tequin question

[jamesd]

I am helped greatly by tequin.
It aleviates almost all (about 95%) of my symptoms - but only while on it.

When I take quercitan (like Quercetin) it can help with the pain but iritates the hell out of my urethra (itchy drippy feeling).

So - I keep taking the tequin - but I am afraid of staying on it indefinitly - I have already been on it for over 4 months - each time I come off of it about two weeks later I am back in hell.

I would like to give it up and just use quercitan plus a few other things (sp, etc. ) but it ain't working that way.

Anyone have a thought?

[ddarcher]

See my post under success stories. You can't stay on antibiotics forever. A combo of treatments has worked wonders for me.

[Richard.N]

There are loads of other meds to try. Have a look at the main site. I'm afraid it's trial, error and luck as to what works for you. Many people seem to take a combination approach. Good luck!

[jamesd]

See my post under success stories. You can't stay on antibiotics forever. A combo of treatments has worked wonders for me.

I reviewed your posting under success stories - it sounds like you tried various things - can you sum up your "regimine" for me?
Thanks

[alprost]

So - I keep taking the tequin - but I am afraid of staying on it indefinitly - I have already been on it for over 4 months - each time I come off of it about two weeks later I am back in hell.

I would like to give it up and just use quercitan plus a few other things (sp, etc. ) but it ain't working that way.

I'd be catious about just stopping ANY prescribed medication without medical advice. The fact that your symptoms are improved so much by an antibiotic and recurs 2 weeks after stopping ABX suggests that you do NOT have chronic prostatitis / chronic pelvic pain syndrome (which is not an infectious disease), but may have prostatitis. (e.g. A quote from Dr Dimitrakov "Chronic pelvic pain syndrome (CPPS) is a poorly understood symptom complex in men. Its hallmark is persistent pelvic pain which is unrelieved by antibiotic treatment")

Therefore, what works for others for chronic prostatitis / chronic pelvic pain syndrome may not work for you if you do have prostatitis. My advice: Find a good Urologist who has a desire to fully investigate your condition and be advised by them re. medications etc. Dr Shoskes website gives a good overview of the different factors which can give rise to symptoms and the appropriate treatments for each of them: http://www.dshoskes.com/cpclinic.html

Al.

[webslave]

The fact that your symptoms are improved so much by an antibiotic and recurs 2 weeks after stopping ABX suggests that you do NOT have chronic prostatitis / chronic pelvic pain syndrome (which is not an infectious disease), but may have prostatitis.

That's not quite right, Al. Antibiotics have several roles, and one of them is to act as anti-inflammatories (for some people, depending on their genetic make-up). The fact that the discomfort returns every time the poster stops the drug is a clear sign that we are not dealing with infection but with inflammation.

More details:
https://ucpps.men/antibiotics-are-anti-inflammatory-agents
https://ucpps.men/bacteria-and-chronic-prostatitis-CPPS

[jamesd]

The fact that the discomfort returns every time the poster stops the drug is a clear sign that we are not dealing with infection but with inflammation.

I would agree with that more if it didn't take about two weeks for it to return - If it was merly inflamation it would seem to return sooner then that - whereas infection would require a 2 weeks or so to grow to anything significant.

Don't get me wrong - I am NOT saying I have an infection - it just adds to the confusion for me - thats all.

[alprost]

That's not quite right, Al. Antibiotics have several roles, and one of them is to act as anti-inflammatories (for some people, depending on their genetic make-up). The fact that the discomfort returns every time the poster stops the drug is a clear sign that we are not dealing with infection but with inflammation.

More details:
https://ucpps.men/antibiotics-are-anti-inflammatory-agents
https://ucpps.men/bacteria-and-chronic-prostatitis-CPPS

Mark, I would argue that some of the recent (and long overdue!) studies of the use of ABX in Type III prostatitis actually argue against antibiotics having significant anti-inflammatory effects in most chronic prostatitis / chronic pelvic pain syndrome patients.

