Oh, what have I done?

Post by **tex** » Thu Oct 30, 2008 4:50 pm

Oops, sorry -I wasn't paying close enough attention. Immodium is the over-the-counter version of Lomotil, except that Immodium does not contain atropine. Atropine is added to Lomotil to make people sick, if they try to take too much of it, (some might choose to take it just to get the opiate effect). A rash is an allergic reaction, and it's possible to react to virtually anything, so a rash is a possibility from any med, (though it's usually a very low odds possibility). Doubling the dose, (if necessary), would probably be better than continuing the Pepto.

As far as the Aciphex affecting the enteric coating on the Entocort is concerned - that's a very good question. I really don't believe that it will, simply because the specs on the drug show the percentage of time that it should keep the pH below 3, and below 4, but no mention of excursions to higher levels, (though that certainly doesn't rule out sporadic higher pH readings). Especially if you are using a 20 mg dose, I doubt that would be enough of an effect to cause Entocort to activate "prematurely".

Of course, the other issue is the fact that Aciphex is a proton pump inhibitor, and, as you are well aware, certain PPIs are known to cause MC for some individuals. Have you ruled out Histamine 2 Blockers, such as Axid, Pepcid, Tagamet, or Zantac? If none of those will do the job, then obviously Aciphex is probably a much better choice than Prevacid, which has actually been documented to cause MC, and Nexium, which you yourself suspect.

I agree with your pharmacist - all three tablets at one time, (preferably first thing in the morning), is the way to go. The idea is to hit the inflammation with enough corticosteroid at one time, to get it's attention, and then let it coast, the rest of the day. Each day, you will build up a higher level of budesonide in your system, until the level reaches equilibrium. Either it will work, or it won't. Go for it - assume that it's going to work, and then look for signs of progress.

Enjoy your weekend, but keep the Lomotil handy, because the Entocort will probably take a week or so to work, unless you're luckier than most of us.

Tex

katinchatt · Post by **katinchatt** » Thu Oct 30, 2008 5:34 pm

tex wrote:Have you ruled out Histamine 2 Blockers, such as Axid, Pepcid, Tagamet, or Zantac? If none of those will do the job, then obviously Aciphex is probably a much better choice than Prevacid, which has actually been documented to cause MC, and Nexium, which you yourself suspect.

Ranitidine (Zantac) is a H2 receptor blocker related to Tagamet, Pepcid and Axid, whereas Prilosec is a proton pump inhibitor (or PPI) related to Prevacid, Aciphex and Protonix. (<Nexium belongs in here)

For some reason, I and Ranitidine do not get along, bad headaches!! But have taken Aciphex for over 4 years with no side effects at all, only the prescribed ones, no reflux that is. Nexium is in the same class as Aciphex, my assumption is based purely on the time frame when my symptoms began, so I'm blaming it (until further notice) on Nexium. Also, have seen where PPI induced MC symptoms/signs were reduced significantly when specifically switched to Aciphex. So there must be a little chemical equation in there somewhere, that just changes everything. Or so I assume (until further notice). Oh my gosh, just sitting here typing the word Nexium has my gut in a growl.

I'm just now getting to the chapter's concerning Hormone Replacement and MC links. Guilty there too! Though I do monthly injections, nothing oral. Am I safer in that respect? 10 years+

Thanks Tex!

Dee · Post by **Dee** » Thu Oct 30, 2008 6:59 pm

Kat,
You can take the Entocort and the Lomotil together. Until I knew the Entocort had fully kicked in and was controlling my symptoms I could take up to 8 Lomotil a day with no problems. My Gi is the one that told me about it being okay to take 2- 4x a day.
Just make sure you take your 3-3mgs of the Entocort in the morning. Doesn't have to be taken with food.

Dee~~~~

katinchatt · Post by **katinchatt** » Thu Oct 30, 2008 7:34 pm

Thanks Dee,

Yes, I think I will definately need it for at least 2 weeks. In a week-10 days I may taper back to 4-6x day, may have to play with it for a while, but I'll get it down.

Thanks Again,
Kat

Post by **tex** » Thu Oct 30, 2008 7:49 pm

Kat,

I don't know if any research has ever been done to look for a correlation between HRT and colitis, but I'm pretty sure that injections would be safer than oral treatments, and I would think that transdermal patches would be even safer. I tried "Googling" "hrt microscopic colitis", and the top two hits were on our own site.

It's kind of hard to believe that we are the top authorities on the internet on that issue, so I reckon that means that nobody knows much about it.

