# indian ibser



## smt (Nov 10, 2012)

Dear Group,
I had posted tgis on welcome; thanks to glolo for answering. For a wider response I am posting it here.
I had stumbled upon this group about a year back and since then I have followed the group off and on. I desperately request suggestions from moderators/members; if Madam Kathleen M. replies I would be very grateful indeed.
I am from India and used to suffer from mild occasional stomach disorders in childhood. I am a postgraduate from the leading indian institute of its kind. I am saying this to indicate that I was able to do justice to the gruelling academic schedule then (no health issues). After that, some job and a research PG in management later, I joined a fulltime Ph.D. course in a respected school 2000 km from home. During October November 2010 I attended a fieldwork in a remote Indian village (defecation in open, issues with potable water, extreme mosquito menace etc). Towards the end of the work around November 2010 I started suffering from loose watery stools (about 3 times per day), extreme flatulence etc. On my way to school I came home and checked with a physician who suspected intestinal TB. He asked me to undergo an ELISA test for TB and go to my school and wait for the results. 14 days later the test came positive. I requested my school to give me leave for a year. The school did so and I came home for traetment. I checked with a specialist and he advised me a TB PCR test, abdominal USG and blood tests: they proved to be negative. I was diagnosed with IBS.
He suggested medicines which were moderately effective. During the last 1.5 years the symptoms have somewhat decreased in intensity, especially during the last 2 months but they still persist. After having visited an experienced MD in Aug 2012 my symptoms improved to an extent. Currently my complaints are: 1.defecating once every 3 days. formed hard stools towards the beginning followed by muddy, mucusy stools towards the end; this shows improvement occasionally. 2. feeling that stool may come out with gas expulsion although it does not. flatulence; occasionally feeling of bubbling in upper abdomen especially after meals. loose stools without pain etc once every1.5 months. occasionally an urge to defecate which goes away. Last December during a flare up episode I may have spotted a small patch (about 1 cm radius) brownish blood in stool although it could have been something else as well. I do not suffer from fever; 2 years back in the village in cold November nights I experienced nightchills while sleeeping for 3 consecutive days.
I am taking Providac (probiotic, 1 per day: can this be increased?), Udiliv (for liver), and fungal diastase and carminatives in sorbitol base. Providac has provided some relief, I believe. Anxiety immediately (I mean it) initiates and aggravates symptoms, whereas a stress free mind and exercise helps symptoms: these are my strong observations. Furthermore, I am lactose intolerant (no milk) and generally try to avoid Indian home made bread (wheat roti). I also try to consume as less oil as is possible in food. I am fond of sweets made from cottage cheese and sugar. I try to take a rice based diet including lentils, fish, vegetables, eggs but also biscuits, tea, which I drink in copious quantities and bread.
Now i am set to go back to my Ph.D. school in the next 14 days. My request to the group is: please guide me further as to what to do to further improve the situation (it has improved by 40%), what additives can be taken, eating habits including eating schedules and coping with tight school schedule.
My latest diagnostic reports: hb 13.7, ESR 04, TC/DC normal, Prothrombin time normal, bilirubin 1.1, SGPT 40, SGOT 41. Stool: mucus: (+). TSH 4.14. All in std units.
Sorry for the long mail. Greetings for the ensuing Indian festival of lights. Thanks and wish all of you the very best. Sincerely Yours.


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## BQ (May 22, 2000)

Ok SMT Your diet sounds fairly good.... You might want to change up the probiotic to one that carries different strains and see if that helps some more.

But let me see if I can get Kathleen to pop in here for ya!

And yes.. hope you had a Happy Diwali!


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## Kathleen M. (Nov 16, 1999)

Sounds like you are doing a lot of the right things. A few thoughts.

You might play with the amount or type of probiotic (may add a different strain rather than just increase what you take).

It is pretty common for a harder stool to be pushed along with softer/looser stools. The body trying to balance that out. You might look at fiber/water in the diet to see if you need a different mix to go more often (or have the stool not get so hard). A low dose of an osmotic may help, but you are getting some of that in the sorbitol based stuff. That may be increasing gas. You might see if you do better gas wise with just fish and no lentils for protein as they can also be a bit gassy.

If stress anxiety is a big problem working on that may be helpful. A lot of the mindfulness techniques from Indian culture are used for stress reduction and anxiety treatment in the West, so mediation may be helpful.

Not sure what else to suggest. Hope this helps.


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## smt (Nov 10, 2012)

Many thanks to BQ and Kathleen for replying. I have a feeling that whenever i try to expel gas some amount of stool or mucus may come out. Any suggestions ? Also my TSH is 4.14 : is this normal considering the controversy? Thanks.


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## Kathleen M. (Nov 16, 1999)

TSH, depends on who you talk to, I think they are in process for narrowing the normal range, so if you look at the older numbers you are OK, but you may now be out of range.

How do you feel? Are you sluggish, gaining weight, etc or do you feel just fine other than the IBS?

The rectum tends to mis-sense things in IBS (so may get urgency that isn't appropriate for what is waiting to come out). You could see if peppermint tea relaxes that a bit, but generally that is where you may need to think about anti-depressants which may or may not be something you are willing to do depending on which ones and what side effects you get (some can make people tired or foggy so may not be good mix with a demanding school schedule).


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## smt (Nov 10, 2012)

Thanks once again for answering. I am thin and lost a few kgs last yr but have gained almost the entire amt since. However, i do feel a little sluggish and have a tendency to be slightly off balance while walking. My current physician has ruled out neurological issues. Unfortunately the gastro who got me tested for tsh wud not listen to me about the tsh controversy. He however sent me to a psychiatrist for my 'apprehensions' who prescribed antidepressants. It is due to the issues that u mentioned that i cud not continue the treatment. The vague impression that i got from him was that this wud generally act against 'depression'; however from what u write it seems that it has a role in the enteric nervous system. Is my understanding correct? My current physician has asked me to do pranayam which are breathing exercises popularised by an indian yoga guru on tv. I am also trying to go easy on stressful issues.


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## Kathleen M. (Nov 16, 1999)

The gut nerves use serotonin (actually a lot more serotonin than your brain's mood nerves) so serotonin effecting drugs also work on the gut nerves.


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## smt (Nov 10, 2012)

Kathleen Madam,
Thanks so much. Occasionally, especially in the mornings, and over the course of the day, twice/thrice I get an urge to defecate. Although in most cases I understand that formed stool would come out, this urge is conformable with soft stools. I do not go however. This then disappears. Looking up this site I believe this is called tenesmus. Is this worrisome? And as I wrote earlier at the end of defecation mucus is present; I understand this when I wash myself with water and bare hands-this is the local practice-I feel too much mucus. Maybe, I feel, somehow these 2 issues are related. Can you please suggest any cure/medicines etc?


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## Kathleen M. (Nov 16, 1999)

I'm not sure when the line is crossed from normal IBS increase in urgency from rectal hypersensitivity and what they call tenesmus (because usually I hear them calling a type of urgency with more severe conditions by this name).

