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Medical Forum / Diseases and Disorders / Prostatitis / November 2004TRUS and EPS
TRUS (a sonographic check of your prostate) and EPS (a culture for bacteria made from prostatatic fluid pressed out during an exam) are mainstream stuff -- at least if you believe the Guidelines of the Centers for Disease Control. But very few doctors seem to give them. who here ever got a TRUS or EPS culture? Did they reveal any information that was worthwhile? Am I alone in being boggled that the problem with mainstream medicine (aka the guidelines) IS THAT NO ONE FOLLOWS IT? - Carlos > TRUS (a sonographic check of your prostate) and EPS (a culture for bacteria > made from prostatatic fluid pressed out during an exam) are mainstream stuff -- [quoted text clipped - 9 lines] > > - Carlos My Uro always wants to do a culture on EPS and has done so a number of times. Almost always finds E Coli. He has also done cultures on semen and WBC in urine. Had a TRUS once. Didn't find anything. I think that in chronic bacterial prostatitis you need to ask to your Uro to perform on the ESP not only the culture to find common bacteria, yeast and protozoa but also research the DNA of the Chlamydia T, ureaplasma, gonococcal and HPV, with PCR technique . If the cultures are negatives should be good to try to detect bacterial signal in prostatic liquid, with 16S ribosomial RNA. Federico Guercini MD >> TRUS (a sonographic check of your prostate) and EPS (a culture for > bacteria [quoted text clipped - 18 lines] > times. Almost always finds E Coli. He has also done cultures on semen and > WBC in urine. Had a TRUS once. Didn't find anything. >I think that in chronic bacterial prostatitis you need to ask to your Uro to >perform on the ESP not only the culture to find common bacteria, yeast and [quoted text clipped - 3 lines] >try to detect bacterial signal in prostatic liquid, with 16S ribosomial RNA. >Federico Guercini MD >> TRUS (a sonographic check of your prostate) and EPS (a culture for >> bacteria >> made from prostatatic fluid pressed out during an exam) are mainstream >> stuff -- at least if you believe the Guidelines of the Centers for Disease >> Control. But very few doctors seem to give them. Dr. Guercini! I am delighted to see you posting here! During the 10 months (and continuing) of my medical problem, I have done many hours of daily research -- and I always find your contributions and articles to be clear and insightful and helpful. I may yet wind up in Rome in your offices if I cannot get a New York doctor to complete the necessary tests. You are one of the very few doctors who even seem to understand this discussion. Here's my delemma on the chance you may be willing to comment further: 1. For the first 4 months of my condition I got no treatment. My doctor believed that my pains had a "pudendal distribution" (perineal, prostate and left-epididymal pains, but also tailbone, rectum and left-sitbone pains) and suspected they were caused by avid bicycling. 2. By the 5th month my symptoms had become much worse (a burning sensation made sitting completely impossible) and my prostate had become clearly a very diseased organ (hard, boggy). 5 weeks of Levaquin cured it. 3. The prostate has remained normal, but the other pains -- mostly left-epididymal, but also left-sitbone and sometimes trailbone) remain. I tried a variety of antibiotics (Septra, Zithromax, Cipro, Doxycycline) (not at the same time) but eventually stopped because of Cipro side-effects, and because they didn't work. 4. A recent semen culture (PCR) was negative -- however, my semen production is low (I could only manage a few drops), and the test was done barely 2 weeks after I stopped Zithromax and Doxycycline. 5. I very recently developed a penile lesion -- a bump that rapidly became a fairly large painless sore, and healed quickly. 2 doctors said it was "nothing", the result of masterbation, but I have 40 years experience with that particular activity, and whatever else can be said about the lesion it was *not* nothing. It also was not herpes (with which I had 25 years ago). My immune system seems active (lymph glands in my shoulders, and to a lesser extent in my groin). I haven't had intercourse for a full year, and never saw such lesions before. HERE ARE THE MYSTERIES 1. Is some sort of pudendal neuropathy still possible? The follow factors seem relevant: ---- I don't have numbness or erectile dysfunction. ---- I MUST have an infection (my prostate was swollen and 5 weeks of Levaquin fixed it). ---- A hi-res MRI showed "mild scarring fat planes surrounding the pudendal nerve at the level of the anus" and "moderate displacement of the sacrococcygeal junction". ---- An ordinary pelvic MRI of the lumbar spine found "Minimal retrolisthesis L4-5" and "Small central L4-5 disk protrusion without compressive change". 