Dealing with IBS/IBD on rotations

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BlueMoon88

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Does anyone else that has done rotations or is going to do them have IBS, ulcerative colitis, or Crohns? I do, and I'm worried about how it will affect me and my ability to do the work. I've been seeing a specialist, but nothing has helped. It's not debilitating, but basically I might have to run to the bathroom more than others - like 3-4 times a day, and not necessarily at opportune times. It's much worse when I'm nervous, which of course I will be. Any suggestions/support and similar experiences are appreciated as I'm worried this could interfere with my whole career.

Oh, I wanted to add that I'm especially worried about surgery since I won't be able to leave surgeries to go use the bathroom! This has also led me to rule out many specialties I might otherwise want to do (ie surgery, anesthesiology, anything with long procedures).

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The difference in IBD and IBS is substantial. From reading your post, it seems that you most likely have IBS. There are medications for this, and behavioral modifications should be of some benefit.
 
BlueMoon88 said:
Does anyone else that has done rotations or is going to do them have IBS, ulcerative colitis, or Crohns? I do, and I'm worried about how it will affect me and my ability to do the work. I've been seeing a specialist, but nothing has helped. It's not debilitating, but basically I might have to run to the bathroom more than others - like 3-4 times a day, and not necessarily at opportune times. It's much worse when I'm nervous, which of course I will be. Any suggestions/support and similar experiences are appreciated as I'm worried this could interfere with my whole career.

Oh, I wanted to add that I'm especially worried about surgery since I won't be able to leave surgeries to go use the bathroom! This has also led me to rule out many specialties I might otherwise want to do (ie surgery, anesthesiology, anything with long procedures).

Sounds like you have IBS. Try eating Activa in the morning. Have you been worked up for Celiac Sprue or any food allergies?
 
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Here's the full story:

The problems started in 2003 - I went to a gastroenterologist who wanted to do a colonoscopy to rule out IBD or CA because there was blood. I didn't want a scopy and was hoping the problem would just go away. I treated it symptomatically with Immodium (which rarely worked) and dealt with it for almost a year before it went away entirely. It did interfere with my schooling during this time, but I got through it. I was perfectly fine for a year before it began again about 8 months ago. Went back to GI, had a scopy. Mucosal edema was apparent, but no ulcerations or obvious inflammation. Pathologist said "no signs of active inflammatory bowel disease." In the meantime, we tried cutting out lactose, and treating symptomatically with diphenoxylate and immodium - this doesn't help, even after taking twice the normal dosages. Because things seemed to be getting worse, I started Asacol a month and a half ago - no change. Now the GI doc wants to do ANOTHER scopy and biopsy, ugh...I don't see how treatment could possibly change since I'm already on Asacol, but anyway...

I know this isn't a forum for medical advice (although any suggestions and insight are appreciated), I mostly was interested in hearing from people with similar experiences or with suggestions on how to deal with rotations (so please don't close the thread).
 
BlueMoon88 said:
Here's the full story:

The problems started in 2003 - I went to a gastroenterologist who wanted to do a colonoscopy to rule out IBD or CA because there was blood. I didn't want a scopy and was hoping the problem would just go away. I treated it symptomatically with Immodium (which rarely worked) and dealt with it for almost a year before it went away entirely. It did interfere with my schooling during this time, but I got through it. I was perfectly fine for a year before it began again about 8 months ago. Went back to GI, had a scopy. Mucosal edema was apparent, but no ulcerations or obvious inflammation. Pathologist said "no signs of active inflammatory bowel disease." In the meantime, we tried cutting out lactose, and treating symptomatically with diphenoxylate and immodium - this doesn't help, even after taking twice the normal dosages. Because things seemed to be getting worse, I started Asacol a month and a half ago - no change. Now the GI doc wants to do ANOTHER scopy and biopsy, ugh...I don't see how treatment could possibly change since I'm already on Asacol, but anyway...

I know this isn't a forum for medical advice (although any suggestions and insight are appreciated), I mostly was interested in hearing from people with similar experiences or with suggestions on how to deal with rotations (so please don't close the thread).

Mucosal edema? Has the GI ruled out Celiac Sprue?
 
MD'05 said:
Mucosal edema? Has the GI ruled out Celiac Sprue?

No, but the mucosal edema was rectal, and Celiac Sprue is small bowel. I'll ask him about getting anti-gliadin antibodies serology. I don't have any problems after drinking beer though, which is full of glutens I believe.
 
BlueMoon88 said:
No, but the mucosal edema was rectal, and Celiac Sprue is small bowel. I'll ask him about getting anti-gliadin antibodies serology. I don't have any problems after drinking beer though, which is full of glutens I believe.

Mucosal edema in the rectum. Anyone in your immediate family have problems with internal hemorrhoids or any similar sigmoid or rectum issues? I'm sure the GI would have seen internal hemorrhoids. Was there anything that might have happened back in 2003 to initiated these symptoms? Trauma such as a rectal fissure, straining with BM? Did the GI see any AVMs? You are probably too young for diverticulosis. Very interesting.
 
I HAVE IBS, so I can tell you what I did (if that's what you have that is). I changed my diet and eating habits so that I didn't eat anything before 10 or 11am, I cut out soda entirely, and I don't eat much sugary stuff. I don't eat anything big after 10pm either. This has decreased the amount of attacks I get dramatically.

