Urinary Tract Infections

By Matthew Craig Park, OMS III, Osteopathic Physician Candidate 2016, and

Courtney Mizuhara-Cheng, D.O., M.S.H.S.

Bacterial infections of the female urinary tract are a frequent clinical problem.  In general, women experience urinary tract infections (UTI) much more than males due to their shorter urethra, which drastically reduces the distance bacteria must travel to access the bladder.  Though teenagers and young adults are often the population associated with such infections due to the onset of sexual activity, increasing age is actually one of the more important risk factors for the onset of UTI, since incontinence, or a lack of bowel or bladder control, and a decline in kidney function are diseases more associated with adulthood.  Fall and winter also seem to be the months where most UTI’s are reported; therefore, it’s important to highlight just what a UTI is, what the risk factors are, and how they can be managed in order to prevent their occurrence.

What is a Urinary Tract Infection (UTI)?  UTI’s are an infection in any part of the urinary system—the kidneys, ureters, bladder, and urethra.  Most infections involve the lower urinary tract, including the bladder and urethra. 

What causes a UTI?  UTI’s often occur when bacteria enter the urinary tract through the urethra and begin multiplying in the bladder.  Normal urine is sterile and contains fluid (mostly water), salts, and waste products, and is free of bacteria, viruses, or fungi.  Infections occur when microorganisms, usually bacteria from the gastrointestinal tract, enter via the opening of the urethra, the hollow tube that carries urine from the bladder to exit the body.  There are 2 main types of UTI: 

1.      Infection of the bladder, or cystitis: The type of UTI is usually secondary to E. coli, a type of bacteria found in the gastrointestinal (GI) tract of normal, healthy people.  The seeding of E coli into the urethra is often due to sexual intercourse, but patients do not need to be sexually active to develop this type of infection. 

2.      Infection of the urethra, or urethritis: This type of UTI occurs when GI bacteria spread from the anus to the urethra.  This is another example of why women are victims of UTI more commonly than men—the close proximity of the female urethra to the anus makes this type of infection much more likely.

Risk	Description
Being female	Shorter urethra means easier access for bacteria
Sexual activity	Accidental seeding of E coli into the urinary tract
Certain types of birth control	Women who use diaphragms carry a higher risk
Completing menopause	Lack of estrogen can cause changes to the urinary tract that make it more vulnerable to infection
Any blockages to the urinary system	Kidney stones or enlarged prostate can trap the urine in the bladder and increase infection risk
Antibiotic Use	This could kill off the beneficial microorganisms of the urinary system that could predispose a patient to colonization from a harmful strain

How do I know if I have a UTI?  UTI’s do not always carry signs and symptoms, but if you are symptomatic, the most common complaints include: a strong, persistent urge to urinate (urinary urgency), a burning sensation when urinating, passing frequent, small amounts of urine (urinary frequency), cloudy urine, strong-smelling urine, pelvic pain in women or rectal pain in men, and urine that may appear red, bright pink, or “cola colored”—a sign of blood in the urine.   If someone has a UTI that goes undiagnosed for an extended period of time, the infection can spread to the kidney and cause a kidney infection, or pyelonephritis.  Pyelonephritis is a much more serious infection that carries more broad signs and symptoms, including a high fever, shaking and chills, nausea, vomiting, and upper back or side (flank) pain.

Part of the urinary tract affected	Signs and Symptoms
Kidney (acute pyelonephritis)	Upper back or side (flank) pain High fever Nausea or vomiting Shaking or chills
Bladder (cystitis)	Pelvic pressure Lower abdomen pain Frequent urination Blood in urine
Urethra (urethritis)	Burning with urination

How is a UTI treated?  Uncomplicated UTI’s are usually easily treated with antibiotics, as they are mostly bacterial in origin.  The type of antibiotic prescribed varies depending on the type of infection, but, usually, some commonly prescribed treatments include: Trimethoprim-sulfamethoxazole (Bactrim, Septra), Amoxicillin, Nitrofurantoin (often indicated in pregnant patients), and Ampicillin, among others.  In addition, proper hydration is often required to help clear the bacteria from the urinary tract.  In general, symptoms clear within a few days of treatment.  Doctors may also prescribe a pain medication (analgesic) to help numb the bladder to relive symptoms of burning with urination.   It should also be noted that a common side effect of urinary tract analgesics is discolored urine, often turning urine orange or red.

