Predictable Visit with GI Today

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Gloria
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Predictable Visit with GI Today

Post by Gloria »

I made an appointment with my GI with a hope that he might have finally learned something about mast cells since I left him the paper "Mastocytic Enterocolitis" a couple of years ago.

Not a chance. I began by telling him that Entocort is helping me very marginally now. I don't think he believes that using it off and on has much to do with the lack of effectiveness. He said some people use it, go off of it, and never need it again. He spent an hour and a half with me, which is to his credit. Most of that time was spent trying to convince me that I should have another colonoscopy while I refused to be convinced.

I brought up the mast cell issue pretty early and told him that I was avoiding high-histamine foods. I mentioned my mouth sores, the hives I had near my eye and on my cheek, the itchy head sores I have gotten the last two summers. I told him how I used to get UTIs and chest pains and no longer get them since I've reduced amines in my diet. My PCP was quite concerned when I told him about my symptoms, but my GI almost seemed amused, or skeptical at the least. He stopped short of ridiculing me for using diet to manage my symptoms and reminded me that it isn't working, saying there is no evidence that it works, using me as his example. He asked me at one point if I've Googled the term Microscopic Colitis. I told him that I did years ago, but not lately. I told him that I go to an MC support website.

I asked him if he's ever ordered a stain to test for excess mast cells. He said he did at Mayo. (That's it?) Then I asked him what treatment he prescribed when someone had the condition. He fudged and said it depended on the person's condition. When I asked him about Gastrocrom, he said he wouldn't prescribe chemicals just to test them.

I asked him if I could do the tryptase blood test and the urine test. No, he wants to rule other things out first. Interpretation - He's never heard of those tests. At least my PCP admitted that he's never heard of them.

At the end of the visit, he said he thinks I should have another stool test to see if I have excess fat in the stool. He also is concerned that I took Cephalexin last May 14 when I had the hive near my eye. He thinks my stool should be tested for C diff, since I was doing OK prior to that time. I stopped taking Entocort on April 12. I suppose it's a possibility, but my deterioration was gradual. I'm not having any cramping or pain, but I think my weight loss adds to his suspicion of C diff. I've lost the weight because I've reduced my calories. I think he's just going by the book with his analysis.

I showed him my spreadsheet containing the foods I eat and their nutritional analysis. I know it looks like I'm anal-retentive, so I explained that I'm a retired math teacher and I like detailed information. I shouldn't have mentioned it because kept referring to my being a math person from that point on. :roll:

As I was leaving, he said he wasn't sure if the pathology lab would be able to test for mast cells and would call me to let me know. Obviously, mast cells haven't ever been on his radar.

I don't have any faith in doctors right now. It wouldn't bother me to send in stool samples, but I'm not sure I want to invest any more time or money with this guy. However, he will prescribe Entocort, and he'll take me under Medicare, which I'll be on in another month. The sad thing is, he's very typical of most GIs.

Meantime, I'm taking 1/2 pill Sominex every evening. So far I haven't seen any improvement, but I'll give it a week or so. I seem to have gurgling every evening before bedtime. I wonder if it's because the Sominex has worn off by then.

Gloria
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tex
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Post by tex »

:sigh:

Yep, he definitely hasn't learned anything about mast cells in the past two years. That's sad.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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draperygoddess
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Post by draperygoddess »

Gloria, I'm so sorry! What a discouraging visit. Hope you're able to get some relief soon!
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tex
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Post by tex »

A C. diff culture test might be a waste of time, but there's definitely a possibility, (however unlikely), that you might have an infection, despite the absence of blood or cramps. That might be worth a try, just to rule it out, because C. Diff can cause mast cells to degranulate.

Here is some earlier research:
These results suggest that mast cells may participate in the initial inflammatory response to C. difficile infection by releasing TNF-α upon interaction with toxin A. However, longer exposure to toxin A affects the release of inflammatory mediators, perhaps because of the alteration of the cytoskeleton and induction of apoptosis. The impaired functions and survival of mast cells by C. difficile toxin A could hamper the capacity of these cells to counteract the infection, thus prolonging the pathogenic effects of C. difficile toxins.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC108266/

And here's some newer research:
We studied the direct effects of TcdA and TcdB on the human mast cell line HMC-1 with respect to degranulation, cytokine release, and the activation of proinflammatory signal pathways. TcdA and TcdB inactivate Rho GTPases, the master regulators of the actin cytoskeleton. The inactivation of Rho GTPases induced a reorganization of the actin cytoskeleton accompanied by morphological changes of cells. The TcdB-induced reorganization of the actin cytoskeleton in HMC-1 cells reduced the number of electron-dense mast cell-specific granules. Accordingly, TcdB induced the release of hexosaminidase, a marker for degranulation, in HMC-1 cells. The actin rearrangement was found to be responsible for degranulation since latrunculin B induced a comparable hexosaminidase release. In addition, TcdB as well as latrunculin B induced the activation of p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase 1/2 and also resulted in a p38 MAPK-dependent increased formation of prostaglandins D2 and E2. The autocrine stimulation of HMC-1 cells by prostaglandins partially contributed to the degranulation.
The red emphasis is mine, of course.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1951994/

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by nancyl »

Gloria,
So sorry to hear about your GI. It is so depressing, like banging your head against a wall. Is there anyone else in your area that you can go to? How about Chicago, are you far from there?

