DEAR READER:
Let me first go through your medication list to determine why you are taking so much medication. You are taking five prescriptions and five over-the-counter supplements.

Let’s start with the prescriptions. First is pravastatin. This is a cholesterol lowering medication. I assume you have a high cholesterol level or have a heart condition that requires your level be reduced. As you may be aware, a recent study reported in the New England Journal of Medicine concerned statin drugs and heart disease. The medicine reduced the incidence of heart attacks by about 50%.

Adalat is an antihypertensive medication. You are likely taking this to reduce your blood pressure either because it is too high or because of a heart condition. Omeprazole is a proton-pump inhibitor used to reduce stomach acid levels for those with frequent acid reflux or gastro-esophageal reflux disease. Finally, your last two prescription medications, prometrium and estradiol are hormone replacement therapy (HRT) drugs used to combat menopause symptoms.

Your over-the-counter supplements include calcium plus D used to prevent osteoporosis, omega-3/omega 6 fish oil to lower blood pressure and cholesterol, a baby aspirin (which should NEVER be given to babies or children despite the name) to make the blood less sticky or reduce pain and vitamins C and E.

Now comes the messy part. Several of your medications and supplements may be interacting with each other. For example, your HRT medications may be worsening your cholesterol levels. Your fish oil supplement may also be worsening your cholesterol levels. While it is shown to improve triglyceride levels it may actually increase the LDL (bad) levels. It can also cause a vitamin E deficiency so most manufacturers add it to the pills. This means that you may actually be over-dosing on the vitamin and the American Heart Association warns against taking 400 IU or more per day due to the increased risk of death. The omega oils may also be contributing to your stomach problems as heartburn and GERD are common side effects. The baby aspirin and, the fish oil may also be working in conjunction to lower your blood clotting ability.

The good news in this situation is that in reviewing the side effects of these medications, none mention urinary odor. The HRT medications do mention the increased risk of urinary tract infections (UTIs). This could be a possible cause of your smelly urine but more common symptoms of a UTI are frequency, urgency, pain or burning on urination and others. Additional causes can include decreased fluid intake which makes the urine more concentrated, changes in diet, such as increased consumption of foods such as asparagus that can cause the urine to develop a strong odor, or kidney abnormalities such as infection or stones.

Since this symptom is fairly new, I urge you to see your primary care physician for testing. He or she can order a urine culture and sensitivity to check for infection. An ultrasound of your kidneys may also be appropriate to rule out stones. If everything comes back normal — yet your symptoms persist — request a referral to a urologist who can perform more advanced testing such as a cystoscopy to check your urethra and the interior of your bladder.

I would also encourage you to discuss your current medications with your physician. You are 78, probably well past menopause and likely do not need your current HRT medications. I would also recommend you eliminate your vitamins C and E unless you are taking them on a physician’s order. The aspirin may also be unnecessary unless you are taking it because of an existing heart condition or a past stroke or heart attack. Perhaps discontinuing your fish oil supplement will calm your stomach and eliminate your need for the omeprazole.

Ten medications is a lot to be taking every day and, it is my assumption that you probably do not need all of them. However, do not discontinue any medication without first informing your physician in case he or she has a sound reason why you should be taking it.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infection”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

The insertion was done twice, both times without lubricant. One of the results was bloody urine. My poor father said “Just imagine being 82 years old and having somebody do something like that to you”. When he told his hometown doctor she just abut came unglued. A male nurse also informed him that he always “lubes the tubes”.

My father is now unable to urinate on his own because of a blockage which his urologist says may have been due to damage caused by the dry insertions. He now has to live with the catheter.

I cringe whenever I think about his experience and wonder how many other elderly people have been subjected to this kind of abuse. Please print this letter so the word can get out about this torturous practice.

DEAR READER:
I was appalled by your father’s experience and as an elderly gentleman cringe at the thought of how painful that must have been.

There is no excuse to put someone through that pain, especially an older individual who was already feeling unwell because of another condition. There is no reason in my mind why a lubricant could not have been used.

I urge you and your father to contact the hospital for an explanation of why a dry insertion was done twice and explain that his current situation is likely due to them. Doctors today are often told to never apologize to patients because it admits fault. In this situation, your father deserves an apology from the nurse and/or physician who performed the catheterizations and perhaps even the hospital that allowed it to happen twice!

I know that most people reading this would believe that legal action is best, but in most cases, this one included, it is not appropriate. Unless medical neglect is undeniable, the expense and hassle are not worth it. First, this case may have been caused by the insertions (and my hunch is that it was) but there is no proof that this is the case. Second, at your father’s age, the stress of a court case is ill advised, especially since he is already ill with a blood disorder. However, someone needs to understand what was done was wrong, traumatic and unacceptable in the future.