What if my symptoms get worse?  Often, women who have had a UTI before can self diagnose their subsequent infections based on similarity of symptoms and expect equal bacterial clearance and symptoms resolution with similar treatments.  However, if not promptly treated, UTI can have serious consequences, which may include: recurrent infections, permanent kidney damage from acute or chronic kidney infection, increased risk of women delivering low birth weight or premature infants.  It is important that if you feel as though you have an infection, please seek medical help as soon as you can.

What can I expect when I see my doctor?  Your doctor will likely inquire about the frequency of the infection and what has worked in the past and any side effects experienced from certain medications.  They will also need a urine sample in order to examine for typical infection markers of UTI.

Connect with your Urinary System 

What is the urinary system?  As stated before, the urinary system is the system where urine is made and evacuated in the body—urine is initially produced in the kidneys, flows out from the kidneys in the ureters and into the bladder, before being expelled from the body through the urethra. 

How does E coli cause UTI?  E coli are a normal inhabitant of the human gastrointestinal tract.  Following accidental colonization into the urethra, small appendages on the bacteria called fimbria allow for the organism to attach to the bladder surface.  Once attached, the bacteria secrete chemicals to allow for penetration into the cells of the bladder.  Inside these cells, the bacteria continue to replicate.  Once a sufficient bacterial colonization occurs and if no treatment has been administered, the bacteria can ascend the ureter towards the kidney.  Urine tests showing + nitrites or leukocyte esterase are highly suggestive of UTI.  Nitrites are positive due to bacterial reduction of endogenous human substances called nitrates into nitrites.   Leukocyte esterase is an enzyme secreted from the natural human immune system white blood cells that aids in inflammation and migration of our body’s immune cells toward the site of infection to help clear the unwanted bacteria.

How does the body work as a unit?  The urinary system is responsible for clearing the normal waste products produced by the human body.  If, for any reason, this system is blocked or cannot function properly, these wastes build up and can have drastic effects on every organ system. 

Harmonize with Body

What is some lifestyle advice?  First and foremost, proper hydration is key.  It is always important to drink enough fluids, especially water, to help dilute urine and flush out any bacteria that may be present incidentally.  Additionally, all patients, especially women, must implement proper wiping techniques after using the restroom—wiping front to back helps prevent bacteria from the anal region from being accidentally implanted at the urethra.  Additionally, emptying your bladder soon after intercourse can also help prevent this improper seeding.  Finally, avoiding potentially irritating feminine products like deodorant sprays or douching can help prevent undue irritation to the urethra.

What is some nutritional advice?  Although not scientifically proven, cranberry juice may have infection-fighting properties and drinking it daily may help prevent UTI.  Some studies have shown that the greatest effect of cranberry juice seems to be in women who have frequent UTI’s.  There are no known studies that show how much or how often cranberry juice should be consumed.

Integrate Complimentary Alternative Medicine

What can be expected during an osteopathic manipulative treatment?  Your osteopathic physician will release strain patterns preventing proper urinary elimination by allowing the nerve and blood supply to the bladder, kidneys and ureter to be unrestrained. The lumbar, sacrum, pelvis and abdomen will be restored to its proper alignment without restriction.   During an infection, lymphatic drainage of the pelvic region can be employed as needed.  Ganglion contractions blocking lymphatic drainage called "Chapman points" can be treated during an infection using firm pressure in a circular fashion until the tender mass disappears.

What are some homeopathic advice?  Depending on the presentation of the infection, certain homeopathic medications are typically useful in decreasing the duration and intensity of the infection.  If you are experiencing sharp burning before, during, and after urination with frequent but scant urination, take five pellets of Cantharis alternating with Mercurius Corrosivus between meals.