2. But if I have an infection, why was the semen culture negative? Why did Levaquin not also cure my epdidymitis? 3. Could the lesions be an clue (such as a Reiter's related autoimmune response? Or Bechet's?) 4. Could an EPS culture (like the one you described) reveal infection where the semen culture did not? Before I follow the pudendal nerve theory (such as a neural block) I hope to try antibiotics again. So far, Levaquin is the only thing that has helped me. Does this make me the ideal candidate for intra-prostatitic (or intra-epididymal) infilitration? My epididymis may be where the problem lies. - Carlos (northernspy1@aol.com) PS I have zero medical training -- so please forgive the medical tone of this post (I got my "MD" on Google!) >> I think that in chronic bacterial prostatitis you need to >> ask to your Uro to perform on the ESP not only the culture [quoted text clipped - 4 lines] >> prostatic liquid, with 16S ribosomial RNA. >> Federico Guercini MD >>> TRUS (a sonographic check of your prostate) and EPS (a culture for >>> bacteria >>> made from prostatatic fluid pressed out during an exam) are mainstream >>> stuff -- at least if you believe the Guidelines of the Centers for Disease >>> Control. But very few doctors seem to give them. > Dr. Guercini! > I am delighted to see you posting here! > During the 10 months (and continuing) of my medical problem, > I have done many hours of daily research -- and I always find your > contributions and articles to be clear and insightful and helpful. > I may yet wind up in Rome in your offices if I cannot get a New York > doctor to complete the necessary tests. You are one of the very few > doctors who even seem to understand this discussion. > Here's my delemma on the chance you may be willing to comment further: > 1. For the first 4 months of my condition I got no treatment. > My doctor believed that my pains had a "pudendal distribution" > (perineal, prostate and left-epididymal pains, but also tailbone, > rectum and left-sitbone pains) and suspected they were caused by > avid bicycling. How can a problem in the prostate cause pain in the tailbone, rectum and left sciatic muscle? I suspect the root cause is something other than the prostate. > 2. By the 5th month my symptoms had become much worse > (a burning sensation made sitting completely impossible) and > my prostate had become clearly a very diseased organ (hard, boggy). > five weeks of Levaquin cured it. The prostate is definitely involved. > 3. The prostate has remained normal, but the other pains > -- mostly left-epididymal, but also left-sitbone and sometimes > trailbone) remain. I tried a variety of antibiotics (Septra, > Zithromax, Cipro, Doxycycline) (not at the same time) but eventually > stopped because of Cipro side-effects, and because they didn't work. > 4. A recent semen culture (PCR) was negative -- however, my semen > production is low (I could only manage a few drops), and the test > was done barely 2 weeks after I stopped Zithromax and Doxycycline. > 5. I very recently developed a penile lesion -- a bump that > rapidly became a fairly large painless sore, and healed quickly. [quoted text clipped - 5 lines] > to a lesser extent in my groin). I haven't had intercourse for > a full year, and never saw such lesions before. > HERE ARE THE MYSTERIES > 1. Is some sort of pudendal neuropathy still possible? The > follow factors seem relevant: > ---- I don't have numbness or erectile dysfunction. > ---- I MUST have an infection (my prostate was swollen and > five weeks of Levaquin fixed it). > > ---- A hi-res MRI showed "mild scarring fat planes surrounding > the pudendal nerve at the level of the anus" and "moderate > displacement of the sacrococcygeal junction". > ---- An ordinary pelvic MRI of the lumbar spine found "Minimal > retrolisthesis L4-5" and "Small central L4-5 disk protrusion > without compressive change". > 2. But if I have an infection, why was the semen culture negative? > Why did Levaquin not also cure my epdidymitis? > 3. Could the lesions be an clue (such as a Reiter's related > autoimmune response? Or Bechet's?) > 4. Could an EPS culture (like the one you described) reveal > infection where the semen culture did not? > Before I follow the pudendal nerve theory (such as a neural block) > I hope to try antibiotics again. So far, Levaquin is the only thing > that has helped me. > Does this make me the ideal candidate for intra-prostatitic (or > intra-epididymal) infilitration? My epididymis may be where > the problem lies. > - Carlos >(northernspy1@aol.com) > PS I have zero medical training -- so please forgive the medical > tone of this post (I got my "MD" on Google!) Interesting, the symptoms you describe are almost exactly the same as I had. After several years I decided to see if I could figure out what was causing my problem. I spent many hours looking at EPS and ARM and have discovered several things. 