I think if it is a couple of minutes here and there that isn't a big deal. I think it is more worrisome when it takes up a lot of your day and interferes with your ability to function. Looking it up tenemus is when there is a "constant need" to go rather than occasional urge with some "gotta go now" sense to it. I mean everyone gets an urge to defecate. If you can ignore it and it goes away that is a pretty normal urge (unless you have ignored it for awhile and now it is "gotta go now" which is normal. If you get a "gotta go NOW! with most every fart or BM that is rectal hypersensitivity).

IBSers tend to make more mucus (that is the irritable part of irritable bowel, mucus happens from every irritableness or irritation)

Some people find an antihistamine (drys up mucus in the nose) seems to help.


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## smt (Nov 10, 2012)

Thanks so much. Madam, my latest blood reports as I quoted in my first post shows SGPT 40,SGOT 41 and bilirubin 1.1-slightly out of range. The physician says this is normal. Should this be investigated?
Also after meals I feel liquid sloshing about in stomach and coupled with this I cannot burp. What is this liquid and is there any exercise to 'learn' to burp. My mother says that after about 4 years of age I have not been able to burp.
One other issue. For the last 7/8 yrs I have a mild tremor in my hands which aggravates under stress and after waking up. Around the same time I developed a little balance problem while walking and cannot handle escalators. My physician has dismissed it. After pursuing this URL and a fibromyalgia website I understand that these are comorbidities of IBS and is called fibromyalgia or essential tremor (my elders in extended family have ET (seems to me by observation); do not know whether ET or FM). Please guide me about handling/treatment as here it seems most ppl are unaware abt the link between IBS and ET/FM. 
Once again heartfelt thanks. Wishing all of you a happy festive season. Regards.


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## Kathleen M. (Nov 16, 1999)

For most tests there is a range near the "normal" range that is still normal. They measure 100 (to make the numbers easy, but they do a lot more than that) healthy people with no problems. The range is set where ~95% of the group measured are all in the range. There are always a few normal people that are outliers, and often the clinically relevant range not right up against the normal range. There is a ways to go before you get to clinically relevant.

Your gut adds water to the food you eat to be able to digest it, and the food in the intestines gets moved along to make room and much of that is still liquid.

not sure about learning how to burp.

You might see a rheumatologist if it seems to be FM or a neurologist to see what is up with the balance and the tremor.


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## smt (Nov 10, 2012)

Thanks very much for ur support and help. Wish me luck for ph d school; tomorrow i take a flight back. Today morning i had my usual brown hard followed by yellowish semiformed stool. I have gone thru ur answer to me (and others) in this regard. My confusion is whether this a typical ibs symptom or a normal person too wud have necessarily have yellow semiformed stool at the end. (coz of stool from diff meals). But then why wud that stool as yet unformed leave the pipeline in normal ppl?


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## Kathleen M. (Nov 16, 1999)

It is more of an IBS thing, but you can sometimes see stool variation (color and firmness) in healthy people.

The harder darker stool may be from an earlier meal and it has just had a bit more processing time. Stool starts out liquid and yellow (or green depending on what color your bile is). As it moves through the colon it becomes more formed and over time becomes more brown.

And sometimes if stuff starts to back up the response is to send stool that will move well to push out the harder stool.


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## smt (Nov 10, 2012)

I am now at school, joined on 1 Dec. For the last 2/3 days, whenever I get up in the morning, immediately I feel an urge to go. Knowing this evil urge, I had tried to avoid it for the past 3 days. Today, however, I gave in and had a small piece of medium hard followed by small soft pieces in rapid succession. After breakfast, when I sit in class ( i am undergoing coursework) i feel gas churning about. for fear of fouling up the atmosphere i cannot let much out. Today, I had a feeling throughout the day that I would have to go and stool may come out with gas ( this however is a common feeling throughout the last 2 yrs.). I feel that urge in the morning is a sign that things are difficult. And throughout the day, there is a feeling of tenesmus ? rectal sensitivity?, which I get at home only occasionally. Also here I am forced to drink tea with milk. Is this a problem? Madam Kathleen, I know that you have been successful in your ph d work inspite of illness. I have seen 2 of your publications on the internet. I want to be a success in my ph d work as well. My school is very strict and 100% attendance is required. Kindly guide me on my current symptoms.


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## Kathleen M. (Nov 16, 1999)

Instead of trying to avoid your bodies natural inclination to have a BM in the morning (when all humans colon is more active) try getting up a bit early so you have time to go in a relaxed way and have time for it to all finish up before heading to class.

I know getting up extra early isn't always an easy thing, but a lot of IBSers find if they just let the body get the poop out in the morning with enough time to get it completed then they do really well for the rest of the day.


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## smt (Nov 10, 2012)

Thanks for replying. Trying to get up early in morning, but for the last 2 days was not able get out the poop. Also I am very gassy, always. In the morning my frequency of farting may be about 6 per hour even at home when I take bland food. Do u think this is extremely abnormal? The trouble is in school the mess supplies spicy food; I avoid most of it. But still beans and legumes are the staple. I take rice with legumes, beans. Shall I request for only boiled legumes? Also a smell has been added to the flatus. My physician in Calcutta, which is where I am basically from, is not willing to prescribe simethicone. Can you suggest anything else so that this curse is atleast substantially eased? When I stay at home, I am able to let the gas out when needed. Then my stools are largely well formed and the gas has no odor.

Another thing, here curd is easily available. Considering I am lactose intolerant can I take large portions? Also would a little milk with tea cause problems; this is important as the mess supplies tea with milk. Thanks once again.


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## Kathleen M. (Nov 16, 1999)

Normal is 12-20 a day and that isnt evenly spread.

Bland food, do you mean starchy food? The more starch you eat the more farts you have.

Beans and legumes are very gassy foods. Rice is usually OK, but the more beans and legumes you eat the more you will fart. Are you vegan/vegetarian? I know a lot of people can't use lean chicken or lean fish for protein and have to rely on beans and lentils.

You can't get simethicone over the counter in India? It isn't prescription in most countries.

Usually with milk a splash or two isn't a problem. Fresh cheeses can still have lactose so also would be something to watch the portions on.


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## smt (Nov 10, 2012)

I am able to post from IE but not from Firefox; earlier this was possible. Thanks for pointing in the direction of browser compatibility.

No, I am not a vegetarian. In Kolkata (Calcutta), at home, I take fish and eggs. I like them. My school, however, is in a state where people are predominantly vegetarian. Eggs are available outside the school gates; they are street food and may be unhygienic. The mess supplies rice (white), lentils, one oily curry and about half the meals, curd (yogurt) from a reasonable brand. Breakfast is usually oily gluten; I have made arrangements for toasted bread but tea is with milk. Under the circumstances, I take rice with a little butter and salt, a little lentil and I pick up the vegetables from the oily gravy. I avoid milk except that with tea; I am trying to make arrangements to have tea without milk; do not know whether would be possible. Kindly advise whether anything more can be done under the circumstances. After about another 8 months of coursework I will get an apartment when I will be able to cook on my own.

Simethicone is OTC, yes, in India. If you can comment on this: brand Distenil: my physician seems to have doubts.

Merry Christmas to you all.


