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#61 of 79 Old 01-03-2006, 10:22 PM
 
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Thats a great result! Phew!!
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#62 of 79 Old 01-03-2006, 11:01 PM
 
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Originally Posted by flyingspaghettimama
I hate doctor-bullies. Good for you for sticking up for your son. It's esp tragic that it happened in a Children's Hospital, for goodness sakes.

It is sad, isn't it? My nasty ped. urologist experience was with the head of the department at our local Children's. Pathetic... and completely inexcusable.
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#63 of 79 Old 01-03-2006, 11:53 PM
 
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Originally Posted by babykaoss
well I just got back from the pediatrician's office. When I told her my experience in th ER she was horrified. She told me that the next time anything happened or I was concerned about ds to just call her, and she gave me her home #. Then she proceeded to tell me she would speak to the chief of staff at Children's, and encouraged me to do the same, and gave me his number as well. She got a clean catch urine sample with the bag and said that everything looked perfect, his blood looked perfect, and that it was a virus he was fighting off, no bacterial infection anywhere.

i feel SO much better now!
Sounds like you have a VERY good ped at least! I am so happy for both of you!

Take care,
Tara

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#64 of 79 Old 01-04-2006, 01:14 AM
 
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Frank, the difference is two fold: the anatomy of the bag and the time in which you have to make a decision about what is going on.

No bags I've seen used could keep the urine from touching other areas of the skin. Cleaning all those little folds of baby skin can be very difficult. The bag for a male baby usually surrounds the penis as well as the testicles. (That's why they use a cup for a male adult---because you can aim, not touch the dies, and not contaminate the sample.)

One could do a UA (urine analysis) on a bag sample first, but it won't necessariliy be accurate. You could still have a low-level kidney infection that would not show up on a bag sample---simply because they assume that there is some contamination with the bag method.

But is that contamination the presence of infection or not? You have a neonate or infant with a fever and a sample collected from a bag which you assume has some contamination from the method.

A UA is usually just that little pee stick that one uses at the midwife/OB.

A microscope isn't going to help. A doctor cannot tell the difference b/w E. coli that comes from poop and E. coli coming from the urine. Most of the bacteria that grow in UTIs are from exposure to feces in the first place. And besides, most ERs send their samples to internal labs. There is a UA microscope method, but not all ERs have that.

And a culture takes min. 48 hours to grow in a less severe infection. (We've had one take 7 days to grow.)

So in an ER situation, especially with a neonate, you don't have 2 days. You need to ascertain as quickly as possible what is causing the fever. A baby can go from a little sick, to septic, to dead in days or hours. Sepsis is very dangerous for anyone, but for a neonate especially.

Again, they assume contamination with a bag sample, so the UA is harder to analyze. If it wasn't a neonate, it wouldn't be as big of a deal.

And either way, no one needs to forcibly retract the foreskin.

So I can recommend my ped urologist as someone who is intact-friendly if someone needs one. He's in Houston. I certainly didn't mean to imply that all doctors or nurses were knowledgeable, just that care didn't need to be refused, just renegotiated should one come up with someone in the ER who is probably an underling anyway.

ETA: babykaoss I didn't mean to imply at all that the doctor should have treated you the way he did. I'm sorry that happened to you. I'm glad your own doctor took you seriously and is willing to take your complaint to the hospital directly. Hope your baby gets better soon.
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#65 of 79 Old 01-04-2006, 01:23 AM
 
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And a culture takes min. 48 hours to grow in a less severe infection. (We've had one take 7 days to grow.)
All the bacterial cultures I've done in veterinary medicine grow in 24 hours.

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#66 of 79 Old 01-04-2006, 01:32 AM
 
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True, they can give you preliminary results in 24 hours. Even 8 hours. Even 2 depending on the infection. When my son was septic from a UTI they had results of rods growing within 2 hours!

But most docs I have worked with don't feel like it's NOT going to be an infection until after 48 hours.

