Long covid, digestive style?

September 14, 2023 7:00 AM

I have an unreliable gut to begin with, but a month ago I had what I thought was bronchitis and took a "z pack" and started getting....well I'll go ahead and put the specifics under the cut in case casual scrollers don't want to read about digestive stuff.

After the antibiotics, I started getting diarrhea. A few weeks later I tested positive for covid and took Paxlovid, but also steroids and more antibiotics, sort of hardcore antibiotics in fact because the doctor was like "could be walking pneumonia on top of covid?"

It has not gotten better. I've been eating some yogurt and pickled stuff and taking some probiotic pills for maybe 5 days and so far...I am too prim to describe in detail but I guess I'd say it's not as bad as it was but still not good.

I normally have what I suppose is IBS though I was never formally diagnosed, not too severe but annoying. This is a step beyond that(urgency, frequency, consistency) and it's hung on a while. YANMD and I will at some point go to the doctor. This morning I took immodium to see what happens but I don't think that's for treating something ongoing maybe.

Could this be long covid? I understand covid has more digestive symptoms these days. Could I just have REALLY fucked up my "gut flora" with the nuke-it-from-orbit antibiotic onslaught (azithrom...whatever, an injection I think was Rocephin though I was out of it and didn't totally catch the name, and amox clav)? Any more general advice?

posted by anonymous to Health & Fitness (13 answers total)

This sounds like the perfect gut storm: abx and Paxlovid, both of which can cause diarrhea. And if your body is delicate, it makes sense that it would take more time. It's not technically long Covid yet, because that's if symptoms persist for 3 months from your positive test. (I'm also in this slow, long recovery period; it is the HOTTEST GARBAGE and I will tell you all about it just after this 2-hour nap in the middle of a workday.) If I were in your shoes, I would probably call or message your PCP and see whether they have any thoughts about what else you could do, and remember that your symptoms are very unlikely to be chronic and ongoing -- but that there might be something medical you can do in the meantime.

This sounds terrible and I'm so sorry.
posted by chesty_a_arthur at 7:06 AM on September 14, 2023 [2 favorites]

I think it's more likely that you-a person with a self-described "unreliable gut" has had to further insult said gut with a triple whammy of antibiotics, steroids, and Paxlovid. All three of those meds are known to disrupt gut flora and cause diarrhea. If you've seen ANY improvement for the past five days, that's a good sign. Make sure to stay hydrated. A lower fiber diet will probably be best tolerated for the moment. Immodium could be used for a short time if you find it helpful, but you're right that it's not a long-term solution.

My gut (see what I did there) tells me that this will resolve in the next couple of weeks, but if another week passes without improvement or if symptoms worsen, you could definitely see your doctor about it. Feel better!
posted by little mouth at 7:06 AM on September 14, 2023 [5 favorites]

I could have had a case of covid back in May, and a week after feeling better I started having stomach symptoms. my stomach was f'd up for 2 weeks - diarrhea, gas, bloating, pain, etc. i origninally thought I had a cold, but after comparing notes and symptoms, it's pretty obvious it was COVID.

Anyways, you absolutely nuked your gut flora from orbit. It's also possible there's something from covid causing irritaiton down there. Eating stuff that's comfortable for your tummy, and recolonizing with probiotics is what I did, and I eventually felt better with regular, comfortable, predictable dumps.
posted by Geckwoistmeinauto at 7:08 AM on September 14, 2023 [2 favorites]

While I agree with folks above on the issues partly being due to an already "unreliable gut" experiencing further insult with a triple whammy of antibiotics, steroids, and Paxlovid, I do want to make a note about my covid experience.

I too have had gut issues for a long time, and this has been complicated by my lactose intolerance kicking into high gear over the last year. With that said, when I had covid last April it hit me in the gut, and hit me hard, with diarrhea, pain, etc.. Things only just seem to be settling down a bit more now, about 5 months later. I tried to do all the usual things to help my gut/flora "reset", including stuff like yogurt (which worked ok with my lactose issues). It took a while for me to be able to eat much of any pickled/fermented stuff, and I advise being careful with that and with probiotics as well ... some of them were too strong in the short term for me. I also wound up using stuff like Beano way more than I ever did in my life. I ate a very careful diet for quite a while (think stuff like chicken and rice.)

