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Dr. Jay Burstein Dr. Jay D. Burstein
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Our Disclaimer
Created: August 8, 2001
Revised: August 22, 2001
JO & JB
Q & A with Dr. Jay : July 2001
Please remember that Dr. Jay does NOT give personal medical advice via the web. Always review any information that you receive on-line with your personal medical care provider. Only your personal doctor can and should make medical recommendations to you.
In this issue:
161.
Kidney infections and IC?
162. Detrol LA, IC Aloe & CystaQ
163. Why would tagamet and pepcid help IC?
164. Cost of Elmiron and it's use during flares
165. Exercise and IC
166. Would daily massages be helpful
to chronic Interstitial Cystitis suffers
167. Using valium for IC symptoms
168. IC & Nerve Pain
169. Can Aminocaproic acid or hydrocortisone
be given as a bladder irrigation?
170. Pool chemicals and IC
171. Have you heard of urethral polyps and that they might
be the cause of IC symtoms?
172. Is there a side effect of Zoloft that could cause
bladder problems?
173. Remissions and IC
174. Men with IC? Are their more?
175. Elmiron & tricyclics?
161. I have had a continuous bladder infection for 8 week's now, and have done various testing on my kidney's and my bladder. I underwent a surgery yesterday, involving my bladder to be full of water and the doctor being able to see inside. He diagnosed me with IC. I had also had an IVP test done on my kidney's which found that 1/3 of my kidney has deteriorated, and there was some clubbing also in the ureter tube. My doctor had told me the deterioration of my kidney has been going on since I was a little girl, and that it is caused from various bladder infections. Could this problem with my kidney have caused the IC in my bladder, or could this disease also stemming from my childhood?
A: Urinary tract infections and catheterizations are two commonly reported "initiating events" that have been reported by many IC patients as triggering the start of their IC. The cause if IC is unknown but apparently some sort of traumatic event (such as infection or catheterization) can precipitate the symptoms of pain and urgency of IC. IC is not known to cause any damage to the upper urinary tract (kidneys and ureter). The source of your kidney changes is likely recurrent infection, which could have occurred during childhood. Be sure to talk to your urologist if further studies are needed to rule out an anatomic abnormality or abnormal ureters as a source of recurrent infection. Long term, low dose antibiotics may be considered to help prevent further infections. The symptoms of IC should be treated as a separate problem.
162. What are your feelings on Detrol LA used for IC to treat bladder spasms, also I have heard of people taking "IC ALOE" what are your feelings on this? Also have you had patients to have luck with Cysta-Q?
A: Here is Dr. Jay's
3-for-1 special:
Detrol LA: This is
a Long-Acting formulation of Detrol that has a 24-hour duration of action.
It can be effective for frequency, urgency and bladder spasms by inhibiting
motor nerve conduction to the bladder. Unfortunately all medications in
this class have side effects of dry mouth, dry eyes and even dizziness.
Other options include Ditropan generic, Ditropan XL, Hyoscyamine, and
probanthine.
IC Aloe: Aloe
Vera is well known as "the burn plant" as it relieves pain
and promotes burn healing. It has significant anti-inflammatory properties.
A highly refined product in capsule form is available for IC sufferers
from Desert Harvest. This is a freeze-dried compound that is highly concentrated,
contains no fillers and is taken orally. It has few side effects and has
been well tolerated. Limited studies have demonstrated 50 to 85% improvement
in symptoms. Large, placebo controlled, multi-center studies are pending.
The suggested dose is 3 capsules twice daily. The company states there
are no known side effects, but remember that IC patients can be sensitive
to any medication or natural product. You may want to try this in small
doses and build up slowly. (www.desertharvest.com)
Cysta-Q: This is a proprietary compound containing mostly quercitin, papain and bromelain. Quercitin, its main active ingredient, is known as a "bioflavenoid". These are naturally occurring substances that have anti-oxidant, anti-inflammatory and mast cell stabilizing properties. Papain and bromelain are needed for adequate absorption after ingestion. This product can also be used for certain cases of non-bacterial prostatitis. The recommended dosage is 1-2 capsules daily and is well tolerated. It does contain cranberry extract but this is non-acidic and should not provoke IC symptoms. Quercitin should not be taken with quinolone antibiotics (Cipro, Levaquin, Floxin). (www.cystaq.com)
163. I have struggled with IC for approximately 10 years and have found that taking a long-acting antacid like Tagamet or Pepcid allows me to eat acidic foods that would otherwise cause a flare. I have never seen a recommendation for use of these products to IC sufferers on any Web sites, nor has any doctor ever recommended them to me. Is there a reason for this? Do they in some way aggravate the condition or is it unsafe to take these on a long-term basis? Thanks!
