I
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Wayne,
Generally, I believe that cholestramine should cause stool color to lighten, in the absence of any other influences. Bile is responsible for breaking down stool and making it brown in color. Cholestramine sequesters bile, and theoretically, at least, this should normally result in a lighter stool color.
Here's the detailed version: The color of stool is normally determined by the presence of bile, specifically, the bilirubin in bile. Bilirubin is formed from hemoglobin, after the hemoglobin is released from red blood cells during their destruction, a part of the normal process of replacing the red blood cells in blood. The released hemoglobin is modified chemically and removed from the blood by the liver. In the liver, the chemically changed hemoglobin, (IOW, the bilirubin), is attached to other chemicals and secreted from the cells of the liver into bile. Bile travels through the bile ducts ,(and the gallbladder), and into the intestines. As the bilirubin travels through the intestines, some of it undergoes further chemical changes, and some of these changes affect the color of stool. These changes depend primarily on the speed with which the intestinal contents move the intestines, (motility). With normal motility, (IOW, if the intestinal contents travel at a normal speed), stool is light to dark brown. With accelerated motility, (as in the case of diarrhea), the chemical changes that occur to bilirubin, (and/or the lack of any chemical changes), may turn the stool green. If there is no bilirubin (bile) in the stool, the stool is a gray, clay-like color, which is an important clue, since it suggests that the flow of bile into the intestine is blocked.
What color are you talking about? ...black, brown, green? Here are the usual causes for black stool color:
# acidified blood
# blood from higher in the digestive tract
# iron supplements or foods high in iron
# Pepto-Bismol or other medicines containing bismuth
# black licorice
# large amounts of spinach or other greens
# blueberries
# aspirin
I'm not saying that I think that you have gallbladder disease, but for reference, the gallbladder is located just under the ribcage, and the pain from gallbladder "issues" often radiates through, and can be felt at the back of the body. With gallbladder disease, pain in that location is often felt soon after eating, (especially fatty foods), and usually passes, after several hours of intense pain. I see no reason why exercise would affect the symptoms of gallbladder disease, though. IOW, if the pain only occurs with exercise, then, gallbladder disease probably wouldn't be implicated.
Presumably, bile sequestering drugs, such as cholestyramine, force the liver to produce more bile, (from stored cholesterol), to replace the bile taken out of action by the drug. I have no idea if this effect on the liver can actually be "felt" by the patient, since I've never taken any of the meds in that class.
It's not impossible that you're having some sort of uncommon adverse reaction to cholestramine, so it might be advisable to check with your doctor, if the symptoms are really bothersome, especially since they have been persisting for over a week, now.
Tex
Generally, I believe that cholestramine should cause stool color to lighten, in the absence of any other influences. Bile is responsible for breaking down stool and making it brown in color. Cholestramine sequesters bile, and theoretically, at least, this should normally result in a lighter stool color.
Here's the detailed version: The color of stool is normally determined by the presence of bile, specifically, the bilirubin in bile. Bilirubin is formed from hemoglobin, after the hemoglobin is released from red blood cells during their destruction, a part of the normal process of replacing the red blood cells in blood. The released hemoglobin is modified chemically and removed from the blood by the liver. In the liver, the chemically changed hemoglobin, (IOW, the bilirubin), is attached to other chemicals and secreted from the cells of the liver into bile. Bile travels through the bile ducts ,(and the gallbladder), and into the intestines. As the bilirubin travels through the intestines, some of it undergoes further chemical changes, and some of these changes affect the color of stool. These changes depend primarily on the speed with which the intestinal contents move the intestines, (motility). With normal motility, (IOW, if the intestinal contents travel at a normal speed), stool is light to dark brown. With accelerated motility, (as in the case of diarrhea), the chemical changes that occur to bilirubin, (and/or the lack of any chemical changes), may turn the stool green. If there is no bilirubin (bile) in the stool, the stool is a gray, clay-like color, which is an important clue, since it suggests that the flow of bile into the intestine is blocked.
What color are you talking about? ...black, brown, green? Here are the usual causes for black stool color:
# acidified blood
# blood from higher in the digestive tract
# iron supplements or foods high in iron
# Pepto-Bismol or other medicines containing bismuth
# black licorice
# large amounts of spinach or other greens
# blueberries
# aspirin
I'm not saying that I think that you have gallbladder disease, but for reference, the gallbladder is located just under the ribcage, and the pain from gallbladder "issues" often radiates through, and can be felt at the back of the body. With gallbladder disease, pain in that location is often felt soon after eating, (especially fatty foods), and usually passes, after several hours of intense pain. I see no reason why exercise would affect the symptoms of gallbladder disease, though. IOW, if the pain only occurs with exercise, then, gallbladder disease probably wouldn't be implicated.
