Stats.

From the National Kidney and Urologic Diseases Information Clearinghouse:

8.1 million visits to the doctor are due to urinary tract infections (UTIs) each year.

The lifetime risk for a woman having a UTI: 50%.

20% of young women with a first UTI will get another one.

Men are less likely to have UTIs but they are more serious if they do occur.


Why am I sharing?  In January, I wrote about my experience with pyelonephritis (kidney infection).  Lucky for me, I was able to put my new found skills to good use when I developed a second infection a month later.  Yes, folks - that is two kidney infections in two months.  Don't be jealous.

It's been too long since my last post, but I'm trying to put my life back in order.

Stay tuned.  I'm nearly back to a fully functioning adult again.


REFERENCES

More info on UTIs and kidneys: http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/

Series: Sickle Cell Disease (Part 3)

                As a final wrap up to this Sickle Cell Series, I will explore what kind of problems people with Sickle Cell Disease face.  In my first post, I described how genes are passed from parent to child to demonstrate the probability of a child inheriting a good hemoglobin gene or a bad hemoglobin gene.  In the second post, I clearly defined the difference between a good hemoglobin gene (which leads to a healthy hemoglobin protein and healthy red blood cells) and a bad hemoglobin gene that yields improperly behaving hemoglobin protein that distorts the red blood cells to a long, sickled shape.

                This leaves us asking the question: What do sickled red blood cells do to the body?

                If you remember from the Sickle Cell Introduction post, I said each person has one of three combinations of hemoglobin genes: two bad genes, two healthy genes, or one of each.  We know how patients with two healthy genes are – happy and healthy!  What about the other two?

Two unhealthy hemoglobin genes, the patient has Sickle Cell Disease: 

              

Hemoglobin’s role is to carry oxygen from the lungs to the far reaches of the body.  Cells require oxygen for their health and function (see Carbon Monoxide post).  Hemoglobin is carried in cells called red blood cells.  Healthy red blood cells are circular and flexible.  Blood (of which red blood cells are a key component) travels through veins and arteries (also known as blood vessels) in the body.  In some places, these vessels become very narrow.  Healthy red blood cells can squeeze through and continue moving along with relative ease.  Unfortunately, sickled red blood cells are sticky and have lost their flexibility.  These cells get stuck in narrow areas.  This difference is nicely illustrated in Figure 53.1, which comes from the National Heart Lung and Blood Institute webpage covering Sickle Cell Disease.

What kind of problems does this lead to?

Pain.  Red blood cells are piling up and trying to pass through areas of narrow vessels, which include the chest, abdomen and joints.  Doctors refer to these times as crises.  The pain can last a few hours or a few weeks.  These crises can happen as often as a dozen times a year and may require hospitalization.  Small blood vessels are also present in the eye so when sickled cells block them, patients may develop vision problems due to retina damage.

Anemia. The sickled red blood cells are weak.  Healthy red blood cells live for about 120 days, but the sickled ones only last 10 – 20 days.    The body is constantly short of red blood cells, which means it's short on hemoglobin and cells are short on oxygen.  This is why Sickle Cells Disease is sometimes referred to as Sickle Cell Anemia.

Spleen damage. The spleen is important for healthy red blood cell function and the body’s ability to deal with infection (quite frankly, just looking up what the spleen does makes me want to write a post on it.  I had no idea!).  Sickled red blood cells can damage the spleen which results in a patient having frequent infections.

Other problems. Delayed growth, swollen hands and feet.  Children with sickle cell disease typically start to show symptoms around 4 months of age.

In my research for this post, I found a blog written by a girl suffering from sickle cell disease.  Beginning in 2007, the blogger used this platform to discuss her trials.  As she states in her first post “My illness does not define me ---I define my illness.  This is my story.”  Reading unfiltered first-hand accounts, which is one of the most useful and unique things about blogs, from someone suffering with this disease is both poignant and fascinating.  In 2010, she moved on to writing on the Sickle Cell Warriors website.  Check them out!

On healthy and one unhealthy hemoglobin gene, patient has Sickle Cell Trait

                Since sickled cells are less common in these patients, their symptoms are usually mild and sometimes unnoticeable.  Rare complications do exist so don’t think that they don’t have any adverse effects, but in general it is seen as a mild problem.  It should also be noted that at low oxygen pressures, cells tend to sickle, especially when coupled with extreme exercise.  This is why Ryan Clark was dissuaded from playing football in Denver; the mile high city has lower air pressure and therefore lower oxygen pressures.

                What is most interesting about sickle cell trait is its resistance to malaria infection.  Without getting into the specifics of malaria infection (because it’s a bit complicated), just know that malaria is caused by a parasite that infects the red blood cells.  Scientists found that red blood cells from sickle cell trait patients sickled in response to parasite infection.  As described above, sickled red blood cells live a much shorter time than healthy red blood cells.  This means that infected, sickled cells will be destroyed quickly by the body.  Less red blood cells with the parasite means less infection and it is more likely that the patient will survive malaria.

                Fascinating!  This is why in incidence of malaria and sickle cell disease tend to be found in the same regions.  Such a detrimental defect in hemoglobin should have been weeded out by natural selection a long time ago (in that those with two unhealthy hemoglobin genes would die before they ever had children either due to Sickle Cells Disease or malaria infection and the gene would not have been passed on), however it persisted.  Those with just one unhealthy hemoglobin gene were more like to survive malaria so the gene hung around in these populations.

