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What Causes Pain Under The Right Rib Cage While On BCG Treatment?
Question: I am still experiencing increased voiding, yesterday at 4.5 Litres. Usually, urine is fairly clear, except cloudy about 4 hour period Saturday afternoon. I have a slight ache under right rib cage at back? Last Tuesday liver and kidney blood tests were good. I am taking BCG treatments for the bladder, completed 1st 6 on Thursday, now 6 weeks off. My ears are ringing, more than normal, but not really bad. I am shakey, worse in the morning. I have had body temps (oral) ranging from 97.8 to 99.3 degrees since Saturday. Last BP was 122/77 a bit lower than my recent normal. Besides bladder cancer, what else. XXXXXXX
Brief Answer:
Likely urinary tract infection
Detailed Answer:
Hi
Thank you for contacting healthcaremagic.
The symptoms you describe are unlikely to be due to bladder cancer as such but likely due to side effects of BCG treatment.
One common side effect that patients develop is urinary tract infection.
I would advice you submit a urine sample for culture and sensitivity and start on an antibiotic called co-amoxyclauv- 625 mg thrice daily after food and this has to be by a prescription from your doctor.
I would also advice you to drink adequate fluids to keep your urine colourless and take paracetomol for low grade fever that you are having.
If the urine culture is negative and the symptoms do not subside then contact the urologist who gave the BCG as very rarely patients can develop what is called BCGiosis which needs specialist treatment.
If urine culture is positive then change the antibiotics according to the culture report and take it for full 7 days and may be 10 days.
Hope that answers your query.
Likely urinary tract infection
Detailed Answer:
Hi
Thank you for contacting healthcaremagic.
The symptoms you describe are unlikely to be due to bladder cancer as such but likely due to side effects of BCG treatment.
One common side effect that patients develop is urinary tract infection.
I would advice you submit a urine sample for culture and sensitivity and start on an antibiotic called co-amoxyclauv- 625 mg thrice daily after food and this has to be by a prescription from your doctor.
I would also advice you to drink adequate fluids to keep your urine colourless and take paracetomol for low grade fever that you are having.
If the urine culture is negative and the symptoms do not subside then contact the urologist who gave the BCG as very rarely patients can develop what is called BCGiosis which needs specialist treatment.
If urine culture is positive then change the antibiotics according to the culture report and take it for full 7 days and may be 10 days.
Hope that answers your query.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
My temp is 97.7 this morning, and have some shakes, I did get a reasonable sleep as I took one regular tylenol last night. Fluid balance was 3.0 litres in and 3.2 L out (voiding). I had a urine test on Sunday, still haven't got results, will call this morning.
What are the early, main symptoms of the BCGiosis you mentioned?
Please
What are the early, main symptoms of the BCGiosis you mentioned?
Please
Brief Answer:
Could be any symptoms
Detailed Answer:
Hi
BCGiosis is a very rare complication that needs to be kept in mind whereby the BCG given into bladder can spread by blood to other parts of the body - to any part of the body really. Hence there are no specific symptoms of BCGiosis but symptoms depend on which organ is affected. Hence if there is no improvement after treating the local bladder infection then please mention this to your urologist. There are no specific tests to diagnose this but needs to be considered if systemic symptoms do not improve.
Hope that answers your query.
Could be any symptoms
Detailed Answer:
Hi
BCGiosis is a very rare complication that needs to be kept in mind whereby the BCG given into bladder can spread by blood to other parts of the body - to any part of the body really. Hence there are no specific symptoms of BCGiosis but symptoms depend on which organ is affected. Hence if there is no improvement after treating the local bladder infection then please mention this to your urologist. There are no specific tests to diagnose this but needs to be considered if systemic symptoms do not improve.
Hope that answers your query.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I went to a clinic tonight, they advise that my urine sample shows no sign of infection (they will still send it for a culture). They did request 2 blood tests, Hemoglobin A1c and a hormone ADH (will try to get into a lab later tomorrow). The Doc advises this brain hormone affects processing of water. Does this sound like a reasonable possibility to you, and can you suggest how I might not be producing enough of the hormone and if it can be replaced by medication?
I have 1 more symptom - ringing in my ears that started just over a week ago, could this be caused by dehydration?
