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  • UTI Prevention - Recommended/Not Recommended Fluids

    I've used a lot of very helpful information that is contained here on CC Forums in trying to help my Dad (T10 & amputee from AAA surgery complications) with his UTI issues. Thank You to ALL who have contributed. Without your knowledge/experiences and willingness to share, most of the information on CC Forums would probably be largely unknown. Vetericyn seems to have helped the most, but his frequency of UTI is still way too much, about every 30 days now. I'm still searching for something to try and get these under control, as much as possible anyway. If I recall correctly from the test they did at Thomas Jefferson, his bladder does not completely empty. I contend that his fluid intake is still an issue. I know water is the #1 recommended, but I don't think he drinks enough, plus, I know he drinks 2 or 3 cups of decaffinated coffee on most days. I would think coffee is not good for the bladder condition. He also takes in a little bit of cranberry and/or orange juice. I also have concerns about his diet. While he's not a big eater at all and eats very little to no junk food, I'm not sure what foods he should/should not be eating. I read somewhere on here where yogurt is a very good thing to be eating. He caths 4 or 5 times a day, clean/sterile method and uses Vetericyn on the cath itself and does the instillation daily too. The fear is too many trips to the hospital for ABX treatment and their eventual failure to kill the bugs. Any/All input is greatly appreciated!

  • #2
    I'm really sorry to hear that your father is still getting bladder infections so frequently. There are so many variables in each of our lives, it is hard to say why he is experiencing this frequency. But, here is my take on a couple of your concerns, for what they are worth.

    Water: At least 1.5 liters a day, better 2-3 liters (especially while on antibiotics and during periods of infection.

    Decaf Coffee: Even decaf coffee has caffeine and in sensitive individuals caffeine can be a bladder irritant. There are some researchers who believe that the caffeine may not only promote symptoms of Interstitial cystitis-chronic inflammation of the bladder wall-but may also promote infection in the urinary tract ("Conquering Bladder and Prostate Problems," Dr. Jerry Blaivas). In addition to caffeine, coffee is high in acid, which contributes to bladder inflammation. A bladder that is in a constant state of inflammation is going to be more prone to bacterial infection than a healthy bladder.

    Vetericyn: How much does he instill? How long does he retain Vetericyn in the bladder? We don't know an exact "prescription" for Vetericyn/Microcyn. It is indeed a trial and error experiment for all of us. One of our members uses 60cc of Vetericyn two times a day. Others use a good deal less. I know of at least one member who manages his bladder with intermittent catheterization and he tolerates Vetericyn so well that he instills Vetericyn into the bladder and leaves it in until the next catheterization.

    Bladder management: Your father does intermittent catheterization 4-5 times a day. What volume of urine does he get with each catheterization? There should be no more than 400-500cc of urine output with each catheterization. If there is more than that amount, he needs to cath more often.
    Can you be more specific about his cathing method? Does he use sterile cath kits each time? Does he use a new catheter each time? Does he clean the meatus with soap and water and/or an antiseptic wipe before each cath. Does he wash his hands thoroughly before each cath? Does he wear gloves to cath himself? Stepping up your game in terms of cleanliness can pay big benefits.

    Supplements:
    He may want to consider adding cranberry extract supplements in the form of pills to his daily routine. Most juices are high in sugar, low in helpful cranberry extract.
    As for yogurt and probiotic supplements, they are good, especially when taking antibiotics to keep a balance of intestinal flora in the gut.

    All the best,
    GJ

    Comment


    • #3
      i used to get uti's pretty darn regularly when I was working. they've really cleared up since i stopped. I think the single most important thing is fluid intake. after that, cathing regularly so bacteria doesn't stay in the bladder for very long. some caffeine is ok but he shouldn't overdo it. uti's are a real frustration...hope things improve

      Comment


      • #4
        [QUOTE=gjnl;1513164, coffee is high in acid, which contributes to bladder inflammation. A bladder that is in a constant state of inflammation is going to be more prone to bacterial infection than a healthy bladder.