Presumably, bile sequestering drugs, such as cholestyramine, force the liver to produce more bile, (from stored cholesterol), to replace the bile taken out of action by the drug. I have no idea if this effect on the liver can actually be "felt" by the patient, since I've never taken any of the meds in that class.
It's not impossible that you're having some sort of uncommon adverse reaction to cholestramine, so it might be advisable to check with your doctor, if the symptoms are really bothersome, especially since they have been persisting for over a week, now.
Tex
Wayne,
Grayish-black doesn't sound like partially digested blood, (usually that's tarry-black), the black flecks could be pieces of blueberry skin, but if this continues, I would suggest that you bring it to your doc's attention.
It's difficult to say exactly what the cholestyramine is "supposed" to do to BMs, because it was not developed to treat D. C is a side effect of cholestyramine, so that's why some docs prescribe it to try to control D.
The bathroom pattern that you describe, (frequent trips, but not much "productivity"), implies that you are experiencing the "C" phase of MC, (or alternating C and D). You definitely do not have the secretory diarrhea that is so common with those who have "D-predominant" MC, or "D-only" MC. Secretory diarrhea results in copious volumes, due to the fact that it is caused by water being secreted into the colon, (whereas normally, the colon removes water, of course). If this is not the previous pattern that you had, then it is probably due to the effect of the cholestyramine.
Another possibility is diverticulitis, and that would explain the pain, especially if the pain is in your lower left quadrant, (since the Sigmoid colon is the most common site for "tics", as the GI docs refer to diverticula). It could also explain the "mixed" D and C, since diverticulitis sometimes presents as a "blockage", or a near-blockage. The "thin" formed BM fragments also fit the pattern of a possible obstruction.
You are within the range of possible candidates, (typically, diverticula begin to show up once we are past the age of 40). However, if any "tics" were present, the endoscopy report should mention them, as they would be obvious during the colonoscopy, and they are always noted, if present. The presence of tics, however, does not guarantee that you will ever have diverticulitis, (which is an accute inflammation of a diverticulum), it merely makes it possible.
At this stage of the game, we all feel like screaming, at times, but trust me, it will get better.
The gluten could also be causing. or contributing to the pain, especially if you're experiencing gas and bloating from it.
Tex
Grayish-black doesn't sound like partially digested blood, (usually that's tarry-black), the black flecks could be pieces of blueberry skin, but if this continues, I would suggest that you bring it to your doc's attention.
It's difficult to say exactly what the cholestyramine is "supposed" to do to BMs, because it was not developed to treat D. C is a side effect of cholestyramine, so that's why some docs prescribe it to try to control D.
The bathroom pattern that you describe, (frequent trips, but not much "productivity"), implies that you are experiencing the "C" phase of MC, (or alternating C and D). You definitely do not have the secretory diarrhea that is so common with those who have "D-predominant" MC, or "D-only" MC. Secretory diarrhea results in copious volumes, due to the fact that it is caused by water being secreted into the colon, (whereas normally, the colon removes water, of course). If this is not the previous pattern that you had, then it is probably due to the effect of the cholestyramine.
Another possibility is diverticulitis, and that would explain the pain, especially if the pain is in your lower left quadrant, (since the Sigmoid colon is the most common site for "tics", as the GI docs refer to diverticula). It could also explain the "mixed" D and C, since diverticulitis sometimes presents as a "blockage", or a near-blockage. The "thin" formed BM fragments also fit the pattern of a possible obstruction.
You are within the range of possible candidates, (typically, diverticula begin to show up once we are past the age of 40). However, if any "tics" were present, the endoscopy report should mention them, as they would be obvious during the colonoscopy, and they are always noted, if present. The presence of tics, however, does not guarantee that you will ever have diverticulitis, (which is an accute inflammation of a diverticulum), it merely makes it possible.
At this stage of the game, we all feel like screaming, at times, but trust me, it will get better.
The gluten could also be causing. or contributing to the pain, especially if you're experiencing gas and bloating from it.
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.
Have hope, PLEASE
With the PP all things are possible. I felt no hope, angry, and depressed when I got here. Now I'm turned around some.
I'm sure Tex will be along when he can.
