Early Christmas gift - stopping the "Big 3"

Oh my Sue! I'm going to do it! Quit it all and see what happens. I'm such a whooos that I wanted a doctor to tell me to stop. But my wonderful bronchiectasis/ntm specialist pulmonologist left although she had assured me that she would still be at U if Chicago for my January appointment. I have made an appointment with my original pulmonologist who does have a specialty in bronchiectasis but referred me to the ntm one when my sputum turned up positive for MAC. She had not put me on the antibiotics or Arikayce.

I woke up this morning coughing up gobs of mucus which has become much, much worse since I started Arikayce last August. Then straight to the bathroom and pain. I finally started thinking rationally and your situation really helped. Thank you so much for sharing!

On Dec 3, I saw a report in mychart about my Oct sputum sample. I had seen good reports from samples since the summer but this one said: culture: no growth for 45 days. Final report. (I think that means they are finished looking at it because there is nothing there!)

What is the worse thing that can happen if I stop? The organisms will come back sooner then if I complete the protocol. I can deal with that if and when it happens.What is the best thing that can happen? The antibiotics are causing my worsening bowel issues and the Arikayce is causing my worsening mucus/breathing issues and I will be able to get my life back.

Tonight will be the first Friday that I will not be taking azithromycin and ethambutol since March.

I'm with you these holidays, Sue. Thank you!

@rits I also want to point out that I nebulize tobramycin for 28 days every other month. It always starts out as an unpleasant experience. For the first two weeks, it causes me to cough my head off and lots of stuff comes up. It makes my lungs feel wet and uncomfortable, it changed my clear sputem green (probably from bringing things up from deeper down) Yesterday was the first day that the sputem came up clear. I will feel great by the end of this treatment. My point is; treatments may not be fun but are neccessary. Of course, you know your body better than anybody, and it may be better for you to quit your meds. I quit ALL of mine for two months last year. I told my dr about it and he laughed and said "Everybody takes a vacation from their meds at some point, and that is ok, just not as long as two months." He said " You do not want to take one step forward, and two steps back." Two months off put me at risk of undoing all of my previous treatment. Let me know if you do feel better off of your meds. Lots of people with chronic illness get weary of taking all of their meds. It is understandable.

@windwalker and @sueinmn

Thank you so much for your responses and advice when I said I was going to stop treatment. I know it would have been better to discuss stopping with my ntm doctor before changing anything but she was leaving the University of Chicago for Tyler, Tx and was no longer seeing patients here and will start in Tx on Feb 1 and I needed to do something. At the end of this month, I have an appointment with the bronchiectasis specialist who referred me for ntm treatment. When MAC was found in my sputum, the plan was that I would return to her for my pulmonology needs (copd and bronchiectasis) once the ntm was successfully treated. I have been negative for MAC and also for Pseudomonas and klebsiella since last summer. I do have some fungi which appear now and then in my sputum but were not found during a bronchoscopy. My ntm expert told me I could stop the oral meds in June or maybe sooner and to stay on Arikayce as long as I can.

I have been having worsening digestive issues and mucus/breathing issues since November. Both seriously diminish my quality of life.

I stopped the oral meds and Arikayce around Christmas for a week. Because I take everything 3x per week, that means I missed two treatments. There was no improvement in my digestive issues. I have had a ab/pelvic ct scan and a pancreatic/liver/ducts, mri over the last few weeks for issues unrelated to my digestive problems and I am seeing my gastroenterologist in a few weeks. I don't believe the antibiotics are related to my problems and intend to continue them as long as my doctors say I should.

When I resumed the Arikayce I immediately noticed a difference. I had had an exacerbation when I first started it in July and it took a month to recover. My doctor told me to try 3x a week and that worked although I had increasing mucus and shortness of breath. In December, I realized that I was not doing activities that I had done before restarting Arikayce in August. Starting in November, I had a dogwalker for all 3 walks daily, which I had never needed before. I told myself that it was because of the winter weather but our temperature was in the 50's. I also was not working out. I haven't been to the building fitness center since September although I used to be there at least 3x per week. I purchased an exercise band in Nov which I've used twice. And, I have to force myself to go to my health club and I used to love going there. I'm at home most of the time!

I stopped Arikayce right after Christmas. When I had started Arikayce in August,I was unable to do Arikayce and saline and my doctor told me that the Arikayce was more important. I was taking it for pseudomonas and klebsiella then. I was negative for MAC and negative for the other two by September. Without Arikayce, I am able to do 3% saline 2x daily along with a smartvest and aerobika. I am walking the dog again but still have not been to the fc but go to my health club. The mucus and breathing are much, much better.

Thanks for listening and your advice. I will discuss all this with my doctor at the end of the month.

