[NP-Clinical] MRSA UTI

Tue Jan 16 07:40:26 PST 2007

OOPS....I meant to say "bone density scan".......quick fingers :).......I would be curious to know if her scan came back with problems in both her spine and hip or just her hip........sounds like you have her documents.....can you post her T scores for each? There is a BIG problem interpreting these scans when there is osteoarthritis......artifacts often show loss of bone in the hip but not the spine - which makes NO sense since bone loss will occur first in the spine.

Some women appear to shrink due to posture related problems with age and also arthritis! For instance, I had to laugh when at my recent annual check up, I was told I GREW an inch!! I have terrible osteoarthritis in my hip but in the past year I have been aggressively dealing with it through exercise/yoga/pilates........clearly I did not grow an inch but my posture changed. The opposite can happen as well and should not be assumed to be bone loss.

If you want to have some fun and your mom is willing.....give her a piece of ph paper and ask her to press it up against the side of her vagina. If it is acidic - you can be sure that she is not lacking in estrogen!

Pat

Pat Camillo PhD,RN,APN,C
Certified Nurse Practitioner in Women's Health,
Gerontology and Menopause
Carmenta Health
1 Kalisa Way Suite 103
Paramus, New Jersey 07652
(201) 265-9042

  ----- Original Message ----- 
  From: Christine Smith 
  To: NP Clinical 
  Sent: Monday, January 15, 2007 12:05 PM
  Subject: Re: [NP-Clinical] MRSA UTI

  Pat,

  Thanks for the wisdom - good thoughts. My mother had a TAHBSO in her 40s. She has not had a bone scan, just a bone density to the hip and spine. When she was dx with Osteoporosis several years ago, I must admit I was a bit surprised. At the time she was 5'10 and 180 - shrunk 1 inch since younger days. Now she is about 150 - a bit too thin in my opinion but she feels she is just right. She is an avid cyclist, was walking 3 miles a day until her knee got worse, but always very active - still water ski's and swims a fair amount. Was skydiving with me three years ago. Always a big milk drinker.

  I am turning in a urine culture today for her. I think you are right about abx pre and post surgery. I will keep you posted.

  CS

    ----- Original Message ----- 
    From: Pat Camillo 
    To: NP Clinical 
    Sent: Monday, January 15, 2007 6:48 AM
    Subject: Re: [NP-Clinical] MRSA UTI

    Regarding the MRSA UTI......one of my graduates found and shared a recent USA article with me that is very interesting......
    http://www.usatoday.com/news/health/2007-01-10-mrsa-usat_x.htm

    Pat 

    Pat Camillo PhD,RN,APN,C
    Certified Nurse Practitioner in Women's Health,
    Gerontology and Menopause
    Carmenta Health
    1 Kalisa Way Suite 103
    Paramus, New Jersey 07652
    (201) 265-9042
      ----- Original Message ----- 
      From: Christine Smith 
      To: NP Clinical 
      Sent: Saturday, January 13, 2007 7:10 PM
      Subject: Re: [NP-Clinical] MRSA UTI

      I have no thoughts on this, and certainly you are our women's health resident expert so I hope someone has some ideas that you have not considered. However, I have another UTI problem. 

      My mother, 69 yo, has frequent UTIs ever since a bladder rupture, S/P motorcycle accident about 10 years ago (my parents were Harley lovers). Anyway, she had severe urge and stress incontinence - was urinating nearly every hour and was always unresponsive to Detrol, Ditropan etc.. She has seen multiple urologists and they felt a cath would be the best option until she did find a female urologist in Portland who did some sort of bladder/urethral repair last Spring.  The incontinence resolved but she has continued to have urgency and was ultimately learning to live with it. 

      NOW, she is scheduled for a knee replacement 1/31. Her orthopod is adamant no infections, including UTIs, or no surgery. She had her pre-op last week and was found to have another UTI and the Pre-op NP put her on Bactrim. No culture was done, and I don't think my mom was clear to the NP on just how bad and frequent her UTIs get. She is now down here in California with me for one week and has worsened. Peeing every hour - driving her nuts, and driving me nuts too. I took a urine sample to work and spun  it - only RBCs. No leukos, nitrites or bacteria. I had switched her to Cipro and after seeing the results of the UA opted to just have her finish the Cipro anyway. 

       No pain, just urgency and frequency. No CVAT. Feels otherwise well. Only on Lipitor and Fosamax and was just started on Atenolol 25mg for  very mildly elevated BP - 136/84. No other health issues except the bladder and DJD.

      With just RBCs it seems I should not need to do a urine culture, right? I can order one for her so she has the results by Tuesday or so - she does not return home until next Monday and so I want to do as much as possible. 

      Thoughts?

      Christine Smith, NP
      Antioch, CA
        ----- Original Message ----- 
        From: Pat Camillo 
        To: NP Clinical 
        Sent: Saturday, January 13, 2007 6:53 AM
        Subject: [NP-Clinical] MRSA UTI

        Recently saw a woman who had been having 2-3 UTI's a year, ran a culture - came back MRSA.......tx with cipro which was found to be sensitive.......she also complains of vulvar burning .....tx with terazole thinking it was yeast following multiple antibiotic therapies......some relief but not gone. I'm beginning to wonder if perhaps the vulvar complaint might be related to the MRSA.....

        Any thoughts would be appreciated :)

        Pat

        Pat Camillo PhD,RN,APN,C
        Certified Nurse Practitioner in Women's Health,
        Gerontology and Menopause
        Carmenta Health
        1 Kalisa Way Suite 103
        Paramus, New Jersey 07652
        (201) 265-9042

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