To give you some encouragement, last night we had corn, black bean and red onion burritos with a bit of cheese and sour cream and salsa. A month post covid, there is no way I would have been able to eat that kind of meal without significant issues. I did fine with it yesterday/today (I did take some Beano.)
posted by gudrun at 9:06 AM on September 14, 2023 [1 favorite]

You should get checked for C Diff. You will also want to consult about a probiotic.
posted by Crystalinne at 9:18 AM on September 14, 2023 [5 favorites]

Seconding the C Diff check. Your Primary Care doctor (assuming USA) can probably do this from the office. A stool sample may be involved.
posted by nkknkk at 9:43 AM on September 14, 2023

If you want to try to rebuild your microbiome, for me, probiotics do not work as well as giving my gut a wide variety of foods for the microorganisms to digest. When I need to take antibiotics I aim to eat 30 different fruits, vegetables, and legumes per week.
posted by metasarah at 10:03 AM on September 14, 2023

whenever i take abx, it takes MONTHS to get back to my normal. i also have an unreliable gut at the best of times. it could just be your body is taking a while to get back to normal.
posted by misanthropicsarah at 10:27 AM on September 14, 2023 [1 favorite]

My poop was green (yes) and weird for literally a whole month, maybe more, after I got covid. I also took paxlovid. Not sure if that's related. No antibiotics though.

I saw enough weird poop related covid queries when I googled to feel satisfied that it was related and within the realm of normal, and I kept getting progressively better, and then all better back to normal after several weeks. Anyway, your timeline along with everything else you've got going on doesn't seem too wild to me, but of course it's never a bad idea to visit a doc just in case.

Now the whole internet knows about my green poop, neat.
posted by phunniemee at 10:43 AM on September 14, 2023 [1 favorite]

It's the antibiotics. They wreck the gut microbiome. If you go on scholar.google.com you can search tons of clinical studies on this topic.

Years ago I went through a lot of GI issues after repeated rounds of antibiotics for different surgeries. It took me a while to recover so patience is key. I tried so many different probiotics but honestly it was hit and miss, the only constantly effective one was saccharomyces boulardii so look for capsules containing that one. It seems to be able to regulate the gut flora and stimulate the production of "good" bacteria.

Diet is more important than taking pills though, so like metasarah says above try and eat lots of veggies and vary your diet.
posted by bitteschoen at 10:48 AM on September 14, 2023 [2 favorites]

I'm a fellow person with a delicate digestive system, so you have my sympathies!

You might see if Florastor helps (I think it's the saccharomyces boulardii recommended above). I had it recommended by a nurse after I got what I thought was either food poisoning or a basic 24 hour gastro bug that lasted for three entire weeks. It's a yeast-based supplement that's supposed to help fix your gut flora during/after antibiotics or a bug. It helped initially and then I went back to being sick, but there are peer-reviewed studies supporting its use and it has a lot of glowing reviews. So, likely worth a try.

You could also give a super strict BRAT diet a try for a few days, especially if you try the lots of veggies plan and find it's causing problems. That's what finally helped me turn the corner -- I really stuck to it and didn't eat anything but plain cereals, white bread, bananas, rice, plain noodles, unsweetened almond milk or gatorade for more than a week. It sucked a lot but anything else pushed me right into a full relapse. I took another week or so to slowly transition back to normal food and have been totally fine since.

Finally, do think about getting tested for c. diff or other infections if you don't get better soon.
posted by snaw at 6:04 PM on September 14, 2023 [1 favorite]

Many people find dairy intolerable after covid, so I would avoid it if you can, at least for a while. I don't think what you're describing is beyond the realm of normal. Almost all of my family members had digestive issues post covid, and dairy exacerbated those issues. People also sometimes develop an intolerance to fermented foods (look up MCAS and the low-histamine diet), so I would see if those are making things worse, rather than better.

I will say I was anemic after covid, and iron supplementation helped a lot of the digestive stuff for me. But after my most recent infection, I am eating a pretty bland diet most of the time over a month out.
posted by luckdragon at 6:56 PM on September 15, 2023 [1 favorite]

Not a sensitive-tummy person, but I had gut issues for about a week after COVID. I did test positive for COVID for 16 straight days (ugh). It makes sense to me that if you are a sensitive-tummy person, you’d have more persistent gut issues.
posted by samthemander at 9:50 PM on September 15, 2023 [1 favorite]