00:01 – Hi, welcome back to the channel. My name is Molly and today at Live UTI Free we’re chatting with Dr.
00:06 – Roscoe Nelson about getting the right UT treatment. If you’re new to our channel be sure to check out
00:12 – the description below as we’ve linked to other resources that you might find helpful. Lastly if
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00:28 – we hope these videos provide the insights you need to take the next step on your UTI recovery journey.
00:40 – So joining us today is Dr. Roscoe Nelson. Firstly thank you for taking the time to share your
00:53 – experience about recurrent UTI in this clinician insight series. Thank you thanks for having me
01:00 – I’m excited to be here and hopefully more people understand what’s going on with these recurrent
01:04 – UTIs. Yeah definitely, so to start things off could you please introduce yourself maybe tell us a
01:10 – little bit about your professional background, what led you to treating patients with recurrent UTIs?
01:16 – Sure so a little bit about my background, I grew up in Southern California, did my undergraduate
01:22 – at Brigham Young University, went to med school back at UC San Diego and then my residency in at
01:28 – UC Davis. I’ve been in Arizona practicing at Arizona Urology Specialist since the late 90s
01:35 – so I’ve been around a little bit and one of the things that just a little background, one of the
01:41 – inventors of Elmiron was a guy named L Parsons and he was on staff at at UC San Diego and so
01:49 – there was exposure but I realised it was a very controversial diagnosis and this medication
01:56 – it worked on some people, it didn’t work on others but I needed some research to try to
02:03 – impress people, get into Urology and they said well go with him and they would have me put potassium
02:08 – citrate in people’s bladders. I remember this is in the early 90s and some of my
02:15 – these patients would literally come off the table in agony it was horrible. I quit I could
02:22 – not do this to these patients and this was a one of their diagnosis methods for what they
02:27 – called interstitial cystitis so keep that in the background. I understood there were patients
02:34 – that had really bad pelvic pain, they thought they were UTIs, their cultures were negative and then
02:41 – and a lot of doctors would just blow it off and even get to the point where there were mental
02:47 – diagnosis. One other patient experience that really kind of shaped me during my residency we had a
02:53 – period where we were we had a residence clinic as a fourth year resident and there was a patient
03:00 – who for seven years she was getting treated with anti-depressants, all kinds of psych meds and
03:09 – she got referred to me for blood in the urine so I looked in her bladder and it was ever since she
03:14 – had had a hysterectomy. I looked in her bladder and there was a suture going from one side of
03:20 – the bladder to the other with a stone on it, jagged stone. Every time she urinated it would grab onto
03:27 – her and we took it out and all surprisingly all her psych problems got better and so these kind of
03:34 – things shape you where you say you know sometimes patients come in all the in the world as a
03:40 – physician isn’t always right we learn things we change our mind and so fast forward probably
03:49 – 15 years ago I had a guy come in and he had he had a test with him and it was it’s what’s
03:55 – now MicroGen, it was called pathogenesis at the time and for those who don’t know it’s a next gen
04:02 – sequencing and at this point it was only it was only PCR polymerase chain reaction and
04:09 – his urinalysis was negative and his culture was negative but his PCR test said he had ecoli and
04:16 – I looked at that test and said oh my gosh this is the holy grail because for years we would call
04:23 – that non-bacterial non-inflammatory chronic prostatitis so I immediately thought of all
04:29 – these women that were diagnosed with Interstitial cystitis and I started running this test and 70
04:36 – 80% of them were bacteria with negative cultures, treated them with the right antibiotics and their
04:44 – lives would get better and so that’s how I kind of got into the realm of this recurrent UTI and
04:51 – so when someone comes in and says well I’ve you know I’ve had what feels like a UTI but my
04:56 – doctors tell me I don’t. I believe them, I listen to them, I’ll run these tests, so that’s
05:01 – kind of where I got started. Yeah no I think one of our most popular articles as well is when UTI
05:07 – tests are negative but they have the symptoms and it’s so frustrating for patients because it’s like
05:12 – where do you go from there? Definitely. Let me ask talk a little bit about that you know the
05:19 – urine test that we use, a urine culture is 70 80 years old technology. They take a sterile swab, wipe
05:27 – it on agar which is basically just a little petri dish of food for the for the bacteria and
05:34 – they look at it at 48 hours and there’s so many things wrong with it so certain bacteria will
05:40 – grow on it and but there’s a lot of bacteria that don’t grow on it. Their viruses won’t grow, fungus
05:46 – won’t grow on it so if you have and if you have one bacteria like ecoli that grows really fast
05:52 – sometimes it will overwhelm some of the slower fastidious bacteria that takes either special
05:59 – tests and so they they’ve looked at DNA tests of people with of women with symptomatic UTI and
