Medical-related question

[leebee]

YES, before anyone chastises me for asking medical questions from strangers on an internet forum, we HAVE already discussed this at length with DH's primary care doctor and infectious disease specialist. I am looking for more information.

DH had a limb/life threatening post-surgical infection and has been on antibiotic therapy for ALL of 2017 (except 4 days). He's currently on doxycycline and rifampin and will continue those for another 7 months. He has weathered this well, but the antibiotics are finally taking their toll on his digestive system/intestines. Without going into all the details, he is starting to have bathroom issues that demand immediate attention and will potentially effect his ability to teach (if you catch my drift ). The doctors all say, "Eat yogurt," which is laughable, and "Take probiotics." He has been eating Activia (he has always eaten yogurt for lunch, so we just changed brands) and taking probiotics (Advanced CD Accuflora w/5 probiotic strains) each morning. He is going to double-up on the probiotic (so 1 pill, 2X a day). None of this is helping the bathroom issues, and things are getting worse every day.

Does anyone have any suggestions, or information about probiotics? DH's doctors talk the talk, but they seem to have no good information on probiotics, what to take, how they work, etc. We are also open to information about other drugs. Is there something he can take that will help with chronic diarrhea, will bulk up stools, etc.? I suggested Immodium, but he's hoping to find something that will help manage the cause, not just the symptoms (although he'll take the Immodium, no doubt). If anyone has solid suggestions or information, I'd love to hear them.

(And for all you medical-types, DH had a high tibial osteotomy in 12/16 which became infected. He had 2 debridements and reconstruction with a gastrocnemius flap and grafting, on IV antibiotics for 6 weeks and now these for a year. Lab reports showed infection with Haemophilus parainfluenza and MSSA- thankfully not MRSA. There's still a plate and 12 screws in there- infectious disease doc says "take them out ASAP" because of biofilms and surgeons say "we're never going back in that knee again.")

 

[mjkacmom]

Has he consulted a gastrointestinal specialist?

 

[leebee]

Has he consulted a gastrointestinal specialist?

Hmmm... No, and I'm not sure either of us thought this was possible. Right now we are managing orthopedic surgeon, reconstructive surgeon, infectious disease specialist, and physical therapist. Maybe I'll give the primary care doctor a call and see if there's a gastro specialist he can consult. Thanks for the thought!

 

[Soldier's*Sweeties]

I had similar issues after just ONE round of strong antibiotics so I feel for your DH! Poor guy.

My first concern would be C-Diff. Did they test him for that?
If it's just a symptom of the antibiotics I would stick with the probiotics but they need to be the live kind(like from a heath food store, not the drug store) and there needs to be so many million units in the dose. I'm not sure of the exact number, but most capsules you get from the drug store are not enough.

Good luck to him!

 

[piccolopat]

Years ago my DH had digestive issues caused by antibiotic poisoning. He was over treated for a lingering respiratory infection and it wiped out almost all the good bacteria in his gut. Afterwards, he was stuck at home because of the very frequent episodes that came on with no notice. After several months of this, he started eating yogurt everyday and over the counter probiotics. He started to see improvements in a couple of weeks but it was a rough time for him. I agree with PP to discuss with a gastro specialist but in the meantime I would try the yogurt and probiotics as they may help him.

 

[StitchesGr8Fan]

He needs to be tested for C. Diff. It's very common in situations like your husband's and it needs to be treated.

 

[Soldier's*Sweeties]

I forgot to add that it does take a while to right itself. It too me about six weeks to get back to normal.

 

[Bilberry]

Since the infection is causing him to take an antibiotic long term (leading to the GI symptoms) if it might help I recently read a book on light therapy helping with over coming bone infections. I'm guessing that is what your husband has by the description given, a bone infection. I've read they can be notoriously difficult to treat.

A guy by the name of Niels Finsen won a noble prize for using light therapy (sun bathing) to help patients over come TB infections. In particular the light therapy was effective for TB infections and other infections of the bones, with 75% success rate. Before Finsen's sun therapy the main alternative was amputation.

Once antibiotics came along, sun therapy stopped being practiced.

If interested, the book was written by a Dr. Zane Kime.

With probiotics, they unfortunately never have helped me. I have an IBD condition, and tried many different types in the past.

 

[mom2rtk]

With such long-term antibiotic treatment, I can't believe they aren't watching for C. Diff already, but I agree with the others that needs to be ruled out.

 

[indimom]

I'm an RN and work on a surgical floor, I've seen post-op and osteo infections, long-term use of antibiotics, and GI results.

It's obvious you are aware of the affects long-term antibiotics can have on the GI tract. It kills off a lot of the intestinal flora, resulting in overgrowth of other forms of (naturally occurring) bacteria. One common offender is C-difficile. CDiff can be dangerous, he should probably have a stool sample tested to be safe. Especially if you feel the symptoms are worsening.
This type of infection would have to be treated with another antibiotic, typically Flagyl. My experience was in the hospital environment with Flagyl in IV form; but I know I had patients go home on oral flagyl if there was a good chance the overgrowth would recur (like continuing to take meds that caused the overgrowth in the first place).

