Help! I don't know where to begin...

Personal experiences with various medications used to control the symptoms of Microscopic Colitis and related issues, should be posted here.

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jane6volt
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Help! I don't know where to begin...

Post by jane6volt »

Hi- My name is Jane, and I was diagnosed with MC about 7 years ago. I had a colonoscopy at that time, which is when my initial diagnosis was made. Since then, because I changed doctors, I had a second colonoscopy about 3 years ago. First, I'll give you some history about myself. I am also a Type 1 diabetic, and have been for 40 years. Though I have had good control of my diabetes at times, I have also had horrible control at times, particularly now, because MC makes it nearly impossible to control my diabetes. I have also been diagnosed with kidney disease ( though they say it hasn't progressed, thank goodness), and diabetic retinopathy ( which also has remained stable since laser treatments on both eyes).

When I saw my first GI doc, and was diagnosed with MC, he presribed Entocort. It literally worked like a dream at the time, and I thought that MC was never going to be a problem again. I was able to resume eating without the effects of diarrhea at all. Unfortunately, that "honeymoon" only lasted a short while - maybe 6 months or so. This doctor was great, and tried other options. I don't remember what exactly he tried ( they were different types of medications in addition to the Entocort), but nothing seemed to work. My husband was transferred with his job, so I left that doc before he really had a chance to try many things. I really felt like he would have tried everything possible to help me, if we hadn't moved. I have since seen 3 other docs in our new area (St.Louis), and have basically been told that there is nothing else that they can do for me, except have me take the Entocort and literally live on antidiarrheal meds ( which take forever to work, if they even do work... I always start out with 3 antidiarrhea pills, and can take up to 10 before they MIGHT begin to work. Same with Pepto Bismol. I'm afraid to do this all of the time, because it can't be good for you to take that much, and only do it when I simply don't know what else to do.

I had found "relief" in that I could actually go to work ( or wherever), if I didn't eat anything at all, all day. I wasn't having diarrhea episodes when I didn't eat, and this is what I have been doing for years. It is not the ideal thing for a Type 1 diabetic, but I am on an insulin pump, so it was manageable - just not the best thing, because when I have arrived home, due to starvation, I have eaten quantitites that do not allow me to keep my blood sugars stable - just because I have been literally starving all day until I got home... I have noticed that the MC has gotten much worse recently, to the point that I can easily have diarrhea so often that I don't count it, AND that I get diarrhea even if I haven't eaten ANYTHING AT ALL. How is that even possible? At a recent visit to my nephrologist (kidney doc), she found that I have low electrolytes , which explains my horrible cramps that I get so often in my feet, legs, ankles, etc. I wasn't surprised when that came up in my last blood work. In fact, I am now looking at the clock and it is 2:48am. Tried several times to sleep, but since I had one of my episodes with nonstop diarrhea all day, I know that my electrolytes are way down. I have already drank 1 1/2 33 ounce bottles of Smartwater, and drank pickle juice ( which usually helps), and drank sugar free tonic water (supposedly the quinine helps with muscle cramps) to try to replenish my electrolytes and get rid of my cramps in my feet so I can sleep. No luck, so here I am.

All I can say is, MC is literally ruining my life, and I don't know what the next step is. I don't know what doc to see now, because the last 3 that I have seen in St. Louis haven't helped at all, and honestly just really didn't seem to care. I am frustrated and need someone to help me - to either find a good doc that will help, or advise me on what to try now. I have seen that gluten free diets are recommended here, but my question is, are they doable without spending a fortune? Money is an issue for me, and I know that I can't afford a diet that is going to be costly. Our insurance had been great up until last year when we got a plan with a huge deductible, so even seeing a new doc is difficult, though I am willing to try a doc that someone has seen (in the St. Louis area), who has been able to help with MC. I just don't want to go through what I have been going through for so long. I am becoming frustrated to the point that I don't know how much longer I can stand this. It is ruining my life. Please, please help!
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tex
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Post by tex »

Hi Jane,

Welcome to the board. I'm sorry that you have been unable to find relief for all these years. Yes, despite most doctors' rather cavalier attitude about this disease, MC can be quite debilitating, and it can be extremely difficult to control the symptoms, especially for someone who has diabetes, because most doctors don't actually know how to control the disease over the long term, due to the fact that only a handful of them are beginning to recognize the diet connection. But controlling the disease is certainly doable, with dedication, patience, and perseverance.

