00:00 – Hi, welcome back to the channel. My name is Molly and today at Live UTI Free we’re chatting with Dr. Heidi
00:06 – Peterson about treatment and recurrent UTIs. If you’re new to our channel, be sure to check out
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00:26 – hope these videos provide the insights you need to take the next step on your UTI recovery
00:31 – Journey. Welcome Dr. Heidi Peterson and thank you for joining our Clinician Insight Series
00:50 – to discuss recurrent and chronic UTI. Thank you for having me, I’m so excited to be here today. Amazing,
00:57 – thank you. So can you tell us a little a bit about yourself, including where you are based, your practice,
01:03 – and how you got here? Sure, I’m a naturopathic physician in Portland Oregon. I’ve been in
01:09 – practice since 1999 and I’ve been passionate about, well particularly Women’s Health but just
01:16 – Health in general my whole career. I taught Women’s Health at the Naturopathic Medical School
01:23 – for 19 years and you know, it’s you know, I just see so many, particularly women dismissed
01:30 – with their health issues and and not addressed properly. Yeah definitely, so when it comes to UTI
01:37 – diagnosis and treatment what type of patients do you tend to see? I see all types of patients while
01:43 – I would say the predominant patients in my practice are women, I see men, transgender, I really
01:49 – will, I’m happy to help anyone in need. Amazing, you mentioned transgender care there, are there any
01:55 – differences in your approach when it comes to transgender care and UTI? Well I think there are
02:01 – some differences. One just being respectful of the patient and their needs and their identity but you
02:07 – know when it comes down to it, a human body is a human body and so there isn’t differences. You
02:12 – know sometimes if they’re on hormone replacement therapy that can affect the tissue as well but
02:19 – you know it’s I think it’s really more just being sensitive in how you interact with the patient
02:24 – but the actual treatment itself really isn’t that different. Yeah definitely, okay, so do
02:31 – you tend to diagnose based on testing alone or in conjunction with patient symptoms? Well
02:37 – historically, I just based on patient symptoms but since about 2000 I’ve been doing PCR testing
02:45 – which has just been a dream come true for me and you know I always had this suspicion that patients
02:52 – had underlying UTI that the the testing wasn’t showing us, and it’s just been fantastic now
02:59 – with PCR based testing to actually get the diagnosis that I actually thought was there.
03:05 – The other thing that I think is really important is that, depending on the anatomy of the
03:11 – patient, you know with women, with people with vaginas, I’m also going to test the vaginal
03:17 – microbiome as well as what’s going on in the bladder and for people with prostates I’m
03:22 – also going to assess the prostate microbiome as well because I think there’s so much cross
03:27 – talk and I think sometimes when providers just focus on treating the bladder and don’t actually
03:33 – treat the sort of surrounding tissue as well, they won’t have as much treatment success. Can
03:40 – you tell me a little bit more about your testing process when you meet a patient, what you tend to
03:45 – do first? Well I tend, I mean I obviously take a good patient history and I think that is
03:51 – very important. All of my patients visits are an hour long and I I think that I have success
03:57 – with chronic cases by really sort of drilling down and finding out when things first happen
04:03 – and you know I saw a patient this week and this is not you know uncommon you know she’s really
04:07 – had chronic UTI since she was 20, and I think that’s really important to know because when you
04:14 – have these patients that have had UTI for like 20 years, treatment is going to take a long time
04:19 – and I really want to you know, set up that expectation like I really think I can help you,
04:25 – but this is a 20-year problem. We have sort of a rough rule in naturopathic medicine that you need
04:31 – a month for every year, a month of treatment for every year you’ve had a problem. So you know this
04:36 – patient that’s had UTI for 20 years you know, it will probably take a couple of years to fully
04:42 – sort it out for her. And then I generally start with the PCR testing. I think
04:49 – that that’s really important. Of course I am a more holistic in my approach so I am going
04:55 – to want to look at you know, just laboratory tests and patients medical histories and make sure you
05:02 – know, that they’re not hypothyroid, if they’re not you know menopausal and the hormones
05:06 – are too low, that they’re not deficient in iron or vitamin D, and all these other things that are so
05:12 – important for immune function because if you’re having sort of, some of these more global
05:17 – health issues, it’s really going to affect how your body can fight these infections. I’ve learned that
05:22 – stress is quite a big one and when speaking to other clinicians they find that’s a big indicator
05:27 – when it comes to UTI as well. Hugely stress, and you know along that topic, you know I think
