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Ask 911Doctor Your Own Question

911Doctor
911Doctor, Doctor
Category: Health
Satisfied Customers: 5094
Experience:  Board Certified Emergency Physician
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Customer Question

Will you tell me what the ER will do
Submitted: 1 year ago.
Category: Health
Expert:  911Doctor replied 1 year ago.

911Doctor :

I do not see your question... just a question about what the ER will do....

911Doctor :

what is your problem?

911Doctor :

how can I help?

Customer: Have blood in my pee. Dx with uti tuesday rxd macrobid. Saturday started havung visble blood in my pee. Ua today showed 3+ blood, 5-9 wbcs, anf 30-50 rbcs
911Doctor :

okay, so why do you need to go to the ER?

Customer: I have a lot of suprapubic pain. At least 8/10
911Doctor :

I see

911Doctor :

are you male or female and how old are you?

911Doctor :

are you vomiting and do you hae feer?

Customer: Female 24. No and no
911Doctor :

okay

911Doctor :

so they will take another urine sample, they will do a blood count, they may need to do a CT scan to see if you have a kidney infection

911Doctor :

and they will give you medicine for pain and for infection

911Doctor :

that's likely what will happen

Customer: Had a ct today. No stones
911Doctor :

okay

Customer: On macrobid and cipro
911Doctor :

so you are going because of pain, is that correct?

Customer: Ya and its clotty blood coming out
911Doctor :

are you sure this blood is not from the vagina?

911Doctor :

when was your last menstrual cycle?

Customer: Yes i am sure. Had a vaginal exam today
911Doctor :

okay

911Doctor :

so you will get a catheter in the bladder and they will likely keep it in for a bit and irrigate it to make sure the blood clears

911Doctor :

you HAVE had a pregnancy test recently correct?

Customer: Yes ive had a pregnancy test today. I dont want a cath
911Doctor :

you need one, and if you refuse one in the ER there is very little they can do for you other than simply give you fluid and medicine

911Doctor :

they will definitely want to do a cath, and in your case it is needed.

Customer: Why? Ive had a bad past. Noone is putting anything in me
911Doctor :

because they will want an accurate urinalysis and culture and that is only possible with a cath.

911Doctor :

the cath will also keep your bladder empty and they can irrigate your bladder to clear the blood.

Customer: Will they let me cath myself?
911Doctor :

this is important because clots can cause you to be unable to urinate, and then you might need a cath in the OR

911Doctor :

I doubt it, has to be done sterile

Customer: I know sterile technique. I cath babies and children everyday in my job
911Doctor :

look, I'm an ER doc and there's no way in the world I would allow you to do that if I wanted a lab on it, period... if you wanted to self cath for relief okay, but otherwise there's all kinds of problems with that. no, they will not let you do that if they know what they are doing.

Customer: So better off not going to the er
911Doctor :

not saying that, just saying that if you go you must let them do what they need to do to help you

Customer: I cant. How do they irrigate it
911Doctor :

once the catheter is in the bladder and the Foley ballon is inflated they put warm saline into the bladder through one of the Foley ports and it comes back out soon and clears the bladder.

Customer: Itd be an indwelling cath? For how long
911Doctor :

As long as necessary. I'm guessing this is what they will do... it's my best guess.

Customer: How long typically?
911Doctor :

we don't even know your diagnosis, so there is no 'typical', but if they do a cath and there's clotted blood you might need to have irrigation of the Foley for a few minutes and it may need to remain in place as long as you are in the ER

Customer: Will i be able to go home tonight
911Doctor :

there is no possible way for me to know that

911Doctor :

from what you are telling me I would guess that you WOULD be able to, especially since your CT scan was normal

Customer: What if its just inflammation of the yrethra
Customer: ?
911Doctor, Doctor
Category: Health
Satisfied Customers: 5094
Experience: Board Certified Emergency Physician
911Doctor and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.
What if its just inflammation of the urethra
Expert:  911Doctor replied 1 year ago.
doubtful given the blood clots and no way to tell without a bladder catheter.

please, just go and let them do what they need to do to help you get better.

there is no way for me to know what they will do, exactly, but they will do what they need to do to make sure they understand what is going on with you and and how to get you better.

best
Customer: replied 1 year ago.
Can they give me a sedative first
Expert:  911Doctor replied 1 year ago.
Not for a Foley catheter. They will use lidocaine gel. A sedative for a minor procedure will not happen partly because its a minor procedure and partly because you will not be allowed to drive home if they do.

