My 2018 and Antibiotics

Antibiotics, Michael Mortensen CC Licence

I have been looking into antibiotics as a result of my hospital visits this year.

So a bit of history.
I have always suffered a little with antibiotics – they have always brought on mild diarrhoea in me, so I have never gone demanding them from the GP. Had the odd course over the years though. I soon learned that live yogurt helped my digestion after the course ended.

In May I started with what I thought was a tummy bug. But I ended up in pain and eventually, at
2am the pain got so bad I got Mrs A to take me to A+E.
Well it turned out I had a burst appendix and underwent 5 hours of keyhole surgery to fix it, and wash out my perineum.
There is a real risk of sepsis with this so they put me on industrial strength intravenous antibiotics for the next 8 days.
Blood tests showed early on there was still another infection, and a CT showed a gall stone. So low fat diet.
Went home for recovery, and I started on the live yogurt stuff to settle my tummy after the antibiotics.
Then at the start of July back to A+E for abdominal pain. Passing a gallstone this time. They did an ERCP (Endoscopic retrograde cholangiopancreatography ) where they stick a camera down your throat, through your stomach and into the start of the small intestine, then do a U turn to go up the common bile duct. There they inject dye into your blood, and take an x-ray. They found a mixture of gravel and pus in my common bile duct (see below) which they cleared out. They also snipped the sphincter where the common bile duct goes into the small intestine so I was able to pass gallstones into my intestine without risk of blocking the common bile duct. Its called the glorious name of “The Sphincter of Oddi”.

Your liver has 2 functions.

1. To destroy old red blood cells. The useful by products of this are returned to the blood to be reused in making new cells. The unwanted stuff is called bilirubin, and that passes down the common bile duct and into your intestine for disposal. Its what gives your poo its colour.
2. Your liver also makes bile, a digestive juice that helps digest fat. But as hunter gatherers we didnt eat fat all the time, but when we had meat we would gorge on it. So the liver passes bile to the gall bladder to store it until we have a heavy intake of fat.

There is a Y shaped tube from the liver and the gall bladder to the small intestine. Because it takes bile from 2 organs, its called the common bile duct. If this gets blocked, the bilirubin cant get out so it ends up in the blood. Its not good as it causes jaundice, making the patient look yellow, yellow whites of the eyes. It also causes the patient to feel lethargic, low libido and other general symptoms. I thought this was just ageing, but it wasnt. Ant the GP never spotted it. And I have heard of others who have felt crap for quite a few years until diagnosed. Even a nurse friend didn't self diagnose it. It could be diagnosed quickly and cheaply with ultrasound – same kit they use on pregnant mothers.
Because the ERCP procedure cause a small injury in my intestine, there is a very large risk of infection from chyme (the food passing down the intestine ), so I was sent home with 2 courses of industrial strength antibiotics. (500mg Amoxycillin and Metronidazole).

After that I had a colonoscopy. The pathology lab found the appendicitis was caused by a polyp at the entrance to the appendix. Because there is a risk of polyps causing bowel cancer they have to look. The only found 1 more ployp and it wasn't they type that causes cancer. But I did have to use a strong laxative to clear out my intestines so the doctor could get a clear view. I don't know what that did to my bacteria in my gut.

Finally, in November they took out my gall bladder – day surgery, and done keyhole – laparoscopically.

I have recovered OK and feel better every day. But my guts still are not right despite the recommended high fibre diet. I get bloating, and also flatulence.

Then beginning of April this year I got stomach pains. Yes, I had stones in my Common Bile Duct, one 12mm diameter. Still, they hoiked them out with another ERCP. But more antibiotics…. 🙁

Some of this may be my body getting used to not having a gall bladder, and my intestines getting fat
with no bile to break it down. It may be due to the high fibre diet. But it may also be due to the antibiotics having killed off much of the bacteria in my guts – the gut flora.

There is some evidence that the appendix does have a role, in that it may store a culture of gut flora, so in case of an intestinal infection, there is something to breed from. But like Noahs Ark!

They have also looked at patients gut flora 10 months after a major antibiotic dose, and found there is still a lack of variety of species. They say that could cause loss of digestive function.

So what can we do after a big antibiotic dose to get better? Its thought a lot of our gut flora come from our mothers during pregnancy and breast feeding.

1 eat a varied healthy diet. Lots of fibre, uncooked vegetables and fruit (so thats salad) from a variety of sources which will have different bacteria on them which may enhance my gut flora.

I have added probiotic yogurt, kaffir,Yakult and also pro-biotic pills to try and add in gut flora. I hope these help will build my gut flora. Also I eat sauerkraut and kimchi, which are fermented vegetables, and also are rich in microbes that could help rebuild gut flora.

This is important because there is evidence that a poor gut flora can cause other health problems like obesity, Type 1 diabetes etc. New thinking is that we have a secondary brain that controls our gut, the Eteric Nervous System or ENS. But the ENS sends messages to our main brain about the health of our digestive system, and that can cause symptoms like tiredness, cravings and mood changes.

I am not suggesting everyone mainlines probiotics. For healthy people eating a mixed diet should be enough. Yes, I dislike salad with the rest of you, but a small amount can keep you healthier. And adding grain into your diet, perhaps with a little muesli, or a seeded bread also helps.

Another thing to avoid is monodiet. That's eating the same thing all the time. So I vary my carbohydrate, eating rye bread, adding stuff like pearl barley and lentils to stews and shepherds pie. Getting most of your carbohydrate from just wheat isn't good.

Yes I still eat fish and chips, pork pies and roast dinners with Yorkshire puddings. Just day to day I make a little effort to vary my diet, especially as I recover from a lot in invasions into my intestines this year.

But I hope this will make people who have had an illness needing heavy antibiotics will think how they will fix their gut flora afterwards. And how little things can make for better health. Especially as much of the stuff I eat is quite nice.

Like fried egg on black rye bread. Mmmm.

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