I did find this, though, (in reference to my comments about the radioactive pill possibly having a connection with triggering MC:

Half of all patients treated with pelvic radiotherapy are troubled by diarrhoea or constipation.8 The causes of constipation have not been investigated. The causes of diarrhoea are many and include accelerated small and large bowel transit, bacterial overgrowth, malabsorption of bile salts, medication, primary fatty acids or carbohydrates, pancreatic insufficiency, physiological changes to the lower gastrointestinal tract, stricture formation, and psychological factors. In addition, radiotherapy may exacerbate pre-existing IBD and induce microscopic colitis.

From this article in "Gut":

http://www.pubmedcentral.nih.gov/articl ... id=1774900

You're most welcome,
Tex

katinchatt · Post by **katinchatt** » Fri Oct 31, 2008 8:31 am

Morning Tex,

Yep, interesting about Radiation Therapy and IBD. and if that is my case, is the exact opposite of why I can't take HR pills. I was 30 when I had a total hysterectomy. Tried pills off and on for years but my symptoms were CRAZY off the chart. I had many "saturation" tests done and it was simply because my body wouldn't absorb the hormones. I will have to wean off my dose via the patches within the next few years...not looking forward to that either

***

I hadn't told my Mom about what I've "really" been going through, she had a stroke earlier this summer and has her own issues. My Sis however filled her in on everything! Well, she called me last night and asked why I didn't just be put on Asacol, since it worked so well for me last time??? What??? SHE REMINDED ME (woman who can't remember what she ate for breakfast) that in the early 80's I had something similar happen, but it was extremely painful, & I had lot's of mucus and blood, My GI at that time, suspected that I may have the early signs of Chrons. However, he wouldn't diagnose me as actually having it, obviously since he wasn't exactly sure, but mostly because of the long term, pre-existing condition troubles I would have in the future. I remembered I had, had a colonoscopy, but for the life of me could not remember why.... Also she said it was ironic that I had just received the Entocort today as she had just had the prescription "Amitiza" filled for my 98 yr. old grandmother.
Amitiza - Lubiprostone increases the secretion of fluid in your intestines to help make it easier to pass stools. Ironic Indeed! Never had another problem after a round of Asacol with the above condition. I do remember it was so, so painful.

Moms, are indeed a good thing! I will never, ever underestimate mine again!

Have a Happy Healthy Day!
Kat

Post by **tex** » Fri Oct 31, 2008 9:37 am

Good Morning Kat,

Yep, moms tend to remember what happens to their babies. That earlier episode is an interesting turn of events. If there was a lot of mucus, you definitely had a lot of inflammation. MC, however, does not present with blood in the stool, (of course, hemorrhoid flareups are quite common with MC, though). If you had had C. diff, or butulism, or something such as that, I don't see how you could have goten rid of it without medical intervention. Maybe it was just something such as salmonella, or some other parasite that the body's immune system can handle.

You know, there is a phenomenon known as a prodrome, which precedes the other IBDs. For example, starting about seven years prior to the development of full-blown symptoms of Crohn's disease, a patient may experience bloating, diarrhea, stomach pain, fever, weight loss, and fatigue. For UC, the prodrome period is much shorter - about a year. As far as I'm aware, no one has "officially" identified a connection with such an event that might be linked with MC, but we've had several discussions about it here on this board. For example, I had random episodes of reactions for a year or two, before the D started and wouldn't stop. Others feel that their MC started suddenly, with no prior warning, (especially those who suspect a med as the cause of their disease).

Obviously, (hindsight is 20-20), you weren't experiencing a prodrome for Crohn's, since roughly 25 years have elapsed since that episode in the early 80s. Maybe you had MC way back then, and the Asacol brought remission, and then you were fortunate enough to have experienced spontaneous remission for all those years between then and your recent flareup.

:fonkycat: wrote:I do remember it was so, so painful.

That sure sounds like C. diff, but I don't see how why Asacol would have controlled it. Could it be possible that perhaps you were treated with either metronidazole, (Flagyl), or vancomycin?

I hope you're feeling better by now.

Tex

katinchatt · Post by **katinchatt** » Fri Oct 31, 2008 10:06 am

Tex,

I remember Flagyl as being prescribed as well. I had a fair amount of D (nothing like now), but the bloody mucus and pain were the big 2 symptoms.

I do feel significantly better than this past week! Everyday it's gotten a tad better, yesterday is when I knew I was getting over my self

imposed relapse, am where I was this time last week. Started the Entocort this morning, no Pepto but doubled my Lomotil. Am definitely on the road to healing! You have no idea (wait, yes you do) how great the feeling is.
25+ years is a long remission if that was the case, but I think you are right about it probably being C.diff. Thank goodness it didn't turn out to be Crohns. I have lot's of Gastro related defective genes in my family, colon cancer as well (Paternal). Both cases were cured and are in remission, caught early! I was told from now on, due to that, and high polyp count on Maternal side, that I will be having colonoscopies every 5 years. Oh Boy! However, it will be nice to keep an eye on the MC.

