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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6929
Experience:  14 years as clinician in the field of Family Practice
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What causes WBCs on a wetprep

Customer Question

What causes WBCs on a wetprep
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD :

Hello agin,

Anthony Bray MD :

WBCs on a wet prep are caused by some irritation of the vaginal wall. This would be some type of infection...

Anthony Bray MD :

I am happy to answer your questions but I do expect reasonable frequency of payments on your part as well

Anthony Bray MD :

The mucosa of the vaginal wall would be basically "patrolled' by low numbers of white cells.. you might see an occasional one on a typical normal wet mount but nut in suignificant numbers. You mainly see epithelial cells...

Anthony Bray MD :

Higher numbers of white cells would indicate infection....

Anthony Bray MD :

I hope this helps. Best Regards,

Anthony Bray MD :

Anthony Bray MD

Customer: replied 1 year ago.
Hi.
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Does that help? Did you have further questions on this??

 

Anthony Bray MD

Customer: replied 1 year ago.
I was going to pay you after that question. You just have to tell me when its time to pay you. What kind of infection causes WBCs on wet prep. I had this same issue at the end of march
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well vaginitis would be the most common cause >> as we discussed before this is an infection of the vaginal wall.. most common causes of this are yeast, gardnerella, trichomonas, and others...

An infection higher of the pelvic organs such as cervicitis would cause a purulent > white cell loaded exudate as well... Infection of the uterus would constitute PID >> PID may include infection of the uterus and up into the fallopian tubes/ ovaries...

So these would be the usual sources...

So the transvaginal ultrasound would be an important aspect of your evaluation I think ..

I hope this helps. Let me know if you have further concerns or questions. Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
I feel like you are frustrated with me now. I am sorry
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I enjoy answering questions but I do need to keep things reasonable >> that is all>> I feel that you go over the line to an extent >> you pay 12 dollars and I answer 50 follow up questions... last round you had not pain even after 45 questions.. I did get frustrated with that....

Don't worry about me though... it is no big deal... I am not difficult to get along with :)

I enjoy fielding your questions >> you are very intelligent and very inquisitive and that is fine by me!! I just do not want to feel taken advantage of either though...

I'm sure that you understand... Best regards XXXXX XXXXX!!

Anthony Bray MD
Customer: replied 1 year ago.
I though on the last batch of questions that i did click accept to one of your answers. So it is my mistake that i didnt. And i am sorry. It was my fault. Please dont be angry at me.


My dr told me i have a cervical cyst which i didnt have last month. Hes sending me to see my gynecologist. What do they do for them
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

A cervical cyst would typically just resolve on its own. There are glands here that secret mucus and if a gland is blocked then it would cause a cyst.

I'm not mad at you. Don't worry!!

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Then why do i have to see my gynecologist? And why in pray tell do transvag u/s hurt so much
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well the transvaginal ultrasound would not be a comfortable exam even under the best circumstances but it should not be that acutely painful. This may indicate a problem such as the possible presence of infection.

The cervical cyst just falls into the type of problem that your primary care doctor is not comfortable with and therefore the referral to the gyn.. The gyn will examine and might recommend excision but may wait to see if it resolved on its own as possible option...

It does seem that you have a couple areas of potential concern that may point to problem... the white cells in the urine.. the white cells on wet prep.. your pelvic discomfort.. the pain on exam.. your doctor suspecting PID tells me that this must reflect an underlying problem.. Did your doctor obtain a blood CBC with white cell diff?? This would be helpful in determining extent to which your body may be fighting infection or not...

Keep in mind too that there may be other reasons for pelvic pain other than infection. Endometriosis, adhesions, fibroids, ovarian cysts are possible sources of pelvic discomfort that would be non-infectious in nature...

I think that the cervical cyst is probably the least of your worries right now (but I did not see this cyst on exam either, mind you..) I think that follow up with Gyn would be a good idea in light of the pelvic discomfort and other abnormal findings though...

I hope this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Dr said he didnt see any cysts on the u/s. the u/s hurt really bad made me want to jump off the table. He did do a cbc. I believe he said wbc was 16.1. I cant get in to see the gynecologist for 2 weeks
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

OK if your CBC showed WBC of 16.1 then that would be consistent with you still fighting a significant infection. That could be pyelonephritis or PID as possible sources. That would be more typical of this level infection vs a bladder only infection...

