HELP! On Z-Pak for bronchitis! Also on Entocort and Asacol

Robin · Post by **Robin** » Wed Nov 16, 2011 8:51 pm

Hi All,

Hope someone can help because I am really miserable. I thought I had a change of season cold or allergies. Took extra vit C, Zrytec and echinacea and I got worse. I had to go to my GP because I was running a fever. She has put me on a Z-Pak and cough medicine with codeine in it (I was told I have bronchitis). I told her I really didn't want to go on those meds, however she told me that was the only way to get better by next week (I am leaving for Hawaii next Friday). I am on 9MG of Entocort and 2400mg of Asacol. I have been on GF,DF, SF and sugar free diet for 4 months. I have been doing great except for the short set back of finding out I have diverticulitis also. I started the antibiotic yesterday and today started the big D again and pain on now my right side! All I ate today was legal chicken soup, applesauce, herb tea and fresh OJ water down! Does ANYONE have any advice or suggestions!!! My husband does not want to go on this vacation now he as asked me to cancel it! I have gone through to much this year NOT to go on a vacation! I just don't want to be sick so ANY advice would be sooooo greatly appreciated.

Thanks
Robin

Joefnh · Post by **Joefnh** » Wed Nov 16, 2011 9:03 pm

Hi Robin that is a tough one and I'm sorry to hear that you're having so many problems right before vacation. It sounds like your doing everything right. I do have a couple of questions. You mentioned Legal chicken soup, is that a brand name? I'm guessing you have carefully checked the ingredients. The other item that stands out is the OJ. I love the stuff but even after a year on meds I'm still sensitive to OJ and other acidic citrus juices. I would think the codeine would help with the D.

I wouldn't worry too much about the diverticulitis as its mostly benign but can be irritated in certain cases by seeds, nuts and other hard to digest small food items.

What are the ingredients in the soup?

Joe

Robin · Post by **Robin** » Wed Nov 16, 2011 9:39 pm

Hi Joe,

The legal chicken soup is the one I make from scratch. I found the recipe in the Specific Carbohydrate Diet cookbook and have been making since the beginning of being Dx with MC. All it is, is a free range chicken, carrots celery and onion thats boiled for hours and then skimmed the fat(which when using a free range there is hardly any fat)remove the carrots, celery and onions when done. I have probably eaten this chicken soup everyday since being Dx it makes my belly happy! LOL The OJ I drink is, half on orange squeezed into a glass and add filtered water the mixture is about 80/20 water being the 80%. I have been drinking that for awhile now to get all those pills down in the morning. I think tomorrow I will cut the OJ and just have tea and see what happens. I feel like I am on a roller coaster ride that I cant seem to get off of.

Thanks Joe
Love
Robin

Joefnh · Post by **Joefnh** » Wed Nov 16, 2011 9:51 pm

Robin the soup sounds great! And it does sound like it should work out well for you, especially since you have already had this in the past successfully. The OJ sounds watered down, maybe try apple juice if you like it. Even though the OJ is watered down you are still drinking a few ounces potentially. I Have no idea if that's it, but it's the only food item that comes to mind. This really can be a roller coaster at times.

The antibiotics are most likely the culprit and for those I dont have any suggestions. This may be one of the those cases of the lesser of 2 evils the bronchitis for a while or D for a while.

I hope this settles down for you, good luck

Joe

Lesley · Post by **Lesley** » Wed Nov 16, 2011 9:59 pm

Robin - the only time I have had flu (followed by bronchitis) in the last 15 years was the year I didn't get a flu shot 4 years ago. I was super sick, and was given a Z pack. I had D SO badly then I am surprised it didn't set off MC. In fact I had it coming out of both ends, so I was sitting on a plastic toilet bowl while I threw up in the toilet. apparently it's a side effect of the Z-pack.
It's a 5 day course of treatment and should kill the bacteria, so you will feel better. I warn you though, when I had it I coughed for 4 months.
Maybe a vacation in Hawaii is the very best thing for you right now.

Post by **tex** » Thu Nov 17, 2011 9:43 am

Hi Robin,

I'm sorry to hear that a lot of things suddenly headed south.

Actually, many of us, (probably most of us), seem to be able to tolerate the Z-pak without any significant problems, so apparently you just happen to be one of the unlucky ones. Of course, it could also be a combination of things. As Joe mentioned, orange juice, (or any source of citric acid), seems to promote D for many of us, (including me), it might be "the straw that broke the camel's back", in combination with the Z-pak.