Customer: replied 1 year ago.
What about like ativan? Im having a panic attack just thinking about it. This is what it looks likehttp://m1280.photobucket.com/albumview/albums/Kate_Miller2007/image_zps9d08969d.jpg.html?o=0&newest=1
Customer: replied 1 year ago.
No cystoscopies? What else could cause blood in my urine
Customer: replied 1 year ago.
Er dr said i was
Fine
Expert:  Chris C. replied 1 year ago.
Did you have to be cathed at the er?
Customer: replied 1 year ago.
No. He didnt do any labs or anything
Expert:  Chris C. replied 1 year ago.
When did you start the cipro?
Customer: replied 1 year ago.
I started macrobid a week ago. Started on the cipro yesterdat even thoughthe nurse practioner said its not a uti
Expert:  Chris C. replied 1 year ago.
Ok what did they say the problem was then that they started the antibiotics?
Customer: replied 1 year ago.
Iwas started on macrobid a week ago for a uti. Ua yesterday showed no nitrates. Said its not a uti but said try cipro to see if it works
Expert:  Chris C. replied 1 year ago.
Depending on the organism that caused the uti it may or may not be sensitive to a certain antibiotic and so the cipro will cover more organisms. Do you feel better since you have been taking the antibiotic? Are you still having clots in the urine? What did the er say about the clots?
Customer: replied 1 year ago.
The uti wascaused by e coli, and was sensative to macrobid. Still having clots in urine and i still feel like crap. This is what my pee looks like


http://s1280.photobucket.com/user/Kate_Miller2007/library/?sort=3&page=1
Expert:  Chris C. replied 1 year ago.
Ok when you told the doctor at the er this what did they say? They must have said more than "you are fine go home". Did they have any explanation at all?
Customer: replied 1 year ago.
The er dr said i was fine. That there is no concern
Expert:  Chris C. replied 1 year ago.
They did a ua in the er and there were visible clots in the sample?
Customer: replied 1 year ago.
No they didnt do a ua. ER did nothinf
Expert:  Chris C. replied 1 year ago.
Do you have a follow-up appt with your pcp? I'm sure if they saw the clotting they would have addressed it.
Customer: replied 1 year ago.
No i dont have a follow up scheduled. The er saw the results of the ua i did at the clinic yesterday morning
Expert:  Chris C. replied 1 year ago.
I would do a follow-up at the clinic if you are still having issues. I don't know why the er did not further evaluate you but you must make sure you are getting the care that makes you feel at ease and in good health. Maybe in the more relaxed environment of the clinic they will take the time to properly address the issue.
Customer: replied 1 year ago.
I dont want to see urology i dont want the
To put anytbing in me. I have huge anxiety over that
Expert:  Chris C. replied 1 year ago.
Yes I understand with your history that this is a major anxiety trigger but if that is what it takes to feel better than isn't the reward worth the anxiety? If we do not address issues of illness they most often do not go away and progress into something much worse.
Customer: replied 1 year ago.
I think a cystoscopy or a catheter would send me backwards emotionally
Expert:  Chris C. replied 1 year ago.
I understand your concerns but you have to remember that this is a trained professional doing it to HELP you and not for any other reason. You should put it in your head that the procedure will help you feel better. The alternative may depending on exactly what you have going on be far worse and result in you having to have a cath anyways and at a point in time when you feel MUCH worse.
Customer: replied 1 year ago.
I just dont want to be aware of what they are doing
Expert:  Chris C. replied 1 year ago.
You can always of course discuss your high level of anxiety with the doctor and they may be able to provide some pharmaceutical relief. It is not normal to sedate for a cath, etc but it may be necessary in your case. The worst thing you can do is nothing and to ignore the problem.
Customer: replied 1 year ago.
Its just that i had a bad childhood and i have panic attacks just thinkig about what. Urologist would do
Expert:  Chris C. replied 1 year ago.
What you must do if you are going to deal with this anxiety is remember and convince yourself that the urologist or any other medical personnel are professionals completing a procedure to help you. They are helping you at your request and the end result is that you feel better. The association between medical encounters and feeling better will reinforce that the actions they take are a positive and meant to help you.
Customer: replied 1 year ago.
Itll give me flashbacks
Expert:  Chris C. replied 1 year ago.
This is something that must be done though? Are you wanting to get really ill?
Customer: replied 1 year ago.
How does anyone know it has to be done? Maybe itll go away
Expert:  Chris C. replied 1 year ago.
Without a proper exam no one knows for sure. Is it worth taking a chance that the problem will get worse just so you do not have to experience some anxiety? What if it doesn't go away?
Customer: replied 1 year ago.
I had a ua, labs, a ct, and apelvic exam
Expert:  Chris C. replied 1 year ago.
When was this last completed?
Customer: replied 1 year ago.
Yesterday
Expert:  Chris C. replied 1 year ago.
So you had testing yesterday at the clinic and then went to the er later in the day?
Customer: replied 1 year ago.
I testing at the clinic at 8 in the am. Then around 2pm i got horrible suprapubic pain that just kept getting worse. So i saw the NP again (one of the perks of working at the clinic) She did a pelvix said everything looked fine. Gave me some tylenol since i cant take NSAIDs. Told me if pain gets worse go to the er
Expert:  Chris C. replied 1 year ago.
So you feel that her assessment is not correct? Would you feel comfortable with someone in the clinic doing cystoscopy or a catheter since you should have a much greater level of trust with these individuals?
Customer: replied 1 year ago.
Her assessment was she isnt quite sure whats causing the blood and to give it time. We have urologists that work at my clinic (3 of them in fact) and i dont know that i could let them do it
Expert:  Chris C. replied 1 year ago.

