Pulmonologist versus Infectious Disease Dr

Posted by bbeers @bbeers, Dec 2, 2023

I was diagnosed with MAC in August. Pulmonary Dr. wanted me to start Big 3 even though I have no symptoms. I asked if I could take one at a time rather than all three at once. He said no. I just wanted to space them out so I could determine which one, if any, was causing side effects. I decided to see an Infectious Disease Dr. and her approach is different. Do you have a preference over one type of Dr. to another. I feel like the ID Dr. might be better equipped to handle this disease. Thank you

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@kitchensink

Thanks for the feedback. I am reading the following on the Mayo clinic website:

Take the capsule on an empty stomach, 1 hour before or 2 hours after a meal, with a full of glass water. It is important to take this medicine on a regular schedule. If this medicine upsets your stomach, take it with food.

Seems kind of contradictory.

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That is the instructions for rifampin, not the other two.

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@sueinmn

Interesting. When my husband had pseudomonas we had to monitor the drugs the pulmo wanted to use. His kidney doc was in a different clinical system. As his CKD progresses we will try to find someone in the same network, but when you're seeking the best available sometimes that isn't an option.
Sue

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What I have learned is that none of the specialists are good at kidney disease so you always need your kidney doctor to weigh in on the meds including dosage. Also do your own research. Little things like pepcid for example need 1/2 dose not full dose, etc etc. My kidney doctor would not allow a port for 2 week antibiotic treatment because 1. infection 2. may need veins or whatever for dialysis in the future - so I had to stay in hospital 2 full weeks for merem IV.

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@bbeers

Thank you for your response. Initially he wanted me to take all 3 at once 3 days a week. Now that I am seeing an ID Dr. she isn't starting me on any meds right now because I have no symptoms. It's kinda like living with a bomb inside of you just waiting to go off and not knowing when that might happen. I believe I got this disease from volunteering to take care of the 4H Gardens. Oh well, it is what it is. Best wishes for good health for you.

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@bbeers

Thank you for your response. Initially he wanted me to take all 3 at once 3 days a week. Now that I am seeing an ID Dr. she isn't starting me on any meds right now because I have no symptoms. It's kinda like living with a bomb inside of you just waiting to go off and not knowing when that might happen. I believe I got this disease from volunteering to take care of the 4H Gardens. Oh well, it is what it is. Best wishes for good health for you.

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Hi,
I’ve been living with the “ticking time bomb” for 6 yrs. I also have minimal symptoms & have never taken the “big 3”. My pulmonologist referred me to an ID Dr. several years ago, but he did not feel my condition warranted treatment (at the time I was regularly coughing up blood). I started nebulizing sodium chloride (3% initially, then 7%) & I really believe that has helped me stay healthy (no colds, flu, or Covid-fingers crossed). I would speak with the ID Dr. about what she would recommend. Regular exercise, a healthy diet, & 7-8 hrs of sleep are all part of my treatment plan! Take care, Linda

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I'm shocked that your doctor wanted you to take them all at once! Normally, they tell you to start with one; a week later then next, and a week later the third one. But...if you have no symptoms; please do NOT take the meds!! Too many side effects. I lost some hearing; my eyes got bad, and my balance off and nausea and lost weight...I was already 95 pounds. After 14 months, I just stopped taking them.

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@kitchensink

I'm newly confirmed for MAC and will start big three after Christmas. Do most people take all three at once? Or can you take one at breakfast, one at lunch, and one at dinner? I was hoping to isolate side effects by taking separately. I need to go back to my ID to confirm before I start.

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Hi, I started the big 3 in October. I take the azithromycin on empty stomach two hours before breakfast. Around noon I take the ethambutol with lunch. Two hours before or after dinner (empty stomach) I take the rifampin. So far so good. I only take on MWF. Best of luck! I also eat yogurt and take probiotics on the days I don’t take the meds.

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@bbeers

Hi Sue, how do you determine if both of them are up to date on those protocols. I have an appt. with the ID Dr. and I can ask her if she treats bronchiectasis and my mild copd. I don't think my Pulmonologist will take kindly to me seeking out an ID Dr. but I could be wrong. Thank you

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Or you could be right...my first pulmonologist "fired" me when I consulted the ID doc after a year of not getting any better. He connected my to a different pulmo with whom he works well. Interesting note - they are all part of the same large clinical practice group that includes all my other docs as well. I guess it all comes down to personalities. But you need to do what is best for you and your health.
Sue

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@bbeers

Hi Sue, how do you determine if both of them are up to date on those protocols. I have an appt. with the ID Dr. and I can ask her if she treats bronchiectasis and my mild copd. I don't think my Pulmonologist will take kindly to me seeking out an ID Dr. but I could be wrong. Thank you

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I have both ID Doctor and Pulmonologist. Both suggest to have each involved. If any doctor is offended by second opinions or having the desire to have another specialist involved, find another doctor

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As sue said,a team, working together! My 1st pulmonologist dr.whom was rated as a Mac Dr. Had missed the disease on my chart! I had to make him turn his computer back on and read further!! Then he seemed unhappy I went to an i.d. Dr. ! My id dr.was the one that stressed the importance of checking vision/hearing/liver.ect. so thankful for this site and Sue's input! Good luck and good health.

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@kitchensink

I'm newly confirmed for MAC and will start big three after Christmas. Do most people take all three at once? Or can you take one at breakfast, one at lunch, and one at dinner? I was hoping to isolate side effects by taking separately. I need to go back to my ID to confirm before I start.

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Hi!
In my case I was given Azith and Ethmbutol as a pair because the Rifampin interacted with my chemo treatments. Once Chemo was over, I started all 3 together which I take at night with no major side effects. Fatigue and a weakness in my legs at times but nothing that prevents me from living my life.
However, I had to drop out of playing competitive sports.
After 6 months (MAC) was still positive and I was approved for Arikayce and continued with the same regimen Big 3 three times p/w. After 2 months on Arikayce, I' had a negative sputum culture so I'm on the right path and once I have had 3 or more negative cultures, I will be weaned off the drugs.

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