My daughter started having recurrent bladder infections when she was undergoing potty training. Thus began a frustrating saga with the family practice physician and his staff. To properly diagnose and treat a bladder infection, the health care provider should evaluate a urine culture and sensitivity results to see what type of bacteria it is and what antibiotics it is sensitive to. However, to get a clean catch urine specimen for culture from an active toddler is no easy task. The alternative is to get a urine catheter specimen. However, to put a urine catheter into a toddler can be traumatic for the little one and quite an ordeal.
After several urine infections over several months, I started to get impatient with the family practice doctor as to an end to this saga. He simply blamed her recurrent infections on a “lack of wiping properly” — as the most common cause for urinary tract infections is fecal contamination in the bladder. I wasn’t buying it.
Physician refuses to give a referral to a specialist
Here’s where belonging to an HMO can be a problem. The family practice physician refused to authorize a referral to a specialist. Fortunately, I had worked in health care as a laboratory medical technologist for many years so I could be creative in navigating the health care system when I had to. I called a reputable pediatric urologist’s office and explained my daughter’s situation. I was told my daughter did indeed need to be seen by a pediatric urologist. I then called back the family practice office and told them that a pediatric urologist insisted that my child needed to be seen and I needed a referral form for the appointment. The family practice office then complied with the request.
Kidney damage and need for surgery
My three-year-old daughter was evaluated by the pediatric urologist shortly thereafter. He ordered an intravenous pyelogram (IVP) test. How an IVP works is radiographic dye is injected into a vein and the blood filters the dye out through the urinary system. As the dye goes through the kidneys, ureters and bladder, xrays are taken that show the anatomy of the urinary system and some function of it. Much to my dismay, the exam showed right-sided vesicoureteral reflux of grade III-IV. Essentially what that meant was the valve that kept urine from backing up from the bladder through the ureter to the kidney was working very poorly. As a consequence, as my daughter got a urinary tract infection, the bacteria in the bladder urine backed up into her right kidney causing damage. Her right kidney was 3 cm. smaller than her left and had scarring. The kidney damage was thought to be a result of the recurrent reflux and urinary tract infections. To say that I was livid with the family practice doctor would be an understatement.
With lower graded reflux (stage I or II), pediatric urologists believe the child may outgrow the problem. However, at stage III to IV (V is the highest), my child’s pediatric urologist believed surgery was the best option. Shortly thereafter, my daughter underwent bladder surgery. According to the pediatric urologist, there was no way to make a new valve; therefore, the pediatric urologist had to cut the ureter/bladder connection and then replant the ureter into the muscle of the bladder in such a way that when the bladder contracts the urine does not back up from the bladder into the ureter and up to the kidney. When the pediatric urologist opened my daughter up, he noted that the valve for the left ureter was not in particularly good shape either; consequently, he replanted that ureter, also. (We had discussed that possibility prior to the surgery).
My daughter got through the surgery well. Afterward, she was put on a course of antibiotic therapy. Then, she was put on low-dose antibiotics to prevent recurrent infection. Because I knew from the literature and feared that overuse of antibiotics could cause virulent infections later, I did not want my daughter left on antibiotic therapy for years. Therefore, I stopped her on the low dose antibiotic therapy after she had been on it for quite some time; instead, I started her on daily cranberry therapy. (Note: The medical literature states that low dose antibiotic therapy is thought to be “safe.”)*
My daughter is now 16 and has had only one bladder infection since that time. I still give her cranberry pills, but not every day. She has not had any complications from the ureter/bladder surgery or the kidney damage as of yet. As for the family practice doctor who would not give me the referral for my daughter to be evaluated by a pediatric urologist, I did not take my daughter back to him.