Joan
I'm sure Tex will be along when he can.
Joan
Wayne,
Despite what your doc says about C, much of the time, my symptoms matched your description almost exactly, including occasionally feeling as though I had had an "accident". Trust me, if you do that often enough, you won't just feel as though you had had an accident - you will have one, or two, or three. Been there, done that.
I realize that it's not good form to dispute the claims of the man wearing the white coat, but the pattern you describe is typical of the way that C presents for some of us. If you were only having "D-phase" reactions, you wouldn't be producing "insignificant" amounts of "pure, (uncolored), water", as a rule. (You would be producing copious amounts, and it usually wouldn't be completely clear). The type of BM you describe is typical of fluids bypassing an "obstruction", or an "impacted" mass. Your doc may not fully understand the total spectrum of C. Most people consider C to mean widely spaced, (days apart), BMs, with hard, dry, "buckshot-like" pellets. But that's not the only medical definition. Constipation can also present as difficult, or incomplete evacuation of the bowels, and that's what's happening in your case. It's sort of the anal equivalent of the "dry heaves". You might want to do some searches for old posts on this topic, (and specify the author, to cut down the number of results found), by another member who often had the same problem, Mike, (username, mle_ii).
YMMV, but here's why I make that statement: I had my last colonoscopy about 8 years ago. Afterwards, the GI doc told me that everything looked normal, and there was nothing wrong with my colon, (he did not take biopsy samples). Five and a half years later, I had to have emergency surgery, to remove a blockage in my Sigmoid colon. After I recovered, I requested a copy of the endoscopy report from that earlier colonoscopy. Guess what? Right there, in black on white, it clearly described the stenosis that eventually led to the emergency surgery. He never said a word about it, after the colonoscopy, though. At the time, he thought I had cancer, and he was convinced that cancer was the cause of my "uncontrollable diarrhea", so all he was looking for during the exam, and all the other tests, was cancer. Obviously, he had a "one-track" mind, and that's why it never occurred to him to take biopsy samples, during the colonoscopy. In the report, he also noted that my colon was unusually "capacious", but he didn't mention that fact to me, either. Well Duh! Years of being bloated because of reacting to gluten, to the point where I sometimes felt as if my gut might burst, will tend to stretch your gut. Yet it didn't mean a thing to him - he really didn't have a clue, because he was focusing on cancer.
The only way to learn about most of the "secondary" details, is to obtain a copy of the report that was written after the procedure, because docs don't tell their patients everything. I guess they figure what you don't know won't hurt you.
Okay, despite all that I've said here, I'm not implying that you have an obstruction, impaction, stenosis, or whatever. I'm just saying that it's a possibility, and that item should be kept in the back of your mind, in the rare event that it might turn out to be the case. I don't believe that it's very likely, however. I really believe that the most likely scenario is that you have the type of "alternating C and D" that a number of us have, and if you search the archives here on this board, you will find that this pattern is much more common than the GI docs realize. Mike has recorded a lengthy journal, by the way, if you want to read his history with MC:
http://www.perskyfarms.com/phpBB2/viewtopic.php?t=43
He mentions the BM pattern we are talking about here, in the very first post, and I'm sure he describes it in much more detail, in later posts.
The fragmentation that you mention is probably due to all the turbidity caused by hyperactive peristalsis of your gut - I had that too, and so did many others here. When I was having symptoms that matched your description, sometimes my gut would seem to writhe like a snake, due to the spasms that would come and go.
Trust me, many of us have had the same experiences, before we found the key to remission. It's miserable while you're reacting, but that just makes you appreciate remission that much more, when you finally achieve it.
Tex
Despite what your doc says about C, much of the time, my symptoms matched your description almost exactly, including occasionally feeling as though I had had an "accident". Trust me, if you do that often enough, you won't just feel as though you had had an accident - you will have one, or two, or three. Been there, done that.
As Polly always says, "Happiness is a dry fart".Wayne wrote:I don't dare try to pass gas if i'm not sitting on the toilet
I realize that it's not good form to dispute the claims of the man wearing the white coat, but the pattern you describe is typical of the way that C presents for some of us. If you were only having "D-phase" reactions, you wouldn't be producing "insignificant" amounts of "pure, (uncolored), water", as a rule. (You would be producing copious amounts, and it usually wouldn't be completely clear). The type of BM you describe is typical of fluids bypassing an "obstruction", or an "impacted" mass. Your doc may not fully understand the total spectrum of C. Most people consider C to mean widely spaced, (days apart), BMs, with hard, dry, "buckshot-like" pellets. But that's not the only medical definition. Constipation can also present as difficult, or incomplete evacuation of the bowels, and that's what's happening in your case. It's sort of the anal equivalent of the "dry heaves". You might want to do some searches for old posts on this topic, (and specify the author, to cut down the number of results found), by another member who often had the same problem, Mike, (username, mle_ii).
