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March 31, 2005
Repeated UTIs
Q: My life revolves around urinary tract infections. I am a 33-year-old woman, and for the past few years I have had one infection after another. What can I do to stop them?
A: Yours is a very common story. In North America, urinary tract infections account for more than seven million doctor visits, more than one million emergency department visits and 100,000 hospitalizations every year.
There are two kinds of such infections. One is kidney infection — pyelonephritis. It produces fever and shaking chills, side pain and often nausea with vomiting. People can be desperately ill and often require hospitalization.
The other and much more common urinary tract infection is bladder infection — cystitis. Painful urination, frequent urination and nighttime urination are its symptoms. Women are more prone to cystitis than men because they have shorter urethras (the tube that empties the bladder) and the opening of their urethra is in a site where the bacterial population is abundant.
There are a number of strategies for women who have one bladder infection after another. One is to take a low dose of antibiotics immediately after sexual relations. Sexual relations massage bacteria into the bladder. A second stratagem is to keep a supply of antibiotics on hand and to self-treat immediately when symptoms appear. A third method for those whose infections are numerous and disruptive is to take a daily dose of antibiotic at bedtime. Therapy usually continues for six months, and sorne women must stay on this regimen for as long as five years.
Can a discussion of bladder infections not mention cranberry juice? Seven or more ounces of the juice daily might prevent bacteria from clinging to the bladder wall and reduce the number of infections.
Q: My husband was diagnosed with Parkinson’s disease six years ago. Six months ago, the diagnosis was changed to multiple system atrophy. In the past six months he has completely lost control of his body and is lying, dying, in a nursing home with hospice care. I have never heard of this disease. How does one get multiple system atrophy?
A: There is no answer to your question. No one has yet figured out how people get this illness.
Multiple system atrophy — MSA can easily be mistaken for
Parkinson’s disease, particularly early in its course. Some estimate that up to three per cent of those diagnosed with Parkinson’s actually have MSA.
There are some unique features to MSA. Many patients experience a great drop in blood pressure when they stand. That makes them dizzy, and they often fall. The condition is called orthostatic hypotension. People without MSA can have orthostatic hypotension, too, but it does provide a way to distinguish Parkinson’s disease from MSA.
Loss of bladder control is another common feature of MSA. Some MSA patients are no longer able to sweat. And many lose the ability to speak clearly because muscles to the vocal cords can be affected by the process.
Multiple system atrophy usually begins earlier than Parkinson’s, around age 50. It runs a much more rapid course to death — six to nine years.
In its early stages, Parkinson’s medicines might help, but there is no special medicine for it.
Q: Can artificial sweeteners raise the level of blood sugar?
A: None of those products raises the blood sugar level. Sugar alcohols — sugar substitutes found in a number of other commercial products — are neither sugars nor alcohols, but they might cause a very slow and small rise in blood sugar. If their content in a product is less than 10 grams, they have no significant effect on blood sugar. n
Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at PO Box 536475, Orlando, FL 32853-6475
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