Frequent urinary tract infections (UTIs) can affect your overall health and wellness. Amber Stephens, MD from Optum - Main discusses how you can decrease your chances of developing a urinary tract infection.
Aug. 14, 2024
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Podcast transcript
INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well being. And now, here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Thank you so much for joining us today on the award winning Docs in a Pod. We're available on radio in Texas and Florida cities. Also available 24-seven wherever you get your podcasts, just look for Docs in a Pod. Our special co-host today, who is just a wonderful, wonderful participant, Dr. Tamika Perry is with us. As many of you know, Dr. Perry is an associate medical director at WellMed and oversees large clinics in the Optum Care North Texas region. She's at the Redbird Clinic outside of Dallas. Dr. Perry earned her undergraduate degree from Prairie View A&M University. Went on to graduate from the Philadelphia College of Osteopathic Medicine, where she was a National Health Service Corps Scholar. She also is board certified by the American Osteopathic Board of Family Physicians. She also has a master's degree in public health with an emphasis in health management and policy. Dr. Perry also is a diplomat of the American Board of Obesity Medicine. She has recently returned from Thailand. She and her daughter make it a habit of visiting all kinds of places around the world. Next stop for Dr. Perry, Chile and Antarctica. Dr. Perry, send us a postcard.
DR. TAMIKA PERRY
I will. I'm going to send you a postcard. Actually, I'm going to send you my selfie because my goal is just to get off the boat, take the selfie so my iPhone knows I was there so when I can look through my photos and go, look where I've been.
RON AARON
Youre talking about Antarctica, right?
DR. TAMIKA PERRY
Yes, absolutely Antarctica.
RON AARON
We will geo locate you there. That's pretty cool.
DR. TAMIKA PERRY
Yes, absolutely. Thailand was super cool. I actually rode elephants when I was there.
RON AARON
Really?
DR. TAMIKA PERRY
Yeah, I didn't know elephants have these kind of course, stiff little hairs that are on them so we had to wear these special pants. Otherwise, they would have got you. But and elephants are very, very intelligent animals. They kind of have a mind of their own. So, my elephant, she wanted to stop every now and then she didn't want to follow the line. She wanted to have some snacks because clearly, she was the boss in that situation. I said, girl, do your thing. Just let us just get to our destination safely.
RON AARON
I love how immediately possessive you became. My elephant.
DR. TAMIKA PERRY
Yeah. My elephant. We bonded.
RON AARON
Well, one of the topics we're taking up today is one that we probably don't talk about enough and that's UTIs, urinary tract infections, in older adults. Im assuming Dr. Perry; you see it in your practice.
DR. TAMIKA PERRY
I do. Every single day. As Dr. Stephens will tell us, regular UTIs can actually have pretty negative sequelae or consequences.
RON AARON
Well, we're going to talk with Dr. Amber Stephens. She's been on Docs in a Pod before, is a great guest. She is a board certified family medicine physician. Earned her medical degree from Drexel University College of Medicine in Philadelphia. Same place that Dr. Perry got her degree in osteopathic medicine. Different school. She completed her residency at Bayfront Family Medicine in St. Petersburg, Florida. Dr. Stephens is affiliated with Optum - Main Clinic. She's married, has two kids, two dogs, two cats, and a bearded dragon. While the bio here says 40, it's now 50 new baby snakes. Loves being a baseball mom and does a lot of media education presentations for Optum. We are always delighted, Dr. Stephens, to have you with us. Welcome aboard. Glad to have you. Why UTIs? Why are they so prevalent? And what is it?
DR. AMBER STEPHENS
Well, thank you so much for having me again. It's always fun to be here. UTIs are substantially more prevalent in the older population for several reasons. One, symptoms are less recognized and they tend to present differently than they do in younger populations. Because of that, they can run their course much faster or even differently, so they will cause other problems. They can cause mental status changes. People can get very sick very quickly. So, it is something that we need to address in an appropriate time frame and in an appropriate fashion.
RON AARON
When we hear UTI, I think we often think of women. Do men get them, too?
