path to take?

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shona
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path to take?

Post by shona »

hi everyone,

very glad to have found this forum :grin:

I'm posting on behalf of my mum who was diagnosed with CC a few months ago, after 5 years of symptoms and tests.

Her GI put her on probiotics at the start of the year (pre-diagnosis) which helped a little, and after the diagnosis they gave her another couple of drugs - I dont have the details of all of them, but believe some were antibiotics and another one was Questran (which did not go well, made her very sick).

I've read a fair bit on this site, so know about people having success with gluten-free diet and/or entocort.

I'm wondering if

1) it's worth getting the enterolab test done, or if she should just start trying a GF diet?

2) if it is worth getting the stool test done, which ones should she do (gluten obviously, but casein and soy as well?). If anyone in Australia has done the enterolab tests, could they tell me how much the test + shipping cost.

3) would it be better to also start on entocort straight away, or should she leave that as a second resort, if the GF doesn't help. I'm not sure if it's better to go on entocort + GF diet then wean off them one at a time to work out if both are needed, or try them separately so it doesn't confuse things.

4) for those who are helped by entocort, are there any who have been taking it long term? Are there are long term side effects other than the minor ones I have read about? (headaches, nausea, etc)

thank you
shona
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tex
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Post by tex »

Hi Shona,

Welcome to our internet family. I don't believe that any of our Australian members have used the tests offered by Enterolab. The closest has probably been a member in Hong Kong.

If your mum needs proof before she is willing to try the diet, then the tests would be beneficial. If she is willing to give the diet a fair trial, then she can probably bypass the tests. Most of the members here are sensitive to gluten and casein, (the primary protein in all dairy products), and about half of us are sensitive to soy. A few have other food sensitivities, of course, such as eggs, yeast, corn, carrageenan, etc.

There is no known cure for collagenous colitis, so some sort of treatment plan must be maintained indefinitely. Many members choose to use both diet and Entocort EC, (or Budenofalk), early on, and then after they achieve remission, they slowly taper off the drug, and maintain remission by diet alone. The reason for using both at first, is to achieve remission as quickly as possible. It can take 6 months to a year to achieve remission by diet alone, but Entocort usually brings improvement in a couple of weeks or so. Unfortunately, some people react adversely to Entocort, so not everyone can use it, but for those who can, it is usually the most effective drug available for treating MC.

We have several members who have been taking Entocort for 2 or 3 years, (often at reduced dosage rates), with no noticeable side effects of any significance. IOW, long term effects seem to be no worse than short term effects, for most people.

Again, welcome aboard, and please feel free to ask anything.

Tex (Wayne)
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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 ant »

Dear Shona

Welcome. I did the enterolab test from Hong Kong. It went well although my "sample" was held up at US customs for a couple of days (those guys need to get a life!!)

Best wishes for your mother and her journey to remission, ant
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Post by Gabes-Apg »

Hi there Shona
i am based in Brisbane, so yes this condition affects all ages in all countries.

answering your questions

1) it's worth getting the enterolab test done, or if she should just start trying a GF diet?

this is personal choice. I couldnt afford the enterolab test or the aussie based lab equivalents
I was already on a reduced gluten, yeast, lactose diet, so it was not too difficult for me to go 100% gluten free
I followed the elmination diet principles and ate gooey rice and chicken for a week and then slowly added an ingredient at a time.
it takes time and patience but in the period of 9 months i have confirmed intolerance to GLuten, Yeast, Dairy and Soy. Plus which vegetables i can and can not eat.

My meals, and lifestyle has changed alot, it was a big adjustment, but it is definately worth it, i am reasonable well, having minimal MC symptoms without having to take steroids, I am pretty chuffed with that outcome. btw - i am 40 years old, work full time, so to be well and not having time off work is very important.


2) if it is worth getting the stool test done, which ones should she do (gluten obviously, but casein and soy as well?). If anyone in Australia has done the enterolab tests, could they tell me how much the test + shipping cost.

the aussie based lab that offered the same testing was $900 AUD
I think the enterolab test for australia was going to be about $600 AUD
based on the cost i didnt investigate the customs implications etc

3) would it be better to also start on entocort straight away, or should she leave that as a second resort, if the GF doesn't help. I'm not sure if it's better to go on entocort + GF diet then wean off them one at a time to work out if both are needed, or try them separately so it doesn't confuse things.

based on history of various people on this site, for majority of thepeople using entocort and going GF will optimise the result, it is not instant it will take a couple of weeks.


4) for those who are helped by entocort, are there any who have been taking it long term? Are there are long term side effects other than the minor ones I have read about? (headaches, nausea, etc)

Due to the tablet cost, doctors do not prescribe it long term, i am not sure what the aussie PBS system is for entocort (ie how many scripts the govt will subsidise) based on the posts from the USA based users they get subsidised scripts for 3 - 6 months.
those that want to continue use are obtaining it via Cananda or India.

