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Marylin Asked August 2019

UTI symptoms but UA is not showing positive. Timing for meds is horrible. What next?

Mom has been suffering with razor sharp pain, frequent urination, & no sleep. Refused walk-in clinic (I offered because she hates NP's). LPN at Assisted Living finally ordered UA, NP visited, & antibiotics prescribed but not getting them due to the pharmacy order coming in 3 days later. Not sure between what mom says & what LPN is passing off as NP's fault what the exact timing is. But, I feel that from Tuesday to Friday, someone should've stepped up by now. Mom is not ever happy there but this situation has caused her to blame more inadequacies on AL & to explode again on me as her POA. LPN says it's the NP's ordering meds from pharmacy outta town that AL uses & NP blames LPN at facility. Am I being overbearing to expect the faculty that gets $120 per day to get mom some immediate relief? I think I know the answer, so here's another question: if the culture has been tested twice (because it has to grow), is it likely going to? And, what else could it be on an 89 year old who's had a hysterectomy & has no discharge?
I had finally learned to cope with mom, had her understand no more drama, but today she went off bringing up all the crap again. I know uti's are hell but I'm saddened over all this. Any advice?

Laura007 Aug 2019
If the UA comes back negative she may have something else going on. Another possible cause of pain in the bladder and urgency is Interstitial Cystitis, which is actually aggravated by acidic drinks like cranberry juice.
It seems unreasonable for them to sit back and wait while this woman suffers. If they keep passing the buck you may have to either demand that they take action to help her or you can take her to the ER.
Marylin Aug 2019
Git an email today from her NP that she doesn't have a UTI. She finished her meds Wed morning, not certain what they were but some antibiotic that mom said was bitter & big.
NP says it's dryness. Told her to use coconut oil 2-3 times daily. If still continues, she'll refer her to a urologist.
NP offered to examine her, but my mom refused.
There is not an RN at ALF, just an LPN.
LPN stays in constant contact with NP who makes rounds each Thursday.
Tothill Aug 2019
Marylin, my heart goes out to you and your Mum. You need to go higher up at the facility. It is unconscionable that your mother has to wait for days for an Rx for an active infection.

There must be an ombudsman there you can speak to and lay a formal complaint.

2 years ago there was a great article in the Guardian about chronic UTIs. You may be able to Google it. The gist of the article was that instead of culturing the pee sample, it must be examined under a microscope immediately, as in fresh while in the office. This is the old fashioned way of checking for a UTI, but not commonly used now. The second point of the article referred to chronic UTIs and best practices for treating them.

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JoAnn29 Aug 2019
First, the NP needs to be aware that Mom now uses the AL pharmacy for her prescriptions. The NP just hands the prescription to the RN at the facility. The RN then sends it to the pharmacy the facility uses.

Be aware that an NP is close to a doctor. You have ur CNA, no medical background. An LPN with limitations on what she can do but does have medical background. RNs are the next tier, more schooling than an LPN. Usually an associates or BA degree. Then you have a NP that goes thru lots more training and has a Masters or even a Doctorate.

I agree, get Mom to the ER. Have them catherized to get all the urine out. They should do a culture but will probably put her on a broad spectrum antibiotic to start with. She should have a probiotic while on antibiotics. A cranberry pill (no juices because of the sugar) may help.
Marylin Aug 2019
I emailed NP as to the 3-day delay in medication. NP said LPN orders meds, so ask her. LPN told me to ask NP. It's a cycle to pass the buck. I don't believe it's humane to ask an 89 year old to suffer 3 days longer into the excruciating razor sharp pains & frequent urination that doesn't allow her to sleep.
earlybird Aug 2019
I would take her to the ER. I have done this many times with my mom for a suspected UTI. She has chronic complicated UTI's, and if not treated early on, she could become septic. Her urologist sometimes is not quick enough prescribing an antibiotic and usually waiting for the sensitivities to come back to see which antibiotic is best, but her symptoms usually gets worse, which lands her in the ER. Now I just take her in to the ER early on, and she is tested and placed on an antibiotic.

AlvaDeer Aug 2019
She could also have a severe urethritis if she is showing no growth on Urine Cultures after 3 days. I am assuming a culture was done. A simple urinalysis is not good enough in this circumstance. A urethritis is an inflammation as opposed to an infection, of the urethra; more common if there is an incontinence issue.

The new UTIs are awful with their not being susceptible to the new antibiotics. New York Times had, about a month ago, a front page Sunday article about how awful and how uncontrollable the new UTIs are.
So sorry all this is going on for you both.
And no, an untreated UTI for three days is not OK. It is enough time for it to go into the kidneys. Thing is, there is little to be done about that if there is that level of negligence.
Marylin Aug 2019
Wow! You sound so knowledgeable, AlvaDeer. Are you a nurse? I'm not having much success with healthcare these days with my own health or family care. Seems each Dr., NP, & LPN drops the ball on truly caring for patients. Once again, it's the weekend & I'm certain nothing will be done until Monday. My mom has had bladder issues & surgery before when she was younger, so she wants a new PC & thinks he'll care more than the one she has now. She's not understanding the wait time to see one nor that healthcare is messed up.
I will look for that article & see if I can send it to NP & LPN for consideration. This is scary!
Thank you!!

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