05:34 – trauma has become such a hot topic and so many people that have a trauma history that causes a
05:40 – lot of stress in their body and really can affect issues in the pelvic floor. I always like to
05:46 – remind people that your pelvic floor muscles are the same muscles in a dog that causes
05:52 – the tail wagging and a lot of motion will go to those muscles and so you know a lot of people will
05:57 – hold stress in their pelvic floor muscles and if the pelvic floor is really tight that really can
06:02 – affect how well treatment proceeds. Are there any common challenges you see patients facing
06:09 – when dealing with recurrent UTI and how will you help patients overcome these? Well, I think
06:14 – first, just realising that they actually have a chronic infection, I mean I think so many
06:19 – patients will go to their provider and they’ll do a urine culture, and you know they’ll either say
06:25 – oh there’s no pathogens there or those are normal flora. And so I think that that is a you
06:32 – know a huge huge problem. I think another problem is, you know, antibiotic resistance or overuse of
06:38 – antibiotics and I certainly prescribe antibiotics, and I think that they’re a great treatment and yet
06:45 – I always feel like there’s a phase where they kind of fail, so I often will start with
06:50 – antibiotics just because they’re easy, they’re they’re fairly inexpensive, and they’re accessible,
06:56 – but at some point I don’t find that they actually always work 100%. And that you know, after I’ve done
07:00 – maybe a couple rounds of antibiotics, if they’re still testing positive for pathogens
07:08 – then I’m really looking to other treatments. One of the treatments that I do in my practice that I’m
07:13 – really excited about is ozone therapy. Could you explain a bit more about ozone and your approach?
07:20 – Yeah yeah, so ozone is 03. People might sort of know ozone, if you know that sort of smell
07:27 – in the air after a thunderstorm with lightning, that is O3. O3 is an unstable molecule that
07:34 – quickly breaks down into free radicals and oxygen. Ozone is really amazing, it’s
07:42 – bacterial static, it kills by viruses and fungi, and one of the thing that’s really great about it
07:48 – is that it’s a physical treatment versus a chemical treatment so the, these pathogens can’t
07:55 – become resistant to it. People don’t actually realise but ozone is actually made by your
08:01 – body, so there are neutrophils that will do it and human cells actually have a way to neutralise it
08:08 – so it’s not harmful to the human cells except for the lungs, but otherwise it’s not harmful to human
08:14 – cells. But it is harmful to all of these other pathogens. It also breaks down biofilms
08:20 – and I’m sure other people have talked about this. I think one of the huge problems in treating these
08:26 – chronic infections is that the pathogens are often hiding in biofilms and you know there’s research
08:31 – that if a pathogen is in a biofilm, it takes a thousand times the antimicrobial agent to
08:36 – kill it than when it’s in the wild, and so it’s really handy that the ozone will you know, while
08:42 – it’s antimicrobial, at the same time will also break down the biofilms. It’s anti-inflammatory,
08:48 – it breaks down mediators of inflammation, it’s analgesic, it breaks down mediators of pain
08:55 – and it’s also immune regulatory, so it’ll stimulate the immune system but without overstimulating it
09:01 – that some things can do, and then the final bit is Ozone does break down into oxygen and so
09:07 – you’ll get an increase of oxygen in the tissue, which actually then promotes the tissue to heal
09:12 – as well so I do feel like it addresses like sort of all of the issues that we’re looking at when
09:18 – we’re when we’re treating these chronic infections. You’ve mentioned antibiotics and you’ve mentioned
09:23 – ozone therapy, is there any other treatment approaches which you look at when an infection
09:27 – is identified? Well certainly, I’m a naturopath so I will do herbal infection,
09:33 – herbal treatments as well. I always include you know a biofilm agent you know. I also
09:42 – specialise in chronic complex illness as well and sometimes when the cases are really challenging
09:47 – you have to look a little bit more globally, like do they have a chronic Vector-Borne illness like
09:53 – Lyme. The other thing sometimes I look at, I’m trained in environmental medicine. Sometimes if
09:59 – people have been exposed to mold, toxic mold in a building, that they they will be get exposed
10:06 – to these chemicals called mycotoxins which are the poisons that make in the mold War. One of
10:11 – the main routes of excretion for mycotoxins are actually in the urine and in fact many ways that
10:16 – we test for them are urine samples so if the urine is full of mycotoxins, that’s immunosuppressive
10:23 – so that can be another you know barrier to to people getting better. I think a big thing in
10:28 – our community is the overlapping symptoms and it’s quite hard, like you mentioned, establishing
10:34 – what needs to be targeted to be treated first, because some of the symptoms are very similar.