Well of course the choice is up to you given the short time since your assessment and that the er doctor said there was nothing to do (although they did not do any testing). If I were you I would see a urologist in your clinic that will be in a familiar environment and should reduce your anxiety level. Regardless if the urologist says you will be fine without medical intervention the irrational fear is something that you have to deal with eventually and why not start doing so now? If you have anxiety medication take it before your visit to help calm your nerves (as long as it is Dr prescribed)

Customer: replied 1 year ago.
I take ativan twice a day
http://s1280.photobucket.com/user/Kate_Miller2007/media/image_zps8799e7f2.jpg.html
Expert:  Chris C. replied 1 year ago.
Since you continue to have the clots I would suggest you get into the clinic and time it just after you take your ativan.
Customer: replied 1 year ago.
Its absolutely necessary isnt it
Expert:  Chris C. replied 1 year ago.
It is at this point yes regardless of your anxiety.
Customer: replied 1 year ago.
Sorry for being a pain
Expert:  Chris C. replied 1 year ago.
No problem. We are here to help! I hope you have found our chat today helpful if so please remember to rate so I get credit for our exchange.
Customer: replied 1 year ago.
Culture grew out ecoli again
Expert:  Chris C. replied 1 year ago.
Ok so that is a good thing. Now you know and have proof that of what the problem is. This shouldn't be that big of a deal with a stronger combination of antibiotics.
Customer: replied 1 year ago.
So i dont need to go to urology
Expert:  Chris C. replied 1 year ago.
That depends on if you continue to pass clots or not. If you continue then yes you should see the urologist. You MAY get lucky and they will resolve without seeing a specialist with a stronger combination of antibiotics.
Customer: replied 1 year ago.
Ive been on cipro since monday
Expert:  Chris C. replied 1 year ago.
Ok well it can take a few days for cipro to really reduce the colony size so that may be enough but if it has went on like it has for some time something stronger or a longer course may be required.
Customer: replied 1 year ago.
Like what?
Expert:  Chris C. replied 1 year ago.
Trimpex, Rocephin, Suprax, Macrobid, and several other that will cover gram negative e, coli.
Customer: replied 1 year ago.
I just finished macrobid last night
Expert:  Chris C. replied 1 year ago.
You need to be patient and give the Cipro a few days to work. You may have to go with something like Rocephin though if the Cipro doesn't do the trick. You also want to keep a close eye on the clots in the urine. If they get worse you will need to get in with the urologist as we discussed before.
Customer: replied 1 year ago.
NP said she will not even think about making a referral until my uti goes away. What does the cystoscopy entail? How are your feet positioned? Will they stop if you ask them to
Expert:  Chris C. replied 1 year ago.
This is a great link that shows the procedure. Watch the video as is will give you some great information. http://www.nhs.uk/conditions/Cystoscopy/Pages/Introduction.aspx
Customer: replied 1 year ago.
What if i have a panic attack while they are doing it
Expert:  Chris C. replied 1 year ago.
You need to discuss your special circumstances with the urologist prior to the procedure and see if he wants to give you something to help with the anxiety.
Customer: replied 1 year ago.
Doesnt everyone have this much anxiety about it
Expert:  Chris C. replied 1 year ago.
No. Some anxiety is normal but as you indicated yesterday you thought that you might have a panic attack just thinking about having the procedure. This is not what would be considered normal in the average patient.
Customer: replied 1 year ago.
Ive just had a hard life. I hate people touching me
Expert:  Chris C. replied 1 year ago.
I understand and while you do not need to go into detail with the urologist if you have to see him/her it is important that they know of your extreme anxiety related to any procedures.
Customer: replied 1 year ago.
Cant i just skip it?
Expert:  Chris C. replied 1 year ago.
That really depends on if you get better after you complete the Cipro and the clots stop. If you do not get better and the clots continue then yes you will have to see the urologist if you want to get better.
Customer: replied 1 year ago.
Blood in pee cant be harmful though can it? How do i make my anxiety about it go away
Expert:  Chris C. replied 1 year ago.
Yes blood in pee is not normal and always indicates a problem in the body.
Customer: replied 1 year ago.
My gyn said i have hemorrhagic cystitis. My symptoms arent better
Expert:  Chris C. replied 1 year ago.

Hemorrhagic cystitis just indicates that there is damage to the bladder's epithelium and blood vessels. This is not unexpected given your positive urine culture. How many days into the cipro course are you? Are you still passing clots?

Customer: replied 1 year ago.
Took my last pillthis am. My health just sucks right now between the urinary stuff and my gi stuff
Expert:  Chris C. replied 1 year ago.
If it continues a cath irrigation or cystoscopy will be required.
Customer: replied 1 year ago.
I see my nurse practioner tomorrow. I will have her do another ua. The amt of blood has lessened but its still there. And i think i may have pus in my pee

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