Questions about Librax

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worrieddoug
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Date Joined Jan 2006
Total Posts : 11
   Posted 11/1/2009 7:28 PM (GMT -7)   
I was diagnosed with IBS a number of years ago, and I've taken Hyoscyamine for three years with no discernible effect. A month ago I visited my gastro doc after three weeks of frequent, loose, mostly black bowel movements--and, after another endoscopy and colonoscopy (which--naturally!--showed nothing except mild diverticulosis), he decided to prescribe Librax.
Is Librax a commonly prescribed med for IBS? I'm just not feeling any effect at all. The cramps still come; everything's the same as it was. I also wasn't thrilled when I read about the working ingredients in Librax: it contains chlordiazepoxide, which is a tranquilizer. But I don't *need* a tranquilizer. I'm not anxious, I'm not panicky--I'm having cramps and painful diarrhea, and the pain is not "all in my mind"! On top of the suffering that IBS patients endure on a daily basis, it's so discouraging to be treated as if we have a psychosomatic, not-very-serious, and ultimately "unreal" illness.

shawn12
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Date Joined Jul 2004
Total Posts : 1293
   Posted 11/2/2009 9:31 AM (GMT -7)   
worrieddoug

Do you know there is basically a "brain" in your gut?

Librax is a common drug for IBS for at least twenty years. It didn't work well for me either.

tranquilizers can have an effrect on calming muslces. Also everyone has anxiety and stressors in their life's, but most don't recognize the full connections. There is also constant communication that gos back and forth between the gut brain and the brain and all pain is actually processed in the brain. All the neurotransmitters made in the brain are also made in the gut. 95 percent of the bodies serotonin is made in the gut for example. The serotonin in the gut is connected to the pain your having as it is the chemical that signals distress from the gut to the brain.

In your sig you have the word worried, why is that?

Modern research over the last ten years has shown that both thte brain and the gut are operation to cause the very real physical symptoms, but it is NOT "ibs is made up by anyone and isn't real" anymore.

You might also not really understand the term "psy·cho·so·mat·ic"

Of or relating to a disorder having physical symptoms but originating from mental or emotional causes.

Relating to or concerned with the influence of the mind on the body, and the body on the mind, especially with respect to disease: psychosomatic medicine.


http://www.answers.com/topic/psychosomatic

For sure the body influences the mind and the mind influences the body, especially in IBS, because of the extremely close connections of the way the digestive system and the brain function together. Even the immune system and working of the digestive system are connected to functioning of the brain. The brain is the boss, even though the digestive system can basically run on its own. They are connected via the vagus nerve and develop together from the embryo.

This is actually western medicince taking a more holistic approach to diseases. Science has moved away from Dualism: a theory that proposes a separation between the mind and the body. towards Holism: a theory built upon the foundation that the mind and body are integrated
and utterly inseparable.

History of Functional Disorders

http://www.med.unc.edu/medicine/fgidc/historyfunctionaldisorders.pdf

Have you also ever heard of the fight or flight responce?

Do you ever worry about an attack coming on? Do you ever worry or fear not finding a bathroom? Do you ever have antisapatory anxiety about going somewhere when your gut is acting up? Do you have any emotional responces to having IBS at all?

IBS is physical and not made up, but the connections to the body are extremely important. Some psychological treatments also work for IBS and have the most effective rates statistically then any other treatments, but they are working on the PHYSICAL underlying disorder.

Think about this some and if you have any questions let me know.

Here are two articles very much worth reading.

Gut Feelings: The Mind-Body Connection

http://www.ahealthyme.com/topic/mindbodygut;$sessionid$TJVAS2IAAETVTWCYSYZSFEQ

Gut Thoughts

http://www.kiwiterapi.dk/index.php?id=42

and

Excellent overview on IBS from John Hopkins Gatroenterology and Hepatology.

http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_id=024CC2E1-2AEB-4D50-9E02-C79825C9F9BF&GDL_Disease_id=F5E21D6B-A88E-44F9-900F-7E295C50D38B

You can also fight pain via the brain, since it is processed there or by changing whats called the "pain gate" pathways.
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.