Pre MC diagnosis when my body was inflammed i was getting alot of headaches, fatigue etc and based on discussions on this site that was the gluten.
if i had to choose which symptoms to have give me headaches and nausea over chronic D and pain.



Hope this helps, as Tex said, there is no cure for this (bugger hey?) each of us has had to come up with the system that works best. everyone is slightly different so what works for one doesnt always work for another.

there is alot of information to absorb, it can be a bit overwhelming at first.
feel free to ask more questions

take care

Gabes
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shona
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Post by shona »

thanks so much for all the replies :)

She is nervous about taking Entocort due to bad experiences with other meds (mainly Questran)

Tex, when you say some people react adversely to it, what sort of reaction do they get?

(I've shown her the information about the enteric coating to reduce absorbtion into the rest of the body)

If she has taken other types of steroids in the past without adverse reaction, is it likely the Entocort won't cause a problem?

I found this post on the elimination diet so will print it out for her: http://www.perskyfarms.com/phpBB2/viewtopic.php?t=732

Also found the Coeliac society of Australia has an iPhone app gluten free diet Australian ingredient list, so I'll get that as going by the numbers from members here it seems fairly likely she has a gluten intolerance.
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Post by Robbie »

Shona, your mum is so fortunate to have you to help her figure out what path to take. Best wishes to you both!
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Post by Linda in BC »

Shona, (or anyone else, please jump in) I was going to be asking my doctor next week about taking Questran as I have to find something else to lower my cholesterol since I stopped taking statins, and I understand it also helps with D. Would you be wiling to tell me a bit about the bad experience your mom had with Questran? Has anyone else have bad reactions to it?
Thanks, Linda
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Post by Gloria »

Shona,

I have been on and off Entocort for the past three years and I haven't had any side effects from it, other than osteoporosis, a known side effect of steroids. I'm not sure how much of the osteoporosis is due to Entocort, and how much is due to genetics. I'm of European descent, small-boned and don't weigh a lot, all of which predispose me to osteoporosis.

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Post by Gabes-Apg »

Linda

you took the words out of my mouth - i use small amounts of questran for the MC control, so am also very interested in hearing what occurred
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Post by Bifcus16 »

Hi Shona,

I'm one of the other Aussie regulars here and I have Lymphocytic Colitis. Welcome to our group.

I didn't do the Enterolab testing, because by the time I found this group I had already worked out how to avoid the D, and I have an immune condition which means the tests (which rely on a part of the immune system called IgA) will not give an accurate result for me.

I have never taken any drugs other than Immodium advanced (the other similar drugs all have lactose). I find that dairy causes D and gluten causes other other symptoms - swellings, painful joints, brain fog - the usual gluten intolerance list!

In your mum's case it might be worth doing the test as it would speed up the time taken to work out via elimination what is causing the problem. It can sometimes take a long time for diet alone to work, so having that evidence of the main culprits can be helpful. That said, for some people the diet shows results in a matter of days - you never know your luck.

Personally, I don't find the diet that big a deal most of the time, but I am lucky and only need to avoid gluten and dairy. It is a nuisance when eating out (which I tend to limit). You do need to be careful about everything you consume - it can take a while to get rid of the hidden sources of gluten, such as medications/vitamins and seasonings etc.

Do you have a doctor who will prescribe Entocort? The GI I talked to about it was reluctant to offer it due to the cost. As I didn't need it at the time I never pursued it.


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Post by tex »

Shona wrote:Tex, when you say some people react adversely to it, what sort of reaction do they get?
Most members who have problems with Entocort, have symptoms such as dizziness, balance issues, vision issues, (such as blurred vision), memory, and cognizance problems, and other neurological issues. Some medications prescribed for MC can make the diarrhea worse, (especially some of the 5-ASA drugs), but I don't recall that happening to anyone on this board, who was taking Entocort. In a certain percentage of cases, Entocort does not seem to benefit the diarrhea, but it virtually never makes it worse. Neurological issues seem to be much more common among the members of this board, who have taken Entocort, than the label suggests.

Budesonide, (the active ingredient in Entocort), is a unique corticosteroid, so a tolerance for other steroids, might not be particularly relevant. Usually, if adverse symptoms are going to appear, they become apparent within a day or so of beginning a treatment regimen with Entocort.

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 shona »

I'll have to double check what adverse reaction she had, but from memory it was things like vision (started with sensitivity to light but got to very blurred vision), vomiting - I'll find out more details and report back :)

Her GI won't give her a prescription for Entocort without seeing her, so next appointment available is the 4 October.