They don't want you taking antibiotics for a UTI that doesn't exist, but they want to feel confident, that even if you are not symptomatic, the infection has cleared. (Yes, a repeat culture is waranted.) Especially in a baby whose brand-new. All obstructions, congenital anomalies, etc are NOT detected on prenatal ultrasound.

And the culture continues to be analyzed and grow. Like I said, we had one take a week---it was negative up until then, when suddenly it grew 10,000 rods. The baby was STILL symtomatic too: still had a low-grade fever and occasional blood staining on the diaper. Up until that point, the UA was clear. The doctor thought he had a virus.
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#67 of 79 Old 01-04-2006, 01:48 AM
 
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I had two UTIs back almost 20 years ago. I gave them a urine sample, they took them to another room where they looked under a microscope and in less than 10 minutes they were back confirming a bacterial infection. Now, in that short time, they weren't able to idenitfy the specific pathogen but they could clearly tell that I had an infection. I got a prescription and was gone. The infection was non-symptiomatic in about a day. I finished the prescription and it was a done deal.



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#68 of 79 Old 01-04-2006, 02:13 AM
 
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And don't they use aspiration to get a sample from cats/dogs?

Frank, but here we're talking about a very new baby. If the abx didn't work for you---it sounds like they just did a UA, well, they could try another. If it doesn't work the baby, the baby could be dead.

Now, there is so much antibiotic resistence that they should culture the urine and check for sensitivities to drugs and then switch the drug if the organism is not responsive. 20 years ago, they didn't do this. Now all abx given should be checked against sensitivities if there is a sample that's culturable (sp? word?).

And again, with a 20, 40, 60 year old man, it's not as big of a deal. Even a ten year old or a two year old probably isn't going to become septic. But an untreated kidney infection in an infant is serious.
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#69 of 79 Old 01-04-2006, 12:35 PM
 
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Originally Posted by mamaverdi
Frank, but here we're talking about a very new baby. If the abx didn't work for you---it sounds like they just did a UA, well, they could try another. If it doesn't work the baby, the baby could be dead.

Now, there is so much antibiotic resistence that they should culture the urine and check for sensitivities to drugs and then switch the drug if the organism is not responsive. 20 years ago, they didn't do this. Now all abx given should be checked against sensitivities if there is a sample that's culturable (sp? word?).

And again, with a 20, 40, 60 year old man, it's not as big of a deal. Even a ten year old or a two year old probably isn't going to become septic. But an untreated kidney infection in an infant is serious.
OK, maybe there is something here I'm misreading or just don't understand. In one breath you seem to be saying that the treatment must be immediate and in the other you seem to be saying to wait the 48 hours for a culture and additional time for the other tests. Which is it? How long would it take to test for antibiotic resistance? How would it be different if they bagged the child and found bacteria in a visual inspection and then went on to do a conventional cath or suprapubic aspiration? If there were some bacteria found in the bagged sample, why not a blood test to look for elevated white cells? What other simple tests could be and should be done to confirm the results of a single test? Regardless of what method of collection is used, if there is and elevated level of bacteria in the urine, it's going to show up. The only question is where did the bacteria come from? Did it come from the bladder or did it come from the (evil) foreskin? Clearly, with careful testing techniques and proper preparation methods, a bagged urine sample is at low risk of contamination. I suspect the real reason the bag collection technique is considered unreliable is because of sloppy techniques and procedures.




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#70 of 79 Old 01-04-2006, 01:04 PM
 
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Originally Posted by mamaverdi
One could do a UA (urine analysis) on a bag sample first, but it won't necessariliy be accurate. You could still have a low-level kidney infection that would not show up on a bag sample---simply because they assume that there is some contamination with the bag method.
I admit my medical knowledge is low, but if they did do a bag specimen and it came back NEGATIVE, wouldn't that be the end of it? Obviously if it came back positive they could either treat or go on to do a cath or aspiration sample for a sterile analysis, but negative is negative, right?

