- HealthQuestParticipantSeptember 25, 2014 at 5:20 pmPost count: 3
I’m about to follow my Integrative Medicine doctor’s prescription to take a 10-day course of 2 antibiotics for SIBO, but I have some real doubts both about the diagnosis and the treatment. Any insight, advice, or reflections would be very welcome.
Here is my information as succinctly as I can put it:
Diagnoses and Findings in Chronological Order:• IBS – diagnosed 20 years ago after Celiac’s ruled out
• Fibromyalgia – diagnosed 2 years ago, very “casual” diagnosis by medical resident
• Mild to moderate Adrenal Fatigue based on 24-hour salivary index – 1 year ago
• Hashimoto’s Thyroiditis based on blood test showing 103.5 IU/ml TPO antibodies – last spring. Re-test of TPO antibodies underway now to see if those numbers are on the move in any way.
o Same blood test showed:
high estrogen & low progesterone at mid-luteal phase
Slightly high Thyroglobulin (74 ug/L)
Slightly high monocytes
Low-ish B12 and magnesium
Low-ish neutrophils, eosinophils, basophils
• Bad bacteria in colon based on Genova 2205 Microbial Ecology profile – September 2014
o low end of acceptable range for all “good” bacteria like those in the bacteroides, clostridia, prevotella, fusobacteria, streptomyces, mycoplasma, lactobacillus, bifidobacter and e.coli families.
o Positive for opportunistic bacteria Achromobacter/Alcaligenes spp.
This bacteria was found to be resistant to amoxicillin, potassium clavula, garlic, arbutin (uva ursi).
o No yeast, parasites.
• SIBO based on 2 Hydrogen Breath Tests – September 2014
o glucose test was negative
no reaction to glucose solution
both hydrogen and methane remained at less than 10 ppm throughout test
o lactulose was positive for SIBO and rapid transit time was noted
nasty gas/diarrhea starting less than an hour after ingestion
baseline hydrogen was 4 ppm
rapid climb to 61 ppm hydrogen at 75 minutes in
second peak of hydrogen at 105 minutes
methane followed same pattern (though values were not as high)
All commensurate/typical symptoms for the above diagnoses:
• Decades of digestive issues – predominantly gas, bloating, diarrhea, nausea, indigestion
• Growing food sensitivities, IE major FODMAP sensitivities, random other issues (flax seeds, brown rice, etc)
• Roaming joint and body pain
• Increasing mental fogginess and memory issues – at times debilitating
• Low mood
• Growing sense of inability to handle stress (IE, big physical response to small stressors)
• Bouts of insomnia
• Much worse PMS, particularly re moods
Current Treatment Approaches – some success but still mildly to moderately symptomatic and still highly reactive to many food triggers and to stress, etc.
• Avoidance of food triggers (FODMAPs, etc)
• Eating a Paleo diet (but w small amounts of dairy, occasional white rice, and probably weekly defeat in the face of insane sugar/chocolate cravings)
• Bioidentical progesterone cream for days 12-26 of cycle: 40mg dose applied to inner labia nightly
• High quality supplement regimen including:
• Vitamins A, B (methylated, otherwise so unpleasant to digest), C, D and E
• HCL (Betaine) with high protein meals like beef
• Adaptogens (like AdrenaSense w rodiola) on rotating basis for adrenals
• Ginger as needed for nausea
• Aiming to get 8 hours of sleep/night (average more like 6-7 with interruptions)
• Attempting to remain peaceful and centered, detached from stressful narratives
New Recommended Treatment for SIBO/LI bacteria:
Rifaximin is not approved for anything other than colitis in Canada, and the cost is prohibitive anyway, so my doctor has asked me to take:
• Flagyl 500mg BID x 10 days
• Cefuroxime 500mg BID x 10 days
He has instructed me to ingest 50 billion+ CFU probiotics for 14 days starting the same day as the antibiotics, then go to 20 billion CFU strength daily for long-term use. I’ve decided on:
• Genestra’s Replenish (100 billion CFU ) 1/day for duration of antibiotics
• Genestra’s HMF Forte (10 billion CFU) 2/day for afterwards
The Dilemma: should I go ahead with the antibiotics?
I’m not convinced of the SIBO diagnosis, and I’m concerned about the impact of the antibiotics. Not sure why my doc (who is also a naturopath) didn’t suggest a “natural” antimicrobial approach like peppermint, oregano, goldenseal, or the like.
I’ve read quite a bit on the unreliability of HBTs for SIBO diagnosis, or at least the variability, and specifically that lactulose testing should be considered less reliable (more false positives) than glucose testing. This journal article is a good example.
• What can I understand from the fact that the glucose test showed no reactivity while the lactulose test was positive? Can we really say I most likely have SIBO?
• Are the antibiotics still required based on the presence of Achromobacter/Alcaligenes bacteria in my large intestine?
• What about the rapid transit issue noted in the lactulose test? How does that impact the picture, or what does it indicate? Funny, rapid transit, because most of the time I feel that what I eat is stuck in my stomach or SI for way longer than it should be. When I take Betaine, I’m amazed at how efficiently food seems to get digested and moved along.
