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Xifaxan
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Hi Wayne,
Sorry about the low energy. My only suggestions about that would be to make sure that you're not deficient in vitamins B-12, folic acid, and/or D3. After your highly-successful weight loss program last summer, it's certainly not impossible that you may have depleted your body's reserves of B-12, and D3 is always in short supply this time of year at the more northern latitudes.
Concerning the withdrawal period, (without any meds), your doc may just be unduly concerned about an adverse drug interaction. Cholestyramine interacts with quite a few other drugs, though Xifaxan, (rifaximin), is not known to be a problem.
The problem with using an antibiotic to treat MC, (or IBS, assuming it actually exists), is that it can only be used for short periods, without running an unacceptable risk of adverse consequences. Ciprofloxacin, for example, will stop the D caused by MC almost instantly, but a few days after the Cipro treatment is discontinued, the D will return. From the article that you cited:
IOW, Rifaximin will probably stop the D, as long as you are taking it, plus a few days longer, but what are you going to do then, when the D resumes? Also, why is he treating you for IBS, when you have MC? The only logical explanation for that would be that he thinks that IBS and MC are one and the same, (which I personally believe may very well be true, but I doubt that he feels that way).
If you try it, good luck with it, and please keep us updated on how it goes.
Tex
Sorry about the low energy. My only suggestions about that would be to make sure that you're not deficient in vitamins B-12, folic acid, and/or D3. After your highly-successful weight loss program last summer, it's certainly not impossible that you may have depleted your body's reserves of B-12, and D3 is always in short supply this time of year at the more northern latitudes.
Concerning the withdrawal period, (without any meds), your doc may just be unduly concerned about an adverse drug interaction. Cholestyramine interacts with quite a few other drugs, though Xifaxan, (rifaximin), is not known to be a problem.
The problem with using an antibiotic to treat MC, (or IBS, assuming it actually exists), is that it can only be used for short periods, without running an unacceptable risk of adverse consequences. Ciprofloxacin, for example, will stop the D caused by MC almost instantly, but a few days after the Cipro treatment is discontinued, the D will return. From the article that you cited:
The recommendation may be new, but there certainly is nothing new about the fact that MC has been misdiagnosed as IBS, ever since the term IBS was "coined". That 4% figure is a cruel joke. It's 4% because they don't normally take biopsy samples from the colons of patients with IBS. (You can't find it if you don't look for it.) There are a heck of a lot of members of this board who were originally "diagnosed" with IBS.The guidelines also will recommend the addition of microscopic colitis to the differential diagnosis of IBS. This addition is based on a prospective, multicenter study that found 4% of 454 people suspected of IBS actually had microscopic colitis.
"This is definitely new ... and potentially a very, very important message from this document," Dr. William D. Chey said during a media briefing at the annual meeting of the American College of Gastroenterology.
"If a patient has diarrhea-predominant IBS and undergoes colonoscopy, it is reasonable to consider taking random biopsies to exclude microscopic colitis," said Dr. Chey, who is professor of medicine at the University of Michigan, Ann Arbor.
The part that I highlighted in red says it all, doesn't it. Relief will probably last for up to a week after the treatment is stopped, and what you do then, is to decide whether you want to resume living with chronic D again, or take an antibiotic for the rest of your life, (or until you develop a severe side effect, and are forced to stop, whichever comes first), and whether you want to be responsible for adding to the huge problem that the medical industry, (and society), already has, with continually increasing bacterial antibiotic resistance, due to the chronic overuse of antibiotics, for non-vital purposes.Another new recommendation is for use of a "nonabsorbable antibiotic" to relieve IBS symptoms. The only approved antibiotic that remains in the gut to alter flora without systemic absorption is rifaximin (Xifaxan), now under investigation as a treatment for IBS. Rifaximin was found to be superior to placebo for improvement of IBS symptoms, especially bloating, in recent studies (Ann. Pharma-cother. 2008;42:408-12; Adv. Med. Sci. 2007;52:139-42).
"What is uncertain is how long the symptom relief lasts and what you should do if the symptoms recur," said Dr. Philip S. Schoenfeld, a gastroenterologist at the University of Michigan, who also spoke at the media briefing.
