Latest / The Shivan Show with Shivan Sarna / Why Does Your UTI Keep Coming Back After Antibiotics? | Ruth Kriz Part 1

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Why Does Your UTI Keep Coming Back After Antibiotics? | Ruth Kriz Part 1 · The Shivan Show with Shivan Sarna

• 0:00
  A UTI can frickin' kill ya.
• 0:02
  25% of the sexual partners of women, every time they ejaculate in that woman's vagina, she's getting reinfected.
• 0:10
  How many of you all have been accused of not knowing how to have basic hygiene?
• 0:16
  Women live like this all the time, and that is not okay with me.
• 0:21
  If you have ever had a urinary tract infection, if you have ever thought, do I have IC?
• 0:27
  Shavon, what's IC?
• 0:28
  Interstitial cystitis.
• 0:30
  That is a mouthful, and I very rarely need to practice my words.
• 0:33
  I need to practice saying that.
• 0:35
  I can see why you might not have heard of it before.
• 0:37
  Have you ever heard of leaky bladder?
• 0:39
  And I'm not talking about when you pee a little because you laughed.
• 0:42
  This session is for you to share with your friends and family and know that a UTI can freaking kill you.
• 0:52
  Okay?
• 0:53
  Be aware.
• 0:55
  Am I trying to scare you?
• 0:56
  No, I'm trying to expand your perspective about the fact that these are things that need to be dealt with and they're very frustrating and they're very painful and you can still have one and not have pain and on and on and on.
• 1:08
  There are answers that have not been prevalently available for.
• 1:12
  And this is me screaming from the mountaintops that you see behind my very special guest, Ruth Kriz, nurse practitioner, who has devoted her professional life to solving these dilemmas for women.
• 1:23
  Hello, my friend.
• 1:26
  Oh, hi, Siobhan.
• 1:26
  It's just a delight to meet with you again and to be able to share with your audience some of the things that I've learned in my many years as a nurse practitioner focusing on why do some people get urinary tract infections?
• 1:41
  Why do other people not get them?
• 1:43
  Why do some people resolve quickly and easily with a short course of antibiotics?
• 1:48
  And why do others struggle with it for decades later?
• 1:51
  I can't imagine having it for decades.
• 1:54
  I've had my fair share here and there, and they've resolved and life goes on.
• 1:59
  But I recently had one and thought, oh my gosh, women live like this all the time.
• 2:07
  And that is not okay with me.
• 2:08
  And I know it's not okay with you.
• 2:10
  So let's get started.
• 2:12
  What is the difference between like a UTI and interstitial cystitis?
• 2:19
  It's the same difference between those two things
• 2:24
  an acute infection versus a chronic infection.
• 2:28
  Because people who've been given the IC label generally have negative cultures and the antibiotics are not working well anymore, if at all, they have put this labeled on people, meaning, oh, it's not an infection.
• 2:45
  All we can do for you is hand you a diet and tell you to have a good life.
• 2:50
  Well, the reality is that interstitial cystitis is a chronic infection.
• 2:58
  It's just that it has become embedded in biofilms.
• 3:02
  And therefore, those bacteria don't spill out readily into the urine to be found on a culture.
• 3:10
  And because the infections are in biofilms, the antibiotics no longer can get to them easily and they quit working.
• 3:18
  So we have the situation where most doctors were trained in hospitals, where patients came with acute infections
• 3:29
  and the infectious disease doctors figured we'd get out the biggest gun possible to treat it with so you don't die, which is a good thing.
• 3:39
  But they have little or no experience with the idea that some infections can become chronic.
• 3:45
  And that's what interstitial cystitis is.
• 3:48
  It's nothing more complicated than this infection has been going on for so long that it's become embedded in the bladder wall, in these biofilm structures, and it no longer looks or responds the same way as an acute infection.
• 4:06
  We're going to talk about testing, by the way, and treatment.
• 4:08
  We're going to cover all of this in this session, this concentrated session.
• 4:11
  But I also wanted to say, if you have an elderly relative who feels like they're losing it, they're not as sharp, they have dementia, oh my gosh, you know, all that.
• 4:22
  They were fine last week or last month.
• 4:25
  This is fast.
• 4:26
  It could be a UTI.
• 4:28
  True or false, Ruth?