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## smt (Nov 10, 2012)

Also to add to my post, how can one bring down the frequency of passin gas, which occasionally is about 10 per hour and why is this so high? Others seem to have much unhygienic meals but do not have it. Frankly when due to social reasons when I withold it as mentioned above in my posts I have a bad time with bloating and other problems. How to get out of this problem? THere is no other doctoral candidate in the class; others are PG candidates and younger. This makes my situation doubly difficult. Any help you provide I will greatly appreciate. Thanks.


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## Kathleen M. (Nov 16, 1999)

How often you fart is a combination of WHICH bacteria you have in your colon (probiotic bacteria make no gas from digesting carbs while methanogens and other bacteria make lots of gas from carbs) and how many carbs you eat that either no human on the planet can digest (our diets are full of these) or carbs you, personally, can't digest/absorb (like lactose or fructose).

Either feed the bacteria less (so limiting beans or legumes and limit starch (although rice is OK) and check out the low FODMAP diet for all the other sources of gas in our diet) or try probiotic bacteria. I greatly lowered my fart frequency with probiotics.

Additionally some gas is absorbed into the blood and comes out in the lungs (why hydrogen breath tests work). Some people may be more efficient at this than others and in general IBSers seem to not process normal amount of gas correctly.

Can you pack in any food (like a breakfast cereal you tolerate as bread/toast has starch you can't digest and gluten) or are you dependent on the school. Small amounts of milk in tea may be OK as usually noticable gas differences is in 8 ounces of milk, not just a tablespoon or two, probiotics are in yogurt but you may need something that is proven to live in humans rather than one that grows well in commercial vats.

Simethicone sometimes works, sometimes doesn't. Try it with every meal for 3-4 days. As long as you can trust the manufacturer I don't think there is much difference in brands, and I don't know much about the manufacturers in India.


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## smt (Nov 10, 2012)

Unfortunately, now I am totally dependent on school for food. At home in Calcutta I digest 3 slices of toasted bread well. I think Indian hand made bread soaked in oil (paratha, puri) creates problems for me. I am taking a probiotic having lactobacillus acidophillus and bifidobacterium (10 billion) once daily. I take around 7 pm and on most days I have an appetite by 9 pm.Here in India VSL 3 has 112.5 billion bacteria. It is not available in this small town. Will I increase my dose of my current probiotic?


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## Kathleen M. (Nov 16, 1999)

It would have more, and a few more species.

It is hard to know which is the right probiotic (are the bacteria alive, and are they the right strains). If this one hasn't made one bit of difference at all after a couple of weeks I would try a different one.


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## smt (Nov 10, 2012)

Kathleen madam and Jeff Sir and others,

Writing this under deep distress. School has relentless pressure (100% attendance, quizzes, exams). Now for the last few days, when I wake up from sleep in the morning, i get an instant urge to pass bowels. They are semiformed, soft with ragged edges and come out in small thin pieces. On top of this like about an year back, I may have spotted a rust colored covering on 1 piece of stool. But these things are so difficult to tell I am not sure. Also today probably there was a spot of blood, again not sure. Today after exams when I slept for an hour in the afternoon, I felt I was sweating for no apparent reason, This continued for about 1.5 hours. The trouble is since the best gastro in Kolkata has said that I do not have ulcer and cancer my folks have dismissed me. School being relentless, in this corner of the country, i do not know what to do. The local physician has said "its all in my head". Also i wish to inform you that when I was in home in Calcutta, and was able to pass gas at will, had diets at will and no stress, I used to generally pass brown/yellow long round pieces. Please treat this as an SOS. Advice please. Just spoke to an acquaintance in Calcutta who had normal blood results but is suffering from ulcer. Please help.


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## Kathleen M. (Nov 16, 1999)

Ulcers usually cause upper GI pain and distress, not effect the stools so much.

The colon normally wants to go in the morning (when it is always most active in every person) and with IBS it can be a bit more urgent and looser than usual.

If you can't change diet, and can't take Imodium in the evening or take Calcium carbonate with meals to try to firm up the stools (loose stools once or twice a day is NOT dangerous) maybe you might think about working on stress reduction.

Stress can cause physical symptoms. It just shows up in whatever part of the body already is having some issues. If you had asthma the stress would be causing breathing issues.

Do you have a spiritual tradition with a mindfulness type of meditation, or are you interested in that kind of thing (either in a spiritual tradition or just on its own).

Anxiously studying your stools never helps and usually never gives anyone any idea of what is going on in there. What you eat can change the stool so if you stare at them often enough you are bound to see some odd things.


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## smt (Nov 10, 2012)

Kathleen Madam,

As always, thanks for the reply. Indeed, stress is playing a part. Also like countless others, I believe *you*, unlike physicians who I do not believe for IBS/IBD. So when you say this, I would believe you. I am seriously searching for CaCO3 tablets here; as far as I know 500 mg without Mg. Please tell.

I wish to say that the 'best' gastro in Calcutta ( an individual aged 75 or so) twice examined me clinically and ordered blood tests and also saw USG results. But he said *he would not order colonoscopy *as this is not required and asked me not to come again as "my serious patients are waiting". Also a very senior MD in Calcutta said I do not have IBD. But inspite of I requesting him to conduct fyrther investigations did not order anything invasive. But inspite of that I have a lingering suspicion; many ppl say colonoscopy is the gold standard. None of my parents have IBD; although my mother's ESR levels are always high. MIne are low. My mother has suffered from intestinal TB in the past. One of my cousins died from cancer in the liver.

Madam, about the sweating: can it be from IBD?

Mindfulnesss techniques: Please help me with any web resource etc on meditation.

One last thing: my appetite is fairly good especially when in good mood.


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## Kathleen M. (Nov 16, 1999)

Generally, if your symptoms are consistant with IBS (which yours seem to be) and all the blood tests are normal (especially when inflammation is very low) the chances that the colonoscopy would find anything is very low.

Over-testing of IBSers seems to only make it worse and all too often just convinces them something was missed rather than reassure them that everything really is OK.

When the risk of perforating the colon is higher than the chance they will find anything many doctors won't do the colonoscopy. Some will, but some will scope everything that moves because they have to pay for the equipment (here in the USA we generally have more problems from too much testing than not nearly enough).

The colonscopy may be "gold standard" for diagnosing something but that does NOT mean everyone always needs one in every instance. In a study where they put IBSers who had IBS symtpoms and blood tests were normal through the ringer of all sorts of invasive testing and imaging they did NOT find anything in 95% of people and most of the other 5% were the sorts of normally abnormal results you find if you do any test on enough healthy people.

http://www.relaxationresponse.org/steps/ is a pretty basic technique that they start a lot of people off with.

I can't find a trained MBSR (mindfulness based stress reduction) certified instructor in India from the main place that trains them here in the USA, but I know a lot of the techniques for that come from traditional Asian meditations

http://en.wikipedia.org/wiki/Mettā has information on loving-kindness the MBSR courses often use a fairly simplified version of this.


