BUBBBLE
Dear Sumner:
I have a challenge for you (as she has been for me since the time I first saw her about one year ago). Gwen is a 55 year old single woman who has already consulted 2 other urologists because of persistent irritative symptoms of the lower urinary tract. Although no infection had ever been documented, she had been treated empirically with various antibiotics, without relief of her symptoms. She underwent both radiological studies and cystoscopy and even had a psychiatric evaluation, none of which revealed any obvious abnormalities. She pleads for help. Can you work any of your magic on her?
Dear Carol:
I appreciate your confidence in my ability to come up with a magical cure. I must confess that I felt a bit uncomfortable as Gwen, during the initial consultation, berated the other physicians that she had seen. Nevertheless, she was receptive to my comments that her irritative symptoms could be caused by something other than infection. She accepted the premise that while urinary tract infections almost always set off a secondary inflammatory reaction, an inflammatory reaction can occur without the presence of infection. We went over some possible causes for her symptoms such as a reaction to perfumed soaps, vaginal creams or bubble bath products, as well as local inflammation of the urethral-vaginal area resulting from atrophic urethrovaginitis or vaginal infection. Gwen volunteered that her symptoms were minimal during the day. However, every evening, despite relaxing in a nice warm sudsy bubble bath, her symptoms of irritation flared up. All of a sudden a wide grin appeared on her face. “Could this pleasurable (albeit transient) activity of the bubble bath be the source of her problem?” she asked. “Yes, indeed!” replied I. She agreed, albeit reluctantly, to give up the bubble baths. She called me last week and reported that her irritative symptoms had completely cleared and that she was overjoyed with her new lease on life.
Since I could have such a happy ending to that adventure, I thought you might enjoy hearing of another case which involved a physician whose twin sons had received a bottle of bubble bath for Christmas. The young lads really enjoyed their nightly bubble baths. However, after just a few days, one of the boys starting wetting his bed and complained of pain during urination. (His twin brother had no such problem). Their father, a physician, immediately became concerned that he was possibly dealing with a very serious underlying condition. He became very distraught, even imagining that his son might end up with a kidney transplant (a good example why physicians should not treat close family members!) Fortunately his wife, the mother of the children , analyzed the situation , and suggested in a very calm voice ( in no way did she wish to embarrass or seem to question the accuracy of the diagnostic acumen of her husband, the physician) that, just perhaps, the bed wetting and the painful urination might be a result of the bubble bath acting as a local irritant. The bubble baths were stopped and the boy’s symptoms cleared completely. However, the physician, the true scientist, wanted to check out the accuracy of the etiology of the symptoms. Accordingly, he added some bubble bath to the tub water of his sons once again. Within twelve hours, the symptoms returned. Yes, the bubble bath was then duly discarded. Ever since that fateful day the family has lived in joyous harmony, although without the pleasures (and trauma) of the bubble bath. (And, Carol, the time for confession has arrived: Since then, my son has had no further such problems.)
