Urinary tract infections are one of the most common out patient medical problems that we see in After Hours Healthcare. It is more common in women than men.  Though not that common in children, it is a problem at times for the pediatric age group.

Not all people with UTI’s need to be treated. These are folks who have no symptoms. This is probably more commonly seen in older women.

Although frequently regarded as a minor annoyance, in some cases UTI’s can be a sign of other pathology in the urinary tract. If UTI’s are frequent, then specialist care should probably be sought to rule out things such as kidney stones, anatomic abnormalities of the urogenital tract, bladder prolapse (“collapsed or fallen bladder”), fistulas (open passages between the bladder and surrounding organs such as the rectum or vagina), or tumors.

UTI’s are caused by bacteria. The most common bacterium that causes UTI’s is E. coli, a natural inhabitant of the digestive tract. Bacteria find their way into the urethra and eventually the bladder, where there is a natural medium in which to grow.

Sexual intercourse, especially when frequent, is associated with increased incidence of UTI’s. Use of spermicides increases the risk further. UTI’s in older women are more likely to be a consequence of age, debility, estrogen deficiency and poor hygiene.

Symptoms of UTI’s:

1. Frequent, painful or burning urination.

2. A sense of having to go again immediately after emptying the bladder. (also known as incomplete emptying or voiding)

3. Urgency, or feeling an urgent need to go to the bathroom

4. Tenderness over the lower abdomen (also known as suprapubic tenderness.)

5. Back pain on either flank just below the rib cage (also known as CVA or costovertebral tenderness.) if the infection is spreading to the kidneys.

6. Blood in the urine. (Known as hematuria)

7. Foul odor of the urine.

8.Cloudy or very murky appearance of urine.

9. Fever is not a common initial sign of UTI, but can be a sign if the infection is spreading to the kidneys or to the blood.

Diagnosis of UTI’s:

1. Often the diagnosis is already well known to the victim, from prior experiences or just from common sense analysis of the symptoms being felt.

2. Clinically, the diagnosis is often made from the symptoms alone

3. A dipstick urinalysis can give with fair reliability a diagnosis of a UTI, but does not specifically tell one which bacterium is causing it. Dipstick kits can be bought over the counter from pharmacies. Like the ones used in medical offices, it can detect the presence of white blood cells (leukocyte esterase) which are frequently increased in the urine with an infection and/or bacteria, which cause an increase in nitrites in the urine.

4. Microbiological culture. This requires a specially handled specimen to be sent to a laboratory that will place a sample of urine in a culture medium and detect both the presence and specific type of bacterium causing the infection. A negative culture is solid evidence that there is no bacterial infection. A positive culture can be caused by contamination, especially if the sample is not collected carefully.

First aid for UTI’s:

1.The best thing to do if you suspect that you have a UTI is to hydrate vigorously.

2. A common household remedy that has been advised is to drink cranberry juice. This is fine as first aid, and may be continued during the antibiotic course.

3. Relief of the burning pain of a UTI can be obtained from a drug called phenazopyridine, which is available over the counter. Brand names for phenazopyridine include Pyridium and Azo. Remember, this medicine only treats the symptoms, not the cause.

Definitive treatment for a symptomatic UTI:

Antibiotics are usually required to clear up a UTI. Commonly prescribed antibiotics are nitrofuantoin (Macrodantin or Macrobid), Septra or Bactrim (aka trimethoprim-sulfamethoxazole or TMP-SMZ), ciprofloxacin (Cipro) and others.

What is the fuss about the whooping cough vaccine all about?

Whooping cough, or pertussis, is a respiratory infection cause by a bacterium named Bordetella pertussis. Whooping cough has been resurgent, especially in California, in the last two years. There were nearly 10,000 cases in 2010, and 10 infant deaths, in California in 2010 from whooping cough. We are on a similar pace, if not higher, in 2011.

Whooping cough is contagious, and is spread in respiratory secretions by person to person contact. Symptoms can last for many weeks, and whooping cough is sometimes referred to as the “hundred day cough.” Whooping cough got its name from a characteristic whooping sound that occurs at the end of a paroxysm of coughing. It can cause sleep disturbance, weight loss, fatigue, and other complications which interfere severely with a person’s lifestyle and daily activities.

So it’s a public health hazard that can be deadly. It can also be debilitating, and can have impacts in the workplace, school and home. But, it can be prevented by the simple act of getting the vaccine for it.

In fact, California state law has recently mandated that all students in middle school and high school MUST have proof of being vaccinated before being allowed to start school this year.