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## smt (Nov 10, 2012)

Thanks. I feel a much assured. i have gone through both URLs and plan to start with this from today. Now, I just have 1 question. I get bouts of sweating (not new symptom) without any apparent reason. This does not happen regularly, and sometimes happens in sleep but more when I am awake. Now the temperatutre in the room is maybe about 20 Celsius: not usual to sweat. Can this be a red flag symptom? I generally have no fever.


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## Kathleen M. (Nov 16, 1999)

There are a lot of causes of night sweats and as long as your physical is OK I would try not to worry about it. If you drink alcohol near bedtime that can do it, and for women it is often a hormone thing, not sure if men's hormones can do it to them or not. They can also be from the normal ups and downs of the body temperature. It doesn't stay exactly the same all the time.


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## smt (Nov 10, 2012)

Kathleen madam,

Sincerely try to imbibe what you say. But when I went to the loo in the morning today, mushy stool with semiliquid last part came out. On top of that I saw a spot on a stool. I used a paper to retrieve that part and saw a blackish (probably not reddish) spot. My hands were trembling. These days we are having exams of coursework so took 2 exams; took medicines as well to stop further stool. Exam continues for the next 2 days. After that my father will come from Calcutta to stay with me for a few days; I have told him the development. The local physician is dismissive but I hear we have a decent cheap hospital here. My term ends on 22 Feb; before that unless compelled to invasive procedures will not be possible. I do not want to drop this term again. But for the time being, what can I tell the hospital to test/diagnose? ( my father wants that some sort of medical help is available). I am so busy and tired all the time. and in your experience what can that black spot be? dried blood? suspect it is something dangerous. If it is blood do you think I can continue with the Ph D? Honestly, I am not so afraid of dying as doing poorly/leaving the course and consequent humiliation. People have expectations on me and pray to God that I can live up to them. I am so afraid I cannot think. On top of that 2 exams per day. Whatever happens, I will cherish the help you and the group gave me.


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## Kathleen M. (Nov 16, 1999)

There can be black spots from something you ate so it could very well be a nothing at all to worry about. In fact it is most likely nothing at all to worry about

The first test would be a stool test for occult blood. As this may not even be blood, there may be ZERO to be so worries bout.

I know plenty of people who have Ph.D.s who have inflammatory bowel diseases which are a lot more than one black spot once on one stool. (you could be worrying yourself into a stomach ulcer, but still that may be unlikely as that tends to be a lot more than one spot on one stool of black and tarry digested blood) so it really isn't either you are completely and totally healthy and you can get a degree or you are sick and you can never get an education of any kind ever so just give it up now.

The anxiety is probably doing much more to interfere with your education than anything else and that may be what you really do need to talk to the doctor about. Anxiety alone can be exhausting.


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## jmc09 (Oct 5, 2009)

You are able to get Ramosetron or IBset in India and its very similar to Lotronex and has been very effective in treating IBS D.
See if you can buy it in a pharmacy or through your doctor.


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## smt (Nov 10, 2012)

Thanks Kathleen madam for replying. Thanks to jmc09 as well.

As you advised, I went to a physician locally in this small town who heard of my suspicion and dismissed it the umpteenth time but sent me for a stool test for occult blood and haemogram. On Saturday my father had come and I took these 2 tests. The results, I am sorry to tell you are shocking. Occult blood *was *found. Hb at 11.6 from 13.7. It is a fact I cannot eat well although I have appetite due to fear. No wt loss. Then I went back to the physician who referred me to a gastro in this small town itself. On Sat itself we went there. The Gastro examined me clinically and through some device my rectum etc as well. He said that I have an anal fissure and the blood is due to that and wrote that on the script. This satisfied my father that I do not have a disease such as cancer and CRohns. On furhrt complaint he referred me to a psychiatric and called me "a difficult psychiatric patient" which again was again appreciated by my father. This doctor is a friend of the doctor at school and I did not know what to say.

Anyway, I am very afraid. My family is saying that There can be no reason for furher complaint; however the bloods that I saw were maroon or black spots. My brother says that this and occult blood cannot be from the fissure. ThaT is the impression I gert from elsewhere as well.* Please HELP. *

PS: I went to another physician as well on Fri who only saw my earlier reports and said that I have only IBS. He did not have the benefit of blood reports.


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## Kathleen M. (Nov 16, 1999)

It does sound like the anxiety is worse than anything else. I don't think the occult blood test can tell if you bled higher up the GI tract vs you bled right at the outlet. I mean it isn't that it tests for something that happens to the blood only after it has been out of the vessels for X number of hours. It tests for Iron. I was on iron supplements and those can turn the test possitive without any blood at all.

You can see spots of dark colors from things in the diet and you can't tell by looking at it if it is blood or a dark bit of something you ate.

I do think the anxiety needs to be treated as that seems to be a lot harder on you than anything else.

That you are maintaining weight is a very positive sign. Most of what you fear will cause you to lose weight even when you eat more than usual.


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## melissacox2013 (Jan 23, 2013)

Though medical professionals have yet to discover the specific medical reason IBS develops, the symptoms can be minimized. Fortunately, IBS does not cause permanent damage, but how people respond to the symptoms can cause great harm. For example, if you eliminate certain foods from your diet, a vitamin or mineral deficiency can develop. Eating provokes the symptoms, but to manage the syndrome it is necessary to know which specific foods to avoid, and how to supplement the vitamins and minerals lost. However, there must be other lifestyle changes and additions that help you manage stress and relax the muscles.

I've run into so many people with the same problems....they referred me to an amazing program that actually works and provides 3 month consultation. Definetely worth checking out.
http://bit.ly/V609Ny


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## smt (Nov 10, 2012)

Thanks again for replying. So, what do you suggest? I do not want to drop this term again and continue till early March (about 40 days) without any invasive procedure. Besides the gastro would not do it, going by what he says currently. I have this liquid sloshing in my stomach throughout the day and of course the feeling that I need to go immediately on getting up in the morning. Do you think that the maroon/crimson blood can be from the fissure? This is a souirce of anxiety.

Anxiety is an issue; however since I have to be very regular in my work it again creates anxiety. If bowels can be a little controlled (consistency, timing) and the gas is eased then it would be so better. In any case so grateful to you and the group for this help.


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## Kathleen M. (Nov 16, 1999)

Have you tried anything to firm up the stool/slow down the gut?

Imodium 2X a day, 300-600 mgs of Calcium Carbonate with each meal? Peppermint Tea?

There are a lot to control IBS bowels, you do not need to figure out how to coerce some worse diagnosis so you will be given powerful medications that are much more likely to interfer with your schooling (Corticosteroids can be heck) than this level of discomfort is.

Sounds like overall the general health is good and that points to IBS, so doing some of the things that you might do even if you had something else as Imodium is the go to for every single cause of diarrhea that is caused by medications or other medications for other disorders do not control seem reasonable. You don't need a colonoscopy to take Imodium.

I'm still not sure what you saw was blood, but fissures generally produce fresher blood than other things so will be more noticably red in color than brown blood from a bleed high in the GI tract.