For example, in the recent study by Dr Dimitrakov reported in Dr Shoskes review article, all patients were classified as being free from bacteria by molecular techniques, and all patients had Type IIIb CPPS. If ABX had significant anti-inflammatory effects in most patients, it would be logical to expect the ABX group to experience greater symptomatic improvements than the placebo group. The fact that there was no difference between the two groups suggests, to me at least, that abx might not have significant anti-inflammatory effects in type IIIb CPPS. However, this is only one study and, as you say, some individuals may get these effects depending on their genetic make up.

I wasn't trying to start a debate about this Mark, honest . I just felt that it was not a good idea to stop taking any prescribed medication without medical advice. Equally, I don't feel that abx have much place in the treatment of true chronic prostatitis / chronic pelvic pain syndrome - I'm sure we both agree on that at least!

[webslave]

Thanks to a lot of recent research, we now know that there really isn't any mystery about this question any more. There are no "hidden" bacteria in either Cat II or Cat III. If you have chronic bacterial prostatitis, it can be tested for, bacteria will be found, and long-term antimicrobials may be (and are often) prescribed. But if there are no bacteria (Cat III), there is no medical need to take antimicrobials, even if they do help your pain.

Moreover, it is well recognized that even if pathogenic bacteria are present in the prostate, as in men with established chronic bacterial prostatitis, they do not cause chronic pelvic pain unless acute urinary tract infection develops

I answered in light of this knowledge. I suggest that you too resist advising men to take or continue taking antimicrobials in situations where cultures are negative.

[alprost]

I answered in light of this knowledge. I suggest that you too resist advising men to take or continue taking antimicrobials in situations where cultures are negative.

Firstly, I never advised anyone to take or to discontinue abx - NEITHER of these are responsible suggestions to make on the internet. I advised him to seek medical advice as to what medications he should take. Advising someone online to discontinue any medication which has been prescribed is irresponsible.

Secondly, how do you know that his cultures are negative? He never posted this information to the best of my knowledge. Has he hed cultures taken?

This quote by Dr Shoskes is quite clear on the use of abx in CP/CPPS: "Prolonged Courses in the absence of documented infection or symptomatic improvement are not warrented"

I'd say that with a 95% symptomatic improvement, and being 'back in hell' (I've been there too in the same situation) 2 weeks after discontinuing abx, that this implications of the above quote are quite clear.

I stand by my original advice - that the poster should seek medical advice re. medications.

[alprost]

But if there are no bacteria (Cat III), there is no medical need to take antimicrobials, even if they do help your pain.

But as the study I referred to highlighted, they don't help pain where there are no bacteria as demonstrated by moleculer techniques. I agree therefore - there is no need to take them in CPPS.

[webslave]

That's just one study. More importantly: we have all seen the thousands of messages posted by men, over the years, telling how antibiotics help them (usually temporarily) despite negative cultures.

This is so well known it's not worth debating.

[alprost]

That's just one study.

Yes, but it is an important study because men with a positive signal for bacterial DNA were excluded. In terms of other studies, as you said yourself, in the study by Nickel et. al. Cipro showed no more effectivness than placebo. Again, if the anti-inflammatory effects in chronic prostatitis / chronic pelvic pain syndrome are significant, you would expect the Cipro group to show significant symptomatic improvement over placebo.

More importantly: we have all seen the thousands of messages posted by men, over the years, telling how antibiotics help them (usually temporarily) despite negative cultures.

To be honest, most of the posts I've read are from people who are not helped by ABX. Sorry to go on about this, it's just that I've been helped AND not been helped by ABX. My prostatitis symptoms i.e. red hot coal in rectum sensation; constant urinary ungency; shooting pains all over my lower abdomen are cleared comletely by abx. A very painful DRE confirmed that this pain was coming from my prostate.

My chronic prostatitis / chronic pelvic pain syndrome symptoms i.e. perineal apin; voiding frequency/dysfunction; benign 'lump/golf ball' in rectum; weak ejaculations etc. are not helped in any way by ABX. A DRE confirmed that this pain was not coming from my prostate. Examination of my pelvic floor confirmed myofacsial pain, and an intensive course of pelvic physio/myofascial release has significantly improved these symptoms, now by around 80%. (although I will probably have jinxed myself by posting this!)

