[loulou]

Hi,I just don't get how IBS can be called functional. Just what's so functional about spending 12 hours a day dealing with one symptom or another. I don't know how people survive for 40 years like this. How do you pay the rent? Also, what's the difference between IBS and chronic functional abdominal pain.LouLou

 

[Popeye]

"Functional" means that there is no visible physical abnormality, disease nor inflammation in your bowel upon examination of your intestines.However, as far as I am concerned, the fact that my brain reacts differently to pain than the "normal" brain, the fact that my enteric nervous system isn't working properly, and the fact that my symptoms are so real, make me disregad the term "functional" and consider IBS a "real illness".

 

[Mike NoLomotil]

Yeah, the term "functional" became obsolete when, over the past several years, the abnormal low level inflammatory activity which characterizes at least those IBS patients with a diarrheic component to their symptoms (roughly 2/3 of the known IBS population) have been quantified. This was first done by jejunal isolation and washing techniques which recovered proof positive of proinflammatory mediators being released in the small bowel which are already known, if released from immunocytes, to have the effects upon nerves and smooth muscle and blood vessles and other structures long observed in patients with certain symptoms...then later by biopsy of the small bowel.There are also signs of chronic activation of the mucosal immunocytes as well, which was first discovered 15 years ago indirectly, through the use of immunomodulators which when administered brought about a very high rate of symptom reduction...and later by biopsy of the outflow tract of the small bowel into the large bowel, and agioan recently through full thickness biopsy of the lower bowel wall. The normal types of examinations done on people whoe present with IBS symptoms did not reveal the colonic mucosal changes as they were not typically looked for, and the upper small bowel has never been examined extensively until recent years, partially due to the inherent difficulties and partly due to false assumptions....that the symptoms, which seemed to origiinate in the colon, must be colo-centric. Absent obvious tissue changes there, it ahs been considered "functional".The only thing that differentiates a so caled "functional" disorder froma a, mmmm, disease with "known pathogenesis" is that the actual pathogenesis of the latter has been discovered, whereas it has not yet been discovered in the former. Once discovered, then the term "funstional" no longer applies.An objective view of current understanding taken in the broad view suggests that "diarheic and cyclic IBS" is not a functional disease or "syndrome" due to expanded understanding and visible quantifiable inflammtory ractions in the shcok organ (small bowel) having been confirmed, and this also makes it clearer that the large bowel is more likely an "affected organ" secondary to the activities wheihc occur consequent to the inflammatory events observed.This is no different than when the technology was developed and applied to study of the lung and substructures in asthma many eons ago..such that asthma magically ceased being considered a "psychosomatic disease" when the allergenic basis for the disease was shown.BUT those patients who have been correctly diagnosded with so called "c-type" IBS....this is clearly a different story and much more porrly understood as yet.MNL

 

[Popeye]

Mike,does that, basically, mean that we're talking about 2 different diseases/conditions when we are talking about IBS-D and IBS-C

 

[eric]

Here is some info on all this Lou Lou.History of Functional Disorders http://www.med.unc.edu/medicine/fgidc/hist...aldisorders.htm Gastrointestinal Motility Disorders Normal Gastrointestinal Motility and Function http://www.med.unc.edu/medicine/fgidc/motility.htm Inflammatory Mediators in Irritable Bowel Syndrome http://www.med.unc.edu/medicine/fgidc/infl...rymediators.htm

 

[Popeye]

Hi, Eric!I haven't said "hi" to you in a long time.Hope you're not angry with me

.

 

[Guest]

If he isn't angry with me, he surely isn't angry with you....

 

[eric]

Popeye, heavens no I am not angry with anyone.

Yes long time, I hope your doing well, . If you need anything let me know.Now, I will admit to getting frustrated sometimes, but usally just in general and that's just a part of life and I always get over it, although there were a few women in my life.

LOLBesides who has never gotten frustrated here.

I certainly hope no one is angry with me either.But I am not angry at anyone and certainly wish everyone good health and the best.