That is concerning and needs to be watched. This makes me more nervous for you...

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I guess just watch for fever and any worsening symptoms
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Right, exactly... you do need to watch for worsening. Your body's defenses are always the main factor that battles infections though. We are spoiled and used to the benefit of antibiotics and they are very useful and often needed but the main defense is always your body's own defense mechanisms. So with time you may improve and I hope that this will be the case for you!!

I do advise that you follow up on the elevated white count, positive U/A and the pelvic discomfort though..

I hope this is helpful for you. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
So do i follow up with my pcp or gynecologist. And how long until i need to follow up
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well you said that you are scheduled to see your GYN in about two weeks , right? I would plan on that for one. I would advise that it would be a good idea to follow up with your PCP next week. I think that a follow up exam and repeat of the U/A , follow up of the results currently pending would be best...

 

I hope this helps. Let me know if you have further >> Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
But do you think more than likely the wbcs in my urine are coming from vaginal contamination. Also can low potassium cause chest pain
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

No I would not expect the low potassium to cause chest pain>> when did that start?? This could well be associated with the findings on your endoscopy.. esophagitis would be the cause that I would first suspect here...

 

I suspect that you have a UTI based on your report of findings. You have the urine culture pending which should help to shed more light on this issue. It is possible that the white cells in the urine could have been from vaginal contamination. I could tell more about this as a possible cause if I had the benefit of viewing the micro findings of the urine...a high number of epithelial cells would be consistent with a higher degree of vaginal contamination...

 

I hope this helps. Best regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Everything else for the urine was normal. No excessive epithelial cells. As for the chest pain i dont really know if its chest related or if my heart feels weird. My fingers are tingly too
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well as I said I would EXPECT that your esophageal irritation would cause some discomfort but I can't tell you with certainty that that is what you are currently feeling....

 

Tingling of the fingers could be parasthesia symptom caused by your low potassium. I would suspect the low K to cause this,...

 

Any irregular heart beat? Anything that makes the discomfort of the chest worse? At your age I would not expect you to be at risk for coronary artery disease....

 

I hope this helps >> Let me know on the added questions>>

Customer: replied 1 year ago.
I know im having palpitations. But this could be related to anxiety. I have had a lot of anxiety about my health lately. My potassium was only a little low, my dr told me to eat a couple of bananas.
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Anxiety is possibly related to some of the symptoms. Anxiety >> esp panic attacks may lead to hyperventilation and this causes change in pH and causes parasthesia symptoms commonly hands and around mouth... so that is a possible cause...

 

If K was only slightly low then that is good and not a serious problem and should correct with time... I would probably be diligent to eat banana a day for week or so at least though...

 

If you have palpitations then PVC's (Premature Ventricular Contractions) are the most common cause of these. A supplement of magnesium oxide 400mg ( available over the counter) helps to decrease these occurring. This would be potentially helpful for this symptom along with correcting the potassium....

 

I hope this helps! Let me know if you have further questions! Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Do you think it sounds like PID? Are you sure you are not mad at me
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Yes > I am sure that I am not mad at you...

 

I am not sure if you have PID or UTI at this point. I more suspect UTI based on the high urine white count...the high WBC portion of your CBC does to me suggest a serious infection as I noted. This could fit with PID but could fit with a more serious UTI too... the urine culture and the results of the pelvic ultrasound should be helpful to determine the source...

 

I hope this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
I have pain up into my shoulders
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

This could be referred type pain as possible. Pain from your esophagus could do this...The inflammation from whatever infection you have going on could be a factor as well as another possibility. Does it hurt to move arms > indicating inflammation affecting the joint??

 

I hope this helps. Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
No, it could be because ive hardly been outta bed for the past week. And the fact that i spent almost 4 hours at the clinic today. Do you think itd be ok to return to work before monday?
Expert:  Anthony Bray, MD replied 1 year ago.

Hi again,

 

Well that makes me a bit nervous.. I do think that your body needs rest to recover>> the body is better able to use energy resources to fight infection and to heal those ulcers when you are resting. I do think that getting up for a short walk several times a day would be to your benefit. I think that full work right now is probably not in your best interest though... Ultimately it is up to you and how you feel...