1. I had an undiagnosable anorectal problem. (impacted/ruptured gland) 2. There was an autoimmune response. (excessive WBC in EPS, alergic reaction to semen in prostrate) 3. The prostrate became blocked by excessive WBC, and mucus. 4. The circulatory system was impared. Unfortunately I was unable to find a Physician or a clinic willing to work with me on my problem so there is little evidence to collaborate my opinion. jrh >Interesting, the symptoms you describe are almost exactly the >same as I had. [quoted text clipped - 15 lines] >to work with me on my problem so there is little evidence to collaborate >my opinion. Ouch! So you're basically abandoned by doctors. Your idea about an underlying vascular problem may be correct. I'm just learning about this area. Try Googling this: "venous congestion" pelvic pain and you'll find lots of information, including the results of an acupuncture study (backed by an MRI!) which showed very promising results in a small test group. >How can a problem in the prostate cause >pain in the tailbone, rectum and left sciatic muscle? I don't get it either, but one theory is pain anywhere along the pudendal nerve pathway can cause pain along any other part. The nerve travels through or near epdidymis, tailbone, sitbone, perineum - all the places I feel pain. - Carlos Dear Carlos Thanks a lot for your very kind words! I have carefully read your email and I have some explications to your questions: 1) the degree of symptoms linked with the pudendal nerve compression/inflammation is proportional to the degree of perineal muscles contraction. It means that the first symptoms are sensitive symptoms (pain on the perineum, groins, haunches, bladder area, coccix ect) and later on sexual symptoms. I give you a therapy for perineal muscles spasm (see below). 2) The EPS and mostly the urine after EPS are more sensitive than only the researches on the sperm sample, because a very hard prostatic massage can release bacteria entrapped inside scares or fibrotic/fibrocalcific areas 3)Because Levaquin helps you but the effect disappears when you stop it, it means you could have Chlamydia as elementary bodies ad reticulary bodies. I think that a good intraprostatic and intraepididimal treatment can help you. You can refer by me to a very skilled doctor in NY: Attila Toth MD -65 E. 79th Street New York, NY 10021 voice 212.717.4444 fax 212.717.1868 Tiltoth@aol.com http://www.fertilitysolution.com/ Submit this therapy to your physician. It is very helpful in the perineal floor muscles spasm. BACLOFENE 10 mg tabs>>>1/2 tablet twice daily for 3 days, after>>>> 1 tablet twice daily for 3 days, after >>>>>2 tablets twice daily for 45 days. After the 45 days of therapy, you have to decrease slowly the doses as you have increased them (1 tab twice daily for 3 days, 1/2 tab twice daily for 3 days) . DILATAN cones (they are dilator cones not available in USA; you can find these in www.sapimed.com )>>> you have to insert into the rectum each cone twice daily for 2 minutes , after immersion for 5 minutes in a very warm water. For 45 days CLONAZEPAM 2.5mg/ml drops>>>3 drops in the morning and 3 drops in the evening. For 45 days. After 15 days of therapy keep me up to dated. Best Regards Federico Guercini PhD M.D. > Dr. Guercini! > [quoted text clipped - 101 lines] > this > post (I got my "MD" on Google!) Hello, I'm curious, how is a EPS done? I had an infectious disease specialist do a prostate massage, then had me pee in a cup. Is this an EPS? I would think they would capture the fluid directly. The culture was negative by the way, which didn't surprise me, I had been on Cipro for three months. Thanks, Larry > TRUS (a sonographic check of your prostate) and EPS (a culture for > bacteria [quoted text clipped - 12 lines] > > - Carlos >'m curious, how is a EPS done? I don't know (having not had one yet). > I had an infectious disease specialist >do a prostate massage, then had me pee in a cup. Is this an EPS? I would >think they would capture the fluid directly. I thought so too -- that the culture would be of the fluid pressed out, not by urine after. Hopefully someone here will explain. >The culture was negative by the >way, which didn't surprise me, I had been on Cipro for three months. This is tricky. Cipro doesn't kill some things -- and in particular may make chlamydia (a very major cause of epididymal pain) persistent. But the key (I think -- again I hope someone smarter than me posts) is what sort of culture is done. Using some methods (PCR? Or the particular RNA probe that Dr. Guercini mentioned? or something else?) I think you can find vestiges of infection even while one antibiotics. The problem with PCR test is it may be overly sensitive -- reporting infections which are