MAC Big Three Side Effects

Posted by arbakr @arbakr, Mar 10, 2023

A few months ago I was diagnosed with Primary Immunodeficiency. My body has stopped producing immunoglobulin G. Next week I'll begin infusion therapy to replace it in my body and repair my immune system. About two months later, I learned I have MAC and bronchiectasis. About a month after I start my infusions I'll begin my antibiotics for MAC.

I'm interested in knowing about others' side effects from the big three. I'm also interested in how you manage your side effects. I know this information will really put my mind at ease. Thank you in advance.

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

@pawster

Rick, This sounds like a tough road. I was thinking of being in a test study for Amikacin. Maybe I'll rethink it! Hoping you get an answer and on the best path! Airway clearance: good nebulizer and nebulizing solutions, nasal rinse, etc. Best to you!

Jump to this post

Don't mean to scare any off but this was my experience. My experience with Arikayce was even worse. Many folks tolerate Amikacin just fine, not me but I do tolerate most other treatments just fine. I have cavitation also, one Dr wants to put me back on Amikacin since I now have a fungal infection after beating Mac 18 months ago

REPLY
@susanlo

Thank you so much for your input! I have a difficult time understanding why my questioning funding in my home state would elicit negative comments but I agree with your assessment that people generally are not interested in research funding.
That’s very interesting that interest did surge in MAC with the AIDS epidemic. It is understandable that with compromised immunity, susceptibility goes up, but from what I’ve read, NTMs are on the rise and not only in the immune compromised. I agree that it takes a very astute doctor to even test for MAC-I wasn’t tested for over 2 years, but they certainly searched for every other possibility in my body. Perhaps if MAC/NTMs were better researched and publicized, especially in areas know to have an unusually high number of cases(again, something that would be common
knowledge of with research)doctors, who have been made aware of heightened risk, would be able to diagnosis the disease much faster. I have a lot of lung damage after going so long without treatment and I am a patient at a state university hospital(in 4 different “speciality”departments).
I truly believe there are many people walking around undiagnosed as the symptoms are so varied, in communities who don’t have access to good health care, among people lacking insurance coverage, and as you said, doctors who are blissfully unaware of these infections.
I am one more in the “secret society” of this debilitating disease. Yes, knowledge is power but sometimes I feel like we are living in an ignorance is bliss reality.
Thank you again for responding!

Jump to this post

I don't want to start or encourage a argument here, and I feel bad that there were negative comments made. In an ideal world, there would be endless funds to study diseases and find cures. However, we live in a world that is far from ideal.

While this very engaging article (https://www.frontiersin.org/articles/10.3389/fimmu.2020.00303/full) and uses
terms that lead one to think NTM/MAC/MAI is "surging" we are not talking about any kind of cause for alarm here.

First, let me say that I am not certain whether the prevalence of NTM is increasing, or its diagnosis. I know of several people who were sputum-tested this winter after CT scans showed bronchiectasis - 2 of them have had symptoms for a while - but not the almost 5 years that I did.

Second, as to being "on the rise and not only in the immune compromised" - it seems in my reading that most cases are still among people who are either immunocompromised, or who have underlying lung conditions that have caused damage - Cystic Fibrosis, COPD, emphysema, bronchiectasis, chronic bronchitis or asthma, or pneumonia (and now COVID) lung damage. It is entirely possible that people with lung diseases, especially CF, are living longer because of better treatment of their primary ailment, and eventually encounter NTM.

Given the rarity of encountering NTM, it does not surprise me that many doctors have a hard time recognizing it. My first pulmonologist has been practicing for over 30 years, mine was only the 27th case he had ever seen and my ID doc had encountered fewer than 50 cases- both work in a huge multi-disciplinary urban clinic, with a typical patient load of around 1000 patients. They have little time to study the most up-to-date protocols for treating MAC or other rare diseases or infections. I spent many hours studying treatment options Connect, in scientific papers and from National Jewish Health, then discussing with my docs. For example, none had heard of 7% saline nebs before I brought it up.