 

I hope this helps>>

 

Anthony Bray MD

Customer: replied 1 year ago.
I was thinking of trying half day tomorriw and friday
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I think a half day may be a reasonable compromise for you...

 

Good luck < I hope that it goes well for you if you work tomorrow..

 

Take care,

 

Anthony Bray MD

Customer: replied 1 year ago.
All i do when i am home is sleep. That cant be good for me to sleep all day. Last time i had ulcers i didnt get any days off
Expert:  Anthony Bray, MD replied 1 year ago.

Hi again,

 

Actually sleep is good for you and this is when your body's healing and defense mechanisms are at their best. I do agree that some getting up and MILD exercise would be to your benefit too. Over-exertion would NOT however...

 

I hope this helps>>

 

Anthony Bray MD

Customer: replied 1 year ago.
So yes to work or no to work
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

If you feel well then you might try the half day. If you feel rotten then stay out!!

 

I hope this helps. Best regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
If the culture comrs back on friday with no definite bacteria whats the next step
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

In that case then follow up would be the next step. This should be a judgment based on both your clinical symptoms >> pelvic pain, fever ,etc and test results > CBC with differential, repeat U/A (cath if necessary) Your results from the transvaginal ultrasound should be back by that time..

I hope this helps. Let me know if you have further questions or concerns. If my answers have been helpful and to your satisfaction then an ACCEPT and positive feedback would be appreciated! Thank You and Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I think the dr had the results of the u/s when i was there. He said he didnt see anything odd. But it sure did hurt like heck
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

OK , I see .. well that sounds reassuring to a point if the Ultrasound looked OK. There are still the issues with your very high WBC and U/A as well as your tenderness. I would advise follow up on these no later than next week...

I hope this helps. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
But how come it coukd hurt so much if it was normal
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

The ultrasound looks for macroscopic changes of the pelvic organs. It MIGHT show endometrial thickening in the event of PID but this test in itself could not determine infection vs no infection per se...

The degree of tenderness may be indicator of infection. This could still be possible with no large scale changes on the ultrasound...

I hope this helps. An ACCEPT on your part would be appreciated at this time..

Best regards,

Anthony Bray MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6929
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and other Health Specialists are ready to help you
Customer: replied 1 year ago.
Would a dr know what to look for on an u/s?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes but this depends on the training and experience of the doctor. Radiologists are the most specifically trained to interpret ultrasound results. A GYN would be familiar with pelvic ultrasounds. Most PCP's would not...again primary care doctors may get training in this if they choose and their experience with this would vary on their specialty and their residency experience...

I hope this helps. Thank YOU!! Best regards>>

Anthony Bray MD
Customer: replied 1 year ago.
Ok. I was just wondering. I just need all my health issues to disappear
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well I do hope that you feel better soon! Good luck in your recovery !! Keep me posted over these next several days...

 

Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Will do. If i make it through the weekend without any wordening symptoms i should be good right. And i dtill dont understand how i could have WBCs in the urine but no nitrates
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

That would be a reasonably good marker > I would agree>> I think that especially if you continue to improve in this time frame that would be a very positive sign for you!!

 

The next five days or so I would agree would be critical to watch for potential worsening and for you to GET HELP if that should occur..

 

I hope this helps. I wish you the best in your ongoing recovery!! Take Care !!

 

Anthony Bray MD

 

Customer: replied 1 year ago.
How can urine have WBCs in it but no nitrates? How can a culture grow but not pinpoint a certain bacteria? To me its seems wasteful to do another culture. I know i should stop worrying about it but i cant
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

The NITRITES are 100% specific to bacterial infection when this is positive it ALWAYS means infection >> this is a byproduct of CERTAIN bacteria... but all bacteria do not produce this...

 

So it is not that SENSITIVE >> a negative result does NOT ALWAYS mean NO infection...

 

That is why it is a useful test on the U/A but you have to look at other components of this test as well...

 

Often a significant UTI will even show the HPF teeming with bacteria.. I don't know what your result looked like in this regard??

 

I hope this helps. Let me know if you have other questions! Take Care!!

 

Anthony Bray MD

Customer: replied 1 year ago.
Will you at least tell me i dont have to worry about it
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well it does not help to worry... just do what you need to do.. if you feel worse then respond and do whatever you need to do... HOPEFULLY you will progressively feel better !!