Just a thought.

Nancy
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Post by carolm »

Gloria, I'm sorry too that you had that deflating experience.
What I don't get is- what has he got to lose by ordering the tests you asked for? Or exploring the avenue that you've been researching? He'd probably learn something in the process.

I hope you find a doc willing to go down that path with you.

I will mention that we have an Affordalab in my town. You can order your own tests and pay out of pocket which didn't seem all that high when I checked on a couple of tests. Not sure if that's an option or even a possibility for you. You've read so much about mast cells that if all you are needing is the tests for confirmation, an independent lab might be worth considering. Just a random thought......

take care,
Carol
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Post by Martha »

Gloria,

I'm sorry. :sad: I can't believe he used you as an example to "prove" that diet doesn't work. How rude is that??

Love,
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Gloria
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Post by Gloria »

Thanks for the support. I was feeling pretty discouraged yesterday, but feel a little better today.

I've decided to get the stool testing - why not? It's not invasive and who knows, maybe I do have C-diff. I doubt it, but I just have time to lose by getting it done. I hope my GI understands that one test can be a false negative, but I doubt it. He never sent me back for retesting when I was first Dx'd.

I didn't mention that I asked him his opinion about Imuran, and he didn't like it at all for MC.
Nancy wrote:Is there anyone else in your area that you can go to? How about Chicago, are you far from there?
I'm about 40 miles from Chicago. There is a practice out of Rush University which understands the mast cell connection with irretractable diarrhea. A friend went to see them per my suggestion. They are under his insurance policy, but not mine. After an expensive colonoscopy and office visit, he was told they didn't find any identifiable condition, so they didn't offer any treatment, other than the standard IBS counsel. He has similar issues to mine and has modified his diet. But he still eats gluten, unfortunately. I might try to get an appointment with them, but I'm sure they'll want to do a colonoscopy, too.

My brother used to live near someone who worked with a doctor's practice in Madison, Wisconsin, the home of the University of Wisconsin. I don't remember what type of practice it was, but I think it had something to do with immunology/allergies. She told my brother that he should get his B12 level tested. He did, and he was low and got shots to get him up to a normal level. I'm going to call him to see if he can talk to her and see if she has any suggestions. I didn't ask him at the time because Entocort was working for me and I still thought I'd be able to achieve remission without it.

The H1 antihistamines don't seem to be helping me. Rather, my BMs are getting worse and the gurgling remains. I've never tried an H2 blocker. I suppose I should, just to see if it makes any difference. I did stop eating all almond products for three days. It's the longest I could go because I dropped to 1000-1200 calories. I improved for a day, but then my usual BMs returned.

I can be like Pat and take meds and Imodium the rest of my life. Imodium has always worked pretty well for me. Pat's able to eat many more foods than I can right now. I guess I'm starting to give up because I'm running out of options. But I feel pretty healthy and have no pain, just a very limited diet.

I'm sorry to complain. I usually try hard not to on the board. I want to follow Maggie's example and keep a stiff upper lip. I was always amazed that she didn't constantly remind us about her lack of success. Suddenly, one day, she was better. I hope that will happen to me.

Gloria
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Post by Lesley »

As they say "from your mouth to God's ear" Gloria.
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tex
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Post by tex »

Gloria,

IMO, here is no reason to apologize for complaining. I truly believe that anything we can do to relieve stress is beneficial, and keeping complaints inside is almost always stressful.

I have to agree that I've always had a lot of respect for Maggie's attitude, too. She has always been a real trooper, despite the hardships. Hopefully, your day will come, too - sooner, rather than later.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by starfire »

I admire both of you (Maggie included) so much, Gloria, but I certainly understand the need to "get it out". I certainly have that need sometimes. It does help to release some pressure occasionally.

I have to believe that you will find some answers one day, Gloria. You certainly deserve to.

Love, Shirley
When the eagles are silent, the parrots begin to jabber"
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Post by jmayk8 »

oye vey!
I have my GI appt today to talk to my Dr. about the same. Wish me luck! I will post on what happens..
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Post by Zizzle »

I'm so sorry Gloria. I think I'm headed for a similar adventure talking to doctors about mast cells. In my case it'll be a young rheumatologist who graduated from med school in 2001, so maybe he won't be so patronizing and set in his ways. It'll be interesting to see what he does with someone who's not actually feeling sick, and who isn't looking for meds to make things better. I want answers, pure and simple, not band-aids.
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Post by Gloria »

Thanks again everyone. I picked up my stool kit for the testing today. The nurse said I could just use any Tupperware container. Really?? I don't think so...

I realized today that my GI never wrote one word down on my report about mast cells or the symptoms I reported to him. It didn't make any impression on him at all. He says what he's writing while he writes, which is how I know.

I think we have a long way to go before our GIs even consider a MCAD diagnosis. I think we're at the same stage with MCAD as we were with MC just a few years ago.

Good luck with your visits Zizzle and Jenny.

Gloria
You never know what you can do until you have to do it.
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