I used to have attacks almost every morning, sometimes so bad that I couldn't stand up. Once I changed my eating habits a bit, I got a lot better. I drink tons of water and some iced tea too, and that's about it.

Also, another big thing is attitude. It's sounds kind of cheesy, but I made myself relax more and take some time to chill out. It helped a LOT.

My $0.02.
 
BlueMoon88 said:
I know this isn't a forum for medical advice (although any suggestions and insight are appreciated), I mostly was interested in hearing from people with similar experiences or with suggestions on how to deal with rotations (so please don't close the thread).

I don't have IBD or IBS (at least I don't think so!) but I have an extremely "nervous stomach" and tend to have to run to the bathroom a lot when I am stressed out. This gets to be a vicious cycle which sounds like what you are describing - I worry about getting diarrhea, which then gives me diarrhea!

A few things I have done - I take Imodium and pepto bismol in the morning on extremely stressful days, as a prophylactic. I think it helps. Also, if you need to go, just go. Especially as a med student, there will almost never be a time that you can't go use the restroom if you need to. Just knowing that you can leave may help with your anxiety about it. When I started third year, I had an extremely bad problem with this, and now as I just about finish fourth year it is basically not a problem at all. I agree with the earlier poster who said just try to relax (which is easier said than done - I'm not making light of it at all).
 
Thank you for this thread...I have IBS too, on top of my other issue that I posted about! (though with a recent time of what seemed to be pseudomembranous colitis...awful (and bloody)...at least I'm hoping and assuming that's what it was, since it went away with Flagyl...I've never had a colonoscopy, though). I deal with it by eating a very limited diet, especially when out in public...which may not be the best way...I may take some of you all's suggestions.
 
Thank you everyone for the great responses!! :love:
This is a really hard thing to struggle with because it's embarrasing, so people don't really talk about it in real life. I think a lot of people struggle with it and don't say anything (estimates are 10% of the population has IBS now).

Originally Posted by MD'05
Mucosal edema in the rectum. Anyone in your immediate family have problems with internal hemorrhoids or any similar sigmoid or rectum issues? I'm sure the GI would have seen internal hemorrhoids. Was there anything that might have happened back in 2003 to initiated these symptoms? Trauma such as a rectal fissure, straining with BM? Did the GI see any AVMs? You are probably too young for diverticulosis. Very interesting.

Only GI history in family is my paternal grandmother had colon cancer that was operated on and has been in remission for decades now. There were no hemorrhoids seen on my scopy, but with my bleeding I expected there to be! There was a benign polyp that was removed. Nothing happened in 2003 that I could see causing this. One day I was out shopping and out of the blue I got real real sick, sicker than I've ever been since (explosive diahrrea). I had just eaten some spicy food, so I attributed it to that. I was fine for about a month and then it happened again, and this time it was the start of the chronic problem (not explosive diahrrea, but urgency and frequency). This led to major anxiety of worrying about getting to a bathroom wherever I went, and I wound up having a panic attack at one point - which of course led to seeing a psychiatrist and getting on xanax and paxil, and seeing a therapist.

Originally Posted by mysophobe
I HAVE IBS, so I can tell you what I did (if that's what you have that is). I changed my diet and eating habits so that I didn't eat anything before 10 or 11am, I cut out soda entirely, and I don't eat much sugary stuff. I don't eat anything big after 10pm either. This has decreased the amount of attacks I get dramatically.
I used to have attacks almost every morning, sometimes so bad that I couldn't stand up. Once I changed my eating habits a bit, I got a lot better. I drink tons of water and some iced tea too, and that's about it.

Good to hear from a fellow sufferer (whether I have IBS or IBD, same symptoms). As it is, I don't eat breakfast, never have. Rarely drink soda - indulge in sugary things occasionally, but haven't noticed a difference in symptoms from that. The only correlation to diet I've found is that pizza makes me sick pretty consistently - but cutting out lactose didn't solve anything so I was confused (could still be the gluten in the dough). One thing I do do all the time, is eat after 10pm. Often I'll eat after midnight. I'm up late studying usually, and if the last time I ate was at 7, I get really hungry around midnight, and I can't sleep hungry at all. I've spent several sleepless nights with a growling stomach, so I don't know if I can stop doing that...maybe I should try adapting my schedule so I eat dinner at 9ish.

My attacks are in the mornings too - but just when I have to be at school, or some place else. At home I'm usually fine.

Originally Posted by beary
I don't have IBD or IBS (at least I don't think so!) but I have an extremely "nervous stomach" and tend to have to run to the bathroom a lot when I am stressed out. This gets to be a vicious cycle which sounds like what you are describing - I worry about getting diarrhea, which then gives me diarrhea!

A few things I have done - I take Imodium and pepto bismol in the morning on extremely stressful days, as a prophylactic. I think it helps. Also, if you need to go, just go. Especially as a med student, there will almost never be a time that you can't go use the restroom if you need to. Just knowing that you can leave may help with your anxiety about it. When I started third year, I had an extremely bad problem with this, and now as I just about finish fourth year it is basically not a problem at all. I agree with the earlier poster who said just try to relax (which is easier said than done - I'm not making light of it at all).

