Chemotherapy induced c-diff question

[RShaffer]

I'm a newbie - not only to this forum, but just tested positive for the first time yesterday, and am in search of information. I was started on Flagyl, and told to discontinue immodium, lomotil and Bentyl.

My doctor is on vacation, so I'll have to wait a week to see him. His on-call partner called me on the phone to tell me the test (which I had to beg for) was positive, there was a script called to my pharmacy, and to go to the ER if I spiked a temp.

I'm 63, and have been undergoing treatment for colon cancer with Folfiri. (Irinotecan, leukovoran, 5-fu and Avastin). I have had folfiri for 2 1/2 years. I haven't had any antibiotics since September of 2016. (Z-pack for gum infection)

Irinotecan is known for causing diarrhea, sometimes to the extreme. It has not been uncommon for me to experience up to 15 bouts a day the week following chemo. I've been attributing my issues to the chemo, now am wondering if it's possible for c-diff to have periods of "flare?"

My question (so many swirling around my head) is - has anyone else been diagnosed with c-diff which was a direct cause from chemotherapy? If so, did the illness or treatment cause a delay of chemo? Did you have to have a negative specimen before resuming chemo? For those with colorectal cancer, did the inflammation in your colon from the c-diff cause a spike in your CEA tumor tracker?

Thank you for allowing me to join this group, and forgive my multiple questions. I'm reading as much as I can, and trying not to freak out too much over this new diagnosis.

[NanciT]

Hello RShaffer and Welcome to the site. Please read the first forum for all new posters

I am sorry you had to find us and are CDIFF positive. It's not clear what may have caused you to have a positive test, I think this is complicated do to the Chemo treatments. The Z Pak back in September 2016 seems unlikely. Unless you have continued with the diarrhea since then, thinking it was from the Chemo.
I wish had some answers for you but I am not sure we have had many members who are currently on Chemo since I have been a member.

My advice would be to ask your Oncologist to work with a GI who is familiar with CDIFF. Or possibly add an ID Physician. Due to the meds you are on, they need to precede with caution. It sounds like you have been on Chemo for some time. If you find the flagyl difficult to take , I would ask for Vancomycin. Any medication needs to be evaluated with the current meds you are on.
We do have many member who go on one round are get through this rather quickly!

So sorry you are going through this and hoping it resolves quickly for you!

NanciT

[RShaffer]

Thank you, Nancy.

I keep detailed symptom/side effect charts to record "events" regarding my chemo treatments. My sister-in-law and I went over the past year's worth of charts and lab results, and did notice an uptick in both bathroom episodes and elevation of white counts about 2 weeks after finishing the z-pack, which at the time was attributed to the length of treatment and dosages.

We lowered the dose occasionally, or delayed a treatment following bad weeks, thinking that was the cause. However, even though we may never know the exact source of the beginning of this, if it is from this particular chemo, I hope my experience can serve as a learning tool for those forming treatment plans for patients on Folfiri, and test when gi issues become severe.

The Flagyl? I've only had 3 doses so far. I'm very very weak and tired. Feel a tad bit light headed. But, once again, it could be from chemo, this illness or the drug. Just more questions to add to my list.

Again, thank you. After reading through many posts all I can say is "bless you all."

[NanciT]

There are so many people that have trouble with Flagyl, if it appears to be an issue ask for Vancomysin. It is generally tolerated much better and I would ask for a taper dose. Take a look under CDI, we have a list of common tapers for both Vanco and DIficid.

Make sure not to become dehydrated which is very common. Try drinking "Smart Water" with electrolytes. Also if you can add a Probiotic ( time this 4 hours after Meds) think about Florester or VSL#3. In our case due to Chemo, run any of this by your Oncologist first.

It sounds like you are really on top of things which is fantastic, keep detailed notes of this also. I would be pushing to have GI Or ID involved with your Oncologist.

Wishing you the best!

NanciT