        Supplements:
        He may want to consider adding cranberry extract supplements in the form of pills to his daily routine.
        GJ[/QUOTE]

        I find this confusing. Isn't cranberry high in acid, too?
        C5/C6

        Comment


        • #5
          I'm a T4,5,6 incomplete para going on 19 years now. I have sensation with my bladder but can't pee on my own, so I self cath several times a day depending on my fluid intake. I get maybe one UTI a year but that manly is due to me having to hold it until I'm where I can get to a restroom etc. I do NOT drink water other than what's in the drinks that I do drink which mainly are soft drinks, poweraid, and a few beer maybe twice a month at the most. I see my urologist once a year for a check up and kidney scan and we've discussed the whole water and cranberry thing before. He told me that for someone who doesn't drink any water, my kidney's are doing great and that the fact that I know when I need to go and I go often is probably why mine are in good shape. As for the cranberry thing, he said that studies have shown that cranberries benefit women more than men. My urologist put me on a medicine called Urex and I take 1 gm pill once a day everyday to help my kidneys fight off any germ that may try and cause an infection.
          SCI Birthday: April 25, 1993
          T4,5,6 Incomplete
          Chair: TiLite TR3

          Comment


          • #6
            Originally posted by 47+years View Post
            I find this confusing. Isn't cranberry high in acid, too?
            I am certainly not an expert on this subject, just recounting what I've read here and about some current studies.

            For many years, it was believed that cranberry juice/extract, once ingested created an acidic condition in the bladder that killed bacteria. Today, that notion has been debunked. Cranberry juice/extract and to some similar degree, apple juice, has a particular kind of an acid that creates (in layman's terms) a slick environment that inhibits bacteria from adhering to the bladder wall. Coffee doesn't have that same kind of acid.

            Acidifying the urine is very difficult, if not impossible. For the most part, acidic juices and supplements that you might think would create an acidic environment in the bladder actually end up creating an alkaline environment in the bladder. The key seems to be the type of acid and the effect the acid has on the bladder lining that makes the difference.

            All the best,
            GJ

            Comment


            • #7
              Originally posted by gjnl View Post
              I am certainly not an expert on this subject, just recounting what I've read here and about some current studies.

              For many years, it was believed that cranberry juice/extract, once ingested created an acidic condition in the bladder that killed bacteria. Today, that notion has been debunked. Cranberry juice/extract and to some similar degree, apple juice, has a particular kind of an acid that creates (in layman's terms) a slick environment that inhibits bacteria from adhering to the bladder wall. Coffee doesn't have that same kind of acid.

              Acidifying the urine is very difficult, if not impossible. For the most part, acidic juices and supplements that you might think would create an acidic environment in the bladder actually end up creating an alkaline environment in the bladder. The key seems to be the type of acid and the effect the acid has on the bladder lining that makes the difference.

              All the best,
              GJ
              Thank you. You may not feel like you're an expert, but you certainly have a lot of knowledge. Sometimes I think those of us who live it day after day are the best resources. I had one wonderful doctor who would say, "Well, you know your own body better than someone else."

              That reminds me of a time when my son gave a speech in his college speech class about how someone in a wheelchair would like to be treated. He had to quote three experts. I had been paralyzed for about 24 years at that time so he explained how I felt. He got a poor grade because the teacher said I was not an expert. I know what the teacher meant, but it still seemed absurd to me.

              It's like my husband's dentist scoffing when he said that orange juice gave him chancre sores. All my husband knew was that for all his life if he drank orange juice within a few hours he had a chancre sore.
              C5/C6

              Comment


              • #8
                I have embedded answers to the questions you asked. Thank you for all the insight.

                Originally posted by gjnl View Post
                I'm really sorry to hear that your father is still getting bladder infections so frequently. There are so many variables in each of our lives, it is hard to say why he is experiencing this frequency. But, here is my take on a couple of your concerns, for what they are worth.

                Water: At least 1.5 liters a day, better 2-3 liters (especially while on antibiotics and during periods of infection. I've been after him to take in more water. Last time he was admitted to hospital, they said he had some dehydration.

                Decaf Coffee: Even decaf coffee has caffeine and in sensitive individuals caffeine can be a bladder irritant. There are some researchers who believe that the caffeine may not only promote symptoms of Interstitial cystitis-chronic inflammation of the bladder wall-but may also promote infection in the urinary tract ("Conquering Bladder and Prostate Problems," Dr. Jerry Blaivas). In addition to caffeine, coffee is high in acid, which contributes to bladder inflammation. A bladder that is in a constant state of inflammation is going to be more prone to bacterial infection than a healthy bladder. Thank you for confirming what I thought I had read about coffee and even decaf not being a good thing.