Common Cold

By Jessie Dhaliwal, OMS III, Osteopathic Physician Candidate 2016 &
Dr. Courtney Mizuhara-Cheng, D.O., M.S.H.S.

As the school year resumes and winter approaches, children become exposed to a wide array of germs.  It becomes common for infections to result in absences as children suffer from runny nose, sneezing, fever, sore throat and cough.  Sharing is often what we encourage our children to do with classmates but sharing infections is something we want to avoid.  If your child presents with sneezing, cough, muscle aches, fatigue, malaise, headache, muscle weakness, loss of appetite, this could be a sign of a viral infection causing the common cold.  Several measures can be done to avoid the common cold and speed up the course if contracted.  The tips provided are only recommendations and should not replace professional evaluation.  If your child does not improve or worsens despite the recommendations below, please schedule an appointment with your health care professional.

What is the common cold?  The common cold is a viral infection of the upper respiratory tract.
What causes the common cold?  The most common cause of the common cold is the rhinovirus which infects the upper respiratory tract after a 12-72 hour exposure.  It thrives in cold temperatures and dry air.
How do I know I have the common cold?  Nasal discharge or runny nose is the most common symptom. The most common initial presenting symptoms are nasal dryness or irritation and sore throat.  The runny nose tends to drip to the back of the throat causing the irritation and pain.  Over time the nasal discharge can cause swelling of the nasal passage and throat making breathing, sleeping and feeding difficult.  The infection typically lasts 10-14 days with the worse symptoms occurring at around 3-5 days upon exposure. The common cold may exacerbate underlying asthma and COPD.
How is the common cold treated?  Rhinovirus infections are usually mild and self-limited and therefore treatment is supportive and focuses on symptomatic relief. Therapy includes rest, hydration, antihistamines and nasal decongestants (phenylephrine).
What if my symptoms get worse?  If your cold symptoms are lasting longer than ten days or worsening, it is recommended that you see a medical professional about other possible therapies.  This could be a sign of a bacterial infection, pneumonia or acute asthma exacerbation which may require prescription medications for improvement.  We can explore some of the common reasons for stomach flu and provide techniques for decreasing the symptoms; however they do not replace the role of a qualified health professional.  If you try any of these techniques and experience worsening symptoms, you should immediately stop and consult a health care professional.
What can I expect when I see the doctor?  Your doctor will likely inquire about possible triggers and timing of your problem.  Lab tests are generally not indicated for the common cold. Depending on your history and physical presentations, your doctor may order imaging, blood work or collect cultures.

CONNECT WITH YOUR UPPER RESPIRATORY SYSTEM

What is the upper respiratory system?  The upper respiratory system starts from the nose and mouth and passes into the lungs.
How does the rhinovirus cause the common cold?  Route of entry of the rhinovirus is via the upper respiratory tract through respiratory droplets. Contagious behavior includes nose blowing, sneezing, and physically transferring infected secretions onto environmental surfaces or paper tissue.  Hand-to-Hand contact of mucous membrane secretions are another common route. The Rhinovirus binds to ICAM-1 on respiratory epithelial cells. ICAM-1 is used to bind endothelial cells to leukocytes. Most infections occur between September to April possibly due to the start of the school year.
The primary site of inoculation is the nasal mucosa, though the conjunctiva may be involved to a lesser extent. The Rhinovirus attaches to upper respiratory tract epithelium and spreads locally. The major human RV receptor is ICAM-1 (found in high quantities in the posterior nasopharynx). Rhinovirus can also infect the Maxillary and Ethmoid sinuses.
How does the body work as a unit?  The respiratory track is necessary for the exchange of oxygen needed to support the body.  If the body is not taking in the appropriate amount of oxygen, the body cannot function effectively.

