Intermittent bladder infections have been a part of my life since grade school – 5th grade I think. I would go to the doctor in my town of 700 residents. The office was one room in his home and he would dispense sulfa tablets in a little envelope from his office. The symptoms would resolve quickly . I got one or two a year for a few years. As my mom also had bladder infections occasionally, no one was concerned.
My worst experience was when I was in my 40s. I had not had an infection in a few years when I got a low cramping sensation just as the airplane door was closed on a flight from Philadelphia to Phoenix. By the time the fasten seat belt light went out for the first time, I bolted for the toilet. The pain was intense when I peed. Before I got back to my seat I felt like I needed to go again. I had no idea how I was going to make it through the next fours. Fortunately I was in the aisle seat and the middle seat was empty. My incessant wiggly in my seat had less impact on others than it might have had. After about 4 trips to the toilet, I asked my aisle mate if she might have any medications that might help. Amazingly she had a few phenazopyridine, also known as Pyridium. I took two and they kept me sane for the rest of the flight. I spent over $100 on inflight calls arranging to get an antibiotic prescribed when I landed in Phoenix and talking with people to keep me distracted. I got the antibiotics on the way to the hotel. The first dose worked well enough that I was able to get through my speech the next morning. Symptoms were completely gone by the time I flew home at the end of the day.
Lesson 1: I started carrying my own water on long flights to stay hydrated. This was before the bottled water industry exploded and I always carried Pyridium and a few antibiotics.
Lesson 2: Up to that point, I was selectively allowing women with recurrent bladder infections to self-treat with antibiotics. Moving forward, for women that commonly traveled I made emergency UTI travel packs (Pyridium and a 3 days of antibiotics) available if they wanted. Over the past decade, with the availability of urgent care centers and concerns about antibiotic resistant bacteria and over use of antibiotics, travel packs may be less appropriate and necessary than twenty years ago – although I still carry mine.
Lesson 3: I gained a deeper empathy for my patients with IC (interstitial cystitis/bladder pain syndrome). The intensity of the discomfort/pain/urgency in my bladder was overwhelming – particularly when the fasten seat belt sign was on and I was not free to use the toilet. Prior to the taking the Pyridium on the flight, there was nothing that could distract me from my bladder. I was fortunate that I knew what was causing these symptoms and was confident that one or two antibiotics would get rid of the symptoms. But what if they didn’t? Many women that end up with a diagnosis of IC describe having UTI symptoms that just don’t go away. I now understood why women told me they sometimes fell asleep on the toilet or chose to sleep in the bathtub when symptoms were at their worst. While our understanding of the complexity of this often debilitating condition has improved over the past 30 years, treatment is still pretty much trial and error through a series of treatments that can work well in some women. We still have much to learn about this pain syndrome.
The flight to Phoenix may have been my first awakening to the prospect of prevention of bladder problems. Waiting for women to show up for care with often inadequate treatments was not good enough. I already understood the power of knowledge and behavior change to treat conditions, why not reposition these strategies for prevention? It took over 15 years for the awakening to evolve into action.
Tamara Unleashed 