This sounds exactly like me! I sit there worrying I'll have to go, which of course sets my bowels rumbling, and it's a self-fulfilling prophecy. It's really hard for me to relax and not worry about it though because there have been so many times (most days) that I DO have to run and go, that if the angel on my one shoulder says to "its okay just relax", the devil on the other side is saying "you know you're going to get sick just like every other day." I also have a big phobia of incontinence - it's never happened, but it's a fear. I use diphenoxylate (prescription-strength immodium basically) PLUS immodium as a prophylactic every morning that I have to be somewhere. It usually doesn't do anything for me. Thanks for the comforting words about being able to go when I need to...as you said, sometimes just knowing that makes it not happen.

Originally Posted by closertofine
Thank you for this thread...I have IBS too, on top of my other issue that I posted about! (though with a recent time of what seemed to be pseudomembranous colitis...awful (and bloody)...at least I'm hoping and assuming that's what it was, since it went away with Flagyl...I've never had a colonoscopy, though). I deal with it by eating a very limited diet, especially when out in public...which may not be the best way...I may take some of you all's suggestions.

I was inspired by your thread to post this one - so thank YOU. :)
I also limit what I eat when I'm in situations where I really don't want to risk getting sick. Often I'll skip lunch entirely and won't eat until 5 or 6 just to try and avoid it.
 
Have you guys been tested for Celiac disease or IBD? I just had blood drawn last week for these tests, and will hopefully find out the results on Friday.

I saw a gastroenterologist a few weeks ago who was very thorough and asked me questions that seemed strange until I did some research afterwards. He asked if I had joint pain (I do), tingling in my lower legs (I do), sores in my mouth (I always thought they were menstrually related) and the usual GI questions about bowel habits and pain.

I've not been officially diagnosed with anything but I have had similar symptoms to what some of you are describing for several years. I'll be glad to get an answer.
 
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mustangsally65 said:
Have you guys been tested for Celiac disease or IBD? I just had blood drawn last week for these tests, and will hopefully find out the results on Friday.

I saw a gastroenterologist a few weeks ago who was very thorough and asked me questions that seemed strange until I did some research afterwards. He asked if I had joint pain (I do), tingling in my lower legs (I do), sores in my mouth (I always thought they were menstrually related) and the usual GI questions about bowel habits and pain.

I've not been officially diagnosed with anything but I have had similar symptoms to what some of you are describing for several years. I'll be glad to get an answer.

What blood tests are being done for IBD? I wasn't aware that any existed. I guess maybe CRP or Sed Rate, or CBC abnormalities - I don't know how commonly it shows up there.

That's funny you mention sores in your mouth - a week or so after my first episode, I came down with what seemed like a bad cold, but it was accompanied by really bad sores in my mouth, mostly on my tongue, that eventually made it near impossible to speak or eat. I wound up going to the ER one night because I couldn't take it anymore, and got a Z-Pack. It all went away a couple days after that and I haven't had any sores since. I wonder if it's related...maybe it's time for me to get a 2nd opinion.
 
BlueMoon88 said:
What blood tests are being done for IBD? I wasn't aware that any existed. I guess maybe CRP or Sed Rate, or CBC abnormalities - I don't know how commonly it shows up there.

The requisition that my doctor gave me was for Prometheus Laboratories in California. I think they're one of the few (if not the only) labs that do these tests.

Go here. There's also a sub-link under the heading for IBD First Step and also Celiac disease testing.

IBD FIRST STEP — Generation II

Non-invasive diagnostic testing for IBD — a disease affecting over 1 million Americans (NIDDK, 10/01)

IBD FIRST STEP is a sensitive serological panel of antibodies optimized to detect inflammatory bowel disease (IBD).

UC- and CD-specific antibodies include:

UC-specific pANCA (Neutrophil-specific nuclear autoantibody)

CD-specific ASCA IgA (Anti-saccharomyces cervisiae)

CD-specific ASCA IgG (Anti-saccharomyces cervisiae)

CD-specific anti-OmpC IgA (Outer membrane porin from E. coli)

Aids in differentiating IBD patients from patients with symptoms similar to irritable bowel syndrome or celiac disease.

The importance of early diagnosis of IBD is underscored by the severity of complications, including colon removal in 25% to 40% of UC patients. (NIDDK, 4/00)

I got a letter today saying Prometheus had received them and that the results had been sent to my physician. I was :mad: they didn't send me the results too. There was also a cost of the test on there in case my insurance didn't pay for it, so if anyone is interested I can look that up for you and post it tomorrow afternoon.

Incidentally, my gastroenterologist also ordered a CRP, Amylase, Lipase, and an ESR. I had a CBC and CMP a week or two ago (ordered by my family doctor). Everything was normal on my CBC except for my monos, if anyone is interested in those results. My sed rate was 25, which is high.

I'll know more on Friday so I'll keep you posted about what I find out.
 