HARMONIZE WITH BODY

What are some lifestyle advise?   Proper hand hygiene is important.  The common cold can be caught from someone else who has it, especially through inadequate hand washing after sneezing or coughing.
    Cleaning objects touched by the affected individual with chlorine-based disinfectants or using a dishwasher can help to eliminate the virus.  The Rhinovirus is not susceptible to alcohols and detergents. Sufficient heating, autoclaving, or the use of chlorine-based disinfectants are effective ways to eliminate the viruses from surfaces and objects.
What are some nutritional advise?  Limiting food is another good precaution that should be taken early in the course of the infection as people with the common cold may have trouble tolerating large meals.  However, remember to refrain from drinking milk as it can make the symptoms of the common cold much, much worse.
What are some exercise advise?  Bed rest is advised for quicker recovery.  Avoid strenuous exercise while suffering from the common cold.

INTEGRATE COMPLIMENTARY ALTERNATIVE MEDICINE

What can be expected during osteopathic manipulative treatment? Chapman reflex points are defined as a system of reflex points on the outside of the human body that reflect dysfunctions in the various organ systems that comprise the body. Chapman reflex points located on the persons sternum and ribs can be tender in the face of a respiratory infection and when treated by a trained osteopathic physician can provide symptomatic relief.  Ethmoid and Vomer rocking is a gentle cranial technique used to promote sinus drainage. Another cranial technique called compression of the fourth ventricle and venous sinus drainage are used to reduce sympathetic outflow and promote drainage. Lymphatic drainage techniques directed along the lymphatics of the upper respiratory system is often used to promote proper lymphatic flow.
What can be expected from homeopathic medicines?  Homeopathic medicines can be used to significantly reduce the symptoms of the common cold.  A watery runny nose can be addressed with Allium cepa if it is aggravated by heat and causing profuse, burning drainage; Kali iodatum if it aggravated by cold; and Arsenicum album if better when the patient warms up.  A thick mucous nasal drainage can be helped with either Kali sulphuricum if runny, profuse and worse with heat; Kali muriaticum if no profuse, crusting and worse with cold; or Dulcamara if nose feels blocked.  

Giving Thanks to Health

By Dr. Courtney Cheng, D.O., M.S.H.S.

With the fall season ending, it seems fitting to enter the winter months giving thanks to our health. As we reflect on the challenges of the past season and all we have overcome, the emphasis on the health and good outcomes that have resulted will bring about plenty more.  If we dwell on what we are missing or the disease, we will never have enough or find health.  Many people find themselves focused on their misfortunes, mistakes, disease that they lose sight of all the wealth, achievements and health. There are often many reasons that can prevent recognition of the health.  The first step in finding the health among disease, pain or health difficulties is to consult a heath care professional for the appropriate action measures.  A health care professional can examine your current medical conditions and discuss appropriate steps to take for success in healthy lifestyle changes.

This article looks at some steps to finding the health through challenging circumstances based on personal experience and medical training.  These tips do not replace the role of a qualified professional.  If you are experiencing medical challenges, consider consulting a medical professional. As a health care professional, my approach is to discover the cause of the problem and provide measures to restore the health.

CONNECT WITH YOUR IMMUNE SYSTEM

We are now entering the colder winter months which increases common cold illnesses.  Taking measures to protect your immune system is important.  Below are a list of tips to improve your immune system:

• Eat a healthy diet rich in fruits and vegetables to help heal inflamed mucous membranes and strengthen the immune system.  
• Make sure to have your vaccinations up-to-date and get vaccinated with the flu vaccine if you are in an at-risk group.  
• Get the appropriate amount of sleep at night.  
• Exercise regularly to help with your cardiovascular fitness and reduce stress.
• Remember the importance of hand hygiene by washing hands regularly.

Despite these measures, sometimes contracting illnesses can be inevitable.  As a mother of two wonderful kids, I have encountered my share of infections as my youngest entered preschool this fall. As many working parents can relate, the start of school and crowded classrooms often results to the unfortunate exchange of germs and illnesses.  My daughter's preschool went through two rounds of hand, foot, mouth disease which she managed to contract both times.  