To prevent that from happening again, you probably need to increase your vitamin D supplementation, unless you know that your 25(OH)D level is already in the upper part of the "normal" range. Vitamin D has what seems to be long-term antibiotic properties, when the blood level is sufficient. A vitamin D level in the upper half of the "normal" range is by far the best deterrent available for cold and flu viruses.

How long have you been taking Asacol? Asacol causes D for many of us. Besides the lactose content, for anyone sensitive to NSAIDs, mesalamine has been shown to stimulate the production of leukotrienes, which can cause inflammation, and trigger a reaction for anyone with an IBD, (especially for anyone with MC). For those individuals, the damage from the Asacol will typically overwhelm the ability of Entocort to control the symptoms. IMO, GI docs who prescribe the two together haven't done their homework, because if Entocort works, the Asacol is superfluous, and if the patient happens to be sensitive to NSAIDs, the mesalamine will prevent the Entocort from working. So what's the point of taking the Asacol? I can't see one, but then, I'm not a doctor.

http://www.nejm.org/doi/full/10.1056/NE ... 3263381320

Love,
Tex

Robin · Post by **Robin** » Thu Nov 17, 2011 5:53 pm

Hi Tex,

Thank god I love you and your post! Because I really didn't want to hear this one(ONLY KIDDING). I have been on Asacol since June. Three weeks ago I was also Dx with Ulcerated Colitis and Diverticulitis. My Gastro wanted me to stay on the Asacol till after my vacation because other than that week of finding out those new Dx's I really haven't had D. So He also put me on the Enocort to make sure I would get through my vacation without any problems. He did tell me to still be careful in what I ate but other than that he didn't say anything else. My GP told me that she didn't think the OJ was a good thing at all. She said when your on Entocort you are to avoid grapefruit, she believes that any acid producing fruit or vegetable should be avoided. I didn't think anything of it because it was soooo watered down. Today I tried apple juice very soft BM (I cant believe I am talking to you about my bathroom habits, how embarrassing) but I have bloating now (I look like I am pregnant LOL). Will there EVER come a day that I will be ME again! This is really crazy now! My husband and best friend think I need to think more positively, but when it always in your face, every moment of everyday, ITS HARD! My GP also made me increase my vit D from 2000 IU to 4000 IU. She did more blood test because the last time she tested for vit D it was very very low. I couldn't understand that either since I live on the water and am always on a boat, jet skiing and swimming in the warm months here in NY. Now it make sense to me but it didn't then!

Thank you so much Tex!
Love
Robin

PS Is it common to gain weight on the Entocort?

Lesley · Post by **Lesley** » Thu Nov 17, 2011 6:01 pm

[quote="Robin"]
This is really crazy now! My husband and best friend think I need to think more positively, but when it always in your face, every moment of everyday, ITS HARD!

My son does that also. I HOPE he never gets this (though I think he is gluten sensitive), but until you have it you don't understand.

Post by **tex** » Thu Nov 17, 2011 6:40 pm

Robin,

Grapefruit juice makes a lot of drugs work more intensely, (IOW, it can cause the effects of an overdose). I have no idea if these compounds are found in citric acid, or just in grapefruit and it's juice, but grapefruit is by far the worst. Here's a description of how it works, and a list of the drugs that it affects.

http://en.wikipedia.org/wiki/Grapefruit ... teractions

You may need to increase your vitamin D dosage even more, because I'm taking 5,500 IU, and I'm located in sunny Texas. I take 2,500 IU in the summer, and last winter I took 4,500 IU, and my 25(OH)D was the same as last year, at 46, last month. I want it higher, so I kicked my dosage up a bit.

With both UC and MC depleting your working supply of D3, it's going to take more than normal rates of vitamin D to get your level up where it needs to be.

Love,
Tex

Kari · Post by **Kari** » Thu Nov 17, 2011 6:46 pm

Hi Robin,

Wow - so sorry this happened to you so close to your vacation :(. A similar thing happened to me shortly before I left for my trip to Europe last June - I got a very painful thrombosed hemorrhoid!!! The MD wanted me to have surgery, but I decided that would make it worse, as I wouldn't have time to heal before the trip, so I waited it out. Thankfully, it got better a couple of days before my trip, so it turned out not to be a big issue.

