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Friday, December 28, 2012

Probiotics and exacerbations

Other than the prevention/treatment of C Diff, looks like these buggers may help prevent exacerbations. 


Pediatr Pulmonol. 2010 Jun;45(6):536-40. doi: 10.1002/ppul.21138.

Probiotic supplementation affects pulmonary exacerbations in patients with cystic fibrosis: a pilot study.


Division of Pediatric Gastroenterology and Nutrition, Safra Children's Hospital, Tel-Hashomer, Israel. weissb@sheba.health.gov.il



Probiotics reduce intestinal inflammation in, and Lactobacillus GG (LGG) reduces pulmonary exacerbation rate cystic fibrosis (CF) patients. We intended to determine the effect of a mixed probiotic preparation on pulmonary exacerbations and inflammatory characteristics of the sputum in CF patients.


A prospective pilot study of 10 CF patients with mild-moderate lung disease and Pseudomonas aeruginosa colonization, treated with probiotics for 6 months. Pulmonary function tests (PFT's), sputum cultures with semi-quantitative bacterial analysis, and sputum neutrophil count and interleukin-8 (IL-8) levels were compared to pre-treatment and post-treatment values. The rate of pulmonary exacerbations was compared to 2 years prior to the study.


The exacerbation rate was significantly reduced in comparison to the previous 2 years and to 6 months post-treatment (P = 0.002). PFT's have not changed at the end of treatment and during 6 months post-treatment. No change in sputum bacteria, neutrophil count, and IL-8 levels was observed.


Probiotics reduce pulmonary exacerbations rate in patients with CF. Probiotics may have a preventive potential for pulmonary deterioration in CF patients.
 [PubMed - indexed for MEDLINE]


Wednesday, December 26, 2012

Well, well, well, look what we have here

Years and year ago, when I was purporting the benefits of the eFlow (loooooong before Cayston was approved.... check out my posts from 6+ years ago), I had a really hard time finding internet links for the eFlow studies that had been conducted.

Ultimately I located them on random internet pages, which were subsequently taken down. After exploring the CF Services webpage (not sure I remember why.... I really despise that pharmacy), I came across the same studies I had referenced years ago:



I still have the pictures of the studies on my blog, but I just found it funny that this information has become a bit more "mainstream."

Happy eFlow-ing.

Sunday, December 9, 2012

C Dff

WARNING: this post contains extensive and graphic discussion of feces. Not for gratuitous purposes, but rather to help out other CFer's who want to prevent or who suffer from C Diff. You are warned. 

Maybe it's just my lack of exposure to the CF community, but I haven't heard many talk about struggles with C Diff (Clostridium difficile). 

So when I was diagnosed with this a week and a half ago, after my second hospital admission in 2 months (I was admitted the 2nd time for sinus surgery and we agreed more IV abx would set me up for a good chance of recovery), I searched the web feverishly for answers for how to treat this potentially deadly condition.

PWCF are no strangers to life-threatening conditions, this is true. But I've mostly been a pulmonary CF type gal for the 31 years I've been on the planet - no real weight problems, despite being PI. I take digestive enzymes, and as of 8 months ago I do have CFRD, but other than that, I don't give my digestive system much attention.

I've always taken probiotics off and on, mostly to either prevent a yeast infection while on IV abx or more recently to boost my immune system (thanks to smart Cyster Mandy). But that was really the extent to which I knew about these little heroes that live in our bodies.

So I'm sure you're absolutely shocked to hear that I went on a whirlwind of research upon being diagnosed with C Diff. I'll give you my research and actions in a few paragraphs - first I'll describe my symptoms. 

I was constipated without a BM for 72 hours - finally had a BM in the early morning of my 1st Friday in the hospital, and I ended up having 7 more that day that were pretty explosive diarrhea . I don't typically get diarrhea with IV abx, but sometimes loose stools. A quick C Diff culture showed I did in fact have the affliction. 

I felt slightly nauseated that Friday, and a bit distended, but nothing too horrendous other than frequent trips to the bathroom. Saturday, however, brought some of the worst pain I have felt since I passed gallstones. I was put on Simethicon and given a small dose or morphine to make me comfortable. I've never been on anything stronger than Tylenol + codeine, so I was pretty afraid of taking a strong pain killer. But the pain was too great and wasn't going away.

I was put on Oral Flagyl and Vanco (in addition to the other 3 IV abx I was on to treat the PA in my lungs) to treat the C Diff - very standard therapy. I was also given packets of lactobacillus to hopefully build up the good bacteria in my gut to combat the C Diff. The lactobacillus was refrigerated by the hospital, but I wasn't sure what the brand was or what the quality was.

