(Sorry. Long.) POOP! And IBS and SIBO and chicken/egg...

Spiky Bugger

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So DS poop is often different. It is also often more frequent...in my case, it used to mean maybe 2 BMs first thing in the morning and even another after breakfast. Let me add right here that MANY GI docs consider 3 or more BMs per day, regardless of things like consistency, urgency and such, to be "diarrhea," and in need of treatment. (I think these guys are related to the RDs who don't understand malabsorption.) For me, this was my new normal and not in need of treatment.

Over the past almost dozen years post-op, there have been episodes of diarrhea. Some...most, to be honest...were immediately related to eating "the wrong stuff," which could also be "too much of the right stuff." (I learned about that from @Sandy , who explained that she--or I--could probably enjoy real sourdough toast with breakfast today...if I didn't have any yesterday and would not be having any tomorrow. I'm 70-yrs-old and still have trouble with the idea of "moderation.") Those episodes, certainly less than once a year, responded to flagyl...and paying attention.

Until last December.

My PCP prescribed flagyl, 250mg, tid, x 10 days. Tiny, temporary improvement. My bariatric surgeon prescribed flagyl...500 mg, tid, x 30 days. A little more improvement, but temporary again. He sent me to a GI doctor. I had stool testing...no parasites, no ova, no c diff (which I had before and which scares me.) So I had SIBO (Small Intestine Bacterial Overgrowth) breath testing.

That came back positive.

The SIBO "experts" all disagree with each other. And to further complicate matters, our altered anatomies add to the possible reasons this is happening. High risk for SIBO (essentially--gas, bloating/distention, diarrhea to the point that I have not had an uninterrupted night's sleep in almost five months, live in Depends "just in case" and don't leave the house except for doctors' appointments) includes any surgery that rearranges guts, plus old age, plus PPIs, plus opioids, so I get to be a Poster Child and some of you may, too.

Anyway, "my" GI doctor decided that my best bet is with Xifaxin. (Thse pills sell for $35.95...each...three times a day...for two weeks...so $1500+. I thought I'd have to pay about $800 out of pocket, but it was "only" $95, so, lucky me.)

And, drum roll please, it seems to be working...dramatically, in only 24 hours.

And if it does work, I probably won't be "cured" the way someone else might be. I have read that digestion slows as we age and I'm old. Opioids slow digestion, and I usually start each day with a Norco. (There may be additional, depending on how my bladder and arthritis are acting.) Proton Pump Inhibitors reduce the acid which also slows digestion. (I'm not sure why Zantac, an H2 blocker, would be any better for this situation...it isn't as helpful for the reflux/GERD, but I changed. I will check with GI doctor.)

The "type" of SIBO I have is primarily the the Hydrogen-producing kind. Given how much gas I have, I'm glad it's not the methane type because this place would smell like a Wisconsin Dairy Farm.

Anyway...a caveat...if your diet is NOT out of control, and if you are having diarrhea, and if your gas and distention are disabling--in my case, my waist measures 5" greater at night than it does in the morning; clothes that were loose in the morning are very tight by evening; bloating is so bad, it's hard to bend down to pick up something I've dropped...it might be time to start reading about SIBO.

BEWARE! The diets you find will be Low FODMAP/SIBO/"Specific Carbohydrate Diet" stuff. You will go nuts trying to figure it all out. But try. And figure out enough to know what you can eat for dinner tonight and breakfast tomorrow.

I hope you like steak and chicken and fish...and I hope you are NOT Sicilian and Mexican, because no garlic...no onion.
 
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That's great to hear about the Xifaxin. I thought flagyl was the only magic bullet for that, so relieved you found an alternative. I'm also hopeful that when you get things calmed down, you can maybe add back in some more interesting foods. I don't think I'd make it without onions/garlic. We went to a noodle house tonight that puts so much garlic in some of their dishes, that they actually offer you a tiny dixie cup of mouthwash when you go to the restroom. Almost 6 hours later and one brushing, and I still have a hint of garlickyness.
 
