Received Medical Records Today ...
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Hi Wayne,
To address your questions:
A long, tortuous colon is, (as you suspect), just doctorspeak for a longer than normal colon, with numerous bends and/or twists. That's a very common configuration, and I'm not sure if the standard they use for "normal" is accurate, because I suspect that most of us here have a colon that meets that description, (I know mine does). At any rate, it seems to be a rather common notation on the colonoscopy report for most of us.
In comment 4., his grammar is incomplete, (he leaves out some words), which could affect the interpretation of this statement, so I'm not exactly sure what point he is trying to make. Actually, the statement appears contradictory, (IOW, it doesn't make sense). Colonic spasms are rather common during colonoscopies, and, of course, they interfere with the exam. I "think" he's trying to say that the spasms that he observed during the exam, can be considered to be unrelated to your "problem", (occluded), but then he relates this to IBS, as if inferring that you have IBS. (I don't understand why IBS would not be considered to be relevant to your "problem", (if IBS is present). His obfuscated doctorspeak does a disservice to clarity.
Lipase is secreted by the pancreas, and is necessary to break down triglycerides, so that absorption across the intestinal mucosa is possible. Though I've never seen a discussion on how this is related to MC, I suggest that this is quite common with MC, since virtually all of us have a fat malabsorption problem while we're reacting.
Elevated globulin levels are a typical marker of chronic inflammatory diseases, (such as MC).
Well, based on the duodenum biopsy results, you clearly don't have overt celiac disease, so I'm sure the celiac blood tests will be negative. I still don't understand why he asked you to do a gluten challenge, with that finding in hand. With no villous atrophy, celliac sprue is ruled out, by definition.
Incidentally, with the lymphoid hyperplasia issue in your ileum, treatment with corticosteroids may be contraindicated, (because of the possible risk of lymphoma development). I don't have a direct reference on that, but since mucosal histology is similar for many/most organs, this information is probably relevant, especially since MC is a result of a compromised immune system:
http://www3.interscience.wiley.com/jour ... 1&SRETRY=0
That makes the case for using diet to control your inflammation much stronger, IMO.
Tex
To address your questions:
A long, tortuous colon is, (as you suspect), just doctorspeak for a longer than normal colon, with numerous bends and/or twists. That's a very common configuration, and I'm not sure if the standard they use for "normal" is accurate, because I suspect that most of us here have a colon that meets that description, (I know mine does). At any rate, it seems to be a rather common notation on the colonoscopy report for most of us.
In comment 4., his grammar is incomplete, (he leaves out some words), which could affect the interpretation of this statement, so I'm not exactly sure what point he is trying to make. Actually, the statement appears contradictory, (IOW, it doesn't make sense). Colonic spasms are rather common during colonoscopies, and, of course, they interfere with the exam. I "think" he's trying to say that the spasms that he observed during the exam, can be considered to be unrelated to your "problem", (occluded), but then he relates this to IBS, as if inferring that you have IBS. (I don't understand why IBS would not be considered to be relevant to your "problem", (if IBS is present). His obfuscated doctorspeak does a disservice to clarity.
Lipase is secreted by the pancreas, and is necessary to break down triglycerides, so that absorption across the intestinal mucosa is possible. Though I've never seen a discussion on how this is related to MC, I suggest that this is quite common with MC, since virtually all of us have a fat malabsorption problem while we're reacting.
Elevated globulin levels are a typical marker of chronic inflammatory diseases, (such as MC).
Well, based on the duodenum biopsy results, you clearly don't have overt celiac disease, so I'm sure the celiac blood tests will be negative. I still don't understand why he asked you to do a gluten challenge, with that finding in hand. With no villous atrophy, celliac sprue is ruled out, by definition.