 

[Mike NoLomotil]

SAILOR-MAN: ________________________________________"basically, mean that we're talking about 2 different diseases/conditions when we are talking about IBS-D and IBS-C " ________________________________________Well, the one thing that is certain is that we have distinctly different symptom sets...clinical presentation...and when folks begin looking into what is happening within the "walls" of the bowels themselves you see certain events occurring in people whose symptoms include diarrhea that are not seen so far in people who do not suffer diarrheic symptoms, rather their symptom core is constipation.When a syndrome is stuck in the phase of study where the actual cellular abnormalities which underly the disease have not been seen, a lot of theory and assumption and logical-extension (branching logic) (translation: conjecture), is applied by investigators. Much of this varies since it is in part driven by the perspective of the investigator (his/her medical specialties). Sometimes funding quid pro quos play a role in what data are collected and how they are viewed. All this is nothing new or unique to this issue. It is just reality.For example, an auto mechanic certified in ignition systems trying to diagnose a misfire is more likely to work his way through the logical progression of how igntion system dysfunction COULD be responsible for the misfiring. However a mechanic certified in fuel systems will tend to interpret the observations and available data from the perspective of "differential diagnosis" of the fuel system first. Each is predisposed to view the event from the perspective of their specialty and interpet data accordianlgy. So one needs to get the two together, and assess their info integratively and objectively, to gain the best understanding of the problem. It becomes especially problematic if chornic misfiring among the population of Lincoln Continentals is the problem being studied, and one guy is picking cars to look at seprate and apart from the other guy...and their selection criteria not only may not be the same but it is mot anyway sionce they are not both looking at the same subjects...only waht may be subjects which may or may not have the exact same problem. This can introduce great "error" into the process, so one has to be careful with the data and how firmly you form conclusions from either one...and apply them across the board.This same principal applies in investigations of human health disorders where the pathogensis is still unclear...like the people who have been lumped together under the IBS symptom based diagnostic criteria, for lack of a better way at the time the concept was conceived.In the early stages of investigation of any clinically-puzzling malady, the collective "you" are stuck with interpreting clinical presentation (symptoms) and a lot of often-indirect physical data. The literature of the last 20 years is rife with proof of this reality. And people tedn to dismiss that which does not fit their personal paradigm, and grant broad leeway to acceptance and interpretation of work which DOES fit theor own paradigm...and then inflict that behavior upon others sometimes to the detriment of progress and the patients care. This also is not unique to 'IBS".For one mere example, on one hand there have been studies which suggested that there is an inflammatory process happening in the gut of d-types by virtue of their response to immuno-modulating drugs and dietary modification and the recovery of certain mediator markers from stool, and so forth. Much of this tended to be set forth in literature which was "immuno centric or allergo centric as well as Euro-centric". On the flipside you may have "pictures" of odd or aberrant neurologic activity within the brain or parts of the peripheral nervous system taken by different investigators on different patients with PRESUMABLY the same symptoms but in whom certain things were not ruled out which were by the other investigators, so the selection criteria may not be the same nor are the subjects. Yet both groups, using such criteria as the Rome symptom based criteria, would be diagnosed in the docs office as having clinical "IBS" absent any identifiable causal basis.