contamination from your hands, for example. - Carlos > Hello, > I'm curious, how is a EPS done? I had an infectious disease specialist [quoted text clipped - 4 lines] > Thanks, > Larry EPS is obtained by massage. Massage is done with a gloved index finger inserted in the anus and firmly pressing on the prostate. You should be able to get at least a few drops of fluid by milking the urethra. My Uro did this directly, putting the drops on a slide for microscopic examination or in a culture media. I suppose that these drops might be contained in the urine after a massage. > > Hello, > > I'm curious, how is a EPS done? I had an infectious disease specialist [quoted text clipped - 12 lines] > culture media. I suppose that these drops might be contained in the urine > after a massage. All, My personal take is that there exists Acute Bacterial Prostatitis, and there exists Chronic Bacterial Prostatitis, but only if one had an Acute Bacterial Prostatitis case that was not fully eradicated. In this case, bacteria is cultured and is just hard to get rid of. I think some of you need to thing long and hard and read this.... http://www.pelvicpain.org/resources/Berger_Prostatitis.pdf Seems like there is more bacteria in controls. WBCs do not really mean much, there are more in controls too. Mak > > > Hello, > > > I'm curious, how is a EPS done? I had an infectious disease specialist [quoted text clipped - 28 lines] > > Mak I didn't really learn anything I didn't already know in Berger's paper. I have Type II, CBP. I don't have CPPS. My initiating injury was Type I ABP. Seems all the emphasis is on CPPS and they still don't know how to get rid of CBP. > I didn't really learn anything I didn't already know in Berger's paper. I > have Type II, CBP. I don't have CPPS. My initiating injury was Type I ABP. > Seems all the emphasis is on CPPS and they still don't know how to get rid > of CBP. Thats because ABP and/or CBP accounts for only 5-10% of ppl who have prostatitis. Do you have a resistant strand of E.Coli or something? If they culture it do they not do sensitivity testing to find out which anti-biotic you should take, which will be most effective? Should be a textbook case, just take 4-12 weeks, low dose anti-biotics, and if it appears after that, you might have an structural abnormality, which keeps re-infecting you and you need to correct that first. See a good Urologist or an Infectious Disease Specialist. Mak >Thats because ABP and/or CBP accounts for only 5-10% of ppl who have >prostatitis. Not exactly. That's the percentage for which a particular pathogen has been identified. And using what tests? If urinary only, it's not enough. - Charles >Thats because ABP and/or CBP accounts for only 5-10% of ppl who have >prostatitis. Note also that the statistic is revealed for its dubious signifance by the vagueness -- 5% or 10%? that's a 100% variation -- what explains it, and where are teh studies? - Carlos > >Thats because ABP and/or CBP accounts for only 5-10% of ppl who have >>prostatitis. [quoted text clipped - 5 lines] > > - Carlos Carlos, you're very vocal here on this topic, but you're also peculiarly lazy when it comes to researching the subject. The studies proving that around 5% men with chronic discomfort symptoms have CBP are easy to find. I suspect you're a troll! If you are not, start here: http://www.chronicpelvicpain.us/viewtopic.php?t=971 The read the studies referenced at http://www.chronicprostatitis.com/ such as The Journal of Urology 2003; 169(2):584-588 Prostate Biopsy Culture Findings of Men With Chronic Pelvic Pain Syndrome do Not Differ From Those of Healthy Controls JAY C. LEE*; CHARLES H. MULLER; IVAN ROTHMAN†; KATHY J. AGNEW; DAVID ESCHENBACH‡; MARCIA A. CIOL; JUDITH A. TURNER; RICHARD E. BERGER ABSTRACT Purpose: Previous reports have identified bacteria in the prostate of men with chronic pelvic pain syndrome. To examine whether prostatic bacteria are more prevalent among patients with chronic pelvic pain syndrome than among those without pelvic pain, we compared 4-glass urine test and prostate biopsy results. Materials and Methods: A total of 120 patients with types IIIa and IIIb chronic pelvic pain syndrome and 60 asymptomatic controls underwent a standard 4-glass urine test, examination of expressed prostatic secretion leukocytes by hemocytometer and transperineal, digitally guided prostate biopsies. Tissue was cultured for aerobes, anaerobes, Trichomonas vaginalis, Chlamydia trachomatis and herpes simplex virus. Skin cultures were performed on a subset of patients and controls. Results: Positive prostate biopsy cultures were obtained from patients and controls. Bacteria were found in 45 of 118 pain patients (38%) and in 21 of 59 controls (36%) (p = 0.74). Older men were more likely to have positive cultures. Men with type IIIa chronic pelvic pain syndrome