[Bud]

Please understand, my intention is not discredit my wife�s doctor by posting what follows. I realize the complexities of the issues surrounding intestinal tract disorders and that specialist and professionals of unquestionable expertise will have opposing views on this subject matter. My intent is only to receive input on the opposing views that follow so that I can weigh that input, like so many others on this board, in my search for direction to minimize the terrible impact this illness has imposed on my wife�s quality of life.As for background on Dr. fine, whose opposing view follows: Dr. Fine, who specializes in intestinal disorders, is a board certified internal medicine doctor and gastroenterologist, professionally involved in patient care, medical research, and teaching for over 10 years. And for anyone interested, his website is www.finerhealth.com. Now to the meat and potatoes �. I posted the following message on Dr. Fine�s bulletin board:�Dr. Fine; My wife was diagnosed with MC (Microscopic Colitis) last October. She had been through numerous tests and procedures including colonoscopy and endoscopy, both with biopsies. Her symptoms are diarrhea (95% morning thing with 3 to 5 BM�s in first 2 hours of waking) and the cramps (pain) that are there all the time and run from mild to dibilitating (definitely the worst part of this ordeal). She also had weight loss. She�s 5� � 6� and went from 138 to 113 in three months and is at 118 now. In January, on the follow-up with the gastro, it was explained that patterns had developed suggesting IBS. One example is that stress can set the cramps off in less than a minute and they are severe. You should also know that food, mainly dinner, also sets it off quickly and water will even set it off. Because of the reaction to stress, the gastro changed his diagnosis to IBS with MC. Additionally, I spend a great amount of time, daily, on a IBS group self help bulletin board where it�s easy to see that her symptoms are more closely tied to IBS, but there�s slight differences in some cases that have me believing there is MC with the IBS. My questions are: 1) Have you ever heard of a person having both IBS and MC going on at the same time? 2)If yes to the above, does IBS and MC tend to work against each other (I was told that they do by a knowledgeable guy on the IBS bulletin board)? 3) Do you have any advise for treatment if this is a combo of IBS and MC?�Dr Fine Responded:�Stress aggravates the symptoms of most GI disorders, especially immune diseases and diarrhea. This would not constitute a diagnosis of IBS and by definition, IBS patients have no other definable syndrome.I would not agree with this diagnosis (and a patient with another diagnosis doesn't need a diagnosis of IBS because it serves no purpose). Most MC patients with pain and cramps have concomitant gluten sensitivity. All MC patients should be tested for this and if positive need to avoid gluten in the diet.Tests for gluten sensitivty are available online from www.enterolab.com Good luck.�There you have it. Sorry for the book, but input on this is extremely important to me. If anyone can help, it would be greatly appreciated.Thank you!

 

[Mike NoLomotil]

Dr. Fine's statement that gluten sensitivity will appear in most MC patients is on the money. Better than 70% will test positive and repsond to a gluten-free diet quickly. He sent you to a test, you can also use rudimentary dietary mgt. and oral challenge to check it out. he is also correct that stress is an aggravant to GI disorders with an immune basis. Quick reaction is do as he suggests. Standard differential dx to r/o gluten sensitivity.

 

[Guest]

Bud: I am diagnosed to have Microscopic (Collagenous) Colitis too. My GI says I have IBS also.I found Dr. Fine through Judy Malinowski's Newsletter and read your post over there at www.finerhealth.com I have found so much more help over here.I am going to my family doc next week and am going to ask for a referral to have the gluten testing with entero labs. So my insurance will pay?Dr. Salt said on his last chat when asked this question that he believes you can have both.There has to be some connection??after investigating both conditions--but I realize they are learning more everyday! I get confused also.Does your wife suffer from depression?What treatment did her doc prescribe?Diet, therapy, otc meds, prescription meds?Does anything help?Good luck in your search--we are in it together. Keep in touch.Take Care and give your wife my regards.Barbara------------------BJV/Female__(D)

 

[flux]

quote:1) Have you ever heard of a person having both IBS and MC going on at the same time?

There is nothing preventing it, although I don't know one would tell. The symptoms of MC are ususally severe and would not meet Rome criteria.

quote:2)If yes to the above, does IBS and MC tend to work against each other (I was told that they do by a knowledgeable guy on the IBS bulletin board)?

I don't know what that means unless one had IBS-C (whatever that really is) and MC since MC ususally results in severe diarrhea.

quote:3) Do you have any advise for treatment if this is a combo of IBS and MC?

