For the collective wisdom . . .

Please limit your post to questions only. You can ask multiple questions in the post. (One post per person per day about yourself. See exception in General C. diff.Discussion.)
Connie
Regular Contributor
Posts: 114
Joined: Fri Jul 15, 2005 11:00 am

For the collective wisdom . . .

Postby Connie » Mon Apr 30, 2007 4:12 pm

These are things I would like to ask our GI or NP, but I hate to waste their time if they are just idle questions (not that I don't have a few legitimate reasons to worry about the unusual happening to Thomas!) After all the information and cases you have collected here over the years, does anyone have any guesses:

1. If it's going to work, how long might it take now that he's started Vanco? Last time, the bleeding was worse, and he started with Flagyl, then Vanco; so it took about 3 weeks for the blood to completely disappear.

2. Could spores from his original infection in the now absent colon eight years ago have survived in the small bowel and caused the current infection??

3. Can c. diff can "simmer" for months or even years without becoming acute? I find this thought distrubing--especially after reading about the rare cases of c. diff enteritis.

4. Now that he has had it in the ileal pouch, is he is at any risk for that?

5. How likely is he to get c. diff in the pouch again? Do I have to be paranoid about giving him ANY antibiotics now? I cancelled the surgery to remove his wisdom teeth originally scheduled for last Friday, but we need to do it soon. They usually prescribe amoxicillin afterward--will have to ask his GI if this is OK or what to do.
Thomas's Mom

Sheila1
Long Time Contributor
Posts: 468
Joined: Sat Aug 26, 2006 4:04 pm

Postby Sheila1 » Mon Apr 30, 2007 8:15 pm

Hi Connie,

The articles by Drs. McDonald and Fordtran (FAQ, Articles by Experts) say fever should resolved within 24-48 hours and diarrhea should resolve in 2 to 5 days. For myself, Vanco didn't resolve d. for several weeks (I think I wasn't on a high enough dose to be honest). Knowing what I know now, I would have called my doctor back if symptoms weren't better within a week.

Dr. Borody's article says evidence indicates the small bowel may be a reservoir for spores as well as the appendix. Dr. McDonald's article (in FAQ, Articles by Experts) explains this in a picture diagram, spores vegetate in the small bowel, it doesn't specifically say the spores reside permanently in the small bowel - but that was my general assumption from the articles.

It is possible for cdiff to 'simmer' if one has a strong enough antibody response to control it, but not strong enough to eradicate it (that is, eliminate all bacteria and prevent spores from vegetating). Unless or until another antibiotic is taken that reduces the good bacteria and allows cdiff to proliferate again. I don't know how long this can occur. I suppose, theoretically, indefinitely if all the conditions were right and the body could not build up more than a 'so-so' response. One medical article I read thought it was possible that as many as 30% of those diagnosed with IBS may, in fact, have low-level cdiff.

I don't know about the ileal pouch...definitely a question for the GI doc.

The last question is another GI doc question - but based on the above articles about spores and that spores are never totally eradicated, I would say it sounds like however he got ill this time (reservoir being small bowel, appendix, etc.) would continue to be a concern in the future. I'm not a doctor though.

Lots of discussion on antibiotics going right now in the forums....as Christina said in another post, sometimes antib. are really needed, and definitely should be taken. Trying the most narrow spectrum is best (ie. pennicillin VK) but they don't work for all infections, sometimes it really is necessary to take a broad spectrum antibx. Clindamycin is really not a 'bad' antibx, per se, but it's use should be limited to necessity (it is great for certain infections that aren't controlled by other types of antibx.) It is the unnecessary and excessive use of antibx. that is a problem.

Taking Vanco at the same time as another antibx. may help prevent cdiff from becoming proliferate while the other medicine is being taken. It may or may not prevent illness, but in theory, will kill the cdiff bacteria at the same time the other antibx. is killing whatever else. This has helped some but not others.

Is your son allergic to penicillin? Penicillin is the first antibx. of choice but most people say they are allergic to it. It can be used for oral surgery and procedures (is preferred for that actually). For your son's surgery, read and print the Antibiotics list in FAQ, it shows 'best' and 'worst' for cdiff, and discuss it with his GI doc.

I don't know anything about a pouch, but I hope this helps.

Fear (and depression) is a major symptom of cdiff, for the patient and the family. You are wise to think of the future and plan for it, but do try, both of you, to not dwell on tomorrow so much that you miss out on the little joys that happen today. It's a tough bug, and you have even greater concerns on top of it, but things will get better.

Hang in there and keep your chin up. Your son is lucky to have such a caring and thorough mom!
~Sheila

Marry
New User
Posts: 27
Joined: Wed Aug 16, 2006 10:56 pm

Postby Marry » Tue May 01, 2007 9:21 am

[quote="Sheila1"] One medical article I read thought it was possible that as many as 30% of those diagnosed with IBS may, in fact, have low-level cdiff.[/quote]

Would you have a link to or a specific article name for that article? I asked my GI about that some time ago and he said "No" very emphatically. (I didn't belive him anyway)

As an aside, I was at an appointment yesterday and asked the doc why I got two different answers from two different docs about a pretty much yes or no medical question. He had a very simple and obvious answer, one is right and the other was wrong! I had to chuckle because I guess I really knew that. It is frustrating though to not know which one is right!!!

Sheila1
Long Time Contributor
Posts: 468
Joined: Sat Aug 26, 2006 4:04 pm

Postby Sheila1 » Tue May 01, 2007 10:07 am

Hi Marry,

I was afraid someone was going to ask me that......I'm going to have to find it again. I'll do some research this evening. I had it in my "library" of saved files until my computer went on the blitz and I lost most of my collection :(

I do know that it was not an official "study" but was a medical doctor's thought of possibility/probability based on his own findings.

It's easy to find articles where celiac disease may be misdiagnosed as IBS in very high percentages, not so easy to find the one I'm looking for..... I'll hunt it down!
~Sheila

Marry
New User
Posts: 27
Joined: Wed Aug 16, 2006 10:56 pm

Postby Marry » Tue May 01, 2007 10:42 am

Thanks...I have tried finding info on that also, to no avail. I have a GI appt. this afternoon and will ask him again.

Connie
Regular Contributor
Posts: 114
Joined: Fri Jul 15, 2005 11:00 am

Postby Connie » Tue May 01, 2007 12:47 pm

. . . fever should resolved within 24-48 hours and diarrhea should resolve in 2 to 5 days.

The first day after starting medication he felt better, then not as good the next two. Movements have decreased in frequency (so at least sleep at night is interrupted less often), but are still very watery. After 3.5 days on Vanco and several days without fever, his temp was 100.6 again last night. I don't understand this fever still coming and going. I guess we're still early in the treatment, so will have to just wait and see.
Thomas's Mom

Bobbie
Administrator
Posts: 12688
Joined: Sat Aug 06, 2005 8:00 pm

Postby Bobbie » Tue May 01, 2007 1:45 pm

Connie,
Don't worry about wasting the doctors' time. You are paying for it!

Can't answer several of your questions. Vancocin usually "kicked in" for me within 3 to 4 days but everyone is different.

See FAQ-Dental Work. Some docs. are no longer giving antibiotics for dental work -- or at least the more broad spectrum ones. Often PenVK will work. Amox. is a bigger offender.

Many years ago, I had all my wisdom teeth pulled at once w/o an antibiotic but they didn't give them so routinely then.


Return to “Questions about Clostridium difficile”



Who is online

Users browsing this forum: No registered users and 25 guests