Dr Louise Newson: [00:00:02] So Kim, I'm very excited. I've sort of hoicked you in after seeing you on Instagram. And Instagram's great for connecting with people. And I just read a few lines about you and I thought I really want to speak to this lady because you've got a story which is hard but it's good because look at you, you're here, you look great. But it's not good and it could have been a lot worse. And do you know what? It resonated with me for two reasons. One is that you had a urinary tract infection which is, and they're so common and they are almost like a bit belittled. And I've had UTIs that have been a bit come and go and I've UTIs where I literally would prefer to die because I've been in so much pain. I've been bleeding blood and just thinking this is terrible. But also you had sepsis which really makes people think, and my 12 year, well when my middle daughter was 12 she had sepsis and we can talk about that but you know those two things, urinary tract infection can cause sepsis and can kill people and it's not spoken about enough. So listening to this story that you're going to tell us is going to make people think differently I hope or some people think differently. So just tell me what happened Kim if you don't mind? [00:01:19][76.9]
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Kim Smith: [00:01:20] Yeah, so I was in Spain on holiday and started to feel a little bit unwell. I didn't have any UTI symptoms, which some people are quite shocked about. But then I started to get kidney pain in my left side and I thought, oh, maybe I've got a UTI and it's gone to my kidneys. And that was the first inkling that I might have a UTI. I'd got severe breastlessness that I'd put down to my asthma. So I was using my inhaler. I was shivering uncontrollably. I'd got the central heating on. We were in a villa and the log burner and I'd got thick jumpers on. I'd got blankets around me and I was shivering. And I just thought, it's the weather. I'm just cold. And my husband kept coming in going, oh it's like a greenhouse in here. I can't sit in here, it too hot. But I was so cold, I didn't know. I hadn't passed much urine that day but hadn't really noticed. And I got really cold hands and feet and I could not get my hands and feet warm. He'd even done me a hot water bottle and I'd put that under my feet. It made no difference. I've got several pairs of thick, fluffy socks on and they were still icy cold, but something in my gut told me that I needed to get checked and it would probably be better to go to the hospital. I must've thought I was quite poorly for me to want to go to the hospital. So in my little bit of Spanish I said to them 'duele aquí' which means pain here and point it to my left side. Stupidly I didn't say 'muy enfermo' which means very ill, I didn't t say 'infección' because I didn t know the word for kidney or urine, I didn't say infection. So they apparently x-rayed my back and I say apparently because I don't remember.  [00:03:12][112.2]
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Dr Louise Newson: [00:03:12] Because you were so poorly?  [00:03:13][0.6]
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Kim Smith: [00:03:14] They, yeah, they x-rayed my back and sent me away saying, nothing's broken. The next day, at some point on my phone, I'd done a Translate app, and I'd written in there, I think I have a urine infection. And I translated it into Spanish and screenshot it. And my husband took me to the doctors. I vaguely remember getting out of the car and trying to shuffle, I could hardly walk at this point. And I was hanging on to my husband and seeing the doctor and I don't remember seeing him. I don t remember going into the doctor but I showed him my phone apparently and he must have done a urine sample and confirmed I've got a urine infection and he gave us a prescription to go to the chemist which we did but the chemists said we don't have any of those antibiotics in stock, come back tomorrow. I now believe it was too late for oral antibiotics at that stage. I now know I needed IV antibiotics and fluids at hospital. So the hospital missed it and then the doctor missed it. I don't think he took my blood pressure or temperature and just sent me away and I went home. I was so unwell and it's not like me to take myself to bed. I just don't do that unless I'm, obviously really ill and I did I took myself to bed and I woke at four in the morning and I said to my husband I'm dying I need to go to hospital. I'm gonna die and I don't even remember getting to the hospital, any part of that at all and I woke up nine plus weeks later in Milton Keynes Hospital, back in the UK because finally my travel insurance after six weeks decided they would fly me back. And being told that all four limbs had to be amputated. And I said to the doctor, yeah, that's fine, how soon can you do it? Because I couldn't even lift them off the bed. It was like somebody had super glued them down. They were so, so heavy. I