As state immunization chief Dr. Eileen Yamada says, students in public and private schools will need to show proof of a TDAP booster shot before starting school and that it’s very important to plan ahead, make appointments now, and keep student immunization records in a safe place.

Parents should check their children’s medical records to make sure they received the TDAP vaccine, which covers pertussis, and not just the TD vaccine which only covers tetanus.

Most students were last immunized before entering kindergarten, between ages 4 and 6, and immunity starts to wear off by the time they reach middle school age. That’s why it’s important to get a “booster” before starting middle school.

Youngsters between the ages of 2 months and 4-6 years get a series of 5 shots before being considered fully immunized. Adolescents and adults should get a dTaP booster. If you are not sure whether you had the dTaP or not, there is no harm in getting it too soon. If you think you have had it, make sure that it was dTaP, not just the tetanus.

Treatment of a suspected whooping cough case is with an antibiotic, usually erythromycin or closely related azithromycin (aka Z pack) or clarithromycin (Biaxin). An alternative antibiotic is TMP-SMZ, aka Bactrim or Septra.

Arguably, two of patient’s biggest pet peeves when it comes to their healthcare are interrupting their daily schedule for routine appointments that inevitably last hours, and not being able to get into the doctor for sudden illnesses and injuries. It always seems to be Friday at 4:59pm when someone notices those spots in the back of the throat that are the hallmark of strep.  Do you suffer until Monday?  You try, until the fever and pain really kick in, then you end up in the emergency or urgent care room, and if the wait does not get you, the bill sure will.  Emergency care is notoriously expensive.

How about another option?  How about a healthcare clinic open after hours?  A place that can take care of last minute ailments, as well as routine examinations, maybe even become your primary physician.  That is exactly what After Hours Healthcare is all about.

Hello, everyone! My name is Dr. Richard Adrouny and I am the Medical Director of After Hours Healthcare. I have been a practicing Oncologist-Hematologist in Los Gatos, CA for over 25 years. I received my undergraduate degree from Duke University, my M.D. from Tulane University and I completed my residency and fellowships at USC and UCLA. I would like to take a moment to introduce you to the story of my clinic.

It was a little over a year ago when I looked out my office window towards Good Samaritan Hospital and thought to myself, “Where do my patients go when they need to see a doctor at night and on the weekends?” The answer was painfully clear to me: the emergency room. That’s right, it did not matter if my patient had something as simple as a cold or as complex as a laceration on their arm. They had to go to the ER if they needed a doctor at night or on weekends. Unfortunately, they would have to wait for hours on end for costly service that could take far less time and far less money if there were an after hours service as an alternative. Considering the hard times our country is facing right now, saving time and money on healthcare is essential!

As a result, I decided to start After Hours Healthcare. It made perfect sense not only to me but to my fellow medical professionals as well as patients. I could keep my office open at night and on the weekend and anybody in the community who needed quality medical care, but did not need to go to the emergency room, could come in. If they wanted to make an appointment, they could, but anybody could walk in during our hours and see a doctor almost immediately.

Soon after starting the clinic, my son Greg, who had just graduated from college and was seeking work in the advertising industry, came to me and asked to do my marketing for me. Within weeks of Greg joining the team, we started seeing an increase in patients. Greg now handles all of the business aspects of the clinic, whereas I handle everything that is medical—we like to joke that we are the yin to the other’s yang. Working with my son has been a blessing.

A year later, the clinic is growing on a consistent basis and we are seeing more patients than ever before. We are rated very well by patients who have seen us and local physicians are referring their patients to us because they understand the value that such a service brings to our community. It is my hope that the entire South Bay community knows about us and allows us to be part of their healthcare team if our services are ever needed.

So what is After Hours Healthcare? We are an urgent care/walk-in clinic located across the street from Good Samaritan Hospital. Our mission is to provide the Bay Area with high quality medical service at convenient hours. Our services include, but are not limited to: physicals, immunizations, family practice, pediatrics, internal medicine, wellness, STD tests, wound care and more. We can take care of other pesky things like insect bites, allergic reactions, lacerations, minor injuries, sinus infections, bladder infections and so forth. We have x-ray and ultrasound services on site.

So, if you need to see a doctor, but it is not a life threatening emergency, we can take care of you—we accept walk-ins or you can make an appointment in advance. We are open seven days a week, 365 days a year. We have a staff of six physicians with a combined experience of more than 150 years in family practice, pediatrics, women’s health and internal medicine. Our supporting staff is very friendly and professional. You can learn more about us throughout our website or call us at 408.356.9300.