high liver enzymes and azythromyacin

[Fran]

I'm so bummed!  I have been doing so well with virtually no symptoms since stopping mino and switching to azythromyacin after having a bad reaction to mino.  But now  my rheumy told me my liver enzymes have skyrocketed and my ANA is still high.  I'm really bummed cuz I've been doing so well and having no symptoms.  She wants me to stop azythromyacin for 2 weeks and then get re-tested.  I'm goign to let Dr. S know this tomorrow.

But I'm feeling like I just can't take anything!  I know you aren't supposed to stop taking antibiotics because the disease will come raging back, but I feel like everything I take, I react to.  Does anyone else have this going on with them?

I haven't taken anything else that I think would affect the liver adversely, no painkillers since last summer, no other medications.  Fish oil, probiotics, turmeric is all I take.  I used to take milk thistle but stopped as I was trying to par down on supplements.  Maybe I need to add that again.

I'm really feeling like I react to everything.  Are there any other symptoms of high liver enzymes?  I just wonder cuz lately I've been extremely irritable and my eyes have been bothering me.  It is probably unrelated, but its been enough where I've really noticed it.

Has anyone stopped the antibiotics and not suffered a relapse?

[Maz]

Hi Fran,

Try not to be too worried about the two week washout. It might be a great opportunity to spend some time just detoxing and working on your gut. This hypersensitivity state is a real pain, but it could be you need this little bit of a break to let your liver and other digestive organs rest. If your enzymes are up, it means your liver isn't doing its toxin dumping as it should and your 'waste disposal unit' is a little backed up.

Definitely get back on the milk thistle, as a staple for a while, as this should help bring the enzymes down, and if you can do the daily lemon/olive oil detox drink every night before bed that should help, too. On an empty stomach, before bed, it acts like a gentle, mini liver flush while you sleep.

See how you go over the next couple weeks. I often hear John's words in my head….”All the organs can herx at times”….so your enzymes, eyes and even the irritability you're feeling may all be herx-related. Will be interesting to hear what Dr S thinks, anyway. I also think it was Rosemary from down under who said that liver enzymes sometimes elevate for a while when a new antibiotic is started. So, fingers crossed this is all that this is. If not, Dr S probably has some alternative abx up his sleeves for you.

Peace, Maz

[Fran]

Thanks Maz!  I needed some gentle calming!  I just get so worked up over all this crap and feel like my body is not cooperating here.  I see you are taking zithro 250 mg every 10 days.  I was taking it 2 x per week and maybe that is too high.  We'll see what Dr. S says tomorrow.  Thanks again.  I used to do the lemon/oo and milk thistle and all that when I was feeling bad but I've been SO good lately with no symptoms that I let those two things slide.  I can see that was a mistake.  Thanks again!

[Maz]

[user=123]Fran[/user] wrote:

I just get so worked up over all this crap and feel like my body is not cooperating here.  I see you are taking zithro 250 mg every 10 days.  I was taking it 2 x per week and maybe that is too high.  We'll see what Dr. S says tomorrow. 

 

No worries, Fran. I still have my bad days and any blip on the road or new symptom can bring all the old fears rushing to the surface. It's natural and we're only human…we've been and are still going through a lot. On an emotional level, to feel we are getting better only to take those steps backwards can feel devastating. The good part is that you're doing really well, considering where this all began for you! That's what you have to hold on to. This is likely just a minor blip, too, so hold tight…Dr S and his reassurances will help put everything into perspective again.

Yes, I added zith recently. I started out on 250mg (bid) Tues and Thurs, but herxed so badly on the following Sat and Mon (exactly 4 days after each dosing day) that I took the advice of someone wiser and lowered my dose to 1 tab every 10 days. I just took the one tab yesterday after a 10 day break, so will see what happens later in the week. If it's still too much, I may take the other suggestion of crushing the tab and dividing it into smaller amounts in veg caps.

Will be interesting to hear what Dr S advises you tomorrow! All the best with that, Fran.

Peace, Maz

 

[John McDonald]

Fran – Minocycline and Zithromax both target a particular bit of the bacteria called the rybosome. But they target different bits of that riboxome. So if a bacteria has a defense against one it may not have a defense against the other. Also, the drugs perfuse tissues quite differently and they persist in serum and tissues for much different intervals. It is reasonable that they target microbes in different organs. I can personally attest to that from my single, then double, then triple antibiotic experience. Each new antibiotic including Mino and Zith has caused herxing in new tissues and organs. I have seen a number of folk on the MP complain of elevated liver enzymes, (or kidney, or thyroid, or eyes , or …). It is also reasonable to me that you have more than one kind of tissue infected, and perhaps by more than one specie of bacteria. I don't think that you have an intolerance. I think you are having a herx, this time in your liver. That doesn't mean that you shouldn't take it seriously, you absolutely should. Kill the microbe, not the patient!

