Dr Appointment

cludwig · Post by **cludwig** » Fri Oct 27, 2006 9:26 pm

Hi Friends,

It has been a crazy week...but I've been dying to tell you all about my Dr. appointment. Dr. Alexander had recommended that I have a phone consult with a Dr. Gallan in NY. He said he thought he was one of the best digestive disorder docs he'd ever met...so I said let's see what he thinks.

A few days before that appointment I was going through some old medical records and I found a 2002 lab results that I had done in my attempt to see why I never felt 100%. It was a stool test and one thing that it tested for was chymotrypsin. Chymotrypsin is a marker enzyme for pancreatic output. A low value suggests poor pancreatic output of all enzymes. Normal is above 9...poor is 4-9 and mine was 3. I remember at the time taking this test into my GI and asking what it meant and he said "nothing" and gave me more prilosec. The test also said I tested pos for C-diff...but I never had D till after surgery.

So, I show up with this lab and Dr Alexander had results from a stool test from a couple of weeks ago and they show large quantities of undigested meat and vegetable fibers. I also test positive for trypsin ( suggests rapid transit time), ph is high at 7.4, and butyrate is low at .11 ( normal is .65-3.84).

My meeting begins with Dr Gallan and they both say I must start using pancreatic enzymes as my body is clearly not making any at all. They stressed how important probiotics are and that it would be worth trying to find a brand that works for me. Then he started talking about D and colitis in general and had some interesting observations. He said in his most difficult D patients that what ends up being the problem for a good majority is an underlying yeast infection. Yeast has never been detected in any of my stool tests and I've never had a vaginal yeast infection...but he said that the yeast is very difficult to detect with a stool test. He said that the weird bacteria in my gut is a symptom of a problem with yeast and I won't be able to correct that without first correcting the yeast issue.
I'm not sure about this...but I am seriously considering this because I continue to have tiny air bubbles floating up from my poop to the top of the toilet water.

His take on D in the morning compared with D after meals (after you have eliminated all allergic foods) is that D after meals can be occurring because a person makes too much acid and it irritates the small intestine and causes it to contract. With morning D he says that it can be caused by bile acids leaking out of the gall bladder and pooling in the small intestines
and causing them to contract in the morning. He said for symptom relief you can take cholystyrmine or chitosan right before bed to absorb the acid before it has a chance to irritate the small intestine.

I started Sunday taking slippery elm and all three pancreatic enzymes....and so far I am tolerating both really well....too soon to make a call on whether or not they are working....but I am just excited that they are not making me ill. I am still thinking about the anti fungal medication. Has anyone tried Diflucan before?

Anyway...no one yelled at me or treated me like an idiot....it was actually pleasant and useful. There's hope!

Love,
Cristi

mle_ii · Post by **mle_ii** » Sat Oct 28, 2006 12:22 am

Wow, very interesting stuff indeed. In fact my recent readings about MC/LC/CC and IBD and a few other reasons led me to investigate issues with the gallbladder. Still more to investigate, but given what vitamins I don't absorb as much of, and others having issues with bile acid and/or gallbladder I'm thinking this could be related. Perhaps damage done to the ilium (the last part of the small intestines) causes this lack of B vitamin absorbtion along with this being the area that reabsorbs bile acid. Some other key absorbtion gets done here as well.

One other thing that led me down this path was the recent study I read and how it mentioned that the inflamation was larger in the ascending colon and progessively has less inflamation the farther into the colon where near the end there isn't much inflamation at all. And since bile acid is supposed to be absorbed just above the first part othe colon (ascending) perhaps the bile acid is part of the cause of inflamation.

Here are a couple of related studies:
This one points towards bilirubin being higher in Crohn's than normal.
http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Here's info about Xanthomas on the eyelid. (which I have).
http://en.wikipedia.org/wiki/Xanthelasma

Another article about bile acid having more cholestanol (please not the different spelling) than it should for folks with xanthomas.