BUT during that period there existed little or no ability to easily perform direct-assessment as to WHY this may be happening...and no concensus on even what should be assayed to isolate the causal basis.In recent years, though, since some folks overseas developed techniques of isolating and studying the repsonses of the upper bowel in people with these symptoms, and even began biopsy of the upper bowel, and others began looking at biopsies of the lower bowel with more attention to specific types of tissue aberrations that are not typically sought out on routine biopsy, and other types of related cells which can chemically influence the function of gut nerves and smooth muscle, as well as folks looking for specific chemicals which can be released by these cell types, the collective "you" can now see (in some cases grudgingly as prior theories historically presented must be reinvented) that there IS (at least in diarrheics) such interesting inflammatory responses as lymphocytic reactivity at the root ganglia on biopsy and such things as mast cell density increase in colon tissue if you actually look for it...etc etc etc...the list goes on beyond the scope of my time today). The presence of cell mediated reactions, and an understanding of what the chemicals are which are liberated into the gut tissue should this occur, provides direct insight into the mechanisms of the "upregulated" or "twitchy bowel" seen in diarrheics. Syetmeic immuno-chemistry assays not yet done will also provide insight into some of the peripheral and central mechanisms of activation hwich ave been observed indirectly.So far, though, this work does NOT provide any insight (except by exclusion) into those 30% or so of the "symptom-based IBS diagnosed" who have the exact opposite primary symptom....that is excessive evacuation versus impeded evacuation.Physioligically there have been, before these things proved out, theories that somehow the same underlying dysfunction could account for physiologically opposite effects. And in the world of theory and hypothesis this was certainly possible.But the more data that are collected the less likely this seems. It seems much more likely that the change in bowel behaviors seen in c-types vs d-types is going to be distinct in pathogenesis...and within each type (so far this is becoming obvious among d-types) there may be multiple different pathways to dysfunction (pathogenesis) and they may or may not be comorbid.Most of the doctors I have worked with over the years who have looked at these conditions from a broad perspective surmised long ago, and those who know me have seen me quote this many times, that what we call "IBS" will someday prove-out to be a syndrome which will be characterized much the same way that Chronic Obstructive Pulmonary Disease, or the old "COPD" label that used to be applied to people with age-onset lung dysfunction...[still is in general]...even when the symptom combinations varied widely and there were evn populations who seemed to be the polar opposite (the so called "Pink puffer" and "Blue Bloater" of old).Of course these turned out to have a common denominator of lung damage, BUT the lesions are distinct and thus account for the characteristic differences in the subpopulations as each affects lung and cardiovascular function distinctly. Even a layperson can understand this if they look in the doctors trusty Merck Manual on page 569 (I don't know the page in the online book, but look under Chronic Obstructive Pulmonary Diseases). That diagram, showing the 3 distinct pathologies and how they can exist alone or can overalp to varying degrees, looks so similar to how things are shaking-out with IBS populations.SO the best way I can answer your question is, yes, if "different diseases" is defined not functionally but by "pathogenesis"...which ultimately it should be. It is compelling to consider the COPD "model" when interpreting the cumulative and wide ranging info available on people who suffer the symptoms we still call "IBS".Now go eat yer spinach...as long as you know you have a had a negative oral challenge or immunoresponse assay to it so it will not provoke symptoms.

MNL

 

[alongtin]

Just wanted to add my two cents!"Functional" only means that the problem is not a physical deformity or abnormality in the digestive system (like a polyp or an ulcer). It just means that the problem lies only in the way the gut "functions." Therefore, IBS is functional because it's not classified as a "disease." I'm sure you've noticed that there's not test FOR IBS. Hope that was in clear terms!Good luck!Amy

 

[Mike NoLomotil]

Sure, absolutley, ans it used to be that way since "time everalsting". The differential diagnostic upper and lower GI standard exams and ll known "bloodwork" (that which was knonw to do) would be normal.The trouble is, since about 1994 or so, now you can do exams which show specific pathology...specific types of low level inflammation, for example, in the small bowel which casn explain and show one of the ways the nerves and smooth muscle become upregulated: diorect action of proinflammatory mediators.Also you can see increased mast cell density in the colon wall of some patients, you can fiond increase exocrine activity (in the form of excess mucous production) etc.These findings are consistent with a population of people who are diagnosed clinically, from their symptoms, as suffering so called "IBS". So as these findings are explored further in the years ahead, and become better understood, and more study uncovers more findings, perhaps this will be seen to be a charatcteristic of something they give a new name to, thus have isolated a specific disease not previosuly isolated. Or they remain "IBS" patients and this pattern is a part of what characterizes the disease of Irritable Bowel Disease instead of Irritable Bowel Syndrome. One morphs semantically into the other via the application in the literature over time. Don't really know which way it will end up going, since there are so many different ideas about how this should be sorted out. Only that it will now inevitably happen.But in any event it is becoming clear that at least no all the people diagnosed sympomologically have a functional disease. There is/are organic disease(s) underlying the symptoms...the collectve "we" just do not understand the whole thing yet. This is the phase of transition between syndromes and diseases and is charatcerized by series of hypotheses and theora to explain the new findings of tissue abnormalities.Functional is simply a convenient transient term applied to diseases whose pathogenesis is not yet visible. When it starts to become visible they are simply no longer functional, that's all.Functional Diseases are analagous to UFO's. They are only UFOs until what they are is identified. Then they are whatever we choose to call them, unless they already have a name for tyhe object found, and we simply could not discern them to be what they are with the equipment and methods available previosuly, which we now come to posess.MNL

 

[Popeye]