worrieddoug
New Member


Date Joined Jan 2006
Total Posts : 11
   Posted 11/2/2009 5:33 PM (GMT -7)   
Are you trying to convince me that I'm anxious and panicky, shawn? :) To answer your questions, yes--I'm aware of the brain-gut axis theory and I'm familiar with the definition of "psychosomatic". The trouble with the classification of IBS as a somatoform disorder is that many doctors, while they might believe their patients are experiencing pain, tend to dismiss that pain because its cause cannot be physically identified. (Take it from me; I've been to three general practitioners and two gastro docs who were dismissive of my physical discomfort.) A holistic approach to medicine is fine, but the whole brain-gut thing is just another hypothesis (albeit an interesting one). Other, more recent research indicates that biochemical changes might be causing IBS. But to many in the medical profession, even the possibility of a psychological component in an illness means that the patient is mentally imbalanced--and the psychological component will be stressed in treatment, to the exclusion of everything else. Which is funny, since none of these doctors have ever asked me if I'm prone to anxiety. When I tell them that I have stomach trouble but their tests don't show that I'm rotting from the inside out, they assume I'm just a little "off" or high-strung.
I'm not. I don't wring my hands in anticipation of an attack or live in fear that I won't be able to find a bathroom; after almost thirty years of cramps and diarrhea, the element of surprise is pretty much gone. When I gotta go, I go, and when I don't I thank God for small favors. What I am at this point is tired and, yes, worried--worried that I'll have to live the rest of my life this way.
I appreciate the links. Recently someone brought the following article to my attention:

http://www.nytimes.com/2005/08/23/health/23gut.html?pagewanted=all

While I don't accept the brain-gut theory lock, stock, and barrel, Dr. Michael Gershon has an interesting approach to it (vastly different than the docs I've encountered, that's for sure), and here is something particularly pertinent that he mentioned in the article: "Dr. Gershon...theorizes that physiology is the original culprit in brain-gut dysfunctions. 'We have identified molecular defects in the gut of everyone who has irritable bowel syndrome,' he said. 'If you were chained by bloody diarrhea to a toilet seat, you, too, might be depressed.'"

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 11/2/2009 7:13 PM (GMT -7)   
worrieddoug,

"Are you trying to convince me that I'm anxious and panicky, shawn? :) "

No, but I am surprized not anxious or stressed to a certain extent. I have had severe IBS for 39 years. I still have some antispatory anxiety of an attack for one. But it effects other emotions I may have as well. I have learned ways to help break the vicious cycle though, not completely but it has helped tremendously, especially after I started to understand it all.


I personally believe my IBS started with an enteric infection and PI IBS developing into "classic IBS". Dr spiller in England is a leading expert on PI IBS.

I hear you with some doctors, I just had an extremely bad experience with one recently. All I can say there is a better doctor.

However that is differnent then researchers and the mechanisms of how digestion works. Serotonin for example is released from the gut and goes to the brain to signal pain, but the brain also signals back to the gut. So far there are abnormalities in both the brain and the gut. Hence a brain gut axis dysfuntion, which doesn't mean its all in someones head or they are making it up its still very physical. Basically that is where they have been know for longer then five years. For example the HPA axis can cause neurogenic inflammation in the gut through the stress responce. Th fight or flight is hardwired to the brain. The immune system is also connected to the HPA axis. What they have now done is combined how the whole body works instead of just the physiology of the gut, because of the major influence of the brain gut connections.

Two people can have the same abnormalities and have different symptoms. Lots of factors come into play then.

I am very familar with Dr. Michael Gershon work and the article, the article I posted has him and DR woods an expert also, who coined the term 'brain in the gut". I am also in contact with Dr Drossman the chairman of the rome committe and one of the world experts, and many other experts in IBS. By the way you can ask him questions tomorrow free on a live chat.

http://www.uncmedresearch.com/PALSchat/UNCchat.php

Do you know who Dr Drossman is and what he does in functional GI disorders.

This is also some material for you.

http://www.med.unc.edu/medicine/fgidc/public_education_materials.htm

also read the one that says

"Irritable Bowel Syndrome by Lin Chang, MD (You will need Adobe Acrobat Reader to view this article. Click here to get the free Acrobatt Reader.)"

and the other links here as well. Dr Mayer from UCLA is also one of the worlds leading experts on IBS. The UNC is studying the gut brain and UCLA the brain and they are sharing the research all over the world.

http://www.ibs.med.ucla.edu/PatientArticles.htm

Have you ever seen Pet or fmri scans of IBSers?

I asked Dr Drossman a while ago about foods, but

"The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.
Doug "

http://www.ibshealth.com/ibsfoods2.htm

You might also be interested in these state of the art videos.

http://www.aboutibs.org/site/learning-center/video-corner/

Worry is a type of stress, as is anxiety, fear, and others, but also not just mental stressors but physical ones as well, say the temperture of foods, weather and other factors there too. Again stress to homeostasis. Its homeostasis and partly how that works.