                Vetericyn: How much does he instill? 30cc X 3 per day. How long does he retain Vetericyn in the bladder? Avg. time is 15-20 minutes. We don't know an exact "prescription" for Vetericyn/Microcyn. It is indeed a trial and error experiment for all of us. One of our members uses 60cc of Vetericyn two times a day. Others use a good deal less. I know of at least one member who manages his bladder with intermittent catheterization and he tolerates Vetericyn so well that he instills Vetericyn into the bladder and leaves it in until the next catheterization.

                Bladder management: Your father does intermittent catheterization 4-5 times a day. Yes. What volume of urine does he get with each catheterization? 200-250cc on average. There should be no more than 400-500cc of urine output with each catheterization. If there is more than that amount, he needs to cath more often.
                Can you be more specific about his cathing method? Does he use sterile cath kits each time? I am unfamiliar with a cath kit. He does swab with iodine and the cath is sprayed with Vetericyn, then lubricated with sterile gel. Does he use a new catheter each time? Yes. Does he clean the meatus with soap and water and/or an antiseptic wipe before each cath. The area is cleaned with a "wipe", which I supsect is probably a baby wipe. Does he wash his hands thoroughly before each cath? He uses hand sanitizer prior to each cath. Does he wear gloves to cath himself? Yes, after hand sanitizing, gloves are worn each time. Stepping up your game in terms of cleanliness can pay big benefits.

                Supplements:
                He may want to consider adding cranberry extract supplements in the form of pills to his daily routine. Takes cranberry pill(s) everyday. Most juices are high in sugar, low in helpful cranberry extract. Drinks very little juice.
                As for yogurt and probiotic supplements, they are good, especially when taking antibiotics to keep a balance of intestinal flora in the gut.

                All the best,
                GJ

                Comment


                • #9
                  Originally posted by DBA1964 View Post
                  I have embedded answers to the questions you asked. Thank you for all the insight.
                  Hydration may be a big part of the problem. I suggest setting up a "water bar" for him. Fill enough pitchers or water bottles with the water that he should consume in a day. Maybe if the water is visible and handy he will be more inclined to remember to drink.

                  You indicated that a test showed that he doesn't empty his bladder completely. Does he void on his own and then cath the residual or does he rely on catheterization to empty his bladder? At 200-250cc per cath, he may be cathing too often (if that is the only method of getting urine out of the bladder) and unnecessarily exposing the urinary tract to bacteria. It is a delicate balance of drinking the right amount, cathing at the right volumes, and not unnecessarily invading the bladder.

                  I am surprised that the Vetericyn is not working, especially at those levels. If he is using regular Vetericyn, he may want to try Vetericyn VF. It is a stronger formulation.

                  When he has been treated with antibiotic therapy, what has been the duration of the course of antibiotics? Often times, urologists prescribe a minimum course of antibiotics when a 10-14 day course may be necessary, especially in cases of recurrent urinary tract infections. It may be time to coordinate the urologists care with an infectious disease physician.

                  Sorry I don't have any magic solutions.

                  All the best,
                  GJ

                  Comment


                  • #10
                    try drinking cranberry juice it help a lot one small glass every day should help

                    Comment


                    • #11
                      Originally posted by gjnl View Post
                      Hydration may be a big part of the problem. I suggest setting up a "water bar" for him. Fill enough pitchers or water bottles with the water that he should consume in a day. Maybe if the water is visible and handy he will be more inclined to remember to drink.GJ
                      In 1966 I was pregnant and having UTI's. My husband started filling a 2 qt. pitcher with water before he left for work and told me I'd better drink that before he got home! Something worked, as I never had another for a long time.

                      C5/C6
                      C5/C6

                      Comment


                      • #12
                        I too, will echo that the amount he is drinking is probably the problem. And while caffeine is NOT good for your bladder, I am more of a proponent of moderation, unless you have tried everything else. A cup or two of decaf coffee may not be worth the arguement! We all have our vices .....

                        If he doesn't like wster, try adding some lemons or oranges to it. It might just make it more palatable for him.

                        Hope that this helps.