 

Get rest and take care of yourself in general > I understand that you are in a nerve racking situation >> I sympathize with you in that!!

 

But keep in mind that as log as you do watch out for yourself and take care of yourself that everything will be fine in the long run. And the long run should not be that long either!! Hang in there!!

 

Best regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Im really pukey feeling. I have diarrhea and chills
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I'm sorry to hear that! You need to be careful as you can ill afford much diarrhea with your recent dehydration. I would suspect that you are still at a deficit in the fluid balance...

 

You need to stay home and not work today of course... I would advise that you call your doctor's office and notify them of your situation...

 

Let me know if you have further questions. I hope that you feel better soon.

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Temp of 101.5 early this am. Now 100.6
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

OK chills, mild fever >> still it points to serious bacterial infection with your WBC so high on your recent test. I would recommend that you call that doctor's office and see if they have any change such as a wish to reconsider an antibiotic for you at this time...

 

I hope this helps. Let me know if you have further questions. I hope that you feel better soon!

 

Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
He just said watch it
Expert:  Anthony Bray, MD replied 1 year ago.

Hi again,

 

OK well watch carefully >> we will see how things go from here to tomorrow...

 

I will be on and off line a bit today but I will be on most hours....

 

Take Care >> I hope that you feel better soon!

 

Anthony Bray MD

Customer: replied 1 year ago.
I just feel miserable
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I'm sorry >> I hope that you do feel better soon! This will pass >> hang in there!!

 

Take Care >> Anthony Bray MD

Customer: replied 1 year ago.
Im having stomach cramping
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

I'm sorry that you have this added symptom. Do you have any MEDS that are antispasmodic ? I thought that with your history of GI problems that Levsin, Levbid, Librax may have been prescribed to you at some point??? One of these would be helpful for that particular symptom...

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I was on librax but my gi dr took me off of it
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Do you have any left? I suppose that it is gone ...you might call your doctor's office to request prescription to help...

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I have like half a bottle left
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Ok ... Well you could take these as before to reduce the cramping in your current situation ...I hope this helps....

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I am really unsteady on my feet
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

That is concerning! Are you light headed? I worry that you may have started from a fluid deficit and this could be made rapidly worse if your diarrhea is very bad ... That us one possible cause of what you feel. Don't hesitate to get further help if you need it! Check your pulse and blood pressure if possible...

Let me know if I may be if further help. Take care,

Anthony Bray MD
Customer: replied 1 year ago.
I am lightheaded. When i stand my ears feel full of pressure and my leg muscles hurt. Pulse is 120. Bp is 96/61
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

It sounds that you are getting volume depleted again. The low BP and high pulse rate would fit with your having recurrence of dehydration as the probable cause if your symptoms here. I think you would be best to seek attention via the ER and have them check you further. You may need IV fluids . The bacterial infection (?? UTi/ PID/ and now lower GI symptoms) may need benefit if antibiotics-- I think it would be best to recheck you CBC this PM..

You may be resistant to return to ER--- let me know if you have further discussion...

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
I was hoping i could wait until tomorrow and see my pcp
Expert:  Anthony Bray, MD replied 1 year ago.
Hello ,

Yes you may be able to manage this in this way--- I tend to be on the cautious side....

It is a judgment call that depends much on how you feel. The light headed feeling is concerning to me. Try at least to take in a fair amount of liquids>> Gatorade, soups etc would add some salts as well as water ( you need both to I
Motive the blood volume) ((presuming that this is indeed the cause of your symptoms.

I hope this is helpful! Let me know if I may be of Further help to you! Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I think i ate some rotten chicken. My stomach is all crazy and im pretty confident im going to be sick
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I'm sorry -- do you have a nausea medicine available? Phenergan or Zofran perhaps ...these would be helpful if you had one of these on hand. Watch for fever + abdominal pain >6/10 ( can't sleep through it) or intractable vomiting or bloody diarrhea as signs to be seen more immediately at ER... Severe abdominal pain( intolerable ) would also be reason to be seen at ER.

Would favor frequent sips of fluids ( Gatorade / chicken soup/etc) as being best tolerated...

I hope this helps. Let me know if you have further questions. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I feel flushed and icky but dont have a fever
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well that sounds much better on balance than yesterday. How are you feeling in general today? Nausea better?? Diarrhea better?? No fever?? I hope that everything is going better for you!

