My husband's doctor put him on Entocort and Asacol HD. After reading about taking both here he decided to stop taking the Asacol, especially since it never seemed to help when taking it alone. A few days ago he noticed that almost immediately after taking the Entocort his stomach felt weird so he decided to try going without it. He still had the D but it wasn't quite as bad and there were no signs of blood, which he had been having. Note, the blood was a small amount.
Friday evening he took one Entocort, had the weird stomach feeling again and was back to watery D with blood in it. We both think this is a reaction to the medication. Any thoughts or comments?
He sees the doctor again in about a month and we're preparing a list of comments and questions. I've decided, and DH agrees, that the doctor is going strictly by the textbook regarding treatment. When he put Jerry on the Entocort he stated that it would be forever.
Barb,
I chose not to do the Entocort that my GI prescribed after my colonoscopy and dx w/MC. Others here have had good and bad reactions to Entocort and I'm sure they will respond to you. IMO, if he wasn't having D w/blood in it before the Entocort, he shouldn't keep taking it.
DON'T let his doctor make him wait a month before he can see him, if he's got blood in his stool then he needs to be seen Monday morning at 8AM. Don't wait and be patient for the Dr's schedule, Jerry needs to see him ASAP, and yes, his doctor is going textbook, squeaky wheel = action - my 2 cents. Almost none of our doctors haven't gone textbook on us. NO steroid should be forever, IMO, and if his Dr. said that then he's an ass and you need to find another Dr. as this guy clearly isn't a healer.
We are what we eat, it's a puzzle, but diet is the answer - not drugs.
Connie
Resolved MC symptoms successfully w/L-Glutamine, Probiotics and Vitamins, GF since 8/'09. DX w/MC 10/'09.
As I said, the blood isn't much and has been there on and off for awhile. We've been thinking it's from hemorrhoid irritation. The doctor (or his nurse on most calls) has been made aware and the pat answer is to bring in a stool sample. According to Jerry's primary doctor, this guy is the best but that's just one person's opinion especially when our endocrinologist, who IS the best, just said that he knew the GI doc and made no other comment. That's a thing that makes me go hmmmmmm.
Again, sorry for rambling but I'm totally stressed out and I know y'all can relate to that.
I have been having small streaks of blood in my stool. I have no history of hemorrhoids, but both Polly and Tex suggested it could be internal hemorrhoids. I wonder if that's what your husband is suffering from?
I agree with Connie. Do get in touch with your GI and let him know about blood in the stools. Also, entocort for life without adequate testing? Or even with? I don;t think so.
Can you try another doc? Can you ask your endocrinologist to suggest someone for you?
According the colonoscopy he does have some internal hemorrhoids. I've sent an email to our endocrinologist asking if he could recommend a good GI. Jerry is wondering about a holistic practitioner but I doubt that would be covered by Medicare.
Good news, he has agreed to a gluten free diet after my rant this morning.
The bleeding almost certainly is from 'roids, because anything more serious would have been noted on the endoscopy, (colonoscopy), report. Hemorrhoids are a very common problem for anyone who has frequent D, especially the high-volume D that can occur with MC. Of course, if your husband happens to have diverticulosis, then it is possible for a diverticulitis infection to cause a blood vessel to fail, due to local trauma.
Therefore, any bleeding that involves a significant volume, (even from 'roids), certainly needs to be investigated, as such a situation can become life-threatening in a hurry - I speak from experience. Issues such as that are often genetic, so his family's history might be helpful as a guide, though it shouldn't be relied on 100%. If he has diverticulosis, it would also have been noted on the endoscopy report. In this case, though, it certainly sounds as though hemorrhoids are the likely cause of the bleeding.
Not to defend his doctor, but we can't really fault him for "going by the book". Unfortunately, that's the safest route for him to follow in the litigious society we live in, and in some cases, insurance companies may not pay, if a doctor deviates too far from the diagnostic and treatment routines generally accepted by the profession as "preferred". If doctors throw caution to the winds, and use a treatment protocol considered to be radical, or "unacceptable" they do so at their own risk.
Neither bleeding, nor diarrhea, are known side effects of orally- administered Entocort/budesonide, but that doesn't mean that it isn't possible - it merely means that it may be a rare side effect. Considering your husband's sequence of experiences, it certainly appears that the bleeding is connected with taking Entocort. The connection may be as simple as increased D, which leads to increased hemorrhoid irritation, but I have no idea why it would trigger D. He may be allergic, (or intolerant) to one of the ingredients, though they all appear to be innocuous.
Is he by any chance taking a PPI? The enteric coating used for Entocort prevents it from being activated until it reaches the ileum and the colon. If he has a noticeable stomach reaction, then something is definitely wrong - maybe he's reacting to the ingredients in the capsule itself, but they are merely gelatin, iron oxide, and titanium dioxide. If a PPI, or some other mechanism, were to cause a huge drop in the acidity of his stomach, then the drug could become activated prematurely, which could result in stomach symptoms.
I wish I could suggest another medication, but unfortunately, I'm not aware of any that he hasn't already tried, that might be more effective, and problem-free. An immune system suppressant, (such as Imuran), would be the next step up the ladder, and that isn't exactly a risk-free treatment - it requires careful monitoring of liver enzymes, etc.
That means that you may need to really concentrate on fine-tuning his diet, to make absolutely sure that he doesn't get any cross-contamination, and all of his food-sensitivities will eventually need to be determined and eliminated from his diet, in order to attain and maintain remission by diet alone. If he's already agreed to try the diet, though, then he's made the first, (and most difficult), step toward getting his life back. Good for him.
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.
Tex, I can't answer about PPI as I don't know what that is. The only other thing he's taking right now is Culturelle, metformin and glyburide and the last two not often. OH! When the doctor recently put him back on Flagyl, he had the same type of reaction - a burning/weird feeling in what he says is his stomach and worse D. We assumed he had developed an intolerance to it.
Initial, incomplete colonoscopy did show diverticulosis but the complete one didn't. Also, no polyps or anything else ugly other the the roids.
I'm off to Whole Foods to see what I GF stuff I can find and afford.
PPI stands for proton pump inhibitor, frequently prescribed for GERD, heartburn, acid indigestion, acid reflux, etc.
The metformin and glyburide pinpoint the likely problem. Didn't your doctor explain that a corticosteroid such as Entocort may cause problems for someone with diabetes? It can cause a serious blood sugar issue. That's probably the source of the symptoms that he experienced. Some diabetics can safely take Entocort, and some can take it with a dose adjustment, (or an adjustment of their diabetes medication/s), but it just doesn't work for some people. Some patients have reported a connection between the use of Flagyl and diabetes, also. His GI doc needs to spend some time updating his knowledge of diseases and drug interactions. Even I'm aware of these drug connections, and I'm not a doctor, nor do I have diabetes.
If you want to try a remedy that may allow him to use Entocort, some people in that situation have been able resolve the issue by taking supplemental chromium, (corticosteroids deplete chromium), to allow them to use Entocort.
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.
Nope, not a word about drug interaction or the efects of the drug on somebody with diabetes. Since Jerry hasn't been eating much he's not been taking the metformin and glyburide much because his blood sugar has been going too low. It's a vicious cycle.