Thanks you so very much for your time. It means a great deal to me to weigh these decisions carefully and to have feedback from trusted sources.JIParticipantSeptember 27, 2014 at 4:03 amPost count: 180
HealthQuest, I can answer one small part of your query. Glucose breath testing only detects SIBO in the earliest part of the small intestine. This is how the lactulose test can be positive while the glucose one is negative. I read this in “Fast Tract Digestion Heartburn”. It makes sense since glucose is one of the sugars that does not cause a lot of gut fermentation. I would say that the lactulose test is the more accurate one for detecting SIBO.kenarParticipantSeptember 27, 2014 at 10:21 amPost count: 4
I’m sorry that you have been suffering this long – it’s been a year of symptoms this time around (I’ve had gastro problems before) and that’s enough to make me crazy. There are many insightful, knowledgeable people hanging out here, and I hope they will chime in. I will add my very anecdotal two cents and tell you that I now realize that many more of us could be dealing with pathogenic parasites than we know. I tested negative for parasites. I was given a stool test only once, very soon after I had returned to the Mid-Atlantic USA after an overseas trip. They also tested for gallbladder, liver, and gluten problems. Nothing came back as a problem. I agreed to take Rifaximin. Didn’t help, didn’t really seem to hurt. I know that this group is not pro-antibiotics, and I agree, but I am just mentioning the Rifaximin because it’s part of the story. The last suggestion from the gastro doc was to try a FODMAP diet. I had already been following the Fast Tract diet, but I agreed to try FODMAP for a month. Not surprisingly FODMAP did not resolve the symptoms or problems. Last visit the doctor suggested Flagyl for 10 days. This echoed exhortations I had received from friends who are retired missionaries and just insisted that it was time for me to see an infectious disease specialist. It’s day 8 of the Flagyl; it’s totally kicking me (side effects of nausea, headaches, horrid metallic taste etc) but I can actually tell that I am getting better. I had gotten to the point where it was clear that I was building up to a seriously nasty fructose intolerance. Any fructose was causing me awful bloat and pain. Since being on Flagyl I have pushed the boundaries and eaten apples 4 days out of the eight. No negative reactions so it looks like I have a winner. I know it’s not everyone’s issue, but I think it’s worth considering taking the Flagyl and Cefuroxime. Sounds like you have a awesome doctor btw; I would love to find a general practitioner like that!HealthQuestParticipantSeptember 27, 2014 at 11:36 amPost count: 3
Thank you both, JL and kenar. I’m really on the fence, but at least it’s good to hear of the lactulose clarification and the positive results you had with Flagyl, kenar. One question, how long has it been since you stopped the Flagyl? Interestingly, I also feel I have a worsening fructose intolerance.HealthQuestParticipantSeptember 27, 2014 at 11:42 amPost count: 3
My apologies, kenar – reading your post again I see you’re still on the Flagyl. 500mg twice daily, by any chance?kenarParticipantSeptember 27, 2014 at 12:05 pmPost count: 4
Understandable you missed it – that was a lot of words I put out there.
Dose is 500mg of Flagyl 3 times/day for 10 days.
My complaints of increasing difficulty in eating anything with any amount of fructose caught the attention of the gastroenterologist. I noticed a difference in what I could eat after 2 full days of taking Flagyl.
This article: http://www.ajtmh.org/content/72/5/501.1.long
found after I started the Flagyl, makes me think we’ve finally hit upon my answer.
I wish you the best-kenarParticipantOctober 2, 2014 at 10:40 pmPost count: 4
How’s it going, HealthQuest? I have been thinking about you. I completed my round of Flagyl (this past Sunday). Many symptoms have cleared up. I do still have SIBO problems, but they are nowhere near as high level as they were prior to the Flagyl. I can eat fruit now without immediate distress. In addition I notice that the increasing problems I was having with dry skin on my feet and legs, and my peeling, splitting fingernails have all ceased. I am continuing on the Fast Tract Diet because it is clear that that also helps me. I do have continued symptoms of acid reflux and I am going to check back with my ear, nose, throat guy on that (just to see how severe it is), but between Fast Tract and the Flagyl, I am feeling like a real person again!ftderParticipantNovember 10, 2014 at 6:43 pmPost count: 210
Health quest, per Norms suggestions to others, I would 150% persue the Fast Track Diet option for a full month at least before resorting to ABX.
Don’t give up on holistic medicine/ingegrative medicine. You have been sick for 20 years, a few rounds of ABX is not going to be a cure-all and will likely create other severe imbalances in your body.
I personally would lood for an integrative medicine or NAtropath that specializes in GUT HEALTH, or consult here with NOrm before resorting to ABX!. Dr. Chris DEcker has a lot of success treating complex gut issues. I am not personally working with her but with a Classically Trained Chinese Medicine Doctor that specializes in IBS with an integrated East/West approach.
Dont give up and remember that there are NO quick fixes. Chronic health issues are DEEP imbalances within the body and take time and care to heal.
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