I have a very sensitive and nervous stomach as well, never looked into being diagnosed with IBD because I don't want to deal with the hassle of it all. I was also worried about third year rotation, also especially with surgery. Somehow I only had to leave the OR once to use the bathroom, and that was after one of the OB's/GYN's fainted right before me and it just got to be too much (but that whole situation was wacky so nobody held it against me that I left...I had to insist to them that I was ok, I wasn't going to faint as well, just had to go to the restroom for a second). Most of my problems are in the morning after eating or drinking for the first time of the day, with rare occassions after eating lunch...rounds are usually first thing in the morning, and then we would eat breakfast together- I found that eating a banana and cereal with very little milk or granola bars usually didn't bother me (or I would eat nothing at all, but then I would get way too hungry, so I usually made myself eat), so I ate that almost every morning, and only then would we go to the OR. You know your body- I would not eat right before OR time, but at least 1 hour before because I knew by then I should be ok. Play around and see what works with you- having an energy bar that you know is usually ok with your system would be especially helpful. Also, are you the type that gets bad before a test but is usually ok once you sit down and start taking it? Once I was actually in the OR I was fine. Also, make sure to figure out which cases you'll be seeing the next day so you can be well-read and prepared- this will boost your confidence and decrease the anxiety (everyone should be doing this anyway).
 
Smackey said:
I have heard positive things from a few physicians on the use of Fish Oil(Omega-3 fatty acids) to relieve IBS and IBD issues. There has also been some recent research into this area.

Here are a few studies:

potential interactions between polyunsaturated fatty acids and colonic inflammatory processes

Effect of fish oil enriched enteral diet on inflammatory bowel disease tissues

At the very least this is an inexpensive treatment that could be easily tried.

Scott

Interesting...I've started taking flax seed oil capsules recently, though not specifically for IBS...but I'm a vegetarian and won't eat fish anyway. I'll have to see if it has a beneficial effect on my symptoms.

I did also go on some Acidophilus supplements after my episode of pseudomembranous colitis, and I've kept taking them because they seem to help somewhat...though now I'm not sure *what* exactly they're helping with...whether it's the IBS, or with some remnants of the colitis...? But anyway, maybe Acidophilus could help with some IBS symptoms...has that been investigated?

Apologies if something didn't make sense...it's late, and my head is foggy...
 
mustangsally65 said:
Have you guys been tested for Celiac disease or IBD? I just had blood drawn last week for these tests, and will hopefully find out the results on Friday.

I saw a gastroenterologist a few weeks ago who was very thorough and asked me questions that seemed strange until I did some research afterwards. He asked if I had joint pain (I do), tingling in my lower legs (I do), sores in my mouth (I always thought they were menstrually related) and the usual GI questions about bowel habits and pain.

I've not been officially diagnosed with anything but I have had similar symptoms to what some of you are describing for several years. I'll be glad to get an answer.
No, I haven't been tested for either, at least not with anything more than the usual (CBC, which did show an iron-deficiency anemia a while back, but that's not too out of the ordinary I guess). And I did have a stool culture several years ago that was normal.

Funny thing is, the maternal side of my family, from at least my grandmother on down, all has digestive "issues"...to the point that it's been dubbed within my family "the Mannheit stomach!" (Mannheit being my grandmother's maiden name...I can't imagine how that could be used to identify me here!). :p I guess in modern terms, it would likely be classified as IBS.

Though I guess it's possible they all had something besides IBS but were never diagnosed...but anyway. I saw a GI doctor a few years back, and with my family history and my similar symptoms, he wrote off the need to do any further testing. I had had an upper GI endoscopy before that, which showed a moderate-sized hiatal hernia, but he said it was nothing to worry about.

But several people have mentioned food allergies, which makes me think...I do always have a swollen belly, especially for my small size...I'd lost a lot of weight recently too. And allergies in general also run in my family...though I don't have many of my own...hmmm...

I think you have a better GI than I do...mine asked very few questions and rushed through everything. Hmmm, tingling in legs and joint pain (yes and yes!), wonder where those fit in...that would be great if I could fix both my digestive and my pain problems with one diagnosis.

Sorry, it's late and I'm rambled on with more personal info than necessary...maybe I should be PM'ing instead? Or is posting this sort of thing benefitting anyone else? I'm leaning towards the idea that people would rather I keep it private...OK, then...my editing fingers are poised and ready :p .
 
I don't think you should keep it to yourself, closer. Unless you want to, of course. ;) I think it's helpful to know what other people are going through, especially since a lot of people are too embarassed to talk about digestive issues.
 
mustangsally65 said:
I think it's helpful to know what other people are going through, especially since a lot of people are too embarassed to talk about digestive issues.

I agree with this. Remember that lots of "nervous stomach"/IBS symptoms improve with age too. (One of the few good things about getting older! :D )
 
I too have long suffered from a diarrhea predominant IBS. I have never been worked up for Celiac, but I plan to some day. If you are like me and don't have time to go see a doc, you could always give yourself a trial of a gluten-free diet. This easier said than done, but it can't hurt you.

I think dietary modifications people suggest can be helpful, but I have found that IBS can pop up in all kinds of situations. I think fiber supplementation helps me, you may want to try it. I have found that eating natural fiber in the form of salads actually works better than the powdered stuff (Metamucil, Citrucel, Benefiber).

I carry chewable immodium with simethicone in my white coat so that I can take it no matter where I am. I try to use it as little as possible though. I only use it on really bad days.

In the hospital, the most annoying part of IBS is finding a bathroom to use. I basically have the hospital's bathrooms mapped out in my head now. IT is unfortunate, but most of the bathrooms at my hospital are single person rooms. It is rather embarassing when you walk out of one and there is someone waiting to step in, but just think to yourself that this is a natural bodily function.