This is why you often find members on Connect suggesting that people seek care at Mayo, NJH, and other centers that specialize in treating NTM.

Finally, when it comes to both identifying NTM and to finding research dollars, let's try a little math -
About 33 million have diabetes in the US (10,000 per 100,000 of the population), resulting in over 100,000 deaths per year and untold billions in health care costs.
About 1.9 million (550 per 100,000) people per year are diagnosed with cancer and over 600,000 die in the US.
About 86,000 - 100,000 people in the US have NTM (25-30 per 100,000)
Unfortunately, with these numbers, it stands to reason that we stand "at the back of the line" with other rare diseases when seeking funds. Do I like it? No, but I don't know what we can do about it.

I don't plan to say more on this subject, as I prefer to spend my limited time trying to point people towards resources for dealing with NTM and other health issues.

Sue

REPLY
@equanimous

I have recently been doing a water aerobics class and read about MAC being chlorine resistant. I wrote my dr to ask if I should d/c pool activity. She said if the pool is well maintained it is okay. I just want to be sure....Does anyone know, if you are already diagnosed with MAC, can going to a pool make it worse?

Jump to this post

I read somewhere that indoor pools are a no go... But you know. Internet.

REPLY
@criggyf1

I’m from North Carolina. What’s PI please?

Jump to this post

Primary Immunodeficiency

REPLY
@criggyf1

What’s do and tx please?

Jump to this post

Sorry about that. Dx and tx are medical abbreviations for diagnosis and treatment.

REPLY
@lauraadam2425

I have never been on the IV course. If for some reason my Dr changes course and treats me for absecsus I will be on IV. They have not taken me off ethanbutol because of eye problems.

Jump to this post

Sorry, I said they had not taken me off ethambutol but they did take me off it.

REPLY
@pawster

Even if you get rid of MAC/NTM the bronchiectasis is always there. Airway clearance is a lifetime thing. I have cavitary MAC/NTM. I'm not sure if that's the same as what you call "abscessus." If you have cavitary, airway clearance is even more important. Best to you in finding the right doctor and in moving forward.

Jump to this post

Abscessus is a bacteria like arupence.. on my CT they found I had nodular not cavitation. I have tried the nebulizer route for a year and could never bring anything up or when I cough nothing comes up.

REPLY

There seem to be so many variations on this disease and our other intertwining issues. In my group of 5 that I personally know in the whole wide world, has trouble ever coughing anything up. She has a doctor at UC Davis who put her on Arekayce spelling?). I don’t know if this would help I. Your case but it’s worth mentioning. I wish you the very best. Keep asking your doctor lots of questions and seek answers. They want to help. Sometimes they don’t know and other times they’re overworked. We must be advocates for ourselves. We’re all in this together. Best to you!

REPLY
@sueinmn

Welcome to Mayo Connect. It seems overwhelming when we first get this diagnosis, but trust me things do get better over time.
I'm going to try to answer several of your questions, but would invite @poodledoc, @irenea8 and other "veterans" to weigh in with their experiences.

First, the vest should be a help with airway clearance, but if you are trying to avoid the antibiotics, I would suggest that you also ask about nebulizing 7% saline, which has the dual advantage of thinning mucus and potentially suppressing the bacteria growth. Here is an article to introduce you to it:https://smartvest.com/blog/airway-clearance-techniques-for-bronchiectasis-and-copd/

Second, most of us were told that outdoor pools are safe. Chlorine does not kill MAC so it lingers in the copious water vapors above an indoor pool or any hotub, so these are to be avoided.

Finally, not everyone experiences hearing loss from the drugs - I got my a baseline hearing test, then was tested by an audiologist every 3 months to be sure, since I already have issues with tinnitus and age-related loss. So if you need to start, just be hypervigilant.

