Taking a fish oil capsule with a meal maximizes absorption and reduces the side effect of the “fish burp.”

ANSWER: Regular drainage of the bladder with a “straight catheter” is the most effective way to reduce the risk of urine infections in a person with a spinal cord injury, but it is not perfect. People may still get bacteria in the bladder.

Although it may be worthwhile to review your catheterization technique with an expert, it’s possible to get infections even with perfect technique. You haven’t become immune to antibiotics, but the frequent use of powerful antibiotics will make you colonized with resistant bacteria, so that if you do get an infection, it’s likely to be with a difficult-to-treat organism.

The CT scan is a good idea to see whether there is an anatomic reason for recurrent (or persistent) infections. I am disappointed to hear your urologist does not seem to be doing his or her best for you. Recurrent infections are dangerous.

Becoming foggy-headed is a sign of serious systemic infection, and sepsis (a dysfunctional body response to infection) is life-threatening. Some people take antibiotics to prevent infection. Often, these are rotated to reduce resistance. A urologist experienced in spinal cord injury, perhaps in consultation with an infectious disease doctor, would be ideal.

DEAR DR. ROACH: When is the best time of day to take things like fish oil, vitamin D3 and calcium supplements? — M.W.R.

ANSWER: There is moderately strong evidence that fish or fish oils may reduce the risk of cardiovascular disease. One or two servings a week of oily fish provides about as much benefit as more. For people who don’t want to eat fish but want the benefit, a fish oil supplement daily (of about 1 gram) provides some of the benefit. I recommend taking it with meals to minimize the side effect of “fish burp” and to maximize absorption. Vitamin D, given to people at risk for deficiency or with proven deficiency, also should be given with meals to improve absorption.

Vitamin D is also needed for some people with inability to absorb vitamins properly. I recommend once-daily dosing with the largest meal of the day. I seldom prescribe calcium supplements anymore. Recent data suggest that vitamin D and calcium together actually increased stroke risk. While vitamin D is important for bone health and is very difficult to get through food, calcium should be consumed as food, not as supplements. In addition to dairy products, many seeds, legumes, almonds and sardines are excellent calcium sources.

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