• 4:29
  True.
• 4:29
  True.
• 4:31
  Absolutely.
• 4:32
  Wild.
• 4:33
  And what about for men?
• 4:34
  What's up with men and their UTIs?
• 4:36
  I've heard of it in the elderly that that was happening to a friend of mine's father.
• 4:40
  And he was like unable to function.
• 4:43
  And he almost set the place on fire with a mishap with a microwave.
• 4:47
  He put it on for 60 minutes instead of six minutes.
• 4:50
  And they almost kicked him out and sent him to memory care.
• 4:53
  But he actually had a UTI.
• 4:55
  Children respond differently to infections.
• 4:58
  Absolutely.
• 4:59
  Senior citizens respond differently to infections.
• 5:03
  Even some people in the middle there don't have the classic symptoms of a UTI, but that doesn't mean they don't have an infection and their body isn't fighting this chronic infection.
• 5:16
  I will say that for almost in all cases that I've seen, men who get urinary tract infections, it's coming from the prostate.
• 5:29
  chronic UTIs, often it's because the vaginal tract is colonized with bacteria and those keep seeding into the bladder.
• 5:40
  And unfortunately, the most commonly prescribed antibiotic for UTI is macrobid.
• 5:47
  Macrobid gets cleared by the urinary tract 90% and will never touch
• 5:54
  any bad bacteria in a woman's vagina.
• 5:57
  So she keeps getting the urinary tract treated, maybe, probably appropriately, but because the reservoir of infection is in the vagina and that's never getting treated, she just keeps reinfecting and reinfecting and reinfecting.
• 6:14
  We also have the issue that 25% of the sexual partners of women also have an undiagnosed asymptomatic prostatitis.
• 6:25
  Every time they ejaculate in that woman's vagina, she's getting reinfected.
• 6:30
  So she goes to the doctor and she says, my symptoms flare every time we have intercourse.
• 6:36
  And the doctor gives her the antibiotic and never checks him.
• 6:40
  You must treat your partners, male or female.
• 6:45
  I don't care who you're into it with.
• 6:47
  You have to treat them.
• 6:49
  If you're junk, J-U-N-Q-U-E, keeping it classy.
• 6:53
  But she's their junk.
• 6:55
  Whatever else you got going on, you need to treat each other, please.
• 7:01
  I'm begging you.
• 7:01
  Don't even get me started about the...
• 7:04
  mouth and stuff.
• 7:05
  Okay.
• 7:06
  So that's also an issue, not for today, but I want your brain to go there and be thinking about that.
• 7:11
  Ruth, what's a biofilm?
• 7:13
  But wait, well, before I go, what's a biofilm?
• 7:15
  What is another name for macro, macro band bid?
• 7:18
  Macro band.
• 7:19
  Macro bid.
• 7:20
  Macro bid.
• 7:20
  Yeah.
• 7:21
  Macro bid is the brand name.
• 7:24
  for the macro crystals of nitrofurantoin.
• 7:28
  So sometimes people will be prescribed straight nitrofurantoin.
• 7:33
  Nitrofurantoin, however, only has a half-life of 20 to 30 minutes.
• 7:39
  If they put the macro crystals in, it now has a half-life of 45 minutes.
• 7:46
  So treating with Macrobid twice a day
• 7:49
  is they work for the occasional acute patient, but rarely if ever works for the chronic patient because of the short half-life.
• 8:00
  This is what I do.
• 8:01
  I want to tell everyone about this.
• 8:04
  You please share this information with your friends.
• 8:06
  Okay, so if you get a script and it says MacroBit or whatever you just said, can you spell the other one or just say it again?
• 8:13
  The other- Nitrofurantoin.
• 8:15
  Okay, thank you.
• 8:16
  N-I-T-R-O-F-U-R-A-N-T-O-I-N.
• 8:21
  Good on you.
• 8:22
  By the way, Ruth is an award-winning weight lifter, power lifter.
• 8:28
  And Ruth, I just want you to know that today, me, Siobhan Singh Sarna, yoga teacher of days gone by, has had my 18th heavy lifting workout session with my trainer.
• 8:43
  You have no idea what that means because I have been sedentary working my ass off in this chair for so long.
• 8:50
  And I finally did it.
• 8:52
  And I think about you and that award winning picture all the time.