                Much more exists on the malaria/sickle cell trait topic as well as everything else discussed in this series.  I tried to give you as many resources as possible at the end of my posts.  Don’t take my word for it or as the last word on these subjects – there is so much more to learn!

REFERENCES

Symptoms of sickle cell disease: http://www.nhlbi.nih.gov/health/health-topics/topics/sca/

 

Symptoms of sickle cells disease: http://www.mayoclinic.com/health/sickle-cell-anemia/DS00324/DSECTION=symptoms

Sickle Cell Blog: http://sicklecellblog.blogspot.com/2010_05_01_archive.html

Sickle Cell Warriors: http://sicklecellwarriors.com/

 

Malaria and Sickle Cell Trait: http://sickle.bwh.harvard.edu/malaria_sickle.html

 

My Pyelonephritis

              It started Wednesday night with a painful bladder and frequent pee breaks.  I pretended that the racking chills and shaking I experienced on my way to work on Thursday was just stress.  Being cooped up in a train for forty five minutes with the above symptoms was enough to worry anyone.  I decided the mild pain and pressure in the middle of my back was due to leaning over my computer.  I happily assured myself that, after sitting at my desk for 1.5 hours without a bathroom break, there wasn’t anything seriously wrong.  Unfortunately, at 2am on Friday morning, the intense shivering gained a new symptom: vomiting.  Off the emergency room – I was not okay.

                This is why I love the city.  At any time of day, there is a place where everyone is awake and waiting to help you, get you some place or give you food.  Cabs were plentiful at 3am, cheery doctors and nurses were waiting for me, and some people-watching helped pass the time.  Please don’t think I was in a good mood (quite the opposite), but I appreciated the beacon of civilization in the middle of a miserable evening.  I didn’t feel so alone.

                A quick urine test sealed my fate – pyelonephritis, also known as a kidney infection.  Great.  May I have some antibiotics, please, sir?

How does this happen?  Urinary tract infections (UTIs) happen when bacteria get in the urethra/bladder.  They find it very cozy there and begin to multiply.  Early symptoms include bladder pain, frequent need to pee, and pain during urination.  If left untreated, the bacteria can spread up to your kidneys.  The symptoms then progress to back pain, fever, shaking chills and vomiting.  Women are more likely to get UTIs than men due to shorter urethras and proximity to a haven of E. coli.  

How does the test work? I had wanted a urine analysis on Thursday afternoon but was unable to get one (because of my own inability to procure a primary care doctor when switching insurance.  Seriously, this whole debacle was a series of failures on my part).  What would a urine analysis have shown?

                Human urine contains nitrate, shown in Figure 51.1.  Some bacteria are able to uptake nitrate and turn it into nitrite (Figure 51.1).  Presence of nitrite in your urine suggests bacteria are present!

               I got my urine analysis in the emergency room.  After telling my story to the doctor, she asked the nurse if my analysis showed blood because my symptoms were more in tune with kidney stones than an infection.  

               "No," he happily replied.  "No blood, but she had nitrites!"

How do the antibiotics work? In order to clear the infection, the bacteria must be killed so antibiotics are necessary.  The word antibiotic is quite simple: “anti” means against in Greek, while “bios” means “life.”  Many different kinds of antibiotics exist, but they all do the same general thing: disrupt bacterial cells without disrupting human cells.  How does one achieve this?

                In broad strokes, bacteria do the same functions as human cells: replicate their DNA, transcribe DNA into RNA, translate RNA into protein (Central Dogmapost), but the proteins they use to do it are a bit different than human proteins.  For example, a protein known as DNA Polymerase is responsible for replicating DNA in cells.  Human DNA polymerase looks very different than bacterial DNA polymerase.  If you can identify a drug that will – say – bind to bacterial DNA polymerase and make it unable to function, then the bacteria will die.  Since human DNA polymerase looks different, that same molecule can’t inactive human DNA polymerase.  Win.  You kill bacteria cells without killing human cells!

                Antibiotics target different things.  Some keep bacteria from making their cell walls, some inhibit different enzymes necessary for bacterial life.  My drug of choice is levofloxacin, which specifically blocks bacterial topoisomerase IV and DNA gyrase.  Both of these are involved in unwinding DNA for replication.  If the bacteria can’t unwind their DNA, they can’t replicate it or continue to grow.  

                After three doses of antibiotics, I feel almost human.  I have three more to go.  Bouncing back from this hasn’t been quite as fast as I’d hoped (today is the first day I can sit at my computer and focus on work), but the shivering chills have stopped and I’m slowly regaining my appetite.  I have weird cravings when I’m sick – tonight, all I want for dinner is fried chicken.

                Much more info is available on UTIs, kidney infections, and antibiotics.  Read more if you are interested!  Also, if you get any of those symptoms, go to a freaking doctor!  Don’t be stupid like me.

                My apologies for being a little MIA in the past week.  Obviously, this is why.  I’m working to update all my blogs now and catch up on work that I’ve missed over the past week.  I have all the Sickle Cell posts outlined so they should be up soon!

REFERENCES

UTI Info from the Mayo Clinic: http://www.mayoclinic.com/health/urinary-tract-infection/DS00286

Some medical info on urine cultures, common UTI bacteria: http://www.medindia.net/education/familymedicine/utinfection-urineculture.htm

Generalized antibiotic information: http://www.medicalnewstoday.com/articles/10278.php

Levofloxacin information: http://bacteria.emedtv.com/levofloxacin/levofloxacin.html