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11 years 1 month ago #25347 by Patricia
good question....actually your uro is doing the right thing by growing a culture which takes a couple of days to determine what drug will treat it. I'd keep him out of the hospital as most cases of VRE are contacted there in the first place. But your infectious disease specialist is also right in that with colonization of VRE if its not symptomatic they don't treat it...but obviously he is symptomatic right now. Tis a quandry??
Poor Dad...sorry he's had to go through so much.
Got to ask...why 6 drugs for blood pressure? Geez!

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11 years 1 month ago #25344 by harleygirl
My 82-year-old father has been diagnosed with yet ANOTHER UTI! He can't seem to get a break from these infections. He was in the hospital in January on IV antibiotics and IV yeast infection meds which he continued at home via PICC line for several weeks. After a 4-week course of the yeast meds, his cultures showed he still had a VRE (vancomycin-resistant enterococcus). The infectious disease doc (not so sure about her!) told him they would not treat it unless he had symptoms.

On Wednesday, he had the tell-tale symptoms: fever, shaking chills, dark urine, flank pain. He immediately got in to see a partner of his uro and took a urine specimen with him to the office. The uro was concerned about decreased output and sent him for a CT scan of the abdomen and kidneys. CT was normal. He gave Dad 3 Proquin pills and said the culture should be grown by Friday so they would know how to treat the infection.

Dad has a stent in each ureter and has had one of them for over two years (they are changed out every 3-4 months). The second one was inserted when scar tissue blocked a ureter and caused hydronephrosis. In my opinion, these stents are most likely the cause of Dad's frequent infections. They protrude from the stoma and serve as a wick for bacteria to travel back to the kidneys. The question is: do you remove the stents and risk scar tissue blocking the ureter again or leave them and keep getting infections? It is sort of the rock-and-the-hard-place scenario.

Dad's nephrologist has put him on 6 different blood pressure meds, one of which elevates potassium. So Dad's potassium was elevated and he has to be on an absolutely awful low potassium diet. You would be so surprised to learn how much potassium is in all foods! He has also been on fluid restriction, and the way Dad thinks, if the doc says 2400ccs, then 1800 would be even better! So he is not drinking as much.

His last blood work showed his hemoglobin down to 10.1, and his white count at 7.5 but neutrophils and monocytes were high. His potassium, however, was back down in normal range but sodium was low! I truly don't think diet could cause this drop in potassium; the doc did reduce the dosage of the BP med that elevates potassium.

I'm worried that Dad will end up in the hospital again (it would be the 3rd time this year!) and that is one place he does NOT want to go. Who should be managing an infection: the urologist or the infectious disease specialist?

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