Vacation was hard on me, back to square one

[tex]

Charlotte,

This is just my opinion, (well - actually, I suppose there are quite a few others who agree with me on this issue), but IMO, it is usually best to get it out of your system. Here's my logic: Diarrhea occurs for a reason - it is a result of a "purge the system" command, from the enteric nervous system.

Diarrhea usually results from a disruption in the digestive system, that is either chemical, or pathogenic in origin. With MC, it is chemical. About 87 % of people with MC, have secretory diarrhea. The main pathophysiological mechanism in LC, (which apparently causes secretory diarrhea), is due to a decrease of active sodium absorption. This obviously results in higher than normal concentrations of sodium in the fecal stream. This chemical change, (together with increased levels of other electrolytes, such as potassium, and chloride), triggers secretory diarrhea. If electrolytes are not only not being absorbed, but are actually being secreted into the lumen, in order to purge the system, then there is little point in trying to prevent it from happening, IMO.

That said, it is usually true that retarding motility helps to restore normal BMS. (Obvious exceptions are C. diff, botulism, salmonila, and other reactions to serious, toxic pathogens). So, I suppose what I am suggesting, is that major reactions are probably best left to run their course, (or at least, not treated with an anti-diarrheal agent), while minor episodes can be safely treated, to enhance the chances of an earlier resolution of symptoms.

I can see at least one advantage to retarding rapid transit BMs - electrolytes are absorbed in the colon, so even if they are secreted into the small intestine, as the result of a "purge" cycle, it is probably still possible to recover at least some of them in the colon, (since electrolytes are the only "nutrients" besides water, that are absorbed in the colon). Of course, doing so may impose an increased risk of inflammation to the colon, since there is evidence that the fecal stream contains toxic inflammatory agents, (which are presumably the reason for the issuance of the "purge command", by the enteric nervous system, in the first place.

At least that's how I see it.

Tex

[Ginny]

Charlotte, I agree with Lyn & Ant, nip in the bud so your body can return back to "normal' as quickly as possible. If I eat something that causes D, I immediately take Imodium and let my gut settle down. I feel much better mentally and physically!

Sorry you had a rough trip; not much of a vacation when you are worrying about what you are eating or the reactions from what you did eat! I pretty much have given up on eating out; too many hidden unknowns, but when you are on a cruise that is a problem.

I am sure you will feel better once you get back on your own routine. Ginny

[wonderwoman]

Tex writes

IMO, it is usually best to get it out of your system. Here's my logic: Diarrhea occurs for a reason - it is a result of a "purge the system" command, from the enteric nervous system.

Tex, that is my thinking also.

I saw the GI on July 8 because the D would not quit after getting back from vacation June 15th. He scheduled a sigmoidoscopy for July 16. Wouldn't you know it but the next day the stools started to firm up and by the time I had the sigmoid they were normal. I was so happy but went in for the sigmoid to r/o other things that may have been going on. The doctor took 6 biopsies in the rectum along with stool samples. What would be the purpose for taking the biopsies again when he found CC in February during the colonoscopy? What would he be checking for this time? I know c-diff, parasites, salmonella, shigella, & campy are through stool samples. Anyway, I am waiting for the lab results which could take 10 days for some of them.

It was the afternoon of the sigmoid that I ate the raw broccoli and started having D again.

Mary Beth, I have not had any Bobs Red Mill GF Hot Cereal (brown rice, corn, sorghum, buckwheat) since maybe June 1. I quit General Mills Rice Chex two weeks ago and that's when I started to notice an improvement. I will probably not eat it anymore. I am back to a lot of rice, quinoa, bananas, chicken, plain cooked vegetables and a little applesauce mixed in the rice or quinoa. This gets tiring after awhile.

This disease is always two steps forward and one step back.

[Gabes-Apg]

Charlotte
the bland diet is just that it is a bit bland, and sometimes it is really hard not to be tempted by foods that are not our friends.
Each time i do feel a pang or longing for ice cream or pastry i think to myself that is more damage that i am
doing to my body, I am 40 with birth defects to my bowel, i have to treasure it, if i want to be well and keep it.

the basis of my diet at the moment is 6 vegetables, rice, stewed lamb, salmon,eggs, rice milk, GF/SF/YF cereal and sav muffins, apple juice and i have just started pureed apple. thats it. (plus the occaisional rice milk chocolate) if i stick to this bland well cooked menu, i dont need meds, I have the energy to do my 50 (or sometimes more) hours at work each week, i sleep well with no discomfort.

If i have anything different to these items i only have it on the weekends when i can have additional rest and relaxation.

i agree with tex about the d and imodium. I have found that having the questran works for me, it doest block or stop the motions, it seems to slow it down, allows the body to time to absorb some of the moisture naturally. I have the small dose when i have had a not soo friendly ingredient, after having it the motions are soft but not D (and not short notice), i do tend to feel a bit blah for a day or so, not sure if that is the questran or the contaminate.

[tex]

The doctor took 6 biopsies in the rectum along with stool samples. What would be the purpose for taking the biopsies again when he found CC in February during the colonoscopy? What would he be checking for this time?

In that area, he would almost surely be looking for the initial stages of ulcerative colitis. I can't think of anything else that would be site-specific to that area, for which biopsies would be helpful, (but I'm no doctor, of course).

I forgot to include one of the main reasons why diarrhea shouldn't be "preserved", when I was writing my previous post. Diarrhea is a collection of partially digested food, and as such, it contains a lot of peptides, (partially broken down amino acid chains), some of which might be more prone to being absorbed into the bloodstream, through malfunctioning tight junctions, if they are not allowed to exit the GI tract as quickly as possible. This is certainly true for those of us who have the leaky gut syndrome, when we are reacting. Those peptides escaping into the bloodstream, and being carried all over the body, where they end up in joints, muscles, and other organs, are what cause us to have joint pains, headaches, migraines, a stiff neck, muscle aches, etc., as side effects of an MC reaction. IOW, that effluent contains precious few nutrients that we would be able to utilize anyway, so the faster it traverses the small intestine, the better off we may be. Once it reaches the colon, it shouldn't be possible for any peptides to be absorbed, (only electolytes and water), so theoretically, at least, it souldn't be as risky for it to linger in the colon. (Of course, the colon is loaded with bacteria that digest partially-digested food by fermentation, and that process will typically generate a lot of gas, bloating, and cramps, (and the resulting nutrient release cannot be absorbed in the colon anyway), so there is really not much point in slowing down the transit time in the colon, either, (except for the benefit of electrolyte and water recovery).

Tex

[Bifcus16]

Hmmm.

How about the observation that once you have had a single dose of the 'stopper', the diarrhea stops completely for that flare?

To me that implies that stopping the D gives the GI system a breather in which to get back into a normal habit. If the irritant was still there, I would expect the D to come back as soon as the drug made it's way out of the system.

So I still favour taking the drug, and if it comes straight back after that, well, look for another way of dealing with it. I certainly wouldn't consider it reasonable to continue to take Immodium on a daily basis for more the 6 tablets in the packet.

That said, I never take the stuff on the first loose movement. It has to be at the second D visit before I will take the drug. Hopefully if I have only taken a small amount of irritant it will have already mostly passed out.

Lyn

[tex]

How about the observation that once you have had a single dose of the 'stopper', the diarrhea stops completely for that flare?

You're right, of course - sometimes the GI system just needs a "shock" of some sort, to jolt it back to reality. At the other extreme, if an anti-diarrheal is needed on a regular, daily basis, that may well be a sign that the D should be purged. I never took anything when I was reacting, but I had alternating D and C, so I didn't have to be concerned with unending D, (usually).

Tex