Urology Revisit: The Good and the Bad

( Edited)

Went back to the urologist today. Good news and bad news. I'll start with the bad and end on the positive?

For starters, she is VERY nice, not the issue. Also, Mark came in with me to ask his own questions and observe and keep from from rambling when I get nervous.

The Bad:

I explained the symptoms I was still having and said that just last night, I turned a corner with the fever, so maybe the nitrofurantoin was finally working on its finally day-and-a-half, and that tends to be how it goes with nitrofurantoin and me.

Her: "I didn't put you on nitrofurantoin, did I? I put you on doxycycline as a trial while waiting for the culture results."

 

Me: "Mm hm, but after completing it, I called, the culture results were back, and you prescribed nitrofurantoin."

 

Her: "I did? After the doxy? (in other words, second-line)?"

 

Me: "Mm hmm.That's what the bottle says, at least lol."

 

Her: "Let me just check my notes. I did, hmm. Well, the culture did say it was susceptible, I guess. But you'd already failed a first trial. Well, let's see what the urinalysis says now."

The urine dip was clear except for moderate blood. 

 

Her: "I'm not going to send for a culture because it's clear and let's just finish the last day of antibiotics and see because we don't want to increase antibiotic resistance."

Sigh. 

You know what else doesn't help antibiotic resistance?

The trial-and-error guinea-pig method with antibiotics that have been proven to not work for, or I need second round of it, OR just takes an extraordinarily long time to work because they're weak and only supposed to be used first line. 

But I was good, I didn't push. I just smiled and joked around, conceded to their authority, like I do.

The last thing anyone wants or needs is for me to go all Karen 😂

 

Me: "Okay, maybe the nitro is finally getting it, as of last night. For me, for whatever reason, my weird body chemistry, nitro just doesn't seem to cut it, and if it does, it takes a long time. If I still have symptoms in about a week, okay if I come back in?"

 

Her: "Absolutely. Have you tried estrogen cream?"

 

Me: "Yep, you prescribed it a few weeks ago. I had previously gotten it from my OB/GYN, but ran out and was dealing with the accident."

Sigh.

She didn't even know what treatment had been tried and she had prescribed or why.

Again, I said nothing, smiled and joked like I always do, but I'm saying what I really think about that on here ... 

Providers? I know you have quotas and are busy, but can you please read your notes about my history BEFORE you enter the room, please? It saves us both time. Thank you!"

Also, see prior posts below about trying to get estrogen cream from this urology office 2 years ago, finally getting it from my GYN.

She even said "New studies have told us more about this."

Hahaha! 😂😂😂

Like I said, these studies came out a few years ago, and I asked about them at this office 2 years ago -  but I didn't say anything, I was good.

PLUS she DID tell me something I didn't know about that, which leads me to the good ...

The Good:

There's actually a new term/diagnosis for the condition which causes frequent/chronic post-menopausal UTIs as a result of the aforementioned studies called "genitourinary syndrome."

Essentially, it means that as a result of these studies, we have learned that both vagina AND the urethra become de-estrogenized after menopause, causing relaxation of tissue in both areas. 

Urologically, condition is what is making post-menopausal women more susceptible to UTIs.

It was long suspected, but only proven a few years ago.

Also - though I had asked the urologist about this last year - it explains why sometimes I get "stingy" down there even when I don't have a UTI.

At the time, he had no idea.

Now, they've finally accepted the studies (that I mentioned 2 years ago!), trynna act like I didn't. 😂

Anyway, what this means for me is, if I DO get a UTI, I'm going to continue to feel it, long after it's gone, to include blood in the urine, stinging/burning, and perhaps even a low-grade fever even after the urine is clear.

Otherwise, Mark asked his own question, which was "Is there any way her blunt force trauma to the abdomen is playing a role, here?"

She said "No, because she's had 2 CT scans bladder injury would've show up on at least one of them."

Fair, that makes  - I considered that and agree with that, actually, but nice to have it confirmed.

