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  • #16
    Originally posted by SCI-Nurse View Post
    I am assuming you mean a symptomatic UTI, not just colonization? IV antibiotics are most likely needed if this is a symptomatic UTI, and your culture and sensitivity (C&S) shows that the bacteria is resistant to all available oral antibiotics. Most often IV antibiotics are used for 4-7 days in this case. Which antibiotic are you getting IV? Some must be given as often as every 6 hours.

    (KLD)
    Yes. I’ve had extreme nerve pain and spasticity since Saturday and nightly soaked clothes and sheets from sweating then freezing while spazzing cycles. I’m normally 3-5 nerve pain but 6-8 since Saturday. And the urologist office failed to get iv antibiotics set up even though they knew since 8am. So I’m hopeful to finally start treatment today.

    Then I need to find a new urologist who cares about patients who are suffering. I worked a full day, managed to get to PT and still had time to determine which antibiotic I was going to need in spite of the pain, but they couldn’t find time to get the treatment set up. Crazy.
    T3 complete since Sept 2015.

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    • #17
      Originally posted by Mize View Post
      Yes. I’ve had extreme nerve pain and spasticity since Saturday and nightly soaked clothes and sheets from sweating then freezing while spazzing cycles. I’m normally 3-5 nerve pain but 6-8 since Saturday. And the urologist office failed to get iv antibiotics set up even though they knew since 8am. So I’m hopeful to finally start treatment today.

      Then I need to find a new urologist who cares about patients who are suffering. I worked a full day, managed to get to PT and still had time to determine which antibiotic I was going to need in spite of the pain, but they couldn’t find time to get the treatment set up. Crazy.
      I seem to remember that the SCI nurses have said, and I know it was GJ's experience that urologists don't necessarily make the best go to physician for treating urinary tract infections. I think the SCI nurses have said urologists are essentially surgeons, and taking the time to treat urinary tract infections doesn't pay the bills and takes up way too much of their time.

      GJ found that having a good understanding with his primary care physician about how SCI complex urinary tract infections should be treated, i.e., urinalysis and culture & sensitivity tests to determine the best antibiotic to treat the bacteria and a longer course of antibiotics was more satisfactory than consulting with the urologist. He used the urologist to have an annual consultation and check up, routine tests and ultrasound imaging, and of course the placement of the suprapubic catheter.

      If and when, urinary tract infections were more difficult to treat, an infectious disease doctor was always more adept at managing antibiotic treatment.

      NL

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      • #18
        NL, I cannot tell you how much it means to me that you stay and continue to help us.

        thank you so much.
        Last edited by Mize; 01-09-2020, 01:24 PM.
        T3 complete since Sept 2015.

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        • #19
          Did you have a fever? Always check for fever if you are having symptoms of a UTI. Fever is a diagnostic criteria for a true UTI, and the most important one (in addition to elevated WBCs in your blood count) for determining that you have pyelonephritis, which is a UTI involving both your kidneys and bladder, and which definitely requires aggressive and prompt treatment as a complex UTI. If you take your temperature and can report that to your physician when you suspect a UTI, they should take prompt action.

          Urologists that specialize in neurologic urology are actually expert in treatment of UTI in persons with SCI, as should be physicians who are board certified in Spinal Cord Medicine, and physiatrists who specialize in SCI management. While an infectious disease physician may be great, they may not be expert in SCI specifically, and generally will not see or consult on management of UTIs directly with the patients without a referral from your primary provider or urologist. Most primary care physicians (family practice, general practice, internal medicine) are not very knowledgeable about anything to do with SCI/D, but you may find one who is willing to learn about it.

          (KLD)
          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.

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          • #20
            Cincinnati has only one board certified SCI doc and he’s VA only. I see a PMNR usually. My urologist is the department head at University of Cincinnati hospital but clearly not competent with SCI.

            I have run a low grade fever with night sweats all week. He knew this.

            Fortunately the ER docs are better. I’m through my first IV and they’ve cleared me of any stones with a CT.
            Won’t be 100% certain no sepsis until the blood cultures come back but it seems unlikely as my fever is still low grade.
            T3 complete since Sept 2015.

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            • #21
              I need some help SCI Nurse. The ER put me on 1 g, 1x per day ceftriaxone IV. My urologist (who told me to find a new urologist because I complained he didn’t recognize AD) told the ER to use 2g, 2x per day (4x the dose!). The ER consulted with a bunch of docs and overruled the urologist.