Let me know if I may be of further help. Take care,

Anthony Bray MD
Customer: replied 1 year ago.
I dont feel well at all. Im nausous. Ive vomitted 3 times. Just took my temp 100.8. I dont know of i should call my dr or not
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Your current condition and symptoms are not in themselves drastic BUT in light of the big picture with your recent abnormal labs plus ulcer disease increases concern here!! I would advise that you update your doctor's office with your symptoms and problems today as it is Friday and see if there is any adjustments to the plan ... I think at least some nausea medicine may be added. Perhaps prelim urine culture results may be in.. ( probably not antibiotic sensitivities)

I hope this helps. Let me know if you have anything further. Take care!

Anthony Bray MD
Customer: replied 1 year ago.
Im sorry im such a pain in the butt
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

You aren't that!! Like I said I enjoy answering your questions! You are fine!! I hope that you feel better soon! I am sorry that you have has such a difficult series if health problems! I expect that this will improve. I have seen this sort of thing many times--- you are having a bad spell of it but you will get back in track! Hang in there!!

Take care!

Anthony Bray MD
Customer: replied 1 year ago.
Do you think its most likely gastroenteritis
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Your situation is complicated in that you have known ulcer disease and this alone could cause the nausea and vomiting if course. Your new onset diarrhea could be a viral gastroenteritis super-imposed on this. That is probably the more likely. I would have some concern over a more serious condition such as Cdiff colitis which would be a potential complication of your recent antibiotic treatment as being possible. Food poisoning would be a consideration as you mentioned but the time course of diarrhea and later vomiting did not strike me as being classic for this... Colitis or food poisoning could explain your fever. Your fever most likely to UTI still -- I think-- but other source such as PID or other are possible...

I hope this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I called my dr at 145 and havent heard back
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Sorry that you are having so much trouble-- what time zone do you live in??

How are you feeling now? Is the vomiting settled down? Diarrhea better?? Do you have any fever now ? How is your dizziness / light- headed sensation ? How are you pulse and BP running? Do you have much abdominal or pelvic pain at this time ??

Let me know and I will get back with you ! These factors will determine how your situation would be best managed at this point.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Right now its 5 pm. I feel sick. Im lightheaded. Diarrhea has settled down have been vomitting on anf off. Temp right now is 101.0. Pulse is 116. I dont know what my bp is. My abdominal pain is pretty much thr same its been since thursday
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

With your current level if symptoms and history I think that seeing an urgent care may be a reasonable compromise between staying at home and waiting vs the ER--- I think they could evaluate you well enough and may be able to help you with rechecking the urine and starting an antibiotic if you need it( which I strongly suspect that you do at this time ) your signs of dehydration could be evaluated as well.

I hope this helps. Let me know if you have further questions. Good luck and get well soon! Best regards !!

Anthony Bray MD
Customer: replied 1 year ago.
I knkw you are not here to argue with me. My urine culture woulda been back today. If it showed something funny dont you think they woulda called?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello !

Yes I would expect that if your urine culture was positive that they SHOULD have called you. I know however that these results often do not translate into the right action as promptly as they should. Did the labs return yet? Have they been reviewed by the MD?? If positive were antibiotics ordered?? If positive results and antibiotic ordered has this been done or does it still wait Friday afternoon in some to do pile waiting for Monday?? I don't know--- I don't like systems that tell you or presume that everything is fine if you don't hear back though... Some offices work on this to save time but I think report back on all results positive or negative is best procedure for a medical office...

So it is up to you as to judging if you need to be seen yet again at this time or wait...

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Also, the center of my chest hurts
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I would suspect that may be due to irritation of the esophagus . You have esophagitis already and have now had more vomiting which is bound to make this worse. I think that this would be the reason for the chest pain or the most likely issue that seems to relate to your recent problems. The Carafate may be helpful in this...

I hope this helps . Let me know if you have further questions! Take care and get better!!

Anthony Bray MD
Customer: replied 1 year ago.
Its all just frustrating
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I understand that. Hang in there -- it will get better with time... You have a set of problems which do contribute to make the other worse---GI problems>>> decline in nutrition>> increased susceptibility to infection>> etc>>> this combination has made your recovery more difficult than usual but you should overcome this and do fine. I do think that you need to continue to watch things closely this next week as well though...