I think mental exercises can actually be of great value. This is especially true when you have the sudden urge to go really bad. This can occur while on rounds, and this is one of those times that you actually may not be able to get to a bathroom. For me, the key is knowing in my head that the urge will pass. If I can hold myself for a couple of minutes I will find relief. Then I can wait until rounds are over and then head to bathroom. This at least works for me.

IBS is really freaking annoying. I think, at least it my case, it is mostly stress/anxiety-related. I remember the beginning of my 3rd year was really tough. But you'll manage. I got through surgery without having to step out of the OR once. A lot of people have this problem. You're definitely not alone.
 
I am a traveler and an Onco certified nurse, and have had Ulcerative Colitis for 17 years.

In my case, family stresses tend to activate the GI portion of the disease more than work stresses. I have changed my diet and lifestyle to allow for better, safer diet, adequate fluid intake, relaxation/yoga techniques and plenty of rest. For about the past 7 years, the GI portion of the disease has been stable. However, I have had some rather severe febrile inflammatory attacks of the joints and skin (atypical erythema nodosum, temps of 101-104, swollen painful joints, nodules, lymphadenapathy, flu like symptoms) that have been related to the disease. I require more prednisone for those than the UC. They are especially aggravated by heat. So this native Floridian spends the monthes of May through November in the North, on assignments.
 
btmed772 said:
I too have long suffered from a diarrhea predominant IBS. I have never been worked up for Celiac, but I plan to some day. If you are like me and don't have time to go see a doc, you could always give yourself a trial of a gluten-free diet. This easier said than done, but it can't hurt you.

I think dietary modifications people suggest can be helpful, but I have found that IBS can pop up in all kinds of situations. I think fiber supplementation helps me, you may want to try it. I have found that eating natural fiber in the form of salads actually works better than the powdered stuff (Metamucil, Citrucel, Benefiber).

I carry chewable immodium with simethicone in my white coat so that I can take it no matter where I am. I try to use it as little as possible though. I only use it on really bad days.

In the hospital, the most annoying part of IBS is finding a bathroom to use. I basically have the hospital's bathrooms mapped out in my head now. IT is unfortunate, but most of the bathrooms at my hospital are single person rooms. It is rather embarassing when you walk out of one and there is someone waiting to step in, but just think to yourself that this is a natural bodily function.

I think mental exercises can actually be of great value. This is especially true when you have the sudden urge to go really bad. This can occur while on rounds, and this is one of those times that you actually may not be able to get to a bathroom. For me, the key is knowing in my head that the urge will pass. If I can hold myself for a couple of minutes I will find relief. Then I can wait until rounds are over and then head to bathroom. This at least works for me.

IBS is really freaking annoying. I think, at least it my case, it is mostly stress/anxiety-related. I remember the beginning of my 3rd year was really tough. But you'll manage. I got through surgery without having to step out of the OR once. A lot of people have this problem. You're definitely not alone.


I guess I will try going gluten-free and see what happens. I think Whole Foods has a fair amount of stuff. I thought fiber would make things worse in the case of diahrrea, no? Maybe not if it bulks up the stool, but my stools are usually not liquid or anything.

I try to wait out the episodes, but after 20-30 minutes I just can't wait anymore. My insides start rumbling, things get very painful, I start getting dizzy and nauseous, and this sounds weird, but my behind sweats profusely when I hold it in :( Sometimes it actually shows through the seat of my pants. I can usually hold it for about 20 minutes, and beyond that it gets unbearable. So in my case, I don't know if just waiting it out is an option much of the time, unless the circumstances of inconvenience are short. Once I go, I'm usually okay. Anyway, thanks for sharing all your stories, this thread is way more popular and supportive than I expected :)
 
Word of advice to everyone who must crap in one of the hospital single-toilet restrooms: there is this spray that comes in little bottles and it has absolutely no scent but can mask any poopy odor. If I have to take a dump at peak restroom usage, I use a bottle of this stuff before exiting and can look the next person in the eye with pride, 'cause they ain't smelling nuthin' but freshness. You can find it in the hospital supply closet near the little tubes of toothpaste.

BlueMoon and Mustang, let us know what they find. Hope you feel better.
 
My school has those automatic air freshener sprayers in the bathrooms. When I'm taking a dump and it gives its little spritz, I'm a little insulted. Like its **** don't stank.
 
Wow, I didn't know they had things like that to eliminate odors. Great idea!

My appointment is at 2:30 today so I'll be posting later this evening about how it went and what my blood test results were. If they tell me, that is. Hopefully it won't be an assembly line procedure and I'll actually have time to talk with my doctor.
 
I'm not starting medical school until this fall, BlueMoon, so if I sound like a layman - well, I am. But I've had UC since my undergrad years over 20 years ago.

My advice is - medical science can offer some useful drugs for IBD (if you do have IBD and not IBS) but you will find a whole lot of "folk wisdom" on the subject - some of which is useful, and a great deal of which is not. You will find over time what works for you. If you didn't do a course of Flagyl - my old GI doc thought every newly-diagnosed case of IBD should take a course of Flagyl regardless of stool culture results - might not be a bad idea. You should indeed try a gluten-free diet to see if that helps.

I have seen studies saying that fish oil with omega-3's is helpful to people with IBD. Not for me it's not. I don't know if my body does something different with prostaglandin production, but I've tried taking fish oil at least a dozen times, and it *always* causes a severe exacerbation for me within 2-3 days and doesn't help a bit. I wish someone could tell me why!