What is of further interest is that Vitamin D also is part of the path towards making Bile Acid and Sterols.

kate_ce1995 · Post by **kate_ce1995** » Sat Oct 28, 2006 6:15 am

That sounds like a most positive meeting! I hope this is your silver bullet!

As for the diflucan, I had a chronic vaginal yeast infection for years. GYN said it was hormonal and if it didn't bother me all the time there was nothing to do. Well, then I change docs and she says, yes we treat. One dose of diflucan and I never had another vaginal yeast infection!

I have wondered about intestinal yeast myself too. Especially since I am a sugaraholic! Do let us know how you are doing.

Katy

Post by **tex** » Sat Oct 28, 2006 8:30 am

Hi Cristi,

Congratulations on a positive experience with the medical world. It's about time you got some cooperation and helpful advice from a doctor.

Yes, yeast is a very insidious parasite. It's a major cause of leaky gut syndrome, for example. If it is indeed overrunning your digestive tract, however, you should occasionally have visable signs of the problem. For example, at one time or another most sufferers of candida have thrush, (white tongue), anal itching, or some other indication of it's presence, (such as an unexplained and strong craving for sugar, or carbs).

I'm concerned that none of your doctors seems to be addressing the primary issue, however - namely, very inadequate gastric acid. This, and this alone, is most likely the cause of the undigested proteins in your stool. You can never have proper digestion, with a gastric pH level that is way too high. Have you ever been tested for somatostatin level? I'm beginning to suspect that you might be having a problem with proper regulation of somatostatin levels. If that's the case, it could be the cause of the low gastric acid problem, and it could also be the cause of pancreatic malfunctions, (and various other things).

An oversupply of somatostatin would suppress the hormone known as "gastrin", which, of course, would interfere with the production of gastric acid. The production of somastatin is regulated by several organs, one of which is the hypothalamus, which I believe you have suspected as a possible source of trouble at one point in the past. Here's some info on the relationships among the various gastric chemicals and hormones:

http://en.wikipedia.org/wiki/Somatostatin

Here's some additional background information that you might find helpful:

http://tjsamson.client.web-health.com/w ... adder.html

Love,
Tex

starfire · Post by **starfire** » Sat Oct 28, 2006 8:30 am

Your appointment actually sounds like an exceptional experience. How nice to be taken seriously and an effort made to resolve your problems. I think you were one lucky lady and I surely hope the new treatments work well for you.

Love, Shirley

JJ · Post by JJ » Sat Oct 28, 2006 9:34 am

Congrats on finding a great doc!

JJ

cludwig · Post by **cludwig** » Sat Oct 28, 2006 10:46 am

Hi Friends,

Mike...the bile acid info is interesting. The Dr whom I am seeing at the Mayo Clinic has published a paper on MC and in it he talks about patients who test positive for excess bile acid being common among MCers and that the ones who don't test positive for excess also responding favorably to cholysteramine to control D.

Katy...I've always been ruled by sugar as well...I worked really hard at not giving in and eating huge amounts. I tried to have one sweet a day after dinner....but I would think about that goodie all day.LOL We get tons of trick or treaters at halloween, so we have lots of candy in the house right now. The peanut M&Ms are calling to me constantly. Man it's torture giving those up.

Tex...That's a really good observation...I need to look into this somatostatin. My stool test from 2002 showed my ph as being 5.0....and that was while I was taking prilosec....so something has changed. Also thank you for pointing out that adrenal stress can cause my stomach to not produce the protective agent it needs against stomach acid. The burning sensation in my stomach is really improved since I started taking the slippery elm.

Thanks for the support Shirley and JJ. Unfortunately this is the Dr who is leaving in a few weeks to go to Fla. to be with his girlfriend. Lucky women...he seems like a great person.

Love,
Cristi

artteacher · Post by **artteacher** » Sat Oct 28, 2006 11:25 am

Thank you SO much for sharing your telephone consult. These things just ring "true" to me. I hope everyone reads your post.

