Tuberculosis (TB): Practice Essentials, Background, Pathophysiology
I Thought I Had A UTI, But It Was Bladder Cancer
Nicky Johnson never expected that working at a pharmacy would end up saving her life.
"If it hadn't been for the poster behind the counter that said 'if you've got blood in your pee, get it checked' I probably would have ignored it when one day I wiped and noticed a pink tinge. Instead I thought 'oh, that's different' – I wasn't on my period. Not long afterwards, it happened again.
"Because I was looking at that poster, day in, day out, I didn't dismiss it, even though it was such a tiny bit of blood. I spoke to my husband about it and he encouraged me to book an appointment with the doctor."
That was in 2018, when Nicky was just 48. Although Nicky knew it was important to get checked out, she didn't really know quite why – or what the blood could be a sign of.
"Cancer was not on my mind. I thought it might be something to do with my kidneys, as my dad died of kidney disease, but truly I didn't expect it to amount to anything. There was no pain, nothing to suggest it was urgent."
The GP confirmed there was blood in her urine, sent a sample off for analysis, and put Nicky on antibiotics in case it was a urinary infection. When the results came back clear of infection, Nicky was referred for a cystoscopy, a procedure during which a camera is inserted into the bladder through the urethra.
During this procedure, the screen was set up so that Nicky could see what the doctors were seeing, as it happened.
"I've never seen the inside of a bladder before, but when I saw mine, I thought 'that doesn't look right.' Everyone was quiet, and then the doctor said 'It's like a carpet…'
"I had multiple tumours carpeting the entire inside of my bladder. It looked really quite dramatic, like little bloody volcanoes. I left in a daze and just burst into tears."
Shortly afterwards, these tumours were officially diagnosed as an aggressive bladder cancer; Nicky was one of 10,500 patients in the UK who finds out they have this form of cancer every year.
It's a rising concern worldwide. By 2040, the annual number of new bladder cancers globally is projected to increase 72.8 per cent (since 2020), while deaths are expected to rise by 86.6 per cent in the same timeframe, according to a study published in the Journal of Global Health last year.
Although the UK is thankfully bucking that trend, with incidences dropping overall, experts say that bladder cancer is still a "Cinderella cancer" (left down in a cellar and nobody goes to look for it) often missed in its early stages because people are simply not familiar with the symptoms.
Improving awareness is crucial, as catching this disease early is key to improving survival rates – at present, there are around 5,500 bladder cancer deaths in the UK every year, or 15 every day, accounting for three per cent of all cancer deaths.
"People tend to associate cancer with lumps, but are much less likely to be aware that blood in the urine or a change in bladder habits can be symptoms of cancer too," says Dr Rachel Orritt, of Cancer Research UK. In the case of bladder cancer, they are often the only symptoms.
"Eight in 10 people with bladder cancer experience blood in the urine as a symptom," says Dr Orritt. "It can be red or brown, and may be there every time or can come and go. It's not usually painful. Other symptoms can include needing to urinate more often or more urgently than usual, or a burning sensation when you pass urine can also be a sign."
These symptoms are similar to those of a urine infection or cystitis, which many people – especially women – experience relatively frequently and can treat over-the-counter, so it's important not to self-diagnose or dismiss the symptoms even if you think it's just a minor illness you've had before.
However, women are far less likely to be diagnosed with bladder cancer than men, with men over the age of 85 most at risk.
The greatest risk factors for the disease are smoking, and long-term exposure to certain carcinogens – in particular aromatic amines and polyaromatic hydrocarbons, chemicals used in the plastic and chemical industries and sometimes produced using metal working fluids. These chemicals have been restricted or banned in the UK for some decades, although the cancer can take many years to develop.
The lining of the bladder is exposed to carcinogens from tobacco smoke or environmental sources when these toxins are excreted in urine. As a result, former factory workers and even hairdressers who worked with older hair dye ingredients which contained some of these toxins are between 16 and 35 per cent more likely to be diagnosed with this cancer.
Nicky, however, is unusual – a relatively young woman who has never knowingly worked with any of these chemicals, and doesn't smoke. "It just goes to show how incredibly important it is to be aware," she says. "When I first saw the consultant who later diagnosed me, he joked, saying I was far too young to be in his clinic. The next time I saw him he was far more serious."
For many people with bladder cancer, the tumours can be cut out and another treatment called BCG – a type of immunotherapy given directly into the bladder – will help prevent it returning, or treat it if it does. But the tumours found in the lining of both Nicky's bladder and, soon after, her urethra, were so aggressively cancerous the organs had to be removed altogether.
"I was numb with shock. You hear cancer and think: 'I'm going to die', but everyone reassured me that because it hadn't spread outside the lining, removing my bladder and urethra would sort it out."
The only option was to remove Nicky's bladder and reconstruct a new one using her bowel and appendix, creating a channel so she could urinate, via catheter, through her belly button – known as a Mitrofanoff procedure.
"It was hard recovering from the 13-hour operation; for seven weeks I had three urine bags attached to me while the internal pouch which had been made was healing,' says Nicky. "Once it had healed, I was able to dispense with the bags and instead catheterise four times a day through my bellybutton."
Painful and terrifying as all this was, Nicky is delighted by the procedure that saved her life. Recovery was long and hard, but her husband Mick and four children kept her spirits up each day. Now, she has no limitations, is back to work in a new pharmacy and swims in the sea regularly.
"I am eternally grateful to the hospital, to my appendix – my little hero, sitting there waiting to be used in a different way – and to Mick and everyone else who has been there to help protect me. Now I am just really keen that others know the signs and symptoms so they can be treated early in case something like this ever happens to them."