couldn't t lift them. And obviously, my muscles had stopped working as well and everything because they had been just laid there for nine weeks, I guess. And then it was just a matter of then being shipped to another hospital for the amputations because my hospital doesn't do amputations. And I spent three months there before going for rehab in London at the Queen Mary Hospital in Roehampton. And I had to literally learn how to walk on my bottom. Yeah, it was quite a traumatic time when I came out of hospital as well because, you know, you're used to having nurses kind of just do everything for you. And then all of a sudden you're at home and you've got to keep asking family. And it's okay to ask a nurse because they're there to do it. When you've got to then start asking family, I was a very independent woman and would be the one running around after everybody else, not asking people to do things for me so I found it really, really hard. I've come a long way since I've learned how to blow dry my own hair. I've learnt how to do my own makeup and even without hands, I can do it. And I do a lot of things now, but my big thing is raising awareness of sepsis and making sure that people understand that any infection is serious and that UTIs are extremely serious for women because so many people just think, oh, it's just a UTI. [00:06:57][223.0]
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Dr Louise Newson: [00:06:59] Yes, and there's a big difference. So, you know, urinary tract infection, the whole urinary tract is a long system and it starts with the kidneys and ends in the urethra that we wee out of. So some people get a bit of cystitis, it burns a bit and stings and they feel absolutely fine. But you had kidney pain. That is a red flag actually, kidney pain in people, could be stones, but if someone then develops a feeling of cold or shivery. That means you need to go to hospital. It doesn't always mean sepsis, but it means you've got possibly pyelonephritis, which means infection in the kidney, which you probably had brewing then at that time. But it's very scary. It must have been very scary for your husband as well? [00:07:45][45.8]
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Kim Smith: [00:07:45] Exactly, yeah. I mean, he was made to wait in a waiting room. And I think they came out to him a couple of hours later and said, she's got hours to live. She won't be needing these and gave him a bag of my clothes. So I've gone in my pyjamas and my dressing gown and my jewellery. And they just gave it to him and said she could die, she's got two hours to live. I was like, oh, wow. He doesn't speak a word of Spanish. They spoke a little bit of English. And so he must have absolutely petrified. And then he had to go home and phone the family. And then they all got flights out.  [00:08:18][33.1]
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Dr Louise Newson: [00:08:20] Goodness, I mean urinary tract infections are very common. In fact, most women have them at some stage of their lives. I don't know the figures, perhaps you do, but I would have thought it's way over 70% of women have had a urinary tract infection.  [00:08:34][14.0]
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Kim Smith: [00:08:35] I don't know, I read that it can be 95% women and 5% men, so I know it's a higher percentage with women than men.  [00:08:43][8.5]
Dr Louise Newson: [00:08:43] Absolutely, yes, yes. It's, and you know, it is very interesting because there's a big move to not give antibiotics for every episode of cystitis. But it's really difficult. As a doctor, I've seen hundreds of thousands of women with urinary tract infections. How do I decide who doesn't need an antibiotic? Actually, we also know that it's not always in the urine test because sometimes you can come back with a negative test, but people still have an infection, which I'm sure you've heard of.  [00:09:16][33.0]
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Kim Smith: [00:09:16] I've had negative tests and I know I've still got an infection.  [00:09:19][3.0]
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Dr Louise Newson: [00:09:20] So, but also as a GP, it can take two or three days or longer if it's over the weekend for a result. So then what do I do as a GP. Do I wait for the result or do I treat the woman? And so it can be very, very difficult. And my sister had a kidney problem and she had to have an operation when she was young and she's very prone to urinary tract infections. And she knows very early on whether she's got an infection or not. But so many times she's been told you can't have antibiotics because we haven't got the urine test result back, but she knows if she has a short course and gets on top of it, it's a lot better. So it can be very difficult to know because guidelines will say different things, different doctors say different things, but actually, like I was saying to you before we started recording, my job as a doctor is to listen to patients and often women know if it's an infection or not and if it is, then they often need antibiotics. Kidney pain, fever really can take a hold as it did for you very quickly. Something like, and you probably know the steps, it's about 30% I think of sepsis is due to urosepsis. So sepsis from urinary tract.  [00:10:36][75.4]