I have printed your letter because others need to know this is not standard practice. You stated that this is abusive behavior and I must agree.

To give you related information, I am sending you copies of my Health Reports “Blood — Donations and Disorders” and “Bladder and Urinary Tract Infections”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I simply started washing “down there” with the betadine and the infection was gone! Now if I feel a UTI starting, I immediately wash or add a few drops to a bottle of prepared douche. It immediately resolves the problem. I hope this helps some of your other readers.

DEAR READER:
Urinary tract infections can be difficult to treat, especially in women who have recurring or frequent infections. Typical treatment usually consists of a course of oral antibiotics but for individuals such as you, finding a simple home treatment to prevent them can be vital.

I am printing your letter in the hopes that it will help other women who suffer from similar situations.

I would also like to recommend drinking a glass of cranberry juice daily that may prevent urinary tract and bladder infections. Drinking several glasses a day during an acute infection can also lessen symptoms and shorten recovery time.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infections”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

While in the hospital, a nurse spilled urine all down my back and I was not given a bath for two days before leaving. I now have to urinate every two hours during the night and have a very odd dark red, half circle on my both of my inner thighs. It does not itch and fades during the night. What should I do?

DEAR READER:
First, I don’t believe that your symptoms have anything to do with the nurse who spilt the urine or the fact that you were not allowed to bathe afterward. I can say that I am truly appalled by the situation and disappointed in the staff for not immediately helping you wash up. That must have been difficult to deal with and I urge you to write a letter to the hospital administrator expressing your dissatisfaction in that situation. There is no excuse for a patient to have to lie is bed covered in urine for two days.

Now to your symptoms. I believe there are two things going on here: first a urinary tract infection or vaginal inflammation and second, skin irritation.

Your symptoms of frequent urination and vaginal irritation suggest to me that you have an infection. Whether it is vaginal or urinary isn’t clear. I suggest you return to your physician and request testing. I recommend a culture and sensitivity to check for urinary infection. If that is negative he or she can either test for vaginal infection or refer you to a gynecologist for testing. Treatment is often easy and involves a course or two of antibiotics. It is always important to have repeat testing after treatment to ensure the infection has cleared.

In the meantime you can try drinking cranberry juice several times a day. Many women have experienced relief from symptoms using this simple remedy. If you do not like cranberry juice, try cranberry extract pills which can be purchased at most pharmacies.

Your inner thigh irritation may be related to your vaginal problems but based on your description that is fades during the night, leads me to believe that it is simply irritation. This could be the result of your clothing but is more likely due to your thighs rubbing together. You do not say if you are overweight or if your thighs touch. When walking or moving, as the skin from both legs comes in contact, its rubs together causing friction that can create a rash. For some this can become raised, red, itchy, or painful. In some cases, it may simply be red. The irritation often disappears or reduces during the night when there is little or no movement.

If this is the cause, losing weight or wearing pants, shorts or stockings on a regular basis may help. Creams or lotions may help. If it is due to your vaginal irritation, relief should be found when the infection is cured.

To give you related information, I am sending you copies of my Health Reports “Vaginal Infections and Disorders” and “Bladder and Urinary Tract Infections”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

It has now been three months since my symptoms started. Do you have any suggestions?

DEAR READER:
The timing of the start of your symptoms and your colonoscopy may suggest a relationship, however I cannot be certain. I am also uncertain about your statement that you could barely get home. Does that mean you drove yourself? Were you in pain? Disoriented? Without specifics it is hard to tell if that experience were related to the colon study. Perhaps you were discharged too soon and were still suffering the effects of the sedative or anesthesia.

As for the urinary tract infection, pain in the side is not common with UTIs unless they have progressed into a kidney infection. The gas pressure could simply be associated pain that, for women is often just above the pubic bone and for men is usually near the rectum. Frequent urination is common for UTI but is generally not limited to nighttime only.

I urge you to be seen by a urologist for testing. He or she should order a urine analysis including a culture and sensitivity to check for bacteria. The specialist may also choose to order imaging studies such as a cystoscopy to visualize the interior of the urethra and bladder. An MRI to check the kidneys and exterior of the bladder may also be helpful.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infections”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure mention the title.

DEAR READER:
I urge you to see your primary care physician to rule out a urinary tract infection (UTI). If left untreated, it can also lead to kidney infection. UTIs often cause odor, burning, itching, and pain.