DR. AMBER STEPHENS
Absolutely. It is less common. The most common bacteria for urinary tract infections comes from the gastrointestinal tract. In general, women have less space between the urethra and the anus, so they are more likely to get these infections just by sheer anatomy. But men most definitely do get these infections as well.
RON AARON
You were talking about some of the problems that a UTI can cause. I mentioned to you off the air, I've got a good friend whose mother, now deceased, but was repeatedly hit by UTIs, very often under and very poorly diagnosed. Often brought about symptoms of dementia and delusions and all kinds of issues which were very troubling. But what I heard you say is that's not unusual.
DR. AMBER STEPHENS
It's not unusual. Mental status changes is something we see frequently in the older population. I have had conversations with patients where they say I'm not having urinary tract symptoms. I don't have any problems with burning or frequency, which most people have heard of urinary tract infections, they're thinking of those things. The reality, though, is the problem is that they're confused, they're disoriented, they're not sure exactly where they are, or they're getting lost or whatever it is, their mental status is not there. You used the term delusions, which that's got a little different connotation for us, the medical field, where it's more of that fixed false beliefs or they're seeing things that aren't there. It can be hallucinations, and that can come along as well. But what I see a lot of is confusion and just decompensation where patients who normally could take care of themselves all of a sudden can't take care of themselves. Incontinence is frequent so that sometimes is even a trigger for some people that that's a problem that's happening.
RON AARON
We're going to come right back to you, but I want to let folks know who may have just joined us. You're listening to the award winning Docs in a Pod. I'm Ron Aaron. Our co-host, Dr. Tameka Perry is with us and we're talking as well with Dr. Amber Stephens. You find her down in the great state of Florida, where she practices. We're talking about UTIs, urinary tract infections. I'm assuming Dr. Stephens; they are easily treatable once you diagnose them.
DR. AMBER STEPHENS
Most of the time, yes. As soon as you make a diagnosis, which for the most part is not difficult to do in an office environment. You can get someone started on antibiotics and you can correct the situation fairly quickly. Where it becomes more complicated is when patients are unaware of what's happening and the illness is allowed to progress. They can become septic, end up needing hospitalization. You can end up with scarring and damage and sometimes it's more complicated than that. Sometimes there's kidney stones, there's anatomic issues that are at play. Menopausal women are more common because there's the estrogen is different and they are more prone to having problems. So, it is straightforward, but it's not at the same time. That's where having a really good conversation with your doctor with any concerns plays an important role.
RON AARON
Tamika, are patients forthcoming when they indicate what could be symptoms of a UTI?
DR. TAMIKA PERRY
I think in the case of a UTI, anecdotally for me, it's not that they're not forthcoming, but like Amber stated earlier, they may be unaware that these are symptoms of a UTI. That's where a good relationship with your PCP comes into play. Because if you give them all the clues, because most certainly you know what's going on with your body, right? You know there's something going on. So, give your PCP those clues and it's our job to put those clues together plus the science we've learned and come up with a diagnosis. It's also important that if you call your doctor's office and say X, Y, and Z is wrong and Amber and I make a diagnosis. Give treatment and if in a few days you don't feel any better or symptoms getting worse, please call back. Because let's just say you had a little bit of blood in the urine. You said I can't really come in; I think it's a UTI. We treat you and it doesn't get better, you need to let us know, even if it doesn't resolve totally because it could be renal cancer, kidney cancer. There's a lot of other things that can go along with that. So, follow up is so important, particularly when it comes to a UTI.
RON AARON
The other thing, Amber, that I'm often aware of, simply because a spouse is telling me, if you get a UTI and you get antibiotics, you then run the risk of a yeast infection.
DR. AMBER STEPHENS
Yes, definitely more so in women and honestly, even in diabetic patients, that's more common. Diabetic patients are more likely to develop urinary tract infections anyway, because especially if they're not real well controlled, they're going to be urinating some sugar, which is going to kind of feed different pathogens or different items down there.
RON AARON
If I'm a bacteria, I love that sugar, right?
DR. AMBER STEPHENS
Yep.
RON AARON
Keep bringing it on.
DR. AMBER STEPHENS
But absolutely when you get the antibiotics, you're killing off some of that good bacteria and now you're left with often a yeast overgrowth. So, it's not uncommon, unfortunately.