              So which is right? 1g/day or 4g/day?

              Oh urologist wanted 7 days, ER 10 days.

              This is at home, nurse administered and I weigh 180#.

              thanks
              T3 complete since Sept 2015.

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              • #22
                Rocephin

                Originally posted by air ohs View Post
                Klebsiella pneumoniae have you had this how did you get rid of it .this uti wont go away dr has tried cefalex and nitro foranton macrodid
                Ask your doctor for rocephin. It will kill the Klebsiella pneumoniae bacteria.

                Ti
                "We must overcome difficulties rather than being overcome by difficulties."

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                • #23
                  They’re the same drug. One is the generic.

                  thanks. Need to understand the dosing
                  T3 complete since Sept 2015.

                  Comment


                  • #24
                    From the PDR:

                    ceftriaxone


                    For the treatment of bacteremia and sepsis.

                    Intravenous or Intramuscular dosage

                    Adults: 1 to 2 g IV or IM every 12 to 24 hours (Max: 4 g/day) depending on severity of illness and causative organism. For sepsis, start within 1 hour of recognition as part of empiric multi-drug therapy. Duration of therapy is generally 7 to 10 days, but may be shorter or longer depending upon patient response, site of infection, and pathogen(s) isolated. Treatment may be narrowed with pathogen identification and/or adequate clinical response.

                    Brand names:
                    Ceftriaxone/Ceftriaxone Sodium Intravenous Inj Sol: 1g, 2g, 50mL
                    Ceftriaxone/Ceftriaxone Sodium/Ceftrisol Plus/Rocephin Intramuscular Inj Pwd F/Sol: 1g, 2g, 10g, 250mg, 500mg
                    Ceftriaxone/Ceftriaxone Sodium/Ceftrisol Plus/Rocephin Intravenous Inj Pwd F/Sol: 1g, 2g, 10g, 250mg, 500mg

                    (KLD)
                    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.

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                    • #25
                      Thank you KLD.
                      T3 complete since Sept 2015.

                      Comment


                      • #26
                        I am hoping for more feedback on this.

                        I started 1g rocephin per day on Thursday at the ER and at home since (IV push). It's worth noting I was writhing in pain at the ER and they gave me the lowest dilauded dose.

                        After the first IV antibiotics and dilauded I was feeling much better with both nerve pain and spasticity way down. The next morning was the same but both slowly increased over the next 24 hours to where I'm still well below the levels of Wednesday and the five days before, but also above my normal levels considerable (UTI was 7-8, now is 4-6, normal issues 3-4.

                        So could my infection be hanging on or could the IV antibiotics create their own bit off discomfort?

                        Wondering if I should've had a higher dose since the doctors disagreed...
                        T3 complete since Sept 2015.

                        Comment


                        • #27
                          Your symptoms are not typical for a UTI, but generally you should start feeling better within 3 days if you are on the correct antibiotic.

                          (KLD)
                          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


                          • #28
                            Originally posted by SCI-Nurse View Post
                            Your symptoms are not typical for a UTI, but generally you should start feeling better within 3 days if you are on the correct antibiotic.
                            Are my symptoms atypical for a complete? I have basically only 4 sensations/symptoms that come from the paralyzed portion of my body:
                            1. Paresthesia / Nerve pain (I call it pain when it gets to 3/10)
                            2. Spasticity
                            3. Nausea
                            4. Sweats/chills

                            So literally anything that happens to my paralyzed body manifests as those symptoms. Pressure sore, too little sleep, any alcohol, etc. all result in some combination of only those symptoms.

                            So the UTI gave me high nerve pain and crazy spasticity. It abated for a day but it's on the increase; is that the UTI getting worse, or is the Rocephin giving me a gut ache or cramps, etc. that translates like a pressure sore/etc as nerve pain and spasms?

                            I noticed the nerve pain increases slightly after administering the Rocephin (saline, rocephin, saline, heparin), I presume from the slight uptick in blood pressure.

                            The mysteries of paralyzed life.
                            T3 complete since Sept 2015.

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                            • #29
                              Just closing the loop on my issue...I hope.

                              Finally managed to get a consult from infectious disease and they said 10 days is not sufficient for this bacteria in an SCI at only 1g/day. They agree with the dose but insist 14-days for the course. It took me 7 days to get an answer.

                              sheesh
                              T3 complete since Sept 2015.

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