MC is the result of severe inflammation in the intestines, and often in other digestive system organs as well. It can be caused my a number of possibilities, but the most important triggers are stress, certain drugs, and sensitivities to certain foods in our diet. When the genes that predispose to MC are triggered, the genes that predispose to certain food sensitivities are triggered at the same time for most of us. Drugs can reduce the inflammation, but they can't prevent the generation of additional inflammation. Only diet changes can do that.

Entocort is the most effective relatively safe drug that is available to treat this disease. For some patients, Entocort can mask their symptoms, but for others, is it not up to the job if we continue to either take a drug that is triggering our symptoms, or if we continue to eat the foods that are causing our inflammation.

Since there are a lot of drugs that can trigger MC, the first thing to do is to determine whether you may be taking any of them, because as long as you take them, you will probably be unable to control your MC symptoms, no matter what other steps you take. These drugs include antibiotics, PPIs, SSRIs, SNRIs, bisphosphonates, statins, beta blockers, and some of the older types of antidepressants. Even HRT and/or other hormonal supplements can prevent remission for some women.

The reason why MC can cause diarrhea (D) even when we are not eating, is because it causes what is known in medical circles as secretory diarrhea. With secretory diarrhea, instead of the colon removing water and electrolytes from the contents (as it is designed to do), it infuses (injects) water and electrolytes, and that can cause watery D even if we stop eating. And that is what makes MC such a dangerous disease, because we can become dehydrated and deficient of electrolytes before we realize the seriousness of the situation.

You will need to make diet changes in order to get your life back, and that will take some careful planning, but fortunately we have other members who are also dealing with the same issues (diabetes and MC), and they can be great sources of support and support, by sharing their own experiences and how they are treating the issues. And there is no reason why the diet should be unduly expensive, because the best way to remove contaminants from the diet is to avoid all processed foods, and cook from scratch, using only whole, safe foods that can be found around the perimeter of most grocery stores.

The first order of the day is to see if you might be taking any drugs that are causing your inflammation. If you will list them, we'll try to determine whether any of them might be contributing to your problems.

Again, welcome aboard, and please feel free to ask anything. Also, you will probably receive many more responses if you post on the Main Message Board, because many members don't usually read posts in these forums that are further down the list.

Tex
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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.
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Post by JLH »

:welcome:

You have found the best place in the world for info and support. Start with the info for newbies and ask questions and use the site search feature after you make five posts. :oops:
DISCLAIMER: I am not a doctor and don't play one on TV.

LDN July 18, 2014

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Post by tex »

Joan,

Newbies can't use the site search feature until they have written at least 5 posts. That restriction prevents spammers from signing up and harvesting our email addresses and other information before they can be tracked down and their membership removed.

Tex
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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.
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Post by MBombardier »

:wave: Welcome, Jane!

When I did some research a year or two ago, I discovered that one of the genes for gluten intolerance is a gene that also causes Type I diabetes. I found this very interesting, as a young friend of mine has Type I diabetes, and his uncle, aunt, and cousin all suffer with various food intolerances, especially gluten. The whole family, which has numerous members, is precious to me and it is hard not to be able to leap in the middle of things and educate them. I have dropped a few nuggets, but...

Eating gluten-free does not have to be expensive. What is expensive is buying gluten-free products. I'm not going to buy four gluten-free buns for $5 when I can make eight of them for maybe $2. St. Louis is big enough to have some stores where you can buy things in bulk. Buying gluten-free flours like rice, sorghum, millet, tapioca, etc., in bulk is significantly less expensive than buying them in little packages. Even Whole Foods has some bulk stuff.

I did a quick internet search, just for fun. St. Louis is in my old stomping grounds--I graduated from high school in Salem, MO, went to Stephens College in Columbia, and still have lots of friends in Missouri, including one in St. Charles. These people http://wildgourdfarm.wordpress.com/ would probably be very helpful to you in hooking you up with gluten-free resources. I would talk to them about Azure Standard. If you are not familiar with Azure, this is a company that sells lots and lots of stuff in bulk. People get together and develop an order, which is dropped off at someone's house (a designated Azure drop house), then everyone divides up their part of the booty.