• 8:55
  So FYI, she's such a baddie.
• 8:58
  Have you ever been overwhelmed by supplements?
• 9:01
  Where to buy them, making sure they're authentic.
• 9:04
  You want professional grade ones?
• 9:05
  Well, I want to tell you about Dr. Allison Seebecker's Fullscript Dispensary.
• 9:09
  This is a place where you can get those types of high quality supplements that are vetted, no counterfeits here, and there are over 15,000 of them for you to choose from with exclusive pricing.
• 9:20
  She's also created community plans with suggestions for some of the favorite conditions like
• 9:26
  allergies, SIBO, IBS, UTIs, you know, the whole alphabet.
• 9:30
  So check it out.
• 9:31
  It's in the links below.
• 9:32
  And it is one of the best ways to get your supplements delivered to your door.
• 9:37
  And remember, exclusive pricing.
• 9:40
  Okay, see you there.
• 9:42
  Back to UTIs.
• 9:43
  What's a biofilm?
• 9:44
  Sorry, I digress, but seriously.
• 9:46
  Oh, no.
• 9:47
  I think that's just great.
• 9:49
  I'm going to share a slide about biofilms.
• 9:51
  It turns out that it's not slime like you find in oil pipes where the original research was done.
• 9:58
  Biofilms have several different ways that they can form in a person.
• 10:05
  The bacteria are free floating in the urine in a woman's bladder.
• 10:12
  Those are called planktonic because they float like a plank or a board.
• 10:16
  And they start attaching to the bladder wall.
• 10:21
  Once they attach, they start forming a biofilm to protect it.
• 10:26
  Now, biofilms are not all created equal, and they get dealt with differently depending upon the type.
• 10:35
  People make fibrin.
• 10:37
  We make it day in and day out.
• 10:40
  Otherwise, we bleed to death.
• 10:43
  But fibrin also can cross-link, kind of like a spider web.
• 10:47
  Think of these strands and form a biofilm structure that's three-dimensional.
• 10:53
  Some people either make too much fibrin or genetically they don't break it down as efficiently as other people.
• 11:03
  This applies to 20% of the general population.
• 11:07
  Yes, the 20% club right here.
• 11:11
  Now,
• 11:12
  In my chronic urinary tract infection population, I found one of those four genetic problems 70% of the time.
• 11:21
  For those people, they are contributing a truckload of fibrin to this biofilm structure that maybe other people don't have extra, and it's not going into biofilms in the bladder necessarily.
• 11:35
  Ruth, what is that 70%?
• 11:37
  What is, is it a genetic marker?
• 11:39
  And then also is plaque on your teeth like that biofilm we wake up in the morning where you're like, oh, I really need to brush my teeth.
• 11:45
  Is that a biofilm just to help people understand?
• 11:48
  One of the first biofilms identified in the medical field was dental plaque.
• 11:52
  Absolutely.
• 11:53
  But its cause can be multifactorial.
• 11:57
  So there are four genetic problems that cause people to have extra fibrin.
• 12:04
  And there is a lab court panel...
• 12:07
  It's test number 505443.
• 12:11
  And that will look for those four genetic problems.
• 12:15
  It will also measure how much fibrin you are making in real time and whether or not it's starting to build up in your arteries.
• 12:25
  Could it be linked to cholesterol?
• 12:27
  No.
• 12:28
  Fibrin lines the arteries and it can either trap red blood cells and you have a clot.
• 12:36
  Okay.
• 12:36
  It can trap bacteria and you can have a chronic infection.
• 12:41
  It can trap viruses and you can have long COVID.
• 12:44
  It can trap cholesterol and you can have atherosclerotic plaque.
• 12:49
  So I don't think the cholesterol is the problem.
• 12:52
  I think it's a fibrin problem in all those cases.
• 12:55
  That was my question.
• 12:56
  Thank you for answering that.
• 12:58
  Okay, that is wild.
• 12:59
  If you are part of the group, are we going to talk about what to do about it?
• 13:03
  Yes.
• 13:04
  If you are the main contributor to the biofilm, however, bacteria, certain bacteria can also make their own biofilm.
• 13:15
  And that isn't always the same type.
• 13:17
  That can be
• 13:18
  Extracellular DNA, that's what you see that H. pylori makes that causes stomach ulcers.
