ciprofloxacin? Ampicillin? Azithromycin? Fosfomycin? Rifaxicin?

I've had most of the above yet every doctor chooses their own preferred antibiotic. Yesterday one GP prescribed Cephalexin and hospital prescribed 3 x Augmentin Duo Forte per day.

These are all for e-coli UTI. How I could possibly go wrong and make it worse? I would have given wife Cephalexin or Augmentin as I have stock for both. Please don't tell me a GP prescribing the exact same thing is going to have different results?

Anyway I'm not being argumentative. I want what's best for my wife and I need to research and to understand so next time I can push to make sure my wife gets best care and is not left to suffer and run off to hospital to sit in waiting room for 3 hours.

That also gets me worked up. Patient with recurring UTI and pyelonephritis comes to emergency and is a mess and is left in waiting room for 3 hours. I know they are busy but that is so wrong it's beyond belief. There's a serious chance of sepsis with pyelonephritis.

 

[Quickstatus]

They don't know what to do.

I suggest seeing a urologist
Has your wife ever had a voiding cystourethrogram, Abdominal Ct with contrast or KUB xray?

 

[Quickstatus]

I’ve been in pain for about a year

So bending over is painful, what makes the pain better?

 

[Pushka]

So outcome after visit to Rheumatologist after critical CRP and ESR markers. I had no symptoms of infection (bacterial or viral) so I presumed a PMR flare. However my markers back then when diagnosed were less than 1/3 of what they currently are. Back in 2022 during that C year I tested positive for it but had no symptoms. So the conclusion we came to, not confirmed, is that once again I had symptomless C but my immune system went into that cytokine storm mode that was discussed during those C times and that was potential cause. As I didn't have c symptoms I never got tested. Thankfully I was already taking steroi_s and blood thinners so it was a matter of the storm passing. She did however check me for GCA but had no 'head' issues so she didn't think it was that. Thank goodness. It would have been really heavy duty steroi_s if so. Onwards.

 

[JohnK]

I suggest seeing a urologist
Has your wife ever had a voiding cystourethrogram, Abdominal Ct with contrast or KUB xray?

Isn't that what Urology outpatients should be suggesting?

I can query regarding voiding cystourethrogram. We've had KUB ultrasound but have to avoid anything with contrast as that sends her into severe panic attacks. Last time they used contrast she was paralysed one side of the body for around 10 minutes. That's a scary sight.

The ultrasound on Thursday night confirms tubulo-interstitial nephritis and recommends going to GP after 10 days of augmentin and for GP to follow up with outpatients.

I don't know we can wait that long. Why they released her from hospital so quickly stumps me. Wife feels nauseous and feels like vomiting. GP not there today but is rostered on tomorrow. If she not feel well we may have to go back to emergency. This is so frustrating.

 

[drron]

John you did not understand what I said.
Read this.

newsGP - Urinary superbugs: Are we going about it wrong?

A new study investigating rates of antimicrobial resistance in aged care highlights the need for a potential overhaul of antibiotic guidelines.

www1.racgp.org.au

Note that this is an Australian study and that it gives the recommended antibiotic for uncomplicated UTI as trimethoprim. The usage of other antibiotics is in part causing the rise in antibiotic resistant E Coli. Many are resistant to multiple antibiotics. Even before I retired I was seeing this frequently and believe me it can be a very serious problem
Your doctors should have done urine collections and testing the e. coli for antibiotic resistance. If none then trimethoprim is the antibiotic to use first. If there is resistance your GP and Urology should be consulting an infectious diseases physician.

 

[JohnK]

Your doctors should have done urine collections and testing the e. coli for antibiotic resistance. If none then trimethoprim is the antibiotic to use first. If there is resistance your GP and Urology should be consulting an infectious diseases physician.

I'm not blaming GP here. Urology is totally at fault due to their lack of inaction. Although I should probably have asked GP to check for antibiotic resistance but they did check cultures. Need to discuss results in detail tomorrow.

I'm not sure Augmentin is the right antibiotic but it is at a higher strength prescribed by hospital. Triprim sounds right to me. I'll push GP for Triprim tomorrow.

I also need to get better at understanding what wife is feeling. She did mention that she felt she'll be sick 6-7 weeks ago which was before the Urology outpatients appointment. She was itchy and slight burning urinating. I didn't think UTI/kidney infection at the time. I thought menopause. We picked up UTI 2 weeks later and that's where I should have pushed for action.

It's so difficult to find the right GP.

 

[Quickstatus]

immune system went into that cytokine storm mode

If you had a cytokine storm you would actually be extremely sick. A lot of C patients actually died because of cytokine storm.

 

[Quickstatus]

Isn't that what Urology outpatients should be suggesting?

Sure but in the end if you think you are not getting anywhere then seek assistance elsewhere. I don't know the full story so difficult to piece everything together from here.

But I suspect the roadblock is the contrast issue. Regardless, your wife needs to have some type of imaging to check for a Structural issue causing recurrent infections. Vesicoureretic reflux is one very common possibility

That's why I'm suggesting you take your wife to see a urologist in their rooms.

 

[prozac]

MrsP can't take a trick atm, bloods last week show high Total Billirubin (18). She has had some bloating and abdominal discomfort. Gall bladder? She (we) doesn't eat fatty foods.
She sees her GP this week so hopefully will get it sorted.

MrsP had an ultrasound with following comments; likely gallbladder adenomyometosis, but no cholelithiatis or cholecystisis
We had a birthday dinner out this week and we shared a S&P Squid entre (lightly battered). She had discomfort next morning.
Open to dietary suggestions?

 

[Pushka]

If you had a cytokine storm you would actually be extremely sick. A lot of C patients actually died because of cytokine storm.

Except I was really sick. just from my blood results done a week later the rheumatologist called me to tell me I was really sick. And set up a monitoring scheme to keep track. And yes people die from it.

 

[Quickstatus]

I was really sick.

Sure but someone with cytokine storm end up in ICU. Most immune responses will cause a cytokine release and make people feel ill. The best analogy is rainy day vs a cyclone.