If you spend some time reading other discussions in this support group, you will find the answers to many of your questions.
Sue

Jump to this post

@equanimous You have found a great place here on Mayo Connect to help educate yourself. My personal experience with bronchiectasis and MAC involved 2 years of a chronic productive cough and a LOT of doctor visits and tests before finally being diagnosed. There are a lot of GPs and even Pulmonologists that simply are not familiar and up to date with our condition. If your Pulmonologist suggests waiting on the antibiotics, I would certainly go with that. The most important thing IMHO is for you to perform airway clearance (=lung hygiene) every day for the rest of your life. For me that includes nebbing with 7% saline (#1 most important) and using the Aerobika There are several youtube videos that will be very helpful, one of my favorites is this one https://www.youtube.com/watch?v=L-EHohMe7II One last piece of advise is to do all the other things to help make you healthier overall to include exercise, a healthy diet, stress reduction etc. Good luck yo you. Bill

REPLY
@sueinmn

I don't want to start or encourage a argument here, and I feel bad that there were negative comments made. In an ideal world, there would be endless funds to study diseases and find cures. However, we live in a world that is far from ideal.

While this very engaging article (https://www.frontiersin.org/articles/10.3389/fimmu.2020.00303/full) and uses
terms that lead one to think NTM/MAC/MAI is "surging" we are not talking about any kind of cause for alarm here.

First, let me say that I am not certain whether the prevalence of NTM is increasing, or its diagnosis. I know of several people who were sputum-tested this winter after CT scans showed bronchiectasis - 2 of them have had symptoms for a while - but not the almost 5 years that I did.

Second, as to being "on the rise and not only in the immune compromised" - it seems in my reading that most cases are still among people who are either immunocompromised, or who have underlying lung conditions that have caused damage - Cystic Fibrosis, COPD, emphysema, bronchiectasis, chronic bronchitis or asthma, or pneumonia (and now COVID) lung damage. It is entirely possible that people with lung diseases, especially CF, are living longer because of better treatment of their primary ailment, and eventually encounter NTM.

Given the rarity of encountering NTM, it does not surprise me that many doctors have a hard time recognizing it. My first pulmonologist has been practicing for over 30 years, mine was only the 27th case he had ever seen and my ID doc had encountered fewer than 50 cases- both work in a huge multi-disciplinary urban clinic, with a typical patient load of around 1000 patients. They have little time to study the most up-to-date protocols for treating MAC or other rare diseases or infections. I spent many hours studying treatment options Connect, in scientific papers and from National Jewish Health, then discussing with my docs. For example, none had heard of 7% saline nebs before I brought it up.

This is why you often find members on Connect suggesting that people seek care at Mayo, NJH, and other centers that specialize in treating NTM.

Finally, when it comes to both identifying NTM and to finding research dollars, let's try a little math -
About 33 million have diabetes in the US (10,000 per 100,000 of the population), resulting in over 100,000 deaths per year and untold billions in health care costs.
About 1.9 million (550 per 100,000) people per year are diagnosed with cancer and over 600,000 die in the US.
About 86,000 - 100,000 people in the US have NTM (25-30 per 100,000)
Unfortunately, with these numbers, it stands to reason that we stand "at the back of the line" with other rare diseases when seeking funds. Do I like it? No, but I don't know what we can do about it.

I don't plan to say more on this subject, as I prefer to spend my limited time trying to point people towards resources for dealing with NTM and other health issues.

Sue

Jump to this post

Thank you for your reply, Sue. That is one of the most comprehensive articles I have read on MAC and I am sending it on to friends and family who don’t really understand about what is going on with my health. I don’t want to belabor the funding point, but I do think (at least in the US) there will probably be a lag(yes, at the back of the line) in research and funding due to the predominant demographic of “older white women” even though the disease is not, by any means, limited to this group.
Thank you so much for taking the time to dive into this discussion. I agree time is much better spent on our on personal journey to better health and helping others if possible.

REPLY
Please sign in or register to post a reply.