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## smt (Nov 10, 2012)

Kathleen,

Once again thanks. I had used metronidazole to bring the stool to some sort of shape; now it is hard, but God knows when it will suddenly change. Is lopox (loperamide) daily harmful or Imodium? But the more pressing problem is that about 2 weeks back I had sudden chills and sweats. Last week when my father was here that got cured. Now again I have suddenly started getting chills and sweats; it feels like mild fever; my lips dry up etc. The doctor here has ruled out anything serious; when I told my physician in Calcitta and informed him of my 11.6 HB (scale 12-15; does this make difference? other scales are 13-17) he said that it is caused by physical (which is considerable on a weak body) and mental stress. Is this possible? Till yesterday I had strong appetite and after many days relished a meal of I am sorry to say, fried rice and chicken ( I had meat or fish after 2 months; hope nothing happens with the fried rice, that was the only available). Tomorrow I am going to check my wt agiin; till 8 days back it was normal. Very stressed about fever. Term is till March 2; desperately hope to hang on till then. The fever is what is causing anxiety; does this point to TB? My mother had it 10 yrs back in the intestine and I was misdiagnosed with it 2 yrs back.


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## Kathleen M. (Nov 16, 1999)

Loperamide is the generic for Imodium in India as well? It should be OK for regular use if you need it and can find a dose that doesn't back you up too much.

It is pretty common to get short term viruses (like a cold but sometimes not even that severe) so I wouldn't go to something serious like TB immediately, and stress can even make you feel a bit hot or cold or clammy.

Yep a lot can make you run just a bit low on hemoglobin from stress or not getting enough iron or vitamin B12 in your diet. Usually go with the range from the lab that did the test as labs can do the same test different ways which can alter the results so you want the lab who did the test to give you the range, not look for one that will make you think something even worse is going on. If you eat mostly vegetarian some people do eventually get low on those things, especially if they aren't always eating all that well to start with and have issues with low appetite. Can you tolerate a stanard multi vitamin? (some people find them hard on their GI tract so can't). It may be worth trying that for a few month and see if that helps as well as work on stress and anxiety reduction.

Did they have to do a TB test before you started school? That is common over here, but not sure about where you are.


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## smt (Nov 10, 2012)

My TB test (PCR: negative) was 2 yrs back; but ESR was 04 about 1 yr back. About 3 months back one very senior MD examined me clinically and said that everything is OK with regard to illnesses. However I was misdiagnosed with TB 2 yrs back when Elisa test for TB came mildly positive. This I was told is non specific so PCR was done. I have more or less maintained wt. till I last saw abt 8 days back and have appetite. I do not know whether I can tolerate a multivitamin; I will ask from the dispensary where they give it free of cost. Can TB test wait for about a month or so till March 03? Or should I do an ESR right now? Extremely worried.


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## Kathleen M. (Nov 16, 1999)

Would getting a slew of tests done even do anything to ease your anxiety?

Usually a day or two of fever every so often is nothing to worry about, especially if it just went away quickly on it's own and it sounds like you weren't even all that sick.


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## smt (Nov 10, 2012)

After a lot of requests to my physician in Calcutta, he has at last prescribed me IBSET (lotronex as jmc09 said), and NOrmaxin (chlordiazepoxide + clidinium bromide) and ambizyme. He says that stool will be hard after this. Since they are not available here my father has sent them; on the way. he is not prescribing loperamide/immodium although I can get them without script. Please tell whether these 3 have sideeffects difficult to sustain in school and whether they are meant for firming up stool. Also, I have urgency, difficulty in morning; once or twice semisolid/semiliquid stool. Also bloating, churning etc. and colonic sounds and perceptible movements such as something is being transported in the intestine after eating, all this if I maintain diet, sleep etc. A feeling that stool may eject anytime with gas. Can this be classified as "mild ibs"? The gastro says so.

Hoping against hope that the medication works. Thanks for helping me out in difficulties.


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## Kathleen M. (Nov 16, 1999)

Do not take Imodium with the Lotronex as Lotronex can be overly constipating and if it does constipated you too much you need to stop. Usually it is more for people who have diarrhea many times a day, not just a couple of times in the morning and if it constipates you a lot it may make you more likely for severe side effects. (usually it doesn't effect daily functioning, but it can cause a lack of blood flow to the colon and hospitalization while that heals up could interfere with school).

The antispasmodic combo pill could make you a bit drowsy depending on how it hits you, but usually people get used to that, but I might start it on a weekend to see how it goes.

Not sure about ambizyme, is that a digestive enzyme thing? Usually wouldn't expect anything that would stop you from going to school with that.

I might call it mild to moderate, as a lot of people are much more severe than what you are experiencing. A lot depends on how much of the problem is you worrying about the problem rather than the symptom by itself is disruptive to functioning. Sometimes the concern and worry can be a lot more debilitating than the symptoms triggering the worry. If it seems more of the problem is worrying about the problem then it may be really more on the mild end. Really a lot of people would love to get their IBS to the point where they just had 1-2 loose stools in the morning. For them that would be a victory, not something that is life ending.


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## smt (Nov 10, 2012)

Thanks for the encouraging response. I have been prescribed 1 per day (IBSET/lotronex): I will start with 1/2 maybe. Does the antispasmodic heve the effect of routinizing colon activity and making stool hard as well? Ambizyme is diiodohydroxyquinoline (says that taking for more than 14 days in high doses may affect optic nerves). Alternatively will only take loperamide (lopox) for the remaining 3 weeks in the term which I have bought OTC.

As regards calcium pills, what is the dosage and ca should be in what form? and is it a fact that Mg should not be there?


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## Kathleen M. (Nov 16, 1999)

It tends to reduce any cramping you have and they tend to slow things down a bit and can makes stools harder.

Usually with Calcium Carbonate people take 300-600 mgs 3X a day with meals. That is in the recommended dose range but more than that gets above the recommended maximum. You want one without added Magnesium or with very low levels of magnesium (like less than 60 mgs)


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## jmc09 (Oct 5, 2009)

Let us know how you do with the ibset(its actually Ramosetron rather than Lotronex but it works in the same way.) 
Surprised that Chlordiapoxide is also being prescribed as that is prescribed on its own for many people.
Your stools should be solid with these drugs.


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## smt (Nov 10, 2012)

Already started with Normaxin (antidepressant) yesterday night: was a little sleepy then; now habituated but feel a sense of calm after taking it. Today I had no school after lunch so it was possible to take; do not know what would I do on weekdays. Today would take the IBSET (Ramosetron) just now. It is now night here; vey tensed about side effect. How long do I need to take to get benefits? The anxiety is largely because of the 100% attendance rule at school; but I have been very regular. I have missed just 1 class in the 2 1/2 months with prior permission. In the exams I have done well; you will be glad to know that in Financial management in a class of 120 ( most younger and much fitter candidates) I am among the top 10. I have done well in most other areas as well. I have given my everything and will continue to do so. It is just that many people, though basically decent, mock at our condition and think that we are some sort of strange creatures. I wish they realise. Regards and thanks to Kathleen, JMC09 and others.


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## jmc09 (Oct 5, 2009)

Ramosetron doesn have the side effects of lotronex, only a bit of constipation, hopefully.