Incidentally, with the lymphoid hyperplasia issue in your ileum, treatment with corticosteroids may be contraindicated, (because of the possible risk of lymphoma development). I don't have a direct reference on that, but since mucosal histology is similar for many/most organs, this information is probably relevant, especially since MC is a result of a compromised immune system:
http://www3.interscience.wiley.com/jour ... 1&SRETRY=0
That makes the case for using diet to control your inflammation much stronger, IMO.
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.
Wayne,
I can't access that site this morning either, and I have my browser set to accept all cookies, but delete them when I close the browser, so apparently that site is having a server problem.
Lymphoid hyperplasia isn't related to colitis, (as far as I'm aware) - it's the rapid growth of normal cells that resemble lymph tissue.
You're right - there's no mention of even checking the thickness of collagen bands in the lamina propria, so evidently he didn't consider it to be important, (the treatment is the same, regardless of the type of MC). However, he says:
Hmmmmmmm. Regarding taking Lialda and Entocort together - I'm not a doctor, but I see no reason why they cannot be taken together. Many patients take Asacol and Entocort together, and Lialda is just one more brand of mesalamine. I don't see anything in it that is remarkable, (when compared with Asacol, for example), except that it does not contain lactose, (which never should have been in Asacol in the first place, since most patients with colitis are lactose intolerant while they are reacting).
If you've been taking Entocort for less than eight weeks, you probably would not need to "withdraw", by tapering the dosage, but since individual effects can vary, it's never a bad idea to wean yourself off any steroid. Compared with prednisolone, Entocort is not a systemic, and only about 10 % of it is actually absorbed into the bloodstream, due to it's delayed release in the ileum and the colon. Therefore, it is not anywhere near as likely to cause a "dependency", the way that Prednisone does.
Many patients have had success by using Entocort to suppress the inflammation, while also taking mesalamine, in order to expedite the transition to mesalamine alone, as a long-term maintenance treatment.
I agree that your doctor seems to have a rather cavalier attitude toward switching meds, and he pretty much seems to be totally oblivious of the expense involved.
Tex
I can't access that site this morning either, and I have my browser set to accept all cookies, but delete them when I close the browser, so apparently that site is having a server problem.
Lymphoid hyperplasia isn't related to colitis, (as far as I'm aware) - it's the rapid growth of normal cells that resemble lymph tissue.
You're right - there's no mention of even checking the thickness of collagen bands in the lamina propria, so evidently he didn't consider it to be important, (the treatment is the same, regardless of the type of MC). However, he says:
This is not typical of LC, since LC is marked, (only), by lymphocytic infiltration into the surface of the epithelium. The lamina propria is sub-epithelial. Thus the "mixed MC" interpretation.However, a mixed acute and chronic inflammatory cell infiltrate is seen within the lamina propria which ranges from mild to moderate in severity. The inflammatory cells can be seen extending both into the surface and glandular epithelium.
Hmmmmmmm. Regarding taking Lialda and Entocort together - I'm not a doctor, but I see no reason why they cannot be taken together. Many patients take Asacol and Entocort together, and Lialda is just one more brand of mesalamine. I don't see anything in it that is remarkable, (when compared with Asacol, for example), except that it does not contain lactose, (which never should have been in Asacol in the first place, since most patients with colitis are lactose intolerant while they are reacting).
If you've been taking Entocort for less than eight weeks, you probably would not need to "withdraw", by tapering the dosage, but since individual effects can vary, it's never a bad idea to wean yourself off any steroid. Compared with prednisolone, Entocort is not a systemic, and only about 10 % of it is actually absorbed into the bloodstream, due to it's delayed release in the ileum and the colon. Therefore, it is not anywhere near as likely to cause a "dependency", the way that Prednisone does.
Many patients have had success by using Entocort to suppress the inflammation, while also taking mesalamine, in order to expedite the transition to mesalamine alone, as a long-term maintenance treatment.
I agree that your doctor seems to have a rather cavalier attitude toward switching meds, and he pretty much seems to be totally oblivious of the expense involved.
That statement is getting pretty close to an oxymoron, isn't it? LOL.and she said to do whatever I wanted but don't take them together.