Since you have a week to get your health under control before leaving, I wouldn't cancel such an anticipated and planned for vacation!!! Even if you're not 100% by the time you leave, you should be able to rest up and take care of yourself on the trip.

that it works out for you.

Love,
Kari

Robin · Post by **Robin** » Fri Nov 18, 2011 8:17 pm

Karri,

Thank you for the motivating words. Sometimes this MC really gets on my last nerve. LOL But I am feeling better since starting the Z-Pak. I don't have D nor do I have C but I know I don't have Norman! I would really love to have Norman! If you see him can you send him my way. LOL

Love Robin

Hi Tex!!!

Thank you so much for the info on grapefruit juice. I knew some of it. But now I am wondering why my GP told me to stay away from high acid fruits and vegetables? HMMMMM

Love Robin

Post by **tex** » Fri Nov 18, 2011 9:51 pm

Robin wrote:But now I am wondering why my GP told me to stay away from high acid fruits and vegetables? HMMMMM

Well, some authorities believe that acidic foods cause a low pH in the intestines, which is claimed to be unhealthy, (because it affects the absorption of certain nutrients, and/or it enhances the purging of certain nutrients by the kidneys). I've never worried about that theory, because the pH of stomach acid is below 2, (or better yet, below 1.5), when everything is working properly, and it's the pancreas' job to supply bicarbonate for the chyme, as it enters the duodenum, in order to neutralize the acid, and create a state of near neutral pH in the intestines. Any acidity level in food is a moot point, (IMO), relative to the pH of the stomach environment. IMO, if the pH of the intestines is out of balance, it's not because of the pH of the food we eat, but because the pancreas is not functioning correctly, (which is often true, when MC is active, but altering the pH of the diet is not likely to correct that problem). That's just my opinion, though, and many people take the food pH issue seriously.

Also, many/most of us cannot tolerate citric acid when our MC is active, simply because we react to it. Maybe she was concerned about that.

Love,
Tex

Robin.booboo · Post by **Robin.booboo** » Sat Nov 19, 2011 12:13 am

Hi Robin,

Are you able to go for periods without urgency? I ask because we made it to Hawaii, last September. I was trying to get diagnosed at the time, and had no idea how to try to contain or manage it, and yeah, I had to head to the restroom during the layover in LA several times, and on the plane, and at the resort, but it was controllable overall. There were no embarrasing accidents, just discomfort on my part, but we kind of got into a routine: get up -> bathroom (sometimes multiple times until ready to go), head to gym, then work out, return to room, bathroom again (sometimes several times), head to the breakfast, return to room and bathroom again. At this point I tried to evacuate as much as possible. I would then be good until early afternoon, when I usually needed another restroom trip or two before we could finish the rest of the day's journey. So, it was actually not that bad. I had a fantastic trip, and certainly wasn't unhappy. The best tips I have at this point as a newbie, but someone who has spent a week in Hawaii (Big Island) during my flare, is:

- Try not to stress - if you have anti-stress meds, now is the time to take them! I did - I had to take my Ativan on the plane. That also helped keep things calm with my body during the travel itself (plane trip days).
- Eat something in the morning, but not much. The buffets can be overwhelming and when I ate too much, I had more problems. There are a lot of Japanese tourists as well as American, so at our location, they had rice (and Jook - rice with turkey gruel, which I did not try) available every morning, so that may work for the GF plan - please let me know if it was available where you went and if you ate it, liked it, reacted or not, etc. -After you eat, go back to the room and spend more quality time with the toilet... As long as you need to... Once that is clear, head off on your journey, and make sure you take sunscreen and water. I was able to go a few hours at a time, so there were no real problems outside of some D noise embarassment at a few public facilities en route - but they are all of trips too, and will never see you again, so it is easier to justify the occasional embarrassing moment at a park toilet.

I didn't see which island, but if you are going to the Big Island, that is where we went and we loved it - enjoy! I hope you have a wonderful trip!

Take care,
Robin

Robin.booboo · Post by **Robin.booboo** » Sat Nov 19, 2011 12:20 am

Sorry, I realized it is the flu/cold/allergy problems you are having right before your trip, not the MC problems. Well, there may be hope in that case as well! I have tons of allergies, but they did not bother me in Hawaii. It is very soothing for some things, like skin irritation (though sun-screen is a MUST). I'm afraid I don't know how it would be if you have a cold or flu illness, though. :(

I hope you feel better and your vacation goes well, in spite of the last minute setback!