A: Interesting question! Tagamet and Pepcid, both available over-the-counter, have a direct effect on the acid producing cells of the stomach lining and essentially reduces acid output of the gastric (stomach) secretions. This helps reduce the symptoms of gastric reflux, "heartburn" and ulcer disease. Prelief (calcium glycerolphoshate) is a chemical substance that neutralizes the acid content of food. This essentially reduces acid secretion by the kidneys into the urine and reduces symptoms in many patients with IC. Reducing stomach acid content does not affect urine acidity and that's why Tagamet and similar products have not been recommended for IC. These medications are relatively safe when taken as directed and you are fortunate to have found such an effective weapon in your arsenal against IC.
164. I was diagnosed with IC 4 years ago and didn't do anything for it, the cost of Rx's was outrageous and I wasn't having symptoms daily, so I managed to get by, until now. This year the flare-ups have been worse for me, still not daily but more frequent. My Dr prescribed Elmiron but I'm not sure if that's the drug for me, where I'm not having daily symptoms, how is this drug going to help me or is it just a waste of money? Thank you for taking the time to read and answer my questions.
A: In my experience when treatment for IC begins early and is aggressive, patients obtain better symptom and flair relief. It does not matter that your symptoms do not occur daily. You should begin establishing a "tool kit" as described on the IC Network and part of that would include Elmiron, as this is the only FDA approved medication for IC. Be sure to discuss your symptoms with a doctor that has interest in IC, as other medications, supplements, dietary changes and other options are available.
165.
I was diagnosed with IC about 2 1/2 years ago and then with Vulvar Vestibulitis
about a year ago. I just underwent a vestibulectomy with vaginal advancement
in February and am recovering successfully from that surgery. My IC has
never been in total remission, but I have retrained my bladder and with
medication and nutrition have minor discomfort and sometimes no pain.
I'm down to using the restroom about 12 times daily. I want to join a
training program for marathon runners beginning this spring, but I'm concerned
that it could cause major problems with my bladder. I have run short distances
successfully in the past when I was first
diagnosed with IC without a lot of discomfort. My bladder is much stronger
now, and this has been a long-term goal of mine.
A: Long-distance running
may possibly produce spasm of the pelvic floor and could provoke symptoms
and flair. Best to start training short distances and build up slowly.
Go for it!
166. Would daily massages be helpful to chronic Interstitial Cystitis suffers, and is it possible that pet dander could add complications to the sufferer?
A: It is well known
that stress increases symptoms of IC and this was confirmed in a controlled
study last year at the University of Iowa. Most diseases respond to stress
levels but IC is particularly sensitive to acute stressor situations.
Any means of reducing stress, including massage is certainly helpful.
The role of allergy in IC remains controversial. Pet dander usually produces
"atopic" (hay fever-like) symptoms, but anyone with persistent
IC symptoms could consider allergy testing. You may want to reduce your
exposure to dander and see if your symptoms improve.
167. My doctor prescribed Valium for me over a year ago? It helped at first but now doesn't offer the same relief. Why would it help IC? Can a patient become resistant to Valium?
A: The bladder rests on a group of muscles collectively called the "pelvic floor". If theses muscles go into spasm, symptoms of IC , such as frequency and pain can often be provoked. Current thinking supports pelvic floor evaluation for anyone suspected of having IC because, if present, this component needs treatment. In many cases both bladder and pelvic floor need attention. All too often the pelvic floor component is overlooked and the patient continues to suffer. You are fortunate in that your pelvic muscles have responded well to treatment. Sometimes the body's chemistry becomes more efficient at metabolizing certain medications and this is called "tachyphylaxis" (Big-time doctor talk). This is nothing to be concerned about and you should respond to a small increase in medication dosage.
168. When my IC flares, I also experience uncomfortable nerve pain under the bottom of my left foot. Is there an association between IC and the swelling of the bladder, and nerve pain/burning in the feet?
A: IC can be thought of as a symptom complex. Frequency and bladder pain are its main symptoms but there is a variety of other associated symptoms that are commonly reported. These include abdominal pain, vaginal pain leg pain and thigh pain. Other associated conditions include Fibromyalgia, migraine headache, premenstrual flair, and irritable bowel disease.
There are very few explanations for the wide variety of complaints and symptoms associated with IC and I could only make a conjecture on the cause of your leg pain. IC may represent a form of disease that actually involves abnormal function of nerve endings. We are just beginning to understand pain transmission and perception and while I know of no real answer to your question here is an attempt to explain some current concepts.
Pain fibers can often get out of control and release excess chemicals that result in over stimulation of surrounding sensory pain nerve fibers. These nerves can actually secrete chemicals (substance P, neurokinins, neuropeptides) that cause other nerves to respond with even more pain. It is obvious that the nerves to your feet are somehow activated during your flairs and this would be explained by an abnormal (neuropathic) response of the nervous tissue likely initiated by sensory nerves of the bladder and surrounding pelvic nerve plexus.
