Month 1, Day 31

At last, Month 1 draws to a close!  Only 8 more months left of the tuberculosis drug INH.

One thing I am incredibly glad for is SUNSHINE!  The spring was long in coming and we are still expecting more storms before my garden can truly be planted.  Nevertheless, the sun has been peeking it's way through in all of it's golden glory the last few days.

I spent some time in the sun yesterday.  In about 10 minutes I had a line that told me the sun had found my white, pasty skin and kissed me with UV and Vitamin D.

In fact, as much as I love the sun I want to be extremely conscious of Vitamin D intake since INH depletes it.  Vitamin D has been traced to all kinds of interesting maladies, not the least of which is arthritis, my newly despicable friend.

So, to that end, here are some Vitamin D facts:

1. INH really drains Vitamin D: "After a single dose of isoniazid the concentration of 1 alpha-,25-dihydroxyvitamin D, the most active metabolite of vitamin D, fell by 47% (P less than 0.01) and was reduced throughout the study." (Source)
2. Vitamin D deficiency has been linked to influenza, cancer and heart disease.  It also plays a major role in weakening of bones. (Source - Wikipedia)
3. Vitamin D plays a crucial role in activating the immune system.  If the T-cells can't find vitamin D, they won't activate...in other words, you get sick. (Source)
4. Humans make 90% of our Vitamin D through sunshine (Source)

 Vitamin D intake sources (from SunshineVitamin.org):

Sunlight Exposure (full body exposure)*	3,000 – 20,000 IU
Salmon (3.5 oz. of fresh, wild salmon)	600 – 1,000 IU
Salmon (3.5 oz. of fresh, farmed salmon)	100 – 250 IU
Fortified Whole Milk, 8-oz. glass**	100 IU
Fortified Multi-vitamin	400 IU

Source: Holick, MF. Vitamin D Deficiency. New England Journal of Medicine, July 2007

* Sun exposure to the arms and legs for 10-15 minutes. The amount of vitamin D produced depends on the intensity of the UVB in the sun and many other factors. Darker-skinned individuals may need 5-10 times more exposure than a fair-skinned person to make the same amount of vitamin D. In northern climates sunlight is too weak in parts of the year to make any vitamin D – a period referred to as ‘Vitamin D Winter’.

** Vitamin D is supplemented into milk. It doesn’t occur naturally in milk.

Interestingly, the experts recommend 25-50 micrograms per day.  In my multivitamin, I get 1000 IU's per day.  Hmmm....translation please?

1 microgram = 40 IU's

So, if my math is right (and it may not be so let me know if not) me taking 1000 IU's per day is only equal to about 25 micrograms.  Then, minus my 47% for INH is about 12 micrograms that I'm getting per day.  That is a poor number for something so vital! If I want to get the full 50 micrograms recommended, then I need a total intake of approximately 4000IU's (accounting for the INH factor) per day.  Ick.  Whta makes more sense  is to just lay out in the sun for about 10 to 15 minutes and soak it in.

So, I'd like to renew my commitment to Vitamin Sun over the next few weeks.  Something incredibly important normally has become vital with my friend, INH.

Here's some more good info on Vitamin D - Get your summer sun dose for the winter months!

Month 1, Day 30

Eureka!  INH can actually induce arthritis!

But wait, let me back up...Last week I went to Public Health for my second visit and an INH refill.  My sweet nurse asked me a few questions, weighed me (I've happily lost 3 pounds) and then got me another bottle of INH.  When I told her that I think INH has caused me to have arthritis she was surprised.  "Really?  And you've never had it before?  Who told you that you had arthritis?"

Well, truth be told, I've self-diagnosed.  In the past, the only times I've felt these arthritic-like symptoms was when I drink wine or beer.  The next morning my hands and joints ache and are incredibly weak.  About my third week in to INH, my hands started aching in EXACTLY THE SAME WAY.  But it didn't go away as the day progressed...my hands just ache all the time.