And Maz said “I still have my bad days and any blip on the road or new symptom can bring all the old fears rushing to the surface.”  Boy isn't that the truth. It took me about 3 years of combined AP and MP, and considerable huge improvement over much of that time before I stopped cringing in fear if I felt even a twinge of pain. Most people I have compared notes with say it is the same. These diseases are so dread that it is just awful to think we may slip back in. But I promise you that this can and does get better. I am forgetting what it is like to hurt. That is a blessed thing. Your day will come too.

[Rosemary Perth Aust.]

The liver enzymes will react for a while =.  Mine is at the moment because of an increase in the Diflucan a fortnight ago.  It is starting to settle down now.  It does take time.  The liver reacts initially with all of them from what I can see, and this frightens Doctors but if we do not take them we will be worse off.  If your eyes are bothering you you sure need something. Makes me wonder.  I do not have any eye trouble since I have things under control. I would get some milk thistle to help and also drink some weak black tea occassionally – decaffientated.   I would also ask if I were you if you could persever for a bit longer if you feel better.  I am not a medical person however my Dr. allows me a bit of rope because he knows little about it.  Though I have made mistakes which we all do at times generally this has allowed me to find out for myself, and get myself back on my feet. You need something for sure.

[Rosemary Perth Aust.]

Sorry did not realise you were taking two per week. That may be a bit strong for you.  Always contact your Dr. when you have an exteme reaction to something.  they do not seem to realise some of us cannot take strong doses.   I have come back from 10 days to once a week , on the Zith so I can try and get off the cephalosporin.

 

[Fran]

Thanks for all the advice.  I spoke with Dr. S and he told me he had never seen elevated liver enzymes and zithro????  Great!  Anyway, I think Rosemary, you may be right in that my dose is too high for me.  I'm goign to go off 2 weeks and then maybe try again with 1 zithro per week or so.  Dr. S mentioned oral clindamyacin but I want to steer clear of that. 

[Maz]

[user=123]Fran[/user] wrote:

I spoke with Dr. S and he told me he had never seen elevated liver enzymes and zithro???? 

 

Fran, thanks for sharing that tidbit. So good to hear feedback like that from such an experienced AP doc.

Hopefully the milk thistle and lemon/olive oil, in addition to reducing your dose, as you say you're going to do, should solve the elevated liver enzymes soon for you. Fingers crossed!

I'm on day 3 1/2 after my zith dose on Sunday and already the palps I experienced on day 4 the week before have started again. Ugh…hoping this, too, shall pass as the herxing fades on this abx.

Peace, Maz

[Fran]

Maz-  It is interesting that you have herzing on Zith.  I had no herxing.  I asked Dr. S if that meant that the antibiotic was doing nothing for me and he said that he doesn't come across a lot of herxing with zith.  Today my left pinky is swollen and sore and wrists hurt.  I haven't taken the zith since Saturday……5 days.  Does that mean that the zith was helping control the RA or does that mean I'm herxing??  I have no idea.  I know that sounds inconsequential….just a little hurting in my pinky and wrists, but its not that, its more I'm worried that's the start of the RA coming to roar back at me.  This disease has made me a nervous paranoid freak….or maybe I was one before but just didn't notice it!  😛

 

[Rosemary Perth Aust.]

Well I tell you I was one of those who did have a herx from Zith and it lasted for 48hours.   Was terrible.   Would not hurt to cut back a bit and see, that is the only way you will find out.  Why are you so concerned about the clinda.  It is magic.  Often many of us need a course in Clinda.  It works wonders on those of us who have had it.  It was just magic for me. Just make sure you have a systemic with all of these or you will have another problem.

All the best.

[Maz]

[user=123]Fran[/user] wrote:

Maz-  It is interesting that you have herzing on Zith.  I had no herxing.  I asked Dr. S if that meant that the antibiotic was doing nothing for me and he said that he doesn't come across a lot of herxing with zith.  Today my left pinky is swollen and sore and wrists hurt.  I haven't taken the zith since Saturday……5 days.  Does that mean that the zith was helping control the RA or does that mean I'm herxing??  