Parents with little children will likely relate to the frustrating lost work hours devoted to caring for sick children and disinfecting the home daily.  Every time she went back to preschool, my daughter seemed to return home with a new viral infection despite our efforts to keep her immune system healthy.  After her fourth common cold illness with spiking fever, I took my daughter to a pediatrician for an outside perspective. The pediatrician could only warn me that children in preschool have an average eight to ten illnesses in a year and sometimes more during their first year of entering a new school environment. Unfortunately, I had to accept the various infections my daughter was contracting.  I appreciate how my daughter was free from infections while at home her first years of life.  Her little body is now having to strengthen its immune system by exposure with illness. 

Sometimes we must go through suffering and pain in order to realize the resilience of our body. What challenge has your body gone through to make it healthier?

HARMONIZE WITH YOUR HEALTH

Challenging our body to make it healthier is not easy.  The path to health is a daily commitment of making difficult choices at every turn.  If we always consider what is in our best interest before we act, we may find ourselves naturally on a healthy path.  However, excuses and complaints often prevent us from acting in our best interest.  

When undergoing a challenging situation, our body and mind will often complain and resist before going in the right direction.  My son started 3rd grade with difficulties meeting the expectations of his new academic and social demands.  Instead of embracing the new challenges to build his knowledge and character, our son resisted with excuses and complaints.  As parents, my husband and I found ourselves focused on being critical of all that he was doing wrong. We failed to listen to the difficulties our son was having in school.  We didn't provide the support or encouragement when our son was undergoing challenges.  Afraid of being reprimanded for making a mistake, our son avoided trying at all.  It took advise from a special education teacher, his teachers and a therapist to remind us to praise his accomplishments instead of focusing on his mistakes.  We created reward charts at school and at home for behaviors we wanted to encourage.  In order to build consistency in proper habits, we highlighted what good behavior or actions looked like.  As a result, our son is doing better at school, home and with his extracurricular activities.  He still has a tendency to complain or explain when he doesn't want to do something that is challenging.  But, he is more willing to accept challenges and we are more patient when he makes mistakes in the process.

Motivational speaker Dr. Wayne Dyer encourages us to, "Never complain.  Never explain.  Just do the best we can."  Think about the last time you complained or explained to justify not challenging your body to become better.  What was the challenge you avoided by making an excuse?  How can you acknowledge and reward yourself for making the steps to success?

INTEGRATE A POSITIVE ATTITUDE

In my medical practice, my intention when treating patients is to find the health in every individual. The potential health of the individual is different for everyone.  The challenges will vary. Restrictions and barriers to health need to be identified and released but not focused on or denied. Instead of focusing on what is unhealthy or finding a label to explain the disease, the challenge it to find the health and maximize your potential with the situation you have.  As my favorite coach John Wooden says, "Success comes from knowing that you did your best to become the best that you are capable of becoming."

Pumpkin Lasagna

by Pallavi Joshi, MA, Candidate for Doctorate in Osteopathic Medicine 2016

For fall, why not try a new twist on traditional lasagna by using pumpkin puree to make a light but filling sauce. This recipe is full of nutrient rich fall produce like chard (high in iron), mushrooms (high in selenium) and pumpkin (high in beta carotene). It uses less cheese than a traditional lasagna so it's a lighter, healthier alternative. 

INGREDIENTS

2 tablespoons olive oil
2 onions, chopped
4 cloves garlic, crushed
2 pounds Swiss chard, tough stems removed, leaves washed well and chopped
2 cups mushrooms (cremini or white), sliced
2 1/4 teaspoons salt
1 teaspoon fresh-ground black pepper
1 cup fresh sage leaves
3 tablespoons butter
1/2 teaspoon grated nutmeg
1/2 teaspoon cayenne
3 cups canned pumpkin puree (one 28-ounce can)
1 1/2 cups grated part-skim mozzarella
1 1/2 cups grated Parmesan
1/2 cup milk
9 no-boil lasagne noodles (about 6 ounces)

DIRECTIONS

In a large nonstick frying pan, heat the oil over moderately low heat. Add the onions and garlic and cook, stirring occasionally, until onions are translucent, about 5 minutes. Increase the heat to moderately high and add the mushrooms, chard, 1 teaspoon salt, 1/2 teaspoon pepper. Cook, stirring, until the chard is wilted and no liquid remains in the pan, 5 to 10 minutes.