Mike,thanks so much for such a detailed answer. I am sorry I haven't responded to you earlier...I've been having a lot of problems with my IBS lately...I don't know if you could try to, at least, help me look for a direction in regard to my IBS symptoms. First of all, I still have no clue whether I am IBS-C or IBS-D....My main symptoms are incomplete evacuation, bloating, a loooooooooot of painful gas, irregualar looking stool,...sometimes I would have cramping and cramping with gas and bloating and after that I will feel an urge to go...it's almost never diarrhea, but is often a soft tiny stool... I go almost every day (2-3-4 times), but I almost never have diarrhea,...it's just incomplete evacuation, gas, pain and cramping...Sometimes when I can't go I have pain in my back...So, do you think that I qualify for the IBS-D type (with the pro-inflammatory processes that you described) or am I a C type?I've tried these things so far:1) Metamucil, Metamucil, Metamucil- often it makes my stool bulkier, but it causes so much gas, bloating and pain that it's not worth it...I've tried everything from 1 teespoon a day to 3 teaspoons a day.2)Flaxseed Oil-no help at all3) Aloe Vera syrup-it helped the first 2-3 days, and, then, it lost its effect4)Magnesium-no help5)Probiotics-no help at all6)Kolinade (for bowel cleansing)-no help at all7)Hypnotherapy-it helped a little in the beginning, but no big changes8) Chinese herbal medicine-bullsh*t9)Gas X-ahhh....helps a little...sometimes...My IBS symptoms seem totally random and I still have to find something that can change my condition big time... I have Heather's book titled "Cooking For IBS", but I still haven't started using the recepies from that book...I still live with my parents and I eat traditional Bosnian cuisine, which my mother tries to adjust for me by putting less fat...Coffee sometimes helps me go, and sometimes just causes more gas and pain...I really don't have a clue what to do next...Also, my brother is developing very early signs of IBS, and my father was diagnosed with IBS a few years ago. So, all three of us (father, brother, I) got IBS only when we moved to Canada (he got it in his 50s and my brother and I in our 20s). I wish I could figure out whether it's genetic or environmental ????Do you have any recommendations for me, for I am kinda starting to lose all hope...Thanks!!!p.s. I tried spinach...it's not the answer

 

[Popeye]

Eric,I'm so glad you're not angry

.I've been listening to sides 2 and 3 of Mike's CDs again, but, for some reason, hypnotherapy does not work for me... I don't know where to go now... I was thinking of asking my Dr. for this Zelnorm...But, I don't know whether I am C at all... Ahhhhh....

 

[Stace]

Popeye,Just wondered if you were ever tested for H. Pylori, a bacteria that causes gastritis and ulcers? That was actually my problem. I picked it up in a foreign country I visited. I thought of this when you said your family moved. Just a guess....Also, have you tried a prescritpion anti-spasmodic like Bentyl or Librax for the pain?Stacey

 

[Popeye]

Hi, Stace!Yeah,...actually, this year when I went back to Bosnia for a visit, my aunt who is a nurse, tested me for H-PYLORI. The test came back positive. Upon returning to Canada I started a treatment for eradication of H-Pylori. And, I had a follow-up test, which showed that I have successfully eradicated it.So, I'm officialy H-Pylori free now,...my symptoms haven't improved one bit, however, after the eradication of the helicobacter

 

[Stace]

Oh, sorry you felt no better after being treated for H. Pylori. It took a few months after I completed treatment to feel really good again. H. Pylori really wreaked havoc on my GI system, causing an ulcer.Hope you are able to find some relief. I'd recommend a prescription anti-spas for the pain, also.Stacey

 

[eric]