So I explained this to my sweet babushka nurse and she wanted to try B6 even though I get 1000% B6 in my multivitamin.  She teetered out and brought back a B6 that gave me 2000% in one pill.  "Try this without taking your multivitamin for a week and see if it helps.  If not, go ahead and start the multivitamin again."

It hasn't helped...not one bit. So I'm taking my multi again slightly early.  It hasn't been quite a week.  Only 5 days.  My hands feel exactly the same.

The good news it that I've made some connections:
1. INH can, in fact, induce arthritis.  There are studies in which it induced acute arthritis, and when the patient when off, the symptoms disappeared.  When started again, the symptoms reappeared. (Source 1), (Source 2)
2. Since my symptoms pre-INH usually appeared after wine/beer, two high-histamine liquids, and since INH inhibits histamine metabolism, it may be that my histamine intake is exceeding my metabolism of histamine, and adding to the arthritic feeling in my hands. In fact, histamine has been associated with arthritis - causing the joints to become "leaky" allowing the arthritic process to start. (Source)

So from here - I'm going to try an experiment. Remove all (or as many as possible - nearly impossible to remove every bit of histamine - See the Histamine Page for more info) histamine foods from my diet.  This really sucks because I really like a lot of them:
* Certain vegetables: tomato, spinach, eggplant, avocado, mushrooms and canned vegetables as well as commercially prepared salads
* Certain fruits: strawberries, bananas, papayas, kiwi, pineapple, mango, tangerines, grapefruits, red prunes, pea
* Red wine vinegar, balsamic vinegar
* Soy sauce
* Sunflower seeds
* Chocolate/cocoa
* Coffee, black tea
* Some fruits: citrus, bananas, strawberries, red prunes, pears, kiwi, raspberries, papaya
* Peanuts, cashews, walnuts

Yep - I'm going to be hurtin' because I have tomatoes and avocados practically every day.  I eat bananas and cocoa all the time.  I love balsamic vinegar.  I include strawberries, kiwi and oranges in my diet frequently. I drink black tea in the form of chai daily.

This sucks - but it sucks worse to have my hands hurt.  It's worth a try for a few weeks to see what happens.
I'll keep you posted.

Month 1, Day 19

Funny how much mis-conception there is about LTBI and INH.  I suppose we remain blissfully ignorant until we can't any longer.  Just the other day my partner was arguing with me about taking probiotics.  "That's what you do when you take an antibiotic", I said.  "That's an antibiotic?  Really?"

Really. INH is a 9-month long antibiotic.

I suppose it's time to really get my elbows flailing as I dig into what INH is all about.  I mean, I know the basics, like it eliminates LTBI and is used in conjunction with other drugs to treat active TB.  I know that it can cause liver toxicity and damage.  But what does it really do?

The funny part is, I don't think the medical professionals REALLY know.  They know that it works to inhibit mycolic reproduction and it's worked marvelously like that since the 1950's when they first started using it.

But how does it really do that?

Background: Isoniazid (Laniazid, Nydrazid), also known as isonicotinylhydrazine (INH), is an organic compound that is the first-line antituberculosis medication in prevention and treatment. It was first discovered in 1912, and later in 1951 it was found to be effective against tuberculosis. Isoniazid is never used on its own to treat active tuberculosis because resistance quickly develops. Isoniazid is available in tablet, syrup, and injectable forms (given intramuscularly or intravenously). Isoniazid is available worldwide, is inexpensive and is generally well tolerated. It is manufactured from isonicotinic acid  (Wikipedia)

^{The Process:} Isoniazid is a prodrug and must be activated by a bacterial catalase-peroxidase enzyme called KatG.^[5] KatG couples the isonicotinic acyl with NADH to form isonicotinic acyl-NADH complex. This complex binds tightly to ketoenoylreductase known as InhA, thereby blocking the natural enoyl-AcpM substrate and the action of fatty acid synthase. This process inhibits the synthesis of mycolic acid, required for the mycobacterial cell wall. A range of radicals are produced by KatG activation of Isoniazid, including nitric oxide^[6] which has also been shown to be important in the action of another antimycobacterial prodrug PA-824.<sup>[7]


