Visit the Microscopic Colitis Foundation Website
I see my GI Tuesday morning, and my purpose during this follow-up visit is to give him information on the MC-celiac genetic connection (he didn't know about this last time we met), and to ask him to prescribe genetic and stool testing to see if my insurance will pick up the tab. Worth a try, right?
So, since he indicated to me last time I saw him that he's always interested in what helps his patients, I want to give him the following articles. Most of them are just the abstract from PubMed or just a couple of pages, so we're not talking major reading. I don't want to overwhelm him, but at the same time I don't want to leave something really important out. What do you think? Additions? Subtractions?
The Role of Diet in Inflammatory Bowel Disease
http://www.wjgnet.com/1007-9327/16/1442.pdf
Does Colonoscopy Cause Increased Ulcerative Colitis Symptoms?
http://deepblue.lib.umich.edu/bitstream ... 49_ftp.pdf
High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome
http://www.nature.com/ajg/journal/v95/n ... 0504a.html
Early Diagnosis Of Gluten Sensitivity: Before the Villi are Gone
https://www.enterolab.com/StaticPages/E ... nosis.aspx
Potential Celiac Patients Show Signs of Disease
http://www.medpagetoday.com/Gastroenter ... logy/23955
An association between microscopic colitis and celiac disease
http://www.ncbi.nlm.nih.gov/pubmed/19631283
A retrospective study on a cohort of patients with lymphocytic colitis
http://www.ncbi.nlm.nih.gov/pubmed/20575599
Collagenous colitis as the presenting feature of biopsy-defined celiac disease
http://www.ncbi.nlm.nih.gov/pubmed/15319648
Info for my GI--What Do Y'all Think?
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
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MBombardier
- Rockhopper Penguin
- Posts: 1523
- Joined: Thu Oct 14, 2010 10:44 am
- Location: Vancouver, WA
Info for my GI--What Do Y'all Think?
Marliss Bombardier
Dum spiro, spero -- While I breathe, I hope
Psoriasis - the dark ages
Hashimoto's Thyroiditis - Dec 2001
Collagenous Colitis - Sept 2010
Granuloma Annulare - June 2011
Dum spiro, spero -- While I breathe, I hope
Psoriasis - the dark ages
Hashimoto's Thyroiditis - Dec 2001
Collagenous Colitis - Sept 2010
Granuloma Annulare - June 2011
That's quite a few articles, but since most of them are short abstracts, that may not be a problem. The subject matter is certainly appropriate, and in general, those look like excellent selections.
Good luck with your meeting with your doctor.
Tex
Good luck with your meeting with your doctor.
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 Marliss,
I might suggest that you cut the list to two or three articles that you think are most important to understanding what is going on with you right now. I am afraid that if you give a whole stack of articles to even the most willing doc, they will go unread. My experience is that taking one or two at a time gets more action. It sounds like the doc is willing, but you don't want to overwhelm him.
Good luck with your appointment. I hope it goes well!
Celie
I might suggest that you cut the list to two or three articles that you think are most important to understanding what is going on with you right now. I am afraid that if you give a whole stack of articles to even the most willing doc, they will go unread. My experience is that taking one or two at a time gets more action. It sounds like the doc is willing, but you don't want to overwhelm him.
Good luck with your appointment. I hope it goes well!
Celie
Marliss,
I suggest making one document out of a number of abstracts to not overwhelm the doctor. Make sure the titles or main points are in Bold. Also make sure you can summarize each one, so the doc can understand without having to read the abstracts for "proof." My docs generally seem to prefer hearing my assessment versus having to read it for themselves. That said, I think you have a good selection. Definitely try to get the gene test covered. I understand the blood tests offer more info about subtypes than Enterolab's cheek swab DNA tests. Since you are already GF, I'm not sure how much info you'll get from a stool or blood test for antibodies. Your doc may suggest a gluten trial (eating the equivalent of 1-2 slices of bread a day) for a couple of weeks to get an accurate result on the blood test, probably less for the stool test. But the gene test is mainstream (unlike Enterolab), so that should be the easier sell.
Good luck! Let us know how it goes.
BTW, I've noticed that none of my docs use a diagnosis code for microscopic colitis or lymphocitic colitis for my visits. It's always IBS, diarrhea, etc.