I'd imagine its best to take it in the morning instead of night myself.


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## smt (Nov 10, 2012)

I have taken 5 doses of Normaxin (chlordiazepoxide + clidinium bromide + *anticholinergic dicyclomine: this I failed to mention in the previous post*) and 2 doses of ramosetron. Havenot gone to the toilet for more than 2 days although morning urge is still there. Should I stop Ramosetron for now? Request Kathleen and jmc09 to advice. also it seems Normaxin has reduced spasms and taken out the churning to a large extent. Appetite is great. but feeling a bit gassy. Attending classes after Normaxin is very challenging. Is this dicyclomine something to be concerned about? Kindly advice.


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## jmc09 (Oct 5, 2009)

I would try the Ramosetron alone for a while as its designed to work on slowing down your digestion and should work by itself.

Then try one of the others by itself and then the other one by itself if needed.

My guess is that by taking too many different drugs together you are over constipating yourself.

PS The dicyclomine is an anti spasmodic I assume and these have been of no use to me so lay off that for a bit too and see if it helps.


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## smt (Nov 10, 2012)

I have taken 6 doses of ramosetron and 12 doses of Normaxin (antispasmodic) and my stools are fairly solid: a little constipated. Normaxin helps with churning and spasms. However, the end portion of stool is always semiliquid (small portion). This is causing me to feel bad. 7 days are left in the term. 4 are exam days. Please, Kathleen: can anything be done to get rid of that last semiliquid portion? and that urge to go again after stool is ejected? Otherwise, I do not have fever now. yesterday night I had an urge to vomit; hence I could not take bfast today: as a result i skipped Ramosetron. Can this be dangerous? Should I take it every day without exceptions? In that case can i take it in the night today? Please advice.


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## Kathleen M. (Nov 16, 1999)

Why is that last little bit making you feel so bad (bad physically or bad emotionally)?

Really a small amount of loose stool is not dangerous and isn't something to be anxious about. Although anxiety often isn't rational and will always find something to be totally freaked about.

The incomplete is harder to deal with, but the medications you are on may help over time. Also relaxing yourself after the BM if you tend to try to focus on the "uh-oh will it stop or come back" type of stressing out that could get it all going again (as you are then telling your body to restart the need to go signal rather than focused on just going on with your day). Also going 2X in the morning is not dangerous and doesn't have to be distressing.

Most of the dosing information is from Asia so I can't look at it, but I don't think it would be dangerous to miss a dose, or terrible to start taking it in the evening, but you could call the pharmacist you got it from or check the information that came with it (or did you not get any paperwork with it).


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## smt (Nov 10, 2012)

Thanks so much Kathleen; you and others have been a source of strength for me. To answer you: bad physically as I ffeel an urge to go immediately after; also mentally as I think that then the Ramosetron too cannot completely eliminate my IBS AND the fact that during lectures etc I may have an uncontrollable urge. The problem is my physician is based in Calcutta whreas I am 2000 km away. My contact is through telephone which he does not take after a certain time or my father has to talk to him. In any case he has asked me to continue using these drugs in the next few months. Now if I can complete this term (God willing 7 more days) and I venture into the next (3 months) then I can be in Calcutta for 2 months for a case study. Then I can go through any invasive procedure required. When I started school in beginning of December I never thought taht I could come even this far. Thanks for all the help you provided.


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## jmc09 (Oct 5, 2009)

The Ramosetron and the Chlordiapoxide CAN work on their own and I would worry less about the semi loose nature and more about the amount of times you go.

3 or less in a day is very,very normal.

I had relief from my IBS for about 12 years and I would usually have 1 massive BM in the morning and that would be it until the following day and I considered that normal enough for me.

I occasionally went twice but the second BM was much smaller.


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## smt (Nov 10, 2012)

Thanks JMC. Yesterday, I had a BM in the morning; a solid piece followed by mushy stool. Till now, toady nothing but gassy. End term exams going on; yesterday slept for about 4 hours in the night. On top of that getting very uncouth behavior from near and dear ones. I am doing well here; my grades will suggest that and I have proof of that. However feeling very very low; really contempLating whether will drop everything or not. But will do what? it sems suicide is the only option. If ramosetron cannot make stools solid eveyday, it seems it is my destiny not to control IBS. I really want you guys to believe taht I tried out everything possible but it is not working out. Thanks anyway, Kathleen and this group has provided me with very strong help. Best wishes. I am sure there are many who will gain help in their fight against this EVIL disease.


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## Kathleen M. (Nov 16, 1999)

So if your stools are not 100% totally solid and perfect every single day you would rather die?

The only two options are perfection or death?!?!!!









Sounds like you are getting some help from the medications or is it exactly the same with or without?

Please tell your doctors you are suicidal. I don't understand why you cannot live if your stools are not perfect every day. I am worried about you.


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## jmc09 (Oct 5, 2009)

If my life depended on having solid stools I would have left this mortal coil 23 years ago!

I dont consider the solidity to be the be all and end all,if you ar only going a couple of times a day then that is ine for anybody,even normal folk.

I get gassy,bloated and rumbling every day but its no big deal.


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## smt (Nov 10, 2012)

Thanks Kathleen and JMC. When I started Ramosetron 10 days back along with Normaxin it was giving benefits; I was moving towards solid stools. Now it is deteriorating. Today my whole stool was mushy and it colored the water yellow. I am thinking that a medicine of the calibre of ramosetron is failing to act: is there no way to even decrease the intensity of my IBS? I do not desire perfection but normal reasonably soft stool will do. Mushy stools everyday under medication-this is what bothers me. On top of that I try to control my diet as far as is possible. My physician as usual is not worried. I have worked out an arrangement with the school: this term is for 2 more days. After that if I can last 80 more days for another term then I can be in Calcutta for an assignment. Then I can go in for invasive procedures. I am going at the most twice true: but the qualty bothers me. And that lingering suspicion: blood. Please answer this 1 question I heard that ramosetron would make stools very hard-then why could it not perform in my case? Is my IBS particularly difficult? Please answer. Eternally grateful to you for taking my queries.


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## Kathleen M. (Nov 16, 1999)

Really your IBS doesn't sound that bad, a couple of mushy stools a day really isn't considered severe. I don't know why it is so problematic that you are suicidal. The suicidal part is much more worrisome to me, please say you will get help before you do something drastic and permanent for something that may not even be a problem for you in a couple of years (as IBS can sometimes just go in remission after awhile, especially when on the milder end like you have).

Also if you are this worried and concerned the anxiety alone could make the medication have a lot harder time working. And just because this didn't work doesn't mean nothing can ever work.

No medication works exactly the same way in everyone every time. If you need that level of perfection you will never see it with any treatment. It may have made stools very hard for SOME people, it never did that for all people in any study. There is always a range of results for everything. Very hard stools tend to be very hard to pass and can rip things on the way out. I don't think you really want that as much as you cannot tolerate mushiness, rock hard isn't better.


