00:00 – Dr. Hlavinka: They are inert in the bloodstream
00:03 – and in the kidney, but in the urinary tract, on the lining layer they go to town.
00:21 – Melissa: Maybe you can talk a little bit about breaking the cycle of a UTI, followed by antibiotics, followed by
00:26 – a yeast infection, followed by a UTI again. People just get stuck in this cycle and don’t know how to treat what, and if they can ever break it.
00:34 – Dr. Hlavinka: That’s a very good question and one for
00:38 – whom I find a very frequent source of referrals from all sorts of female health care providers.
00:47 – And it’s because no one really wants to take the trouble to to break that cycle. No one wants to
00:54 – take the trouble to just put the brakes on and see where you are. Stop everything and be able
01:02 – to kind of dial back and see what you really need. And even in a young woman, particularly young women
01:08 – on oral contraceptives. We spoke about that last time – the impact of the anti-estrogenic effects
01:13 – of oral contraceptives. Even in young women on oral contraceptives, many times
01:18 – you may have to do a vaginal estrogen supplementation. You may have to do mechanical
01:26 – cleansing. I don’t mean that like douching or anything like that. We’re totally against that as
01:30 – you know, but we’re talking about with some of the supplements and cleanses like probiotic cleanses.
01:36 – Or refresh and replenish is what it’s called here in the U.S. These are these are pH chemical balance,
01:44 – anti-inflammatory and physiologically balanced solutions that can sort of just restore the
01:53 – normal chemical environment to the vagina, which is lost during this circumstance. And many times
01:58 – all these medications and antibiotics and the yeast overgrowth and bacterial growth create
02:04 – a menopausal state in the vagina. One that’s untreated. And I’ve seen enormous changes, not to
02:10 – mention the inflammatory process, the irritation, the redness, the discharge, the pain, the spasm.
02:19 – You get there, and you just have to just dial back and treat everything, honestly. And I’ve done
02:24 – everything from telling any partners to stay away for a long time, to using long-acting local
02:31 – anesthetics that last like eight hours. Just whatever it takes to get the woman comfortable
02:36 – and get some form of physiologic balance restored in her vagina.
02:40 – And then start back again with Microgen vagina and bladder and swab the genitalia, because you get
02:48 – surprises when you swab the genitalia, that coliform organisms like the ones that inhabit the
02:54 – rectum can live in the external genitalia in some susceptible women. And they are the source of it.
03:00 – And obviously, important to modify sexual activities and timing and things like that
03:07 – to prevent that. But for me it’s a full court press under those circumstances and then be very careful.
03:15 – I do believe in prevention and we’ll talk about that I think in a moment.
03:19 – Melissa: Do you think it’s possible for most people to come off antibiotics, and if so, when is the window for them to do that?
03:26 – We get this question a lot: Can I stop now or should I wait until I’ve done this or that?
03:33 – Dr. Hlavinka: I think that depends. Not trying to be recalcitrant to answer that question, but I think that depends
03:39 – on the the severity of the infection, the frequency with that patient, how refractory they’ve been
03:46 – in the past, if they’re someone who’s never been off an antibiotics for three years. The answer is
03:51 – different than somebody for the last three months we’ve struggled. But again, typically that normal
03:58 – vaginal and pelvic floor environment is going to be much more difficult to
04:02 – re-establish in those that have been more longer standing. So I would say
04:09 – it’s always appropriate once you’ve treated for an adequate course to stop and see what happens.
04:14 – But I’d like to follow that with, okay but we’re going to do prebiotics vaginally, we’re going
04:21 – to do high-dose probiotics intestinally now for at least a week before you come off,
04:28 – we’re going to make sure, we’re going to do a vaginal pH, we’re going to look and see.
04:33 – We’ll do a wet prep and make sure you don’t already have some form of bacterial overgrowth
04:37 – or fungal overgrowth that’s going to cause you to relapse after you stop the antibiotics.
04:42 – And just be proactive about all these issues, not just wait till a patient comes in miserable
04:48 – and she’s been waiting three weeks to get in to see you, and then all bets are off because the
04:53 – inflammatory cycle is just out of control under those circumstances.