IOW, Rifaximin will probably stop the D, as long as you are taking it, plus a few days longer, but what are you going to do then, when the D resumes? Also, why is he treating you for IBS, when you have MC? The only logical explanation for that would be that he thinks that IBS and MC are one and the same, (which I personally believe may very well be true, but I doubt that he feels that way).
If you try it, good luck with it, and please keep us updated on how it goes.
Tex
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.
Wayne,
I wish I had that information. That particular member e-mailed that information to me, and never posted. Her e-mail is on another computer that had a hard drive failure sometime after that, so I'm not sure that I still have that e-mail. That's an interesting question, though, so I may try to e-mail her, (if the e-mail address that I have on file for her is still current), to see if she will provide an update, or any insight.
Tex
I wish I had that information. That particular member e-mailed that information to me, and never posted. Her e-mail is on another computer that had a hard drive failure sometime after that, so I'm not sure that I still have that e-mail. That's an interesting question, though, so I may try to e-mail her, (if the e-mail address that I have on file for her is still current), to see if she will provide an update, or any insight.
Tex
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.
My second GI doc, I am on my 4th, wanted to put me on it but chose instead for me to take Neomycin and if it helped them he would put me on the Xifaxin. Well, the Neo made me so sick that he pretty much gave up and sent me to a Nutritionist who requested that he give me that breath test as well as one for fructose intolerance and lactose intolerance. He lied to her and said he had offered me the tests but I didn't want to drive the hour drive to his office. He comes to my small town a few times a month. She knew he was lying - I would go anywhere. I didn't realize that one could be tested for Small Intestine Bacterial Overgrowth, SIBO. Taking antibiotics when they aren't needed is really bad for your system. I'm not sure I've truly gotten over it and it has been almost 2 years.
Going even further back the first internist I saw for this put me on Doxycline, the first GI put me on Flagyl. None of it worked. I think they made me worse. Get tested!
Pat
Going even further back the first internist I saw for this put me on Doxycline, the first GI put me on Flagyl. None of it worked. I think they made me worse. Get tested!
Pat
Wayne,
I found that e-mail on a third generation computer, (that is, two generations prior to the one I am using right now), and I already received a response from her. Before I post what she said, though, I'm waiting for her permission to allow me to quote her e-mail, (since it sounds so much better than paraphrasing it). If I don't receive her permission to post a quote, I reckon I'll paraphrase what she said, tomorrow. You'll like what she said.
Tex
I found that e-mail on a third generation computer, (that is, two generations prior to the one I am using right now), and I already received a response from her. Before I post what she said, though, I'm waiting for her permission to allow me to quote her e-mail, (since it sounds so much better than paraphrasing it). If I don't receive her permission to post a quote, I reckon I'll paraphrase what she said, tomorrow. You'll like what she said.
Tex
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.
Wayne,
Okay, here's her response. Remember, though, that we are all different, so for all we know, this may only work for a limited number of people:
Hi Wayne,
I am very happy to say I am doing fantastic. I took Asacol for about a month longer. I have had absolutely no problems at all and take no medicine and haven't for almost two years and have no diet restrictions. To be honest, even though I had every test possibly and MC was the diagnosis, I was convinced that some where I picked up an intestinal bug and it finally left my system and the diarrhea I had for so long caused the reading of the Colonoscopy to be MC. But, maybe it was the medication and I am in remission. I hate to admit it, but I canceled my follow up doctor's appointment because I was doing so well, did not see the point.
I hope others are as successful as I was...it is almost like it was a nightmare and not something I actually went through.
Kind Regards,
It does sound encouraging, though, doesn't it.
Tex
Okay, here's her response. Remember, though, that we are all different, so for all we know, this may only work for a limited number of people:
Hi Wayne,
I am very happy to say I am doing fantastic. I took Asacol for about a month longer. I have had absolutely no problems at all and take no medicine and haven't for almost two years and have no diet restrictions. To be honest, even though I had every test possibly and MC was the diagnosis, I was convinced that some where I picked up an intestinal bug and it finally left my system and the diarrhea I had for so long caused the reading of the Colonoscopy to be MC. But, maybe it was the medication and I am in remission. I hate to admit it, but I canceled my follow up doctor's appointment because I was doing so well, did not see the point.
