Shown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by dove on June 20, 2002, at 15:02:56
About 6 or 7 months ago, when my Prozac was upped to 40 mgs per day I started to have, on average, one bladder infection or UTI per month. I wasn't sure if the increased Prozac was increasing the availability of my Amitriptyline dosage or if something else was taking place. I talked to every p-doc and regular doc I knew (and who had the time to "reassure" me) and was told that none of my meds could possibly cause reoccurring UTI problems.
Well, I've been cheating on my meds--one of the reasons I haven't been very active on the board lately. I cut my Amitriptyline cold-turkey, bad idea, but lost 10 pounds within 10 days and cut a very resistant and persistent UTI off within days.
However, the UTI's weren't/aren't done with me yet, and yes, I went to the clinic a million times, had all the normal labs done and then some. They did the whole growing thing, couldn't find anything, couldn't tell me if it was bacterial, viral, gram positive or negative, nada!!! I've gone through a plethora of antibiotics of every sort, dosage, time-length, and strength; they are always a mere temporary fix. I've been taking loads of cranberry capsules--doc prescribed and recommended, with no "real" or measurable results.
So, I cut my Neurontin out completely--on gut-instinct (no logic whatsoever)--along with lowering my Prozac back down to 20 mgs p/day, Klonopin @ 2 mgs p/day, Serzone @ 300 mgs p/day, and Adderall @ 30 mgs p/day. No Amitriptyline or Neurontin, and I feel not "normal", not necessarily "well", but not suicidal either. I can *feel* more, my physical being is still having some trouble adapting to the extreme med change, but I'm managing, except for the UTIs!!!
However, the UTIs have lessened in frequency, length, pain, and kidney involvement. Not enough water consumption during the day results in irritable symptoms the next morning. Too much liquid also results in irritation and pain the following day. Too much liquid also results in fatigue, apathy, and very noticeable and uncomfortable bloating, but I was told that diuretics would only worsen the situation. I've also been experiencing lower blood pressure readings and higher heart-rates, especially resting heart-rates.
Any thoughts or ideas would be very welcome at this point, and I apologize for rambling on so.
dove
BTW, I did confess to my p-doc regarding my strike on meds, he was pleased I didn't end up going into seizures or committed to in-patient, he was also proud of me for taking such big-steps but would rather do things a little more gradual from now on. He's told me to go back to 50 mgs of Amitriptyline p/day and back to 40 mgs of Prozac p/day (I haven't done so yet due to the UTI problems). He's an old 1960's p-doc, who prefers the combo of meds and talk therapy approach, but says that 'they' won't allow him to practice that way anymore without charging the most outrageous fees imaginable. He skimps on my billing record every other time I see him.
The normal psyche routine is the 10 minute med refill update appointment; the 15 minute med refill, review and update appointment; the 45 minute record review with possible med overhaul; or the 60-90 minute complete overview or initial psyche intake. He schedules me for the 10 minute and gives me 20, and he'll schedule me for 15 and give me 35, so I can't complain :o) Especially since he actually listens to me and treats me like someone with a brain!!!
Posted by medlib on June 23, 2002, at 4:11:47
In reply to UTI's - bladder infections and p-meds???, posted by dove on June 20, 2002, at 15:02:56
Hi Dove--
I've been kinda looking for your name amongst the Old-Timers. It's good to know you're still with us, but not so good that things are not so good for you right now.
UTIs are the pits! It's bad enough that women can't pee standing up; having to put up with UTIs is just one indignity too many. Not only are our body orifices ridiculously close together, our urethras are so much shorter than men's, for pathogens it's like comparing a suburban commute to a cross country trip.
Re *your* UTIs: their cause may be fungal, most probably Candidiasis (yeast), a common inhabitant of vaginal tracts. Just as nearly everyone's throat has a few Strep A bacteria, most vaginas have a few yeast cells; in both cases, competition from other common pathogens keeps any one type from increasing to a number large enough to cause an illness. Unfortunately, antibiotics kill off enough bacteria to leave a "clear field" for fungi to multiply (and migrate). If that *is* the cause, some fluconazole should bring relief--hopefully, for longer than a month.