Love, Marsha

grannyh · Post by **grannyh** » Sat Oct 28, 2006 12:11 pm

Interesting about the gall bladder angle.. this week I had an ultrasound for gall bladder and upper GI as well. Have been having all kinds of mysterious pains... will have to wait til thursday for the results.

My husband has always suspected a gall bladder problem and had some kinda scan about 4 years ago that showed sediment in the gall bladder..the inept gastro doc I was seeing at the time gave me cholystyrmine and it made me sick as a dog and I bloated like a toad with massive D and "barfing" at the same time and almost croaked from dehydration! I had not yet been diagnosed with collagenous colitis and the gastro doc at the time said all my problems were stress related and if I didn't see a shrink and go on prozac (or something similar) he wouldn't see me again. I never went back to him and was later lucky enough to find a doc who did find the collagenous colitis.

It took me 2 years to decide to take entocort ... and it has worked well so far.
grannyh

cludwig · Post by **cludwig** » Sat Oct 28, 2006 1:51 pm

Hi Grannyh,

I forgot that about 5 years ago I had a similar scan and it showed sediment in my gall bladder. They said it wasn't doing anything and didn't give me anything to take at the time. However, right after my surgery my Dr gave me cholystymine to try....before diagnoses and diet changes....it didn't make me sick at all...but it didn't help with the D at that time. I may in the future give it another try as my D isn't as bad now as it was when I first tried it.

What is it with these awful awful GI who blame us when they can't figure out what is wrong with us? I started seeing GI at 15 for digestive problems and they always told me there was nothing wrong with me and suggested it was all in my head. Having practically grown up repeatedly hearing this BS from everyone of them, it does mess with your head. All of you have given me the courage to question these jerks and try to find answers elsewhere.

There was an interesting article in the NY Times' Science section where Dr were complaining about patients getting on the internet. The example they gave was of a disease people are getting that they don't believe exists. These patients had posted their symptoms and other people joined in and said they had the same thing but had been suffering for years because their Dr said they were nuts. So the Dr said that was causing people to manifest these symptoms simply from reading about it. I found it interesting that they didn't have the same objections to us all being bombarded with all the drug company advertisements on TV. For some reasons they are perfectly fine writing a million prescriptions for people who come in to their office after hearing about a drug from a commercial.

Sorry...needed to rant.

I'm glad the entocort is working well for you. It is nice to find something to make us feel better so we can have a better life.

Love,
Cristi

grannyh · Post by **grannyh** » Sat Oct 28, 2006 2:17 pm

I don't know how to spell it but the scan was something like "hyda scan"??
grannyh

cludwig · Post by **cludwig** » Sat Oct 28, 2006 3:00 pm

Hi Grannyh,

I am trying to remember....but not much is coming back. It seems to me that I had an ultrasound at one point that found stones but then the next time I had one they were gone and there was just sediment. I also had a test where they gave me an injection of something to make the gall bladder contract and I had to lie still for a long time and they put more stuff at different times into an IV. I don't remember what the test was called or even if they were taking pictures or what the diagnoses was. Nothing came of it though. I wonder if gall bladder problems run in families. I know my mom had hers removed...she didn't have any problems...but then that woman is as strong as an ox...she eats like a truck driver and has never had any problems. I unfortunately didn't get any of those good genes.

Love, Cristi

Post by **tex** » Sat Oct 28, 2006 4:37 pm

Grannyh,

You're probably referring to a HIDA scan:

http://www.medicinenet.com/cholescintig ... rticle.htm

Tex

grannyh · Post by **grannyh** » Sat Oct 28, 2006 4:41 pm

Tex is right about the test.. i had to lay on a table forever and had an iv in my arm.. the tech came over every so often and did something with the iv.. we must have had the same test.
grannyh

harvest_table · Post by **harvest_table** » Fri Nov 03, 2006 12:46 am

Cristi,

Are you taking DHEA? If so, how long have you been taking it?

So glad to hear your on an upswing.

Love,
Joanna