Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts

Thursday, December 11, 2008

Prescription Medication #2: Clindamycin

IMPORTANT: My reason for including entries about prescription medication is to simply share some basic information, and the experiences of those who used them. But nothing in this blog is a substitute for a discussion with your doctor, and reading the literature that you get from your doctor/pharmacist.

Currently, there are three types of antibiotics widely used to treat BV. I'm going to cover some basic information about each.

This is an overview of Clindamycin, which comes in three forms.

Clindamycin (oral)

  • Description: oral capsules, typical regimen is 300 mg, 2x a day, for 7 days
  • Pros: a broad-spectrum antibiotic, provides an alternative to patients who can't take Flagyl; does not cause nausea when consumed with alcohol
  • Cons:
    • may cause overgrowth of Streptococcus (Strep) bacteria

    • From the literature that patients receive with this drug - "WARNING: This medicine should be used only for serious infections because infrequently there are severe, rarely fatal, intestinal problems (pseudomembranous colitis) that can occur."

Cleocin (vaginal cream)

  • Description: 3- or 7-day vaginal ovules/suppositories
I don't know much more about Cleocin because it doesn't seem to be very widely prescribed.


Clindesse (vaginal cream)

  • Description: one-dose vaginal cream
  • Cure Rate: The company claimed 88% (PDF file), but was cited by the FDA (PDF file) for overstating that figure, among other claims: "The e-Pharm/alert e-mail is false or misleading because it overstates and misrepresents the efficacy of Clindesse, presents unsubstantiated superiority and patient compliance claims, and minimizes the risks and limitations to the indication associated with Clindesse."
  • Pros: a broad-spectrum antibiotic, provides an alternative to patients who can't take Flagyl; does not cause nausea when consumed with alcohol; one-dose convenience
  • Cons:
    • Clindesse can be systemically absorbed, and can cause all the side effects of oral Clindamycin, such as pseudomembranous colitis

    • From this source: "... clindamycin vaginal cream, which was frequently used for bacterial vaginosis during pregnancy, is no longer approved because it results in a strep vaginosis."

My Recommendation:

Should you use Clindamycin or Clindesse for BV? In short, no. Doctors used to prescribe it often, and may still do. But I keep finding more sources that say that it causes Strep bacteria overgrowth, and that is a real concern. Not to mention that Clindesse is apparently not very effective, and the company that makes it has overstated how well it works. So these are definitely more reasons to avoid it. Many women have used Clindamycin and Clindesse (myself included) in the past. But I think we need to stay away from it from now on.

Unless you have a very compelling reason to avoid Flagyl (e.g., an allergy), I would recommend that you avoid all forms of Clindamycin. (And wanting to not go without drinking alcohol for a week is not a compelling reason!)

Sunday, December 7, 2008

Prescription Medication #1: Metronidazole

IMPORTANT: My reason for including entries about prescription medication is to simply share some basic information, and the experiences of those who used them. But nothing in this blog is a substitute for a discussion with your doctor, and reading the literature that you get from your doctor/pharmacist.

Currently, there are three types of antibiotics widely used to treat BV. I'm going to cover some basic information about each.

This is an overview of the most prescribed medication for BV: Metronidazole, which comes in two forms.

Metronidazole, a.k.a. Flagyl (oral)

  • Description: oral tablets - typical regimen is 500 mg, 2x a day, for 7 days or 2000 mg single-dose
  • Cure Rate: 95%, single-dose 84%
  • Pros: the first-line-of-defense for BV, has high cure rate; generic version is inexpensive
  • Cons: causes metallic taste in mouth; do not drink even a drop of alcohol while taking this, and for 3 days afterwards (not even cough syrup, or even a bite of tiramisu - it will make you very nauseous!)

Metrogel (vaginal gel)

  • Description: Vaginal gel
  • Cure Rate: 75% for 3-day regimen
  • Pros: you can avoid some of the side effects of the oral Flagyl (although you should still avoid alcohol)
  • Cons: the cure rate is lower than with the oral medication according to some sources

My Recommendation:

Whether you choose the Flagyl or Metrogel for your treatment is up to you and your doctor. However, I think it is better to take the oral medication if possible. In recent years, there are more and more research that shows that BV germs can travel from your lower genital tract to your upper genital tract and cause problems. So for that reason, taking the oral medication instead of the intra-vaginal gel/cream may be a better choice.

Many Bust Lounge members have used both types of these medications. Some have shared that after taking it several times, Flagyl makes them nauseous, even when alcohol is not consumed. Some members have also reported that they feel depressed after taking Flagyl.

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The cure rate information is from this source.

Your Gynecologist Appointment

As persistent BV sufferers, many ladies have visited their gynecologist more times than they would like. These are some tips for your visit.

Thing to Do (& Not Do)

  • Keep a journal of your appointments. Type up a list/table on your computer, recording the dates, tests, and results of your trips to the gynecologist, plus any other notes you want to add.

    Printing out this list and giving it to your doctor to put in your file is a good idea, so they can get a better picture of your health history. This is especially useful if you're going to a new doctor - the less they have to handwrite stuff in your file, the less time you both waste.
  • Bring with you a list of questions you want to ask the doctor. Sometimes when you're half-naked and swaddled with a giant paper napkin, you can forget all the questions you wanted to ask.
  • Do not douche, have intercourse, or use other products (e.g., creams, suppositories) in your vagina before your exam.

    A lot of sources tell you to not do these things for 24 hours before your exam. My suggestion is to avoid all these for even longer, or not do them at all, if possible. You want your doctor to examine you when the symptoms are at their worst.

    You should also avoid baths before your exam, because it can wash away your vaginal secretions. One Bust Lounge poster said that she knew she had BV, but she took a bath the day before her exam and her doctor found nothing. She went back later without a bath, and the doctor finally diagnosed her BV.

