Endocarditis—again

[mecretired]

Some of you may remember my post from last year in August? For those of you who don’t—I ran a fever off and on from mid March 2019 until hospitalized in August for endocarditis. My pcp gave me 4 rounds of antibiotics from March to August which temporarily got rid of the fever. Anyway I was in the hospital for 7 days—diagnosed with endocarditis—strep bacteria—discharged with a picc line and 6 wks of rocephin. Fast forward—June 20,2020 I developed a fever of 102.3! COVID-19 test was negative. Got in to see pcp who did tons of lab work—she called me at 8am the next day to say blood cultures were already growing. She called my cardiologist who insisted that I get to the hospital immediately (4 1/2 hrs away). I ended up spending 6 days in the hospital. Ekg, echo, tee, chest ct all showed heart was ok. Bacteria in my blood was, again, strep but a different strain than last year. So I was discharged with picc line and 4 weeks of rocephin. Infectious disease doctor said most strep comes from the mouth and almost insisted I had something going on there. So I saw my dentist when I got home—no plaque, healthy gums, not even a cavity. But I have wondered for some time about the requirement to take antibiotics before getting my teeth cleaned (I have a mechanical aortic valve). Why wouldn’t I need antibiotics when I flossed my teeth?? Anyway the ID has put me on long term Cefadroxil since I’ve had this strep bacteria in my blood 2x only 10 months apart. Thoughts? Comments? Questions?

 

[coffeelover]

Sounds like you have been dealing with alot. Hope you feel better soon!...You as some very good questions... similarly I often wonder if I should rinse my mouth with Listerine before I floss? No MF has ever suggested it...Unfortunately I only floss once a week and haven't used Listerine yet.

 

[OldManEmu]

You may recall that I commented on you thread when you had the initial endocarditis. Having been the cause of my original AVR 16 years ago I have asked my cardio a lot of questions over the years about the chance of a reinfection. Once you have had endocarditis you are more likely to get it again than someone that never has, hence why antibiotics before dental work. Antibiotics are no longer recommended for dental work in patients that have never have endocarditis and have no other complicating health problems even if they have a VR. I was also advised that antibiotics should also be taken before an endoscopy of the digestive tract and the colon due to the risk of causing bleeding in a high bacteria area. Flossing your teeth should only be a risk if there is any blood in which case you are flossing to hard anyway. I do use mouth wash when flossing to reduce the bacteria in my mouth and I do floss nightly after my last meal. There is a risk, all be it low any time the skin is broken especially if it is enough to bleed. Being in my 50's the cardio said it isn't realistic to think you are going to go through another 30 years of life without another scratch or cut, just be vigilant for the signs of endocarditis. Being permanently on antibiotics when there is no infection isn't good either.

 

[mecretired]

Sounds like you have been dealing with alot. Hope you feel better soon!...You as some very good questions... similarly I often wonder if I should rinse my mouth with Listerine before I floss? No MF has ever suggested it...Unfortunately I only floss once a week and haven't used Listerine yet.

 

[mecretired]

I use listerene but have been using it after flossing—duh! It only makes sense to do it before.

 

[mecretired]

You may recall that I commented on you thread when you had the initial endocarditis. Having been the cause of my original AVR 16 years ago I have asked my cardio a lot of questions over the years about the chance of a reinfection. Once you have had endocarditis you are more likely to get it again than someone that never has, hence why antibiotics before dental work. Antibiotics are no longer recommended for dental work in patients that have never have endocarditis and have no other complicating health problems even if they have a VR. I was also advised that antibiotics should also be taken before an endoscopy of the digestive tract and the colon due to the risk of causing bleeding in a high bacteria area. Flossing your teeth should only be a risk if there is any blood in which case you are flossing to hard anyway. I do use mouth wash when flossing to reduce the bacteria in my mouth and I do floss nightly after my last meal. There is a risk, all be it low any time the skin is broken especially if it is enough to bleed. Being in my 50's the cardio said it isn't realistic to think you are going to go through another 30 years of life without another scratch or cut, just be vigilant for the signs of endocarditis. Being permanently on antibiotics when there is no infection isn't good either.