Hi Fran,

Well, can only share my short experience of being on zith these past few weeks, but regular as clockwork I have a bad day around day 4 after taking my dose. Yesterday, as sheer timing would have it (my 48th birthday), I felt awful :crying:…and it was one of those days I had to keep going, as my daughter was taking her driving test – took all morning from 8am to midday! – and then we had a lunch out to celebrate her passing it. After getting home in the afternoon, I had to give in and go to bed for a couple hours to sleep it off and then felt better….reminding myself it was exactly 4 days since my Sunday dose.

One blessing is that my herxes are getting easier to distinguish with pulsing….battery-acid-flowing-through-veins feeling, general malaise and fatigue (the kind where you just can't keep your eyes open any longer), an increase in joint aches/pains and palps. Then, just as mysteriously as the symptoms arrive, they disappear the next day. I woke up feeling refreshed, no stiffness and my knees even felt better than before. Bizarre, eh?

It is very hard to distinguish herx from flare, especially in the beginning when the underlying disease state is still active and operating like in the background like a hidden computer program. Herxes tend to be temporary worsenings for me now and pretty much anything goes…including what you describe… They present differently in everyone, though, because we all have unique pathogen loads. I may just have a pathogen that goes kicking and screaming a few days after my dose. For others, they may have a pathogen that is a little more resistant or that tends to be more vulnerable at a different point in its life cycle, so their herx may take a shorter or longer time to emerge. Herxes can also be occurring without much notice within the body and not discernable, at all. Many of our internal organs have few nerve endings, so pain isn't always felt.

Maybe the rule of thumb is to just journal your symptoms for a while. See if things improve or worsen and how long this takes. If your symptoms improve within a short span of time, it's likely just a herx. If it goes on for months, then whether herx or flare, it's still inflammation that should be addressed. The good thing about journaling is that if it occurs again, you can look for patterns (days symptoms occur after dosing, types of symptoms, etc.) and begin to get more in tune with distinguishing herx from flare.

The heartening thing is that you've done so remarkably well in a relatively short space of time!  This should tell you that you're responding and that the abx are doing their stuff. It may just be that your disease process is just puttering out, like an engine that's slowly dying.  There may even be other little coinfections that are now having their way now that the prevailing one is dying out. So, keep the faith, Fran and keep up the detoxing!  😉

Peace, Maz

[pam]

I too am having issues with elevated liver enzymes and had to stop my 200mg/day of minocin for the second time. I am really concerned. After 30 days, we will retest and see where the enzymes are. I wonder what my options are at this point. Will clindy IVs send the enzymes sky-high again?

Again thanks to all of you on this board for your great information and support.

Pam

SD and RA, on AP 18mon, off 1 mon, on 2 mon, off now

 

[Rosemary Perth Aust.]

Fran the oxygen baths are great also.  The formula is on the site.  I have just pushed through this problem which has been continual with the changes all the time.  Ease off the abx until I picked up.   Your stools are milky colour also when the liver is under pressure.   No matter what you take the same thing will happen – the secret is easing up until it passes.  It is your body telling you how much you can tolerate.  Eventually you will be able to increase.  That's what makes this treatment simple but not easy.  Taking the morphine has helped my liver cope much better even though I hate the stuff it does seem to make life a little less complicated and me more comforatable so long as you have no addiction to anything else.  I was given 30mg. twice a day.  This is the most we can get here orally. Most people will not even consider it but wanted to tell you anyway.  I have no doubt I will be able to go off it, when the problem is under control.

[linda]

Hi Rosemary,

I just wanted to post a word of caution in using drugs that are metabolised by the liver when liver function tests come back abnormal. Elimination half-lives may be longer than normal and result in the accumulation of the drug. Morphine and other pain meds are metabolised in the liver. They can still be used, but the time between doses should be longer than the norm. Antibiotic doses should also be adjusted, as you mentioned. Milky white stools sound pretty scary to me, I'd be afraid to take just about any drug until that problem was resolved. Just out of curiosity, how does morphine help your liver cope better?

From what I've read here and in various articles about biologics and AP, abx are still much easier on the liver than mtx and biologics like remicade. I'm in the same boat as you, I'm unable to take either one until my digestive problems are diagnosed ( I'm waiting on the results of an ultrasound of liver, pancreas and gallbladder, any stomach or small intestinal problems have been cleared). Some other symptoms of liver dysfunction are itching, jaundice, fatigue and pain in the upper right side of the abdomen. You're spot on when you talked about our bodies letting us know what they can tolerate, especially when some of us are sort of on our own with these abx. We have to be doubly vigilant in monitering any changes, like stool color, white patches in our mouths, dark urine, etc. Thank goodness we have each other and the internet for information. I sure hope your liver recheck comes back normal so you can continue with the AP.

linda

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