What does work for me, though... I am moderately lactose intolerent (probably from my Indian blood). Lots of people with IBD are lactose intolerent to some degree. I don't get classic cramps or violent diarrhea from dairy products but I do get copious amounts of crampy gas... I'm probably over-feeding my colon flora with undigested lactose. I take a lactase capsule with every serving of dairy and it has helped a great deal. I also try to remember to eat one fat-free yogurt per day - a little extra lactobacillus seems to help my gut a lot. I take one baby aspirin a day for my platelets and I've noticed that it seems to help my gut a little, too, which surprises me with that small of a dose.

When you have an exacerbation - one last resort you can try before taking steroids is to get some edible Aloe Vera gel at the health food store (they also have Aloe Vera juice, but the gel is better for this). It is the most repulsive thing you can ingest (think salty slime and I'll leave it at that). Keep it in the refrigerator - it's perishable and it's also intolerable at room temperature. It's gross, but it has helped me once or twice (careful if you have diarrhea, though, it has laxative effects). I just looked - Mayo Clinic says the aloe vera gel evidence for UC is "limited but promising."

If nothing else works, though, don't hesitate to take the prednisone. It's not the end of the world, and (as beary said) IBD for me has diminished a lot over the years.

THANK YOU for having the courage to discuss this issue - your posts and the great replies really made me feel better. Good luck to you and to Mustang Sally.
 
Thanks for the well wishes. I saw my gastroenterologist this afternoon and he said my celiac and IBD panels came back negative, so that's good I guess. But I found out that the sedative meds they give you for endoscopies don't work on me. :oops: I had a colonoscopy back in January and it was no problem at all but I was fairly alert before the procedure was even over. I was happy because I hate being drugged, and I didn't think anything about it.

But today towards the end of my endoscopy I started vomiting while he was trying to stop a biopsy site from bleeding. He ended up removing the scope before he finished and I'm NPO now again until tomorrow morning (except for water). Apparently I have a hiatal hernia and part of my stomach protrudes up into my diaphragm. He also said I had a lot of polyps in my stomach, about 20. Overall it wasn't a bad experience at all, but I didn't get a definitive diagnosis and he's sending me for an upper GI in two weeks.

So more waiting for me. But thanks for thinking about me and I hope you guys are feeling better too. I'll be fine once my throat stops hurting. :rolleyes:
 
I've been suffering with IBS for over 10 years now, so i can relate to your problem. My issues are worst in the morning but can occur at any time of the day, especially if anxiety gets added to the mix. I was very nervous about third year, and picked a pathway that allowed me to schedule surgery in the spring (thinking maybe with time i could get used to the routine of clinical rotations). I did what a lot of you are suggesting - ate little, no caffeine, took a lot of Pepto or Immodium, etc. I also tried to get placed on surgical rotations not known for their lengthy procedures (no whipples for me). I was lucky in that the first place was flexible about what you scrubbed in on - only twice did i have to leave the OR. The second place made you scrub in, but it was pediatric burn surgery which is usually pretty quick. Only once there did I have to leave. It was embarrassing to leave, yes, but ultimately didn't seem to affect my grade. And i'm not going into surgery, never even considered it b/c of my GI issues.

If I have any advice, it's one: an echo of what others have said - try to find ways to relax, even though i know that's really tough. Esp. when you are stading in a 3 hour surgery and have all the time in the world to think about your stomach. Two: Watch what you eat beforehand. I ate a small breakfast and an even smaller lunch if i knew i was going back into surgery in the afternoon. I was hungry, yes, but it helped to have less food in me. And three: talk to your GI dr about some of the other meds. Flagyl didn't do anything for me, neither did amitriptylline or some others. I'm now on Lotronex, which is a miracle worker. It doesn't eliminate the crampy pain or gas, but almost entirely took care of the diarrhea. I consider that a win. It's not a drug for everone - you have to fill out some contract and have regular f/u once you start, but it's worth a shot if you've exhausted your other options. I had already been through years of fiber supplements, yogurt, etc. and had even tried all the other supposed rememdies, like peppermint oil.
 
I'm 23 now and I have sufferred from IBS for at least 5 years. al for breakI have seen FPs and GIs, but none have really offerred much help.. I get cankersores in my mouth and on one has ever asked me about this... I even told them this...

Anyways, I have had some recent luck so I thought I would share with you what has helped me. We just got done taking our nutrition class so I made some serious lifestyle changes.... I have not had any diarrhea for like 3 weeks (an all time record). Here is what I have changed:
-take multivitamin everyday
-run/rollerblade 1 mile everyday
-Eat oatmeal for breakfast
-have a yogurt for lunch
-eliminated regular soda, only drink diet now.
-Try and eat one of the following everday: carrots, green beans, raw broccoli, salad (the only vegetables that i like).
-Eat lots of fruit.

With this said, I think the oatmeal and exercising has made the biggest difference.
 
For the person that had trouble with the sedation during an endo....some GIs are using propofolol. It is amazingly better.

Folk remedies....macaroon cookies work nicely.
 
