Resolved question:
Introduction:
Hello, I am Saswati Chakraborty. I want consultation of an Urologist for my mother Mrs. Kumkum Chakraborty.
History of the Patient:
Mrs, Chakraborty had a recurrent senile UTI first in the year 2006, with symptoms of Dysuria and micturition. At that time the patient consulted Dr. K Pradhan (Kolkata) and under his advice, she conducted an USG of whole abdomen and ECG with Urine culture. The infection was caused mainly by E.coli organism. Dr. Pradhan conducted cyctoscopic urethral dilation under GA and day stay. After that she was given Conjugase (0.625 mg) and Evalon cream to apply daily. Post operation, the patient got fully cured with no discomfort in urine passage.
However, in the year 2011, again recurrent UTI occurred and this time, it was quite serious, with fever and almost same symptoms like the first (difficulty in urine passage, discomfort and dysuria and presence of blood in the urine). She was then admitted in Zenith Hospital (Kolkata) under Dr. Narayan Banerjee and under the combined treatment of Gynac (Sutapa Banerjee), Urologist (Dr. Arindam Dutta) and Dr. Banerjee himself, the patient underwent conservative treatment, with no surgical procedures. She remained admitted from 14.12.2011 to 20.12.2011. In this phase, the patient was given Tablet Urispas (200), for 5 days, to continue with Pan 40 for 2 weeks, Antibiotic (Tablet Glevo 500 mg) for 5 days, Urilizer to be continued and Evalon cream to be applied, Tablet Trika (0.5) for 10 days, Liquid Duphalac 15 mil (for 1 month) and Niftas (100) for 1 month. She had no surgical procedures this time however, the doctor (Urologist-Dr. Arindam Dutta) advised to continue take Veltum 0.2. Upon his advice, the patient took Veltum (0.2) for 1 month and the condition was fine. Since the condition of patient was fine, hence doctor further did not go for cystoscopic dilation.
Present Problem: In the present year 2015, from the month of february, the patient is complaining of discomfort while passing urine and burning sensation in the vaginal area, stomach area and back area. There is no difficulty in urine passage though as patient was taking Veltam 0.2 and there were no traces of blood in urine or fever. In this period, the patient consulted Dr. Anil Chomal (Consultant Urologist-Kolkata) and he gave Tablet Duonem (200) mg-antibiotics for 6 days. After taking the antibiotics, still the discomfort did not pacify and hence the patient reported back to Dr. Arindum Dutta (who treated her in the year 2011). with his consultation, the patient took Zanocein (antibiotic 200 mg) and Urispas tablet. But still there was no improvement. Then the patient went for urine culture after 2 weeks of antibiotic course completion from Roy and Tribedi. I am attaching the reports of Roy and Tribedi (Urine Culture and Urinanalysis). Please have a look. The culture report is normal with no suspicious findings and normal pus cells count. Then she consulted Dr. Manoj Sharma (General Medicine) for her burning sensation as she was confused, since no medicines were working in her case. Dr. Manoj Sharma also gave her an Antibiotic (percin 600) for 10 days. After taking this antibiotic, also the condition did not improve, then Dr.Arindum Dutta advised for Cystoscopic Dilation. She underwent the second cystoscopic dilation on 28.04.2015. The urinal passage was narrow as per cystoscopic reports and was extended upto 26 Vr. other wise there were no suspicious findings from the cystoscopic dilation report (I am attaching the report herewith of cystoscopic dilation).After the cystoscpic procedure, the patient is complaining of increased burning sensation in the vaginal, pelvic and stomach region. A gynaecological consultation has also been followed up after cystoscopy to see if there are any redness and swelling in the vulvo-vaginal area. However, the gynaecologist has confirmed from local observation that no abnormalities has been found in the uterus. However, she has given a lactic acid wash (Lactacyd) followed by premarin ointment application with application of surfaz sn to avoid any chances of vaginitis. Now she is complaining of terrible burning feeling particularly after urinating and after fecal procedures. In the afternoon from 3.30 p.m to 5.30 p.m the condition worsens and she cant rest her body as she is saying that her chest area, stomach area, lower back and legs are constantly burning in that particular time. There are no blood with urine. Urination flow is alright. Upon advice of consultant family physician she is now taking K-Mac for relief. However there are no signs of relief yet.Present Problem: She is complaining of severe burning sensations in the stomach, pelvic area, vaginal region after urine discharge and anus region. Burning worsens in the afternoon.