When you get a chance also on anxiety and how its hard wirded to the brain. I think you might find it interesting.

Time magazine The science of anxiety.

http://www.time.com/time/europe/magazine/2002/0826/anxiety/story.html

There are stress hormones and neurotransmitters connected to the gut and to the brain and to stressors. Some people also have IBS more severe then others and that even makes a difference. So even the physiological cell changes in the gut can effect the brain and then the brain back to the gut. This opens up more treatment options.

One more for you both on the same page.


Fibromyalgia and irritable bowel syndrome: How real must they be?

"Letter to the Editor, New York Times
Dear Editor:

We are writing to you as academic gastroenterologists with careers in the scientific investigation and clinical care of patients with gastrointestinal disorders, as well as the executive directors from an international patient advocacy group for the functional gastrointestinal disorders, including irritable bowel syndrome. We are compelled to address the comments made by Alex Berenson in his recent article “Drug Approved. Is Disease Real?” (Jan. 14, 2008). We do understand his concerns that massive direct to consumer marketing efforts for common medical disorders may be a thinly veiled strategy for a pharmaceutical company to obtain a quick profit. Certainly this is an important issue to study. However to adequately explore this question would require attention to the specific features of the therapeutic agent and its risk/benefit ratio, the type of disorder being treated and its health care impact, and the needs and interests of the patient.

The more critical issue we want to address is the impact of Mr. Berenson’s statements which seek to make these points by relegating fibromyalgia or as stated, IBS to a “nebulous” state, something not real. "


Really worth reading.

Interpreting pain sensitivity in irritable bowel syndrome: what's the cause?


"1.The human pain experience is multidimensional. It is influenced by a variety of factors, including input from sensory nerve pathways, cognitive and emotional factors, the general homeostatic state of the organism, and by recall of past memories and experiences. This “deconstruction” of the human pain experiences into its multiple neurobiological dimensions has only recently become possible using sophisticated neuroimaging techniques of the brain. At the level of the brain, there is no distinction between psychological and physiological mechanisms (a main hypothesis of the authors is that there is such a distinction). Even though some aspects of the pain experience are generated in the brain by limbic circuits (such as arousal or anxiety) and others by cortical pathways (such as belief systems and coping skills) all pain dimensions are generated by neurobiological activity. "

http://www.aboutibs.org/site/news-events/news/commentary#Pain
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.


worrieddoug
New Member


Date Joined Jan 2006
Total Posts : 11
   Posted 11/3/2009 2:10 AM (GMT -7)   
Just read the Berenson article, and I applaud the gastro docs who took offense to IBS being described as "nebulous". Again, while I'm not sold on the brain-gut theory, I don't dismiss it out of hand. My point is that when there's a psychological component involved, it's a little too easy for doctors to take the same position Berenson took: that the illness isn't "real" because a physical cause can't be pinpointed. The fact that so many IBS patients--like you and me--have had negative experiences with doctors indicates that there's a problem with the way the disease is viewed and treated. What I like about Dr. Gershon's approach is that it emphasizes the physical reality of IBS discomfort, and I hope that this becomes increasingly customary because docs aren't likely to take the disease seriously until inflammatory cytokines (or some other demonstrable physical cause, whatever it might be) are accepted by the medical orthodoxy as the cause of IBS.
I don't discount the unpleasantness of anxiety, either; I'm sure it's a difficult burden to bear in addition to the cramps and other physical manifestations of IBS. (I will read the "Time" article in the morning.) But I find it strange that every doctor I've visited when I had stomach trouble simply assumed--rather than going to the trouble of asking me--that I was a tense, anxious person. This is the closed circle of IBS: patient complains of stomach pains and diarrhea; tests show that GI tract looks okay; patient must have IBS; IBS is psychosomatic, so patient must be anxious and worried; therefore, treat with anti-anxiety medications (or don't treat at all).  
  

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 11/3/2009 10:29 AM (GMT -7)   
Worried Doug, keep reading the articles and I do understand what your saying, but there needs to be more education to new medical students and to doctors on the condition and they need to help explain things to their patients better, I believe.

The experts are trying hard to educate primary care, gi doctors and the public that it is a REAL Psychophysiological disorder. Hence one reason I was showing you the article. But also the one on pain.

"Psychophysiology is the branch of physiology that is concerned with the relationship between mental (psyche) and physical (physiological) processes; it is the scientific study of the interaction between mind and body. The field of psychophysiology draws upon the work of physicians, psychologists, biochemists, neurologists, engineers, and other scientists.