Assuming it's not CDiff, chronic diarrhea can still be dangerous, causing dehydration and possibly electrolyte imbalance. He should hydrate well and often, Gatorade or similar would be a good choice. He needs a good probiotic, if you are just choosing from the store, check with your MD or your pharmacist to see if there is something better available.

The BRAT diet may help bulk stools a bit. And, there are other foods besides yogurt to help with good gut bacteria, like sourdough breads. You can bring up a list online.

Imodium and similar meds are not typically recommended for chronic long-lasting diarrhea. You really need to discuss this with your MD before you proceed.

On a different note, you may want to talk to another ortho surgeon. Maybe they can try antiobiotic beads/seeds directly at the site of infection. Maybe the hardware should be removed. Maybe not. But, I think I'd be looking for a second opinion at this point, just to be safe.

 

[leebee]

Thanks for everyone's responses... keep 'em coming! I've responded to a few specifically, but I appreciate them all!

I had similar issues after just ONE round of strong antibiotics so I feel for your DH! Poor guy. My first concern would be C-Diff. Did they test him for that? NO...
If it's just a symptom of the antibiotics I would stick with the probiotics but they need to be the live kind(like from a heath food store, not the drug store) and there needs to be so many million units in the dose. I'm not sure of the exact number, but most capsules you get from the drug store are not enough.

Good luck to him!

We've been buying the probiotics from Walmart. I'll hit the health food store TODAY. Thanks for the info!

He needs to be tested for C. Diff. It's very common in situations like your husband's and it needs to be treated.

C.diff was mentioned a lot at the beginning (back in January) but nobody has mentioned it since and I'd kind-of forgotten about it. I'll have him call someone (PCP or infectious disease doc) on Monday and ask about testing. Thanks for the reminder!

Since the infection is causing him to take an antibiotic long term (leading to the GI symptoms) if it might help I recently read a book on light therapy helping with over coming bone infections. I'm guessing that is what your husband has by the description given, a bone infection. I've read they can be notoriously difficult to treat. A guy by the name of Niels Finsen won a noble prize for using light therapy (sun bathing) to help patients over come TB infections. In particular the light therapy was effective for TB infections and other infections of the bones, with 75% success rate. Before Finsen's sun therapy the main alternative was amputation. Once antibiotics came along, sun therapy stopped being practiced. If interested, the book was written by a Dr. Zane Kime. With probiotics, they unfortunately never have helped me. I have an IBD condition, and tried many different types in the past.

I'll look this up for the information, but I don't think it's a possibility as the antibiotics he's taking means he cannot be in sunlight for very long. He's using SPF 75 regularly, every day, but he got burned yesterday when he spent an hour mowing the lawn. It's not bad, but he's VERY sun-sensitive right now.

I'm an RN and work on a surgical floor, I've seen post-op and osteo infections, long-term use of antibiotics, and GI results.

It's obvious you are aware of the affects long-term antibiotics can have on the GI tract. It kills off a lot of the intestinal flora, resulting in overgrowth of other forms of (naturally occurring) bacteria. One common offender is C-difficile. CDiff can be dangerous, he should probably have a stool sample tested to be safe. Especially if you feel the symptoms are worsening.
This type of infection would have to be treated with another antibiotic, typically Flagyl. My experience was in the hospital environment with Flagyl in IV form; but I know I had patients go home on oral flagyl if there was a good chance the overgrowth would recur (like continuing to take meds that caused the overgrowth in the first place).
I thought flagyl was an antiprotozoal but see that it can be used for other bacteria. We'll ask...

Assuming it's not CDiff, chronic diarrhea can still be dangerous, causing dehydration and possibly electrolyte imbalance. He should hydrate well and often, Gatorade or similar would be a good choice. He needs a good probiotic, if you are just choosing from the store, check with your MD or your pharmacist to see if there is something better available.

The BRAT diet may help bulk stools a bit. And, there are other foods besides yogurt to help with good gut bacteria, like sourdough breads. You can bring up a list online.

Imodium and similar meds are not typically recommended for chronic long-lasting diarrhea. You really need to discuss this with your MD before you proceed. This is what he is concerned about. I didn't know if taking it short-term might help him manage the symptoms while waiting for other things to work.

On a different note, you may want to talk to another ortho surgeon. Maybe they can try antiobiotic beads/seeds directly at the site of infection. Maybe the hardware should be removed. Maybe not. But, I think I'd be looking for a second opinion at this point, just to be safe. This is the big concern. The infectious disease specialist is very concerned about biofilms, and there's almost no info available on H.paraflu in bone/joint infections; I believe she said there's an article from a Canadian group, published in 2016, that says they found 16 prior reports. DH is lucky #17, lol. The surgeons are concerned with the reconfigured anatomy, scar tissue (osteotomy was surgery #3 and then the subsequent debridements and reconstruction) and reduced vascularity to the area and don't want to go in again, ever. It's a quandary, for sure. We are thinking of asking his PCP for a referral in Boston...

Thanks again for all the help and suggestions!

