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.