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#71 of 79 Old 01-04-2006, 01:20 PM - Thread Starter
 
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Originally Posted by CallMeMommy
I admit my medical knowledge is low, but if they did do a bag specimen and it came back NEGATIVE, wouldn't that be the end of it? Obviously if it came back positive they could either treat or go on to do a cath or aspiration sample for a sterile analysis, but negative is negative, right?
thats what my ped said, along w/ the blood test and culture coming back negative and his fever dramatically reducing itself, she said all of those together assured her that he was fine. She said that if the bag specimen was dirty or borderline in anyway she would then want to cath him to check again but it was clean so........she told me not to worry about him!

Sarah- following my bliss, mama to 3 :
Dd to Ds: "Let's have a snack party! I got us chips, and a hammer!"
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#72 of 79 Old 01-04-2006, 01:43 PM
 
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This is a good point to note, whenever I've not cleaned properly for a clean-catch urine specimen, the person doing the microscope work has said so and asked for another specimen. They can see if it's not a clean specimen and will know if they can't work with it. So it makes sense to try the least invasive thing first, the bag, and see if you can get a clean catch, before trying for the cath'd specimen.

Sarah, Great news about Baby T! And good job mama, sticking up for your kid. You know now for sure that you did the right thing at the ER, as your ped thought they were awful and took care of the baby in a gentle, non-invasive manner.

Proof positive we can seek western medical care and not be invaded and violated. It can be done gently and responsibly. But we as mothers, fathers, and patients have to be knowledgable, discerning customers.
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#73 of 79 Old 01-04-2006, 02:02 PM
 
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I've been following for a while, and just a little bit shy about relating my experiences.

But what I got out of it is these posts that that particular doctor involved thinks is this: "bagged urine can't be cultured" Or, "urine can only be cultured if it was collected using a catheter."

That is something I don't understand. I used to have frequent UTI's after I got married. (before I was married, I'd never "you know"ed before, and when I started "you know"ing regularly, I got them very frequently...)

My doctor did a culture on one of my cup collected (the equivalent of a bag collection on an infant..) specimens, and confirmed that the antibiotic I was taking would kill the infection. Which it did.

Now, in my shy and humble opinion, an adult would be a little to a lot more difficult to get a clean, culturable (new word?) catch on without using a catheter than an infant. As in, it would be easier to scrub and disinfect the nooks and crannies, as it were, on an infant than an adult. (infants don't have hair and infant boys don't discharge...)

I say all of this to make this point: If they can do an accurate culture on an adult's cup collected urine, I don't understand why they can't consider a cleaned and disinfected infant's bag collected urine to be clean enough to do an accurate and conclusive culture on, you know?

But I am not medical-versed, so maybe there is something that I don't know.

This whole thread is a source of enlightenment should something happen to us that I should be aware of.

Anyhow, BabyK, I am glad that your baby is doing better!
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#74 of 79 Old 01-04-2006, 02:41 PM
 
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Originally Posted by CallMeMommy
I admit my medical knowledge is low, but if they did do a bag specimen and it came back NEGATIVE, wouldn't that be the end of it? Obviously if it came back positive they could either treat or go on to do a cath or aspiration sample for a sterile analysis, but negative is negative, right?
That's exactly what I've been trying to say. I want to give totally accurate information and the way I seem to do that is to be very verbose and I think sometimes that verbosity obscures the real message.

(Wow! A short post for me!)



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#75 of 79 Old 01-04-2006, 03:02 PM
 
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I love your long posts, Frank. They are often so enlightening and educational.
It's like "Sesame Street for the Penis". We learn about a foreign language (medical lingo), how to be kind to each other (to our sons), and how to relate to new people (doctors who may/may not be ignorant about penises).
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#76 of 79 Old 01-04-2006, 04:19 PM
 
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Originally Posted by LeosMama
I love your long posts, Frank. They are often so enlightening and educational.
It's like "Sesame Street for the Penis". We learn about a foreign language (medical lingo), how to be kind to each other (to our sons), and how to relate to new people (doctors who may/may not be ignorant about penises).