• 13:24
  It makes its own biofilm.
• 13:27
  There's also some very common bacteria like E. coli and Klebsiella that make a different type of biofilm called Curli, C-U-R-L-I.
• 13:38
  Those are amyloid fibers that are used to attach the bacteria to the surface, but then continue to make this three-dimensional structure grow.
• 13:49
  As it grows and becomes bigger, you find that some of these bacteria are really deeply embedded.
• 13:57
  They are not getting the same nutrients as the free-floating ones or the ones on the surface, and so they become dormant.
• 14:06
  They are not multiplying, they're just hanging out, hibernating.
• 14:11
  And the problem with these, these are called persister cells, is that even if you are successful in getting an antibiotic to penetrate the biofoam, which is not easy, by the way, it still doesn't kill the persister cells because they're not actively growing.
• 14:29
  Antibiotics only work on growing cells.
• 14:33
  I had no idea.
• 14:34
  Okay.
• 14:34
  No.
• 14:35
  If you think about a walled city, remember the ancient Greeks and Romans figured out early on that if all they ever did was go after the raiding party that periodically decided to come out of the walled city...
• 14:53
  which is what happens with the mature biofilm, you get a bulge, gets too big for its britches and spills bacteria out.
• 15:01
  If you're only killing off the raiding party that periodically comes out of the walled city, you're never really getting rid of the main bulk of the infection.
• 15:13
  only way you're going to be successful in eradicating the infection permanently is if you break down the biofilm.
• 15:22
  And you break down the biofilm with supplements that are targeted toward fibrin, extracellular DNA, or curly.
• 15:33
  And once you know what kind of bacteria you have, whether or not they make a biofilm and what type, and whether you are contributing extra fibrin and what the underlying mechanism is for your body so you can normalize it, then you will successfully break down the city wall and get rid of all the infections.
• 15:59
  And that way you're still not struggling with every month or two
• 16:03
  flaring with the raiding party coming out of the biofilm.
• 16:07
  And that's my point.
• 16:08
  The chronic UTI patient has a chronic infection.
• 16:12
  And unfortunately, most doctors view episodes as a new infection because you didn't wipe front to back.
• 16:20
  Oh my gosh, if I hear that,
• 16:23
  One more time.
• 16:24
  Oh, we didn't think it was a clean catch.
• 16:28
  I'm pissed off about that.
• 16:29
  No pun intended.
• 16:31
  I mean, seriously, how many of you all have been accused of not knowing how to have basic hygiene?
• 16:38
  It flared because the biofilm felt like it.
• 16:42
  Yeah.
• 16:43
  Is there food that makes it worse and more irritated and more like, biofilm growth?
• 16:48
  Yay!
• 16:49
  Well, no, that's not a main consideration.
• 16:53
  There are foods that because they are fermented or very acidic or very bladder irritants that can contribute to the symptoms, but not because you've done anything good or bad with the biofilms.
• 17:10
  This is what a bladder wall looks like covered.
• 17:15
  In biofilm.
• 17:16
  And here's one up close and personal, getting ready to explode and spill out more bacteria.
• 17:26
  So for those people who don't believe in biofilms, number one, it's not a religion.
• 17:31
  And number two, I have pictures.
• 17:33
  It's like saying, oh, I don't believe in small intestinal bacterial overgrowth.
• 17:36
  Really?
• 17:37
  It ain't a religion.
• 17:38
  Okay.
• 17:39
  Thank you.
• 17:39
  That was really, really powerful.
• 17:41
  So what can we do about it?
• 17:44
  Whether you're part of the 20% or you just have that every so often UTI, what can we do to help, first of all, inhibit getting them?
• 17:53
  Second of all, get rid of the biofilms.
• 17:56
  First of all, accurate testing.
• 17:59
  Let's go there.
• 18:01
  Cultures miss a truckload of bacteria that more advanced molecular testing can find.
• 18:10
  It turns out that 90% of UTIs really are not being caused by E. coli.
• 18:18
  It turns out the culture media favors the growth of E. coli.
• 18:21
  It's rapid growing.
• 18:23
  and therefore it's gonna be found most often in 24 hours.
• 18:28
  We have slow-growing bacteria that aren't even starting to grow on a culture plate yet after 24 hours.