Alright - I can tell I'm going to have to work more on this - very convoluted!</sup>

Month 1, Day 21

This morning, I woke up on top of the world.  I dug out my old Tom Petty Wildflowers CD and blasted it on my way to pick up my son from Grandma's.  With the windows rolled down, the heater on and blue skies ahead, all of my problems seemed trivial.  I kept quoting a line from Tom Petty to everyone I saw:
People come, people go, some grow young, some grow cold.

Tonight, I'm tired, nay- exhausted - my hands hurt and I'm ready for bed.  Got up at around 8 and it's 9 at night now.  So much for long days.

The fatigue is really getting to me.  I'm not sure I can blame it all on INH, but certainly the aching hands and some tiredness is feasible.  The one variable today is that I had a big bowl of Mac N Cheese.  The cheese was fake so it was all still Vegan (here's the recipe, and yes it's YUMMY!) but not gluten free.  I gobbled the pasta down like there was no tomorrow.  It's possible that I'm having a reaction tonight to the whopping load I've put on my digestive track tonight.  Or, maybe I'm having a slight allergic reaction to gluten and my body can't handle the histamines.

But that doesn't explain my usual fatigue of late.  Either way, back to gluten free.  If it makes me feel better, then I'd like to keep it up.  Now, if only I could find a way to help my hands...

Month 1, Day 16

Very tired today.  This could be caused by my cycle (sorry guys) or something else.  But man, I am TIRED! Didn't want to get up today - draggin' my arse around.  Would gladly have stayed in bed for another 3 hours.  Yes, the time just changed, but even before that I was experiencing this.
Could be any number of things...

Now, for ladies only.  About menstruation...

I usually find that with a relatively healthy diet, non-stressful month, my cycles are fairly easy - last about 7 days, heavy, but no real emotional havoc done.  This month was about the same, but I haven't taken anything for the cramps (acetamenophyn aversion), and fatigue city!  Not complete yet, so I'm not sure about length.  I'm assuming it will be about the same as well.

Month 1, Day 14

Tingling fingers

The last two fingers on my left hand, pinky and ringfinger are both a bit tingly - almost like the painful tingle from when you have little invisible rose thorns in your hand.  It started yesterday with my pinky finger and this morning I have it on my ring finger too.  We'll see if it gets worse or better.

Usually, the prescription I've seen for tingling hands and feet during INH (I guess it's pretty common) is to take B6. I'm already taking a ton of B6. 

This could be unrelated to INH...I did go rock climbing at a rock wall yesterday, so maybe I touched something that irritated me.

Since this isn't bad, yet...I'll try not to worry much!

Month 1, Day 13

Bloody Stools!

Really intense too.  So, I'm either thinking that I've been eating too many Goji berries and that is coloring everything, the goji berries are putting too much fiber in my diet and causing bleeding, the INH is causing the bleeding, or my probiotic has stopped working.

I'll need to try:

1. A new probiotic.  Just not satisfied with the one I have (New Chapter Dairy free)
2. Reducing the amount of Goji berries I take every day (Right now about 1 cup per day)
3. Cleaning up the diet a bit.  I've been eating fake cheeses (soy and almond), fake milks, rice flour breads, etc.  I think I'll go back to whole grains, fruits, veges and nuts.

I know that Bloody stools are possibly one of the side effects of INH.  If it continues, or gets worse, I'll want probably call public health.

Month 1, Day 12

Missed my pill again last night, so took it this morning at 6.  I figure that 14 hours between now and my next pill should be enough time, given that INH peaks in the system 90 minutes after taking it.

I was thinking about the beer I wanted to have yesterday.  My partner brought up a good point.  One beer, or one glass of wine every week won't hurt, right?