06:08 – about 50% are polymicrobial, meaning they’ll have more than one bacteria and they get treated
06:16 – for ecoli and they don’t get better and then pretty soon you treat them enough and ecoli quits growing
06:22 – out they still have symptoms but if you look at their DNA it will be you know greater than 100,000
06:28 – per milliliter DNA counts of multiple bacteria. So there are multiple reasons those the regular
06:37 – standard culture are not sufficient it’s great for 21y old female comes in first UTI you do a culture
06:45 – you treat it she gets better that’s that’s a fine cheap test but for your patients, the patients that
06:51 – are on your website they need something more. Yeah definitely. So I know we’ve touched on this
06:57 – a little bit but could you describe the types of tests that you use when examining a patient so for
07:02 – recurrent or chronic UTI and what clinical signs may guide these decisions? Sure, so my starting
07:09 – point right now, I’ll get a history and I’ll get a urinalysis and a culture. I want
07:14 – to see are there inflammatory cells and I want to see what grows out on the culture, I
07:19 – do get useful information on that. My go-to test right now is Pathnostics. Pathnostics it’s a
07:26 – little bigger PCR test. I believe they have 46 or 48 different things they’re looking for but
07:34 – the one thing they do that I like is they have a pulled sensitivity test so the bacteria they
07:42 – and the microorganisms can share information and share some of these genes to protect themselves
07:49 – and so what pathnostics does is it pulls them together and says what is this collective? We
07:56 – can talk about biofilms you know later but it it looks at the collective and says what is that
08:02 – collective sensitive to and treats it, so I love the pathnostics. I’ll check a kidney function,
08:09 – I’m a urologist, I’m going to check an ultrasound of their kidneys and I’m going to check
08:14 – I’m going to look in their bladder and do a pelvic exam. There are things you have
08:18 – to watch out for, I will find patients with staghorn which are big branch kidney stones that are
08:25 – bacteria holding bacteria that don’t cause back pain and they’ll just be draining bacteria in the
08:31 – body. You got to clear that kind of thing out, sometimes people have congenital problems
08:38 – reflux and you have to make sure there’s not an anatomical problem, suburethral diverticulum is
08:45 – a if you don’t look for that you’ll never find it but you know once a year I’ll find a woman who
08:52 – has a an abscess underneath the the urethra that will fill with bacteria and then rupture
08:59 – into the urethra, they’ll have painful intercourse, recurrent UTIs and it’s not really an embedded UTI.
09:07 – It’s needs to surgically be repaired so I rule and I’ve had people diagnosed with Interstitial
09:12 – cystitis that had urethral cancer so I’m gonna make sure it’s not all the bad things and then
09:18 – I’m going to engage in treating them. So that’s my work up, it’s going to be urine culture, I do
09:23 – pathnostics, I’ll get a check kidney function ultrasound and do a cyst on exam. Interesting, so
09:32 – it sounds like there’s quite a few factors which can increase the risk of UTI and that you look
09:38 – for as well when you’re testing for UTI as well. Yeah and there’s some things you can’t really test for,
09:45 – you know every person has a different cellular makeup and and areas for bacteria to attach to.
09:52 – Your different than me, you get some of these from your you know genetically from your parents
09:57 – and some people are more prone to having bacteria be able to attach to their urethra some people
10:06 – are less prone and then the the normal flora that we all have the bacteria that are supposed
10:11 – to be on us in us that help us, some of them have more aggressive forms of those. Those are hard to
10:17 – test for but those are things that you take into consideration you know and you’ll hear yeah my
10:23 – sister has recurrent UTI, my mom had recurrent or worse I’ve had patients where their mom had their
10:29 – bladder removed because they diagnosed her with Interstitial cystitis and I think it was
10:36 – probably recurrent UTI. So in terms of treatment, what is your typical treatment approach when you
10:42 – identify an infection? So I’m going to go back just a teeny bit. You know when people come in
10:49 – with this pelvic pain sometimes they’re diagnosed with a lot of different things, they’ll be
10:53 – diagnosed with Interstitial cystitis. I believe there’s probably five main things that are that
10:59 – may be going on. I think interstitial cystitis is real, I think it’s very rare, that would be a defect in
11:05 – the lining of the bladder. There’s probably some people that have that. There are some people that
11:10 – have pelvic floor dysfunction where just like, you can get TMJ and give you a headache your
11:17 – pelvic floor can spasm, can give you pelvic pain a lot of women that are postmenopausal or per
11:23 – menopausal when they start losing that estrogen it can make things uncomfortable, it makes them more
11:29 – to infection, that plays a role, there are people that just have food intolerances that
11:36 – irritate the bladder and but I think the majority of these symptoms are these chronic recurrent UTIs
11:42 – biofilms embedded UTIs but all five of those things play on each other. If you have chronic cystitis you
11:50 – you’re going to destroy your lining of your bladder or just from recurrent infections