Rita (apologies for the long post)

@rits Mostly gut issues - stomach pain, frequent loose stools or actual diarrhea, nausea. Also fatigue & zero energy. It is worse if I fail to take probiotics and eat yogurt for a few days. It also got worse this summer when I had to start taking the meds daily. Both the ID doc and lung doc confirmed this week that the longer I am on the meds, the worse the symptoms are likely to be. It was a big part of the reason for stopping them now even though I have never converted to negative sputum cultures.
Do you use a probiotic and/or live-culture yogurt to help replenish the gut bacteria? Have you talked to your doctor(s) about possibility of stopping sooner than the 12-month mark?

Hi Sue. I hope your gut is doing better. This is going to be long but I hope it helps others. I saw my gastroenterologist last week about my worsening digestive issues. We have a long relationship going backmore than 20 years when I first started seeing him for problems following radiation for my first cancer. Btw that radiation caused colon cancer which he discovered during a colonoscopy.

He said that the antibiotics absolutely could be causing my digestive problems even though I did ok on them for months. Probiotics as well as yogurt in most cases are not helpful. There are many different strains of bacteria in the digestive system, and each of us has a different mixture of good and bad. It's not possible to tell at a given moment which bacteria is causing the balance of any individual to be off and figure out which good bacteria to add. Probiotics, which usually consist of several different kinds of bacteria, in some people at some moment, may lead to a better balance but it is hit or miss. In my case, the 3 different kinds of probiotics I tried, all of which had been recommended to patients at NJH or by id doctors elsewhere, made my problems worse. He did, however, recommend trying Align which has only one strain of a beneficial bacteria.

The problematic antibiotic is Azithromycin which speeds up digestion causing diarrhea and also changes the bacterial balance. He said that I won't be able to tell if it is the antibiotics causing the worsening issues until I stop them. He also said that I was NOT to stop early because the digestive problem is temporary and not harmful to the body while the lung infection is much more serious and can cause permanent damage.

He did give me a description for Xifaxan, an antibiotic that kills e coli, which costs a whopping $1900 for 42 pills (3 a day for two weeks) but my copay is a measly $50. I took it about 3 years ago and couldn't finish the prescription. Talk about diarrhea! Not only couldn''t I leave the house, I couldn't leave the bathroom! He told me that I didn't need to complete the whole course but getting rid of even some if the e coli we all have in our colon should help. It did help a couple of years ago. I'm not going to use it until after some appointments I have coming up including the pulmonologist next week.

Have your digestive problems resolved now that you have bern off antibiotics for about a month? Because you apparently still have some MAC 🙁 have other symptoms improved? I'm curious as to whether the symptoms such as fatigue are caused by the disease or the antibiotics. Hope you are doing great!

Rita

@windwalker and @sueinmn

Thank you so much for your responses and advice when I said I was going to stop treatment. I know it would have been better to discuss stopping with my ntm doctor before changing anything but she was leaving the University of Chicago for Tyler, Tx and was no longer seeing patients here and will start in Tx on Feb 1 and I needed to do something. At the end of this month, I have an appointment with the bronchiectasis specialist who referred me for ntm treatment. When MAC was found in my sputum, the plan was that I would return to her for my pulmonology needs (copd and bronchiectasis) once the ntm was successfully treated. I have been negative for MAC and also for Pseudomonas and klebsiella since last summer. I do have some fungi which appear now and then in my sputum but were not found during a bronchoscopy. My ntm expert told me I could stop the oral meds in June or maybe sooner and to stay on Arikayce as long as I can.

I have been having worsening digestive issues and mucus/breathing issues since November. Both seriously diminish my quality of life.

I stopped the oral meds and Arikayce around Christmas for a week. Because I take everything 3x per week, that means I missed two treatments. There was no improvement in my digestive issues. I have had a ab/pelvic ct scan and a pancreatic/liver/ducts, mri over the last few weeks for issues unrelated to my digestive problems and I am seeing my gastroenterologist in a few weeks. I don't believe the antibiotics are related to my problems and intend to continue them as long as my doctors say I should.

When I resumed the Arikayce I immediately noticed a difference. I had had an exacerbation when I first started it in July and it took a month to recover. My doctor told me to try 3x a week and that worked although I had increasing mucus and shortness of breath. In December, I realized that I was not doing activities that I had done before restarting Arikayce in August. Starting in November, I had a dogwalker for all 3 walks daily, which I had never needed before. I told myself that it was because of the winter weather but our temperature was in the 50's. I also was not working out. I haven't been to the building fitness center since September although I used to be there at least 3x per week. I purchased an exercise band in Nov which I've used twice. And, I have to force myself to go to my health club and I used to love going there. I'm at home most of the time!

I stopped Arikayce right after Christmas. When I had started Arikayce in August,I was unable to do Arikayce and saline and my doctor told me that the Arikayce was more important. I was taking it for pseudomonas and klebsiella then. I was negative for MAC and negative for the other two by September. Without Arikayce, I am able to do 3% saline 2x daily along with a smartvest and aerobika. I am walking the dog again but still have not been to the fc but go to my health club. The mucus and breathing are much, much better.

Thanks for listening and your advice. I will discuss all this with my doctor at the end of the month.

Rita (apologies for the long post)