Weaning Off Entocort

Discussions on the details of treatment programs using either diet, medications, or a combination of the two, can take place here.

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tex
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Post by tex »

Hi Gloria,

Thanks for the update.

The cold capsules may have contained an NSAID. There are a number of meds that can cause an MC flare, on their own, for susceptible individuals, and NSAIDs are in that group, (as I'm sure you know).

Also, it's possible that the cold virus itself may be causing the D. We MCers become so attuned to our bowel behavior patterns that we often forget that people without MC also get D once in a while.

Hopefully you'll be back on track in a day or so. If it lasts much longer, though, you may have to consider going back to a higher dosage rate for a while. You know your body, and how it reacts, better than anyone else, so you're in the best position to make that decision.

Good luck,
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 Gloria »

Thank you Tex. Things are better today. I'm going to stay on the 3 mg for a few more days to see if I can maintain with the lower dosage. My cold medicine contained acetaminophen which I have used occasionally without a problem. Hopefully this was just a blip on the radar.

I'm noticing that I'm not getting over the cold as quickly as usual. It could be because my immune system is somewhat suppressed or it could be because I've stopped taking the cold medicine.

My GI cancelled today's appointment and rescheduled for two weeks from now, which will give me a little more time to test the 3 mg dosage. I have an appointment on Saturday with my Internist. I'd like to get blood work done to see if my cholesterol has gone down on this diet, though I know that body cholesterol is largely genetic. I'm taking a pretty strong statin. I haven't seen my Internist since my Dx. I may talk to him about the Enterolab tests and my diet. Are Internists more open about dietary solutions than GIs?
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Post by tex »

Gloria,

I hate to bring this up, but it's possible that the statin may be contributing to, or even causing your MC reactions, which may be why Entocort is having such a tough time controlling the D. Statins are one of a group of several drugs, (also including NSAIDs, SSRIs, and beta-blockers, for example), that are known to pose a risk for triggering MC.

One of the main disadvantages of the corticosteroids is the fact that they are immune system suppressants, which means that anyone taking them has a higher risk of infections, and infections that do occur, tend to be more persistent.

Of course, it depends on the individual, but I have a hunch that on the average, more internists would be open to dietary treatment, than GI docs. (I'm basing my hunch on the fact that most GI docs seem to be inordinately opposed to any attempts to control a disease by diet alone, so that in itself should raise the odds that percentage-wise, more internists would be likely to be in favor of it).

Here's a reference on drug-induced MC:

http://www.blackwell-synergy.com/doi/ab ... alCode=ajg

Note especially, the last paragraph in the abstract:
CONCLUSIONS: Drug consumption increases the risk of microscopic colitis. Some drugs might be trigger factors of colonic inflammation in predisposed hosts, and others might only worsen self-evolving microscopic colitis.
It's good to "hear" that you're doing better today, and I apologize for being the bearer of, (possibly), bad news, (about the statin).

Tex

P S I don't think there's any significant risk of the acetaminophen causing an MC "flare", but I suppose anything is possible, since we all react differently to different drugs. There is no documented evidence against it in the literature, as far as I can see. I never hesitate to take Tylenol, if I feel the need for a painkiller, and I've never noticed any adverse reactions to it.
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Post by Gloria »

Well, I think this thread needs to be renamed "Maintaining on Entocort." After three trips to the bathroom yesterday and D this morning, I upped my dosage back to 6 mg. I clearly am not able to maintain remission with less. :sad:

I'm going to have a long (I hope) talk with my Internist on Saturday about the meds I'm on. I'm taking Vytorin, which is in the news right now for being ineffective at reducing plaque buildup in the arteries. I'm a size 8 petite, but my cholesterol was 336 before the meds. Go figure.

