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My recent endoscopy showed some narrowing of my esophagus. My biopsy results came back benign and normal (whew!!). I still feel something is stuck in my throat (my thyroid hormone tests back in Dec. were good). Maybe it’s some side effect for me from my long-term use of tetracycline/doxycycline. I’m thinking of asking my dr. to switch me to another drug. What is a good alternative? I saw that some of you use clindamycin, some clarithromycin, some zithromax, etc. Which one is gentler on the esophagus? Thanks.
I don’t know if this will help at all, but I have found that I get the globus sensation (of something stuck in throat) under two conditions – if I am eating food that I am allergic to (like gluten or soy) or if my seasonal allergies are acting up or I’ve had a head cold.
I have not been diagnosed with SD but I have the same esophagus that you would – I have no peristalsis in lower 2/3 of my esophagus… and stress is a huge trigger for me with motility troubles. When I start having that globus sensation these days I just sort of pound myself on the lower back gently to release any trapped air and then I consciously make myself relax and remember that nothing is actually stuck, it is just reacting to an irritant. Interestingly, the day my GI told me that I have non-erosive reflux disease and am at very low risk of developing bad esophageal problems, my NERD went away and so did most of my swallowing trouble. I think worry and stress can definitely exacerbate problems like these.
Best of luck to you… hope an experienced member of the board can give you great suggestions about the best antibiotic to take. Warmly,
A
Thanks, hopefulmama, for your suggestions. I am going to take some allergy medicine and see if that helps. That sounds like a good idea. I do have seasonal allergy and now is the season. On the other hand, after taking tetracycline for 3 years and doxycycline for 1.5 years, it may also be time for me to rotate to another one. And I just don’t know what else to rotate to.
There is a liquid doxy but I don’t know if that would be better. Also they are working on a doxy patch which was posted here awhile ago.
I know people who have good results with zith but I have not taken it myself.
Good luck whatever you decide.
Jan
@Hoping wrote:
My recent endoscopy showed some narrowing of my esophagus. My biopsy results came back benign and normal (whew!!). I still feel something is stuck in my throat (my thyroid hormone tests back in Dec. were good). Maybe it’s some side effect for me from my long-term use of tetracycline/doxycycline. I’m thinking of asking my dr. to switch me to another drug. What is a good alternative? I saw that some of you use clindamycin, some clarithromycin, some zithromax, etc. Which one is gentler on the esophagus? Thanks.
Hi Hoping,
Did anyone check to see if you have any thyroid nodules? A person can euthyroid (normal labs), but still have thyroid nodules which can make one feel as if there is a lump in the throat. Of course, esophageal narrowing can also cause this sensation and have heard this a number of times here. Some folk will try esophageal stretching to alleviate symptoms, but any procedure comes with risks of complications with SD.
I noticed you have both a lupus and SD dx and have tried mino for a short period of a few weeks only, is that right? Is the lupus dx the reason you haven’t used minocycline? If so, it might interest you to know that some of the more experienced AP docs are actually using mino for their lupus patients. If it would help, I can send you Dr. S’s contact info so you could drop him an email to ask about this. He’s very kind about answering patient enquiries and it may provide a nice solution….Minocin comes in a smallish capsule with time-released pellets that dissolve further down in the gut to prevent reflux and associated esophageal issues, which is why many SDers prefer it.
I think the thing is that if a person has a SD dx, then it’s just wisest to remain on a tetracycline for its immune-modulating effects. Alternatives, like macrolides (clindamycin, azithromycin, clarithromycin) can definitely support the therapy in some cases, but SD patients should really keep a tetracycline as the mainstay of their therapy.
Jan’s suggestion of looking into a liquid form of doxy might help, but if swallowing isn’t the problem, per say, then brand name doxy, called Doryx, is time-released (a capsule-shaped pill with time-released pellets) was made specifically to be easier on the gut.
Also, any reason why you have had to switch from tetra to mino to doxy so quickly over the course of the last couple of years? The typical time frame suggested for tetra rotation is around the 5 year mark. You might find this link helpful, Hoping…see Point #10.
http://roadback.org/index.cfm/fuseaction/education.display/display_id/131.html
“10. Does the drug need to be rotated? Antibiotic therapy is a long-term therapy, months and years in most, – even for a lifetime in some. After 5-6 years, a patient can become tolerant of an antibiotic. Rotating to another antibiotic even within the same drug class can keep response optimal and avoid plateaus.”
I know it’s a bit late to be just now responding to this but I don’t get as much time to visit here at “The Road Back” as I’d like.
I, too, had this issue when I first started and I can honestly say it doesn’t happen much anymore. Two things help me: I always take with a small bit of food to get it to go down. The other thing is I take it with a warmer liquid. I find that when I stay warm (in every way), I do better and that includes avoiding cold drinks.
Laura
Thanks Maz and lyndsaylee.