A psychophysiological disorder is characterized by physical symptoms that are partly induced by emotional factors. Some of the more common emotional states responsible in forming illness include anxiety, stress, and fear. Common psychosomatic ailments include migraine headaches, attention deficit hyperactivity disorder (ADHD), arthritis, ulcerative colitis, and heart disease."

There has been this seperation in the past and it has hindered very important research, now they are moving to holitic and there is no seperation between mind and body, or brain and body.

Stress and foods don't cause IBS, but can be major factors in generating symptoms for most IBSers, especially those with moderate to severe IBS. Even the act of eating which is in part a neurological mechanism.

When they poll IBSers on stress and symptoms the statistical numbers are very high. I don't think many doctors that have even slightly studied IBS, believe anymore its not real disorder or someone is making it up, maybe a few. But they also don't have time to explain all the connections in short visits. I have seen a lot of doctors and have had two bad experiences out of perhaps ten doctors or more. The two bad experience was with one, a RN Nurse who are now doing more doctor type practices and one primary care doctor. None with any gi specialists personally.

A good doctor-patient relationship is very important in helping someone treat there IBS.

I agree with you in finding physical abnormalities and they are looking both in the brain and in the gut and how they both communicate. There are bottom up models and top down models.

There are also impairments to the brain seen in IBSers with pet and fmri scans being studied.

Funny you should mention "inflammatory cytokines", because they too

"A chain of events that begins with stress and/or depression can lead to increased production of proinflammatory cytokines, thus raising the risk for certain diseases and conditions linked to inflammation."

http://nccam.nih.gov/news/newsletter/2008_october/stresslink.htm

Hence one reason why I mentioned neurogenic inflammation stress can cause or reactivate inflammation. The stress system helps fight infections and can effect the immune system.

Proinflammatory Cytokine Gene Polymorphisms in Irritable Bowel Syndrome.

http://www.ncbi.nlm.nih.gov/pubmed/19844779?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2

anti-anxiety medications are not just because of anxiety, but as I mentioned before serotonin is the neurotransmitter from the gut that signals to the brain pain, so altering it can have an effect both on the gut and the brain. I agree sometimes they are given out to quickly to people.

The Use of Antidepressants in the Treatment of IBS and Other Functional GI Disorders - C. Dalton and D. Drossman

http://www.med.unc.edu/medicine/fgidc/antidepressants.pdf

Also like I said psychological treatments have shown to be very effective for IBS, specifically Gut directed hypnotherapy and CBT as well as a few others. So they might not cure someone completely, but they can majorally reduce the symptoms and help a person quality of life and management. For example and this was done and has been done for the last 20 years by a senior GI doctor in England.

"New York Times - Let the Mind Help Tame An Irritable Bowel

The brain has the ability to inhibit sensations from the gut. But, as Dr. Gerson put it, ”I.B.S. patients tend to be hypervigilant — too aware of what is going on in their gut.” Through techniques like hypnotherapy and cognitive-behavioral therapy, it is possible to change how the brain perceives what is happening in the body.

In hypnotherapy, patients learn to visualize their colon as functioning more normally. In cognitive-behavioral therapy or short-term psychotherapy, patients can learn to change symptom-provoking beliefs, like thinking that their colon will always be abnormal or that a given circumstance will provoke symptoms.

In a British study of 204 patients in which more than two-thirds of them were initially helped by hypnotherapy, 81 percent of those maintained the improvement up to five years after the treatment. Learning to practice stress-reduction and relaxation techniques can be as helpful as learning which foods to avoid.

New York Times, Sep 2nd 2008

Five years after treatment and a big study with 81 percent helped.

and

There are three primary features of FGIDs - motility, sensation, and brain-gut dysfunction:

Motility is the muscular activity of the GI tract. Normal motility (e.g., peristalsis) is an orderly sequence of muscular contractions from the top to the bottom. In FGIDs, the motility is abnormal - there can be muscular spasms that can cause pain, and the contractions can be very rapid (fast motility is diarrhea) or very slow (slow motility is constipation).

Sensation is how the nerves of the GI tract respond to stimuli (for example, digesting a meal). In FGIDs, the nerves are sometimes so sensitive that even normal contractions can bring on pain or discomfort.

Brain-gut dysfunction relates to the disharmony in the way the brain and GI system communicate. With FGIDs, the regulatory conduit between the brain and gut function may be impaired and this can lead to increased pain and bowel difficulties which can be worsened by stress.

http://www.med.unc.edu/medicine/fgidc/patient_care_fgid.htm
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

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