Then she said "I think what's gone on here is that she ran out of her estrogen cream and was unable to get back to her GYN and get more because of the accident, and as she said, her immune system is overwhelmed, right now, and it's not going to help her immune system to load her down with three rounds of antibiotics, and in fact, might make it worse, and leads to resistance."

Well, okay, but if I DO need another round - either because the current bacteria was masked due to current antibiotic use - OR - because I get a subsequent UTI with a different bacteria (which HAS happened before; in 2025, I got 3 UTIs back-to-back with 3 different bacteria) - then I will, regardless.

But of course, I didn't say that, just thought it.

Then afterwards, Mark said this to me:

"Okay, so I see the problem, it's the same as with our PCP.  It's not your nervous rambling, which isn't as bad as you think. And if anything, you're STILL too nice and apologize like every 5 seconds!"

"The problem is - you're catching them off guard. They don't expect patients to be as informed as you are and that level of a questioning. They mostly just deal with questions about how to take their meds, etc."

"I could see it on her face, just like I can Dr. M.  They're surprised you know about these things. So even though you're not meaning to, you catch them off guard because they don't expect you to be so informed  You're not TRYING to challenge them or embarrass them, you're just asking an intelligent question." 

"Some doctors love that, others take that personally and get defensive. Dr. M does is like that, too, with BOTH of us.  Others, like your neurosurgeon or Hamburg ER physicians, don't. "

"Some people just don't like to be questioned, even with sugar on top, ESPECIALLY doctors. It's like they take it as criticism rather than what actually is, just asking for clarification to better understand their rationale or about new studies to see if they apply to you and why/why not. Never ME, of course, I'm never like that. 😂 "

I laughed because, well, he's indirectly, but openly, recognizing that he is one of those people that tends to lean towards arrogance and gets a littttle defensive if people ask him a simple question - albeit sarcastically 😂

Not just me, anybody - and we've figured out what that's about. Whenever anybody asks him for clarification or what his rationale was, he takes it as criticism, when it isn't - it's people asking him for clarification and rationale, just to gain better understanding, BEFORE they place judgment.

Thus, hmm, may be true.

Here, I'm looking for ways to blame myself every time, but also scratching my head in frustration when I can't figure it out and things still don't make sense and I'm not getting the answers I need.

And the part of that I can control in that is ...

To accept that sometimes I'm not going to get the answers I need and it's okay. 

Other times, it's not okay, like when I'm still not better after treatment. 

As long as I'm kind as can be when I ask my questions, the rest is on them if they feel challenged or defensive, right?

Sound good?

Okay, let's go with that 😂

So the plan is to get referred to Baptist Health Urology by my new PCP when I see her in January. If I get another one before then, I will go back here.

Because when you're years ahead of your provider on the latest studies, Houston, we have a problem.

BTW, the reason I'm ahead isn't because I'm some hypochondriac who reads up on everything just for fun- it's because of my former job.

Not just being a medical transcriptionist for all medical disciplines (though it helps), but because my last contract gig for the last 6 years - before we were replaced by to AI last year.

I transcribed the interviews between major pharmaceutical companies and key-opinion-leader providers and insurance companies before new product launches. 

Thus, I have seen hundreds of newer clinical studies on many conditions and heard them debated. 

With regard to urology, I found out about the latests studies on chronic UTIs in postmenopausal women because there was discussion about a new vaccine currently in trial for women with UTIs that was mentioned briefly, as part of another discussion.

In fact, I still have subscriptions to peer-reviewed medical journals and get key email updates for new items, and occasionally I look at them if they're relevant to conditions people I know have or if they're breakthrough treatments for any disease state.

Regardless, from what my mom said about her urologist, he is up on these things, including doing a PCR assay if the bacteria isn't showing on urine dip or even culture but there are clear symptoms.

In the meantime, if not completely better a week after second round of antibiotics, I will come back and see this office (or if I have a new one).

Sheesh, all's well that ends well, I guess?