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## jmc09 (Oct 5, 2009)

smt said:


> Thanks Kathleen and JMC. When I started Ramosetron 10 days back along with Normaxin it was giving benefits; I was moving towards solid stools. Now it is deteriorating. Today my whole stool was mushy and it colored the water yellow. I am thinking that a medicine of the calibre of ramosetron is failing to act: is there no way to even decrease the intensity of my IBS? I do not desire perfection but normal reasonably soft stool will do. Mushy stools everyday under medication-this is what bothers me. On top of that I try to control my diet as far as is possible. My physician as usual is not worried. I have worked out an arrangement with the school: this term is for 2 more days. After that if I can last 80 more days for another term then I can be in Calcutta for an assignment. Then I can go in for invasive procedures. I am going at the most twice true: but the qualty bothers me. And that lingering suspicion: blood. Please answer this 1 question I heard that ramosetron would make stools very hard-then why could it not perform in my case? Is my IBS particularly difficult? Please answer. Eternally grateful to you for taking my queries.


The Normaxin is chlordiapoxide isnt it?

This and the IBSet are a potent mix but not everything works for everybody.

How long have you been taking these drugs for?


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## jmc09 (Oct 5, 2009)

jmc09 said:


> The Normaxin is chlordiapoxide isnt it?
> 
> This and the IBSet are a potent mix but not everything works for everybody.
> 
> How long have you been taking these drugs for?


Also,cant you take loperamide too?


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## smt (Nov 10, 2012)

Heartfelt thanks to Kathleen and JMC for your concerns. I have been taking Normaxin and Ramosetron for 12 days. Does it mean it will not work for me? Normaxin is chlordiapoxide and dicyclomine. Loperamide is something which I have kept for extreme emergency. In my pocket there are always 2 tablets and in my bag a water bottle wherever I go. Except when there is a presentation I go to class in sandals for this very reason (Indian toilets are difficult to use with shoes). Kathleen, I am giving you my word of honour that I would not act irrationally, although occasionally it becomes very agonizing. Today my term ended; from Monday another starts. This will be for another 3 months, after which I would stay in Calcutta for 2 months for writing a case on a local organization. I have been able to attend all classes except one that is 209 out of 210. I am among top 10-15% of a younger, much fitter class. I am not bragging; just saying that I am giving my 100%. I am longing to start writing my dissertation although I have to wait for another 6 months. The problem with mushy stools is that there is a feeling that it may come out anytime. Through the last 3.5 months you have patiently answered my endless queries and I do not have words to thank you. Today the school is having a party; Chinese food such as chilli chicken will be served. I want to eat chicken as generally I do not get to eat anything other than rice , pulses potato and curd. But should I eat this meat; it is actually an Indianised version of the Chinese food with lots of spices which is difficult to get rid off. And they will give mixed vegetables and i have asked authorities to keep a little plain rice for me. Hope to have a decent dinner after many days and sleep for 8 hours. As always, thanks.


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## smt (Nov 10, 2012)

To add to my post, for the last 2 days I have a small swelling on the inside of my bottom lip and 2 small nodules which hurt when I eat, especiallly hot items. A search on the web says that it is a characteristic feature of Crohns. But I have had mouth ulcers such as this even earlier which went away automatically. Any thoughts?


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## Kathleen M. (Nov 16, 1999)

Most of the time they are just the chancre sores that almost every single healthy person gets at some point in their life. Stop looking for the worst possible thing it could be. It really isn't healthy to try to find more things to worry about.

You are not having the other symptoms typical of Crohn's so I wouldn't worry. People with Crohn's usually aren't presenting as mild IBS, the symptoms tend to be like severe IBS, not mild IBS. If you cannot stop worrying and looking for the catastrophe in every single thing that happens you need to talk to a professional about that, you don't have to live with all that burden. Dr. Google is not your friend. Stop trying to find any sign of disaster, it isn't good for you.


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## smt (Nov 10, 2012)

Thank you Kathleen. The mouth sores went away. Into the new term till May end: since I am on fellowship, again I have to be pretty committed. After no stool for 72 hours, today morning I had completely mushy stool. i hate to present such details, but it seems medicines are not working. My father in my hometown would meet the physician on Thursday. Yesterday one of my professors empathetically heard about this and said that I've got to live with this and so must have a strategy of dealing with it. So if I have 2 BM of mushy nature per day, (a conservative scenario), what can be done? and in your vast experience did you see any individual on whom Ramosetron did not have any effect? What is your estimate of my case from my descriptions? Also, my physician in Calcutta has said that if I wish i should do the colonoscopy after 3 months. It is not immediately required.


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## Kathleen M. (Nov 16, 1999)

No drug is 100% so in my experience every single drug will have someone that it doesn't work for (most drugs are approved if they help from 40-80% of people as placebos usually help 20-35% of people so as long as it is better than placebo it is approved). EVERY DRUG. If you need your medications to br 100% totally effective for everyone than no one could ever take any drug as there is always someone who will not respond and no drug would ever be approved. Humans are too variable, some people have paradoxical reponses, some people just don't respond at all, FOR EVERY DRUG. So unless Ramosetron is somehow the only drug in all the world that can't possibly work the same way all of human pharmacology works then in my experience there will be plenty of people it doesn't work for. It just works for more people than a placebo does.

It is normal to have from 1-3 BMs a day so millions if not billions of people have to deal with having more than one BM a day. As long as it comes out, consistancy really isn't normally that major a problem. Mushy is much better than so hard and dry it takes half an hour or longer every BM to get out (which I think would be way more disruptive to your studies than having to wipe an extra time or two every BM). I know a lot of our constipated IBSers would really be happy for a mushy stool that would come out rather than they very hard stools you want that often take intervention (like a greased finger) to get out of the body.

2 mushy stools a day is mild IBS. 2 stools a day is in the range normal human biology. Most people can cope with 2 BM's a day just fine. Why is it impossible for you to deal with? Are you in a situation where there are no bathrooms available to you? How do you deal with having to urinate several times a day? Most people have to urinate way more than 2X a day.

No stools for 72 hours when you normally go 2X a day sounds like some medication is working even if it didn't fix the consistency enough for you. Usually drugs work more on frequency dirctly than consistency. They aren't designed to only make a stool hard and have no other effect on the body. Usually stool consistency effects are a byproduct of whatever esle they are doing.

Why is mushy so terrible? Like I said a lot of people would love mushy if it meant they actually got to have a BM at all.


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## jmc09 (Oct 5, 2009)

If i went 72 hours without a stool i would consider that a big success. 
Something is definitely working even if you dont recognise this.


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## jmc09 (Oct 5, 2009)

Is the IBSet available as a prescription or an over the counter drug in India?


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## smt (Nov 10, 2012)

IBSET is available as a prescription drug in India.


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## jmc09 (Oct 5, 2009)

smt said:


> IBSET is available as a prescription drug in India.


Thanks for the information and best wishes.


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## smt (Nov 10, 2012)

For the last 2 times I have had a BM after 4 days; however the stool is initially solid, not hard followed by mushy stools. I also am gassy and nauseous occasionally. Also, i have urges sometimes to go to the toilet. Normaxin has a relaxing effect. Do you suppose this is an improvement? What can be done to make the complete stool hard and reduce gas and nausea? Also i want to cut off the urge.