Hi guys! This discussion is very old but i will try to freshen it. How are you all doing now? How are your medical careers going on? Are there more medical students in this forum who suffer from IBS? I have IBS for many years since I was a teenager. Mornings are the worst for me, sometimes I have to go to the bathroom 3-5 times. Sometimes I get diarrhea after meals. So usually I am in a constant fear to become sick and need to go to the bathroom as quick as possible. I am thinking of radiology residency but before that... Next month surgery rotation starts and I am deeply afraid of it. It would be great to hear some positive stories!
 
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What are the consideration for fecal transplant or defined bacterial infusions in this? From what I have read, they seem to have been very effective with low risks, especially considering their success with patients unresponsive to other treatments.
 
Hi guys! This discussion is very old but i will try to freshen it. How are you all doing now? How are your medical careers going on? Are there more medical students in this forum who suffer from IBS? I have IBS for many years until I was a teenager. Mornings are the worst for me, sometimes I have to go to the bathroom 3-5 times. Sometimes I get diarrhea after meals. So usually I am in a constant fear to become sick and need to go to the bathroom as quick as possible. I am thinking of radiology residency but before that... Next month surgery rotation starts and I am deeply afraid of it. It would be great to hear some positive stories!

Hey, we do exist. I was diagnosed with IBS-D during the summer when I started studying for step 1. I had terrible anxiety and panic attacks, at one point I couldn't eat because I had a constant feeling of liquid going back up my esophagus. All that stress actually gave me GERD, too. After many weeks of PPI therapy and dicyclomine, I can finally say I am better. It took me months, I hope you improve! The worst part of living with this is that I, too, constantly fear another attack which might cause one eventually. I try to eat mild meals because anything "heavy" will make me go to the bathroom. I think I need a benzo to be honest, but I'm trying to be better than that and fighting it. The strange thing is that when I am at the hospital and with patients I never have symptoms because my mind is focused on something else. My problem is when I have periods of high stress such as dedicated study days for exams. I usually have diarrhea, sometimes in the mornings but usually my worst attacks occur right before bedtime. Loperamide saves me. Nothing can help the feeling of wanting to vomit though... I blamed so many things that might be the cause of my symptoms and I couldn't admit to myself that the cause was anxiety. The first few times, for example, I thought I had food poisoning that was happening a little too often. I even convinced myself I might have celiac disease or some other form of malabsorption because I felt so sick. To be honest, I did not have any real medical diagnostic tests done (besides standard CBC/lipid panel/Thyroid hormones) but I can see how it is stress related. It's important to find stress-relaxation techniques. Well that was a long story... I hope I can be my normal self again in the future.
 
Hi guys! This discussion is very old but i will try to freshen it. How are you all doing now? How are your medical careers going on? Are there more medical students in this forum who suffer from IBS? I have IBS for many years until I was a teenager. Mornings are the worst for me, sometimes I have to go to the bathroom 3-5 times. Sometimes I get diarrhea after meals. So usually I am in a constant fear to become sick and need to go to the bathroom as quick as possible. I am thinking of radiology residency but before that... Next month surgery rotation starts and I am deeply afraid of it. It would be great to hear some positive stories!

I too was terrified of my surgery rotation for the same reason, but it can be managed well. Figure out things that are pretty benign for you to eat (for me, granola bars for breakfast and sandwiches for lunch) and don't overeat. The main thing that saved me, as blueforest also said, was loperamide. I can't emphasize enough how much that and simethicone helped. I was in complete dread of surgery, but prophylactic loperamide each morning allowed me to go 8 weeks without even a single moment of panic.
 
I forgot to mention also how overeating really causes more suffering for me, too. Last night I made a simple pan-fried chicken breast with steamed vegetables... and way too much brown rice. After a few hours of not eating because of rotations, I came home and just devoured my dinner. Can you imagine what happened when I tried falling asleep? Nausea, intestinal discomfort, and annoying and loud bowel sounds causing me to toss and turn till about 2am. When I finally woke up I didn't feel better until that fearful bowel moment. I popped a dicyclomine right before I left for rotations today (didn't use it in weeks) and almost passed out today because I was feeling severely dehydrated and hot. Totally embarrassing, the doctor felt terrible and apologized for his tight office space... I swear this never happened to me before. I assisted in multiple C-sections during OB/GYN and never had this feeling... I was usually the person helping out my other friends who really did pass out. It was a rough day :( When I came home I was so upset with myself I almost questioned my abilities and If I will pass out during residency what will happen then? Endless cycle of stupidity and feelings of guilt....

I've developed food aversions to things that made me really sick. Undercooked broccoli... don't come near me. I can't even eat "whole healthy" grains because of the colicky pain and occasional diarrhea. However, white rice, white bread/buns/bagels without many seeds and pasta are perfectly fine for me. All these "simple" carbs that a normal person tries to avoid to stay lean are what work best for me.
 
What are the consideration for fecal transplant or defined bacterial infusions in this? From what I have read, they seem to have been very effective with low risks, especially considering their success with patients unresponsive to other treatments.
Well, I read a lot about that. Where I live the only indication for transplantation is C. difficile infection. Fecal transplant is very effective curing it but there are lack of studies with IBS (small samples, positive effect in ~70% is promising, though). Some people do this at home and there are some success stories on the internet but I would rather wait for more medical studies.