Tex
Old news but...........
I wanted to raise the flag.
My doc said my choice was either Lialda or Entocort.
She was so wrong, GF is the way for me. I'm not even taking Welchol at the moment..........
My doc said my choice was either Lialda or Entocort.
She was so wrong, GF is the way for me. I'm not even taking Welchol at the moment..........
NO, NO, NO
Good for YOU and the PP.
Wayne,
Actually, joint pain is one of the symptoms of MC, (actually, it's from the leaky gut syndrome, but that is also linked with MC).
I'm not sure about the pain when walking. A hiatal hernia can reduce abdominal blood flow to the digestive tract and to your legs. It can also reduce breathing capacity, significantly for some people. I'm sure the degree of pain varies from person to person, but hiatal hernias are notorious for "impersonating" a heart attack. A lot of members have them, and I don't understand why your doc didn't mention it, since it definitely can/will have a significant influence on your health, and general sense of well-being.
Just because MC can't be cured, doesn't mean that it can't be totally controlled. The reason we say that it can't be cured, is because it always has the potential to reappear, if you "experience" one of the triggers, (IOW, eat something you are intolerant to, take a med that can cause it, etc.,), or stop taking a maintenance med. As long as you're careful to avoid any triggers, or you diligently take a med for maintenance, you should remain in remission. Many doctors claim that you are "cured", when the D stops, with an eight-week course of Pepto-Bismol or Entocort, for example. When the D begins again, after the residual effect of the med wears off, they say you had a relapse. Yeah, sure.
A few lucky people experience spontaneous remission, where MC goes into remission, for an indeterminate amount of time, without any treatment. The same thing can happen with the other IBDs, such as Crohn's and UC. The problem, of course, is that the remission can also end, just as mysteriously as it began. By contrast, if you maintain your "treatment" program, whether it be meds or diet, or a combination, you should be pretty much immune to any reactions, for the rest of your life.
Yep, it doesn't take a treatment program with Entocort long to "consume" the amount of money necessary to buy some tests at Enterolab. And, I suspect you're quite correct - you can bet that your doc will claim credit for any remission, when it arrives. LOL.
Tex
Actually, joint pain is one of the symptoms of MC, (actually, it's from the leaky gut syndrome, but that is also linked with MC).
I'm not sure about the pain when walking. A hiatal hernia can reduce abdominal blood flow to the digestive tract and to your legs. It can also reduce breathing capacity, significantly for some people. I'm sure the degree of pain varies from person to person, but hiatal hernias are notorious for "impersonating" a heart attack. A lot of members have them, and I don't understand why your doc didn't mention it, since it definitely can/will have a significant influence on your health, and general sense of well-being.
Just because MC can't be cured, doesn't mean that it can't be totally controlled. The reason we say that it can't be cured, is because it always has the potential to reappear, if you "experience" one of the triggers, (IOW, eat something you are intolerant to, take a med that can cause it, etc.,), or stop taking a maintenance med. As long as you're careful to avoid any triggers, or you diligently take a med for maintenance, you should remain in remission. Many doctors claim that you are "cured", when the D stops, with an eight-week course of Pepto-Bismol or Entocort, for example. When the D begins again, after the residual effect of the med wears off, they say you had a relapse. Yeah, sure.
A few lucky people experience spontaneous remission, where MC goes into remission, for an indeterminate amount of time, without any treatment. The same thing can happen with the other IBDs, such as Crohn's and UC. The problem, of course, is that the remission can also end, just as mysteriously as it began. By contrast, if you maintain your "treatment" program, whether it be meds or diet, or a combination, you should be pretty much immune to any reactions, for the rest of your life.
Yep, it doesn't take a treatment program with Entocort long to "consume" the amount of money necessary to buy some tests at Enterolab. And, I suspect you're quite correct - you can bet that your doc will claim credit for any remission, when it arrives. LOL.
Tex