 

[Gracie09]

Try kefir. It's a fermented milk drink. It can also be made into yogurt or smoothies. Whenever dd has antibiotics (which is very rare) they do a number on her stomach. Kefir seems to help more than anything. I get her "bug juice" a yogurt drink that has cartoon bugs on it. She loves it and I see a difference in her stomach issues

 

[wilkeliza]

Is the probiotic you are taking one that had to be kept refrigerated or just an off the shelf one? If it is off the shelf switch that. I was told probiotics from the shelf probably have dead stuff in them and not active but from the fridge they should all be active. I did notice stuff off the shelf never worked but the stuff I got from Whole Foods and out of their refrigerated probiotics section definitely helped me.

 

[Southernmiss]

I'm becoming more of a believer in functional medicine doctors who treat the whole person, not just symptoms and know much more about nutrition and nutrients. They look at everything a patient's experiencing and treat the cause not the symptoms. So many mds only treat symptoms with pharmaceutical drugs instead if natural remedies that treat the problem and not the symptoms.

The natural whole foods market for kefir and refrigerated probiotics are good starting places.

 

[DaisyJ]

If it isn't c diff, have him try kefir. It is basically a drinkable yogurt. My sister has colitis and kefir has made a huge difference for her.

 

[DaisyJ]

http://lifewaykefir.com/what-is-kefir/

 

[The Mystery Machine]

Looks like everyone has hit on most points, get tested for C-diff, go to GI doc, better probiotics, etc.

LIPID PANEL is the first test on the list. You can get that from your PCP. Get a fresh one along with a POOP test for CDiff.

One thought...has he had his gallbladder checked if he has one? Surgeries and illness and make you liver, gallbladder, etc...go crazy. Right now my liver is inflamed beyond all reason.This is what you need to see a GI. They do the whole digestive system.

I have had minor bouts of "yeast attacks" on my digestive system a couple of times. Once when I was on bedrest in the hospital for several weeks on IV antibiotics and the other was when I took steroids and end up with digestive complications.

You have to go easy on sugar and carbs. It sucks. Make a food journal and start checking out the diet and foods.

Good Luck to your family!

 

[wgeo]

IF you are looking for other ways to get active probiotics you could try Kombucha drinks. They are a refrigerated tea like drink. The Walmarts around here do sell them but they're expensive (like $3-4) a bottle, and well they're an acquired taste. My husband likes them, I can't stand them. When his stomach starts to go bad that's his first choice to "fix" it since he doesn't like the taste of Activia.

 

[lsyorke]

If I was on IV antibiotics for over a year and had hardware anywhere in my body, I'd be looking to get that hardware removed. Bottom line is once there is infection with hardware it's going to always be a problem since the hardware is a foreign body. Second opinion time and a test for cdiff(can't believe ID didn't do this already).
Sorry, this is a tough situation for him and one that doesn't have an easy answer. One can't stay on antibiotics forever without affecting other body systems, as you've discovered.

 

[Pipkin]

YES, before anyone chastises me for asking medical questions from strangers on an internet forum, we HAVE already discussed this at length with DH's primary care doctor and infectious disease specialist. I am looking for more information.

DH had a limb/life threatening post-surgical infection and has been on antibiotic therapy for ALL of 2017 (except 4 days). He's currently on doxycycline and rifampin and will continue those for another 7 months. He has weathered this well, but the antibiotics are finally taking their toll on his digestive system/intestines. Without going into all the details, he is starting to have bathroom issues that demand immediate attention and will potentially effect his ability to teach (if you catch my drift ). The doctors all say, "Eat yogurt," which is laughable, and "Take probiotics." He has been eating Activia (he has always eaten yogurt for lunch, so we just changed brands) and taking probiotics (Advanced CD Accuflora w/5 probiotic strains) each morning. He is going to double-up on the probiotic (so 1 pill, 2X a day). None of this is helping the bathroom issues, and things are getting worse every day.

Does anyone have any suggestions, or information about probiotics? DH's doctors talk the talk, but they seem to have no good information on probiotics, what to take, how they work, etc. We are also open to information about other drugs. Is there something he can take that will help with chronic diarrhea, will bulk up stools, etc.? I suggested Immodium, but he's hoping to find something that will help manage the cause, not just the symptoms (although he'll take the Immodium, no doubt). If anyone has solid suggestions or information, I'd love to hear them.

(And for all you medical-types, DH had a high tibial osteotomy in 12/16 which became infected. He had 2 debridements and reconstruction with a gastrocnemius flap and grafting, on IV antibiotics for 6 weeks and now these for a year. Lab reports showed infection with Haemophilus parainfluenza and MSSA- thankfully not MRSA. There's still a plate and 12 screws in there- infectious disease doc says "take them out ASAP" because of biofilms and surgeons say "we're never going back in that knee again.")

I haven't read all of the replies but as you know, antibiotics do affect the normal flora in the gut. Has he had a stool analysis and culture? Often C-diff (clostridium difficile) emerges in that environment. You won't know without a culture. The treatment for that is Flagyl or the more costly vancomycin. I wouldn't hesitate to use Imodium for symptomatic relief. Do consultant gi doc but I would insist on stool cultures to rule out C-diff. If he has taken any proton pump inhibitors such as over the counter Omeprazole, he is particularly at risk.