Bladder infection usually is not deadly
DEAR DR. DONOHUE: A 62-year-old female goes to the doctor on Wednesday for a urinary-tract infection. An antibiotic is prescribed and the patient is compliant in taking it. On Friday at 10 p.m., she vomits uncontrollably. EMS transports her to the hospital. Her skin is warm. All vitals are within normal limits, but her heart rate is somewhat high, at 99. At 6 a.m. on Saturday, she codes and cannot be resuscitated. The cause of death is listed as sepsis. What can someone do to prevent sepsis? — M.E.
ANSWER: “Sepsis” means that bacteria and their toxins have gained access to the blood. The heart beats fast; breathing becomes rapid and shallow; blood pressure drops. All this happens very rapidly, and sepsis frequently ends in death in spite of heroic efforts — including strong antibiotics and blood-pressure-raising medicines.
I have to conclude the bacteria in your friend’s case originated from her urinary tract infection. When speaking of urinary tract infections, the most common is a bladder infection, cystitis. It causes frequent urination and pain on urination. It’s an infection that often can be treated with antibiotics at home. Rarely is it deadly.
Urinary-tract infection also can be a kidney infection, a much more serious infection. It’s usually treated in the hospital. People with a kidney infection have a temperature, feel terrible and often complain of lower-back pain. It’s not difficult to distinguish a bladder infection from a kidney infection. Kidney infections can be a source of sepsis.
Preventing sepsis is a tall order. Prompt attention to any bacterial infection is one preventive step, but most infections do not end so unexpectedly, rapidly or lethally as the one you cite.
DEAR DR. DONOHUE: I am a 27-year-old man. About four weeks ago, I woke up with an inflamed elbow that was painful to touch and to movement. I iced it, elevated it and took some ibuprofen. The pain decreased, but not the swelling. After two weeks, I went to see my doctor, and she told me it is bursitis. I hope you can give me some information on what bursitis is and what the best treatment for it is. — K.M.
ANSWER: We have hundreds of bursa. They’re small disks inserted between tendons and bones to prevent friction when tendons rub against bones. Tendons do that every time a muscle contracts. That’s how we move our arms, legs and all body parts.
Bursitis is inflammation of a bursa. Inflammation generates fluids, which fill and distend the bursa.
You’ve heard of and maybe seen housemaid’s knee. It’s a swelling that occurs just below the knee and on the front of the lower leg. That’s a bursa. It’s called housemaid’s knee because it’s a common affliction of those who work on bent knees, as in scrubbing floors. It also happens to people who lay carpets, install tiles and do gardening. It even happens to people who don’t do those things.
The elbow is another common spot for bursitis. Trauma, overuse, gout, arthritis and infections are some of its causes. Trauma can be so minor that you never paid any attention to it.
Rest and anti-inflammatory medicines like ibuprofen can ease pain and reduce inflammation. However, it takes quite a while for the swelling to subside completely.
If the swelling doesn’t go away or if pain persists, the doctor can drain the fluid with a needle and syringe. The fluid is sent to the lab for examination. That helps make a diagnosis, and it permits the identification of serious causes, like an infection.
DEAR DR. DONOHUE: I read that the Food and Drug Administration approved three medicines for fibromyalgia. One was Cymbalta. I had a bout with depression, and my doctor prescribed Cymbalta. Will you explain why it’s used for fibromyalgia? — M.D.
ANSWER: Cymbalta is an antidepressant. It’s also used for pain relief, usually in lower doses. Many medicines have more than one use. Amitriptyline, another antidepressant, is frequently prescribed for pain. So is the anti-seizure drug Neurontin. The examples of such use are many.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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