Popeye, I am not totally convinced yet HT does not work for you really. I suggest you start from the begining again, stay positive and just work straight through the tapes, you took breaks I believe when you first did them and there were some other reasons in there. Another aspecct of this is the more you do it the deeper you can learn how to get into a trance.With that said, there is also the option of seeing one in person, you should really consider, it might be you need individual sessions.Also with that said, lol, it maybe worth going the CBT route on the concious level and see how you do with that as that would be my next suggestion if in fact the HT is a no go for you.I have followed your symptoms and what you have posted here over the year and in no way am I trying to diagnose you (that's important that you were diagnosed and continue to investigate those avenues) but I feel that your IBS waxes and wanes, you have rectal sensitivtiy and symptoms indicative of IBS.I know when you first started the tapes you went into a period of remission almost off the bat, this could have been just the waxing and waning of the IBS and a good spell or just the placebo effect that can have a big impact on IBS and the power of the mind over the gut and IBS. I hope no matter what you do you continue to investigate the avenues of Mind body treatments for IBS as I think still along with other approaches they will help you the most in the long run.If you need anything let me know and I willl help with whatever I can.Remeber if you start the tapes again from the begining stay positive (negative thinking that they will not or did not help is self defeating in this) that they will help this time, some people had to do them twice to find results. Now it is possible it might not but why think that way and they won't hurt even if its just relaxing for the half hour a day.If at that time its a no go, seriously consider seeing one or the CBT approach from someone who knows and can deal with IBS and the individual.I hope this helps. I know your still struggling but you WILL find the approaches and things to help, its just a matter sometimes of some trials and errors, but just doing things can help in there own rights as well in being positive and moving forward.

 

[Mike NoLomotil]

Sailor Man:Sorry to be so slow responding these days...got my own stupid "medical issues" to deal with for now (not IBS) which are also cutting into time.I don't have the benefit of wathcing your symptoms and history for 2 years Like Eric has, if I did I would feel more comfortable making suggestions as to what to look at study or consider.So IF I ask a question you already answered, be patient with me as I just am not able to go back and read your prior posts, or even this whole thread again....just respond briefly to the following:...or you can give me the url where it exists and I will go read it. _________________________________"My main symptoms are incomplete evacuation, bloating, a loooooooooot of painful gas, irregualar looking stool,...sometimes I would have cramping and cramping with gas and bloating and after that I will feel an urge to go...it's almost never diarrhea, but is often a soft tiny stool... I go almost every day (2-3-4 times), but I almost never have diarrhea,...it's just incomplete evacuation, gas, pain and cramping...Sometimes when I can't go I have pain in my back...So, do you think that I qualify for the IBS-D type (with the pro-inflammatory processes that you described) or am I a C type?" ___________________________Let me just respond in the random fashion in which thoughts pop into my head.First, I think we all have a tendency, it is the nature of the mind, to get fixated on categorizing patients or ourselves...labelling if you will...what SEEM to be certain general SUBpopulations of all the great masses of people walking around whose doctors told them they have "IBS" when there was no obvious and immediate answer to their symptoms.There are, one can see if you are out there talking with masses of IBSers, and I am sure that regardless of perspectives almost evryone agrees to this, that there are a BUNCH of people walking around who were not "Diagnose" with "IBS" as carefully and thoroughly as they could have been.It is not as common as we assume that a complete and classic differential diagnosis is done when the patient rpesents with these changes in bowel habits...in fact it is not even close to universal that the doctor stares ata copy of the Criteria Du Jour (lets say now it is Rome II) to make a diagnosis that is symptom based.This is what makes it soooooo hard to talk to people about their symptoms and give advice without being guarded, mcuh less, as Eric points out, for laypeople to be diagosticians-on-line. Hell ethical doctors won't be diagnostician-on-line.All one should do, and can do, is try to listen and ask as many questions as possible before trying to steer the person to something that you know from your experience may have good chance of helping them improve their life. There is that rule that the famed William Osler, MD set forth, to abide by, which says: "If you talk to the patient long enough he will tell you exactly what is worng with him". This is of especially acute particularity in people who ahve been told they have this mystical IBS thingie.Now, just fronm what little I have heard and seen you write, and add it to what you just said, the thing that pops into my head is "are you being seen by a BoardC ertified GI doc, and if so what tests have been done on you so far". has anything been done which had the word "motility" attached to it in any way when they explained it to you?I would not use thr term "qualify" for this or that...I would say that in some doctors eyes they would (after some very routine tests) probably say you have IBS and send you on the path of medication:diet experimentation, on the other hand if you were seen i a major GI clinica at a major medical center, with thsoe symptoms, they woukd be predisposed to looking deeper beiofre making pronouncements.That is my "intellectual" response to the questions...find out exaclty who you be seeing and exaclty what ahs been tested exaclty what treatments have been tried and exactly what the outcomes were before making any suggestions...and only answer specific questions about a specific topic which has a a specific answer.