04:59 – Melissa: Right, definitely. And that’s kind of the next question: What can you do to support that recovery? But you’re suggesting that
05:05 – you should really start that immediately, not wait until you start to have symptoms again.
05:10 – Dr. Hlavinka: My patients, forgive me for interrupting, Melissa. My patients get a prescription for high-dose
05:16 – probiotics and specifically how to take them. With the same prescription they
05:22 – get a dietary handout that shows them what to avoid that may cause problems with the antibiotics.
05:30 – We’re very specific about how to take the antibiotics with other food, so you don’t have
05:36 – an interaction or diminishment in absorption. How to take them with the timing with the probiotics.
05:42 – What to do for vaginal health during that time. What you can do to support vaginal health during
05:46 – that time. All those things we send them out at the same time.
05:49 – Melissa: Okay. Are there any supplements that you recommend taking that can help prevent UTI?
05:55 – Dr. Hlavinka: Specific D-mannose is something we give because D-mannose has been shown to help. And then
06:10 – of course I’m a strong believer in cranberry if you don’t have IC. A lot of patients with IC, the
06:17 – acid that you need to get enough cranberry isn’t good.
06:27 – You need to have really good pure cranberry extract with 65 milligrams of pure cranberry
06:33 – extract and that needs to be given three or four times a day. Typically that takes the 200 milligram
06:41 – capsule in order to be able to get that. I just strongly believe in those preventions.
06:46 – Melissa: People are starting to ask a lot of questions about vaginal suppository
06:51 – probiotics. You mentioned prebiotics. How should you use the suppository probiotics and
06:56 – should you always use them at the same time as oral probiotics and for how long?
07:04 – Dr. Hlavinka: The prebiotics are just basically a different form. They’re ones that are basically preparing
07:12 – to recreate the lactic acid environment from Lactobacillus in the vagina. And so the prebiotics
07:16 – typically are those that are given either in the suppository or a ovule or something like that.
07:21 – There are some liquid forms you can give through something that looks like a tampon inserter and
07:28 – those are available too. Those are very helpful. Again if you’re irritated down there you
07:31 – don’t want to do those things but that actually is the most important thing you can do to make sure
07:36 – that there’s no long-term complication antibiotic therapy. Now does a woman need to do that the
07:41 – first time she gets an infection or if she’s one that gets them every three months, no,
07:46 – you can get over that, that’s fine, but for most women who have chronic infections some form of
07:53 – of preventive maintenance of vaginal health is essential in my opinion.
07:57 – Melissa: Is this a short-term kind of treatment approach or should you be using the prebiotics for a long time?
07:58 – Dr. Hlavinka: Well, I tell everybody I can about the value of probiotics, and probiotics are absolutely
08:09 – essential for immune system boosting. We’ve got all those gut bacteria, there’s all sorts
08:16 – of interplay between the gut microbiome and our immune system, our liver function.
08:24 – There’s even a sort of, they call it a gut brain connection, between
08:27 – the microbiome and the brain and we’ve shown that things like depression and things like that,
08:32 – anxiety related, are related to changing the gut microbiome. So having a healthy constituted
08:40 – gut microbiome to me is an essential part of overall health and a simple thing to do, but we
08:48 – docs screw that up all the time by giving people antibiotics to destroy it immediately. It can
08:53 – take weeks or months to rebuild, so I tell my patients they should be on 60 80 billion of
09:02 – probiotics, 60 to 80 billion colonies per probiotics daily and then double that when you’re on
09:08 – antibiotics. So that’s basically what I tell them.
09:11 – Melissa: Okay sure. And what about Hiprex? What’s your opinion on that and do you ever use it in your practice?
09:18 – Dr. Hlavinka: I like what we call the urinary antiseptics and the reason I like them is that they have a nifty little way
09:26 – of getting in the bladder and in the urine without causing any interactions in the bloodstream. So
09:34 – they’re inert in the bloodstream and in the kidney but in the urinary tract, on the lining
09:40 – layer, they go to town. And so that’s good because they’re also sort of a bacterial suppressant.
09:49 – Chemically, they inhibit the growth of the bacteria so it dies and to me that’s very important because
09:57 – that keeps you having your full armamentarium of antibiotics. You don’t create resistance that
10:02 – way. Now can patients become resistant? Sure. Sure they can, but that’s through a different mechanism