This is so well known it's not worth debating.

OK I'll leave it at that
Al.

[webslave]

Yes, but it is an important study.

How do you know? What about all the important studies in other areas of medicine that show clear indication of the anti-inflammatory effects of antibiotics? Are they less important than this one study?

In terms of other studies, as you said yourself, in the study by Nickel et. al. Cipro showed no more effectivness than placebo. Again, if the anti-inflammatory effects in chronic prostatitis / chronic pelvic pain syndrome are significant, you would expect the Cipro group to show significant symptomatic improvement over placebo.

Not if the effect is temporary, as it so often is. Once the patient stops the antibiotic, the effect goes away, so that testing a few months later shows no improvemnt over placebo. The same thing would happen if you took, and then stopped, a NSAID.

To be honest, most of the posts I've read are from people who are not helped by ABX.

I must have a lot more experience reading messages on this topic than you do, it seems.

Sorry to go on about this, it's just that I've been helped AND not been helped by ABX. My prostatitis symptoms i.e. red hot coal in rectum sensation; shooting pains all over my lower abdomen are cleared comletely by abx. A very painful DRE confirmed that this pain was coming from my prostate. My chronic prostatitis / chronic pelvic pain syndrome symptoms i.e. perineal apin; voiding frequency/dysfunction; benign 'lump/golf ball' in rectum; weak ejaculations etc. are not helped in any way by ABX. A DRE confirmed that this pain was not coming from my prostate. Examination of my pelvic floor confirmed myofacsial pain, and an intensive course of pelvic physio has significantly improved these symptoms, now by around 80%. (although I will probably have jinxed myself by posting this!)

Just because things don't seem intuitively logical to you does not mean that they are not so. If, for argument sake, your pain is being initiated by mast cells, then abx could be working on one of the many pathways of inflammation and pain that result. If you study mast cells you will find that they product a bunch of pain and inflammation mediators. Abx cannot combat them all. Nor can antihistamines (which don't touch prostaglandins, for example). Abx like Cipro are sometimes effective (in genetically predisposed people) in subduing inflammation and pain by lowering levels of TNF-alpha, IL-6, IL-1, and PGE(2).

It's a complex subject, but the thrust of recent research is to question and even discourage the use of antibiotics to treat Cat III CPPS.

I hope this helps.

[alprost]

What about all the important studies in other areas of medicine that show clear indication of the anti-inflammatory effects of antibiotics? Are they less important than this one study?

You obviously know a lot about this, and I'm certainly not questioning whether or not abx have anti-inflammatory effects - I'm just questioning how significant these effects are in type III CPPS.

Not if the effect is temporary, as it so often is. Once the patient stops the antibiotic, the effect goes away, so that testing a few months later shows no improvemnt over placebo. The same thing would happen if you took, and then stopped, a NSAID.

If this is what happened in the Nickel studey, then of course, you are correct. However, in Dr Dimitrakov's study the trial period for the drug/placebo was 6 weeks, and, if I have read Dr. Shoskes review paper correctly, there was no difference between Cipro and placebo at the end of this 6 week period. Would this be expected if Cipro had significant anti-inflammatory effects in IIIb CPPS?

I must have a lot more experience reading messages on this topic than you do, it seems.

I certainly can't argue with you on that one!

Just because things don't seem intuitively logical to you does not mean that they are not so. If, for argument sake, your pain is being initiated by mast cells, then abx could be working on one of the many pathways of inflammation and pain that result. If you study mast cells you will find that they product a bunch of pain and inflammation mediators. Abx cannot combat them all. Nor can antihistamines (which don't touch prostaglandins, for example). Abx like Cipro are sometimes effective (in genetically predisposed people) in subduing inflammation and pain by lowering levels of TNF-alpha, IL-6, IL-1, and PGE(2).

Interesting stuff - you have certainly made me think about things from a different angle.

but the thrust of recent research is to question and even discourage the use of antibiotics to treat Cat III CPPS.

I could not agree more.
Al.