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## Kathleen M. (Nov 16, 1999)

When you don't go for 4 days your body may push less hard stool along to get the hard stool out.

Why is hard and only hard stool so important to you? It is not unhealthy to have a bit softer stool and usually on the softer side is better than too hard. Really hard stool means you are a bit constipated. Maybe you want to be constipated all the time, but it isn't always good for you.

If you want hard stool not going for 4 days will be more likely to do that than when you go 2X a day so I guess it could be an improvement. It indicates something is working, but if you want NO soft or mushy stool at all you have to get the hard stool to the end just a bit faster (so maybe every other day rather than every 4th day) so your body won't have to get it out using the softer stool.

Normal consistency usually isn't really hard, so you may be aiming for mildly constipated rather than normal and with IBS if you get too hard stool that takes too long to pass you will very likely always have to deal with your body getting it to move with some mushy stool behind it.


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## jmc09 (Oct 5, 2009)

Not going for 4 days is a fantastic improvement surely? I dont really understand what you want out of them.

I think you are more than normal and I'm extremely jealous of your success. I would give my right arm to not need to go for a few days.


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## smt (Nov 10, 2012)

Thanks Kathleen and also JMC. Although the initial part is solid, I have a feeling that something is 'not normal' and mushy will always come out with mucus at the end and the last part is really semiliquid not semisloid. Having said that i believe the antispasmodic has slowed down my system and reduced the churning. It has reduced my urge to an extent. I do not see the effects of ramosetron, may be it is the solidity at the beginning. Also, dicyclomine etc is making me very tired and I am sleeping like a log. JMC, I wish you success ( if mine can be called so) as well. After taking the dicyclomine, I feel kind of happy. The mornings are little difficult with some amount of urge and gas; evenings are better. more over there is always tension in the school. This affects well being. But I guess this is a small improvement. Greetings for the ensuing Indian festival of colors (Holi). With best wishes to all of you.


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## jmc09 (Oct 5, 2009)

Smt,your stress is making your symptoms seem much worse than they are.
I get gas every single day and stomach churning but as long as i only go a couple of times then i am more than happy.
I suggest you think in the same way.


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## rellybelly17 (Jun 10, 2011)

Have you tried the FODMAP diet? it worked great for me! also, eliminating processed foods and soda. Keep trying!


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## smt (Nov 10, 2012)

Kathleen, JMC thanks to all of you. Today my mid term exams of this term ended; only about 45 days remain now to go to my home town. For the last 25 days my stool has become hard mainly, with a little mucous at the end. However, the anticholinergic is making me very tired. I am now going once every 3 days. Will I continue with Ramosetron? The anticholinergic is making me sleep excessively. Currently, I feel the situation is better. Kathleen, please suggest whether as my physician says I would stop Ramosetron and take a probiotic known as Darolac (containing Lactobacillus and Acidophillus)? Again thanks to all who helped me on this forum. I would continue to need your help. Sincerely Yours.


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## Kathleen M. (Nov 16, 1999)

You don't know until you try. If the doctor thinks it is worth a try, it maybe. However if you are feeling good right now, I might wait until the end of the term and then make the medication switch.


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## smt (Nov 10, 2012)

Thanks Kathleen. During the last 3 days, due to a religious festival I got 3 successive days of leave. As a result I slept a lot - about 10 hours daily. As such I was constipated, but today it was horrible; after 5 days I went and took 1.5 hrs to get it out. Extremely hard. However towards the end soft. Is this the work of Ramosetron? I am now taking it every alternate day. Shall I drop it altogether? On top of that it is summer in India; and this is a desert state. My room has no A/C; I sit in the AC rooms alot; however I am always sweating. Probably I need more water intake. Besides that any more suggestions?. To be honest I was better in the last month or so than I ever was during the last 2.5 yrs. Anticholinergic has helped me. Also, I have a feeling after meals that something is near my throat; maybe some food. What is this? Also, I am not looking at the stool these days; so any abnormality cannot be detected. Please suggest what can be done to reduce the constipation.


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## Kathleen M. (Nov 16, 1999)

Unfortunately sometimes hard stools are also very hard to pass.

Drinking more water seems reasonable. I might back off the Ramosetron for a week or two and see how the other controls are doing. If the other medcations are enough, then just stick with those. If things get loose/diarrhea then you might add it back, start with 1 every other day, and if you don't go for 2 days don't take it until things start moving.

People can get some functional problems up top and that "something stuck sensation" can be one of those, as long at it seems you are swallowing as before I'd just leave it alone. If you seem to have real issues with swallowing, or this is really bothersome you might need to have the up top scoped. If you have a lot of heartburn sometimes that can cause swallowing issues that need some intervention.


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## smt (Nov 10, 2012)

Kathleen, thanks so much. I have stopped taking Ramosetron for the past 3 weeks. The constipation is gone and I am having stools, not so hard in 3-4 days. But the good health that I was enjoying has gone to an extent from last Sunday; that gurgling is back occasionally, and that 'feeling' of solidity is gone to an extent. For the last 10 days or so I have been going through an emotional turmoil over a relationship. Relationships in my country are emotional to start with; and of course there is no guarantee that it will go anywhere. In my case that probability is even less given my health, prospects, and other factors, which are interrelated. I am saying this because I want to ask whether as an IBS sufferer it would be proper to even think of any relationship, albeit only emotional? And is it possible that it is taking a toll on my health? The concerned individual knows about my health and seems to hate it. I would take your word as the last word on this. You are like an elder sister to me and if I live for 3 more/ 5 more years I want to contribute to human well being through knowledge generation in my area; as an IBS sufferer am I wavering from that commitment? If I have asked anything improper, I apologize in advance. If possible, do reply.


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## smt (Nov 10, 2012)

I would like to get an answer to this question. This time I reckon the anxiety is mainly psychological; and hence an answer would help me to alleviate to an extent, the suffering. Frustration due to the disease had led me to put a time period on my life: I did not literally mean it. An answer to this question would really help me. Whoever has any experience with this sort of thing can reply. I am copy pasting my message few days back. In general, is it advisable to maintain this sort of emotional relationship with IBS?

Kathleen, thanks so much. I have stopped taking Ramosetron for the past 3 weeks. The constipation is gone and I am having stools, not so hard in 3-4 days. But the good health that I was enjoying has gone to an extent from last Sunday; that gurgling is back occasionally, and that 'feeling' of solidity is gone to an extent. For the last 10 days or so I have been going through an emotional turmoil over a relationship. Relationships in my country are emotional to start with; and of course there is no guarantee that it will go anywhere. In my case that probability is even less given my health, prospects, and other factors, which are interrelated. I am saying this because I want to ask whether as an IBS sufferer it would be proper to even think of any relationship, albeit only emotional? And is it possible that it is taking a toll on my health? The concerned individual knows about my health and seems to hate it. I would take your word as the last word on this. You are like an elder sister to me and if I live for 3 more/ 5 more years I want to contribute to human well being through knowledge generation in my area; as an IBS sufferer am I wavering from that commitment? If I have asked anything improper, I apologize in advance. If possible, do reply.


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