I hope others are as successful as I was...it is almost like it was a nightmare and not something I actually went through.
Kind Regards,
It does sound encouraging, though, doesn't it.
Tex
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.
Wayne,
She never posted - she e-mailed me about not being able to log onto the board, and she included that treatment information in her e-mail. Even after correcting the log-in problem, she never posted.
Yes, the way I read it, she started taking Flora-Q at the same time as the rifaximin, and ended the treatment regimen with four days of rifaximin only. FWIW, Flora-Q does appear to be a good blend of probiotic strains. I'm as puzzled as you are, over why a probiotic is used during the first part of the antibiotic treatment, but not in the final stages. That seems totally bass-ackwards, of course. It makes me wonder if this is pseudoscience, that by some strange coincidence happens to work, under certain circumstances, for certain individuals, (if the moon is full), or if there is a scientifically valid explanation for why it works.
From the post that you quoted:
Of course, in the real world, not everything is "logical", and that point is sometimes difficult for some of us with a scientific background, to fully comprehend. The other problem is that we know that the bacteria in a probiotic are incapable of actually colonizing the gut. At best, they are only temporary residents, and they will simply die out, if not continuously replaced with new bacteria, via regular probiotic consumption. In view of all that, there may be more here than meets the eye. Perhaps the bacteria in the Flora-Q capsules help to stress the resident "bad" bacteria, (by trying to move in on them), which makes the stressed "bad" bacteria, more vulnerable to the rifaximin. Or, maybe by distracting the attention of the bad bacteria, this allows the rifaximin to exploit a weakness in the composition of the bad bactera, and which allows it to destroy them much more efficiently than it would be able to do, otherwise. I'm just thinking out loud, here, but if this treatment actually works, then something of that sort, may be playing a part.
The bottom line is, since MC affects people in so many different ways, I/we should always be open to other innovative ways to get the upper hand over the disease. I've always maintained that anything is fair, not only love and war, but also in treating MC.
Maybe Polly has some insight on this, since she once considered trying this treatment, herself.
Tex
She never posted - she e-mailed me about not being able to log onto the board, and she included that treatment information in her e-mail. Even after correcting the log-in problem, she never posted.
Yes, the way I read it, she started taking Flora-Q at the same time as the rifaximin, and ended the treatment regimen with four days of rifaximin only. FWIW, Flora-Q does appear to be a good blend of probiotic strains. I'm as puzzled as you are, over why a probiotic is used during the first part of the antibiotic treatment, but not in the final stages. That seems totally bass-ackwards, of course. It makes me wonder if this is pseudoscience, that by some strange coincidence happens to work, under certain circumstances, for certain individuals, (if the moon is full), or if there is a scientifically valid explanation for why it works.
From the post that you quoted:
OK, the obvious problem with this statement, is that there is little point in taking an antibiotic, if it is not going to effectively kill off all the bacteria. Typically, only a small percentage of the bacteria in a probiotic capsule ever survive long enough to get to where they need to be, and actually provide any beneficial effect, anyway. Obviously, if an antibiotic won't even kill all of the few, weakened, "good" bacteria, included in a probiotic capsule, then it certainly isn't likely to have much of an effect on the billions of "bad" bacteria that are healthy, and already well established in the gut. At least that seems logical to me.Yes, antibiotics will kill off good bacteria, but I have also seen it recommended that you take two and three times the normal amount of probiotics while on antibiotics--so the antibiotics can't possibly kill off all of it--
Of course, in the real world, not everything is "logical", and that point is sometimes difficult for some of us with a scientific background, to fully comprehend. The other problem is that we know that the bacteria in a probiotic are incapable of actually colonizing the gut. At best, they are only temporary residents, and they will simply die out, if not continuously replaced with new bacteria, via regular probiotic consumption. In view of all that, there may be more here than meets the eye. Perhaps the bacteria in the Flora-Q capsules help to stress the resident "bad" bacteria, (by trying to move in on them), which makes the stressed "bad" bacteria, more vulnerable to the rifaximin. Or, maybe by distracting the attention of the bad bacteria, this allows the rifaximin to exploit a weakness in the composition of the bad bactera, and which allows it to destroy them much more efficiently than it would be able to do, otherwise. I'm just thinking out loud, here, but if this treatment actually works, then something of that sort, may be playing a part.
