Today is my first antibiotic-free day in 10 months. Two weeks ago, I transitioned from 100mg of doxycycline twice a day, to 100mg of doxy once a day. Today, I begin the next step-down phase of 100mg of doxy every other day.
For those that don’t know, I’ve been taking antibiotics for 15 of the last 22 months. In January 2013, I was diagnosed with a skin infection of the second and third dermal layers on my face that occurred as a result of an allergic reaction to toothpaste. That diagnosis came after four+ months of symptoms, and kicked off the first five-month course of twice a day doxy. I really thought I’d kicked this thing’s ass back in May 2013, and because I was symptom-free, the dermatologist & I both agreed I could stop. Five months later, I started noticing symptoms again, and in early November 2013, I went back on the doxy.
I’ve put my body through the ringer many times before in my life, but this was by far one of the toughest experiences simply because of what you have to regulate in order for doxycycline to be effective. You can’t take any medications or supplements 2-3hrs before or after you take a dose. You can’t lie down for 30min after taking the doxy because it has the potential to cause esophageal erosion. You have to slather yourself with sunblock and avoid sun exposure at all cost, not just because of the risk of sunburns but because drug-induced photosensitivity puts you at an increased risk of skin cancer. You have to drink a full 8oz of water with every dose, and you definitely have take doxy with food.
And right there, the challenge began.
At first I was told I only needed to be dairy-free for 2-3hrs before and after every dose. Okay, sounds fairly simple, right? No cheese, no milk? Nope. As is explored in a fantastic book called Salt Sugar Fat: How The Food Giants Hooked Us by Michael Moss, dairy has made its way into almost every kind of processed food you can think of, and not always in obvious places. Thank goodness milk is on the allergen ingredient list, but avoiding it in today’s busy lifestyle is still a challenge. But wait, there’s more! It wasn’t until three months into the second round of treatment that I asked why dairy was to be avoided (and this right here is why you ALWAYS ask questions of your health practitioners! ALWAYS!). As I learned, calcium blocks the absorption of antibiotics, and since there’s so much calcium in dairy, you should avoid it before and after a dose in order to make the medication work as intended.
Well guess what kids? These days, added calcium is in almost everything, especially dairy-free products, from instant flavored oatmeal to tofu, from plain Cheerios to almond, soy, rice, and coconut milk. And guess who thought waaayyy back at the beginning “Well if I can’t have low fat milk in my coffee/with my cereal/in my baking, I’ll just go to almond milk that provides a whopping 45% of my daily value of calcium per serving”? That’s right, yours truly. But when medical practitioners are saying “dairy dairy dairy” and you’ve avoid exactly that… I mean, would you have thought any kind of calcium was bad? Or would you have done just what I did and go dairy-free, but not added-calcium-free?
Once I started looking, I found added calcium in the craziest places - dairy-free popsicles, crackers, just about every cereal on the grocery store shelves, orange juice, even some dairy-free cheese. You want something milk-like in your coffee? Your options are non-dairy creamer (AKA plastic), canned coconut milk (mmmm, guar gum), or you make something yourself. You want cereal? Good luck unless you’re going to make both the cereal and the milk-substitute you intend to eat it with. Add to this the number of unprocessed foods that are naturally high in calcium (i.e., kale, almonds, broccoli, quinoa, etc.) and honestly, what the hell are you supposed to eat? How much calcium is too much calcium?
I asked this question for nearly a month straight, turning to my doctor, my dermatologist, two nutrition specialists, a registered dietitian and one in dietetics school, and a few other health practitioners. No one could tell me how much calcium was too much calcium. A month of eating almost nothing twice a day but plain rolled oats, graham crackers, marshmallow fluff, peanut butter, and plain lean proteins. For all I knew, even 18mg of calcium in a cup of avocado might’ve been too much. My hair started falling out. I started bruising more easily, and I already bruise pretty easily on the best of days. My eyelashes grew so brittle they would pull right out when I put on mascara. I started seeing cracks at the base of my fingernails. It didn’t seem matter that I was taking a calcium supplement and eating calcium-rich foods in-between doses. I was basically falling apart.
Finally in February, someone went the extra mile for me. In the course of my asking, I posed the calcium question to a pharmacist who gave me the usual “I don’t know, sorry” answer. I thought that was it, checked the box, and tried to move on. But my question stuck with her, and a little over a week later, I got a VoiceMail that changed everything. She decided to go to one of her pharmacology professors, who in turn did some research on his own. And the answer? Anything more than 30%-40% of your daily value of calcium, per serving, is too much calcium to ingest while simultaneously ingesting an antibiotic. In other words, as long as the ingredient label said a particular food had naturally occurring calcium and the nutrition facts panel (or the DV% I could find online) said anything less than 25%, I could eat it. (Why 25% if the pharmacist said 30%-40%? ‘Cause I’d rather play it safe and do less that potentially permissible.)
Kale? Back on the menu. Avocados? I’m surprised I didn’t turn green from eating as many as I did. Beans and blueberries and tofu (made without added calcium)? Yup, hells yes, and you betcha! It took another month or so, but by mid-March, I felt less brittle and more like my pre-calcium-deficient self. I found a food routine I could accept, even though some of it required substantial investments of both time and money, as well as sacrificing certain standards. I ate fruits and vegetables out of season, often trucked or flown in from other parts of the country, or even the world. And sometimes, I ate whatever the fuck I wanted, even though it set back my mental doxy dose clock, ‘cause really, life is too short.
It worked. I get to be done - DONE! - in just two more weeks. As psyched as I am, I’d be lying if I said this was easy. I’m still worried that maybe, just like last summer, this is a remission of sorts and in a few months I’ll have to start all this crap up again. It’s a possibility my dermatologist and I discussed at my appointment two weeks ago. Apparently I’ve been on doxy the longest of all her patients, ever. I tend to think Round One and the first three months of Round Two didn’t really count, thanks to interference from the calcium-enriched almond milk I was consuming in coffee and sometimes for dinner. Even if the last seven months of doxy are all that have “counted,” my doctor said my skin looks totally clear of infection, and I certainly haven’t had any symptoms in months. But I so very badly do not want to have to do Round Three, and therein lies my worry. It might take me months to believe this thing is gone for good.
And silly as it might sound, I still haven’t wrapped my brain around certain things I’ll be gaining back. I can take a nap without having to worry if 35min since taking an antibiotic is still too soon to avoid esophageal erosion. Next time I have a cold, I can bombard my body with meds and supplements all day long without worry. If I have a headache, I won’t have to try and think through whether or not I can take something - I can just take fucking something! If my still-healing foot hurts first thing in the morning, I can take something for it right away instead of waiting till I’m 2-3hrs past my first dose of doxy. I’ll still use sunblock like crazy, but now I’ll go back to my normally sensitive skin instead of this drug-induced photosensitivity crap. And the food part… I mean, what will my morning coffee taste like if I go back to using low fat milk from our local dairy? Will it be amazing, or will it taste odd? Will I go back to pre-packaged instant oatmeal as work day breakfasts, or will I still prep my rolled oats and fruit in little mason jars so the oats can soak overnight? These are really basic things, I know, but they’re things I’ve been denied for so long. I truly don’t know how things will taste or what it’ll feel like to be free to do/eat/take whatever, once I’m all the way off the doxy.
One thing’s for sure. My first full doxy-free day is going to be AMAZING! I might eat nothing but cheese all day long!!!