169. Can Aminocaproic acid or hydrocortisone be given as a bladder irrigation? If so, could you site some references? Thank you for your time.
A: Aminocaproic acid is used in certain blood clotting disorders associated with the circulatory system, certain cancers or surgery. It is not recommended for IC. Hydrocortisone is commonly used in addition to DMSO for treatment of IC that is usually referred to as "DMSO cocktail".
170. I was trying an alternative chemical to chlorine in my hot tub and was wondering if potassium monosulfate might have caused my latest flare. Is this chemical known to be a specific irritant for IC sufferers.
A: I am not sure as to the chemistry of potassium monosulfate but potassium has a well-known reputation for being a primary initiator in the pain cascade of IC. Many IC patients have a bladder lining that leaks potassium toward the muscle layer that contains pain nerve fibers. The potassium then triggers these nerves, which produces the characteristic pain and frequency of IC. This does not happen to all IC sufferers but is an excellent explanation on a physiologic basis. Be sure to review Dr. Parsons interview on ICN.
171. Have you heard of urethral polyps and that they might be the cause of IC symtoms? My urologist wants to burn my urethral polyps off. I can urine okay most of the time but do have difficulty getting started especially when I'm in a flare.
A: Urethral polyps
occur as a response to inflammation of the lining of the urethra. They
are benign, finger-like growths and do not become cancerous. They may
actually obstruct the flow of urine if they significantly enlarge or are
present in large numbers. Even if they are fulgurated (burned off), you
still may have symptoms and you should then be considered as having a
variant of IC, the so-called" urethral syndrome" that can present
with symptoms of urgency, frequency and pain. This is very much like IC,
but the discomfort typically is reported as centered on the urethra instead
of the bladder. Regardless, further management is indicated.
172. Is there a side effect of Zoloft that could cause bladder problems? I have been on it for a few months and my doctor told me to increase my dose from 50mg. to 100mg. and right away I noticed more problems with IC.
A: Tricyclic antidepressants such as amitriptyline (Elavil) can have a significant pain modulating effect for many patients with IC. As you are having difficulty tolerating Zoloft be sure to ask your doctor for a change to a different medication. Sometimes the filler material used in medicines, even over the counter preparations, can cause bladder irritation. I tend to prefer Elavil as it has significant advantages to other antidepressants. (see below)
173. I was diagnosed with IC when I was 20 years old. I had a cystoscopy and took imiperane. My symptoms went away for almost four years. Now they have started up again. Do I have a better chance of going into remission again since my first remission was so long?
A: Predicting the course of IC and its flair is difficult, if not impossible. What is fortunate is that you responded so well to the initial episode. What is very important is that you treat this recent flair immediately and aggressively. Your outcome should be good.
174. I was recently diagnosed with I.C. after experiencing much pain & discomfort for over 12 yrs. Do the experts still believe that for Males, its only 10% that has this condition or do they believe its much higher?
A: In my opinion the 10% number is an estimation of physician experience rather than hard statistical data. Since males have a prostate gland it appears to me that most urologist tend to blame the prostate gland rather than considering the bladder and IC. Recent studies have demonstrated significant similarities between symptoms of chronic prostatitis and IC, but doctors remain hesitant to follow through to rule out IC with diagnostic evaluations. Remember that just 20 years ago most doctors were convinced that IC did not exist. It is now an acceptable diagnosis for women and I think, in time, as a percentage, more men will be diagnosed appropriately with IC.
175. I am currently on Elmiron and am looking for an anti- depressant to take with it, to perhaps (hopefully) make me feel better. My uro told me that Prozac and Elmiron work quite well together, but from what I understand, it is not from the Tricyclic family, and this perplexes me. Do you have any experience with that combination?
A: Tricyclic antidepressants
are a very interesting class of medication. Amitriptyline (Elavil) is
the most studied of the group and for this reason tends to be the most
prescribed for IC. Other than its antidepressant effect it has several
properties that are beneficial for the IC patient.. It has a side effect
of drowsiness that helps those suffering with sleep deprivation from nighttime
pain or frequency. It blocks the transmission of pain. In fact it is widely
prescribed in pain clinics. It has anti-histamine properties just like
hydoxyzine and can relieve inflammation. It also relaxes the muscle of
the bladder to promote functional capacity and thus reduce frequency.
Amitriptyline unfortunately does have side effects such as fatigue, weight
gain, excessive sleepiness and decrease libido but is overall a well tolerated
medication. As far as Prozac is concerned, it has a different mode of
action by increasing active levels of serotonin but is not well studied
for management if IC or chronic pain. It certainly has excellent antidepressant
properties but, to my knowledge, does not have the effect on pain perception
or bladder function as the tricyclics, which are preferred for IC patients.