Something else that a lot of people don't realize is that when you go gluten-free, the money that you would spend on processed foods goes to things like vegetables, fruits, meat, so there is not so great a difference in expense as you might think. As Tex said, shop around the edges of the grocery store and cook from scratch. :smile: If you need recipes there is Dee's Kitchen here on the forum, and there's Pinterest. I love Pinterest--I am continually amazed at all the wonderful recipes that are GF/DF/SF and whatever-else free.
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jane6volt
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Post by jane6volt »

Thank you soooo much for your support and kind words. I know that this is the place to begin to look for help, and I am looking forward to getting to know others who have found relief from MC. I began looking today at grocery stores in my area for gluten free foods, and have subscribed to a woman's pinterest site who cooks only gluten free for herself and her children.

In all honesty, I don't take very many medications. I take Apidra insulin via my insulin pump, Entocort (though I am almost out and will need to find a new doc to get a refill), 2 80mg aspirin (to prevent heart attack and stroke risk from the diabetes), 10mg of Lisinopril for my kidney disease, and I take Tylenol and Tylenol PM occasionally, as needed. I do take a multivitamin for women each day, and in the winter, I take Vitamin C. Other than the Pepto Bismol and anti-diarrhea medicine, that's it. Would any of these be possible triggers, Tex?

That is interesting that the gene that causes diabetes also causes gluten intolerence. My mom has been diagnosed with celiac disease, but she has a non symtomatic type, and since she doesn't have symptoms, she doesn't follow the diet. The problem is, her body is not using the nutrients properly, and her doctor really feels that she needs to follow the diet. She is stubborn though, and won't budge. All of my children have very sensitive stomachs, and I am constantly worrying that they too will be plagued by an autoimmune disorder. It is true that they definitely seem to run in families. I appreciate the link to wildgourdfarm and your information about Azure Standard. I will definitely take a look and see what resources they have available. I think that Trader Joe offers quite a few bulk options as well as gluten free. I will check there and at Whole Foods once I look through some of the recipes to see what I will need. This is going to be a challenge, but I am more than up for the challenge as long as there is some kind of relief in sight!

Thank you again for your help. My son is the one who insisted that I reach out to folks on this website, and I am glad that he did!
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Post by Gloria »

Welcome Jane!! :wave:

The 2-80mg of aspirin most certainly could have caused your MC since there is a known relationship between taking NSAIDS and MC. I used to take a daily maintenance aspirin dose before I got MC (my parents both had strokes in their late 60's). I no longer take it because of my MC. My parents were both smokers, and I'm not, so I'm hoping I'm not as high risk as they were.

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Post by tex »

Jane,

It's typical for synthetic insulin to trigger the production of antibodies in the body (which surely causes some degree of inflammation), but as far as I'm aware, those antibodies are not normally associated with the inflammation that leads to MC. Unfortunately this is just a fact of life for anyone who has to deal with Type 1 diabetes, since you can't do without the insulin supplement. Tylenol (and presumably Tylenol PM) shouldn't cause any problems, and the Pepto-Bismol should be OK if you haven't noticed any obvious side effects from it by now.

Whether or not the multivitamin might cause problems depends on its inactive ingredients, and whether or not you are sensitive to soy (since soy is a common ingredient in many vitamins). Some of us have problems with ascorbic acid (vitamin C), but that doesn't necessarily apply to everyone here. Some researchers have associated ACE inhibitors (such as Lisinopril) with MC, but it's not a strong association, so the odds are relatively low that it might be a problem for you.

I agree with Gloria that the biggest risk is the aspirin, because NSAIDs are strongly associated with MC. Still, there's a chance that it might not trigger MC in your case, but it's a significant risk, unfortunately. I wonder if you could take something such as Plavix, or the generic (clopidogrel), instead? I take clopidogrel for stroke prevention. Plavix is relatively expensive, but the generic is more reasonably priced. Your doctor would surely be able to advise you on whether or not this might be a workable option for you. It requires a prescription, of course.

Another thing that bothers me about the aspirin is that aspirin can increase the effects of insulin glulisine and cause your blood sugar levels to get too low. It's a known drug interaction for Apidra, so perhaps your doctor has already discussed this with you, and the two of you have decided that it is not a reason for concern in your case, and/or you have adjusted your insulin pump to compensate for this interaction.

FYI, if you are taking the vitamin C to boost your immune system, and/or to increase your resistance to colds or viruses, you will find that vitamin D is much more effective for boosting the immune system and warding off viruses. Most of us who have an IBD or other autoimmune issues tend to be either deficient or insufficient in vitamin D, and research shows that vitamin D deficiency significantly increases the risks of developing additional autoimmune diseases.

