It’s been a rough road with UTI’s. I kick it and 2 weeks later it’s back. Frustrating. Painful. Annoying as heck.

Urgent care and gynecologists do the standard cultures and want to slam me with antibiotics (which don’t work and have strong affects because of the Lyme).

My Lyme doctor has been using Microgen DX testing and was able to consult with a UTI expert, Ruth Kris, MSN, APRN. She was a wealth of knowledge and gave him/us a crash course in chronic UTI’s and my specific issues. Below are notes from that call, with a little info added from her website and interviews I’ve watched.

TESTING

Standard UTI cultures only test fast growing bacteria and misses a lot of infections. 

• Most standard tests look at fast growing bacteria and misses slow growing.
• Some bacteria don’t like the culture medium and won’t grow.
• Bacteria can live in different forms – they have a cell wall and sometimes when they are treated with antibiotics they are driven into a cell wall deficient form (L form) which won’t grow on a standard culture plate but will be detected by standard dna testing.

Microgen DX testing is highly accurate with 2 levels of testing:

1. PCR (polymerase chain reaction) – gives fast results but can only be done on a limited number of pathogens at a time. 
2. Next generation sequencing (NGS) – identifies more bacteria, fungi, and antibiotic resistance genes.

LYME & OTHER ISSUES AFFECTING BLADDER PROBLEMS

There is a huge connection between people with Lyme disease and bladder problems. WHO KNEW?

• Lyme depresses the immune system so bladder bacteria becomes easier to grow.
• Bladder problems are related to the length of time since the original Lyme infection, not the severity of the infection. So those with chronic Lyme are more prone to recurrent/chronic UTI’s.
• There is a connection between low vitamin D and people with Lyme disease. We burn through it when it activates to help fight the tick-borne infections. The bladder wall needs vitamin D to make cathelicidin (which protects from infection). D needs to be above 50 to protect the bladder. (Note: mine runs about 20)
• Lyme disease produces ammonia as an exotoxin. See below.
• Many Lymies have dysbiosis which increases the risk of harmful bacteria migrating to the bladder.

AMMONIA

Your body clears “excess ammonia by converting ornithine to citrulline in the Urea Cycle. However, if you produce too much ammonia or can’t convert ornithine to citrulline well, not all of the ammonia is cleared and the urine pH raises, favoring the growth of pathogens that flourish at a pH greater than 6.2.”

“This high ammonia level damages the GAG layer of the bladder wall, creating further damage by the bacteria not only attaching to the surface, but by invading the damaged bladder wall.”

In addition to damaging the gag layer and raising pH, ammonia drives the bacteria into biofilms and stabilizes the biofilms.

The GAG (glycosaminoglycan) layer is a thin protective coating of the inner bladder wall that protects the bladders delicate surface from harsh urine. Damage to this layer can lead to irritation, pain, urgency, and frequent urination, which are common in conditions like interstitial cystitis (IC) or painful bladder syndrome.

Gene Mutations / SNP’s

CBS (cystathionine beta-synthase) gene mutations can disrupt the urea cycle leading to increased activity of the cystathionine beta-synthase enzyme, resulting in elevated ammonia levels in the body. Gene mutations seem to be common with lymies.

Urea cycle SNP’s limit the conversion of ornithine to citrulline.

SNP’s (single-nucleotide polymorphism) are genetic variations where a single building block differs at a specific position in the genome. I have several urea cycle SNP’s.

Reduce Ammonia:

Check first morning ph to assess ammonia level – if high, follow this protocol:

Clear Ammonia

• Ammonia Scavenger
• L-Ornithine HCL

Kidney Stones

Calcium oxalate precipitates out when the pH is greater than 6.0 and forms that type of kidney stone.

If the pH is lower than 5.5, they precipitate out uric acid crystals and they get that type of kidney stone.

PhAdjust helps bring up the pH. Don’t use reverse osmosis water; it is very acidifying.

VITAMIN D

There is a connection between Lyme and low vitamin D – it activates to help fight the tick-borne infections. The bladder wall needs vitamin D to make cathelicidin which helps prevent UTIs. Activated vitamin D (not stored form) is so potent it can kill tuberculosis.

D is the precursor to cortisol – when you have high pain and low sleep, you have higher demand for cortisol – low d, hard to handle stress.

It is also the precursor for progesterone (helps balance estrogens) and helps absorb calcium to fight osteoporosis.

Mushrooms are high in vitamin d.

Prescription form is vit d2 – otc is d3 but is more bioavailable and a better choice.

Oral is ok but may not be absorbed well if you have gut issues – patch Md is a transdermal form – injections may also be used

Dose – goal is 50 – 80:

• Restorative 10,000 units daily for 2-3 months
• Maintenance 5,000 units

MY PROTOCOL

Everyone is different – different pathogens need different treatments, so I highly encourage you to do the Microgen Women’s Key test and talk with a specialist to get the best protocol for the pathogens you’re dealing with.

My main problem right now is E. Coli – so that’s the focus. I also have low levels of prevotella (which thrives with pH above 7) and gardnerella (thrives pH above 6.5). These should resolve by reducing the pH.

E. coli makes amyloid fiber biofilms, which are used to attach the bacteria to the bladder wall. So we need to break down the type of biofilm made by E. coli. Other pathogens make other types of biofilms (such as extracellular). 

1. Maintain pH – ongoing
   • Test first morning
   • Take ammonia scavenger if high
2. Vitamin D daily – check levels
3. Breakdown/reduce bacteria biofilm
   • NAC (great for liver support too)
   • Turmeric or curcumin
4. After 2 days, add antibioitics – there are a couple of options for E.Coli but we chose Fosfomycin because it works strictly on the bladder and won’t cause Lyme die off (which can cause more ammonia as well as a herx reaction). (1 packet every other day for 3 doses at bedtime). I prefer natural, like oregano, but I am choosing to go pharmaceutical this time because of the severity and how long it’s been.
5. Load up on probiotics and saccromyces boulardi during and after to protect the gut, vaginal and bladder flora. I chose Ortho-Biotic.
6. After the antibiotics, add lumbrokinase to break down the fibrins – 2 caps daily first am – nothing for 30 mins after. Recommended to stay on these because the genetic issues contribute to the biofilm structures.
   • No NSAIDs (including white willow bark)
   • Stop 1 week before surgery or after trauma (ie car crash)
   • Advise doctors that you’re taking it
7. Retest after antibiotics using Microgen’s Womens Key kit – both urine and vaginal. Breaking down the biofilms may reveal other bacteria.
   • If symptomatic – test in 1 week
   • If not symptomatic – test in 2 weeks

SUPPLEMENTS – Feminologist