The bottom line is, since MC affects people in so many different ways, I/we should always be open to other innovative ways to get the upper hand over the disease. I've always maintained that anything is fair, not only love and war, but also in treating MC.
Maybe Polly has some insight on this, since she once considered trying this treatment, herself.
Tex
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.
Pat,
Believe me, I understand, and I do appreciate what you are saying, and I felt the same way, when I first started considering the facts surrounding this concept, but this particular treatment regimen appears to exploit a unique approach that pretty much totally transcends the ways that we normally think about the gut flora-probiotic-antibiotic relationship.
I've posted my thoughts on this at various times in the past, but since it's been a while since I last mentioned it, maybe I should point out that, contrary to conventional thinking, I have never truly believed the "autoimune" label that the medical establishment has placed on this disease, (and related diseases, for that matter). I don't want to put words in her mouth, but I believe that Polly feels the same way, or at least has the same suspicions. (Polly, please correct me, if I am wrong). Ever since I first saw the similarity between human IBDs and Paratuberculosis, (or Johne's Disease), in cattle, and certain other ungulates, I have felt the same as others, who believe that there is a link between human IBDs, and mycobacterium avium subspecies paratuberculosis, (or MAP), which implies that the bacterium may be transmitted by milk.
Anyway, without going into detail about that theory, suffice to say, that I/we believe that MC is caused by a bacterium, that we have, (so far, at least), been unable to detect in tissue samples of MC patients. If we could vanquish that bacterium from our cells, all our symptoms, (including food sensitivities), would probably disappear.
Tex
Believe me, I understand, and I do appreciate what you are saying, and I felt the same way, when I first started considering the facts surrounding this concept, but this particular treatment regimen appears to exploit a unique approach that pretty much totally transcends the ways that we normally think about the gut flora-probiotic-antibiotic relationship.
I've posted my thoughts on this at various times in the past, but since it's been a while since I last mentioned it, maybe I should point out that, contrary to conventional thinking, I have never truly believed the "autoimune" label that the medical establishment has placed on this disease, (and related diseases, for that matter). I don't want to put words in her mouth, but I believe that Polly feels the same way, or at least has the same suspicions. (Polly, please correct me, if I am wrong). Ever since I first saw the similarity between human IBDs and Paratuberculosis, (or Johne's Disease), in cattle, and certain other ungulates, I have felt the same as others, who believe that there is a link between human IBDs, and mycobacterium avium subspecies paratuberculosis, (or MAP), which implies that the bacterium may be transmitted by milk.
Anyway, without going into detail about that theory, suffice to say, that I/we believe that MC is caused by a bacterium, that we have, (so far, at least), been unable to detect in tissue samples of MC patients. If we could vanquish that bacterium from our cells, all our symptoms, (including food sensitivities), would probably disappear.
Tex
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.
Hi All!
I recall reading about some good results with Xifaxan. Unfortunately I can't remember where I saw it. But I was impressed enought to consider trying it at one point. I never did because I finally figured out all of my food intolerances and put the MC into remission.
Sorry I'm not more helpful.
Love,
Polly
I recall reading about some good results with Xifaxan. Unfortunately I can't remember where I saw it. But I was impressed enought to consider trying it at one point. I never did because I finally figured out all of my food intolerances and put the MC into remission.
Sorry I'm not more helpful.
Love,
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
Polly,
You may be thinking about your e-mail exchange with Dr. Lewey:
http://www.perskyfarms.com/phpBB2/viewt ... aq+xifaxan
Love,
Tex
You may be thinking about your e-mail exchange with Dr. Lewey:
http://www.perskyfarms.com/phpBB2/viewt ... aq+xifaxan
Love,
Tex
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.