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Kim Smith: [00:10:35] Yeah, it's one of the highest causes.  [00:10:37][1.8]
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Dr Louise Newson: [00:10:38] Yes, and it's, you know, it's more common as we age. It's more common in women. A lot of women, when I used to look after women in nursing homes, they would be very confused, delirious. We wouldn't know what was going on and then we realised that it was a urine infection. So you don't even have to have classical symptoms. And you know sepsis means different things to different people doesn't it. I think there's still some confusion.  [00:11:04][26.1]
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Kim Smith: [00:11:10] I think mine was extremely drastic. You know, to lose my limbs from it. I mean, I'm lucky I didn't die, because so many do die, and I find I'm lucky. I mean people say, oh, poor you. And I'm like, I don't need your pity. I don't need pity. You know, I want you to learn about sepsis is what I want. I don't need pity and I'm doing great. I've got a good life. I'm happy and, you know, I'm raising awareness of sepsis. I'm doing something really healthy, really good, you know it's... I had a message just a couple of nights ago about I'd saved this lady's life because of my posts and my videos. She'd gone to the hospital and got treatment and she had got sepsis from what I'd said in my videos, so I won't stop. I will never stop.  [00:11:56][45.8]
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Dr Louise Newson: [00:11:57] It's so important, but how would you, if someone stopped you in the street and said, what is sepsis? What do you say? What's your answer?  [00:12:04][6.9]
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Kim Smith: [00:12:05] I just tell them sepsis is an extreme reaction by the immune system to an infection and anyone can get it at any time. It doesn't matter if you're fit and healthy because I was fit and healthy and to seek medical advice. Usually I tell them to go to A&E because you need IV antibiotics and fluids and going to your doctor isn't really going to give you IV antibiotics. If you can't get to hospital, phone 999, because most of the paramedics are very well trained. They certainly are in the south anyway, and get treatment because sepsis can kill so fast. I mean, I've known of people die within 24 hours.  [00:12:48][43.0]
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Dr Louise Newson: [00:12:50] It's the speed, I think, is really important. And I do think as patients, we have to advocate for ourselves or our relatives.  [00:12:56][5.3]
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Kim Smith: [00:12:57] Absolutely.  [00:12:57][0.0]
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Dr Louise Newson: [00:12:57] I think if we say that word, I think it could be sepsis, could they, you know, what about giving intravenous antibiotics. No-one is going to tell me off as a doctor for giving intravenous antibiotics if someone doesn't have sepsis. But it could go wrong the other way. And it is about the language I think is really important. A lot of people now are aware thankfully of sepsis. When my daughter had it, I knew she was ill and she had a lot of pain in her hip, actually, but a hip is a really unusual place to get an infection. And she had this awful pain and was getting worse. It woke her up twice in the night and the second time I said to my husband, something's not right. I can't carry her. She was too big then for me to carry her down the stairs to take her to the hospital, so we had to call an ambulance and they gave her heavy duty painkillers and even then she was in pain and going to the hospital. The x-ray was normal. So the doctor said, she can go home and have some physiotherapy. And I said, but she starting to vomit, right. There's something going on, she's not right. But even then as a doctor, sepsis wasn't on my radar. The next day, she got worse. They did another ultrasound scan that was normal, I said she needs an MRI scan, something's not right, and they went, oh, you're very anxious. I think we'll wait till tomorrow. And I said, look, I'm really anxious because she's really ill, actually, and I'm because really concerned. And then she became very unwell and the MRI showed this florid infection. But actually what they did was they said she's got osteomyelitis, which means infection of the bone.  [00:14:27][90.6]
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Kim Smith: [00:14:28] Bone, yeah.  [00:14:28][0.6]