11:55 – you’re going to be more sensitive to food. If you have if you’re menopausal or peri-menopausal
12:00 – you’re going to invite that it changes the pH in the vagina, you’re going to invite more of these
12:05 – nasty bacteria closer to your urethra and bladder and then as these things happen your pelvic floor
12:11 – starts to spasm and so I can see where a doctor is going to go down one pathway but all five of
12:17 – those things are interrelated and so when I treat them it depends how symptomatic they
12:23 – are. If it is a I get a UTI four times a year I you know and and I take an antibiotic and I
12:32 – get better, I treat that person different than the patient who said who will tell me that you know
12:37 – for 25 years I’ve been having ongoing pain and all my tests are negative. I think the pathology
12:45 – that’s going on is a little bit more involved in that second patient but I’ll typically focus
12:51 – on I believe in antibiotics, I’m a doctor I believe in antibiotics. I will typically do
12:58 – my pathnostics and treat that with 10 to 14 days. The short courses, three days antibiotics for
13:06 – the 21y old female with her first UTI that’s fine. For the person who’s had four UTIs a year
13:12 – for 10 years, three days antibiotics probably is not going to treat that embedded UTI or
13:20 – biofilm, so I’m going to give them 10 to 14 days of a pathnostics based antibiotic and then
13:27 – I’ll put them on Macrobid. I like Macrobid, it’s an antibiotic you don’t get resistant to. It’s not it
13:35 – doesn’t kill bacteria, it’s starves them, it’s called bacteriostatic as opposed to bactericidal.
13:40 – It’s very weak, it doesn’t penetrate the tissue very well but Nitrofurantoin is the other
13:47 – name for it, Nitrofurantoin, Macrodantin or Macrobid all the same thing. It is a good preventive
13:55 – or antibiotic that can allow that bladder to heal and to slough off some of those bad
14:02 – that bad the infected cells and regrow new lining, so I like Macrobid. There’s a you know,
14:10 – there’s very rare pulmonary issues with Macrobid, that’s the main one, it doesn’t cause yeast
14:15 – infections, doesn’t cause bowel issues as often so you know we go through those risks but I’ll
14:21 – use I’ll put them on that daily for a period of time. I’ll try to calm their bladder down. I’ll
14:27 – use either an anti you know I I like Vesicare oxybutynin is a very nasty drug. Solifenacin
14:34 – which is Vesicare, little calmer but if they’re really symptomatic from the frequency, urgency I’ll
14:40 – work on that. There are medicines like urbel euroes urel, they’re all the same thing just little
14:47 – different combinations that can give them a soothing, just to get them comfortable.
14:53 – If it’s a bad bacteria that has a lot of resistances I’ll use methenamine or hiprex.
15:01 – That has to be used with vitamin C and sometimes the vitamin C can be irritating but that’s it’s
15:06 – it’s more like an antiseptic. I’ll give them the here’s a list of foods that might bother you. If
15:13 – they have a lot of pelvic floor spasm when I do the exam, I might have them see physical therapy
15:18 – to try to get that to relax and if they’re peri- menopausal or menopausal I’ll try to get
15:26 – them on either vaginal estrogen systemic. I’m more of a fan of bioidentical. My
15:37 – wife takes uh bioidentical testosterone and you know the bodies are brilliant, the body will take
15:42 – that testosterone if you understand the hormonal cascade and convert that into estrogen and so she
15:49 – gets her, she gets bioidentical very low doses. She converts it into her own estrogen and so that’s
15:55 – kind of my throw everything at. I had a physician who was disabled, she was on disability
16:03 – because of this problem and I threw everything. I put all all eight of those things at her and she
16:10 – was working in six weeks, she was back working and she feels normal now. We’ve and we
16:16 – backed off she’s not on, I left one important thing out, we’ve taken off a bunch of those she
16:23 – doesn’t have to see PT but her longterm she’s not on Vesicare, I think she’s just on hormones and
16:29 – then one of the main stages I like the natural stuff. The goal on these is get people into
16:35 – the the proanthocyanidin, d’mannose type realm and that is more of a maintenance. Those are
16:44 – two natural substances that proanthocyanidin is found in it’s kind of active ingredient in
16:49 – cranberry how cranberries work. proanthocyanidin is that active ingredient, if you just try to do cranberry
16:56 – or cranberry juice you’re going to get too much much sugar, you’re not going to get enough of that
17:00 – proanthocyanidin and d’mannose is a type of sugar. Both of them work by, this is very simplified but the
17:07 – bacteria basically have to attach and these two products will grab onto those and the
17:17 – the stuff that grabs onto your, your tissue and help prevent that attachment so I’ll
17:25 – get them on that with everything else and then start backing off the antibiotics, backing off the
17:29 – hiprex, backing off the you know that, so long term I’d like to see these people on a d’mannose
17:35 – pac product to prevent. I think it’s a really important point the fact that patients almost
17:41 – need to understand that it is an individualized approach and it almost what happens what helps
17:47 – one individual might not help another and it is kind of finding that thing that works for you.