I also am concerned about the Fosamax I'm taking for osteoporosis because it can affect the upper intestines. I haven't had any malabsorption problems, but it stands to reason that if the medication can affect the small intestines, it can also affect the lower intestines. I have taken calcium and vitamin D supplements for years while also eating dairy three times per day. Obviously nothing I've tried in my diet has prevented the osteoporosis. There's always the probability that this autoimmune condition has given me the osteoporosis. But now I'm on a steroid, which also can cause it. I'm cursed if I do and cursed if I don't. :???:

The other reality is that I'm highly reactive to gluten and soy, even while on Entocort. I've eaten a little bit of cheese as a test without a problem. But I've even gotten a rash from soy body cream. And I reacted to whatever bit of gluten was left in the crevices of my turkey roasting rack. I have been drinking at least two glasses of Rice Dream milk each day and I know that it contains minute amounts of gluten. I may need to switch to the Hemp milk, but it's so expensive at $14.76 per gallon. How can I retire with those kinds of prices for food? :shrug: Perhaps I can make my own rice milk once I retire. Or, better yet, maybe I can resume drinking regular milk someday if I'm not reacting to cheddar cheese. Hope springs eternal.

I'm trying to stay upbeat because I know that many of you didn't have Entocort when you were battling this disease. I'm grateful that it is available and even if I have to stay at 6 mg, it's doing the job.
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Post by tex »

Hi Gloria,

I really believe that once your gut has a chance to completely heal, you'll be able to cut the budesonide down to at least 3mg per day, and probably lower. The odds are high that eventually, you will probably be able to completely end the treatment, but that's still a ways down the track. Healing is a process that takes time, and every time a reaction occurs, the healing process gets set back a little. Eventually, though, if you stay the course, healing will occur, and you'll regain your confidence.

Yep, you're kinda between a rock and a hard place with the meds. Hopefully your Internist will be able to shed some light on the situation.

One of the least understood paradoxes in the medical world is, (IMO), the fact that the citizens of the countries that consume the most milk, and use the most calcium supplements, consistently have the worst problems with osteoporosis. People in the countries that drink very little milk, and take virtually no calcium supplements, don't have osteoporosis problems. Maybe it's just a coincidence, but the correlation is undeniable. Clearly, the supplements don't work very well, (if, indeed, they work at all - and that includes drinking milk), for the general population. In fact, I sometimes wonder if they could in some way be causing the problem. Historically, milk wasn't a particularly big diet item, until the dairy industry began to hire lobbyists, to convince the government and the medical industry that it is "essential" for good health. But is it?

Celiac disease definitely causes osteoporosis, so I see no reason why MC would not have a similar effect. I'm kind of concerned about your situation with that issue, especially if it has been a problem for a significant length of time. There are other ways to prevent osteoporosis. Our paleo ancestors did not drink milk, nor take calcium supplements, and their bones were very dense. Have you by any chance reviewed the articles cited in these posts, (concerning calcium and calcium supplements)? The first topic contains a couple of excellent discussions of solutions from a paleo viewpoint, and the second contains suggestions by a doctor, (a woman doctor), and it includes comments about calcium supplements and/or drugs, and it specifically contains a discussion on Fosamax.

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=497

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=4683

Also, are you aware of this database with comments by women who are actually using Fosamax? WARNING! This is rather scary reading.

http://www.askapatient.com/viewrating.a ... me=FOSAMAX

Fosamax, of course, is sometimes prescribed to prevent steroid-induced osteoporosis, so there's a good chance that your doctor will view it favorably, from that aspect.

Hempmilk definitely is expensive. About all I use it for is GF rice or corn cereal, a couple of times a week, but it probably works OK for cooking, also. I've never tried drinking it, though I'm sure it's good, (at $1.85 per 16 oz. glass, it should be).

Looking back, (six or seven years ago), Entocort might have been available, but I was totally ignorant of it, when I was trying to find a solution, and my GI doc never suggested it, (of course, that's not surprising, since he never discovered what was wrong with me, in the first place). I can't speak for anyone else, of course, but as miserable as I was, with the uncontrollable D, I can guarandang T you that I would have jumped on Entocort like a chicken on a June bug, if it had been offered to me. LOL.