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Dr Louise Newson: [00:14:29] And was very ill and went to the ward. And it was only a few days later, I said to myself, actually she's got sepsis, but they never use that word. So the physiotherapist used to come and make her walk. And I said, no, she's still really ill. She's still getting fevers. She's not right. And it made me realise, in medicine, the language of what you use is really important. When I told the school, oh, she's off because she's got an infection of her hip, they were like, oh that's a shame. But once I started to say she's had sepsis, it was like, Oh my gosh, is there anything I can do? Are you all right? And I thought, actually, isn't that interesting because for me as a doctor, I'm quite old now, so I wasn't trained in sepsis, I was trained in infections, so like you had pyelonephritis but it did develop to sepsis. But it's that language I think is so important, but it's also important for us when we're with a patient or we are a patient to use that language properly. So if you had known the Spanish for sepsis, that would have been you know...  [00:15:30][61.0]
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Kim Smith: [00:15:30] No, but I didn't even know what sepsis was back then. I had no idea what sepsis was. I didn t know the word for urine or kidney to even say. So I didn't say infection. If I'd have said infection, would they have checked me more? I don't know.  [00:15:45][14.5]
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Dr Louise Newson: [00:15:46] It's impossible to know, isn't it?  [00:15:47][1.4]
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Kim Smith: [00:15:47] If I had gone to Milton Keynes Hospital, would they have done any different? I do not know. I don't t know if it would have been any different in the UK. I probably would have got to the doctors. First of all, and I probably would have asked for antibiotics because I thought I had a urine infection. If I still hadn't have been well, I'd have probably gone to the hospital then. But it's hard to know because it happens in this country as well as abroad. So it happens all over the world, unfortunately.  [00:16:15][27.5]
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Dr Louise Newson: [00:16:15] Of course it does. So awareness is really important, intravenous antibiotics really important and admission to hospital and we've got Martha's Law that's come in now where people can ask for second opinions and actually when it stopped, my husband's a doctor but when he read about it, he couldn't even read, he gets very traumatised thinking about what if it had happened to my daughter. You can't because you don't know but I can guess what would have happened if she'd been sent home because she was so poorly. It's so important, you know, yes, I was labelled as an anxious mother, I can get over that but a lot of people aren't so gobby. [00:16:53][37.7]
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Kim Smith: [00:16:53] I've had that as a mother, being told I was an anxious mother, when my daughter was a baby and she was vomiting and had diarrhoea and losing weight. And they told me I was just a neurotic mother, was what they said. And I said, no, there's something wrong. Every time she's eating, she's then vomiting and she's got diarrhoea. So what is going on. It turned out that she'd be in hospital, they'd give her all kinds of treatment. She'd be fine, they'd send her home. But what I didn't know, because I had another child at home that I had to be at home for, I was going home overnight, coming back in the morning. They were giving her Farley's rusks a day before she was leaving hospital and she was supposed to be non-cow's milk. She was, they thought she was allergic to cow's milk and lactose and sugar. They're giving her Farley's rusks and that's full of lactose sugar. So she was then back 48 hours later. So I think they thought I was taking her home and feeding her something she shouldn't be having, which I was only giving her vegetables and doing what they told me. And then I'm back again. So yeah, I sorted it out on my own at home in the end.  [00:17:58][65.6]
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Dr Louise Newson: [00:18:02] So, but listening is the most important thing, you know, for people as patients they have to be listened to. And the other thing is, I know you told me before, you don't mind me saying that you're using vaginal hormones and that's really important because we know one of the reasons that women are more likely to get infections is because of hormonal changes. And we've known actually since the 1980s that vaginal hormones will reduce frequency and severity of urinary tract infections, yet only the minority of menopausal women are given vaginal hormones, which are very safe, they don't get absorbed in the body, you know, including women who've had breast cancer can usually very safely use them. So anyone that's had any urinary tract infection, certainly recurrent urinary tract infections, should be prescribed vaginal hormones. Yet a lot of times that's not even spoken about or considered.  [00:18:58][56.1]
