What a Good GI Doctor Can be Like

[wonderwoman]

Matthew, Dr Fine at Enterolab is the one that recommends 8 Pepto Bismol a day for I think up to 2 or 3 months. My GI Doctor told me on Thursday of last week to switch to Imodium. The box says 4 a day but GI said I could take up to 8 a day. Since neither of them are stopping the D, I am not going to take them any more.

Gloria, you are right, my Imodium does have lactose in it. I had to get out the magnifying glass to read the small print. I am not dairy sensitive but have been avoidig it for a year.

I only use fresh vegetables and when I bought fresh green beans awhile ago and cooked them I ended up putting them in the food processor. I felt they were too coarse. Maybe I didn't cook them long enough. I even find frozen to be too chewy for me now. This week I bought canned green beans because they are softer. I can eat them cold right out of the can.

My daughter cut up squash, sweet potato and parsnips and baked them. They were so good. I bought some and because I don't like to use my oven in the summer I put them in the crock pot. The sweet potatoes gave a sweetness to the squash and parsnips. I will tell my DH he will need to eat the rest of them. I do love brocoli and cauliflower but thought they may be too gassy.

My fiber chart lists 1 cup of these cooked vegies as follows

asparagus 3.4, beets 2.85, broccoli 4.5, cauliflower 3.43, carrots 5.22, corn 4.66, green beans 3.95, peas 8.84, med. potato 4.80, spinach 4.32, sweet potato 5.94, summer squash 2.52, winter squash 5.74, tomato 1 med 1.00, 1 lg. parsnip 2.8

these are the vegetables I eat and according to this there isn't a big difference in the fiber content but I will try choosing some of the lower ones, except tomatoes.

Thanks for your interest. I appreciate everyones comments.

[MaggieRedwings]

Morning Charlotte,

So very sorry to read and hear what you are dealing with. You have already received many replies with great advice and I don't think I can add much there. The only thing I can see is that Dr. Fine no longer recommends the Pepto routine as a treatment.

I do hope you get better fast and that your new PC is a keeper.

Love, Maggie

[Rosie]

Charlotte, it's really tough to be going through a nasty flare after you were doing so well. I hope you get it under control soon. You certainly are doing a lot, and I hope that something works soon.

I just wanted to mention something. You said:

Gloria, you are right, my Imodium does have lactose in it.

I've found that all the generic loperamide I've come across contains lactose, but the brand name Imodium A-D caplets do not. The chewables look OK except for sucralose, if you are sensitive to that. The Imodium Multi-Symptom Relief also has contains the anti-gas simethicome. The chewable contains sorbitol and saccharine. The caplets look OK.

Rosie

[wonderwoman]

Just to let everyone know, I went off the Imodium today. With 21 episodes of "D" yesterday I decided they weren't working so why take them.

I am increasing my liquids because of the drop in my blood pressure. I purchased a sport drink yesterday but it doesn't taste that great. I wanted to make the drink I saw posted here. I made it several months ago but I can't locate the recipe. It had water, baking soda, and salt for sure. Maybe a little sugar but I don't know the amount of each. Can anyone give me the link.

I'm still waiting for the nurse to call me after the other GI doctor reads my report.

[tex]

I'm guessing this is the rehydration recipe you were looking for:

1 quart (950 ml) water
½ teaspoon (2.5 g) baking soda
½ teaspoon (2.5 g) table salt
3 to 4 tablespoons (45 to 60 g) sugar
If available, add ¼ teaspoon (1.25 g) salt substitute, such as "Lite Salt".
(source http://my.webmd.com/hw/health_guide_ato ... ar=hw86827 ).

From here:

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=992

Tex

[Gloria]

Charlotte,

How are you doing so far today?

Gloria

[harma]

good morning Charlotte, very sorry to hear things are going so bad and you can't reach your GI before monday. I hope the cause of your D will be found and with the right medication you feel better soon.

harma

[wonderwoman]

This really is a disease of trial and error! Yesterday (June 29) I quit the Imodium and until noon was still having D but not nearly as often, and then by late afternoon and evening I was much better. I am wondering if the Imodium was disagreeing with me because the longer I took it, it seemed the worse the D became. I did purchase the generic with the lactose in it without realizing it, however, I am not dairy intolerant per Enterolab. but still avoiding dairy.

At 4:30 yesterday the GI's nurse called me. She said the other GI in the office looked at my records, the lab reports from the stool samples on July 16 (negative again), the diary and records I brought in, and he recommended I NOT go on Flagyl, but instead he switched me from Balsalazide to Entocort. I said I was familiar with the drug. We were having a "microburst" at the time (high winds and a downpour of rain) so I didn't adventure out before the pharmacy closed but will get it first thing this morning. In fact we were disconnected as the phones went out at the clinic because of the storm. She called me again from her cell phone. I thanked her for spending time with me on Wednesday and for everything else she had done for me because this has been going on way too long. I hated to wait until my GI got back on Monday for his reply.

The nurse said I should continue taking the Imodium for several days yet along with the Entocort. I didn't tell her I wouldn't. I don't know if I should take the Entocort with food or not. My other RX I could take with or without food.

I mixed up 2 quarts of the rehydration recipe and am drinking it. It is better tasting than the sport drink I got, but that is gone now. I took my blood pressure several times this morning and it has gone up. 92/56 pulse 64, and 95/56 pulse 62.
Normal for me is about 103/60 and pulse 60 so I still have a little way to go.

Will get broccoli and cauliflower when I am out this morning.