I think that you would probably benefit to be seen at urgent care and checked again but I know that you are bound to be so tired of these doctor visits and of course I can't guarantee you that you would get productive results--- I confess that I worry about that high white count and your prolonged symptoms and fever. It seems to be ill defined illness...white cells in the urine, pelvic tenderness, now diarrhea and vomiting...

I hope this helps. Let me know if you have further questions.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Do you think a repeat ua can wait until monday? Idk if urgent care would order ine since i just had one done wednesday
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well yes it probably can wait... They probably would follow up the urine as it might have gotten worse and be more clearly diagnostic( or it could be better or it may have had white cells from vaginal contaminate...) if you don't feel too bad you could opt to wait and see how it goes-- you could always go to urgent care Sat or Sun if needed... And ER as more of last resort....

I hope this helps.. Let me know if you have further questions. Update me with any changes . Take care!

Anthony Bray MD
Customer: replied 1 year ago.
What do you think is all going on with me?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Well --- I suspect A) ulcers/gastritis/esophagitis B) UTI C) gastroenteritis as the last component now aggravating you with more diarrhea and vomiting.

I qualify this by acknowledging that there may be differences to these components of illness as I suspect . You know the PID does seem to remain in question but I think that your PCP would have given you antibiotics if this was the apparent case---- the decision not to treat seems to me to indicate that PID seems to be less likely to be the diagnosis....similar argument might be made for UTI but your high WBC's on the U/A just seems more consistent with probable UTI to me....

The diarrhea and fever might also correspond with colitis due to bacterial cause as another possibility but you were sick prior to the onset of the diarrhea... So if the diarrhea is more than short lived and mild then stool samples for ova parasites, white cells, cultures and C. Diff would be potentially helpful...

I hope that this helps. Let me know if you have further questions or discussion. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I know my dr told me if mt crp was higher he woulda given me a shot of rocephin
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,I know-- you told me that--- I would think that your WBC would have been convincing for significant infection--- was this mainly neutrophils or do you know?? The blood WBC would not indicate the source of infection however which seems to remain in question... Do you have any history of kidney stones? A stone may serve as a nidus of infection... The dehydration would increase risk of kidney stone formation significantly...You do need follow up of the high blood WBCs... This indicator should be confirmed to be normal again as you recover. PID would be expected to cause severe pelvic pain and some vaginal discharge. This may cause fever and could produce nausea as well. There could even be concern here for toxic shock syndrome caused by a strep bacteria( more common with tampon use ) >> fever, pelvic pain, tachycardia and low BP could fit with TSS as a possible concern as well...I hope this helps. Let me know if you have further concerns or questions. Best Regards,Anthony Bray MD
Customer: replied 1 year ago.
Thank you for all your help! Ifvinstill have fever tomorriw do you recommend urgent care
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes I think that would be a good idea. I think especially if you have any trend of worsening that you should be seen sooner vs later!

I hope you recover soon! Take care!

Anthony Bray MD
Customer: replied 1 year ago.
You do know i am thankful for all your help right
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,

Well I am very glad! Thank you!! Take care!!

Anthony Bray MD
Customer: replied 1 year ago.
So if a urine culture grows anything does that mean there is an infection
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Yes that would confirm a urinary tract infection. Call Monday to request your results-- don't presume that no news is good news--- it may be the case but as I noted earlier it could just be that the results may be in a slow process of response...

I hope this helps. Take care!

Anthony Bray MD
Customer: replied 1 year ago.
So when my culture from my ua i did last friday showed i had a uti since it had growth???
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Well it is agreed that greater than 50 thousand colonies/ml of a bacteria would define an infection. Less than this and some may treat and others may consider non-significant( ex- 10 thousand colonies/ml) In the event of poly microbial growth this is usually interpreted as contaminated sample rather than infection. It is most typical with a true UTI to get a result of a pathogen such as E. coli ( = culprit on 90% of UTI's) and greater than 100 thousand colonies/ml... This would be the more classic rip roaring UTI result .

I hope this helps to clarify. Please start a new thread at this time as this thread has grown to more than 50 Q and A's now.... Thanks---

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Very last comment. I am down 20#
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

That is very concerning ! Don't hesitate to seek further help this weekend if you need to!

I hope that you do well this weekend! Take care,

Anthony Bray MD

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