were more likely than those with type IIIb to have positive prostate biopsy cultures. Conclusions: Bacteria cultured from transperineal prostatic biopsies do not differ between men with and without chronic pelvic pain syndrome. Prostatic bacteria obtained by biopsy are probably not etiologically related to the symptoms in the majority of men with chronic pelvic pain syndrome. ++++++++++++++++++++++++++++++++ What do the experts say? ============================== The Journal of Urology 2003; 169(2):597-598 Editorial: Emerging Concepts in the Management of Prostatitis/chronic Pelvic Pain Syndrome Anthony J. Schaeffer Department of Urology Northwestern University Medical School Chicago, Illinois The etiology of the chronic pelvic pain syndrome remains an enigma. Traditional thinking implicates the prostate as a primary source of the discomfort and bacteria and/or inflammatory cells as the cause of prostate malfunction. To this end, a lot of time and effort have been spent using traditional culture and more sophisticated polymerase chain reaction techniques to identify putative bacterial pathogens that could infect the prostate and lead to the development of the chronic pelvic pain syndrome. Previous studies using sophisticated polymerase chain reaction technology have failed to identify evidence of bacteria in prostatic tissue obtained from young, presumably healthy cadaver specimens. Traditional techniques to identify bacteria in the prostate are based on localization studies that identify bacteria in prostatic fluid and/or post-prostatic massage voided urine. Obviously, contamination of these specimens from urethral organisms is a common concern and the significance of low numbers of bacteria in expressed prostatic secretions is questionable. To avoid this problem, Lee et al (2003) performed transperineal tissue biopsies of the prostate. Contamination of the skin was negligible. Using aggressive culture techniques, they identified low numbers of nonpathogenic bacteria in about 30% of the patients and controls. Older men were more likely to have positive cultures, as were those with inflammation in the prostatic fluid. None of the counts was high enough and/or associated with recognized pathogenic bacteria and, therefore, these bacteria are probably colonizing bacteria rather than infecting strains. Since the patients in these studies were older, it is likely that in time urethral bacteria colonized the prostatic ducts. However, these bacteria apparently do not lead to a host response and, particularly, there is no evidence that they are associated with symptoms. It is well recognized that even if pathogenic bacteria are present in the prostate, as in men with established chronic bacterial prostatitis, they do not cause chronic pelvic pain unless acute urinary tract infection develops. Taken together, these data suggest that bacteria do not have a significant role in the development of the chronic pelvic pain syndrome. The clinical observation that antimicrobial therapy reduces symptomatology in men with chronic pelvic pain syndrome is being tested in a double-blinded NIH controlled study. Since antimicrobials may have anti-inflammatory activity, it is possible that these drugs may benefit the patient by reducing inflammation rather than eradicating bacteria. > The studies proving that >around 5% men with chronic discomfort symptoms have CBP are easy to find. I [quoted text clipped - 5 lines] >bacteria obtained by biopsy are probably not etiologically related to the >symptoms in the majority of men with chronic pelvic pain syndrome. You stated: "Thats because ABP and/or CBP accounts for only 5-10% of ppl who have prostatitis." so you were talking about ABP **and** CBP, but the study you cite (quoted above) refers to a different population -- namely ALL chronic pelvic pain. That's a big difference. The "B" in ABP and CBP is bacterial -- and that population should not be confused with pelvic pain that (as in the study) is (1) only chronic, and (2) not limited to bacterial cases. It's easy to find other statistics, especially when you're talking about new cases -- to the effect that most epididymitis (at least) is bacterial. Then for chronic cases there's the really odd result that antibiotics in one study helped 57% -- and those who benefited did not correlate with who appeared to be infected [see below]. So maybe there was an infection that we don't know how to test for; or maybe the antibiotics caused a big improvement not related to killing an infection. I doubt if anyone knows, but it implies not trying antibiotics is nuts. Them there is a doctor who claims "chronic prostatitis is almost always an autoimmune problem" (a theory that got a big boost when a guy going for a kidney transplant had his immune system knocked out, which also stopped his pelvic pain!). What I see as