By Tedler D. Depaynos, MD
The 78 years old lady patient was brought to the Emergency Room just after midnight. Her relatives hired a private vehicle of a neighbor who uses it to ferry vegetables. They live in a remote barrio of a distant municipality in Benguet and they have to travel at least 4 hours to reach the hospital.
Actually the patient has been complaining of abdominal pain for more than a week already and she was brought to the local Health Center for treatment. She was advised hospitalization for more work up because of their abdominal findings and considering her age. The patient, however, refused despite her children’s encouragement so she was brought home with medications.
This is usually the attitude of patients from this age group and not only applicable to those in the rural areas but even professionals like a lawyer we are familiar with. They are very stoic to pain so that if ever they decide to go to a hospital for treatment there is really something wrong and the pain is no longer endurable. Sometimes complications are already present. Hence, in this elderly patient who had to travel a long distance and arriving at a very unholy hour, she must have been attended immediately.
The pain was on the left lower quadrant of the slightly distended abdomen and associated with difficulty of urination. She was diagnosed to have a severe Urinary Tract Infection (UTI) which was confirmed by a simple urinalysis. Fortunately, the abdominal ultrasound was basically normal specially the kidneys because the infection could be associated with a stone. Severe and chronic urinary tract may eventually involve the urine pathway and kidneys called Urethritis and Pyelonephritis. This is routinely entertained by MDs especially if the patient manifests fever.
In general, urinary tract infection in females is an ascending infection. Bacteria may come from the vagina and ascends into the urinary bladder. In males they are usually systemic, meaning that the infection comes from the blood going into the kidneys. It then descends into the urinary bladder. The resulting pus that is being excreted is usually diluted by urine. If it is concentrated especially when it comes out in the morning, other conditions like Sexually Transmitted Diseases are entertained despite vocal denials of secret and hidden encounters.
The children claim that the patient never had fever or perhaps it was undetected. The abdominal x-rays revealed distended intestines filled with fecal material. This may be a reflex intestinal ileus or paralysis due to the pain because when a laxative was given, the relief was immediate and the bowel movement became regular. Actually this is more observed in the elderly.
A simple urinary tract infection may be easy to treat but one has to take medicines not less than 10 days. Some MDs prescribe it for 2-3 weeks especially in severe ones. Intake of at least a gallon of water per day is also advised. Some patients however stop their medications when the pain disappears. Pain may disappear but the bacteria may still be present. They may have weakened, hence, the relief. But when the medicines are discontinued they regain their strength and even become resistant to the usual medicines. A recurring infection or a chronic one ensues. Hence stronger and more expensive medicines are prescribed.
The elderly patient was given intravenous medications and when she felt relief of her symptoms after a few days, she insisted with a loud voice to be discharged prematurely. She was much worried of her rice fields running out of irrigation despite the assurance of her children. Actually, her relatives whispered, the real reason she wanted to go home was that she did not like to die in the hospital. So as not to stress their grand “lola”, the children consented and promised to give the home medicines without fail.
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