Cancer Research UK nurse helpline: If you or someone close to you have been affected by cancer and you've got questions, you can call Cancer Research UK nurses on freephone 0808 800 4040, Monday to Friday
Dr. Roach: Flare-up Of Osteoarthritis Occurs After A Urinary Tract Infection
Dr. Roach: I am a 75-year-old woman in generally good health. A couple of weeks ago, I woke up with an awful pain in my hand. Then I noticed hard bumps on my knuckles. Shortly thereafter, I was diagnosed with a UTI. Just as my antibiotics were finished, I came down with some kind of infection that caused a fever, headaches and body aches. One morning, I vomited bile.
As the fever subsided, I began experiencing pain in my neck, shoulders and back, which felt very much like arthritis. Can infections bring on a sudden flare-up of osteoarthritis (OA)? — P.T.
Answer: It sure sounds like the infections caused the flare-ups in your case, but the published data I could find on triggers of OA did not include infections. The most common cause of a flare-up is a higher-than-usual amount of exercise. Overdoing exercise caused flare-ups that were defined with elevated pain scores, but some studies also saw worsened swelling, stiffness and psychological effects, including sleep, mood and overall functioning.
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Other causes that can trigger flare-ups of OA include worsening mental health, knee or hip injuries, high-heeled shoes, and temperature changes in the environment.
Although OA is the most common cause of joint pain in older adults, there is a condition that can look just like OA, except it is much more likely to flare up. This is called calcium pyrophosphate deposition disease, or pseudogout. Flare-ups are caused by increased crystals inside the joint, and infections have clearly been indicated as a potential cause of a pseudogout flare-up.
A plain X-ray usually makes the diagnosis of pseudogout. This is one reason I make sure to get at least one set of X-rays in a person I suspect to have OA.
The "hard bumps" on your knuckles sound like Heberden's nodes, which are benign, bony abnormalities that are found with OA. However, it's certainly possible to have both OA and pseudogout, so a visit to your regular doctor or an expert (such as a rheumatologist, orthopedic surgeon or physiatrist) might be reasonable to confirm the diagnosis, as the treatment for pseudogout includes some additional treatments that aren't used for OA.
Dr. Roach: My spouse is 73 years old. He is planning on having a penile implant performed shortly. He is tired of giving himself penile shots for eight years since his prostate cancer surgery in 2016. Are there any significant concerns with this type of surgery? — J.S.
Answer: Even with the best experts, sexual problems after prostate cancer treatment, especially surgery, are common. Erectile dysfunction is probably the most common problem, but men may also have changes in ejaculatory function, orgasm, libido, and even the size and shape of their penis after surgery.
Many surgeons use medications like sildenafil (Viagra) to try to prevent irreversible changes to the penis after surgery. Unfortunately, this isn't 100% effective, and if oral treatments don't work, injections are often highly effective. This can be with one medicine (such as alprostadil) or a combination of them. Vacuum devices are another option.
If injections don't work (or, as your husband found, a man doesn't want to keep doing them), then a prosthesis is a very good option. The major concern with this surgery are infections, and current data show that the risk of infection is about 1%. The device can fail mechanically, with surgical revision needed in 5% to 15% of people over a seven-year span. The newest devices are more reliable than earlier models. Patient satisfaction rates are above 90%.
Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Common Condition Warning Over Symptom That Can Happen Eight Times A Day
It could cause serious health issues (Image: Getty)Individuals with a common condition may experience a particular symptom up to eight times daily. But while they should seek medical assistance it is often ignored.
In August there were more than 37,000 Google searches for 'cystitis' in the UK. As well as this, a LloydsPharmacy Online Doctor survey of 500 individuals found that 33 percent had ignored early cystitis symptoms.
Health professionals warn that while cystitis may resolve on its own, neglecting its symptoms can lead to kidney infections, potentially causing permanent kidney damage. In extreme cases, this can result in severe consequences.
To help people cope with the symptoms and what to do, Dr Bhavini Shah, a GP from LloydsPharmacy Online Doctor, explains the symptoms, treatments, and prevention options for cystitis patients. Here is what you need to know.
What is cystitis?Cystitis is a condition that starts with inflammation in the bladder and is usually caused by a urinary tract infection (UTI). It is most likely to occur in women, but it can affect anyone of any age. Some people suffer from cystitis a lot more than others, which could indicate the need for they may need regular and long-term treatment to help with symptoms.
What are the symptoms of cystitis?The most common symptom of cystitis is the frequent urge to urinate, even if you have recently emptied your bladder. For most people, it's normal to urinate between four and eight times a day.
Other symptoms include:
Symptoms of a mild urinary tract infection (UTI) can often resolve themselves within a few days. It's recommended to drink plenty of water and refrain from sexual activity during this time. Over-the-counter pain relievers may help ease any pain or discomfort. Cystitis usually responds to a three-day course of a prescribed medication called Nitrofurantoin.
How do I prevent cystitis?To reduce the risk of cystitis, it's advised to avoid scented soaps or strong chemicals for washing the genital area, and to wear breathable, cotton underwear. It's important to urinate right after sex and to opt for showers over baths. While cystitis sachets or cranberry drinks may help prevent cystitis, there is no proven evidence that they alleviate symptoms once an infection has begun. For those with a catheter, regular cleaning of the tube is essential to avoid infections.
How can cystitis affect men?In the UK, 20 percent of urinary tract infection (UTI) cases occur in men. UTIs are uncommon in men under 50, with age being a significant risk factor. In men, UTIs may result from diabetes or conditions that affect the bladder or kidneys. An obstruction in the urinary tract, like an enlarged prostate, can also lead to UTIs in older men. Not having sex is advised during cystitis treatment to avoid introducing new bacteria.
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