a complication is doctors in my experience are very slow to do semen cultures or EPS cultures. How many guy's conditions became chronic because they never got the correct antibiotics? or maybe not, but what was the downside in trying? In any event, I am hardly a troll -- since I advocate nothing. I have no idea what cause chronic pelvic pain. Every answer has its passionate advocates, and none of those answers seem to solve a large number of cases. Meanwhile even the cases medicine can handle appear to be neglected. There appears to be no doubt that SOME cases (I won't argue with the percents) fall into each of the following categories. - infection (and the note that widely prescribed Cipro is a lousy choice for at least some of the major causes of infection, esp. chlamydia) - pelvic muscle disorder that persists after the stimulus for pain is gone - anatomical problems revealed by MRI (cyst on nerve, variocele, spinal problem at L4/L5, and maybe absess, stones, strictures, urinary reflux) - other wackier or more speculative or rare causes: venous congestion, hormone related, autoimmune possibility, tumor But how many men even know all those categories exist, and get tested for them? (I'm sure that's an incomplete list) What makes this confusing is everything seems to cause everything else. Chlamydia can cause infection which can cause an autoimmune disorder called Reiter's. Any pain can cause a nerve to refer pain to other places, and can cause muscle spasm. Or is it muscle spasm which if it perpetuates causes nerve damage? - Carlos ======== Urol 2001 May;165(5):1539-44 Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial. Nickel JC, Downey J, Johnston B, Clark J, Group TC Department of Urology, Queen's University, Kingston, Canada. Of the patients 57% believed that they had moderate to marked improvement. All categories of the chronic prostatitis/chronic pelvic pain syndrome and patients in whom antibody was positive or negative had significant improvement in the NIH chronic prostatitis symptom index, symptom severity index, symptom frequency questionnaire and quality of life scores compared with baseline (p <0.001). There was no significant difference in patient response to the stratification based on culture, leukocyte, that is categories II, IIIA and IIIB had same beneficial response, or antibody status. CONCLUSIONS: Culture, leukocyte and antibody status of prostate specific specimens does not predict antibiotic response in patients with the chronic prostatitis/chronic pelvic pain syndrome. The perceived beneficial effect of antibiotics needs to be evaluated in a randomized placebo controlled trial. > Then for chronic cases there's the really odd result that antibiotics in > one > study helped 57% -- and those who benefited did not correlate with who > appeared to be infected [see below]. Who did the study? How reputable? Funded by drug companies? Was it replicated? What was the exact definition of the treatment cohort: often the abstract does not explain that they selected bacterial cases only. > I doubt if anyone knows, but it implies not trying antibiotics is nuts. Ha! Please, stop being silly. Nobody who reads this newsgroup has failed to be treated with antibiotics, usually several kinds. Yopu ae simply taking us back into a past we're all trying to forget. > Them > there is a doctor who claims "chronic prostatitis is almost always an > autoimmune problem" (a theory that got a big boost when a guy going for a > kidney transplant had his immune system knocked out, which also stopped > his > pelvic pain!). Yes, and if he really had a hidden bacterial infection, the immunosuppression would have let it rampage through his system. Please think. > What I see as a complication is doctors in my experience are very slow to > do > semen cultures or EPS cultures. Because they find from experince that it doesn't help. Try reading a bit. Engagae brain before keyboard: http://www.chronicprostatitis.com/epscultures.html > How many guy's conditions became chronic > because they never got the correct antibiotics? or maybe not, but what > was the > downside in trying? You want the downside to using antibiotics when there is no infection? Okaaaay: http://www.chronicpelvicpain.us/viewtopic.php?t=1693 > In any event, I am hardly a troll -- since I advocate nothing. I have > no > idea what cause chronic pelvic pain. Every answer has its passionate > advocates, and none of those answers seem to solve a large number of > cases. Wrong. We have not seen comprehensive studies on the newer psycho-neuromuscular theories (stress + spasm +- allergy +- other factors = nerve-driven mast cell degranulation + inflammation) . All we do know is that antibiotics are not statistically better than placebo. That's been proved. > Meanwhile even the cases medicine can handle appear to be neglected. > There [quoted text clipped - 5 lines] > for > at least some of the major causes of infection, esp. chlamydia) You're talking nonsense again. Go to Medline and look up the studies on CP/CPPS. Chlamydia is found to be present in a very small percentage of cases. (Ignore studies by those who would promote their clinics and claim to find chl. in almost every patient.) The original poster stated only 5-10% of men presenting with CP-type LUTS have infection, and you'll find, if you were prepared to do the research, that he is right. > - pelvic muscle disorder that persists after the stimulus for pain is gone More nonsense. If a person is tense and anxious by nature and reacts to stress by raising pelvic muscle tonus, the stimulus is never gone. > - anatomical problems revealed by MRI (cyst on nerve, variocele, spinal > problem at L4/L5, and maybe absess, stones, strictures, urinary reflux) Extremely rare, despite the one or two who claim otherwise. Some doctors in this field are bordering on the unethical. > - other wackier or more speculative or rare causes: venous congestion, > hormone > related, autoimmune possibility, tumor Tumor? Vanishingly rare. Congestion? Show me even ONE good study backing that one! We know men with CPPS have a higher blood flow in their prostates by doppler, but that's it so far. Hormone related? No solid proof. Nobody studies where hormones were used to treat had impressive results. This is confirmed anecdotally. The autoimmune theory has gone nowhere. > But how many men even know all those categories exist, and get tested for > them? > (I'm sure that's an incomplete list) You're a talker, not a reader or thinker. And you're spreeading FUD and misinformation here. > What makes this confusing is everything seems to cause everything else. > Chlamydia can cause infection which can cause an autoimmune disorder > called > Reiter's. Reiter's is usually caused by several types of bacteria ( Shigella, Salmonella, Yersinia, or Campylobacter) during enteric infections. Chlamydia is not a major cause. > Any pain can cause a nerve to refer pain to other places, and can > cause muscle spasm. Or is it muscle spasm which if it perpetuates causes > nerve > damage? You really do not understand the newer thoeries at all. PLEASE do a little more reading. >You really do not understand the newer thoeries at all. PLEASE do a little >more reading. Fair enough! But... >>study helped 57% -- and those who benefited did not correlate with who >> appeared to be infected [see below]. > >Who did the study? I gave the citation. I believe Nicols (the guy in Canada) was one of the names on it. >Nobody who reads this newsgroup has failed to >be treated with antibiotics, usually several kinds. Let's not get too crazy -- even you admit (I think) 5% to 10% are bacterial -- why can't antibitoics cure them? And I'm not clear on 10% of what (of chronic cases, or the much larger superset of everyone who gets these symptoms, including those that don't become chronic). I had a very swollen boggy prostate. 5 weeks of Levaquin fixed that -- seemingly for good (3 months later at least my prostate is still normal). Too bad for me that the epididymal and sitbone (etc) pains have remained and gotton worse. >http://www.chronicprostatitis.com/epscultures.html >You want the downside to using antibiotics when there is no infection? >Okaaaay: >http://www.chronicpelvicpain.us/viewtopic.php?t=1693 Thanks (really) although I hope not all YOU have to sell is trigger points. - Charles >here is a doctor who claims "chronic prostatitis is almost always an >> autoimmune problem" (a theory that got a big boost when a guy going for a [quoted text clipped - 4 lines] >Yes, and if he really had a hidden bacterial infection, the >immunosuppression would have let it rampage through his system. Please We disagree. an infection and an autimmune response can co-exist (some websites say) (yes, I know I website is nto a "study"). You kill the infection, and you may stop the autoimmune response. note that the infection can affect one organ, and the autoimmune response affect a wholly different one. The classic example is rheumatic fever which derives from a strep throat infection. www.medical-library.net/sitesd/_rheumatic_fever.html But perhaps more offten (as with rheumatic fever) the original infection is GONE but the immune response remains. I'm not saying I belieive it, but it makes sense. I note I sometimes have Reiter's symtoms (pink eye, painful heels) which could mean something. >You want the downside to using antibiotics when there is no infection? >Okaaaay: >http://www.chronicpelvicpain.us/viewtopic.php?t=1693 To the extent we're talking quinolones (as that website does) I agree --- doctors universally neglect to warn that the side effects can be gruesome especially when you take quinolones for MONTHS (they're only