Misdiagnosis? Or remission?

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Feb 8, 2013
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Hey everyone I'm new here. I was hoping to keep this short but medical histories are hard to condense. Basically, I was diagnosed with UC/Crohn's but the symptoms don't really add up for me.

I was diagnosed with UC (or some type of IBD) in May 2007 by my local GI doctor and put on Asacol. In July 2007 I was experiencing severe pain in my front-right abdomen and after going to the Mayo Clinic I was diagnosed with Primary Sclerosing Cholangitis (PSC) in the liver and an "indeterminate IBD" that was in remission. I was kept on Asacol and given Ursodiol for the liver. Within months the Ursodiol completely reversed my liver condition and my liver enzymes went back to normal limits. Between 2007 and 2009 I was also very active in Taekwondo in addition to taking my meds and I felt pretty good aside from some occasional heartburn.

Around April/May 2011 I was experiencing severe pain in my front-right abdomen again and it ended up being gall-stones stuck in a diseased gall-bladder, so I had that taken out ASAP. A month later I was in California for a two-month intensive foreign language program and I felt fine, aside from being gassy after meals. On the positive side I could pass the gas easily and my bowel movements were quite regular.

In May-July 2012 I was in Japan for another language program for a month, still on my medication, but I felt better than I ever have. It was probably the food and daily walking, but my bowel movements were very regular, I experienced no pain and only had heartburn once (probably wasn't used to the soft-boiled eggs in ramen at first).

After going to Japan, in August, I had something that I would call a "flare up" but it wasn't really a typical nightmare flare up. Come to think of it, I have never really had a flare up at all until then. 30 minutes to an hour after eating lunch I would have emergency bowel movements that weren't quite diarrhea but weren't normal either. No pain, no bleeding, just emergency evacuations. Then they stopped. For all I know I could have just had difficulty re-adjusting to American food.

During this psuedo-flare-up I was also having severe, debilitating heartburn that felt like an alien trying to claw its way out of my chest. This, I discovered, was actually the Asacol! I stopped taking Asacol for a few weeks and had no heartburn. None. Tried Asacol again and 10 minutes after my first dose the alien came back. I tried talking to my GI doctor about all this and he just tried switching me to Apriso, which is practically the same thing as Asacol and will probably give me the same heartburn if I took it, which I won't because I can't afford the $320 per month price tag anyway.

In conclusion, I have been off Asacol for 5 months, I have been off of Ursodiol for about the same if not a little more, and I've been taking probiotic, eating a carton of yogurt every day, and adding more organic vegetables to my diet, and nothing seems to be wrong with me. I eat lots of Korean food, which is loaded with red chili pepper powder/paste, and it doesn't bother my stomach at all. My tongue is still having trouble though :D I also noticed that when on Asacol I would rarely get gas and when I did, it would be trapped and cause acute pain. Now that I'm off Asacol I get gas on a fairly normal basis and it just passes without any effort.

My liver enzymes are normal as of last week. The only "symptoms" I have that could possibly be associated with UC/Crohn's are bloating, fatigue, and irregular bowel movements (one every two to three days). My stool is normal, so I think these "symptoms" are more a product of my current lifestyle (work online, classes online, don't really leave my computer chair). If I manage the motivation to get some regular exercise I'm sure all of those will get back to normal.

Looking back to 2007, and even before then, I have never had any issues with bloody stool, constant diarrhea, going to the bathroom multiple times a day, or any of the other tell-tale symptoms of IBD. The only sypmtom I really had was abdominal pain. So in the end, how feasible is it that I was completely misdiagnosed? Could my gall-bladder have been diseased from the beginning, causing my whole gut to go off to the point where it appeared as though I had IBD? Or do I just have a very mild case of IBD?
 
I don't recall exactly, but I believe it was done via colonoscopy. I've had 4 of the bloody things and I'm in no hurry to get another. The procedure itself is fine. The prep is hell. All liquid preps make me gag and nearly puke before I can even swallow them.

I'm not sure if biopsies were involved. I know I had a biopsy on my last colonoscopy, but don't remember the first one.
 
could you just be intolerant to mesalamine and it caused you all that trouble.

also, what were your initial symptoms that lead you to the uc diagnosis.

ju
 
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It's very much possible that I am intolerant, or somehow have become intolerant (it worked for 6 years without a problem), to mesalamine, which makes me wonder why my doctor just switched me over to another mesalamine....

My initial symptoms were stomach pain, fatigue, and inability to gain weight. That was about it.
 
The only way to confirm a UC or Crohn's diagnosis is via biopsy which are usually taken during a colonoscopy. Then a pathologist will prepare the biopsies to be looked under a microscope (they stain the piece of colon, then slice it thinly and put in between two slides of glass) and look at the cellular activity.

