Update on the Pus Cell Scenario

[Udkas]

Hi Guys,
Well I am utterly, utterly miserable, no other way to put it, just plain miserable, sorry I shouldn't be like this as I know so many of you have so much more to deal with in the way of problems than myself but however this is how I feel now.

My results this test were normal this time, so obviously before it was not a clean enough catch.  My GP is telling me it's all neurological.  I'm not sure if to be pleased with this answer or not!!!  I am just not convinced that it is neurological and if it is neurological is this what I have to look forward to every time I have an attack.  I just want to go somewhere and have a good cry... I am unwell with a flu thing and tired and fed up.. I still feel like something else is wrong.  Why the leuckocytes, protien, blood etc.

I tried to jump up and down on the phone to my GP and he mentioned ringing my neuro and he has ordered some blood tests for tomorrow and I know one of them is diabetes but mmmm I don't think it's that.

Cheers,
Udkas.

[PastorDan]

I had amitriptyline before the gabapentin, and it was relatively benign.  They discontinued it several weeks after starting the gabapentin, simply because the gabapentin was helping and the amitriptyline hadn't had much effect on me.

Sure praying you feel better soon.

Incidentally, have you specifically asked your PCP to refer you to a urologist, or a urogynecologist as ess suggested?  Sometimes docs can't see what's right in front of their faces.  We already knew that, though, didn't we?

[Udkas]

Hi there again,
Thank You is such a small word to show such large gratitude for the advice and information.

I will keep you posted on the blood tests I have had done and the results, I think depending on the outcome of these my Dr is ringing my neuro.  I am on the neurontin and have decided to try the amitryptiline tonight as I don't have to go anywhere tomorrow.

I would happily go to a urologist infact I would would fly to the moon right now if I thought it would bring relief!  But the reality is that I need a referral and my Dr hasn't ordered one... I sounded like a pleading whinging whining desperate child on the phone yesterday!!!  I just want relief, it is wearing me down emotionally.

Maybe if he contacts my neuro he might or at least I can trust his judgement if it is neurological or not.  I am starting to believe it is, but to confuse the issue now I have a bad cold where I am coughing up the greenies and blood...lol
so also running temperatures.

Thanks so much for your support, I am starting to feel like a hypercondriac. (sorry can't spell that) could this truly my neurological.

Cheers,
Kathy. xx

[Karen99]

Hi.  There is nothing AND I MEAN NOTHING that MS or TM can do directly that creates protein and "pus" in urine in and of itself.  It is possible that not emptying your bladder completely can cause secondary problems.  

I'm about to cry from frustration and am uncomfortable with the blood, protein, etc coming and going.  The "flu" stuff with swollen lymph nodes could be related, maybe, maybe not.  It is important to know.  

You are OVERDUE seeing a urologist anyway, so make use of your insurance choices and get yourself to a urologist.  

Has your GP done blood tests to see how your kidneys are functioning?  How about a CBC and Chem Panel?

I am going to repost Quix's response:    

What you are describing is called "sterile pyuria" and "sterile hematuria" with proteinuria.  You can probably guess that when you put "-uria" on the end of something it means "in the urine".  Also sterile refers to nothing growing on culture of the urine.  This needs to be worked up aggressively (read that AGGRESSIVELY).  You need a cathed urine or a really, really clean catch.  this is to show that the pus cells, blood and protein are not from another location like the vagina or an abcess close by.

Everybody is right.  You also need a referral to a Urologist.  These are the plumbing doctors.  A nephrologist deals with the very complex workings of the kidney itself, as it filters out toxins and waste products from the body.  You may need a look-see inside the bladder, called a cystoscopy.

One of the first things you need done is an ultrasound of the kidneys.

Now, what could this be?  You have gotten good answers.  Yes, this could be a large stone higher in the pipes near the kidney.  This can cause a blockage and end up damaging the kidney as Dan says.

The words "sterile pyuria" immediately bring up one thing in a phsycian's mind.  It sounds foreign and impossible, but tuberculosis of the urinary system is a major cause of this, even now.  Your doctor should collect the first am void for three mornings and send it for TB culture, called acid-fast bacteria culture.  this is treatable, but it has to be found first.  You should have a TB skin test, called a PPD and maybe a chest X-ray.

Also there are other organisms that won't grow on a standard culture - like atypical bacteria (eg. Chlamydia) or fungal infections.

When there is blood in the urine one has to think of kidney disease itself.  So you should have a blood test to look at your renal function.  This should definitely include a BUN and creatinine found in a basic chem panel.  The doctors should decide if you need a creatinine clearance test to see if your kidneys are functioning normally.  Also you need a full urinalysis to look for abnormal cells called casts and also for crystals.  At any time have you had a strep infection and had dark urine (like cola)?

Other things that need to be ruled out include a cancer in the urinary system.  Your urine needs to be spun down and sent for "cytology" (the study of cells) to look for abnormal cells.  This would be less common, but can also be a cause of sterile pyuria and hematuria.

Blood in the bladder can cause nasty bladder spasms, which may be part of your discomfort.

Sometimes one can continue to have pus and blood in the urine after a treated bladder infection, but this should go away with a couple weeks max.  There are also things like a lowgrade abcess in the appendix that is adjacent to the bladder causing an inflammation in the bladder, but will also be sterile.  All urine is (or is supposed to be) sterile as long as it is inside the body.

So you can see that this is not something that we "sit on" so to speak.  We know the things that cause this and we know what to do.

Important and these are things your GP should be ordering:

Blood tests to look at renal function.
Kidney ultrasound
Urine cytology
Full Urinalysis with microscopic
PPD
Urine for culture of acid-fast bacteria, atypical bacteria, and fungal infections.

Referral to Urologist unless the renal function tests or ultrasound are abnormal - then referral to a Nephrologist.  Man, this is basic medicine and stuff I did all the time.  It is not rocket surgery!

I hope this helps.  Remember, I told you about all that it "could" be.  Most of those things are not common, but sterile pyuria/hematuria/proteinuria is NOT normal.

Quix

[essdipity]

Absolutely, if you have not been seen by a urologist, and preferably a urogynecologist, make this a prioirty. No matter what it is, you need it pinned down. If all the pain and discomfort does turn out to be neurological, Lyrica, Neurontin and other meds could possibly help.

Hang  in there, friend.

ess

[Lulu54]

Hi Udkas,
It sounds like you your GP need to come to an understanding that not all of the things that go wrong as associated with your MS - that might be the case here too.  You can save that discussion until later though because for now you need some relief.

Can you get in touch with your neuro and get their advice?  They might be the ones more likely to send you to a urologist to double check everything.  

I am so sorry you are miserable with this - you know all of us need to get over the thinking that we shouldn't complain because others have it worse.  Yes, others do have it worse and that will always be the case.  But the "others" aren't living in your body at the present time - they would want you to get help too!  You and your health and comfort are as important as the next person's well being. If it helps, I often catch myself thinkingthe same way.

take care and make that phone call,
Lulu

[Sarahsmom46]

If this is truly neurological as the GP said, then honey that is our reality.  Lots of us are having pain and sensations that come back with normal tests and the docs attribute it to the MS or other neuro issues.  I hate that because like you I think its something else, but once the docs believe you have a neuro disorder, then that's what they want to slap it on.  

However, you've been already told this, you need to see a urologist. Period!  There is more than meets the eye or test here.  

Otherwise I hope things are going fairly routinely for you. Take care.

Julie