approved for something like weeks). I've experienced some of the side effects from Cirpro (joint pain, insomnia, nausea) and they're bad and in some people they claim they don't go away. But show me the authority that proves it's dangerous to take plunky old doxycycling for a year. Little or no downside there. Ask Gabe. www.drmirkin.com/morehealth/2521.html www.drmirkin.com/archive/7207.html www.rheumatic.org/mirkin.htm http://www.immunesupport.com/library/showarticle.cfm/ID/4090/ Why I Prescribe Antibiotics to Patients with Chronic Fatigue Syndrome, Fibromyalgia, Multiple Chemical Sensitivity, and Other Autoimmune Diseases - Carlos > >here is a doctor who claims "chronic prostatitis is almost always an >>> autoimmune problem" (a theory that got a big boost when a guy going for [quoted text clipped - 13 lines] > stop > the autoimmune response. You're missing the point. If you have any kind of infection and during this infection someone wiped out your immune system with immunosuppressants, you'd get a MASSIVE, maybe even life-threatening infection. Capiche? There's nothing to combat the bugs or keep them in check. > note that the infection can affect one organ, and the autoimmune response > affect a wholly different one. The classic example is rheumatic fever [quoted text clipped - 9 lines] > makes sense. I note I sometimes have Reiter's symtoms (pink eye, painful > heels) which could mean something. Have you had the HLA B-27 antigen blood test yet? Use Google ... > But show me the authority that proves it's dangerous to take plunky old > doxycycling for a year. Little or no downside there. LEARN TO USE MEDLINE, YOU LAZY c.nt. http://tinyurl.com/4tnnn http://tinyurl.com/4jmoy http://tinyurl.com/56onc > Ask Gabe. > www.drmirkin.com/morehealth/2521.html > www.drmirkin.com/archive/7207.html > www.rheumatic.org/mirkin.htm > http://www.immunesupport.com/library/showarticle.cfm/ID/4090/ Gabe Mirkin is a certifiable nutcase. See http://www.chronicpelvicpain.us/viewtopic.php?t=1825 > > >here is a doctor who claims "chronic prostatitis is almost always an > >>> autoimmune problem" (a theory that got a big boost when a guy going for [quoted text clipped - 51 lines] > Gabe Mirkin is a certifiable nutcase. See > http://www.chronicpelvicpain.us/viewtopic.php?t=1825 Let me tell you all a little something about infection. It it easy to wish for an infection. Sure, why not? Take a little pill and it is all over. Please... As for Mirkin, he quotes Shoskes at CC in Florida and says he agrees. Ask Shoskes, he does not. I have been to Shoskes, had my EPF checked, was checked by three URG, to other doctors, had seemen cultured, urine for days, even sent epf and firt void urin to lab in Denmark for Mycoplasma etc, DNA and real time PCR tests. No bactieria. Most of us do not. I am living proof. You must check out http://www.pelvicpainhelp.com/ I suffered for 3 years. Once you rule out something like cancer, duct problems, and bactiria, then this is where to turn. I just left a clinic there and for the first time I have some relief from pissing 20 times a day and that buring golf ball. >If you have any kind of infection and during this >infection someone wiped out your immune system with immunosuppressants, >you'd get a MASSIVE, maybe even life-threatening infection. Capiche? There's >nothing to combat the bugs or keep them in check. Yeah, I get that, but I'm not talking about wiping out my immune system, which no one is going to do for me anyway. I'm merely reporting the view (not my view necessarily -- I'm floundering around looking for potenital answers) that (1) there is evidence some pelvic stuff is autoimmune related, and (2) some autoimmune stuff is a reaction to an ongoing infection, in which case antibiotics to cure the infection might also cure the autoimmune response. I don't know if that's literally true, but I did not make it up. > note I sometimes have Reiter's symtoms (pink eye, painful >> heels) which could mean something. > >Have you had the HLA B-27 antigen blood test yet? Yep, I know about that. I've had trouble (until recently, when I started breaking out with open sores) getting doctors to even consider the autoimmune idea. >LEARN TO USE MEDLINE, YOU LAZY c.nt. > http://tinyurl.com/4tnnn > http://tinyurl.com/4jmoy > http://tinyurl.com/56onc Thanks (for the links, anyway!). > Gabe Mirkin is a certifiable nutcase. See > http://www.chronicpelvicpain.us/viewtopic.php?t=1825 Thanks for that, although I'm not ready to abandon my Gabe worship for the moment. But your link includes a comment by Dr. Shoskes that is very unfavorable to Gabe, which counts for a lot. Dr. Shoskes is one of the few bright lights in this area -- and he does recognize that in come cases he tests for bacteria, kills bacteria, and effects a cure. - Carlos |
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