I looked it up and lo and behold, there doesn't seem to be a code for MC, LC, or MC. Is this true?? Am I missing something?? The closest I could find was:
2011 ICD-9-CM Diagnosis Code 558- Other and unspecified noninfectious gastroenteritis and colitis
But the subcategories don't include MC. How can this be? Does this mean our insurance companies don't know our diagnosis?? They think we have IBS?!?
2011 ICD-9-CM Diagnosis Code 558.1
Gastroenteritis and colitis due to radiation
2011 ICD-9-CM Diagnosis Code 558.2
Toxic gastroenteritis and colitis
2011 ICD-9-CM Diagnosis Code 558.3
Allergic gastroenteritis and colitis
2011 ICD-9-CM Diagnosis Code 558.4
Eosinophilic gastroenteritis and colitis
2011 ICD-9-CM Diagnosis Code 558.41
Eosinophilic gastroenteritis
2011 ICD-9-CM Diagnosis Code 558.42
Eosinophilic colitis
2011 ICD-9-CM Diagnosis Code 558.9
Other and unspecified noninfectious gastroenteritis and colitis
557.*
I suggest making one document out of a number of abstracts to not overwhelm the doctor. Make sure the titles or main points are in Bold. Also make sure you can summarize each one, so the doc can understand without having to read the abstracts for "proof." My docs generally seem to prefer hearing my assessment versus having to read it for themselves. That said, I think you have a good selection. Definitely try to get the gene test covered. I understand the blood tests offer more info about subtypes than Enterolab's cheek swab DNA tests. Since you are already GF, I'm not sure how much info you'll get from a stool or blood test for antibodies. Your doc may suggest a gluten trial (eating the equivalent of 1-2 slices of bread a day) for a couple of weeks to get an accurate result on the blood test, probably less for the stool test. But the gene test is mainstream (unlike Enterolab), so that should be the easier sell.
Good luck! Let us know how it goes.
BTW, I've noticed that none of my docs use a diagnosis code for microscopic colitis or lymphocitic colitis for my visits. It's always IBS, diarrhea, etc.
I looked it up and lo and behold, there doesn't seem to be a code for MC, LC, or MC. Is this true?? Am I missing something?? The closest I could find was:
2011 ICD-9-CM Diagnosis Code 558- Other and unspecified noninfectious gastroenteritis and colitis
But the subcategories don't include MC. How can this be? Does this mean our insurance companies don't know our diagnosis?? They think we have IBS?!?
2011 ICD-9-CM Diagnosis Code 558.1
Gastroenteritis and colitis due to radiation
2011 ICD-9-CM Diagnosis Code 558.2
Toxic gastroenteritis and colitis
2011 ICD-9-CM Diagnosis Code 558.3
Allergic gastroenteritis and colitis
2011 ICD-9-CM Diagnosis Code 558.4
Eosinophilic gastroenteritis and colitis
2011 ICD-9-CM Diagnosis Code 558.41
Eosinophilic gastroenteritis
2011 ICD-9-CM Diagnosis Code 558.42
Eosinophilic colitis
2011 ICD-9-CM Diagnosis Code 558.9
Other and unspecified noninfectious gastroenteritis and colitis
557.*
Very interesting observation, Zizzle. We aren't even on their radar.
Marliss,
I brought a 4-page to my GI, and it was clear that he never read it when I called to follow up. I agree that you should have a short list of articles, summarized so that they will pique his interest.
Gloria
Marliss,
I brought a 4-page to my GI, and it was clear that he never read it when I called to follow up. I agree that you should have a short list of articles, summarized so that they will pique his interest.
Gloria
You never know what you can do until you have to do it.
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MBombardier
- Rockhopper Penguin
- Posts: 1523
- Joined: Thu Oct 14, 2010 10:44 am
- Location: Vancouver, WA
Very good suggestions, ladies! It occurred to me to ask how long my appointment is supposed to be when I check in. I think that I will "tell" him as much as possible, however, do so in a tactful, inquiring sort of way to draw him out and not make him think that I think I know better (even if I do). I will also have a summary of the pertinent articles with me so that if something comes up that he wants to know more about, I have it there. I like my GI--he's a down-to-earth sort of guy, and I don't want to alienate him.