I think MC is usually treated like IBD...

quote: Better than 70% will test positive and repsond to a gluten-free diet quickly

From what I can tell, sometimes celiac and MC appear to be one and the same and other times not. But this statistic sounds made up and it is probably meaningless anyway: 70% of what population? Who has been tested? Many celiacs go undiagnosed and MC is probably a rare disease. Anyway, there is a related condition collagenous colitis and that makes the relationships more complicated.

 

[eric]

Bud, I would look at treating the MC to get it in remission and see what effect it will have as it is much more serious. I will also keep looking into this, but I recommend doing some more searches in medscape as new articles are being posted all the time.Waht he said here "I would not agree with this diagnosis (and a patient with another diagnosis doesn't need a diagnosis of IBS because it serves no purpose). The no purpose here is take care of the organic disease first.------------------ http://webpotential.com/ericibs/index.htm

 

[Guest]

bump for Bud...anybody else have an answer?------------------BJV/Female__(D)

 

[Bud]

Before I get started �.. to the respondents, a heartfelt �THANKS.� Your responses individually, were informative, but together, were conclusive. What I mean by this is that these posts have validated my recent thoughts that MC (Microscopic Colitis) should have been equal in importance when I began to prioritize IBS. I somewhat, although not totally, shrugged of the MC because I wasn�t seeing much on severe pain being associated with it (her pain is crippling at times - all too often) nor was I seeing a strong relation to the �stress-trigger� that she definitely has. I also should mention that it was a phone conversation with Shawn (Eric) a couple of weeks ago that brought focus back to MC (Thanks Shawn) which eventually led to the post to Dr. Fine and this thread.As for the gluten sensitivity, there�ve been four lab analysis where it was included. I believe three were from stool specimens and one was definitely from a biopsy. If memory serves correctly, not being 100% certain which specific test was high, the biopsy and two of the others came back in the normal range while the fourth came back one point above the high-normal line (30 being high-normal with her at 31). Because of the above normal reading on one, the Doctor prescribed a gluten-free diet, which we did. However at best it was a two week half-assed attempt in which only three days were 100% gluten free with the remainder being minimal wheat consumption and the results were zero so we shrugged the gluten idea off.Mike, I�m curious ��. Is a �standard differential dx to r/o gluten sensitivity� test a standard test that my doctor will be familiar with? Please don�t tell me your firm is the only one that offers it.Barbara, �YES!!!!!!!� My wife has suffered depression since afflicted with this illness. She�s had a couple of really bad spells where we considered counseling and anti-depressants, but she�s got it under control in that she�ll have occasional attacks, but can pull herself out within, at the most, a day. Bad part is that after living with this always-upbeat woman for 37 years, to see her go through these bouts of depression tears my heart apart. As for the doctor�s prescribed treatments:Asacol (for diarrhea) from Oct thru Feb � Seemed a little effective in beginning, but she took herself off it in Feb and suffered no adverse effects. Hydrocod/Apap (for pain) � This is only used as a last resort when she can�t handle the pain any longer as she has always been reluctant to use pain medications. It is effective in dulling the pain when it�s severe, taking it from like a 10 to an 8 or 7.Wheat-Free Diet � Covered aboveShe also started taking Caltrate in mid April and had good results, but we�re questioning now whether it was just the beginning of a �good period� that coincided with her beginning the caltrate as she�s going through a bad period now.Once again ��. THANKS TO ALL!

 

[Mike NoLomotil]

BUD: naw...I was writing fast becasue I am in a hurry...got the kids this weekend (wife working at night) and had to go home early...same today...gotta go soon and my PC at home is still in the box (moved a week ago). What my too-quick statement meant is that I felt the DOCTOR was following a typical approach in differential diagnosis...and there are many ways to look for gluten sensitivity. It just depends what direction you want to come at it from. Double blind placebo controlled oral challenge is still the gold standard, and no I would not suggest our company is the only one to go to for this. You can look on the product board for a colorful conversation on what the doctors I work with do and realtive reactions to same. For what you appear to have you should get satisfactory outcomes with traditional means. I will have to defer until another day when I have more time to reply to Flux's usual suggestions that everything we do is a fantasy or made up. Have to go pull references, and frankly since a whole body of immunologic research by respected doctors is basically being ignored and will continue to be ignored as somehow delusional, why bother?