Certainly, but that doesn't mean that your GI doc would tell you about it. I'm talking about a partial blockage, obviously, not a total blockage, (since you can't survive for very long with a total blockage).Wayne wrote:And wouldn't a blockage have been observed during my procedures?
YMMV, but here's why I make that statement: I had my last colonoscopy about 8 years ago. Afterwards, the GI doc told me that everything looked normal, and there was nothing wrong with my colon, (he did not take biopsy samples). Five and a half years later, I had to have emergency surgery, to remove a blockage in my Sigmoid colon. After I recovered, I requested a copy of the endoscopy report from that earlier colonoscopy. Guess what? Right there, in black on white, it clearly described the stenosis that eventually led to the emergency surgery. He never said a word about it, after the colonoscopy, though. At the time, he thought I had cancer, and he was convinced that cancer was the cause of my "uncontrollable diarrhea", so all he was looking for during the exam, and all the other tests, was cancer. Obviously, he had a "one-track" mind, and that's why it never occurred to him to take biopsy samples, during the colonoscopy. In the report, he also noted that my colon was unusually "capacious", but he didn't mention that fact to me, either. Well Duh! Years of being bloated because of reacting to gluten, to the point where I sometimes felt as if my gut might burst, will tend to stretch your gut. Yet it didn't mean a thing to him - he really didn't have a clue, because he was focusing on cancer.
The only way to learn about most of the "secondary" details, is to obtain a copy of the report that was written after the procedure, because docs don't tell their patients everything. I guess they figure what you don't know won't hurt you.
Okay, despite all that I've said here, I'm not implying that you have an obstruction, impaction, stenosis, or whatever. I'm just saying that it's a possibility, and that item should be kept in the back of your mind, in the rare event that it might turn out to be the case. I don't believe that it's very likely, however. I really believe that the most likely scenario is that you have the type of "alternating C and D" that a number of us have, and if you search the archives here on this board, you will find that this pattern is much more common than the GI docs realize. Mike has recorded a lengthy journal, by the way, if you want to read his history with MC:
http://www.perskyfarms.com/phpBB2/viewtopic.php?t=43
He mentions the BM pattern we are talking about here, in the very first post, and I'm sure he describes it in much more detail, in later posts.
The fragmentation that you mention is probably due to all the turbidity caused by hyperactive peristalsis of your gut - I had that too, and so did many others here. When I was having symptoms that matched your description, sometimes my gut would seem to writhe like a snake, due to the spasms that would come and go.
Trust me, many of us have had the same experiences, before we found the key to remission. It's miserable while you're reacting, but that just makes you appreciate remission that much more, when you finally achieve it.
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.
Pardon my ignorance, please
I think DB said there is an upper part that the colonoscopy can't get to. I think that's why he had to swallow the pill camera. I have no idea if this even applies or is correct..........
Yep, the small intestine alone is typically over 20 feet long, and the colon is over five feet long. The endoscopes that are used for "upper" exams, are typically less than three and a half feet long, (1.05 meters). The Pentax colonoscopes typically used for "lower" exams, are only a little over five and a half feet long, (1.7 meters). That leaves a heck of a lot of "unexplored" territory in between. The "upper" scopes can barely peer just a little past the stomach, into the duodemum, (far enough to get biopsy samples from the proximal end of the small intestine), and the "lower" scopes can barely peer past the cecal valve, into the distal end of the ileum, at the bottom end of the small intestine. There's no way to view any part of the jejunum, the middle third of the small intestine, nor the adjacent parts of the duodenum and the ileum.
Tex
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.
-
barbaranoela
- Emperor Penguin
- Posts: 5394
- Joined: Wed May 25, 2005 6:11 pm
- Location: New York
Hi Wayne----
Your post really made me feel so badly for U---
Chronic D---to me--is SOMETHING not right---thats what happened to me---on the bowl all thetime---and when my condition worsened--my movements were gritty---
Choles. drink did ZIP for me----
Dont give up-----as I say to all---*U will get on that wellness road* Keep heading for it~~~~~
Understand the frustration too----
Keep us up dated---ok!!!