Why is it, do you think, that what men call "intuition", women think of as "common sense"? Your "hunches" about your psych meds are, quite likely, mostly correct. Although neither med you mentioned *causes* UTIs, both can exacerbate an existing problem or make one more likely to recur. In particular, Amitrip's strong anticholinergic side effects (dry mouth, etc.) can cause urinary retention or dilation of the urinary tract; both conditions can cause bladder spasms. Supposedly, Neurontin causes UT probs only "infrequently" (which drug lit defines as btw. 1/100 and 1/1000). And we *know* how accurately drug companies report adverse effects.
Re fluids and the bladder: Yet another case of "damned if you do and damned if you don't. Insufficient oral intake leads to highly concentrated urine, which is very irritating to the bladder and urethra--ergo, b. spasms. Then, there's the tried-but-true maxim, "water follows salt". Occasionally, drinking a lot of water without sufficient salt (sodium) in your diet will lead to hyponatremia (a $10 word for low serum sodium). When kidneys resorb (take back) all of the too few sodium ions from the blood plasma they filter, excess water follows the sodium back into the bloodstream, and out of blood vessels into body tissues--causing edema, or "bloating". As blood volume increases, so does urine volume; more urine plus urinary retention leads to overstretched bladder muscles, which spasm. In any case, spasms cut off urine flow prematurely; the residual retained urine is an ideal environment for growth of infectious organisms. Tidy, isn't it, how both extremes lead to the same painful result? Symptoms of hyponatremia can include fatigue, lethargy, nausea and/or vomiting, lowered blood pressure, and more. (Under normal circumstances, our bodies correct such electrolyte imbalances via our sense of thirst and the hormone ADH.)
So...medwise, you intuitlvely did the right thing, but you did it the wrong way--and your doc is sending you back to "Go" to do it correctly this time? Riiightt!!! In the spirit of civility, perhaps you could tell him you appreciate his sense of humor.
Arrrgghh! It's times like these I really miss Cam, who could be 10 times clearer with one-tenth of the words.
Still stupidly waiting for a better alternative---a cynical medlib
Posted by dove on June 24, 2002, at 15:04:07
In reply to Re: UTI's - bladder infections and p-meds??? » dove, posted by medlib on June 23, 2002, at 4:11:47
>Not only are our body orifices ridiculously close together, our urethras are so much shorter than men's, for pathogens it's like comparing a suburban commute to a cross country trip.
>Thank you *so* much for the good laugh :o) Seriously, I needed the lovely ironic empathy-filled exposition on the rigors of surviving the infamous and recurring female UTI syndrome!!! Nothing satisfies my humourous side more than satirical analogies that hit the mark bang-on!
Re: fungal and yeast (candidiasis) infections, they looked into those and told me that these were definitively ruled out at this point. Sometime, during the second or third infection, I did indeed try fluconazole, which, BTW, had some nasty side-effects waiting for me. I'm doing all the hygienic behavior that supposedly discourages infections, along with the pre-emptive cranberry gluttony and metabolite-balancing fluid intake.
I'm also attempting to track the UTIs in tandem with my menstrual cycle (and my depressive symptoms, self-injurious contemplations, suicidal ideations, anxiety/panic levels, and plain old PMS symptoms), just to see what I come up with. So far, my calendar data shows a peculiar pattern for the UTIs. For the first 4 UTIs, they all began on the 5th of the Month, with symptoms resurfacing on the 20th. Since then, the UTIs show up between the 7th and 10th of the month and either again on the 20th or the following month on the 20th, like clockwork! So, I'm working on figuring out those particulars that the medical community finds apparently inconclusive and irrelevant.
I'll have to look into the "damned if you do and damned if you don't" hyponatremia, water/sodium connection, a complicated yet intriguing cycle of chaos one might say :o)
Thanks for your support and advice, I appreciate it *soooo* much. And you did a beautiful job clarifying the possible connections and various causative agents!!! And I too enjoy seeing your "handle" back on the boards :o)
dove
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