Zizzle, I had a blood test for two of the antibodies right after my colonoscopy, and they were both negative. I'll have to look again on Dr. Fine's site, but I think one can be GF for some months before the antibodies disappear from the stool, at least for his testing. It's good to know that the blood gene test is mainstream. He's more likely to go for that and because it is more likely my insurance will pay for it.
I will also ask him what diagnostic code he uses. Since the MDs do everything on the computer now, it is harder to peek and see for myself, lol.
Thanks again!!
Zizzle, I had a blood test for two of the antibodies right after my colonoscopy, and they were both negative. I'll have to look again on Dr. Fine's site, but I think one can be GF for some months before the antibodies disappear from the stool, at least for his testing. It's good to know that the blood gene test is mainstream. He's more likely to go for that and because it is more likely my insurance will pay for it.
I will also ask him what diagnostic code he uses. Since the MDs do everything on the computer now, it is harder to peek and see for myself, lol.
Thanks again!!
Marliss Bombardier
Dum spiro, spero -- While I breathe, I hope
Psoriasis - the dark ages
Hashimoto's Thyroiditis - Dec 2001
Collagenous Colitis - Sept 2010
Granuloma Annulare - June 2011
Dum spiro, spero -- While I breathe, I hope
Psoriasis - the dark ages
Hashimoto's Thyroiditis - Dec 2001
Collagenous Colitis - Sept 2010
Granuloma Annulare - June 2011
Marliss,
Enterolab's stool tests for gliadin, (gluten), will reliably detect gluten antibodies for at least a year after the GF diet has been adopted, and in some cases up to 2 years later, (but they would rather that you do the test before a year has elapsed, obviously, since the test can be unreliable, after that). They are much, much more sensitive than the blood tests, which become unreliable a few weeks to a month or so after the GF diet is adopted. The other food antibodies, however, do not have near the persistence as gluten antibodies, and they may not be reliably detected in stool tests after a month or so of excluding them from the diet has elapsed.
Regarding the diagnostic codes - now you see why some of us have always referred to MC as an "orphan disease".
Tex
Enterolab's stool tests for gliadin, (gluten), will reliably detect gluten antibodies for at least a year after the GF diet has been adopted, and in some cases up to 2 years later, (but they would rather that you do the test before a year has elapsed, obviously, since the test can be unreliable, after that). They are much, much more sensitive than the blood tests, which become unreliable a few weeks to a month or so after the GF diet is adopted. The other food antibodies, however, do not have near the persistence as gluten antibodies, and they may not be reliably detected in stool tests after a month or so of excluding them from the diet has elapsed.
Regarding the diagnostic codes - now you see why some of us have always referred to MC as an "orphan disease".
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.
I suppose we should rename MC "dietetic colitis." Interestingly, when I told my OB/GYN about the diagnosis and resulting diet (he's also a brilliant PhD chemist & knows a ton about all aspects of medicine -- I used to work for him), he didn't seem to recognize the term MC, then I said LC, and he said "Ahh, lymphocyte infiltration of the bowel wall!!" Then he wrote in my chart "food intolerances." I guess it's that simple... 
558.9 Other and unspecified noninfectious gastroenteritis and colitis
Colitis, NOS, allergic, dietetic, or noninfectious
Diarrhea, allergic, dietetic, or noninfectious
Enteritis, NOS, allergic, dietetic, or noninfectious
Gastroenteritis, NOS, allergic, dietetic, or noninfectious
Ileitis, NOS, allergic, dietetic, or noninfectious
Jejunitis, NOS, allergic, dietetic, or noninfectious
Sigmoiditis, NOS, allergic, dietetic, or noninfectious
558.9 Other and unspecified noninfectious gastroenteritis and colitis
Colitis, NOS, allergic, dietetic, or noninfectious
Diarrhea, allergic, dietetic, or noninfectious
Enteritis, NOS, allergic, dietetic, or noninfectious
Gastroenteritis, NOS, allergic, dietetic, or noninfectious
Ileitis, NOS, allergic, dietetic, or noninfectious
Jejunitis, NOS, allergic, dietetic, or noninfectious
Sigmoiditis, NOS, allergic, dietetic, or noninfectious