I had a 325 acetaminophen last night, the excess voiding was much improved overnight (totals 3.1 litres out and 3.0 in over 24 hours), so I will take one again tonight. XXXXXXX
I have 1 more symptom - ringing in my ears that started just over a week ago, could this be caused by dehydration?
I had a 325 acetaminophen last night, the excess voiding was much improved overnight (totals 3.1 litres out and 3.0 in over 24 hours), so I will take one again tonight. XXXXXXX
Brief Answer:
ADH deficiency can be a possibility.
Detailed Answer:
Hi
Even though the urine sample has not shown signs of infection, I would wait for the culture report.
HbA1c is to check for your diabetic status as one symptoms of diabetes is increased voiding. ADH is a hormone produced by brain that makes the kidney conserve water and if deficient can lead to excess urine production by kidneys. Deficiency can sometimes be part of ageing or acute illness. Even though it is a possible cause, it usually does not present as sudden onset of increased voiding. It also does not explain the low grade fever you are having.
If ADH is decreased then it can be treated by a medicine called desmotabs or desmopressin spray.
The other possible explanation of increased voiding is irritability of bladder caused by BCG . To see whether it is a bladder issue or not a frequency volume chart can be helpful. Please note down all your fluid intake in millilitres along with time and type of fluids and also the urine output volume and time over a 24 hour period. If the volume of urine passed is consistently below 200 ml then it is predominantly bladder problem. If the volume of urine passed is significantly greater than your intake then it could be kidney or ADH problem or due to diabetes among other causes.
Ringing in years may be due to dehydration also.
Yes you could take acetaminophen if it helps.
ADH deficiency can be a possibility.
Detailed Answer:
Hi
Even though the urine sample has not shown signs of infection, I would wait for the culture report.
HbA1c is to check for your diabetic status as one symptoms of diabetes is increased voiding. ADH is a hormone produced by brain that makes the kidney conserve water and if deficient can lead to excess urine production by kidneys. Deficiency can sometimes be part of ageing or acute illness. Even though it is a possible cause, it usually does not present as sudden onset of increased voiding. It also does not explain the low grade fever you are having.
If ADH is decreased then it can be treated by a medicine called desmotabs or desmopressin spray.
The other possible explanation of increased voiding is irritability of bladder caused by BCG . To see whether it is a bladder issue or not a frequency volume chart can be helpful. Please note down all your fluid intake in millilitres along with time and type of fluids and also the urine output volume and time over a 24 hour period. If the volume of urine passed is consistently below 200 ml then it is predominantly bladder problem. If the volume of urine passed is significantly greater than your intake then it could be kidney or ADH problem or due to diabetes among other causes.
Ringing in years may be due to dehydration also.
Yes you could take acetaminophen if it helps.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Volume of urine usually over 200 ml each void,up to 550 ml; past 24 hours nearly in balance again at 3.3 L. This morning my temp is only 96.8, is this serious? quite shakey as well. In the early mornings I seem to have a horizontal rigid area in my stomach, (upper abdomen), not really noticeable later in the day. I forgot to mention this to the Doc yesterday. Is there a way I can check this so I can describe it better to the Doc? (example maybe the size of 1/2 a banana which it is approximately). XXXXXXX
Brief Answer:
Reassuring findings
Detailed Answer:
Hi
Since the fluid output is equal to intake, and since you are passing reasonable amount in each void, it is unlikely you will have any problem with your kidneys and the capacity of bladder seems good.
Your weight is about 57 kg and 1.8 litres of fluids are enough for you per day. Since you are drinking about three litres, this itself might be the cause of increased frequency of urination. Occasionally overdrinking of plain water alone without any added minerals may also cause dizziness/shakiness.
The body temperature might have become normal due to acetaminophen and hence urinary tract infection is still a possibility.
Only a clinical examination will tell us the cause of the rigid area in the upper abdomen.
Thank you
Reassuring findings
Detailed Answer:
Hi
Since the fluid output is equal to intake, and since you are passing reasonable amount in each void, it is unlikely you will have any problem with your kidneys and the capacity of bladder seems good.
Your weight is about 57 kg and 1.8 litres of fluids are enough for you per day. Since you are drinking about three litres, this itself might be the cause of increased frequency of urination. Occasionally overdrinking of plain water alone without any added minerals may also cause dizziness/shakiness.
