New approach from my Consultant

[fatbuster205]

Hi Guys,

Had an interesting appointment today with my consultant, Dr Patterson of the Royal Victoria Hospital, Belfast. I haven't seen him for a couple of years - often I get to see the juniors or the specialist nurse. My symptoms have remained stable in so far as it is normal for me to go between 5 and 9 times a day - usually 4s and then down to 1 on the Bristol Stool Chart! (I have been known to do the entire stool chart in a day!).

Anyway he said would I consider going back on Entocort but I explained I would not be happy about weight gain. The other meds e.g. pentasa have never worked for me. So he has decided to go back to starters and do a colonoscopy again because he has never done one on me. I changed consultant because the original guy was a dinosaur! He explained that things have moved on so much over the last 10 years but he wants to do a number of biopsies. Plus he is wondering whether I might have bile salts getting into my large intestine and or pancreatic malabsorption. I have very rapid transport - food goes through me at the slowest in 12 hours and usually much less. Plus my stools when very loose are often very yellow in colour!

He is taking me off lansoprazole and putting me on a different med. I take it for two reasons - acid and asthma so it is a bit more complicated than just plain acid.

I have to deliver some stool samples (because he now knows these give better results when looking for inflammatory markers - things really have moved on and I think he might have read the copy of your book, Wayne, that I gave him!!!). Also have to have a scan. I have generally felt quite well this last couple of years and frankly got used to my ridiculous and unpredictable bowel movements. However, the frequency and urgency (and occasional incontinence accident) he feels is not acceptable so here's hoping I get some good answers.

There has definitely been a huge change in approach in Northern Ireland about microscopic colitis. He is keen to check exactly what type or types I have and to resolve the problems. 100% behind my diet. It so refreshing! Normally NHS appointments, particularly with a consultant, are 15 minutes maximum. I was with him 45 minutes and had a really good conversation. I am happy with his plan and he is not giving me klean prep but something that does the same job but only involves 2 litres rather than 4!!!

So watch this space over the next 3 or 4 months while this all happens!! I will stay in contact!

Regards,
Anne

[tex]

Hi Anne,

You've definitely got a keeper there. That sounds very encouraging. Yes, bile acid malabsorption (BAM) in your terminal ileum could be the remaining problem. The terminal ileum is where unused bile acid is normally absorbed and recycled. But MC often causes the terminal ileum to be inflamed, and when the inflammation is severe enough, the colon may be getting flooded with bile salts, which of course can cause diarrhea.

I understand that physicians in Europe have a test for BAM, so you have a good chance of finally getting some answers. Here in the U. S., physicians have no approved test to detect BAM. It will be very interesting to see how this plays out.

Thanks for sharing.

Tex

[fatbuster205]

Just to update you all - I am now awaiting an appointment for a colonoscopy and am booked in on 3 January for a NM Radionuclide Sehcat Bile Study, going back for a second scan a week later. Interestingly enough I have always thought there was a problem with my terminal ileum and since reading up a bit, this approach definitely is worth exploration. So I might have a little glow in the new year!!
Anne