RON AARON
How do you treat yeast infection?
DR. AMBER STEPHENS
I usually recommend an over the counter three-day program for a lot of patients. There's also a tablet that can be prescribed depending on the patient and the medications they're on, et cetera. But that's not usually difficult to manage.
RON AARON
Now I've seen some television ads, a young woman and apparently her spouse, who say, I used to have UTIs all the time and then I have developed this liquid, and you drink it, you'll never get a UTI again. Of course, you run the risk then of people self-medicating.
DR. TAMIKA PERRY
Yeah, absolutely. I don't know about never again, but there are most certainly things that we can do to help the health of our bladder, right? We want to drink lots of water. Cranberry juice kind of makes the pH and the acidity of the urine non-conducive to bacteria in the bladder. We're talking about pure cranberry juice, not like cran grape, you know what I mean? We want the stuff like that's kind of bitter, but most certainly lots of water. I cannot emphasize the importance again of having that relationship with your PCP to be able to tell them, hey, something's going on with me.
RON AARON
So, if the juice puckers up your lips, it's the right acidity?
DR. TAMIKA PERRY
That's probably the one you want.
RON AARON
Now would you recommend on a daily basis that people drink some unsweetened sugar free cranberry juice?
DR. TAMIKA PERRY
I would recommend on a daily basis people drink water.
DR. AMBER STEPHENS
Yeah, hydrate.
RON AARON
Yeah. How much water should we drink? I drink a ton of water.
DR. TAMIKA PERRY
This question is like the question throughout time. I think the best medical answer that I have ever gotten is that you want to look at your urine. Now, of course there's some caveats to this. If you have chronic kidney disease, if you have CHF, I want you to speak with your PCP, but generally you want your urine to be clear, almost like water, so just a hint of a color, a hint of an odor. Anything more than that, more color, more odor, you probably need to drink more water.
RON AARON
I've seen in some physician's offices a chart in the bathroom showing the various colors of urine and a sign that says, here's where you want to be.
DR. TAMIKA PERRY
Right, correct. Amber, what do you suggest for your patients?
DR. AMBER STEPHENS
I would say for most people, I tell them, don't wait until you're thirsty. If you're waiting until you're thirsty, you're already behind. We do talk about the, you want that light yellow, very, very light yellow color to the urine. Here in Florida, and I know in San Antonio, a lot of other places, it's very hot. So, like I said, not waiting till you're thirsty. Depending on the patient and the health issues, sometimes we're even talking about extra hydration just to make sure that we're not getting behind in other ways as well.
RON AARON
All right, stay with us. We're going to come right back to both of you. I'm Ron Aaron. You're listening to the award winning Docs in a Pod, available on podcast wherever you get your podcasts and on the radio as well in number of markets in Texas and Florida. Our co-host, Dr. Tamika Perry is with us and our special guest, Dr. Amber Stephens. We're talking about UTIs, urinary tract infections. You're listening to Docs in a Pod.
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RON AARON
Thank you so much for sticking with us right here on the award winning Docs in a Pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, and we're talking with Dr. Amber Stephens. Dr. Stephens and Dr. Perry and I have been talking about urinary tract infections, how they're diagnosed, how they're treated, and the bottom line is your PCP and you ought to have a partnership that you're comfortable going to them if you think you may have a problem or lay out the symptoms and they can help diagnose it. Dr. Stephens, what are some of the other bladder-related urinary tract issues that men and women ought to be aware of?
DR. AMBER STEPHENS
I would say let's start with things that can mimic urinary tract infections, vaginal infections. Like we mentioned yeast infections before the break. Sometimes that can cause burning and irritation so women will sometimes mistake that, occasionally men as well, if they're having issues with a yeast infection along the penis.
RON AARON
So, bottom line. When you pee, man or woman, it shouldn't burn.
DR. AMBER STEPHENS
Should never burn, please. Also, STDs. While I know we're talking about older populations, that's not unheard of or uncommon. Sexually transmitted diseases can mimic as well and chronic prostatitis or acute prostatitis in men can also give similar sensations and cause some urinary symptoms.