                        CKF
                        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                        Comment


                        • #13
                          I have embedded additional info and a question or two in your reply message. Thanks again for your insight.

                          Originally posted by gjnl View Post
                          Hydration may be a big part of the problem. I suggest setting up a "water bar" for him. Fill enough pitchers or water bottles with the water that he should consume in a day. Maybe if the water is visible and handy he will be more inclined to remember to drink.

                          You indicated that a test showed that he doesn't empty his bladder completely. Does he void on his own and then cath the residual or does he rely on catheterization to empty his bladder? He is cathed all the time. He does not void into any sort of urinal device. I was in the exam room at Thomas Jefferson when they did the test where the bladder is filled and then it is let to empty. I don't recall how much saline they instilled, I'm guessing around 500, but I remember the doc saying that 320 had come out. At 200-250cc per cath, he may be cathing too often (if that is the only method of getting urine out of the bladder) and unnecessarily exposing the urinary tract to bacteria. It is a delicate balance of drinking the right amount, cathing at the right volumes, and not unnecessarily invading the bladder. In your thought of possibly cathing too often, are you thinking that more volume will produce more pressure, thereby expelling more fluid when he voids? I had been thinking that, but the docs had recommended the high frequency of cathing, so I didn't question it.

                          I am surprised that the Vetericyn is not working, especially at those levels. If he is using regular Vetericyn, he may want to try Vetericyn VF. It is a stronger formulation. Vetericyn seems to have stretched the frequency of UTI out from about every 2 weeks to about every 30 days. So it has helped, just trying to find some other things to go along with it in hopes of reducing the frequency of UTI even further.

                          When he has been treated with antibiotic therapy, what has been the duration of the course of antibiotics? He has had various durations. From 3-5 days thru 21 day IV program thru a pic line. All had been prescribed by the infectious disease doctor. Often times, urologists prescribe a minimum course of antibiotics when a 10-14 day course may be necessary, especially in cases of recurrent urinary tract infections. It may be time to coordinate the urologists care with an infectious disease physician.

                          Sorry I don't have any magic solutions. There is definitely no magic to be found in all this and I definitely feel for all those that are patients or caregivers. The local medical people that my father deals with routinely do not have a lot, if any, experience with SCI patients, so they are not much help in providing information or suggestions of things that he could/should be doing to help his situation. Thus far, it's been all research for us.

                          All the best,
                          GJ

                          Comment


                          • #14
                            UTI recurrence

                            Dear DBA1964
                            You have been given good advice from many replies. I would keep in close contact with urologist, infectious disease providers to get a handle on the best maintenance therapies after he resolves these acute issues

                            In response to a comment on eating yogurt- it has probiotic properties that helps normalize gastrointestinal flora when antibiotics have wiped that out. It also comes in an oral form called Probiotic or Acidophilus. I advise patients to take it if they experience diarrhea while taking antibiotics.

                            I hope all goes better for you and your father at getting to the root cause of these recurrent infections.
                            pbr
                            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                            Comment


                            • #15
                              Agreed. This forum is an absolute godsend of great information and I appreciate all the great input from everyone. While I would normally agree with your recommendation relative to close contact with the urologist and infectious disease providers, we have repeatedly asked these folks about that very thing regarding maintenance therapies. To date, they've offered no plans, suggestions or otherwise. I think it is simply because they have little to no experience with SCI patients/neurogenic bladder conditions. With each and every UTI, the routine is the same. My plan at the moment is to map out a game plan, utilzing all the great information that has been provided here, and move out and try to get some sort of regimen going that will help cut down the frequency of UTI with my father.

                              Thank you for the insight on yogurt and probiotics.

                              Originally posted by SCI-Nurse View Post
                              Dear DBA1964
                              You have been given good advice from many replies. I would keep in close contact with urologist, infectious disease providers to get a handle on the best maintenance therapies after he resolves these acute issues

                              In response to a comment on eating yogurt- it has probiotic properties that helps normalize gastrointestinal flora when antibiotics have wiped that out. It also comes in an oral form called Probiotic or Acidophilus. I advise patients to take it if they experience diarrhea while taking antibiotics.

                              I hope all goes better for you and your father at getting to the root cause of these recurrent infections.
                              pbr

                              Comment

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