Thanks for starting me thinking about this in a new way. Call me confused, but if a low acid stomach and PPIs encourage development of bad bacteria downstream, wouldn't a diet high in acids have benefits? I know chilis aren't on the SIBO diet, but as just a common DS patient without SIBO, I do better on a spicy diet than a bland one. We have a low acid producing situation, just from the gastrectomy part of DS, no? A week in New Mexico with an improvement in my symptoms with daily spicy foods started me adding chili to my diet. That's not the chili that Americans think about with beans and meat, but the hot spice, like using Sriracha, hot green chili (like Hatch), and red chili flakes. I add these to things I cook, like soup and stews, even Italian red pasta sauce, and we eat hot Indian and Thai curry sauces. Not fake Mexican food, like Taco Bell, but the real spicy Mexican sauces and salsas I make with fresh chili peppers. I haven't needed fluconazole since I started this, and it seems to help with intestinal gas. Far from irritating the intestinal lining or causing reflux, it seems to calm it. I eat yogurt and sauerkraut and other probiotic foods, but haven't seen as dramatic an effect as eating spicy chili. Am I alone in this or are we all different in what works for us? I am sorry you have dealt with such a tough disease, and glad the rifaximin has worked. After reading about the SIBO diet, it is confusing how dramatic the differences are in recommendations. I guess trial and error is the only thing that leads to an individual solution.
 
That is good news Sue. I am glad the XIFAXIN is working for you and hope it gets even better for you.

I have done numerous rounds of Flagyl for SIBO and like you had minimal improvement. Your post makes me think that I need to get the breath test for SIBO for a definitive diagnosis. I don't like taking antibiotics when I don't actually have an infection. I think that I may have had SIBO several times, but I am not sure that is the problem now. I think it is my plumbing twisting again and being partially blocked at times. This is why I believe I go from constipation like symptoms (go those day but it hard to go, I am bloated and distended most of the day, and when I do go it is often small amounts of formed stool but very hard to get out) to diarrhea where I have clean out days. The SIBO breath test is something I need to do to rule that in or out and then take the appropriate treatment path.


BTW, a Mayo Dr prescribed Xifaxin for Cameron several years ago because he was diagnosed with SIBO after his Dr scoped him and sent biopsies for pathology . Our insurance company would not approve it and we lost the appeal. If I do have SIBO again I am hoping the numerous Flagyl failures are documentation and justification for me to get XIFAXIN if I am SIBO positive again.
 
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Thanks for starting me thinking about this in a new way. Call me confused, but if a low acid stomach and PPIs encourage development of bad bacteria downstream, wouldn't a diet high in acids have benefits? I know chilis aren't on the SIBO diet, but as just a common DS patient without SIBO, I do better on a spicy diet than a bland one. We have a low acid producing situation, just from the gastrectomy part of DS, no? A week in New Mexico with an improvement in my symptoms with daily spicy foods started me adding chili to my diet. That's not the chili that Americans think about with beans and meat, but the hot spice, like using Sriracha, hot green chili (like Hatch), and red chili flakes. I add these to things I cook, like soup and stews, even Italian red pasta sauce, and we eat hot Indian and Thai curry sauces. Not fake Mexican food, like Taco Bell, but the real spicy Mexican sauces and salsas I make with fresh chili peppers. I haven't needed fluconazole since I started this, and it seems to help with intestinal gas. Far from irritating the intestinal lining or causing reflux, it seems to calm it. I eat yogurt and sauerkraut and other probiotic foods, but haven't seen as dramatic an effect as eating spicy chili. Am I alone in this or are we all different in what works for us? I am sorry you have dealt with such a tough disease, and glad the rifaximin has worked. After reading about the SIBO diet, it is confusing how dramatic the differences are in recommendations. I guess trial and error is the only thing that leads to an individual solution.
I am a spice girl(I wish). Love spicy food. Have you ever tried Walkerswood? Yum!!!
 

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