RON AARON
In fact, the center for disease control recently put out a statement about the incredible rapid increase in STDs among older people.
DR. TAMIKA PERRY
Thank you, Viagra.
RON AARON
Because they figure, I can't get pregnant. Why do we have to use a condom?
DR. TAMIKA PERRY
Now that some of that vitality has been restored with Viagra, Cialis, you know what I mean? You guys brought up a very, very valid point. Once upon a time in my career, I had an 82-year-old who we were talking to very candidly. She says, Dr. Perry, I have some questions to ask you. I'm a little embarrassed. I may be 82, but I still have relations. And I was like great, relations are great exercise. Lets talk about your concerns. These were some of her concerns, like, what do I look for? What are some of the symptoms? Like Dr. Stephens said, some of the symptoms of STDs can mimic a UTI, so it is important that you inform your provider. It is important that your provider asks if you're having UTI symptoms, are you sexually active?
DR. AMBER STEPHENS
Absolutely. Along the same line too, especially in women, urinating after intercourse is one of the things you can do to prevent a urinary tract infection.
DR. TAMIKA PERRY
Absolutely.
RON AARON
Why?
DR. AMBER STEPHENS
Because it flushes the pipes for lack of a better way of putting it. When you have intercourse, there's a lot of friction in an area that's very close to where the bacteria are coming from. It's not hard for that to get pushed into the urethra to develop a urinary tract infection if it's allowed to sit and fester.
RON AARON
So, flush it out?
DR. AMBER STEPHENS
Flush it out, yeah. That's a great preventative to urinate after intercourse or honestly, any kind of stimulation in that area just to make sure that we're not inoculating the bacteria into the urethra.
RON AARON
Dr. Perry, do you talk with your patients about that?
DR. TAMIKA PERRY
I do. I do. There are several routes of inoculation and that's implanting bacteria where it probably wouldn't normally plant it. There are several routes, especially during sexual activity. So, we do go over those different routes and what you can do to prevent that unnecessary inoculation from happening.
RON AARON
Have we developed newer, better antibiotics, or are the old antibiotics still the standby?
DR. AMBER STEPHENS
I mean, I still use a lot of old antibiotics to treat urinary tract infections with fairly good results. I'm not going to list anything off because that's going to be patient specific but there are newer things that are out there for sure. You don't necessarily always want to throw what's newer at something if the older is going to work just fine. You're asking for allergies, not to mention increased costs and frankly, a lot of those newer drugs are going to be your IV antibiotics that are going to be presented at the level of the hospital anyway. So, I would say most of us are using generic meds that have been around for 20, 30, 40 years or longer with great results.
RON AARON
IV antibiotics, if they have to be hospital-based administered, has to drive the cost up.
DR. AMBER STEPHENS
Well, tremendously, yeah. I mean, we don't want anybody to get admitted to the hospital for any reason, but an admission in general is going to be very expensive.
DR. TAMIKA PERRY
Especially when you could have gotten a 4 or 5 dollar antibiotic to prevent the hospitalization to begin with. Like she said earlier, most of it comes from a bacteria in the GI tract and we kind of know which antibiotics are going to work to throw out that bacteria. We also quite often will get a culture and sensitivity, and it tells us exactly which antibiotics work against that UTI. So, if we didn't hit it on the nail on the head the first time, we still got a chance.
DR. AMBER STEPHENS
Right. That's why I really push to have my patients come in and give me that urine sample before they get their antibiotics because if you take even one dose of an antibiotic before you provide that sample to send off for culture, that culture is going to most likely come back negative. Then if the antibiotic isn't working, you don't really know what you're doing. It's hard to make good clinical decisions without all the information.
DR. TAMIKA PERRY
Yes.
RON AARON
What about taking antibiotics prophylactically? Folks say, I've been going down to Mexico and buying a lot of penicillin. I just pop those pills and I'm not going to have a problem.
