Dealing with a Flare

[Adelaide]

It has been quite a while since I have commented on here. I have now had this disease for over 12 years. I have never been in full remission but things became manageable after medication and sorting out my diet years ago.

I believe my MC started with antibiotics so I am always very careful if I have to go on antibiotics. However in the last few months I have had cataract surgery and the doctor put me on 4 weeks of antibiotic and anti inflammatory eye drops for each eye. Since it was my eyes I wanted to do the right thing and I was hopeful that eye drops would be different from tablets. They weren’t! It has been 2 months since I finished all my drops. Things started to go downhill slowly but now I find myself in full flare.

Now I have to go back to the drawing board and start again. It is so exhausting! When I was diagnosed (which was about 4 years after initial symptoms) I went on Budesonide for 7 months which gave me a kick start and I went gluten and dairy free. Now I am wondering if I am able to get some sort of relief from this flare from diet alone or should I be looking at medication again?

[tex]

I'm sorry to read that you've had a relapse. These are uncharted waters, but if extra careful diet restrictions don't bring relief within a reasonable amount of time, it may be necessary to use medication. If you use budesonide (which is usually the best choice) it's best to start with a full dose, because a reduced Initial dose rarely does the job for difficult cases. Have you seen the newsletter the Microscopic Colitis Foundation published back in January of this year? If you haven't already seen it, you might find something beneficial in that newsletter. For your convenience, here's a direct link where you can either read or download a copy of that newsletter:

https://www.microscopiccolitisfoundatio ... mplate.pdf

I hope this helps.

Tex

[Adelaide]

Thank you so much for your reply Tex and for the link to the article. I have read it and will read it again. I made an appointment with my GP but couldn’t get in for four weeks and then I am sure I will get referred to a specialist which will take more time (the health system in Australia has really gone downhill). So I will take this time period to address what I am eating because I know I have been complacent with my diet lately. My hope is that I will get on top of this with diet alone and never need to go on the medication.

I am thankful to you Tex and also to Gabes for your expertise and for the time you take to help people. Even though I haven’t posted on here for awhile I often use the search bar to look up information.

[tex]

With that much wait time before your appointment, I would be surprised if you're not able to regain remission before the appointment.

And you're not alone in Australia. Healthcare has deteriorated all over the world during the last few years. Wait times are still pretty miserable here in the U.S., but they seem to be finally improving. The biggest problem here is that healthcare is becoming so expensive that it may soon be affordable only by the wealthy.

Tex

[Adelaide]

Hi Tex

One thing with this flare that is different is that this time I am dealing with bloating and gas and that is something that has always been quite minimal. Do you have any clue why this would be different? I just wonder if anything else could be going on as well.

[tex]

The bloating that's associated with MC is usually the result of opportunistic gut bacteria taking advantage of partially digested food. Although this is usually associated with cross-contamination of the diet by gluten, it can also be caused by diet contamination with any of the other food sensitivities that cause our immune system to produce antibodies. And because you suspect that the flare may be due to antibiotic use, dysbosis (an adverse gut bacteria imbalance) may be the primary problem.

You might try a good, high population probiotic for a week or two to see if that helps, but also, make sure that none of the foods in your diet are somehow being cross contaminated with gluten, soy, or casein. If you're using any commercial products, sometimes manufacturers change ingredients without prior notice, so read the labels carefully. But although that happens in the U.S., Australia has such strict allergen laws that contaminated products that are sold as allergen free, are very unlikely to be contaminated. Is anyone else in the house eating any of the foods that cause you to react? If so, your food might be getting contaminated on countertops, or by other means, in the kitchen.

Have you changed any cosmetics, soap, shampoo, detergent, skin care products, etc., in the past few months? Any highly stressful situations?

Tex

[Adelaide]

I definitely think it has something to do with gut bacteria. Both my initial entry into this disease and this flare as well came after antibiotics.

Cross contamination is definitely a consideration as I have a husband who loves gluten laden products. I will have to be more diligent in this area.

Thanks Tex

[tex]

If there's any wheat-based flour in the house, the problem is probably cross-contamination with gluten, because once a bag of flour is opened, particles drift everywhere, and can even settle out on dishes in a cabinet. Toasters are also a common source of cross-contamination. If microbiome dysbosis is the problem, and it won't respond to a careful diet, a possible solution might be fecal transplant. Although that's usually used to resolve a case of antibiotic resistant Clostridioides difficile, it should work for other types of dysbosis.

https://medicalxpress.com/news/2024-04- ... y-nwletter

https://genomemedicine.biomedcentral.co ... 6-7#citeas

A fecal transplants would probably be considered to be a last ditch effort to resolve the problem.

Tex

[Adelaide]

I am sure I have quite a bit of flour flying around the house and definitely in the toaster. Gabes and I talked about FMT a few years back. I am not sure how available it is in Australia but I am pretty sure the priority is for patients with C-Diff. Definitely a last resort. I am going to try the probiotics. I have some of them at the moment and will get some saccharomyces boulardii. Pity I can’t get VSL#3 here because I heard that is very good. I think it can be ordered but I don’t know if I would trust it with no refrigeration and Australia Post delivery times.

[tex]

If your diet is being cross contaminated with gluten, achieving remission will almost surely be impossible. Probiotics, fecal transplants, or any other treatment will likely not be able to overcome the damaging effects of gluten. At least, that's been our experience, in general.

Tex

[Gabes-Apg]

Bioceuticals have a good boulardi product
(I took it 9 years ago)

SB Floractive

[Adelaide]

Thanks Gabes! That is helpful to know.