Minutus

Hi,
Does anyone have any experience treating urinary reflux? This is the case of a 6 year old child, who has been diagnosed as having level 1 of urinary reflux and is on preventive antibiotics. The bind is that if they stop the antibiotic, the child immediately gets UTI's which aren't always immediately apparent so they only discover the infection when it's already progressed. They have tried this, as they aren't happy with the idea of long-term antibiotic. So if homeopathic treatment is being given alongside the antibiotic, how can you tell when there's enough improvement to stop the antibiotic?
I posted a question on this list about a different patient with reflux about a year and a half ago - someone wrote to me off list giving suggestions of what indications to look out for which would show that there is improvement in the condition, even while the px is still on preventive antibiotics. I vaguely remember that it had something to do with the quantity, frequency and form of urination (dribbling, flow etc.). Does anyone have any ideas on this?
Thanks,
Vera
Does anyone have any ideas on this?
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Dear Vera

I am assuming that what you refer to is Upper Urinary Tract Infection.
(often due to E Coli).

The ureter passes obliquely through the wall of the bladder. The way the
ureter/bladder junction is designed is such that as the bladder fills, the
end of the ureter is squeezed close by the expansion of the bladder. This
would normally stop any reflux.

How do we know there is reflux? (And this assumes that the infection is not
through the blood).

If a child is now suffering from frequent reflux and consequent UUTI, then I
would suspect some kind of pathology. Has this been checked?
I hope some one has checked to make sure sexual abuse is not taking place.

What are the symptoms of the child?

In terms of knowing whether the homoeopathic treatment has had any effect, I
guess the medics will just look at the Urinary symptoms and so cannot see
anything for some time, but hopefully to a homoeopath, there would be other
symptoms indicating whether the child is better or worse.

From Davidson's Principle & Practice of Medicine:
Very few organisms are required to infect the the medulla and once
established there, their eradication is difficult because of low blood flow,
high osmolality and high concentration of H+ and ammonia interfere with
mobilisation of leucocytes and phagocytosis.
The high osmolality probably favours conversion of bacteria to antibiotic
resistant L-forms."

One way is to make sure there is high through put of water through the
kidneys. Does child drink enough water and does he have any urination
problems?

Good luck + Rgds
Soroush

Dear Soroush,
The child isn't a patient of mine, so I don't have a full symptom picture. The child was tested around a year ago, and found to have reflux. Tests included ultrasound and catheterization (she was anaethsetized for the catheterization). So there is definitely a problem with the anatomical structure, although this is something that can clear up on its own in some kids. The mother suspects that the child must have had the condition for a while, as she used to suffer from very bad stomach aches in the lower abdomen as a baby, and constant very high fevers.
The question remains - how to tell if there is an improvement from homeopathic remedies when it's too risky to take her off the preventive antibiotic. If I can find some possible responses, the parents will be very happy to try homeopathic remedies with the child, they are not happy with giving such frequent doses of antibiotics, and apparently the child also doesn't want to take the medicine. I think one of the responses I got when I last asked the question is that if the reflux is resolving, the quantity of urine the child passes each time will increase. Does this make sense to anyone?
Regards,
Vera

Finrod wrote:

Dear Vera

snip..

How do we know there is reflux? (And this assumes that the infection is not
through the blood).
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Hi Vera,

It's hard to say much without knowing more about the case, but the
approach I was taught, when you need to have improvement before
withdrawing drugs, is simply to look for significant and stable
improvement in other areas of the case, before withdrawing the drugs.
No doubt there are other areas to serve as markers--sleep, energy,
temperament, appetite, anything like that? Not that these other areas
have to be pathological in order to serve as markers, they just need to
be clear enough that they can be meaningfully used to assess her level
of *overall* improvement. Does this seem like an approach you could
use in this case?
Shannon

Dear Vera

This can be regarded indeed as a dilemma and I sympathise with you, the
patient and her parents.

If it was my patient, I would think carefully about my plan of campaign.

One plan would be to take the case as fully as possible and additionally get
the patient and her parents to remember as many symptoms as possible before
A/B treatment. On the basis of the old abdominal symptoms you may be able
to work out the acute remedy.**

Assuming a good clear remedy is indicated, I prescribe the remedy in LM
potency and closely monitor any changes and hopefully that these changes are
all for the better.
On the assumption that as other symptoms have improved it is logical to
assume that firstly she is more able to resist the E-Coli and also that
perhaps any pathological abnormality may have improved also.

I would ensure that extreme hygiene is observed that the genital area is
washed after every passage of urine and stool and also if paper is used that
she is taught to wipe from front to back. This is critical.

With the agreement of everyone concerned, I would then think about the
removal of A/B.
Once the A/B is removed, then I would like the child under close observation
and have the urine tested also for any bacterial presence on a regular
basis.

The results can be that she remains symptom free - all fair and good.
On the other hand, some urinary symptoms may develop and these would be your
best guiding symptoms as to what remedy to prescribe as the acute remedy **
and not only bring relief but crack the case.

I wish you all the best.

Rgds
Soroush

Hi Soroush,

I like your suggestions! But I'd think that an acute remedy, while
useful, is less important than the chronic remedy. Her
chronic/constitutional remedy could set right the *reason* for these
infections, but the acute may not be able to do that.
(And remembering symptoms prior to ABs, as you suggest, could be useful
toward that end as well!)
Best,
Shannon

Vera,

If you contact me privately with your email address, I will be able to send
you some information that is relevant to your query.

Robyn

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This is a double edged sword - the kidneys can become damaged from
repeated UTI but the long term damage from the antibiotics is also
worrying. The fact that the parents want to use homeopathy suggests to
me that somewhere along the line they have to commit and go with
homeopathy and wait and see what happens, otherwise how is the cycle
going to be broken.

If this were my case I would take the whole case from a chronic point
of view and prescribe accordingly. Then watch and wait and see what
happens and at some point the AB's will have to be stopped. When taking
the case I would also take full details of the UTI's so you can prepare
in case of an acute episode and when and if the acute does happen take
the acute case again to check all details and prescribe. Then you will
know what progress is being made. As with any acute that is quite
dangerous you have to be spot on with the rx. Best wishes, Joy
http://www.homeopathicmateriamedica.com
http://www.homeopathicmateriamedica.blogspot.com
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Thanks Joy. Problem is that often the UTI's start without symptoms, only becoming symptomatic when the risk of kidney damage is high. It seems clear that the first step is to take the chronic case, and a clear improvement in the generals and m&e implies that maybe the child is on the mend. Thinking about it though, it would also be logical that if the child is on the mend, there may be a more copious flow when she urinates as none of the urine is escaping up the ureters, so maybe that could also be used as an indicator.
I'll pass on the suggestions to the parents - I doubt that they would come to me as I live far away and there are plenty of good homeopaths in their area, but it will give them some pointers about treatment.
Regards,
Vera

Joy Lucas wrote:
This is a double edged sword - the kidneys can become damaged from
repeated UTI but the long term damage from the antibiotics is also
worrying. The fact that the parents want to use homeopathy suggests to
me that somewhere along the line they have to commit and go with
homeopathy and wait and see what happens, otherwise how is the cycle
going to be broken.

(snip)
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It seems there would be some urine test that could indicate whether the
kidneys are emptying fully... What is it that causes (could cause)
kidney damage--if bacteria, can the urine be monitored periodically for
bacteria?
Shannon