I use listerene but have been using it after flossing—duh! It only makes sense to do it before.
I didn’t realize that once you’ve had endocarditis you are more susceptible to getting it again . I’m not crazy about being on long term antibiotics but— we don’t know where I’m getting the strep so I don’t have too many options.

 

[KatherineA]

My dentist advised me to use listerine before brushing after my surgery, which was January 7 this year I don’t have anything going on specifically, no gum disease and no cavities for years. She also recommends I continue using this Ayurvedic mouthwash was called the Daily Swish that I had started about a year or two ago. More like a daily hold and swish as one holds and swishes the stuff for a good 7-10 minutes then spits.

I and she notice a difference in General gum condition with the Swish. My mouth feels better to me and I never have any bleeding or even hint of it with the Daily Swish. I have a sort of twisted bicuspid that always wants to trap bits of food, but it’s “tighter” and things don’t “stick” there with the Swish stuff.

It is my understanding the sesame oil in It incorporates a drawing or pulling or neutralizing action on mouth bacteria. She said I could use plain sesame oil instead of the Daily swish for the same effect. But, I like the Swish taste better and it doesn’t take much to use.

I too was advised by Cleveland surgeon and my local cardiologist to take 4 antibiotics an hour before my exam in June. I did. My stomach objected some that day. But any discomfort passed quickly and I soothed it with yogurt etc.

 

[QuincyRunner]

Since my experience with endocarditis resulting in a mechanical mitral valve was a result of a teeth cleaning at the dentist (with no previous health condition other than a minor heart murmur), I am ultra fastidious about dental hygiene and still paranoid during my twice a year dental cleanings. I now use mouth wash twice a day before brushing but I use a waterpik in lieu of flossing as it seems to clean just as well but without being so invasive. Of course I also take the 2,000 milligrams of amoxicillin before seeing the dentist about virtually anything at all.

 

[tom in MO]

For better gum cleaning, you may want to try a Water Pik, it's clinically proven to be effective.

It is rare, but some humans can be asymptomatic carriers and also humans can get strep from dogs. Back in the 60s a family I grew up with kept getting strep and they supposedly traced it to the dog.

 

[ejc61]

I take 2000 mg amoxicillin before dental every since my mitral valve repair in 2009. Since my endocarditis in 2014, it still take my amoxicillin prior to dental. I also talk with my ID doctor, per my cardio, for any procedure including biopsies, colonoscopies, general surgery such as a hernia.

 

[pellicle]

Some of you may remember my post from last year in August?...

sorry to read of your difficulties, it can sometimes be a long road (I have a little experience with that myself)

Keep focused only on the day to day and don't let it get you down.

Why wouldn’t I need antibiotics when I flossed my teeth?? Anyway the ID has put me on long term Cefadroxil since I’ve had this strep bacteria in my blood 2x only 10 months apart. Thoughts? Comments? Questions?

well simply flossing your teeth should not need antibiotic cover, however a sub-gingival clean at the dentists (if you ever watch it) involves a lot of forcible scraping of the tooth to clear off the polysacharide "coral reef" that the bacteria build on your teeth. There is a lot of bleeding and you may not notice it because of the suction used. Now if simple flossing produces bleeding you know that this means you have a serious "coral reef" in there and needs dental work.

Because of this I go to a dentist about every 6 months for a scale and clean (and take antibiotic cover when that happens).

So as you've said you have no plaque (pretty rare) I can only say that it may not have been through your teeth ... often one never finds out the source of the infection.

I hope things get better soon

Best Wishes

 

[mecretired]

For better gum cleaning, you may want to try a Water Pik, it's clinically proven to be effective.