17:52 – Yeah I think that’s really important. That’s a great point, everybody’s different. Yeah. I reached
17:58 – out to a company because I was frustrated with the cost of these natural products. Yeah. And you know
18:03 – you’re go on and there’s some really good ones out there, there are some really good
18:07 – ones that where people understand it but you know there everybody’s selling something. I reached
18:14 – out to a company and they created a microbial it’s called Purology but the website’s mypurology.com
18:21 – and its a PAC d’mannose combo, you take it twice a day it’s reasonably priced and you know where you’re
18:30 – talking about you know less than a dollar a day and it’s good product it’s made in the
18:36 – US I don’t know if they ship it abroad but it’s a decent product and you know some of them I’ve
18:41 – I’ve go through all of them, some of them have yet you know hundreds of dollars a month getting
18:45 – good stuff but I think this is you know measured out tested, secondary tested pac so. So moving
18:55 – on, beyond treating the infection, do you have any tips on preventing future UTIs? You know
19:03 – I sent you a link it was a second link and maybe put that with the video because what I did
19:09 – I felt bad for patients and I don’t want to you know, it’s how many times are you
19:15 – told wipe front to back, I wipe front to back, yeah, I pee after sex, I do this, I go through I
19:22 – think I have 12 little videos and if you sign up it’s I’m not selling anything or you know it is
19:28 – you sign up you get a two or three minute video every day for 12 days and it’s like okay what
19:35 – about this, what about that, things that you may not think of, the type of material in your
19:42 – panties, the you know the type of underwear you wear, the you know some certain habits that you
19:47 – might have, some sexual practices you might have, things you got to think about and it’s just two
19:52 – three minutes and if almost every person that goes through those will say ah I thought
20:00 – about this but I wasn’t thinking about that and so for the you know for the young healthy person
20:05 – like if you came in my office you know unless you’ve had your ovaries removed, your hormones
20:09 – are probably normal, I would you know I would treat it I would get you on a d’mannose
20:16 – pac product and then I would have you come back and test it again and I’d probably have you you
20:21 – know do the the physical things to prevent say on the d’mannose pac for a period of time. If you
20:29 – have those bad bacteria as part of your natural as part of your bacterial bio you know what’s
20:38 – in your normal flora, you’re going to be prone to that potentially the rest of your life you
20:43 – know you might be somebody that stays on those natural products forever. Thank you, yeah that’s
20:49 – interesting. I’ll make sure to add the link in the description for that so people can have
20:53 – a look and so finally what is the best way for patients to reach out to your practice about
20:58 – about recurrent and chronic UTIs? So I have a website it’s called peedoc.com and on the front page
21:08 – I talk about UTI but under conditions treated I I’ll change my website all the time but
21:15 – right now it’s on the front page and there’s conditions treated recurrent UTI there is a
21:22 – request a call. But if you go on my website and it says request a call, it’s actually an email
21:28 – goes directly to me and I’ll route you to the person that you need to get in. I that’s
21:36 – probably the best way to get a hold of me is through through my website. Okay thank you I’ll
21:41 – add those details as well to the description. So, thank you for talking to us today and providing
21:48 – these insights into the testing and treatment of recurrent UTI. For anyone that’s interested I
21:53 – will add a link to the bottom of this video but thank you very much. Molly thank you very much for
21:59 – having me. Thanks so much for watching, I hope you found this video helpful. You’re always welcome to
22:05 – reach out for more information about clinicians who specialize in recurrent and chronic UTI. Our
22:11 – contact is below in the description. If you’d like to learn more about this or related topics
22:16 – be sure to check out our other videos or head over to liveutifree.com for other articles in
22:22 – recurrent UTI treatment options. Of course if you like what we’re doing on this channel make sure
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22:32 – about future videos. Thank you so much for joining us for our clinician insight series. If you
22:38 – have suggestions for who we should interview next be sure to give us a comment.