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Kim Smith: [00:18:59] No, so many women don't know, you know, when they see my videos talking about, you know, getting vaginal estrogen, they're like, Oh, I didn't know that. I didn't know I could get that. And, you know, and how can you have it? And I said, well, it's either a pesary or a gel, I believe, but maybe there's cream as well. I'm not sure. I'm not a doctor. So I don't know, but, you know, and speak to your doctor.  [00:19:18][19.6]
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Dr Louise Newson: [00:19:18] It's so important because some of my patients say to me, my doctor says I don't need vaginal hormones because I'm not sexually active and it's like, hang on, it's not just for the vagina, it goes through into the bladder and it makes a massive difference and you know, because urosepsis, as you say, is common and it is still up there, it is not reducing and partly because women are living longer, they are menopausal for longer, they've got low hormones for longer and they're not being given any vaginal hormones.  [00:19:49][30.6]
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Kim Smith: [00:19:50] The doctor I saw at the Portland hospital about my constant UTIs actually said that pregnant women really need it and breastfeeding mothers need it.  [00:20:01][11.7]
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Dr Louise Newson: [00:20:02] And yes. [00:20:03][0.9]
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Kim Smith: [00:20:04] They're not told, they're not told.  [00:20:06][1.2]
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Dr Louise Newson: [00:20:07] No, of course not, no one's told anything but also people on contraceptives that can often, because it's synthetic hormones, often can increase someone's incidence and risk of having urinary tract infections. So anybody of any age actually can use vaginal hormones and once you start using them you should really continue as well because, but also systemic hormones can really help prime our immune system so the hormones help our immune system to work effectively, because there's one thing avoiding an infection, but if you have one, you want to make sure that your body is really fit to fight it, so it doesn't take a hold.  [00:20:44][37.4]
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Kim Smith: [00:20:45] Yeah, absolutely.  [00:20:45][0.4]
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Dr Louise Newson: [00:20:47] So we've known that for many years that the hormones can really improve the way our immune system works as well. So a lot of people we see who've had urinary tract infections, we give systemic HRT and testosterone if they need it, as well as vaginal hormones, and there are different preparations as well...  [00:21:05][18.5]
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Kim Smith: [00:21:05] So you can have both?  [00:21:06][0.5]
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Dr Louise Newson: [00:21:07] Ye, absolutely.  [00:21:07][0.8]
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Kim Smith: [00:21:08] HRT and vaginal?  [00:21:08][0.5]
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Dr Louise Newson: [00:21:09] Yes and a lot a lot people need both. So there's quite a lot of people who are on HRT and then their hormones drop and then they need vaginal hormones as well. So, I mean, I'm 55 and I have been on HRT for about 10 years and I just had HRT and testosterone and then I had a hysterectomy and I got urine tract infection after UTI, UTI all the time and I had them when I was younger as well, but they were really severe. And so using vaginal hormones has transformed literally my life.  [00:21:41][31.6]
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Kim Smith: [00:21:41] That's amazing. Yeah.  [00:21:42][0.8]
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Dr Louise Newson: [00:21:43] So a lot of people say, well, it can't be hormonal because I'm on HRT, but you can just get it differently and different amounts. And so there are the vaginal, like you say, there's the vaginal estrogen, pessary, the little tablet, there is a cream, there's a gel, there are a ring actually that's a silicone ring that's slow release estrogen for about three months. And then there's something called Intrarosa or prasterone, which is a daily pessary of DHEA. So it converts to estrogen and testosterone. And that's more effective at reducing urinary tract infections than just vaginal estrogen.  [00:22:17][34.5]
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Kim Smith: [00:22:19] Wow, I think I need that then.  [00:22:20][1.3]
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Dr Louise Newson: [00:22:21] Yes, I mean honestly, anything that's going to help reduce urinary tract infections is really, really important.  [00:22:29][7.3]