10:40 – Yes, no it is very, it is very complicated and you know sometimes with my patients I make
10:47 – the analogy that treatment is a little bit like rock climbing, where you know you might sort of
10:51 – focus on one area for a while and then you might go to another area and then come back.
10:55 – It’s really really challenging, you can’t treat all of these things at once and I think that’s you
11:00 – know sort of, it’s sort of a journey that you’re on and trying to figure out what is really the
11:05 – biggest driver behind the chronic infection and I don’t think it’s always the same for everybody and
11:09 – that’s what makes it so hard. So what advice would you give to someone who suspects they have a UTI
11:15 – but maybe testing negative? Oh my gosh find a good provider, but I you know I say that and as if
11:22 – that’s an easy thing to do, and you know I think right now it seems like at least post-COVID in
11:28 – America it’s really hard to get, find any doctors or to get in anywhere and I think really you know
11:34 – using your network of friends and colleagues, and and you know doctors and just asking around for
11:40 – someone who actually believes in this, and will do you know, will do the PCR testing and will do the
11:46 – deeper dive, but I think you know, it’s it’s really demoralising when you really feel uncomfortable
11:52 – and you know I think most people who’ve had a UTI know what it feels like and know when they
11:56 – have one and I think it’s just horrible when you go to provider and they say you don’t. And I
12:02 – get frustrated you know many many many doctors in America you know quote unquote don’t believe in
12:08 – the PCR testing for UTI but I’m sort of like, but you use PCR to diagnose COVID and I don’t really
12:15 – understand that if you believe in it for COVID, why don’t you believe in it for UTI? Like it’s
12:19 – it’s very baffling to me. So are there any typical conditions that we mentioned like overlapping
12:25 – symptoms and conditions which you have to target, are there common condition that you find link
12:30 – with UTI? Oh you know so many, well first of all in in you know older women or older people with
12:37 – vaginas, you really have to treat the decrease in hormones and I think you know that is,
12:44 – needs to be address properly and I actually get quite frustrated, in America they often will
12:51 – prescribe estrogen cream to women with chronic UTI but the standard way to apply it
12:58 – here is with an applicator and I think you kind of miss the boat because I think one of the most
13:02 – important things with is when women have UTI, is to apply estrogen actually over the
13:09 – urethra and the top in the opening of the vagina, and the top of the vagina to get
13:14 – the front door closed because as I tell people, estrogen is like lycra in your tissue and as you
13:20 – get older and your estrogen levels drops, you know your tissue everywhere including
13:24 – the urethra so you know when I, you do an exam and I can see the urethra just hanging open, you
13:30 – know you got to close the front door, but so many ways that patients are instructed to do
13:35 – these treatments actually aren’t targeted to the most, they’re not applying the hormone where they
13:40 – actually really really need it. So I think you know that that is a huge huge obstacle and then
13:48 – like I said earlier maybe looking at these big you know looking more globally and not just always
13:54 – being like you know what’s the antimicrobial? or what’s going on with the bladder? But really
13:59 – doing a global health assessment to see why their immune system isn’t really clearing the infection
14:05 – because I think people kind of forget in this age of antibiotics and they really think oh the
14:10 – antibiotic clears the infection and that’s not actually true, the antibiotic will get the level
14:16 – of the pathogen down but at the end of the day it’s really your immune system that’s clearing
14:20 – the infection and so if you know, if you’ve done lots and lots of treatment and
14:27 – you’re not having success then I do think you have to question you know, what is going on
14:32 – with the immune system and why isn’t it why isn’t it clearing these infections? That’s
14:39 – really interesting, do you have any advice for individuals for preventing future UTI? Well
14:47 – you know certainly, I think you know frequent urination and you know it’s very sad
14:54 – I had to, I’ve had to write the letters here for my younger students that many of the like
15:00 – high schools here, they don’t want students leaving the classroom to go to the bathroom and so
15:06 – I’ll write these letters of medical the next that so and so it’s medically necessary that
15:10 – they when they need to use the restroom they can use it, which I think is ridiculous but you know I
15:15 – think and I think also can apply to teachers. I’ve worked with teachers and they aren’t giving you