The body temperature might have become normal due to acetaminophen and hence urinary tract infection is still a possibility.
Only a clinical examination will tell us the cause of the rigid area in the upper abdomen.
Thank you
Above answer was peer-reviewed by :
Dr. Prasad
Is there a correct way to bring my water consumption down to normal? I have been keeping it higher in case of large void overnight so I don't get into a large negative position like has happened twice in the the past month, although once it may have been because I ate a square of dark chocolate that I was warned against doing (due to BCG).
I saw an endocrinologist today, Dr. XXXXXXX Gill, she agrees with not treating my subclinical hypothyroid condition. I have had the ADH and Hemoglobin Ac1 blood tests plus the Creatinine, electrolytes, albumin and calcium tests she ordered. Still have am cortisol and ACTH to be done (not to be done late in the day). What is ACTH test for?
When I list liquid consumption it includes coconut water, milk and mineral water, less than half is straight tap water. I appreciate your continuing support. XXXXXXX
I saw an endocrinologist today, Dr. XXXXXXX Gill, she agrees with not treating my subclinical hypothyroid condition. I have had the ADH and Hemoglobin Ac1 blood tests plus the Creatinine, electrolytes, albumin and calcium tests she ordered. Still have am cortisol and ACTH to be done (not to be done late in the day). What is ACTH test for?
When I list liquid consumption it includes coconut water, milk and mineral water, less than half is straight tap water. I appreciate your continuing support. XXXXXXX
Brief Answer:
See advice below
Detailed Answer:
Hi
The best guide to adequacy of fluid intake is thirst. You will need a minimum of your body weight in kilograms x 30 ml of water per day. Additional fluids above this is to be taken to make the urine colourless. If still you are thirsty above this then you need to take more fluids to quench the thirst.
Steroid hormones called cortisol again are one way the body maintains the salt content and fluid content in the body as well as other functions. ACTH tests this pathway. All these tests are done to find the cause of shakiness that you are experiencing. It is unlikely to be related to the BCG that you have had.
Thank you
See advice below
Detailed Answer:
Hi
The best guide to adequacy of fluid intake is thirst. You will need a minimum of your body weight in kilograms x 30 ml of water per day. Additional fluids above this is to be taken to make the urine colourless. If still you are thirsty above this then you need to take more fluids to quench the thirst.
Steroid hormones called cortisol again are one way the body maintains the salt content and fluid content in the body as well as other functions. ACTH tests this pathway. All these tests are done to find the cause of shakiness that you are experiencing. It is unlikely to be related to the BCG that you have had.
Thank you
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I have symptoms suggesting BCGiosis, ears ringing, odd feeling in my back, still have slight temp, down another pound, shakiness worst in mornings, but no cough yet. Would getting started on regular antibiotics sooner rather than later help? (like ciproflaxin) I have 2 choices over the weekend: a walk in clinic with limited expertise but good chance to get an antibiotic prescription, while the hospital Emerg I went to last weekend over the voiding was a total waste of time, worse it was very tiring (waiting room with excess A/C etc) and resulted in exposure to a variety of other sick people. If correct about BCGiosis, I suppose this means no more BCG treatments?
My urologist's office only suggested to go to the Emerg if pain, bleeding or fever over 38 C, I have none of these. XXXXXXX XXXXXXX
My urologist's office only suggested to go to the Emerg if pain, bleeding or fever over 38 C, I have none of these. XXXXXXX XXXXXXX
Brief Answer:
Yes please start on antibiotics.
Detailed Answer:
Hi
I agree you should start on antibiotics like co-amoxyclauv 625 mg thrice daily. Try to avoid ciproflocaxin for now until urine culture reports are back. I agree if this is BCG complication then you will not be receiving any more BCG into bladder.
Thank you.
Yes please start on antibiotics.
Detailed Answer:
Hi
I agree you should start on antibiotics like co-amoxyclauv 625 mg thrice daily. Try to avoid ciproflocaxin for now until urine culture reports are back. I agree if this is BCG complication then you will not be receiving any more BCG into bladder.
Thank you.
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Above answer was peer-reviewed by :
Dr. Prasad
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