Heat the oven to 400°. In a saucepan, heat the butter over moderately low heat until it begins to brown and smell nutty. It is better to use a light colored pan so you can see the butter changing color. Take it off the heat and immediately stir in the sage leaves. In a medium bowl, mix together the pumpkin, the brown butter and sage mixture, and the remaining 1 1/4 teaspoons salt, 1/2 teaspoon pepper, 1/2 teaspoon cayenne, and 1/4 teaspoon nutmeg.

Pour the milk into an 8-by-12-inch baking dish. Top the milk with one third of the noodles, then spread half the pumpkin mixture over the noodles. Layer half the Swiss chard and mushroom mixture over the pumpkin and top with a second layer of noodles. Top with half the mozzarella and half the parmesan. Repeat with another layer of pumpkin, vegetables and noodles. Spread the remaining pumpkin mixture evenly over the top of the lasagne, sprinkle with the remaining 1 cup of Parmesan. Cover with aluminum foil and bake for 20 minutes. Uncover and bake until golden, about 15 minutes more.

Variations: 
This recipe can be made vegan by using vegan cheese (such as Daiya)
Use zucchini strips instead of noodles to make the recipe low carb
Use kale or butternut squash instead of chard or pumpkin for a change

Is there Mercury in My Vaccine?

By Kelsey Goodwin, Candidate for Doctorate in Osteopathic Medicine 2016

In the past few years there has been a lot of discussion in the media regarding the presence of mercury in vaccines and the potentially dangerous effects of this. This fear, along with several other concerns, has led to a movement in which parents are refusing to vaccinate their children. The form of mercury that is present in vaccines, if any at all, is in a substance called Thimerosal.

What is Thimerosal? 

Thimerosal is a mercury-containing organic compound that has been historically used as a preservative in many drug products including vaccines. The function of Thimerosal in these products is to prevent the growth of bacteria and fungi, which is a risk especially with multi-use vaccine
vials. In fact, in the early days of immunizations there are multiple cases reporting the deaths of children that were vaccinated with injections that came from multi-dose vials that lacked a preservative.

After investigation it was determined that these children died because the vaccination vial had been contaminated and as a result a staphylococcus species of bacteria was injected into their bodies. Cases such as this emphasize the importance of using some form of preservative in our vaccines.

Why is Thimerosal dangerous? 

Since Thimerosal contains mercury, it is associated with risks of being neurotoxic. Symptoms that are directly related to mercury exposure include neurologic dysfunction and developmental delays in children. These symptoms, however, have only been reported after injecting products that contained 3 mg/kg or more of Thimerosal.

How is the FDA dealing with this issue?

In recent years Thimerosal has become known for potentially being neurotoxic, as a result the FDA has removed it from or reduced it to trace amounts in routine vaccines for children six and younger. A trace amount of Thimerosol is considered 1 mcg or less, which is significantly lower than 3 mg/kg which is the lowest reported dose of Thimerosal that has caused neurological side effects. According to the FDA (hyperlink), the one exception from this rule is the inactivated influenza vaccine which contains 12.5 mcg/0.25 mL dose. As an alternative option for patients that are at a slightly increased risk of Thimerosal toxicity (i.e. infants, pregnant patients and children), there is a preservative-free version of the influenza vaccine which only contains trace amounts of Thimerosal.

Integrate your Physician. 

If you are concerned about the presence of Thimerosal in your annual influenza vaccine, or that of your children, ask your physician or pharmacist about the preservative-free version.

http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228