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#77 of 79 Old 01-04-2006, 08:45 PM
 
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I have been gone a while and am glad to return and read that you knew what you knew and that you did not buckle to bullying. I am especially glad to hear that your boy is doing well.

My sister's DS was forcibly retracted in an ER and I have been quite motivated to find a way to educate parents before they find themselves in the ER without knowing what to stand up for. I am so glad you knew where to draw the line. More work is needed to educate doctors to provide good medical care without insisting on damaging procedures when other methods are available.

Enjoy This Happy New Year
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#78 of 79 Old 01-04-2006, 08:57 PM
 
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YOU DID THE RIGHT THING NOT LETTING THE DR TOUCHING YOUR SON !!HOW IS HE NOW??IT'S AWFUL WHEN LITTLE ONES ARE SICK AND PARENTS FEEL SO HELPLESS WHEN WE CAN'T HELP THEM !!HOPE ALL IS WELL!!

Mom of 8 children 4 Boys : and 4 girls :2 dogs named Kibblez and Brook , sadly miss my Husband that passed 03/03/2007 !Trully Miss my Brother Joey that passed on 3/25/09..Sadly miss my dearest son T.J that passed 1/19/2014 forever in my heart!
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#79 of 79 Old 01-05-2006, 01:31 AM
 
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Originally Posted by Frankly Speaking
OK, maybe there is something here I'm misreading or just don't understand. In one breath you seem to be saying that the treatment must be immediate and in the other you seem to be saying to wait the 48 hours for a culture and additional time for the other tests. Which is it? How long would it take to test for antibiotic resistance? How would it be different if they bagged the child and found bacteria in a visual inspection and then went on to do a conventional cath or suprapubic aspiration? If there were some bacteria found in the bagged sample, why not a blood test to look for elevated white cells? What other simple tests could be and should be done to confirm the results of a single test? Regardless of what method of collection is used, if there is and elevated level of bacteria in the urine, it's going to show up. The only question is where did the bacteria come from? Did it come from the bladder or did it come from the (evil) foreskin? Clearly, with careful testing techniques and proper preparation methods, a bagged urine sample is at low risk of contamination. I suspect the real reason the bag collection technique is considered unreliable is because of sloppy techniques and procedures.

Well, it's both. If an infant has an infection one wants to catch it immediately and begin treatment. But the culture takes a while that's why you have the urine analysis. When the culture and sensitivities come back, one either discontinues the medication, continues, or switches to one that the bacteria is sensitive to.

The problem here really is three-fold:
(1) the urine analysis is a much less exact test than a urine culture. False positives and false negatives are fairly common.
(2) most bags are poorly designed. They touch the skin of the child as well allowing the urine to touch the skin. Unlike a cup or catheter sample where the stream is direct and does not touch skin.
(3) you have an infant with a fever of unknown origin who is much more suceptible to being overtaken by infection.

Things that can be done to reduce false negative or positives:
*Microscopic UA: which is urine analysis with a microscope, not a dip-stick
*Better bag design: there are some that have a spout at the bottom from which the urine can be taken, instead of pouring it back out the other way
*Thorough cleaning of the entire area that the bag will touch.

There is the possibility of a false negative on a UA where a child has an obstruction. Less invasive than a catheter would be to ask for a renal ultrasound of the child. This would help rule out obstruction, and one can visualize the bladder and kidneys to see if there is debris (which would be a sign of infection). It gives the ER doc a test to order, and it keeps them away from your baby's genitalia with sharp objects.

In fact based on my son's experience, I would say ask for an ultrasound before allowing them to cath especially if the bag sample came back positive.

Still clear as mud?
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