You're very welcome,

Tex
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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.
jane6volt
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Post by jane6volt »

Thanks so much for your help and thoughts on the meds that I take, Gloria and Tex. I looked at the label of the multivitamin and it does say "Gluten Free". Would that mean that it shouldn't contain the soy? I can look at it again to check for soy. I will talk with my endocrinologist about switching from the aspirin to something else - the clopidogrel, if possible. He has been wonderful about prescribing anything possible in generic form, so I know that won't be a problem, as long as he feels that it is something that will be a replacement for the low dose aspirin and stroke prevention. Unfortunately, I know that they will keep me on the ACE inhibitor, no matter what. I have early stage kidney disease, and the ACE Inhibitor is something that I need to keep it in check, unfortunately. :sad: I really hope that it is not what is causing the problem for me... I have been taking it since 1994, and I know that the MC started (much, much less severe) way back in 1989. That was long before I took the low dose aspirin for the diabetes, but as a child I took aspirin frequently. Makes me think that maybe the aspirin was the culprit.

I wasn't aware of the fact that Vitamin D was effective for boosting the immune system. I will definitely try the Vitamin D. Any particular type of Vitamin D? I know there are different types, and I am not knowledgeable about them at all. One of my docs did blood work several years ago and found that my Vitamin D was low and prescribed a high dose of it. I don't know if blood work has been done recently to check that. I will mention it to my endocrinologist when I see him in September. The endocrinologist that discovered the low Vitamin D moved away, and I am not sure if this one has checked it in the past 2 years that I have been seeing him. Thanks so much for your insights. I am working on the gluten free diet now. That is going to be the biggest challenge for me, I think. But, if it will help, it will definitely be worth it.

Thanks again for all of your thoughts and help!
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Post by tex »

When the label on a vitamin product (or anything else, for that matter) says, "Gluten Free", but doesn't say "Dairy Free", or "Soy Free", it's usually safe to assume that the product does indeed contain dairy and soy ingredients.

If you can find a substitute for the aspirin, so that you can totally avoid NSAIDs in the future, that may be very beneficial for helping to control your GI issues.

Most prescription vitamin D is in the form of vitamin D2, while most over-the-counter vitamin D is vitamin D3. Why doctors prescribe vitamin D2 is beyond me, because tests show that vitamin D3 is much more effective for most people. If you were low on vitamin D several years ago, and you are not still taking a supplement, then the odds are very high that you are vitamin D deficient now. If your doctor won't agree to that test, you can order a test kit yourself (for $65, more or less). That's what I did, the last time I was tested, because my doctor never remembered to order the test.

I had been taking an average dose of around 2,500 IU of vitamin D per day in the summer, and around 5,500 IU per day during the rest of the year, and I live in sunny Central Texas. My vitamin D blood test results {the 25(OH)D test}, usually run in the 45–55 range. I'd like to see it a bit higher, so I've increased my dosage by 1,000 IU per day since the last test result (which was 55).

Tex
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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.
jane6volt
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Post by jane6volt »

Thanks, Tex -I haven't been on here for awhile, so sorry for such a late reply. I have started the gluten free diet, and have a lot to learn, but am doing my best. I have found out, through much research, about a doc here in St. Louis that is supposed to specialize in MC. He is in the same practice with the one that I last saw, so she must release me from her care before I can see the new doc, but the receptionist said that it shouldn't be a problem. As soon as that happens, I will make an appointment with the new one - my fingers are crossed!. I will ask either the new GI doc or my endocrinologist about being tested for low Vitamin D - whoever I see first. Thanks for the info about the diferent Vitamin D's. It is good to know that Vitamin D2 is the one to take.

Thanks again for your help! :smile:
Jane
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Post by tex »

Jane,

No, no, no — it's better to take vitamin D3. D3 usually provides faster results for most people. Either one will work, it's just that D3 seems to work better than D2 for most of us.

Good luck with the diet. It's never easy to get used to such drastic diet changes, but as time goes on, it gets easier, and eventually the new diet becomes the norm. And as we start to feel better, it's easier to appreciate the diet changes.

And good luck with your new doctor. Just remember that it's still very difficult to find a GI specialist who realizes that diet is the key for controlling MC. They are slowly learning, but unfortunately the medical schools are way behind on this issue, so doctors don't get the training that they need. Most of us just have to make the diet changes on our own, despite what our doctors tell us. Maybe you will be lucky though, and your new doctor will be one of the enlightened ones.

Tex
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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.
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