Luckily the pain of Saturday never came back - thanks to lots of praying and I think the Flagyl and Vanco (and maybe even Simethicon) were doing their job. The diarrhea, however, did not go away until well over a week later. More on that later. 

As I was healing from my 1st sinus surgery and cranky lungs, I shook my head at myself for not proactively taking probiotics after my hospitalization discharge in October and prior to my admission in November. I knew in the back of my mind this was important, but with all the fevers, lethargy, blah blah blah I was dealing with I just didn't get it done. I asked my doc why he didn't put me on probiotics - he said the studies were mixed on whether probiotics really helped  prevent C Diff. There you go.

So back to the research - I first wanted to understand the exact mechanism of C Diff. Essentially, one can acquire C diff in two different ways - either getting it from someone else (not washing your hands....most commonly in hospital or long term care facilities) or through over use of abx. The abx CFer's normally use are "broad spectrum" - meaning the abx kill the PA we want dead, but the abx also kill some of the good bacteria in our intestines. 

As any of us who have had a yeast infection can attest, the balance between bacteria species, bacteria and fungus, etc etc is very fragile. And when the balance is disrupted, yeast infections and C Diff can result, to name a few afflictions. C Diff is particularly worrisome because the overgrowth of the bacteria releases toxins from the bacteria, causing inflammation of the colon or even damage to the intestines. Scary scary stuff.

So, what I'm hoping to pass on to my fellow CFer's are a few foods for thought on treating and preventing C Diff. This is my research thus far, what has worked for me, and what else I have in my tool box in case things get worse.

  • Not all probiotics are made the same. Most notably, good bacteria can be destroyed in your probiotic quite quickly
    1. Ask the store where you are purchasing the probiotic if the item arrives to the store refrigerated. Often, probiotics need to be refrigerated, otherwise the bacteria die off. So if you're purchasing a probiotic from a refrigerator in the store, but the probiotic was transported by truck at room temp for 3 days just to get there, are you really getting your money's worth? Or more importantly, what your digestive tract needs? I was shocked that my favorite brand of probiotics didn't arrive at my store refrigerated. So I chose a different brand
    2. Read packaging to determine how the probiotics are created. Some yogurt products are infused with the good bacteria, then fermented. This can destroy the bacteria
    3. Location of the manufacturer is important as well. I chose a manufacturer just a few dozen miles from the store - I figure the refrigeration transport will have more integrity and the product is fresh

  • If things escalated, I was ready to visit a local doctor for a fecal transplant. Not the most glamorous, but scientifically and logically it makes sense. I have no desire to lose my colon over this C Diff infection http://fecalmicrobiotatransplantation.com/FMT/home.html. Things have not escalated and I haven't resorted to this method - but I just want to throw it out there in case anyone needs it/ wants to research it. C Diff is serious.

I realize this post is all over the place, but I want to get out as much info as possible. 2 days ago, Friday, I was released from the hospital, PICC line pulled, no more abx except for the Flagyl and Vanco. I immediately went to the store to pick out a probiotic. After looking at the criteria above, I chose http://www.biokplus.com/en-us   Strawberry probiotic (yes, it has a little added sugar Mandy, I know, I know....) with 50 billion live and active cultures for my struggling belly. Now I'm just telling you what I chose and what was best for me - it's important that you do your research for which probiotic is best for your situation.

Friday night I drank my 1st 1/2 jar of the probiotic (I didn't want to start off too aggressively... too many good bacteria can be disruptive as well) and I drank the other 1/2 Saturday morning. Saturday evening (last night) I have my first formed BM and much more appetite than I had had in over a week. This morning, Sunday, another formed BM. 

To be fair, I was taken off IV abx 36 hours before this solid BM. So it's possible that being off the IV abx helped the good bacteria start to grow. But I am convinced that the probiotic certainly helped the good bacteria and of course implanted more good bacteria for my digestive system to work and the C Diff to settle down a bit.

I will keep you guys posted, as I'm certainly not out of the woods yet. C Diff can re-occur after my Flagyl/Vanco cycle ends, or of course with my next round of abx. But I feel more confident with the right probiotic in hand I can try to PREVENT the infection in the future, and treat it if it comes back. 

Oh yes, and my sinuses and lungs are doing fine too. 

Hoping this info can help other CFer's out there who are need of help - C Diff is certainly a nightmare. FIGHT ON!