Maz, the reason why I switched to mino was because after taking tetracycline for 3 years, my ANA is still very high, it didn’t come down a bit. So I tried mino because many of you say that mino/doxy penetrates better. Maybe because I wanted to get to the “right” dosage of 200mg MWF too quickly that I herx badly – having a fever of 102.6, shoulder pain, etc… Then I dropped the mino and asked my doc to prescribe doxy for me. With doxy, I ramped up gradually, and before the esophagus issue I was only taking 100mg 2 times a day MF. I started out with generic doxy, and then last October, I started taking brand name Vibramycin from buylowdrugs.com (my doc, for some reason, couldn’t prescribe Doryx, but Vibra was o.k.). About a month after I started Vibramycin, I began my acid reflux problem, which then evolved?/changed? into this esophagus issue. I am staying away from my doxy for 2 weeks and see if it’s related. If not, then I will get back on it. Maybe I should try mino again and start from low dose.
lyndsaylee, I’ll try swallowing the pill with a little food. That’s a good idea. How does warm food/fluid help with acid reflux?
My esophageal problem wasn’t related to acid reflux – (at least I don’t think so). Mine just felt like the pill got stuck – although once, it felt like it burned the heck out of my esophagus – perhaps why the literature says not to lay down within a half hour of taking it?!? Was that acid reflux? I don’t know, but it’s never happened again. And then once, I had the grandmother of all esophageal events – an esophageal spasm – I initially thought I was having a heart attack – It was really painful and scary! But, thankfully, that has not happened again. In all fairness, it may not have had anything to do with the mino as at the time I had been experimenting with some other Chinese medicine. I just happened to be chunking down the mino when it occurred. That is when I learned to slow down, relax and drink warm or at least not cold liquids. But, like I said, these types of things are mostly a thing of the past now. I stopped having that stuck feeling when I starting having a little bit to eat to make it go down. I don’t have this problem taking other pills.
lyndsaylee: Good to read your experience. Mine is probably not esophageal spasm because it has been like that for 2 months now.
Maz: I’ll keep in mind the possibility of thyroid nodule. That’s a good point, too. I wonder how people discover that they have nodules.
@Hoping wrote:
Maz[/b]: I’ll keep in mind the possibility of thyroid nodule. That’s a good point, too. I wonder how people discover that they have nodules.
Hi Hoping,
That’s a good question, because I have thyroid nodules and always test euthyroid (TSH in normal range). The way I discovered them was by chance really. I’d been using bio-identical hormones and it caused my thyroid to go temporarily out of balance, as I’d been overdosed with estradiol. The doctor who had rx’d the hormones found my thyroid peroxidase (TPO) was elevated and sent me for an RAI scan, which showed the nodules…then I went for an ultrasound and fine needle biopsy of the nodules. I have one right over my isthmus (the small connecting piece of tissue right over the esophagus). So when this flares, I can feel pressure on the front of my neck and sometimes a cap will get stuck and I need to keep washing it down with water. Interestingly, since being on abx therapy, my TPO has also gone back and remained in normal range…but I still have the bothersome nodules that I have to keep checking now.
So, sometimes, unless thyroid labs are abnormal or a person gets symptoms, then the only way to know if one has thyroid nodules is to get an ultrasound. I have to be honest and say that I would never have an RAI scan again. There is no point, because it’s safer to have an ultrasound and, if necessary, a needle-biopsy on thyroid nodules. I had both hot and cold nodules on the RAI scan, but it was a procedure that ultimately didn’t say any more than the ultrasound and biopsy could reveal.
If there is discomfort in the neck area with swallowing and there is no other reason for it, then this is one of the reasons a thyroid ultrasound is performed. Any doc can order the ultrasound…GP/PCP/IM, ob/gyne, rheumy, etc. It’s a pretty standard, non-invasive test.
Lyndsaylee, yes…absolutely, a stuck tetra cap in the esophagus can cause severe esophageal burning, so painful it can send one to the ER, my doc warned. This happened to my daughter who was at college and taking doxy for acne. She took the cap just as she was going to bed and woke in the night with severe esophageal pain as the cap hadn’t gone right down. It took about two weeks for her to be able to swallow food comfortably again due to the ulceration it caused…very painful. It’s so important to make sure that tetra, doxy or mino cap goes right down into the stomach, with a full glass of water, and then to remain upright after the dose for a good hour or two. Even reflux can bring some of the medication back up into the esophagus and cause burning pain, too. So sorry to hear you suffered this prob, but glad you’ve worked it out now. 🙂
YOWEE, Maz! Well, I didn’t have it for two weeks but I did have it for several days. I remember drinking lots of Aloe Vera! The esophageal spasm was different – there was no burning and when it was over, it was over – thank goodness.
@Hoping wrote:
Maz, is the pelleted Minocin smaller than a regular capsule so swallowing it is easier?
Good question, Hoping! If comparing between the original Wyeth/Triax pellet brand (pea green capsule) and some generics, then, yes, it does appear to be slightly smaller in size. However, I only used the Wyeth/Triax brand, manufactured in the US, once…then I switched to the cheaper Canadian Stiefel pelleted brand. Both were fairly small capsules when compared to an earlier generic powdered minocycline I was rx’d by accident. I think it’s going to depend on what you’re taking now when comparing, though. 😉 It was definitely a whole lot smaller than the brand Doryx (pelletized capsule-shaped pill) or even the generic 500mg tetras capsules I now take…perhaps by as much as half the size.
@Hoping wrote:
Maz, I’d like to have Dr. S.’s contact info. Thanks.
Sure, Hoping, with pleasure. Will send a PM now with the contact info. 🙂
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