    So make sure your doctor doesn't miss the diagnosis! Don't douche, take a bath, have intercourse, or use any products before your exam! If your symptoms are bothering you, use ice packs or pain relievers instead, and just ride it out until you get into the doctor's office.

Saturday, December 6, 2008

Doctor Can Be Jerks - You're Still Going to Need One

My previous post was about how some doctors make mistakes, and some don't have the best bedside manners. And if you encounter such a doctor, you need to be proactive and don't take their word for everything.

But while my blog will offer a lot of tips and research for BV sufferers, one thing I impress on everyone is that medical attention is required. There are no shortcuts and no substitutes.

Reasons you need to go to the doctor:

  1. BV requires prescription drugs for treatment. I know you probably researched BV on the internet and found this blog because you were hoping for an over-the-counter (OTC), perhaps homeopathic or naturopathic cure. Let me disabuse you of that notion right now. In my experience, most of them generally do not work, so most of the OTC tips you find on the internet will be a waste of your time and money.

    (However, there are OTC supplements that are very useful for BV sufferers, and I will cover them in detail in my future posts.)

    Medical care is just something you are going to need at some point in dealing with BV. So there is no getting around it - medical care is absolutely the first step anytime you notice an unusual odor or color in your vaginal discharge.

    I know many people do not have health insurance. Not to mention no one enjoys a trip to the gynecologist. But if you think something is wrong, don't put if off. Explore all the resources in your community, such as Planned Parenthood, or other family planning or health clinics, and make it a priority to take care of your health.


  2. BV has health consequences. In the past, BV was considered a "nuisance" infection that was bothersome, but not dangerous. But more and more research is showing that untreated BV may result in potentially serious health consequences. (I will detail them in a future post.)

  3. It could be something else. Quite a few ladies I've encountered thought they had BV, but a trip to the gynecologist revealed that they had other problems. The other discovered problems were usually more serious than BV, (e.g., an STD), so it was a good thing that they got medical care.

    Remember, BV can occur simultaneously with other problems. So even if you are sure that your symptoms are BV, you can't rule out the possibility of other problems.

    If you are sexually active, there is always a chance that you have an STD. Quite a few of them do not even present symptoms. (For example, did you know that up to 75% of women and 50% of men who have Chlamydia have no symptoms?) So always be vigilant and get regular exams.

Doctors can make mistakes, and they can be jerks. Trust me, I know. But don't let them discourage you from seeking medical care. Put yourself first, always.

Tuesday, December 2, 2008

Doctors Don't Know Everything (And Sometimes, They're Jerks)

BV is a very common problem, but it is not very well understood. As a result, many ladies have encountered doctors who dismiss the problem as not a big deal, or even fail to diagnose/treat it. More and more research is showing that untreated BV contributes to permanent damage of your upper genital tract. So be proactive about your health, and don't let your doctor shrug you off. Switch doctors if necessary.

I had my share of bad doctor experiences. I suffered from BV for about 7 years. And during the first 3 years, I went to the gynecologist many times complaining about my symptoms. I think I had more than 15 trips to 3 different gynecologists, and all of them failed to diagnose my problem. (After a while, whenever I saw the doctor slip on the latex gloves, I just felt like screaming.) They kept sending me home with pain medication, telling me that I may have ovarian cysts, or just pre-menstral cramps. It was very frustrating.

I assumed that since all these doctors are telling me nothing is wrong, I should trust them, right? But I'd always come home and think ... 'Nope, something is still wrong.'

When I was finally diagnosed with BV, I was so relieved that I just started crying. I knew something was wrong for years, and somebody finally figured it out!

Other Bust Lounge posters have shared many stories like that, too. Not only do some doctors fail to diagnose and treat the problem, they disrespect you. I understand this frustration as much as anyone. I've had doctors call me "over-sensitive," "paranoid," and "hypochondriac." It's frustrating and upsetting, and some ladies are permanently discouraged from going back to the doctor.

But never give up! As I said in my previous message, medical care is necessary at some point. So it's important to find a doctor who will treat you properly. If they brush you off, don't just take their word for it. If your doctor treats you in a way that makes you feel uncomfortable in any way, find another doctor. Make your health a priority.

Recently I read the story of Ayala Miron, a woman who suffered from ovarian cancer for years but her doctor failed to diagnose her despite examining her many times. It certainly put things in perspective for me. (BV is awful, but nothing compared to cancer!) And it is also a good lesson for us all. To quote Ms. Miron herself:

"Women need to trust their own bodies. If you're feeling that something is wrong, don't assume anything. Be persistent. And don't wait."

Monday, December 1, 2008

What Is BV?

Bacterial Vaginosis (BV) is the most common cause of vaginitis. It is caused by an imbalance of bacteria that live in your vagina.

In the simplest terms: in an healthy vagina, the "good" bacteria (e.g., Lactobacillus) is dominant. If you have BV, the "bad" bacteria (e.g., Gardnerella vaginalis) have overgrown and taken over.

Symptoms:

The main symptoms are color and unpleasant odor in your vaginal discharge. The color may vary from gray, yellow, or green. The odor is typically described as "fishy." Some ladies have also described it as "like ammonia," or even "hot garbage." The consistency of the discharge is sometimes described as "slick."

The chief complaint for BV sufferers is the odor. Sometimes the odor is strong enough that other people may notice it during your normal daily activity. Naturally, the unpleasant odor can affect your sex life.

A healthy vaginal discharge is clear or milky, and generally has no odor. You know how many people joke about vaginas smelling like fish? This is because BV is very common and a lot of ladies have it. So don't feel bad if you have BV. But do something about it.

Generally, anytime you see any discharge that has unusual color or odor, you need to seek medical attention. It's not going to go away if you ignore it.