A test called a culture and sensitivity (C & S) is simple, painless and usually takes only 24-48 hours to complete. If infection is present, the laboratory technicians will test the bacterial sensitivity to a variety of antibiotics to determine which is most effective. UTIs are usually simple to treat using antibiotics. If the infection has moved to the kidneys, however, treatment will take much longer.

If infection is not present, the problem may be due to dehydration. Perhaps you are not drinking as much water as you did when you were younger. This can lead to darker, stronger urine that often is accompanied by a harsh odor. Try increasing your water intake. If this eliminates the problem, you may have found your solution.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infections”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Water and other fluids are a vital part of everyone’s daily diet. I often receive letters from people who drink at least eight glasses of water a day, in addition to other fluids, because they have read they should do so for good health. My response is to drink when you are thirsty. However, in your case, your body apparently doesn’t signal you as it does others. Therefore, remembering to drink 32 ounces of water a day appears appropriate.

Another excellent means of combating UTIs is to drink 100% cranberry juice or taking cranberry extract gel caps at the first signs of an infection.

DEAR READER:
I have received several letters indicating vinegar as a good urinary tract infection (UTI) preventive. This is most likely due to its acidity.

You do not say if you have had appropriate testing to find out why you are having so many infections. However, I assume since you are receiving the Cleveland Ostomy News pamphlet that you have a colostomy (artificial opening in which urine and feces leave the body). If this is the case, UTIs are common and particularly difficult to treat.

I have not heard of the Alka-Seltzer remedy and cannot imagine how it could cure an infection. Most UTIs are caused by bacteria and require antibiotics for treatment. Alka-Seltzer is an over-the-counter medication for stomach upset. If any of my readers have had experience using this remedy please let me know whether it was success or not.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infections”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

After three weeks of taking 200 mg per day, I was no longer getting up. If I consume a large amount of liquid late in the evening, I get up only once. It also comes with the added benefit of no headache in the morning because of a lack of sleep.

Thank you so much for passing on this information. It has truly made a great difference in my life.

DEAR READER:
I have had no experience with this alternative therapy but it appears to be harmless. I am glad you had positive results. However, as with every alternative remedy, I expect many patients will write me with negative comments. No therapy works for every person but for those it does, stick with it.

Night time urination is a common problem, especially as we age. It can have many causes from simply drinking too much liquid at night to a weakened bladder to bladder infection or cancer. It is always important to have thorough testing for persistent, frequent urination to rule out a serious cause. Home remedies are only acceptable for the treatment of benign causes.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infections”. Other Readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

When these infections first started, there were several antibiotics that seemed to work. Now there is only one, Macrobid 100 mg. I take it two times a day for a full course immediately followed by Bactrim 400/80 mg once every night. My urologist said the Bactrim is supposed to “clean” my urine while I sleep.

I have followed these instructions for more than a year now. This therapy does not work. Three to five days after I finish the Macrobid, I have another infection! I am very worried about my kidneys. Will they eventually get infected too? What will happen when the Macrobid stops being effective? I have asked these questions of my urologist and the response is that only time will tell. Please help.

DEAR READER:
You appear to have a resistant chronic infection. This means that the infection is not being completely eradicated after finishing the course of Macrobid. This may be happening for several reasons. The most likely cause is that you are not being given the medication long enough. This could also explain why the infection is not responding to as many medications as it previously was. (If an antibiotic repeatedly fails to kill all the bacteria, they will eventually build up a resistance to it, making the medication ineffective.) Another possibility is that the infection is already in your kidneys. Kidney infections can be very difficult to treat because antibiotics do not readily penetrate the outer layers. A final option is that you have a combination infection. For example, the bacteria were not eliminated properly, built up a resistance to every antibiotic but Macrobid, moved into your kidneys and are persisting. In either case, I believe that you should take an extended course of antibiotics. Rather than the standard 10-day course (which I assume you receive on a regular basis), your urologist should try a one or two month course followed by testing to ensure the infection has been eliminated.

As an aside, the Bactrim does not appear to have any effect on your infection, if symptoms return after the Macrobid is stopped. Speak to your urologist about discontinuing the medication.

If your urologist is unwilling to listen to your concerns and make some appropriate changes to your current treatment, you should find someone else. A new physician will also bring a new perspective to the situation and may have other suggestions or treatments. If you decide to make the change, I recommend you seek out someone who is well-versed in chronic or recurring bladder infections in women.

This situation is not best handled by a wait-and-see format. Without proper treatment, the infection will only worsen. You need a physician willing to try different options.

Good luck and let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infections”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.