• 18:35
  We have cell wall deficient bacteria that won't grow on a culture plate.
• 18:40
  They have been driven into a cell wall deficient form by the use of long-term antibiotics, which I do not recommend, by the way.
• 18:49
  It causes more drug resistance and the cell wall deficient form that then they can't find and tell you you don't have an infection even though you're symptomatic of the wazoo.
• 19:02
  Microgen DX bacteria,
• 19:05
  does both PCR testing, which other companies are limited to 24 pathogens with PCR.
• 19:14
  But in addition to looking for 17 drug resistance genes with PCR testing, they do next generation sequencing for over 60,000 pathogens.
• 19:28
  They are also able to find the cell wall deficient forms and they're able to find the anaerobes, the ones that flourish without oxygen.
• 19:39
  And that's the other problem with the cultures.
• 19:42
  You expose the urine to air,
• 19:45
  And the ones that don't like air curl up and die before you can find them.
• 19:51
  Interestingly, with these chronic infections, as we continue breaking down the biofilms, when we get to the bottom, the ones that were deeply buried, they're mostly all anaerobic bacteria.
• 20:02
  Interesting.
• 20:03
  So the lab is called Microgen DX.
• 20:06
  Right.
• 20:07
  And you can pee in a cup at home.
• 20:08
  I want you to pee in a cup at home, but only after you've done a week of biofilm disruption.
• 20:13
  Otherwise, you're going to find maybe a little E. coli and some lactobacilli.
• 20:18
  Let's go back and pick up that point you made earlier about the contaminated urine specimens.
• 20:23
  First of all, labs do not understand that biofilms are a community with multiple pathogens partying.
• 20:32
  And so if they find more than two pathogens on a specimen, they declare it to be contaminated.
• 20:38
  Oh wait, hold on, what?
• 20:40
  Yep, they didn't get the memo.
• 20:44
  I mean, logically, I can see how that would have happened back in the day.
• 20:48
  But here we are.
• 20:49
  Oh, my gosh.
• 20:50
  So first of all, they don't understand that.
• 20:52
  Secondly, when you have, and I want to talk about ammonia and pH of the urine in particular, but when you have pathogens that prefer a high pH urine, which is the majority of them that we find in the chronic population.
• 21:11
  And what's high pH to you?
• 21:14
  Anything above 6.0.
• 21:15
  And how are we, we're peeing on a strip?
• 21:19
  We're just looking at the first one a year in pH with a pH test strip.
• 21:23
  Are there any specific pH test strips to get?
• 21:27
  Just the ones that have the gradations of 0.25.
• 21:31
  So don't get one that measures 1, 2, 3, 4, 5, 6, 7, 8, 9.
• 21:35
  Get the ones that measure...
• 21:37
  you know, 4.25, 4.5, 4.75, and on up.
• 21:43
  We need that small gradation pH.
• 21:46
  But anyway, when you have a pH that's too alkaline, and therefore the bacteria are partying because they love that higher pH, the body in a female takes lactobacilli from the vagina, and we want a nice, healthy, medium load of lactobacilli there,
• 22:08
  and sends it to the bladder to produce lactic acid.
• 22:13
  The lactic acid pulls the pH down and the bacteria are not happy.
• 22:19
  And so when the commercial labs see that lactobacilli in a urine specimen, they say, it's contaminated.
• 22:30
  It has urogenital flora.
• 22:33
  The body is doing exactly what it's supposed to do.
• 22:36
  I do not believe that any woman giving a urine specimen is dripping your lactobacilli out of her vagina simultaneously.
• 22:45
  Okay.
• 22:46
  That lactobacilli intentionally went there, and I see it on these Microgen DX reports when I see those pathogens that like a high pH.
• 22:57
  And when those are treated and go away, the lactobacilli goes away because it's not needed anymore.
• 23:03
  My point with the E. coli is that Microgen did a study with 157,000 urine specimens from the chronic population.
• 23:14
  they found about 5,800 different species of bacteria.
• 23:22
  And that's another reason why the PCR-only labs that are only checking for 24 isn't good enough in the chronic population.
• 23:30
  You think?
• 23:31
  And they found E. coli in only 28% of the cases.