For instance, my biopsy report on a caecum, transverse colon and rectum biopsies showed an active chronic colitis, whereas biopsies in my stomach were negative. Coupled with the pancolitis the scope picked up, the diagnosis is 100% confirmed.

Flare-ups can be mild or violent, it looks like you did experience a mild flare during your stay in Japan.

I am allergic to 5-ASA (I get severe headaches, patches of red skin, pain worsens, etc.) and the symptoms you describe do not match that of a 5-ASA allergy. However, it does sound like you have issues with acidity, as I do. My heartburns are irregular but when they happen, your alien metaphor sounds just right.

The easy fix: proton pump inhibitors (PPI) medication, such as Pantoloc 40mg. They are extremely effective at regulating acid production in the stomach and very good at preventing heartburns.

I never go anywhere without pantoloc on my person in case the heartburns do happen. When I'm out of pantoloc (it hasn't happened in a long time but I was once stuck in Mexico with the heartburns), I eat a crapload of oatmeal and it helps tremendously as well.

I would first ask your GI how he diagnosed you to make sure you were properly diagnosed, and I would also ask him for some PPI to keep those heartburns in check!

I hope you'll feel better soon!
 
Thanks. I'll ask. I was never told which area of the colon the ulcerative colitis is. I don't think they ever took a biopsy of my stomach.

As for Japan, the flare-up was actually after. Of the two times I've been to Japan I have felt much better there--even gained weight--than I ever do here in the States.

The thing I hate about PPIs is having to take medication to solve problems caused by another medication when the first medication is supposed make everything better...I'm tired of throwing money at these pharmaceutical companies and the longer I do the more it looks like they purposely arranged things to be like this so that they can get more profits.
 
It's true it's very annoying, but consider where would you be without any medication at all? I do think pharmaceutical companies are right up there with banks, insurance companies and oil companies in forming a group of despicable corporations only driven by profit, but it's how the world is and we have to deal with it.

Ever since I stopped taking prednisone and I am on medical cannabis I haven't had heartburns. I'm a legal patient in Canada and can grow my own legally, so it's all natural, all organic, and no pharmaceutical companies are getting my money. Well, they still get it for the Imuran, but not for anything else. ;)

This is not an option for everyone though, and again, there is no doubt the pharmaceutical companies don't want people to start growing their own medicine.

In your current situation though, you either can take the PPIs or or suffer the heartburns, or stop taking 5-ASA altogether and then deal with a flaring disease.

Go with the lesser of evils if you can :)
 
I need to have a chat with my insurance first ;)

I don't understand how I suddenly became intolerant of Asacol after 6 years of use, and especially after doing so well when I was in Japan just prior. In Japan I took a full 2800mg dose daily without problems, but after returning a 1400mg dose was enough to trigger a severe reaction.
 
Pantoloc is really cheap (like 35$ for a month's worth) and if you go with the generic it's about 20$.

Anyone can develop allergies with prolonged exposure to any substance. People with IBD already have at least one genetic defect that led to our immune system being programmed incorrectly, so it's no surprise we're susceptible to allergic reactions of all sort.
 
you can develop intolerances at any time of your life especially after a bout of IBD> active disease makes the bowel more sensitive to allergens.

my own personal experience was with eggs. through a food diary and elimination I discovered that half an hour after eating eggs I was in serious pain. I would get cramps that started of mild and grew to me curled up in a ball and then they would ease again. this would last up to 4 hrs.
ive ate eggs all my life and my favourite desert is/was pavlova. im 33 and never had this problem before my Uc diagnosis 2 yrs ago.

my initial symptom were blood and mucous in the stool. your symptoms seem vague but no Gi would give a Uc diagnosis lightly without proper biopsies and a colonoscopy. you say you've had 4 colonoscopies so im sure they are right.

FrancisK7 is right, there are many cheap over the counter products for heartburn. if you had a headache would you not buy Tylenol because you are lining pharmaceutical companies pockets.
also there are plenty of home remedies and natural remedies for heartburn. one I found good, whilst I was heavily pregnant and had it chronically, is warm milk and honey.
lying on your left side in bed also helps as the oesophagus is more left sided than centre and acid cant travel upwards.
anyway keep asking questions and researching.
we are all our own advocates for our health.
ju
 
There is also a very small percentage of people, who will go into what is called "spontaneous remission" and no one knows why. Even terminal cancer patients -- see article on this from Discover Magazinehttp://discovermagazine.com/2007/sep/the-body-can-stave-off-terminal-cancer-sometimes#.URqOh3y9KSM

Granted, the percentage is minuscule, but it does happen, and the mystery of how and why remains,
 

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