Well, in fact, the lady at the public health office told me the same thing.  "It's OK to have a few drinks every now and then, it's the continued drinking that's bad."

Well, now...I'll admit, when I was pregnant I drank a glass of wine about every other week, sometimes every week, and my son is healthy, energetic and smart.  No harm to him!  Just how dangerous is a glass of wine or a bottle of beer once a week?

Hmmmm...Research time!  Now, if some of this is wrong, please don't hesitate to tell me!  I'm just trying to piece it together as best as I can.

Background:
Only a small amount of alcohol is metabolized in the stomach.  The rest is pretty much absorbed through the stomach and intestines into the bloodstream and then transported to the liver ("first pass metabolism").  The liver is the primary site of alcohol metabolism. In general, only about 10 percent of a low dose of alcohol is eliminated by first pass metabolism, and as alcohol ingestion increases, the amount metabolized decreases (due to decreased glutathione).  Alcohol that has not been eliminated is recirculated through the body water (blood and water surrounding the cells).  It comes back to the liver through this circulation where it ideally is broken down by several different enzymes (ADH and cytocrome P450 are the two most important).  (Source)

P450 converts alcohol to acetaldehyde (more toxic than alcohol itself), and is popularly thought to be the cause of hangovers. The acetaldehyde is then attacked by another enzyme, acetaldehyde dehydrogenase, and another substance called glutathione, which contains high quantities of cysteine (a substance that is attracted to acetaldehyde). Together, the acetaldehyde dehydrogenase and the glutathione form the nontoxic acetate (a substance similar to vinegar).  Drinking a lot of alcohol will decrease glutathione levels and make it very difficult to metabolize the alcohol quickly. (Source)

INH Role:
INH induces the P450 enzyme.  This causes oxidation to occur, creating acetaldehyde. INH also depletes glutathione. (Source) This causes excess acetaldehyde to remain in the body.  Acetaldehyde toxicity can result in really terrible headaches and vomiting, although I couldn't find anything on pure INH association.

Here's a quote I like:
Although probably best recognized as an inhibitor of drug metabolism, isoniazid has a biphasic effect of inhibition-induction on one cytochrome P450 isozyme, CYP2E1, which partially explains the interaction with acetaminophen and increased risk of hepatotoxicity. (Source)

Additionally, INH reduces Histamine metabolism. (Source).  Guess what many alcohols are high in?  Right, Histamines!

INH and Hepatitis:
INH increases the chance for Hepatitis. (Source) Risk factors associated with this are:

• Age (older means increased risk)
• Gender (we females have it rough)
• Genetic predisposition (undefined as yet)
• Drug interactions (with drugs that induce P450)
• Phenobarbital
• Rifampin
• Alcohol- Slow acetylators of INH may be at greater risk for adverse drug interactions, as the degree of inhibition is concentration dependent. (Source)

Conclusion: 
Hey, I might try a glass of wine every now and then...but for the most part, I plan on STAYING AWAY!  The risk factor is high, and in an unknown quantity.  Since I am older (will turn 40 while on this drug), female and don't know my genetic predisposition, the risks weigh against me.  Additionally, with decreased histamine metabolism I could have an allergic response.  Hmmm...If I do drink, I plan on taking additional antioxidants and drinking tons of water with it!!!  Of course, that will be a different post!

One last thing - If you really have to drink (and I would say limited quantities is very, very important) you may want to try supplementing your diet with things that will increase your antioxidant levels.  Here's a page I found that offers suggestions:

Typical doses of cysteine that are sufficient to block a major portion of the toxic effect of alcohol/acetaldehyde are about 200 mg per ounce of alcohol consumed. However, the rapid assimilation and metabolism of alcohol requires both prior and concurrent dosing of cysteine to maintain protection. Furthermore, a multifold excess of vitamin C is required to keep the cysteine in it’s reduced state and “on the job” against acetaldehyde. I use capsules (because they dissolve fast) containing 200 mg cysteine plus 600 mg of vitamin C (with or without extra B-1). I take one before I start drinking, one with each additional drink and one when I’m finished. It works remarkably well.

