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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56372
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I am a 61yo straight male in typically excellent health, but

Customer Question

I am a 61yo straight male in typically excellent health, but since graduate school have had a history of UTI's every three years or so, despite having none of the classic anatomical, behavioral or lifestyle predispositions to this fairly uncommon situation. My personal hygiene is scrupulous. My career has been in the clinical diagnostics industry with my last assignment involving clinical microbiology screening systems.

There is no history of renal or bladder disease in my family for three generations. My maternal maternal great grandmother succumbed in the 30's to what then was termed Bright's Disease.

Starting back in grad school when I was in my 20's and continuing since, I have been repeatedly and extensively worked up at major University Medical Centers (Iowa City, Duke) but no explanation ever has been found. The past two decades I keep a cycle of cipro on hand in case of recurrence and typically that 5 days in abolishes all symptoms uneventfully until the next bout a couple years later.

In the past decade, in conjunction with semi-annual checkups, there typically are 3 or 4 rbc and, rarely, a white cell, in virtually every urinalysis. It seems to be baseline and the most extensive urological workup ever similarly has shown no explanation for the cells.

A kidney ultrasound 4 years ago identified a small renal cyst, after which I went through the last extensive workup involving 3 return visits, endless urine collections and finally a cytoscopy. All unremarkable.

The only advice I ever received from a urologist (affiliated with Duke), that from a cytoscopy, was to limit my caffeine intake by mixing caffeinated and decaffeinated coffee beans, since I drink 4-5 cups per day, and I have been compliant.

I have been sexually active my whole adult life. My two wives and longtime girlfriend seem to have had no remarkable issues. I also am physically active. I ride and jump horses 3 times a week or more (English). One of my wives was a microbiologist and the other a Professor of Pathology at a major University Medical Center. They both are conversant with this history and neither found any cause for alarm.

My primary care physician who acknowledges that this borderline normal rbc business is baseline for me over the past two dozen checkups, now wants me to go be evaluated again. I will grudgingly comply but since nothing has changed and moreover I haven't had a UTI for the past two years, this seems like an expensive and unpleasant waste of my time and of medical resources. (Were the cell counts suddenly higher, that would be of course be a different story.)

I'm sure he is in part eyeing liability issues. What, if anything, should I suggest to the urologist to look for when I turn up next for this latest referral, since nobody ever has found anything before and nothing has changed since?

I am increasingly unwilling to endure this painful probing unless there is a medically plausible basis for it. Right now it strikes me as simply CYA, which is not a sufficient reason for me to passively endure yet another uncomfortable and pointless workup.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello from JA

Cipro has anti-inflammatory effects as well as anti biotic effects. All antibiotics do. What stands out in your story is no positive cultures identifying any bug.
I am Dr. Thomas, board certified in internal medicine and I can help you with this and any follow up questions. I cover a lot of ground and might give you an answer or ask for information, but use reply to communicate with me for questions or added details.


Typical of prostate inflammation.

This can be bacterial or non bacterial.

It is most likely what is going on, and non-bacterial prostadynia is difficult to treat.

What has helped many patients
prostate massage
rye rhizome
quercitin
Using flax daily.
Anti-inflammatory, nutrient dense diet.


This is feasible both during acute attacks but as a preventative.

A urine culture after vigorous prostate massage should be done to see if there is a bug identified.

I find nothing else concerning about your history.

OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.
Customer: replied 1 year ago.

There are no prostate issues and never have been going back a decade and more and feedback from rectal exams is that everything is perfect. Certainly no symptoms consistent with that.

My last PSA (2 days ago) was in the middle of the normal range and the prostate feedback is also 2 days fresh.

Sorry that I neglected to include this information.

Expert:  Dr. Thomas, MD replied 1 year ago.
Prostadynia typically shows no findings at all.

In any case, if you think these are UTIs where is the objective evidence?

I would not treat them without first doing a urine culture in every single case.

If there is a bug that makes sense, then OK.

If you have had a normal cystoscopy, do you need further work up? No not in my view. I would confirm this with the urologist, and ask about prostadynia.


OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.
Customer: replied 1 year ago.

Thank you.

The objective evidence despite nothing ever culturing out, is that cipro consistently has abolished the characteristic and striking symptoms of a UTI. Not a placebo effect.

I am not sparring with you but merely seeking to fill in gaps the better to help you consider my situation and my reluctance to be probed again with no symptoms whatever evident on the strength of a ten year baseline that wobbles between 3 rbs and 4 rbc with 3 rbc being some arbitrary normal range limit.

Expert:  Dr. Thomas, MD replied 1 year ago.
AS I told you, all antibiotics can act in an anti inflammatory as well as anti biotic fashion.
So I still see no objective evidence of infection.

Therefore, I would culture first before using cipro.
Objectively, cipro is a lousy antibiotic for UTI and is no longer recommended as a first line drug among forefront researchers and physicians.
It is also a potentially dangerous drug.

So, I would work further with the urologist on what is exactly going on, and discuss the approach as well as prostadynia.

Again, I don't see any other work up and expense needed here.

OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.
Customer: replied 1 year ago.

Okay, thank you. You have provided me with some intelligent discussion points that I can and will use.

One last follow-on and then I think I will be fully prepared.

As I mentioned, I ride and jump horses (English) 3 times or more a week, and have done so for a dozen years or more. Rarely is there any painful clash with the saddle while riding or jumping, but there definitely is deep contact with no pain or discomfort between the saddle and the space behind my testicles between my legs when I'm not in 2-point (hovering above the saddle). Can this gentle but chronic contact possibly contribute to the stray rbc's? Another talking point with the urologist, one that my primary care physician mentioned but seemed unwilling to use as a satisfactory explanation without calling in a 3rd party.

Expert:  Dr. Thomas, MD replied 1 year ago.
I am not so concerned about the RBCs, yes they can come from prostate inflammation, but can also simply be march hematuria and yes can be from riding, as can prostadynia be aggravated from riding.

OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.
Customer: replied 1 year ago.

Thank you, XXXXX XXXXX very pleased for your feedback and comments about the aggravating effects of riding on both of what you've termed "march hematuria" and on prostadynia.

I don't know the term "march hematuria". Perhaps there is an equivalent term. If so, I'd appreciate knowing the equivalent.

Thank you for being so thorough and complete in your answers. I'm sure you don't encounter so many inquiries from non-physician scientists who don't know all that much, but just enough as the saying goes 'to be dangerous'.

I am happy to give you positive feedback. You certainly have earned it.

Expert:  Dr. Thomas, MD replied 1 year ago.
March hematuria is the term, it is benign hematuria usually after exercise.

You are welcome anytime, any questions.

OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56372
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
Dr. Thomas, MD and 9 other Medical Specialists are ready to help you
Customer: replied 1 year ago.

Thank you for your help at the time I inquired and the follow up. Hope each back-and-forth for clarification didn't get billed afresh as a new question ;-) I did leave you a gratuity.

The referral my primary care MD was so anxious about seems not to have turned up yet. Probably just to preserve the long ago relationship with the urologist I should schedule an appointment and pay the co-pay, bring him up to date, and tell him that I think anything that has been baseline for ten years, both before and after his last extensive workup including an unremarkable cytoscopy and other lengthy urine studies, is nothing I care to pursue but that I'm willing to consider some trivial non-invasive tests .

Kind regards,
Steve

Expert:  Dr. Thomas, MD replied 1 year ago.
Yes I think that would be fine.
You can find me for new questions any time.

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