Enterolab results are in! (Sara, we guessed wrong...)

mzh · Post by **mzh** » Tue Dec 27, 2011 10:48 am

Tex, do you know how one checks for too much bile? My GI doc gave me samples of Welchol a couple years ago; it didn't seem to do much for me one way or the other. I got is as a "Here, try this" from the same GI doc who told me pills are seen in the toilet b/c I have a short colon.

There have been no gallbladder (or pancreas) diagnostics ever done.

PS. I do have a gallbladder but there are times when my BMs are soft, semi-formed and gray - and when I'm feeling *really* lousy. I know that may be from a lack of bile or maybe from way too fast transit, which I'm prone to have.

Post by **tex** » Tue Dec 27, 2011 11:57 am

Marcia,

The pills in the toilet are there because of rapid transit, not because of a short colon. I don't even have a colon, and a significant length of my terminal ileum is also missing, and even though I take a lot of pills, none of them ever show up in my ileostomy pouch.

To test for excess amounts of bile, the SeHCAT test is used:

http://en.wikipedia.org/wiki/SeHCAT

Anyone who has rapid transit, due to celiac disease, MC, or some other IBD, is naturally going to have excess amounts of bile in their stool, because bile fatty acids are normally absorbed in the terminal ileum, but when the terminal ileum is inflamed, (which is the case for most people with MC), it doesn't absorb those bile salts very effectively, and the rapid transit makes the problem even worse, because it doesn't allow sufficient time for absorption to take place, even if everything is working normally, otherwise. IOW, our accumulated experience here on the board has shown that when MC is controlled, the bile salts problem will almost always disappear.

There's a fair chance that your pancreas may not be producing normal amounts of lipase enzyme, as well, and when that happens, the bile salts remain tied up with fat particles and therefore neither the fat nor the bile is in a state where it can be absorbed when it passes through the terminal ileum, which also contributes to D. That too will normally clear up when the MC is resolved.

Tex

DebE13 · Post by **DebE13** » Wed Dec 28, 2011 6:59 pm

So Tex, would it be a good idea to try entocort or diet alone? My test kit is on its way to TX as I type. I'm still taking prednisone (sigh)and am on 15 mg & still tapering. Not looking forward to the D coming back but can't wait to sleep past 3 AM. Entocort didn't help 3 years ago but I also wasn't watching my diet. After I get the results do I just put up with the D until I have a better idea of what foods are causing me problems? I'm now afraid my results won't show much. My GI approved the testing & requested the results be sent to his office. It would be horrible if I fall within the normal ranges.

It's hard to tell if changing my diet has helped because of the prednisone. Everything is always soft ranging from normal to floating to what I record as spattery. Just wondering what has been the most effective for most- meds & diet or diet & lots of patience.

Post by **tex** » Wed Dec 28, 2011 7:43 pm

If you sent a sample to Enterolab, and you filled out the questionnaire either online, or with the kit, (including your e-mail address), then you should be able to access your test results online, as soon as they are available, (the turnaround time was 3 weeks, when I sent them a sample a couple of weeks ago). Assuming you listed an e-mail address, they should e-mail you a copy of the results. If you let your doctor fill out that form, instead, then you may not get a copy of the results.

Don't worry, if you have MC, the chances of you not having any food-sensitivities are slim to none. That would only be true if your case was drug-induced. If prednisone didn't bring normal BMs within a week, then your food-sensitivities are fairly serious, and it will probably take a significant amount of time, (on the order of 3 to 6 months, or more), for the diet to bring enough healing to allow the D to stop. (Of course, drug-induced MC would trump all that).

The most effective treatment, (the fastest to remission), is Entocort plus diet changes, followed by Entocort alone, and the slowest route to remission is diet alone. However, Entocort alone doesn't always work for everyone, and diet alone doesn't always work, if you have so many food-sensitivities that you're not able to avoid all of them, or if you overlook a food-sensitivity in your diet, even in trace amounts, in some cases. A relapse will virtually always occur when Entocort is discontinued, unless an allergen-free diet has been followed for a sufficiently-long period of time, (typically 6 months to a year).

If any part of my explanation is confusing, please ask for a better explanation, and pinpoint the part where I didn't do a good job, and I'll try to do a better job of answering your questions.

Tex

DebE13 · Post by **DebE13** » Thu Dec 29, 2011 4:45 am

Tex- as always, your answers are very thorough. I'm lacking in patience and am trying to figure out how I should go about badgering my GI about what I want to do next. It's frustrating because I ask for the long-term plan but only get the week to week answers of checking in. The prednisone was supposed to be a short term use to get the D back under control after 3+ years of uncontrolled D, dietary changes that didn't help (knew there were food issues but didn't know how to go about finding them- until now

), and to control the downward spiral of my health in general and that was back in July. I actually thought I was going to die this summer because my health was so bad so I suppose I should be thankful that I'm on my way to improved health.

I asked my GI about the Entocort a few weeks ago at the same time I asked him about the Enterolab testing. I have to check in again next week for the dosage change so will bring it up again then. He extended my current dose another 2 weeks with a decrease to 15 mg starting next week. Once I get to the 10/5 mg area is when I started to have problems last time and it took a 40mg dose to bring it back under control. It's going to be the same cycle again and I'm NOT increasing it again this time around. I should cut him some slack since he did write the lab orders for me and actually wants to see the results. I filled out the on-line questionaire so I'll be able check for the results.

As for the cause of my CC, I really don't know. I can tell you the exact day it started. I got flu one weekend and the D never got better after all the other fluish symptoms went away. In high school I used to get headaches every afternoon and used ibuprofin frequently. In my 20/30's I had horrible migraines (often associated but limited to my menstrual cycle) and regularly took 6 ibuprofin at a time which really didn't help much but I was desparate for relief. I haven't had a migraine since I changed my diet. I also took birth control pills for well over 15 years. I haven't had any genetic testing done (yet) but I suspect that also. It really makes me sad that I could have been the cause of these problems and angry that the medical community didn't inform me of the dangers of these drugs. Stupidity/ignorance on my part and a western philosophy of take a pill and everything will be better on theirs.

I can't change what's been done but look forward to some results that will get me back on my way to having a more normal life. I'm sure I'll have lots more questions when my results are in! Thanks for all the good info.

Post by **tex** » Thu Dec 29, 2011 9:58 am

DebE wrote:It's frustrating because I ask for the long-term plan but only get the week to week answers of checking in.

He can't give you a long-range plan, because the medical profession doesn't really have a long-range plan for treating MC. Their ultimate plan is to keep trying various drugs until the disease finally runs it's course, and resolves on it's own. The problem is, the faulty research studies that strategy is based on, claim that the disease resolves on it's own in roughly 3 years, even without any treatment. Of course, our combined experiences on this board have shown that those studies were corrupt, and their claims are totally false. Those studies were done over 20 years ago, but many doctors actually still believe that they represent valid research data.

http://gut.bmj.com/content/43/5/629

http://www.ncbi.nlm.nih.gov/pubmed/8995938

This more recent study, proves those studies to be false.

http://www.ncbi.nlm.nih.gov/pubmed/1698 ... d_RVDocSum

Tex