15:20 – know given restroom breaks or you know many people in their workplace environments are not doing that
15:24 – and I think you know when people need to urinate you you certainly want to you know
15:32 – have that opportunity. Certainly, you know drinking plenty of water. Although I do
15:39 – want to tell you something that changed my treatment protocol a few years ago when another
15:44 – provider pointed this out, you certainly want to you know hydrate a lot and that really helps keeps
15:49 – the bladder flesh except for if you are taking an antimicrobial agent whether it be herbal or
15:55 – antibiotics, that is actually a time you don’t want to over-hydrate because then you’re actually
15:59 – diluting the antimicrobial effect of whatever you’re taking in your urine, so I think a lot
16:05 – of patients with chronic UTI sort of got the memo to over-hydrate but that actually isn’t
16:10 – good during antimicrobial treatment. Obviously urinating post sex is really
16:18 – helpful, you know something that everybody should be taught but some people aren’t. I’m
16:24 – actually a huge fan of bidets. So, you can buy you know for in America about $300, these little
16:32 – bidet, that you can install on your toilet and they have sort of different settings and
16:38 – they have sort of a setting to clean the rectum or rectal area and then they have a more anterior
16:43 – setting for the vagina and I think that is a really really great way to sort of cleanse the
16:49 – tissue you know after urinating or after sex and really healthier for the tissue. Toilet paper
16:55 – is actually not healthy for those sensitive tissues and if you’ve got chronic irritated
17:01 – tissues that really using a bidet is better and of course I laughed during the pandemic
17:05 – in America there was, you know people were panic buying toilet paper and I’m like well if you just
17:10 – have a bidet then you don’t have to worry at all so that that is a really great
17:16 – for chronic UTI but also I recommend it to my patients with you know digestive issues and
17:22 – just in general, it’s healthier for those for those tissues. So I you know I certainly like
17:30 – things like cranberry and d-mannose, oh probiotics I’m a huge fan of, and you know I do really, the
17:38 – probiotics have come become more specific in that you know, there are probiotics for your mouth,
17:44 – there’s probiotics for your nose, and there’s particular strains that are more specific for
17:48 – the urogenital tract and so lots of my patients will come in and they’ll be on probiotics but I’m
17:53 – really going to put them on, you know looking for rhamnosus and reuteri and crispatus like really
18:00 – those strains that are specific for the general urinary tract ,and so I think if you’re struggling
18:05 – with chronic UTI, you really would or even preventing you know, making sure that you’re getting in some way in your diet or
18:11 – from a supplement, those strains that are specific for the general urinary tract. Thank you, that’s a
18:23 – great list to go with. So how can patients contact you if they’d like to inquire about working with
18:30 – you? Sure, I have a website I have a doctorheidi.com doctor spelled out and they can inquire working with
18:37 – me. I will tell people that unfortunately the ozone therapy, which I find really amazing has to
18:44 – be done in person but there is, there’s the American Academy of ozone therapy for
18:89 – American-based patients and I know that actually there’s quite a bit of ozone therapy in Europe
18:50 – as well, I know the main textbooks come out of Spain. I apologise, I don’t actually know what the
18:56 – group over there is called, but I do know that it’s available so if people are interested in that, I’m quite happy to work with them but that
19:06 – does sort of require them to come in person. Well thank you for providing us some insight into the
19:13 – testing and treatment methods for the use of chronic and recurrent UTI. I will include your
19:19 – link to your practice in the description below for those that are interested. Well thank you, and
19:24 – I just, you know, I want to close and tell people there is hope and you can get better
19:29 – and just don’t give up and don’t let any provider bully you into thinking that you don’t need help.
19:37 – That’s amazing, thank you. Alright, thank you. Thanks so much for watching. I hope you found
19:42 – this video helpful. You’re always welcome to reach out to us for more information about clinicians
19:47 – who specialise in recurrent and chronic UTI. Our contact is in the description below. If you’d like
19:53 – to learn more about this or related topics, be sure to check out our other videos or head over to
19:58 – liveutifree.com for other articles on our current UTI treatment options. Of course, if you like what
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20:14 – Insight Series, if you have suggestions for who we should interview next be sure to drop us a comment.