I know there are some holes in my research, so I welcome any additional comments you may have!  

Month 1, Day 11

I wanted a Beer last night so bad...Hard to remember when you're in the midst of good music, dancing and love that I'm trying to avoid alcohol. 

Either way - got home so tired, took my pill then crawled into bed.  I could have sworn that as I was dropping off to sleep my lips went numb.  Since I didn't really have a good handle on reality at that point, I am not going to put it down as a symptom...but I'll try to make sure I look for that again!

My probiotic isn't working that well.  I bought a dairy-free version that doesn't list how many live cultures are in it.  I may need to go back and purchase one that has some dairy just to get a higher strength.  By the way, if you don't know how I know they aren't working, um, well, it's because I have more diarrhea than usual.  I'm not going to go into a whole poop diagnosis, but antibiotics tend to kill your friendly bacteria in the intestines.  Symptoms of this can include cramping, diarrhea and gas.  One way to offset this is to replace the friendly bacteria through supplementation - probiotics!

Month 1, Day 10

Goji Berry Heaven!  I am addicted to Goji Berries, or wolfberries, or whatever you want to call them.  I don't care if they are the latest craze, or fad, but I love 'em!  I bought some from my next door neighbor who sells Young Living, but think I may go through this place and buy 9 pounds!  My favorite drink of the week:

Darcy's Goji Berry Tea
Handful Goji Berries (good handful)
Hot water
1/2 lemon
1/2 packet Stevia

YUM!

Goji Berries are actually great for the liver.  There's a ton of marketing hype out there, and several unsubstantiated claims, but I think the biggest evidence is how it makes me feel.  Whatever the claims, studies or hype, I've noticed that I actually have more clarity, and feel warmer.  I sometimes have a slight flush which could be from the large amounts of Niacin in the berries.  The berries are a great snack too, and I have no problem eating a handful to satisfy the munchies.

Speaking of Niacin or B3 - INH depletes levels of Niacin in the body.  I'll go more into this tomorrow!

Last night I worked out on the elliptical at the gym.  I spent about 30 minutes cranking and realized, again, how out of shape I was.  However, this morning I'm not really musclesore...I was concerned that I'd have a repeat of my lactic acid fest from a few days ago, not other than some arthritic symptoms, I'm fine.

For breakfast this morning I munched on some of my bluberry-banana loaf, which is incredibly filling and some pinion nuts.  Hopefully this will tide me over to lunch - I have green beans, potatoes and chickpeas in a cauliflower sauce - a little bland but still delicious!

I noticed last night that the pill is becoming a habit to take before bed.  I almost (but not quite) didn't have to think about grabbing it.  My steps just led me to the counter to take my pill.

Month 1, Day 9

Fatigue.

For the most part, I'm been fine.  But I've been noticing this low-grade fatigue over the last week.  I don't think it has anything to do with being lazy, sick or overworked.  I think it has to do with INH.

It's not exhausting me or making me keel over at the end of the day into a pile of bones.  It's just a feeling of lethargy.  Like I need to push a little harder to make things happen.  I need to psych myself up more to do active things. After last week's experience with the Lactic Acid, I realize that I don't want to have another episode of that.  What would be ideal is daily exercise to avoid anything dramatic.  But of course, that is difficult for me, since I'm out of shape.

So, work into it, they say...and so I must.  And most likely, the daily exercise will give me more energy!

On a different note, someone told me today that I look really healthy! I guess going from zero pills daily to 8 pills, better diet, lots of water and better nutrition daily says something, even if one of those pills are INH.  I think that when the body is clean, it makes it much, much simpler to process out toxins in the body.

