Like I said before, it can be where they trained. Some training facilities are top notch, and others are terrible. The older nurses you have encountered could be ones who couldn't find a role in a hospital setting which often tend to be much higher stress, except perhaps the night shift on med-surg. We train nurses in Alaska that are only adequate for Alaska and often cannot compete with nurses trained elsewhere. The same is true for laboratory people and radiology staff members. We have no medical school here, nor do we train respiratory or physical therapists to my knowledge, at least I have never met any who were trained in the state. If you have good nurses, you are blessed. Most of the nurses trained under the old system are all retired and probably couldn't keep up with the technology anyway. They were trained for patient care and that was what I liked about them.
I had a CT scan on my bladder yesterday and saw my urologist today. He was his old happy self. I have 2 stones that are gonna be removed (I've been through this once), and I am getting a script for an antibiotic to inject into my bladder via the catheter. A nurse did my first treatment while I was there today. This is kind of blazing new trails, and is sort of what I read about on an Australian website. The doctor said that there is no concern with bacteria developing a resistance to this stuff, it's that strong. My doctor also reminded me that this could all go away if I self-catheterized, so he put "that thing" on the table. He also said that while he was removing the stone (under anesthesia) he'll look to see if something can be done so I can pee normally (but I'm not very hopeful.) If the antibiotic kills the bacteria and puts an end to the sediment and stones, that will be my preferred path. I also found out that my concern over hyper-sterility with the flush process is probably unnecessary, so now I can use the entirety of the 100ml bottles of sterile water that I'm buying rather than using 60ml/tossing 40ml with each flush. That will save me some money.
For the curious, the antibiotic is gentimicin. It comes in a vial, I mix it in a 60cc syringe with sterile water, then inject it into the catheter. Gentimicin is injected into a muscle or into a vein via an IV.
Gentimicin is good stuff, but any antibiotic can stimulate resistance. Gentimicin is an aminoglycoside and is often given along with a beta-lactam antibiotic like ampicillin or even penicillin, as it works in a symbiotic way to prevent resistance from forming and and the two together are stronger than either alone. I know...TMI, right?
There is no such thing as TM when it comes to I. I have yet to hear from Walmart that my script is ready...it causes me concern since it's been 4 hours. I wonder if it got called in. I grabbed the drug name from the Patient Portal...I don't know if it comes mixed with other antibiotics. I doubt it, since I have to use a needle to extract it from the single-dose vial. One would hope that injecting the drug physically onto the bacteria (and letting it sit for 30 minutes) would be about as good as it gets. I'm supposed to use it 3x a week. I might be able to get off the oral nitrofuratoin if this works. That would please me. But part of the purpose for the gentimicin is to prevent the biofilm from forming on the cath. The biofilm is where the bacteria gain refuge from antibiotics, so it's possible that (as you said) the nitrofuratoin is the other partner in the relationship.
Gentamicin is not a drug normally given on an outpatient basis as far a I know, so Walmart may have to order it from the warehouse.
I just reread the Queensland Spinal Cord Injuries Service document, and the blockage-prevention flush is not an antibiotic. This explains why I was able to find it available for purchase without a script (in Australia.) It is an "electrolysed bladder rinse solution" that "physically removes UTI causing bacteria and biofilms." You can flush the excess down the toilet. The marketing slick for Microdox says you can pre-treat catheters before insertion with it to prevent biofilm from forming. This seems similar to a study I read on the Cleveland Health Clinic website that focused on in-hospital patients who are short-term (7 days) catheterized. They found that pre-treating the catheter helped to prevent/lessen the biofilm, so the bacteria had no place to hide from antibiotics.
THAT'S interesting. The pdf I linked says "Non-antibiotic. Does not promote bacterial resistance." The product page says: For the prevention and treatment of urinary tract infection (UTI) Physically removes UTI causing bacteria and bacterial biofilm Powerful local antimicrobial action Non irritating and Non toxic Non-antibiotic Active Ingredient: Microdacyn Super Oxidised Solution (SOS) $24.30AU I wonder if someone poached a brand. I cannot find developers/patent holders for the products (I just made a cursory search.) Perhaps there are only domestic patents (although that does not make sense for the antibiotic.)
I am glad he finally provided this avenue for you. It seemed sensible to me. Not that I have experience with pharmaceuticals...
He said we were in unchartered waters in doing this. (And to think I had to beat up the last guy to get a 24 hour urine lab done.)