Kat

katinchatt · Post by **katinchatt** » Sat Nov 01, 2008 6:53 am

Morning All,

OK, now I'm beginning to wonder if the Pepto all this time, was making my symptoms worse? The rash on my neck and chest, slowly abated along with my dreadful black tounge. Also, my D in an extreme fashion! Could I have been at the toxic level? I know Entocort doesn't work in 24 hours, however things really turned around in my favor that quickly. Yesterday I kinda followed my gut as far as Lomotil (I can judge what's coming on) and ended up only taking 4. I should have posed that query sooner, but gonna run like heck with it now!!

Everyone have wonderful weekend, heading to the Great Smoky Mountains to take in all the beautiful fall colors.

Kat

Post by **tex** » Sat Nov 01, 2008 10:02 am

Kat,

It sure sounds as though the Pepto was probably the culprit, (that's why Dr. Fine no longer recommends it).

Have fun, and I hope you don't have to make any mad dashes through the poison ivy thickets.

Tex

katinchatt · Post by **katinchatt** » Mon Nov 03, 2008 10:32 am

No Poison Ivy needed!

Actually, I'm kinda at a loss for words! (for a change)...lol

You'd think I never had MC, if you judged it by my last few days. 3 days of 100% NORMAL! Once in the morning, semi-solid reminder of the good old days. I've only taken 2 Lomotil daily with my 3 Entocort. My skin is looking better everyday. (That was another matter, all those drying out meds will zap your skin, in a hurry). The only signs I have at all are, about an hour before and an hour after my am movement I get severe cramping. I'm guessing since nothing even semi-solid has gone this route in a few months the inflammation is "feeling it" move thru. However, after that I'm as good as gold! I think this will help enlighten me on how I'm progressing. << Did any of that make sense?

So, like I said , I'm kinda at a loss for words! I truly believe the Pepto was slowing doing me in. I actually have an appetite and am not afraid of eating a few things I haven't had the "guts" to in a few months!

My weekend in the mountains was SPECTACULAR! Healing powers abound up there!

Have a Great Week Ya'll!
Kat

Post by **tex** » Mon Nov 03, 2008 1:42 pm

,

Now that's the kind of post we all like to see.

I think you're right about the Pepto.

Thanks for the inspiration, and I hope this trend continues.

Tex

thedell19 · Post by **thedell19** » Mon Nov 03, 2008 4:35 pm

Ha! That is a good story...

Gloria · Post by **Gloria** » Mon Nov 03, 2008 10:31 pm

Yes, it does sound like the Pepto was aggravating your MC, like it did mine. I'm glad to see that you are getting back to normal.

Gloria

katinchatt · Post by **katinchatt** » Tue Nov 04, 2008 9:22 am

Yes, doing much better. I'm still trying to get the Librax & Lomotil doses down. Maybe backed off both a little to soon, but hopefully back on track today. Why I can't get it thru my thick skull that just because I"m feeling better, it does not mean I'm am better !!! The cramping is my biggest concern at the moment. First few days it was a couple of hours in the AM (centered around my morning "business") yesterday ~ it was all day, followed by D all evening. So, again I'm playing with my dosage, so not to have a day like that again.

How important is it to know "where in your colon" your MC is? According to the below, if say for instance it's in the descending colon, Entocort may not help.......... because my pain/cramping "I feel" is in my descending colon. Any thought's on this?

*****
ENTOCORT® EC is a medicine that helps treat
mild to moderate Crohn’s disease. The
medicine works mainly in one area of your body:
a part of your small intestine called the ileum
and a part of your large intestine called the
ascending colon. Crohn’s disease is commonly
found in this area.
*****

Also, does anyone suggest a mild sleep aid? I'm finding that this med is making it difficult to fall asleep and stay asleep, I'm waking up almost every hour. Over the counter PM drugs are not helping ~ & I probably don't need to be taking those anyway. Melatonin has never worked for me either, it helps me go to sleep but after 2 hours, I'm totally wired.

I do have a GI appt. Thursday and was going to cancel (all I wanted was Entocort anyway) however I may go ahead and see him. I want to know "where" the MC was found and discuss this sleeping issue w/him. Besides, I think he needs the education benefits of my visit. He should pay me!...................lol lol

Med labels say to not operate heavy machinery, they should probably say something about making important decisions, like voting! So here's to who ever get's my vote, it all may depend on how I'm feeling at that very moment ;)

Kat

What happend on October 25, 2007, when there was 160 people on-line at 11:00PM? Curious minds and all................