Last night I made a Blueberry Banana Bread (Awesome Source) because I wanted something yummy.  It was absolutely delicious:

3 large over-ripe bananas
2 tablespoons lemon juice
1/3 cup (80 ml) vanilla soymilk (or apple sauce)
1/2 cup (120 ml) agave nectar
2 cups (240 g) white whole wheat flour (or regular whole wheat flour) (Note: I used Brown Rice Flour instead of whole wheat to avoid gluten. 
3/4 teaspoon baking powder
3/4 teaspoon baking soda
1/2 teaspoon salt
1 cup (240 ml) blueberries

Preheat oven to 350F. Spray or wipe a 9x5-inch loaf pan with oil (I used a silicon loaf pan).

Mix the soymilk with 1 tablespoon of the lemon juice and let stand until it curdles. (If using apple sauce, skip this step and add the lemon juice to the bananas.)
In a large bowl, mash the bananas and add the remaining lemon juice, soymilk, and agave nectar. Stir well to combine. In a separate bowl, combine the flour, baking powder, soda, and salt. Add the dry ingredients to the banana mixture, and stir just until the mixture is well-combined. Fold in the blueberries.
Spread the mixture evenly in the prepared pan and bake until a knife inserted in the center comes out clean, about 50-60 minutes. Allow to cool before cutting and serving.
Servings: 12

Month 1, Day 7

Well, I'm definitely getting into the swing of things.  I leave my pill out on the counter so it stares me down at night.  I drink 32 oz of water first thing in the morning accompanied by a probiotic.  I take a multivitamin daily, 3 after breakfast and 3 after lunch.

I'd say the first week was pretty good.  Feels like it's been forever already, though.  To go from taking no pills, to 8 pills a day is quite the adjustment.

As a wrap-up, my symptoms have been relatively minor.  I did notice that after playing racquetball for the first time in forever Thursday evening and getting incredibly musclesore, the pain actually seemed to linger longer than usual.  In addition to my right hand cramping up, my left hand cramped up too, and I had intense weakness in both hands.  Could just be that I'm THAT out of shape, but I'd like to look into the theory of INH interaction with lactic acid.  Actually - just did a cursory check - looks like INH actually raises the level of lactic acidosis in the system.  Makes sense that extreme exercise can actually create lactic acidosis in the body with INH.

Month 1, Day 5

Totally forgot to take the pill last night.  So at 5am, I woke up and remembered and panicked.  I figured it would be OK to take it then, and then another 14 hours later...so I took it, worried that I might feel some side-effects.  The only thing I felt was great when I woke up again at 8:15, realizing I'd slept in way too long and had to get to work.

This actually gives me some more confidence to take this pill on an empty stomach.  Since I didn't experience and side-effects like nausea, headaches, etc, I might want to try taking this in the middle of the day rather than after dinner so I don't forget it!  We'll see...

Month 1 - Day 4

Felt great this morning. 1 side-effect, diarrhea - ick. Luckily, I just bought from the store yesterday a hardy probiotic (acidopholis/lactobacillus friendly bacteria mix). Antibiotics usually kill friendly bacteria in your colon leading to symptoms like gas, diarrhea, etc. So this morning I took my probiotic 20 min before breakfast.

Drank 32 oz of water first thing.

B - Cut up banana, raw almonds, dried strawberries, hemp seed and coconut milk
S - Carrots and hummus
L - Salad and dressing
S - Banana chips (a lot)
D -Butternut squash soup with cauliflower, chocolate brittle

By the way, I love chocolate, so need to make a healthy, yummy alternative to the chocolate you usually buy...

So, here's what I do:

1/2c Coconut oil
1/2c maple syrup
1/2c cocoa powder
dash of vanilla
1/2c chopped almonds

Blend the top 4 ingredients until smooth, then add in almonds. Smooth it onto some plastic wrap and let it harden in the freezer.

It tastes like fudge, is raw and healthy!

Pill:
Totally forgot - woke up at 5am and remembered...will talk about on next post.

Month 1 - Day 3

Felt very dry this morning...woke up and knew I needed water.