Luve, your HOKIE friend
Barbara----
Your post really made me feel so badly for U---
Chronic D---to me--is SOMETHING not right---thats what happened to me---on the bowl all thetime---and when my condition worsened--my movements were gritty---
Choles. drink did ZIP for me----
Dont give up-----as I say to all---*U will get on that wellness road* Keep heading for it~~~~~
Understand the frustration too----
Keep us up dated---ok!!!
Luve, your HOKIE friend
Barbara----
the fruit of the spirit is love, joy, peace, patience, kindness, goodness, faithfulness and self-control
Darn, I wish I had toilet paper stock! Seriously, you can beat this, probably more with Tex's help than your doctors' help.
I stood up to my doctor by saying NO to her suggestions of Prometheus Labs and an allergist.
I'd guess that, indeed, it might be the gluten. Going GF has made all the difference in the world to me. YMMV
YMMV=your mileage may vary=disclaimer
I am not a doctor and don't play one on TV. Besides I am a BM, beginning member (name my DD made up) to replace newbie.
I stood up to my doctor by saying NO to her suggestions of Prometheus Labs and an allergist.
I'd guess that, indeed, it might be the gluten. Going GF has made all the difference in the world to me. YMMV
YMMV=your mileage may vary=disclaimer
I am not a doctor and don't play one on TV. Besides I am a BM, beginning member (name my DD made up) to replace newbie.
Wayne,
Actually, it doesn't really matter whether it's D or C - the treatment is the same.
The "foam" is probably from aerated mucous, and it's an indication of inflammation. When the digestive tract is inflamed, it produces copious amounts of mucous, to help protect the surface of the mucosa from any irritants in the lumen. This is why, for example, you can usually tell that you are about to vomit, by all the saliva that you find yourself swallowing just prior to the "event". The body is "coating" the esophagus, so that it can safely withstand the onslaught of stomach acids. Likewise, when the colon is inflamed, it's very common to see large amounts of mucous in the bowl, along with a BM.
Some doctors seem to appreciate seeing that their patients have gone to the trouble to learn a bit about their issues, while others appear to feel threatened, and can get downright "testy", especially if a patient obviously knows more about it than the doctor. Some doctors are willing to learn about an unfamiliar disease, right along with the patient, while others just get huffy and defensive about it. My experience has been that most of them fall into the latter category, but YMMV.
Unless you pick up the records personally, from the records department, it's common for the transfer of records, (for example, requested at a doctor's office, from another doctor's office), to take up to 60 days.
Yep, the doctors have us over a barrel. They hold the key to all the tests, and only they can write prescriptions. Consequently, when they don't know what they're doing, they charge us just as much as if they did know, a privilege that is rather unique in the business world - sort of like having a license to steal. LOL.
Tex
Actually, it doesn't really matter whether it's D or C - the treatment is the same.
Sort of, but I think that the colon also loses flexibility when it's inflamed, and it can become distorted, (maybe even flattened, in sections), due to pressure distribution irregularities.Wayne wrote:then I would assume that my colon passage has been narrowed because of the thickening of the walls which accounts for the narrow BMs. ?????
The "foam" is probably from aerated mucous, and it's an indication of inflammation. When the digestive tract is inflamed, it produces copious amounts of mucous, to help protect the surface of the mucosa from any irritants in the lumen. This is why, for example, you can usually tell that you are about to vomit, by all the saliva that you find yourself swallowing just prior to the "event". The body is "coating" the esophagus, so that it can safely withstand the onslaught of stomach acids. Likewise, when the colon is inflamed, it's very common to see large amounts of mucous in the bowl, along with a BM.
Some doctors seem to appreciate seeing that their patients have gone to the trouble to learn a bit about their issues, while others appear to feel threatened, and can get downright "testy", especially if a patient obviously knows more about it than the doctor. Some doctors are willing to learn about an unfamiliar disease, right along with the patient, while others just get huffy and defensive about it. My experience has been that most of them fall into the latter category, but YMMV.
Unless you pick up the records personally, from the records department, it's common for the transfer of records, (for example, requested at a doctor's office, from another doctor's office), to take up to 60 days.
Yep, the doctors have us over a barrel. They hold the key to all the tests, and only they can write prescriptions. Consequently, when they don't know what they're doing, they charge us just as much as if they did know, a privilege that is rather unique in the business world - sort of like having a license to steal. LOL.
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.