Thanks to everyone for your help and support.

[Polly]

Good news, Charlotte!

I agree 100% with your doc's plan. I'm glad you will stay off of the Imodium. You know, you COULD be lactose-intolerant. Dr. Fine's test does not pick that up. So you could be negative for dairy (like you were) and still have a lactose intolerance. Maybe that's what was going on with the Imodium.

Smart thinking to make up your own electrolye solution. Gatorade is the pits for us - dyes, preservatives, phony flavors, too much sugar, etc. I tried some recently and had D within one hour of taking about an ounce. I can't imagine why that junk is still on the market!

Anyway, you are now on the road to recovery, and I couldn't be happier for you.

Love,

Polly

[tex]

Charlotte,

I'm glad to hear that your situation is rapidly improving. Kudos to the GI doc - I agree with Polly, that was definitely the best choice, IMO. And kudos to your doc's nurse, for going out of her way to help you. I hope your doc appreciates how much she contributes to his office.

Please keep us updated.

Tex

[Gloria]

Charlotte,

This really is a disease of trial and error!

You can say that again! I guess that's why I have some understanding of doctors' reluctance to deal with the dietary management of this disease. We are all different and react differently to a variety of foods.

I'm so glad you're feeling better and your blood pressure is up. Here's hoping that Entocort will be a miracle drug for you as it has been for so many of us on the board. I think you're smart to ignore the nurse's advise to continue taking the Imodium. Perhaps you are intolerant to lactose as Polly wrote.

Gloria

[Gabes-Apg]

Charlotte
hope things have improved and you got some support from the GI docs.

It will take time for your body to recover.

for 10 years i avoided gluten, yeast and lactose 85% of the time. with the MC diagnosis i went GF/YF/LF 100% within 5 months it became evident i was caesin intolerant and soy intollerant. I have given up all dairy and soy.

I think others have mentioned that 6 months into the diet other intollerances became evident, maybe you are super sensitive to Lactose and maybe the gel cap they are in??

Keep up a really bland high fluids diet, take it day by day.

take care

[wonderwoman]

Friday I wrote and said I had gone off Imodium on Thursday and my D gradually decreased. Then Friday morning I went to the pharmacy and got the Entocort. I am starting out on 3 Entocort a day.

I had “D” four times before 8:00am that Friday morning, one D at 10:00am, and then none until 5:30pm and then the stool was already firming up. Nurse wanted me to continue with the Imodium but I didn’t.

Saturday morning I took Entocort again and I felt great. Energy level was up. Blood pressure was normal again. And I did NOT have a BM all day long. How many months has it been I asked?

By Sunday morning I was bloated again and was concerned that now I would be constipated. I did have my first NORMAN today at 11:30 am. I told my husband I was going to mark it on the calendar in red letters.




I really wonder now if something in the Pepto Bismol I took for 3 weeks in June while on vacation and then for a week in July, and also the Imodium I took following that was causing me to have the severe diarrhea. Because I said over and over again it was not gluten, especially after getting home June 14 and I was doing my own cooking again. I may never know. But I will not take them again.

I plan on continuing with the strict, very simple, plain, GF,DF,SF diet. I will slowly add back my vitamins and minerals even though I don’t believe they were causing it.

On Friday afternoon the nurse called here to see how I was doing. I was not home at the time. She told my husband that I should call her if I had any questions. I want to thank her again when I see her for taking the time with me on Wednesday, and for asking the other GI doctor to look at my records so I wouldn’t have to wait until my doctor was back on Monday. Maybe I will send her a Thank You card. Yes, that’s what I will do.

I had asked if I should take the Entocort with food or on an empty stomach and no one replied. I couldn't find the answer anywhere when I googled it.

Polly wrote

You know, you COULD be lactose-intolerant. Dr. Fine's test does not pick that up. So you could be negative for dairy (like you were) and still have a lactose intolerance. Maybe that's what was going on with the Imodium.

I thought about this all week end and didn’t understand it. After re-reading it again I do understand it. Dr Fine does not test for lactose intolerance. And because I am not dairy sensitive, even though I am avoiding it, if I read that something like Imodium had some lactose in it I might think it was OK to consume because it’s not like drinking a whole glass of milk or a container of yogurt. Where I don’t eat items with soy or gluten. I am on my third contact lens prescription and still can’t see to read. The fourth trial pair should be here this week. It is terrible to try to read labels even with a good prescription.

Maybe I'll have a clean toilet again!

[Joefnh]

That's great that the meds are starting to work Charlotte, I was getting concerned at the level of D that you were experiencing.


I hope your healing continues

Best wishes

--Joe

[tex]

I had asked if I should take the Entocort with food or on an empty stomach and no one replied. I couldn't find the answer anywhere when I googled it.

Sorry I missed that. The official label does not have any such restrictions, (except to take it in the morning, take it whole, and DO NOT take it with grapefruit juice) - IOW, it can be taken either on an empty stomach, or with food.

The thing about lactose intolerance is that anytime we have enteritis, (intestinal inflammation), our small intestine attenuates the production of lactase enzyme, and if the enteritis goes on long enough, or is severe enough, in some cases lactase production can be terminated completely. After the production of lactase enzyme is depressed, the other enzymes, in order, will follow suit. This is true for everyone, whether they have an IBD or not. When the enteritis passes, the enzyme production will resume, but lactase will be the last to be restored. That's why we have to automatically assume that we are lactose intolerant when we are reacting, whether we are casein sensitive, or not.

Tex