Tex
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Post by Gloria »

Once again, thank you Tex. It's late and I'll read these tomorrow. I know there are problems associated with Fosamax. I initially was on it for a few months several years ago and got off it. Then I became concerned about the bone loss and went back on it again.

I appreciate your taking the time to post the links for me.

Gloria
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Post by starfire »

I think that ,unless there is a calcium absorbtion problem, increasing your weight bearing activity will help a lot with bone density without meds. It worked for me.

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Post by Gloria »

Yes, Shirley, I've read that weight-bearing exercise helps build bone mass. I guess I'm waiting until I retire in July to begin a serious exercise program. Right now I exercise about once a week when I've had a decent night's sleep.

I saw my Internist today and didn't get much satisfaction from his responses. He's letting me decide if I want to remain on the Vytorin - actually wrote another prescription for it and never entered into a discussion about the latest news that it's not very effective. He seemed to focus on my numbers, which are pretty good since I've been on it. I'll be getting blood work done this week and will be interested in seeing if the numbers have changed since being on this diet.

I showed him my Enterolab test results and he said "Stool testing?" He pretty much shrugged his shoulders and said with the Internet, doctors have become more accepting of alternate medicines and treatments. He encouraged me to share the Enterolab results with my GI. He never heard of MC. He's not that old, either - I'd say about mid-upper 30s.

He told me that I don't have rheumatoid arthritis in my hands because they would have shown some deformity by now and also blood tests would have shown the disease. He said the Entocort is reducing the inflammation which was probably due to osteoarthritis.

He said that Fosamax would affect my small intestine, not my large colon. That's about as much as he talked about the Fosamax.

I don't think that he remembers me from one visit to the next. It's not his fault; I haven't seen him for over a year. I was pretty disappointed in the visit.
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Post by tex »

Gloria,

Dealing with doctors can be frustrating, can't it. It does seem surprising that, (considering his relatively young age), he could be specializing in internal medicine and never have heard of MC. That kind of makes me wonder if he's even aware of the bad press that Vytorin has received lately, but surely he is. Never heard of stool testing, either? Hmmmmm. I wonder if he lives in a shell, or if he actually makes any effort to continue his medical education.

It's relatively easy to determine the difference between RA and OA, just by considering the symptoms that you experience. Just because your hands don't show any obvious deformity, doesn't necessarily rule out RA. The damage may be subtle. The very fact that you have MC means that you are very susceptible to other autoimmune diseases. Since he has never heard of MC, he is obviously unaware of that fact. Consider the comparison of symptoms at this site, and judge for yourself:

http://ra.com/ra/rastore/cgi-bin/ProdSu ... ot_303.htm

I have had serious RA in the past, (and yes, a couple of my fingers became very deformed). The problem was resolved when I went on a gluten-free, casein-free diet. After about five years on the diet, not quite two years ago, I started "trying" dairy products again, and when I couldn't notice any digestive system problems, after a few months I started eating more and more of it. After about a year of that, I noticed that my arthritis symptoms were returning, so last November, it dawned on me what was happening, and I cut out all dairy products again. That did the trick. I can't say that I am now 100% RA free, but it is definitely down to a minimal level, and no longer a significant problem. It no longer affects my lifestyle in the least.

Incidentally, are you aware that osteoporosis is a result of years of untreated gluten sensitivity, and that eliminating gluten from the diet will resolve that problem? It's possible that you may have been gluten sensitive for many years, but were asymptomatic . You may no longer need Fosamax if you follow the GF diet. Here's a reference with a lot of information along these lines.

http://www.enabling.org/ia/celiac/bones.html

Thanks for posting that. It's always informative to read about the experiences that others are having, while trying to find a doctor who actually understands the mechanics of MC. I'll bet that most of us here are shaking our heads in agreement, as we read your post, because most of us have been in similar situations, numerous times, unfortunately.

Tex
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Post by Gloria »

Another update -
I saw my GI on Monday. I explained that I've been having trouble when I reduce the Entocort dosage to 3 mg/day. He said it's because I'm not entirely healed. He said if he were to do another sigmoidoscopy, he's sure I'd still have the lymphocytes - not as many, but they'd still be there. He's having me stay on 6 mg. for another 6 months, but leaving it up to me if I feel I can reduce sooner. I'm glad he's not resisting keeping me on the Entocort.