Once upon a time I used to start the morning with 32 oz of water. The purpose was not only to hydrate but to flush the kidneys of water soluble toxins and also flush the intestinal tract. I think I'll start this up again. The body is practically a bag of water, and needs to be changed just like a fishbowl. If you don't get enough water, those water soluble toxins just tend to hang out in the body. The new rule of thumb for water is half your body weight in water each day. I weigh around 130 (hoping that goes down!). So I should be drinking about 65 oz of water each day.

Drinking 32oz of water before doing anything else can be difficult the first couple of days. But it makes sense to get half my water consumption out of the way and provide a fresh start for my body each morning.

Today my diet is:
B- Medley of rolled oats, roasted almonds, banana, figs and coconut milk
S-Rice cake and 2 cuties
L- Rice, steamed kale, olives, tomatoes and a brown rice tortilla
S-Banana chips
D-Butternut squash soup, Salad, Chocolate bark (coconut oil, maple syrup, cocoa powder, almonds)

Took pill before bed.

Month 1 - Day 2

Well, as far as I can tell, the only symptom I might have had this morning was arthritic fingers. Very often when I drink red wine I tend to get a bit arthritic the next morning and this was reminiscent of that. No, I didn't chug the open bottle of my favorite red wine to finish it off...just took one little pill.

I did, however, chug wine on Friday and Saturday night, as well as eating cheese, meat and chocolate. Hey, I'm going to miss my wine and cheese! I don't know if that would continue to affect my liver, or make it more difficult for my liver to process the pill. We'll see as we go along.

I'd like to research more how INH is processed by the liver.

Tonight, I will also spread out the time that I take the pill to 1 hour after eating. I'm nervous about the nausea, but experienced none last night. Ideally, from what I've read, I should take the pill 2 hours after eating to ensure maximum efficacy.

My Diet Today:
B-Ezekial with Avocado, Tomato, Spike and Earth Balance
S-2 cuties (tangerines)
L-Baked Sweet Potato loaded with Earth's Balance, 1/2 c. tabhouli, nuts
S- Carrots/Hummus, Chips and Salsa when home
D-Stuffed portobello mushrooms, rice and lemon bars for dessert.

I ate at around 7:30 but kept eating until about 8:30...taking pill right before bed.

Month 1 - Day 1

The Public Health Department nurse who interviewed me after my PPD and chest Xray suggested that I take my INH pill after dinner to lighten nausea. I think that's a great idea, so my first day, possibly week, will just be about remembering to take my pill.

The Public Health department in Santa Fe, New Mexico was very easy to work with on my initial visit. After looking at my paperwork, the sweet, elderly hispanic nurse asked me a few questions that she'll ask every month as I return for my next 30-day dose. These questions help them identify what symptoms I have, and if I might be reacting adversly to INH. To me, if I vomit, that will be an adverse reaction, but the next medication in line might be even worse.

Since INH is hard on the liver (thus the increased risk of hepatits and requirement of little alcohol and increased problems with blood sugar) my desire through this 9 months is to provide adequate liver support. I hope to try different things that I wouldn't normally try. Although my diet is usually pretty good, I believe this 9 months will push me above and beyond my normal diet and force me to be as clean as possible. Imagine that...

My Diet Today:
Breakfast: Ezekial Toast with Avocado, Tomato and spike
Snack: Big bag of carrots and Hummus
Lunch: Cooked veges with goddess dressing on top
Snack: Grapefruit and nuts
Dinner: Kale and a Millet pilaf

My diet is pretty healthy for the most part anyhow, so this isn't a huge change for me. I could understand how this would really suck for a lot of people who drink soda, eat a lot of chips and refined products, etc. I'm pretty lucky on this end.

The First Pill
This morning I set out the bottle. It still has the little flap of info attached to the lid. I lifted it up and felt a little like Socrates holding his hemlock. Tonight, at 8'clock on the nose less that 10 minutes after dinner, I popped the pill in while my partner was singing to me. At 9:00 PM, I feel my normal tired.

We'll see how I feel tomorrow...bedtime at 10 tonight.