I got a shipping quote if we decide to go ahead with the Enterolab tests - $92 for 2 business days. If we decide to spend the money (and I am leaning towards that, I'm frustrated at 5 years of guessing/trialling), which option would be better?

1) "Gluten Sensitivity Stool and Gene Panel Complete" ($369) - gluten, transglutaminase (autoimmune response), malabsorption, gluten gene, and milk.

2) "Gluten Sensitivity Stool Panel Complete" ($249) - gluten, transglutaminase (autoimmune response) and malabsorption

3) Gluten $99 + Milk $99 + Soy $99 ?

I guess I don't understand the point of the gluten gene test or the transglutaminase test if you are already testing for the gluten sensitivity?

Also does the malabsorption test just give a position/negative, or would it give more information which could be used to work out with enzymes would help - I'm fairly sure she does has malabsorption issues (going by weight & time taken to get the diagnosis) so maybe it would just be better to ask her GI for enzymes without doing the test?

Thank you
shona
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Post by shona »

Gabes-Apg wrote:the aussie based lab that offered the same testing was $900 AUD
I think the enterolab test for australia was going to be about $600 AUD
based on the cost i didnt investigate the customs implications etc
Gabes, I forgot to ask if you have any more details about the lab which does the same tests here in Australia?

thanks :)
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Post by tex »

Shona wrote:I'll have to double check what adverse reaction she had, but from memory it was things like vision (started with sensitivity to light but got to very blurred vision), vomiting - I'll find out more details and report back :)
If she is having those symptoms without taking any drugs, those sound like classic migraine symptoms, which is a somewhat common issue with MC. I had problems with those symptoms myself, when I was reacting. Gluten can cross the blood/brain barrier, to cause such neurological issues. It's even possible to have migraines without a headache. Those are called acephalgic migraines, if a visual aura is involved, without pain.
Shona wrote:I guess I don't understand the point of the gluten gene test or the transglutaminase test if you are already testing for the gluten sensitivity?
The gene test can be useful in some cases, but it is not necessary. It can define whether or not celiac disease is a possibility, and in some cases, it can predict how many food sensitivities are likely to be a problem, and how difficult it may be to achieve remission. IOW, people with double DQ genes have more food sensitivities, and usually have a more difficult time achieving remission. The tissue transglutaminase antibody test simply determines whether or not an autoimmune reaction is present. For most of us who are symptomatic, that test result will be positive, of course. When uncontrollable diarrhea is present, along with a diagnosis of MC, the existence of an autoimmune reaction is pretty much of a no-brainer.

The fecal fat malabsorption test simply determines whether or not a significant fat malabsorption problem exists. Essentially, what this implies, is whether or not the small intestine is involved in the reaction, since fat is normally absorbed in the small intestine. Many of us with MC have a mild to moderate fat malabsorption problem while we are reacting, but if there is a serious malabsorption problem, then celiac disease may be a possibility, since a large number for a malabsorption test result implies the possibility of significant damage to the villi of the small intestine. This test result is reported as a number. Anything below 300 is considered normal. No other information is provided with the test result, however.

The most common food sensitivities among the members of this board, are gluten, dairy products, and soy, in that order of prevalence.

I'm not familiar with the test offered in Australia, but the tests we are referring to on this board, are only offered by the lab in Dallas, Texas, USA. No other lab in the world is licensed to use this technology. Prior to the development of the food sensitivity stool tests at Enterolab, all of the stool tests offered by other labs, (for food sensitivities), were notorious for providing unreliable results, and they are the primary reason why so many doctors are so reluctant to adopt the tests offered by Enterolab.

Incidentally, regarding enzyme supplements - I once tried a highly-recommended enzyme blend, to see if it would improve my digestion while my gut was still healing. The first pill I took, made me sick as a dog for about 4 days. Within 2 hours I was vomiting, and after that, every hour or two, the process was repeated. Of course after a few episodes, I was down to the dry heaves, but it still wasn't much fun. Fortunately, that part of it only lasted for one day. I never touched another enzyme supplement again. :lol: Of course, that doesn't mean that they might not work for someone else, but I learned that they definitely don't work for me.

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.
shona
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Post by shona »

She doesn't have those symptoms without the drugs, they stopped a day or two after she stopped taking the Questran (which was a few months ago)

Thanks for the extra info about the tests.

She has had the test for cceliac (negative) and her CC diagnosis was discovered by biopsy so I guess we don't need the gene test or the transglutaminase test.

I'll order the gluten, milk and soy tests.

If the entocort & GF diet starts working at reducing/stopping the D & her gut gets a chance to start healing and she still can't put weight on in a few months I guess we can look at getting the malabsorption test then and think about enzymes after that :)
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