Hey, we do exist. I was diagnosed with IBS-D during the summer when I started studying for step 1. I had terrible anxiety and panic attacks, at one point I couldn't eat because I had a constant feeling of liquid going back up my esophagus. All that stress actually gave me GERD, too. After many weeks of PPI therapy and dicyclomine, I can finally say I am better. It took me months, I hope you improve! The worst part of living with this is that I, too, constantly fear another attack which might cause one eventually. I try to eat mild meals because anything "heavy" will make me go to the bathroom. I think I need a benzo to be honest, but I'm trying to be better than that and fighting it. The strange thing is that when I am at the hospital and with patients I never have symptoms because my mind is focused on something else. My problem is when I have periods of high stress such as dedicated study days for exams. I usually have diarrhea, sometimes in the mornings but usually my worst attacks occur right before bedtime. Loperamide saves me. Nothing can help the feeling of wanting to vomit though... I blamed so many things that might be the cause of my symptoms and I couldn't admit to myself that the cause was anxiety. The first few times, for example, I thought I had food poisoning that was happening a little too often. I even convinced myself I might have celiac disease or some other form of malabsorption because I felt so sick. To be honest, I did not have any real medical diagnostic tests done (besides standard CBC/lipid panel/Thyroid hormones) but I can see how it is stress related. It's important to find stress-relaxation techniques. Well that was a long story... I hope I can be my normal self again in the future.
Hey, nice to hear from you. I also feel quite well when I am concentrated on doing something, also have GERD and Loperamide saves me a lot, too. I was diagnosed when I was around 16, so doctors didn't recommend colonoscopy, only irigoscopy to exclude diverticulosis, I guess. IBS is definitely stress related, before exams I feel nausea too. Although I never have diarrhea in the evening or at night. Well, I hope we both will manage without benzo!

www.myginutrition.com

And so ends the medical advice ITT from me
I tried the diet for 2-3 months two years ago, it had no positive effect for my IBS symptoms, I only lost weight which wasn't a desirable effect because I'm already too skinny. However, I am trying it again because I desperately need to feel better.

I too was terrified of my surgery rotation for the same reason, but it can be managed well. Figure out things that are pretty benign for you to eat (for me, granola bars for breakfast and sandwiches for lunch) and don't overeat. The main thing that saved me, as blueforest also said, was loperamide. I can't emphasize enough how much that and simethicone helped. I was in complete dread of surgery, but prophylactic loperamide each morning allowed me to go 8 weeks without even a single moment of panic.

Small meals helps me a lot, also eating slowly is very important. However, it is hard for me to find out what things are benign for me to eat because sometimes I can feel well after eating a pizza and sometimes get diarrhea after. Now I'm strictly avoiding junk food, milk, also I try to limit products that contain gluten. Also I run 2-3 miles at least 3 times a week, it makes my mood better. If i need to leave the home at 7 am I wake up around 4.30 am, that's hard. Because of my new regime I don't consume enough calories and that's worrying a bit. I avoid taking loperamide daily because I'm afraid that it won't help in the future. When I was abroad I took it 5 days in a row, never longer. Have you noticed the change of the effect after taking it for 8 weeks?
 
I avoid taking loperamide daily because I'm afraid that it won't help in the future. When I was abroad I took it 5 days in a row, never longer. Have you noticed the change of the effect after taking it for 8 weeks?

I'm actually at 5 months now of taking it essentially every day, and there has been no decreased efficacy or potency. People develop rapid tolerance to many effects of opioids, but thankfully constipation is not one of the effects tolerance develops to. However, I hope not to take it longer than 2 years, as I would prefer to avoid the (slight but present) risk of QT prolongation with 2+ years of usage. Good luck!
 
I'm actually at 5 months now of taking it essentially every day, and there has been no decreased efficacy or potency. People develop rapid tolerance to many effects of opioids, but thankfully constipation is not one of the effects tolerance develops to. However, I hope not to take it longer than 2 years, as I would prefer to avoid the (slight but present) risk of QT prolongation with 2+ years of usage. Good luck!
Good to hear that, feeling more relaxed now!
 
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Had IBS diagnosed during surgical rotation. Did elimination diet and found out I needed Beano since I developed an intolerance to onions all of a sudden. Worked like a charm.
 
This thread is hilarious... and makes me glad that I'm not alone in the struggles. I definitely have IBS. It wasn't really bad until recently though (I'm a third year...convenient?). Anyway, I'll just get the urge randomly and most of the time I can try to not think about it and will it away but there was only one time driving home when I REALLY needed to go. I luckily made it home and to the bathroom but it was CLOSE. I've even started keeping TP in my car for long car rides in case I, god forbid, get the urge and need to stop on the side of the road to go (sad, I know but thankfully has never happened). But besides that drive home from school, the only other time I was millimeters away from an explosion was during a surgery. We were wearing lead and I started getting really hot and sweaty and I tried so hard to not think about it but it kept coming back. The only thing that kept my hanging in there was that the case was almost over and I made it but it was really close. I find it's always the worst when you're just observing and not doing anything. Luckily, I've always kept pepto in my white coat because of course the one day I didn't, I was dying. I think the best thing is to try to block all thoughts of it out of your mind and keep pepto nearby to ease the mind because at least for me, it's mostly anxiety... and I refuse to get on SSRIs.

Oh.. and I also refuse to let this stop me from applying for surgery next year :)
 
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