DR. AMBER STEPHENS
There's a role for prophylactic antibiotic use and it's for somebody who has had frequent urinary tract infections, has had an appropriate workup to rule out or rule in anatomical issues and other problems at play. There are different ways to do that and obviously a discussion to be had with a primary care doctor or even a urologist for that matter. Sometimes women will take antibiotics after intercourse, sometimes they take something several times a week, sometimes it's every day. It depends on what the medication is and what the situation is, but that is not a recommended route to take on your own. That is something that we do after we've tried everything else and we're not getting what we need.
RON AARON
If you do that, do the little bugs hanging out in your body become resistant over time to those antibiotics?
DR. TAMIKA PERRY
Yes. Bacteria are smart little guys. They go, oh, okay, this is how you're trying to kill me. Let me just change myself around a little bit so the antibiotic doesn't work against me anymore. That's exactly what happens. Antibiotics aren't necessarily benign. That's why they're not over the counter. I would recommend against going somewhere, ordering from a different country, going to a different country, buying antibiotics, and just taking them daily. Let me repeat this. Dr. Stephens and I advise against that.
DR. AMBER STEPHENS
Amen.
RON AARON
I guess part of the challenge is, are your patients being open and honest with you about what they're taking. They're asked when they visit their PCP to bring all the medications in and maybe they leave on the shelf at home that antibiotic they've been squirreling away.
DR. TAMIKA PERRY
You're absolutely right, but you have to have that open, honest relationship with your PCP.
DR. AMBER STEPHENS
I love to say that people are always honest, but we know that's probably not the case. The other reality is that a lot of people will get antibiotics for something else and not doing what they're told won't finish the whole thing and squirrel away a couple of days worth. Then when they get sick or have a problem, they'll take it. Not realizing that maybe that antibiotic they had for a sinus infection is really not going to do anything for that UTI, but they've just made it a lot harder for me to treat that UTI.
RON AARON
That's really interesting. So, self-diagnosis and Dr. Google may not be the best advice?
DR. TAMIKA PERRY
Dr. Google cannot compete with our years of school and hard study.
DR. AMBER STEPHENS
And just plain experience and education.
RON AARON
Now, before we let you go, you touched earlier on how a UTI and a yeast infection may trigger incontinence, which I know a lot of folks will talk about. How, do you treat urinary incontinence, Dr. Stephens?
DR. AMBER STEPHENS
Well, I think the first thing to consider is we have to know why it's happening. If someone has a new-onset urinary incontinence, I'm going to be asking them, when did this start? Do we have any other symptoms that are going on with it? I will usually check a urine in the office and then maybe even send it for culture, depending on what I'm seeing. I want to make sure there's no infection because that's frankly the easiest thing to treat if that's what the cause is. Other things that can cause incontinence that are probably far more common are things like pelvic floor weaknesses, which we see particularly in women who've had a lot of babies or maybe even one or two babies, if they never really rehabbed the pelvic floor, or if they were even a little bit older when they had those babies, sometimes it just doesn't want to go back the way it was before. Working with them on those aspects. There are medications for incontinence if it's urgency based, but there's risk to those and a lot of side effects. That's really not something I love to utilize if we can avoid it. Then there's some other issues like neurological issues that can be contributing factors. But you're looking at that more as an exclusion and not something that you're assuming right away is the problem.
RON AARON
Is the diagnostic path similar in men and women?
DR. AMBER STEPHENS
It's similar on that respect. You're still going to be ruling out infection. You're going to be looking at, is there something neurological going on? Obviously, men do not have babies. Biological men do not have babies. So, there's that element that's not contributing, but I have seen men with pelvic floor weakness before for different reasons, straining, hernias, et cetera. It's not as common, but it happens.
RON AARON
Well, we are flat out of time, and I want to thank you again, Dr. Stephens for being with us. We hope to have you back again, and I'm sure we will. Dr. Amber Stephens. To our co-host, Dr. Tamika Perry, thank you so much. Thank you all for joining us today on the award winning Docs in a Pod. I'm Ron Aaron. We'll talk with you soon.
OUTRO
Executive Producers for Docs in a Pod are Dan Calderon and Lia Medrano. Associate Producers Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. We welcome your emails with suggestions and comments on this program at radio@wellmed.net. And be sure to listen next week to Docs in a Pod presented by WellMed.
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This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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