Posted 8/15/2008 8:15 AM (GMT -7)
Thank you for your message summarizing your situation and treatments. I hope the Welchol and Align will help you to improve or resolve your diarrhea problems.
You asked for encouragement and while I am going to mostly report on things that didn’t work for me, I am encouraged to believe I can handle my issues based on what I have learned so far. So maybe you can glean some things from my experience that would of interest to you.
To explain my situation, over the last couple of years I have gradually developed a diarrhea problem manifested by occasional urgent, explosive diarrhea about 30 minutes to 1 hour after a meal. When I am at home this is no problem, but when my wife and I go out to dinner, often with friends, it can be a real problem. I had experienced three episodes of bowel incontinence during a three month period before my seeking medical help in May. But I have improved to the extent that I haven’t experienced any more of these episodes of bowel incontinence more recently.
Let me explain a little further that my wife and I used to travel a lot but have not traveled very much since 9/11. My wife doesn’t want to fly and I don’t like to drive for long periods. So my diarrhea problem has not been a high priority issue and the main reason I started seeking help is that I want to fly on a trip to Washington on September 13. I am a WWII veteran and some benevolent persons in my area ( and I have heard other places in the U. S. ) have started flying WWII veterans to Washington , DC , to visit the WWII Memorial. It is a one day trip, i. e., up and back home on the same day.
So my immediate goal was to figure a way to make this trip without having the diarrhea incontinence problem. With that explanation I am going to enclose some excerpts from 1) a FAX sent to my Nurse Practitioner and Gastrointerologist and 2) an email sent to my adult children which summarizes my situation as of July 31.
FAX, July 31
This is an update on my situation and a request for your guidance on what I could do next.
Regarding my IBS situation, briefly I am presently "going back to the drawing board". Over the last 6 weeks 1)I have tried a new fiber supplement, Benefiber, 2) tried a new prescript ion drug, Questran, 3) tried imodium, 4) tried a prescript ion diarrhea stopper, Lomotil, 5)tried another prescript ion drug, Welchol, 6) tried a probiotic, Culturelle, and 7)tried a yogurt product, Activa. about one week ago, I experienced 10 diarrhea BM's in one day, and I decided to stop all of these and start over again as soon as I learn a more hopeful course of action.
Some of the things I have learned so far are: 1) I feel better and do better without any of the medications I have tried so far, 2) it takes probably at least one week to stabilize on a new medication before you can make any decisions about results, 3) if worse comes to worse, I can make the Washington trip by just not eating for the 12 hours on the trip. (It is up to Washington and back home in the same day), and 4) I am going to ask my nurse practitioner about seeing a gastrointerologist who specializes in treating IBS. The nurse practitioner I have been seeing is very likeable, easy to talk to, and helpful.
I feel much better right now doing nothing and it is something I could live with this way if necessary.
To update, I haven’t taken any fiber supplement or other IBS medications since June 25, and I have generally done better during this period than when I was trying all the medications. However, during the last 2-3 days I have started getting a hemorrhoid as evidenced by blood traces. So I feel that I should gradually start some type of fiber supplement again.
Also, I learned recently that I have been selected to for the next Washington trip on September 13. I am scheduled to attend an orientation meeting regarding the trip on this Thursday, July 24.
Ms. (blank): 1) What would be a reasonable next step? 2) Is re-starting a fiber supplement a good interim step at present? 3) Should I schedule a visit to see you?
Thanks for your help, Paul Taylor. PS- I promise to not tell you any more jokes next time.
Excerpt from Email to my Adult Children, July 31
I saw the nurse practitioner today. I reviewed what has been tried and explained that for about 4 weeks I haven't taken any IBS medication except stool softeners. And I feel fine.
Then I explained that my only goal at this point was to figure a way to make the Washington trip without an episode of bowel incontinence. After a thorough discussion of all the issues she said the only thing she could recommend at this point was to restart use of a fiber supplement. I asked her if she knew of a medical person who specialized in IBS treatment. She said she had been discussing my case with the Gastointerologist for whom she works, and she felt he had some ideas.
So Dr. (blank) came in and we had a good discussion of all the issues and mainly I reiterated that I was doing fine and feeling fine. My only goal was to figure some way to avoid a bowel incontinence on the Washington trip. So he said that he sometimes advises a colon flush to his patients and this would be appropriate for my situation. Prior to this I had always taken a dim view of all the advertisements and rip offs for over the counter stuff they are selling. But he explained to me the mechanics of how this can be helpful from time to time. So I am going to take 8 ounces of magnesium citrate one evening. This is the extreme laxative you take in preparation for a colonoscopy. He said this would give at least 3 days of being diarrhea free. So I am going to try it, maybe a couple of times, before the trip.
Also I ask both of them about wearing an adult diaper (like Depends). Ms. (blank) said she didn't think it would be necessary, but Dr. (blank) said, "Go for it. It won't hurt anything and could give peace of mind."
Anyway so I plan to gradually use up all the fiber supplement I have and then go back to regular use of Metamucil.
And I feel confident now that I can handle the trip OK.
Also, I was very pleased to get to know Dr. (blank) better. All previous times he had been very hurried and aloof. But this time we had a very good conversation, even discussing a mutual friend. So I was very pleased overall.
Antsie, since the above email I have tried the magnesium citrate once and while it did not eliminate diarrhea completely, it did reduce it significantly for about three days.
So I am definitely planning to go on the Washington trip 1)by doing the magnesium citrate thing one day prior to the trip, 2) getting some Depends and probably wear them, 3) select some type of food that I could take with me and possibly declining part of or all the scheduled meals, 4) at my orientation meeting regarding the trip, I alert ed the medical staff person that I had this IBS problem and she is going to have me seated near the bathroom on the airplane.
In the meantime I plan to ask my Gastrointerologist if he has any other ideas for me to try.
And based on some of the reading I have done in researching this problem, I have started doing some exercising of the anal sphincter muscle aimed toward strengthening the sphincter. (This is something I did for my urethra sphincter several years ago when I experienced bladder incontinence following prostate cancer surgery.)
And 7Lil, thank you for your commentary. Good to hear from you again.