********THIS IS NOT MEDICAL ADVICE******** It relates to an interesting conversation I had with my urologist regarding sterile conditions. This also relates to the comment I deleted because I did not want to unfairly ask for this type of advice. I have been buying the sterile water in use to flush my cath/bladder with in 100ml bottles. It is way more expensive than buying it in 500ml and 1 liter bottles...over 4x the cost. Urologists use the larger bottles, pour what they need into a sterile container, and put the remainder of the bottle back on the shelf. I do not have a sterile container, and buying disposable ones are marginally cost-justifiable. So I use the 100ml bottles, draw out the 60ml I need for that flush, and toss the remaining 40ml down the sink (because I assume I have contaminated the water for future use by dipping the syringe into it.) I've been doing this for almost 5 months, often twice a day. About 6 weeks ago a nurse on their Help Line told me that I could use my own container and just rinse it out under hot tap water to clean it. Like so much advice the professionals have given me, this made no sense. (1) Hot tap water is not all that hot, and (2) organisms grow in water heaters. But it got me to thinking. So I started using a small measuring glass and pouring lots boiling water into it to the point it greatly overflowed and covered the rim and the outside. Then I poured the 60ml of sterile water I needed into that from the 100ml bottle, and retained the 40ml for the next flush (I was told that opened sterile water containers are good for 30 days.) I had done this for several weeks. When 2 recent lab reports came back showing "Contaminated Specimen" for the first time ever in my life, I feared that I had caused a problem (even though the bacteria-caused sediment had started again two months earlier.) So I asked my doctor about it all today. -He said that he has patients that reuse their catheters by washing them in soap and water...this shocks me. -He told me there was little chance of me causing issues by using the glass that had been scalded with the boiling water, even though that is sanitized and not truly sterilized. (He said I could wipe the glass out with alcohol if it would make me feel better.) -He also told me that drawing water out of a bottle with a sterile syringe would not contaminate the remaining water (this sort of makes sense), so I do not need an intermediate container to prevent contaminating the source bottle...each day I can dip another sterile syringe into the same container to draw out that session's amount until I use all the water (up to 30 days.) But it still introduces risk. -I also asked about whether to use plain sterile water or sterile saline solution to flush my cath/bladder (there are urology clinic websites that are adamant that you never use sterile water, and there are others equally adamant that you never use saline.) Both he and his nurses say that it does not matter which I use...they grab whatever is handy. I'm sticking with plain because it makes sense that in this application, the saline may lyse (damage bladder cell walls) as often as I'm flushing, and I see no downside to using plain water. The doctor did not think lysis to be likely. I had gone back to throwing away the remaining 40ml of sterile water when I saw the negative lab reports. I'm now thinking of buying some disposable sterile containers, since the nurse gave me a couple of 500ml bottles and I'm using this antibiotic. I hate to say I don't trust much of their advice, but I really don't. (No wonder they think I'm an a$$hole.) So much of the basics on this stuff is so very confusing, and you are never instructed up front.
I told you what the urology nurse told me about reusing catheters. She said not usually recommended, but some people can't afford new ones all the time. I think pouring off into a clinically clean receptacle would be fine. I think glass (Pyrex type) would be best, as very hot or boiling water wouldn't faze it. It is generally recommended not to stick anything into a container. It is best to pour off what you will use and save the rest. I don't think water or saline would matter, since the salt concentration of urine could almost span the spectrum although normal saline would probably be the best. Use half-normal saline if you want. That would be a 50/50 of the saline and water. Don't sweat the small stuff. This urologist sounds like he is thinking you retain or have gained some bladder muscle function, and that would be great news!
This is the 5 oz. glass I had used as the intermediate container: I have a few on hand that I use for measuring out my vinegar/water shots. Maybe I have read too much, but given that I am injecting fluids directly into an internal organ, I have tried to be hyper-hygienic. Regarding getting bladder function back...I've not tested it, but it would be easy enough to do by plugging the cath. I may have posted somewhere here that the prior urologist was giving me retention tests every 6 months to make sure the urine was not backing up to my kidneys. So I would drink water an hour ahead of time and hold it, they would do a retention scan, then I would empty and they would do another retention scan. My daily retention level was always around 400ml. But just that brief period of holding that surplus amount would stretch my bladder to the point it would only empty to 650ml. When I sat for a few minutes after the exam was done, I could empty down to what felt like 400ml (this was not measured.) This pretty much had been my long-term real world experience, making road trips a nightmare. So I'd be shocked if function returned, and I sure would not trust it to last too long...being cathed may have given my bladder a rest, but just one episode of not being able to find a bathroom when I needed one would stretch it back to the point of not functioning again. Keep in mind that I pass 4 liters a day, which is great for my kidneys but rough on my bladder. I think my urologist was just making a side comment that he was gonna look around while he was removing the stones to see if there was any way to fix things, but the urodynamic showed that this is not likely (my prior urologist did the same thing when he removed the last stone.)