Present Medications: She is now presently taking these medications:1. K-Mac: 2 tspns after dinner with Urispass,2. Atorva after lunch3. Febutaz 40 after lunch4. Pantocid DSR in the morning5. Losarbeta in the morning6. Durajoint after dinner (1 tablet daily)7. From 2011 she was consuming Veltam 0.2 but considering the side effects of tamsulosine, the drug has been recently stopped for past 2 days.8. Ativan (Clonazepam) 1 tablet after dinner.She has no history of adverse reactions to any sulfa drugs or any other allergies.I have described the whole condition of the patient. The patient has a history of hypertension, where she suffers from high blood pressure, for which she is taking beta blocker (LosarBeta). The drug has controlled her BP to 130/80 with no fluctuations (several times measured). The reports of sugar shows that she is not diabetic and for cholesterol, she is now taking atorva, however, her level is normal <124. She had no previous surgeries except two time dilation (2006, 2015) and one surgical procedure during the birth of her first child. She has no allergies.
My Questions are:
1. What is causing such irritating and burning sensation in the stomach, pelvic and vaginal region, specially after urinal and fecal procedure?
2. How long this will sustain?
3. Is this something to do with cystoscopic procedures?
4. Does this condition indicate interstitial bladder cystitis? or Renal Tubular Acidosis?
5. How to get relief from such condition?
6. After reading the whole case, and studying the reports, do you think that the patient is suffering from any other serious complications?
7. Can there be any GERD problems going on?8. The patient is consuming Veltum 0.2 from 2011 to 2015. Can this may cause side effects?
I am attaching the following reports1. USG Report2. Report of Blood Sugar (Fasting and PP) and Serum Cholesterol3. Report of Cystoscopic Findings (Recent 28.04.2015)4. Urine Culture Report5. Urinanalysis Report
Please help.
Saswati Chakraborty
Senior MBA Consultant and Tutor,UK Dissertations and Assignments,
Submitted:
4 Days
Category:
Urologist
Hello,
Thank you for your query at DoctorSpring.com
What is causing this burning sensation is very difficult to point out. However I want your mother to get her thyroid profile, vitamin B 12 and vitamin D level. Abnormalities of any of these can cause such severe burning sensation.
It is very difficult to say how long the problem shall last, however symptoms shall improve gradually if any of the above results are abnormal and the same are corrected.
Your mother's symptoms are not because of cystoscopy. Whether she is suffering from interstitial cystitis or not is very difficult to reach out. However, there is no harm done in trying treatment for the same.
Your mother is not suffering from any major complications and there is no role of GERD. Long term use of alpha blockers such as veltam does not cause any long term side effects and hence no worries on that part.
In the end get your mother investigated as mentioned above and also start her on treatment for interstitial cystitis.
Take care
Sincerely
Rajiv Goel
Hello Dr. Goel,
Thank you very much for your answer. As you have mentioned for the following tests, Thyroid, Vitamin B12 and Vitamin D, in this case let me bring to your notice that she has already conducted the thyroid tests recently in the month of February, since when she started having the burning problems. The TSH serum levels are 1.77, which is normal and within the range. For Vit D, she is already taking medicines from 2013, and completed the cycle of 1 tablet per week for 2 months and then 1 tablet for 6 months. After that she stopped taking the medicines. But now again she started it and consuming it as 4 tablets per month for 2 months and then 1 tablet for 1 month schedule. The name of the medicine is Vitamin D3 (60K). So I dont think there may be any chances of Vit D3 deficit. Now the remaining B12 test is remaining. She is also consuming Neurobion Forte, which consists of Vit B-complex and Vitamin B12. Well if you suggest, then we will surely go for Vit B12 test, Thyroid Profile and Vit D3. Since the Thyroid report was done in month of February, the recent reports will be done and again sent to you. I will attach the reports once they are done.