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Kim Smith: [00:22:29] Absolutely, because I'm currently waiting for a double hand transplant too...  [00:22:33][4.0]
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Dr Louise Newson: [00:22:35] Wow!  [00:22:35][0.0]
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Kim Smith: [00:22:35] ...and when that does happen, I will then be on immune suppressants for the rest of my life, so then that's going to make me even more at risk of things. [00:22:42][6.9]
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Dr Louise Newson: [00:22:44] So you want your immune system to be as strong as possible.  [00:22:45][0.8]
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Kim Smith: [00:22:46] Yeah absolutely.  [00:22:46][0.5]
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Dr Louise Newson: [00:22:47] Absolutely and it's very important I've got a pathology degree as well as a medicine degree so I spent a lot of time in my pathology degree learning about the immune system and what makes it as healthy as possible and we know that hormones do as well as lots of other things so really important but the work you're doing Kim is incredible. And like you say, people, especially women, share stories, they share experiences, they talk, they learn from each other. And you are living proof not just how sepsis doesn't always kill, but also your positivity just shines through here today but also on your Instagram. And, you know, that's so commendable. It really is.  [00:23:25][38.8]
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Kim Smith: [00:23:26] Everyone says that. I'm just me. I've just always been the same, but yeah.  [00:23:30][4.5]
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Dr Louise Newson: [00:23:31] It's great. So I'm really grateful for you coming on just talking about this. I always end my podcast with three take-home tips, so you can't be excluded. So three things that everyone needs to know about sepsis.  [00:23:46][14.9]
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Kim Smith: [00:23:46] Everyone needs to know the symptoms. So the symptoms are slurred speech and confusion, extreme shivering and muscle pain, passing little or no urine in a day, severe breathlessness, it feels like you're going to die, skin mottled or discoloured. You can also have cold limbs, cold skin to touch or cold hands and feet. You could also have extremely high or low blood pressure and temperature. And if you've got any of these, they are big red flags, so that's about sepsis.  [00:24:18][32.7]
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Dr Louise Newson: [00:24:19] Two other things that we need to know about sepsis. So those are the symptoms. What should people do if they think that they've got sepsis or someone that they know might have sepsis? [00:24:28][8.6]
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Kim Smith: [00:24:28] I always tell people if you if you think you've got sepsis, get to hospital immediately. Tell them you've got an infection and you suspect you have sepsis, you have the symptoms. If you get fobbed off, which often patients do, ask for a second opinion or tell them no I'm really not well and I need you to listen to me. And then ask for second opinion if they won't listen to you. Because I tell people, don't get fobbed off. Don't let them fob you off. If you think it's something wrong, trust your gut and tell them nicely that you need them to listen to you and that you them to check you because you know something isn't right.  [00:25:08][40.9]
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Dr Louise Newson: [00:25:10] Yeah, so important and then the third thing I think really if you agree would be just other people need to learn and help that person. [00:25:18][9.0]
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Kim Smith: [00:25:19] Absolutely. Everybody needs to learn what sepsis is to keep everybody else alive. You know, it might not be you, but it might be your family member. It might be a friend down the road. It may be a neighbour and they might not know what sepsis is. But by telling them about sepsis and making everybody aware, we are going to save lives. And that's what I bang on about all the time so that people understand everybody needs to know what it is, because it can be anybody at any time.  [00:25:46][27.6]
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Dr Louise Newson: [00:25:47] Absolutely. So keep banging the the drum and using your vaginal hormones that's for sure.  [00:25:52][5.2]
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Kim Smith: [00:25:53] Yes I will and I think I'm going to wait for your email and I'm going to be contacting my GP about getting HRT again, so thank you.  [00:26:00][7.4]
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Dr Louise Newson: [00:26:01] Thanks kim, it's been great,.  [00:26:02][1.0]
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Kim Smith: [00:26:02] Thank you, thank you very much.  [00:26:02]