• 23:36
  So that means that presuming that someone has E. coli and giving them macrobid is missing the appropriate antibiotic the other 72% of the time, which means these bacteria can now wall off in biofilms and the person can have chronic infections because they weren't treated properly to begin with.
• 23:57
  Wow.
• 23:58
  So I'm just going to quickly tell you my story about this.
• 24:00
  I went and had blood work done, typical panel stuff, you know, and they make you pee in a cup while you're there.
• 24:06
  I was like, okay, fine.
• 24:07
  And so they cultured the pee just as part of the urine.
• 24:11
  It's just part of the typical thing.
• 24:12
  And they're like, oh, we think you have an infection.
• 24:15
  And I was like, okay, well, I have no symptoms, but I do think my Epstein-Barr virus was back.
• 24:21
  Okay, so this is what was going on in my head.
• 24:23
  I was fatigued.
• 24:24
  I was very tired.
• 24:27
  I was low ferritin, and that'll do it to you too.
• 24:31
  But then I was exposed to smoke when I was at a conference from wildfires in Canada, and I got really sick.
• 24:38
  And I thought, oh my gosh, my Epstein-Barr virus is active again.
• 24:42
  And it showed that I had had an exposure or reactivation, but that it wasn't active anymore.
• 24:48
  But the antibodies were going crazy.
• 24:49
  Fine.
• 24:50
  So I'm like, I know Ruth Grins is and I know she knows things about UTIs and I'm not playing.
• 24:57
  So David and I sent off RP in the cup and they have a couples test now at MicroGen DX, by the way, where you can send in two samples, one from one partner, one from the other.
• 25:08
  And sure enough, we both have a UTI.
• 25:11
  He gets his cleared, treating him.
• 25:13
  I get mine not cleared.
• 25:15
  Not cleared.
• 25:17
  And not cleared again.
• 25:19
  And not cleared again.
• 25:20
  I mean, it was going on.
• 25:21
  And I was feeling very, very ill and very frustrated.
• 25:27
  I did one treatment, and all of a sudden, it did start to show me symptoms.
• 25:31
  Like, I must have gotten rid of one aspect of the overgrowth of bacteria, and then something else, like, bloomed.
• 25:38
  And I was like, damn.
• 25:40
  I am sick.
• 25:42
  What the hell?
• 25:43
  This sucks.
• 25:44
  So I kept working the plan and, uh, with Dr. Ann Hill, who's amazing.
• 25:49
  And then I worked with the people at the pharmacy.
• 25:55
  Infuserve America.
• 25:56
  That's the one.
• 25:57
  It doesn't roll off the tongue.
• 25:59
  Um, um,
• 25:59
  which is weird because when I used to work right near there, I used to drive by there all the time.
• 26:03
  And I was like, oh, that's cool.
• 26:04
  Anyway, they're a compounding pharmacy.
• 26:06
  And they're very educated in these tests.
• 26:09
  And so we did the whole, I self-catheterized.
• 26:14
  And I had limited success with the self-catheterization.
• 26:17
  I have to admit, it is not,
• 26:20
  elegant and graceful, but I can see why it would be effective because you're targeting it right there in the bladder.
• 26:28
  Tell us a little bit about that.
• 26:30
  And for those of you who have like tried all of the antibiotics and you've done the azo...
• 26:36
  God bless that product because, man, if you're in pain, it can help you short term.
• 26:39
  I don't know what you think about it, but it helped me.
• 26:41
  Tell us just like you're in it.
• 26:43
  What should we do?
• 26:45
  How can we get there?
• 26:47
  How can we get it resolved, Ruth?
• 26:49
  Okay.
• 26:49
  First of all, you had different layers of bacteria because of your genetics, more so than other people.
• 26:56
  Right.
• 26:56
  Right.
• 26:58
  And that means when you wipe one pathogen, the major player off the playing field, the other smaller guys can now come out of the biofilm.
• 27:08
  They fight to become the big player.
• 27:11
  We never try to go after all of them at once because if we expose the little guys to an antibiotic prematurely, that's how drug resistance happens.
• 27:21
  So we are very strategic about what gets treated when.
• 27:25
  There's never going to be a one and done in the chronic person who has the genetics in which we know there's extensive biofilms.
• 27:33
  People can get there with oral antibiotics, but we all know that that comes with a price.