I asked him about the Vytorin and the Fosamax. He said it wouldn't hurt to go off each of them for two weeks to see if I had any improvement.

I tested the waters to see if I could engage him in a conversation about food being a possible cause. I told him about my allergic reaction to soy body cream and said I decided to discontinue eating anything with soy as a result. His reaction was polite curiosity, no more. So once again, I didn't talk to him about the Enterolab tests. :turtle:

The one downside I'm attributing to the Entocort is that I seem to be more susceptible to colds and less able to get over them quickly. I'm on my second cold this month - first one lasted two weeks and then the next one kicked in. I've had it for a week now with little reduction in symptoms. Since I'm in Utah visiting my newest granddaughter (1 week old), I'm taking all kinds of things to keep the symptoms at bay and am hoping I'm not contagious anymore.

Some friends brought a meal in last night: chicken enchiladas with cheese, sour cream, and flour tortillas. I indulged and had the pudding D this morning. Back on track this afternoon with Norman almost at my door. It's hard to eat in someone else's home. I brought 1 suitcase filled entirely with my food items. I still need to go to the grocery store for meats and fresh food items.

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Post by tex »

Hi Gloria,

At least your GI doc recognizes that it takes a while for the MC damage to heal. I think you're wise to not press the Enterolab test issue with him, (unless you're considering switching doctors). Most of the medical specialists don't seem to appreciate a patient trying to teach them anything, (even though they clearly need all the help they can get. LOL).

Yep, the corticosteroids work by suppressing the immune system, so extra vigilance is advisable, to avoid coming down with viruses and infections - tough to do for a teacher, of course. Hopefully, you will eventually be able to phase it out completely, or at least cut it down to a maintenance dose, without losing control.

Thanks for the update.

Tex
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Post by Gloria »

It's been a few weeks since I've updated my progress. I have regressed this past week - Norman didn't visit me. :sad: It's been about a month since I've had just 1 BM per day. More typical for me is 2 per day right now. This pattern doesn't seem right considering that I'm on 6 mg/Entocort per day.

The main change in my diet this past week was to eat about 3 tablespoons of blueberries every morning in my buckwheat cereal. So, no more blueberries for a while. I'm starting to suspect that I can't eat certain raw fruits. I stopped eating raw apples several months ago. I've also decided to try drinking Hemp milk for a couple of weeks to see if that makes any difference.

Went to my granddaughter's birthday party yesterday. My daughter made GF brownies for me from a mix she got at Trader Joes. A couple of hours after I got home, I was in the bathroom. I suspect she might have used soybean oil in the mix. I don't have the heart to ask her.
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Post by tex »

Gloria wrote:Went to my granddaughter's birthday party yesterday. My daughter made GF brownies for me from a mix she got at Trader Joes. A couple of hours after I got home, I was in the bathroom. I suspect she might have used soybean oil in the mix. I don't have the heart to ask her.
I know what you mean. I've gotten to the point where I wish friends and relatives wouldn't try to cook anything for me. After they go to all that trouble, what can you do? You hold your breath and eat it, and often regret it later. Most people seem to have trouble just keeping something 100% gluten-free, let alone avoiding all the casein, soy, corn, or whatever.

I'm sorry to see that Norman is still AWOL. I'm puzzled too, at why the combination of diet and Entocort still isn't quite enough to do the trick.

Thanks for the update.
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 Gloria »

I don't want to bore you with my progress, but I started drinking the Hemp milk and also stopped eating the blueberries yesterday. Norman has already visited me today after ignoring me for most of the month. I guess he doesn't like keeping company with some of my food companions. :shrug:

Now what will I do with my 2-month supply of rice milk...?
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Post by tex »

Hey, a positive report such as that is definitely not boring.

Wait a minute - were you using that rice milk up until yesterday?

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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