It is rare, but some humans can be asymptomatic carriers and also humans can get strep from dogs. Back in the 60s a family I grew up with kept getting strep and they supposedly traced it to the dog.

Don’t have a dog but I am going to check out a water pik. I have never had any dental problems. So I’ve probably gotten a little lax on things like using listerene before brushing/flossing. I’ve already learned more today than I’ve gotten from my medical professionals. I appreciate all of you so much. Keep the advice coming.

 

[jcgtok17]

I have a daily dose of Sawacillin (250mg) since my AVR surgery. My IE came from my own mouth (tooth plaque). I have a mandated cleaning every 2 months, but comes around quickly!

 

[ejc61]

One thing that I have done since getting IE once, is if I had a fever of about 101.5 for a day without going down, go straight for the culture. Since my episode 6 years ago, I have had several prostate biopsies which have resulted in some fevers which resulted in hospitalization for observation and iv antibiotics. It wasn't IE but the risk is there. I had a type A flu last year and a fever around 101, my PCP and I messaged a couple of times a day with an update. If you don't have one on your staff, I'd look into consulting an Infectious Disease doctor just to have on the side to consult if you have procedures in the future. My cardio is totally on board with that. She has been with me for 6 years now and I only see her if something is coming up, for example, another prostate biopsy, maybe a prostatectomy, a colonoscopy. Give yourself some piece of mind,

 

[mecretired]

Thanks for all the comments. I WILL be using mouthwash twice daily before brushing. I have also gotten a waterpik. I will continue dentist visits every six months. AND I will go for blood cultures immediately if I start a fever.

 

[carolinemc]

You may recall that I commented on you thread when you had the initial endocarditis. Having been the cause of my original AVR 16 years ago I have asked my cardio a lot of questions over the years about the chance of a reinfection. Once you have had endocarditis you are more likely to get it again than someone that never has, hence why antibiotics before dental work. Antibiotics are no longer recommended for dental work in patients that have never have endocarditis and have no other complicating health problems even if they have a VR. I was also advised that antibiotics should also be taken before an endoscopy of the digestive tract and the colon due to the risk of causing bleeding in a high bacteria area. Flossing your teeth should only be a risk if there is any blood in which case you are flossing to hard anyway. I do use mouth wash when flossing to reduce the bacteria in my mouth and I do floss nightly after my last meal. There is a risk, all be it low any time the skin is broken especially if it is enough to bleed. Being in my 50's the cardio said it isn't realistic to think you are going to go through another 30 years of life without another scratch or cut, just be vigilant for the signs of endocarditis. Being permanently on antibiotics when there is no infection isn't good either.

We take antibiotics in America. It is required for dental cleaning and dental work. We are being safe here. Too many have taken the chance without and some have died without antibiotics. Good luck that you never have endocarditis. For the antibiotics are preventive medicine.

 

[carolinemc]

W

My dentist advised me to use listerine before brushing after my surgery, which was January 7 this year I don’t have anything going on specifically, no gum disease and no cavities for years. She also recommends I continue using this Ayurvedic mouthwash was called the Daily Swish that I had started about a year or two ago. More like a daily hold and swish as one holds and swishes the stuff for a good 7-10 minutes then spits.

I and she notice a difference in General gum condition with the Swish. My mouth feels better to me and I never have any bleeding or even hint of it with the Daily Swish. I have a sort of twisted bicuspid that always wants to trap bits of food, but it’s “tighter” and things don’t “stick” there with the Swish stuff.

It is my understanding the sesame oil in It incorporates a drawing or pulling or neutralizing action on mouth bacteria. She said I could use plain sesame oil instead of the Daily swish for the same effect. But, I like the Swish taste better and it doesn’t take much to use.

I too was advised by Cleveland surgeon and my local cardiologist to take 4 antibiotics an hour before my exam in June. I did. My stomach objected some that day. But any discomfort passed quickly and I soothed it with yogurt etc.

Always take food with Antibiotics. Never on empty stomach. I did that with a different botic and was so sick.