• 27:39
  So for some people that have multi-drug resistance or they have gut issues in which it's not wise for them to take oral antibiotics at this point, the Infuserve America Compounding Pharmacy, primarily Randy Breton and I have worked for about 15 years figuring out
• 27:58
  Which IV antibiotics can be made into a bladder installation and then used topically in the bladder?
• 28:06
  So this involves a very small pediatric catheter being inserted into the bladder, one ounce of liquid that has the antibiotic in it being pushed in through a syringe.
• 28:19
  The catheter comes out.
• 28:21
  You hold it for a couple hours and hopefully at some point all night long, and that puts the antibiotic...
• 28:27
  directly where the infection is with an additional biofilm disruptor.
• 28:32
  You get rid of the infections more thoroughly than people who have to rely on just the orals, but it is expensive.
• 28:39
  So, you know, the issue is, do you keep fighting these infections and spending thousands of dollars every year?
• 28:47
  or you get the appropriate testing.
• 28:50
  You get the right antibiotic delivered the right way in the proper strength.
• 28:54
  This is a two week course, just like an oral courses for a chronic infection and you eradicate it for good.
• 29:02
  So,
• 29:05
  You know, most doctors just are continuing to treat it with short courses of oral antibiotics, or they put you on a suppressive therapy of a long-term protocol with a sub-therapeutic dose.
• 29:20
  Well, whoever thought giving anybody a subtherapeutic dose was going to do anything more than keep them off your doorstep for a couple of months and then you're right back where you started from.
• 29:30
  But now you have more drug resistance and you may have driven these bacteria into a cell wall deficient form.
• 29:37
  So I just don't think that's the correct way to go.
• 29:41
  And by the way, Ruth and I are not anti-practitioner.
• 29:45
  We are pro-practitioner.
• 29:47
  We want all the practitioners around the world to have this information so that they can help and support more people.
• 29:53
  So that's why we're doing this.
• 29:54
  We're not trying to slam the OBGYN or the nurse practitioner who are in it to help you and serve you and the urologist and all that.
• 30:02
  Sorry, it did sound a little frustrated earlier.
• 30:04
  I have been in situations multiple times with me and also the woman who I...
• 30:08
  often care for of being, it wasn't gaslighting.
• 30:14
  It was more at the mercy of the knowledge level of the primary listener.
• 30:20
  I don't think there was malintent at all.
• 30:24
  And I have a, you know, a lot of radar for that.
• 30:26
  It was just, it was buttoned up against the limitations of the knowledge base at the time.
• 30:31
  Okay.
• 30:32
  How can you tell if you're one of the 20 percenters, Ruth?
• 30:35
  You can do that test, but what is the genetics that is, you know, that they should look to?
• 30:41
  Let's say they already have a, you know, a DNA test.
• 30:44
  Is there anything to look for?
• 30:46
  It won't be on the traditional test, to be honest.
• 30:49
  Some of them are missing.
• 30:51
  One of them is not even a genetic test.
• 30:53
  It's just either your liver protein, little a level, which is a form of bad LDL cholesterol.
• 30:59
  Either it's high or it's not.
• 31:01
  So you really need a practitioner who has listened to some of my training, who has worked with me, who consults with me.
• 31:08
  I have just pulled up my website, ruthkriz.com.
• 31:15
  is my website.
• 31:16
  I have somebody that's been helping me every week for the past couple months make this website something that is really helpful.
• 31:26
  I know the patient information is not as thorough as the practitioner is currently.
• 31:32
  However, patients can go to the provider selection tool, and you can look by state,
• 31:40
  And I have some European and Australian and UK countries who also have practitioners who consult with me.
• 31:48
  And when you go to the state that you are in, you can find people who have a license for that state.
• 31:57
  Now, that doesn't necessarily mean that they are physically located in that state, but they are permitted to do telemedicine, have a Zoom call with you.
• 32:08
  They can fully order the lab tests that you need for microgen,
• 32:15
  The LabCorp hypercoagulation, that genetic panel, they can prescribe in your state.
• 32:21
  They can manage everything that needs to be prescribed for chronic urinary tract infections virtually.
• 32:28
  They don't have to see you in person.
• 32:31
  That is huge, huge, huge, huge.
• 32:34
  Fantastic.
• 32:35
  And by the way, kudos to your website designer.
