00:00 – Culture plates only favor the growth of fast-growing bacteria
00:05 – that like the culture media so it misses a lot of infection.
00:22 – Melissa: Today we’re talking with Ruth Kriz, a chronic UTI and IC specialist, and we’re really happy to
00:27 – have you on board Ruth. We received hundreds of questions from our audience for you so
00:31 – I’m hoping you can shed some light on some of these topics. But maybe first
00:34 – you can just tell us a little bit more about your background and your work in this field?
00:39 – Ruth: Certainly. I’m a Nurse Practitioner. When I was in my early 30s I was diagnosed with interstitial
00:46 – cystitis. I had symptoms for about 11 years, six of which were chronic pain. And basically I was told
00:57 – to go learn to live with it and that interstitial cystitis was chronic, degenerative and incurable.
01:04 – And that set me on a path for the past 40 years of trying to sort out the root causes and how
01:12 – to treat it, and I think iI’ve come up with some answers that can maybe help some of your audience.
01:19 – Melissa: Great, we’re looking forward to hearing them. First maybe you can tell us a little bit more
01:24 – about interstitial cystitis. So what is IC and how do you think it differs from chronic UTI?
01:30 – Ruth: That’s a very important question because I think that there’s a lot of confusion
01:34 – concerning the terminology. When people get urinary tract infections they have pain, burning,
01:41 – frequency, urgency and they go to their practitioner. A dipstick is done
01:49 – looking for leukocytes and nitrites and those can be highly inaccurate. And then based on that they
01:57 – are often given an antibiotic and sometimes a culture is sent and sometimes a culture is not.
02:03 – The problem we have here diagnostically is that if the culture is positive, and by the way,
02:10 – culture plates only favor the growth of fast-growing bacteria that like the culture media,
02:17 – so it misses a lot of infection. Then they’re given an antibiotic and if it doesn’t grow anything
02:26 – they’re told it’s culture negative and they don’t need an antibiotic, and they don’t have an
02:30 – infection, even if they’re still symptomatic. When cultures come back repeatedly that are negative
02:37 – oftentimes the IC diagnosis is given at that point. A more thorough diagnosis would involve
02:46 – looking at the bladder through a cystoscope and somehow there’s this magic point in time
02:52 – when if the urologist with the naked eye using the cystoscope can now see damage to the bladder wall
03:01 – then the IC label is is applied. Otherwise, there are a lot of other labels that are given,
03:08 – such as urethritis, trigonitis. I’ve heard pre-IC.
03:16 – There’s a lot of terminology that’s being thrown out there and yet I think all of this is
03:21 – is really on a continuum. The bladder wall damage from infection can take place years before the
03:28 – bladder wall is sufficiently damaged that the IC label is now applied. Oftentimes it says that it’s
03:36 – a diagnosis of exclusion, so if you go through your logical testing they’ve ruled out bladder cancer,
03:44 – which by the way is painless blood in the urine, they’ve ruled out some other conditions with
03:51 – bladder stones and oxalate crystals, and some other things that can give people urinary symptoms.
04:01 – If they’ve ruled those things out and excluded them they therefore say well since we can’t
04:07 – find that it’s any of these things we will now call it IC and people now have that label.
04:15 – Melissa: So basically they just figured out what it’s not but they’re not sure what it is?
04:21 – Ruth: Exactly and it still doesn’t tell you what the cause is. I mean I believe things have causes.
04:28 – Melissa: That makes sense. Are there more accurate tests that you feel can help clear up the uncertainty around these different levels of diagnosis?
04:35 – Ruth: Well I am delighted to tell you that now we do have those other tests.
04:41 – Years ago when I was first diagnosed all we had was a standard urine culture.
04:46 – I worked with the Dr Paul Fugazzotto, a PhD microbiologist who was in the 1980s and 90s
04:56 – using a broth culturing technique that is somewhat better than standard culture plates. But it has its
05:05 – own set of biases. Once again we have a culture media that some bacteria like and others do not.
05:13 – He was culturing for a week which will help to find the slow growing bacteria,
05:20 – but once again there are some bacteria that are not hydrophilic – water loving – that can still
05:29 – be found in the urine and those might grow differently on another culture media.
05:39 – So about eight years ago I started using MicrogenDX, which is a company using DNA testing. There are
05:50 – several other companies also out there doing DNA testing and one of two techniques are used most
06:00 – popularly. The first is PCR (polymerase chain reaction). PCR can be done on a limited number of organisms
06:10 – but it requires a special primer for each one. It’s highly accurate, it has a fast turnaround,
06:17 – but it is limited by how many organisms you can test for at one time. The other technique is
06:25 – called next generation sequencing and that one is not quite as high in accuracy. It takes much
06:36 – longer to do. But MicrogenDX that does PCR for the most common pathogens reported as level one, uses
06:48 – next generation sequencing for level two, which will look for over 50 000 different
06:55 – bacteria and fungi. And so these are able to find things that typically wouldn’t be identified on
07:05 – a culture plate. When you’re doing a culture the lab technician has to look at the culture plate
07:11 – and pick out which colonies are then going to be identified. And so if you have
07:17 – a slower growing one you might have fewer on the culture plate and that one will be
07:24 – assumed to not be a contributor to your symptoms. And so the ones that are most frequently picked
07:31 – out are the fast growing ones which typically is E. coli. And the slower growing ones get missed.
07:39 – Melissa: Have you had a lot of IC patients that have used this different type of testing
07:43 – and have had positive results after negative cultures?
07:50 – Ruth: Oh, hundreds of them. There are several reasons why culture might be negative. One of the reasons is that
07:58 – it doesn’t pick up the slower growing bacteria or that bacteria doesn’t like that culture medium,
08:04 – but another huge reason is that bacteria can live in different forms.
08:10 – Most bacteria have a cell wall, however when they’re exposed to certain antibiotics
08:16 – it drives them into a cell wall deficient form or an L-form and those cell wall deficient forms
08:26 – won’t grow on a standard urine culture plate but absolutely are detected by DNA testing.