Sounds like equivocating, actualy I am not I am fishing.I will come back tomorrow to see what is on the drag line and then respiond from there.Again sorry if all this was answered before...but digging time is just not there....but if it is all in one lace maybe I can provide some helpful input, maybe not. We'll see.Hugs to Olive.MNLPSI am not surprised by the HP therapy outcome in the context of your symptom descrption.

 

[Popeye]

Eric,thanks a lot for your response. You're right - my IBS waxes and wanes and certain moments of anxiety trigger my symptoms. For instance, if I stay at home in the morning, I eat, have my coffee, I have a BM and have a reasonably good day. If, for instance, my friends invite me to go for a trip to Montreal with them, I'll wake up early, I'll eat and have my coffee, but I won't be able to go. Then, I'll be thinking about my stomach, fearing that I'll get gas and pain, which, eventually, I do get. My stomach, will spasm, I'll bloat, and feel like ####.No, I didn't make any breaks while listening to the CDs the first time. Not one break. I found the CDs really relaxing, but, generally, they did not help my symptoms. For instance, if I have to wake up early in the morning, my stomach will be HORRIBLE, regardless of whether I listened to the CDs or not the night before. Mornings are really bad for me. Things are much better if I don't wake up till about 10:00 -10:30...Yes,...perhaps I should give the CDs another try, but it kinda requires a lot of will and enthusiasm, which I don't really have at this point. Maybe, I'll really make myself do the tapes again (even though I'm horrible with visualisation...).As for trying CBT or a live hypnotherapist...I don't know how to do that in Ottawa,...I would first really, really like to find a regular doctor knowledgable about IBS....that would be a good start. Both my GI and my family doctor dismiss IBS as a minor irritant, they don't really have time for me, and they both keep telling me to take Metamucil. I hate Canadian doctors !!!! As if I haven't been taking Metamucil for 2 years already...Anyway, thanks a lot for everything, Eric.

 

[Popeye]

Hello there, Mike !!! "If you talk to the patient long enough he will tell you exactly what is wrong with him".I really like this quote. Unfortunately, both my family doctor and GI specialist are ALWAYS in a bloody hurry when they see me. They do not have time to talk to me at all and I get a feeling that I bother them if I mention problems with my stomach. My family Dr. once prescribed DICETEL for me and that was it. They both just keep telling me to experiment with the doses of METAMUCIL and that that will help. They say change your diet without any insight, as if that means change your socks. My GI, by the way, is an older gentleman, a pretty ignorant git, and every time I go to see him, I get this unbearable urge to punch him right in the face (every time he mentions Metamucil I just go nuts... of course, I don't show it...I guess if i were Popeye really, I wouldn't hesitate to punch him

).He's done the following tests on me:Small bowel seriesBarium EnemaX-RaysUltrasoundLactose IntoleranceStool examination for blood and idigestionThey all came back FINE.I was supposed to have a colonoscopy done on the 24 of October, but I chickened out, and postponed it for March.Now, my symptoms are:*change in bowel consistency, shape,frequency*pain that is sometimes relieved by defecation (sometimes, actually, the pain starts with the bowel movement...that happens if I have, and I have it often, incomplete evacuation)* incomplete evacuation* a lot of pain, bloating, and GAS* sometimes I do not have pain, but I just need to go to the loo 4-5 times a day (never diarrhea, just softer smaller or thinner stool)* sometimes when I can't go I have pain in my back* I do have anxiety because of IBS, and as the time passes by, I am becoming more and more withdrawn, avoiding social activities, trips, etc.Sometimes when I know I have to go somewhere, I cannot have a BM, which, as a result, almost always results in a pain, bloating, gas, discomfort, etc.I think gas, pain, and cramping are my biggest problem. When I had my ultrasound done, I was told that my intestines were FULL OF GAS.Anyway, that's pretty much my story. I've had IBS for almost 5 years now; it came very, very, very gradually.Thanks a lot for everything, Mike.I will appreciate any suggestion, recommendation.I've tried things like chinese herbs, dicetel, metamucil, bowel cleansing products, chinese herbs, probiotics, flaxseed oil, magnesium, hypnotherapy, even St. John's Wort, etc. I still haven't found ANY connection with the food... I just have good and bad days randomly...Mornings are particularly horrible for me...