You have mentioned about to start the treatment for interstitial bladder problems. Can you suggest the name of the medicine which can be given safely at this juncture to the patient. However, based on the urine culture and urine analysis, there is no established infection or pus cells. Hence, do you think patient can safely consume the drug of interstitial bladder cystitis.
Doctor, I myself is a microbiologist, hence if you explain me the medical consequences, I will be able to understand the present conditions. If you feel that there is any necessaity to admit the patient and she needs a through check up, then you can explain to me clearly.
Best Regards,
Thanks for your time given to us!!
Saswati
Kindly get all the tests repeated.
She can certainly start herself on T. Cystopen thrice daily for suspected interstitial cystitis.
She shall not develop any serious complications because of these symptoms. She does not seem to be having anything major and hospitalization is probably not going to help. She shall need further evaluation if her symptoms don't get resolved or worsen or she develops some new symptoms.
Take care.
Hello Dr. Goel,
Thank you very much for your timely advice and response! You have have advised to take T. Cystopen (pentosanpolysulphatwe) for the interstertitial cystitis. But you have not mention how long she will take the medicine. You have mentioned to take the drug thrice daily. When the drug should be taken. Please mention the drug regimen, dosage, and are you asking for t.cystopen 100 mg dose. I hope this drug will not interact with k-mac.
I will surely come back with the tests of the three things within few days. Allow me few days kindly.
She should take cystopen 100 mg thrice daily after meals for 4 weeks and you let me know how she is doing. Stop her k mac.
It is not doing anything.
Take care
Sincerely
Rajiv Goel
Hello Dr. Goel.
Hope everything is fine at your at your end. I am sorry for the late reply. Actually I was waiting for my mom to get fine for the tests done (Vit D3, Vit B12 and Thyroid). In the mean time I ordered our pharmacists for Cystoepen tablets. Yesterday, I got the medicines (Cystopen-Pentosan Polysulphate, Price 500, 10 capsules). I stopped KMac as suggested and when she was still suffering from burning sensations, at night I gave Cystopen (1 hour before meal) as suggested in the drug regime. You suggested to take the drug after meal, however, I read about the administration of the drug and it is instructed that the drug should be given 1 hour before meal or 2 hours after meal. Since 2 hours after meal consumption is a problem, hence I gave her the drug one hour before meal. After almost half an hour, she started fidgetating and complained about tremendous discomfort, increased burning (more burning experienced that she usually used to experience) and started perspiring badly. I did not understand but I feel, that it ocurred as a drug side reaction. Yesterday, whole night she could not sleep, and she also complained yesterday that she is feeling burning while passing urine, which she did not feel all this while. Uptill now, only the burnning was there after urine passage, but after the consumption of this Cystopen, the overall burning sensation has increased somehow, I think. In the morning, she said that her stomach is upset, and she is having loose motions. I looked up for the drug side effects and all the reactions, which my mom is suffering from yesterday is mentioned in the side reactions of the drug.
I am really confused doc, since, I could not do the tests, as in this condition, I cannot take my mom for the tests and after taking cystopen, she is having all these increased side effects. What you advise now? Should I stop the medicine. I really dont know, what is happening with my mother, because, now this is the continous 4th month that she is going through this unbearable burning and discomfort. Whenever, she is passing urine, her whole urinal passage, rectal passage, stomach is burining like a furnace. What to do? I am really feeling helpless. I think Cystopen is of no use to her.
Please advice the suitable.
Best Regards,
Saswati
Your mother is experiencing side effects of cystopen and all these troubles are more when you take it prior to meals. Stop cystopen.
Start your mother on t.tryptomer 10 mg twice daily for 4 weeks. In addition start her on citrosoda sachet twice daily for 5 days and let me know how your mother is doing.
Take care
Sincerely
Rajiv Goel