Management of The Problem:

Several steps are taken to manage the problem. They start with the bowel routine to ensure regular movements (as much as possible).

Catheterization was performed on a regular basis to get control of the situation and ensure the bladder was expanding normally and reduce the pain experienced by Katie when her bladder would not expand and subsequently could not empty because the sphincter muscle would not open when necessary. When output is noticeably reduced in the diaper, we started measuring the output by weighing the diapers. Results of catherization were also measured to determine output, and ensure complete eviction of the urine and thereby reduce the chance of normally sterile urine becoming infected in her bladder. The need for catheterization is signaled to caregivers by Katie through visual signs such as grimacing or screaming. Katie will settle once she perceives the procedure of catheterizing is being started.

Ditrapan was given 3 times a day to maintain bladder expansion. Monitoring of the output was also done to ensure the bladder is not constricting. In the event that catheterization produces results larger than 300cc, Ditrapan is cut back. When on Ditrapan, Katie’s ability to express on her own is reduced and often catheterizing is the only way to provide relief. This ties in to the overall state of the bladder. When the bladder is irritated (yeast infection?) there is less ability to urinate on her own, and a greater need for the ditrapan.

Recently the Toronto Hospital for Sick Children suggested that we begin irrigating her bladder with saline solution to reduce the possibility of infections starting and traveling to the kidneys. This procedure is similar to catheterization and was performed three times a day along with the catheterization process. The quantity of water injected in this method is measured to again see how much can be tolerated before it is expelled by Katie. There appears to be no discomfort in this process. This is another measure as to how the bladder is functioning. When it is in stress, there is less it will tolerate before expelling the water around the catheter. The one modification to this procedure that we made was to change saline water for distilled water. This was done after trying saline water to find Katie became extremely agitated and started screaming her displeasure. With distilled water that did not happened even once. This again pointed us in the direction of an underlying yeast problem that had irritated her bladder.

Once the problem was controlled it became obvious that Katie inflicted many symptoms upon herself in her attempt to stop the pain she was feeling. We believe that with yeast infections there came an irritation of the membranes around the uretha. This could be seen as brighter red inflammed areas. Katie prevented herself from voiding in order not to further irritate these inflamed areas that must have been extremely sensitive. The results made her appear to have a valve and bladder problem. By catheterizing for a period and controlling the yeast problem, Katie developed the confidence to void on her own when appropriate. We still need to watch for irritation from yeast infections, as Katie will start to hold back on voiding. The two problems go hand in hand and are complicated by her incontinence.

Medications given as a prophylactic are Septra and Macrodantin. Both of these antibiotics have side affects most pronounced in her bowel movements. We have reduced this to one Septra tablet daily and no UTI’s for over two years. Part of this success has been attributed to the reduction in sugar intake, strict procedures and the addition of garlic tablets 4 times a day. Garlic has also seen the improvement in her general health, noticeably fewer colds and infections

Candida (Yeast Infections)

Kidney Infections - the treatment

Hospitalization of Katie and the administration of Intravenous antibiotics have been the solution to date. Both Gentamicin and Amphocylin have been the drugs used in combination. The treatment lasts for a week. Katie slowly recovers and is started on water and slowly transferred to feeds at a slow speed. This process then sees Katie seemingly go from bad to good and then worse again. This is due to the fact that her bowels are shut down and have to start up again. Why this happens is not clear to us. Usually there is a hard plug that eventually comes out followed by diarrhea. This process seems to repeat after each lengthy illness.

The strong treatment of antibiotics helps the yeast get out of control and hence a vicious cycle starts. Knowing this helps in planning her recovery and reduce the period of discomfort.