• 32:38
  It's beautiful.
• 32:39
  And I've seen it come a long way from when I first met you.
• 32:43
  It looks great.
• 32:44
  So congratulations and really fantastic.
• 32:47
  I have to look, but I want to make sure that you have, the patients have access for the directions on how to collect a specimen.
• 32:57
  If we really want to know what's embedded, you have to have a biofilm disruptor for a week prior.
• 33:03
  Okay, which are your favorites?
• 33:05
  And the one that we generally use for most everybody is Kirkman Biofilm Defense.
• 33:11
  I use the femologist.com website.
• 33:14
  We're also going to start supplying microgen test kits through there.
• 33:19
  That's a work in progress.
• 33:20
  It's not quite ready.
• 33:23
  Getting the proper testing is only going to be worth what you pay for it.
• 33:28
  if we know what's embedded in those biofilms.
• 33:31
  And if you don't take a biofilm disruptor first, we will probably find some lactobacilli and maybe a little E. coli and not much else.
• 33:41
  Once a biofilm disruptor is taken for a week prior and then the urine specimen is collected, lo and behold, we often find four, five, eight
• 33:51
  sometimes as many as 18 pathogens that have come out of that biofilm.
• 33:56
  And so it's not contaminated.
• 33:58
  And I want people to use a soap and water wash, not any of those antiseptic wipes.
• 34:04
  I think it's a very talented woman who can collect a...
• 34:07
  clean catch urine without any of that urine touching the inner labia that has the antiseptic on it.
• 34:13
  So I think a soap and water wash with a rinse is perfectly adequate.
• 34:19
  I'm not seeing skin contaminants in those specimens with the soap and water wash. And the other validation to me that these pathogens that we're finding are not skin contaminants is I'm not finding skin.
• 34:36
  any of the skin flora that would be there if it were truly a contaminated specimen.
• 34:41
  Okay.
• 34:43
  Can I do the microgen test without a prescription?
• 34:48
  Yes, people can pay for it and they can take the test on their own.
• 34:52
  The problem is finding a practitioner who knows what to do with it.
• 34:56
  But at least you can get started on your own.
• 34:59
  Well, you can, but you can't get those results to one of the practitioners.
• 35:03
  Okay.
• 35:04
  Yes, you can.
• 35:05
  You can.
• 35:07
  Certainly.
• 35:07
  Yeah.
• 35:08
  Okay.
• 35:08
  I find that with home testing, sometimes it's great to show up for that first appointment with the test result, but you have to have been your own advocate and pretty savvy to get to that point.
• 35:19
  Otherwise, the first appointment is often, okay, we'll order the test and then it gets started.
• 35:25
  Sure.
• 35:25
  And that's a delay.
• 35:26
  Yeah.
• 35:26
  No, I understand that.
• 35:28
  No, I understand that.
• 35:35
  becoming more and more convinced that that is a huge player in why people have some of these infections.
• 35:46
  If you enjoyed this conversation where we covered why interstitial cystitis may be a chronic infection rather than a mystery condition, why a urine culture can come back clean while you still feel sick, and why treatment has to be sequenced instead of just throwing everything at once at the problem.
• 36:04
  Stay tuned for part two, where we'll discuss ammonia and what it does to the bladder wall overnight, your first morning urine pH, and the number to aim for, the genetics behind making too much ammonia, and why mold could change how often you're up in the night, bacterial vaginosis and what the standard test misses, and vaginal pH and how to bring it back into range.
• 36:27
  So that's a wrap on today's episode.
• 36:29
  Thank you so much for being here.
• 36:30
  It genuinely means everything to me.
• 36:32
  If something in this conversation sparks something for you, share it with a woman or a guy in your life who needs to hear it.
• 36:39
  That's how this show grows.
• 36:41
  That's how we heal the planet together.
• 36:42
  And that's how we really connect.
• 36:44
  For more resources, free tools, and everything we talked about today, head over to SiobhanSarna.com.
• 36:49
  That's S-H-I-V-A-N-S-A-R-N-A dot com.
• 36:54
  It's all there waiting for you.
• 36:55
  And until next time, keep asking the questions, keep finding the answers.
• 36:59
  You deserve the full picture and the very best.
• 37:02
  Namaste.
• 37:02
  you