SIBO!

I have been a very good student of my own health lately. Be prepared for a lot of heavily-researched medical terminology. I had a breath lactulose test on Wednesday to check for Small Intestinal Bacterial Overgrowth, and tested... *drumroll*... positive!

SIBO, as it's otherwise called, is defined as "a bacterial population in the small intestine exceeding 105–106 organisms/mL." For reference, a healthy person's small intestine contains around less than 103 organisms/mL, and most of these are the good bacteria. That's 1000, in non-mathematical terms, little bacterias swimming around in one milliliter of your average person's small intestine, and over 100,000 to 1 million per milliliter for someone who has tested positive for SIBO. (Ducowicz)

Surprisingly enough to remember, Dr. Amy Myers, who wrote The Autoimmune Solution I followed last year, also discusses SIBO in her book, as "disturbances in gut immune function... increases the likelihood of developing SIBO." Something interesting that she notes is that certain types of probiotics taken can actually exacerbate certain SIBO symptoms. I've been taking probiotics religiously for years, believing it would help my lactose intolerance... so this makes sense. I haven't taken any since before my EGD, and thinking back, I would accurately say that my symptoms (abdominally at least) have been slightly less agitated lately. I even ate cheese ravioli at Olive Garden the other day with no following pain! I have also been taking hyoscamine, an intestinal muscle relaxer, before meals I know might cause "stomach anger" (like the cheese ravioli) at the request of my GI doctor, and that seems to be helping as well.

Referring back to the gastritis findings from that EGD, the same source mentions that "bacterial overgrowth may induce an inflammatory response in the intestinal mucosa, further exacerbating the typical symptoms of SIBO." (Ducowicz)  Although the chronic inflammation was found in the gastric region (stomach) and not the intestines, this is one possible explanation for it. I was seen in the ER for an E. coli infection obtained from our cruise last month, where they also found some possible mesenteric adenitis--a fancy term for more inflammation, but this time in the mesentary, the tissue that attaches your GI tract to your abdominal wall. This wasn't very surprising, but it made me think that maybe all this inflammation is just happening everywhere, and wasn't the cause of my overall GI issues after all. The gastritis might have happened because of SIBO, or even vice-versa, as "small intestine dysmotility" (food either passes too slow or too fast or both) can create a great little atmosphere for all of the bad bacteria to grow out of control.

My GI doctor, when first discussing the SIBO test, mentioned that treatment for it is a lot like getting rid of overgrown weeds on your lawn. The best way to make sure it doesn't come back, or at least prolong their regrowth for as long as possible, is to rip out the whole layer of weeds and the grass, replant the grass, and feed it daily with a combination weed killer and grass food. He explained that for SIBO, you follow a similar pattern of treatment: kill all of the bacteria in the intestines (good and bad) with a strong antibiotic treatment, take specific probiotics to encourage the regrowth of the good bacteria, and follow a specific diet to make sure we keep the bad bacteria at bay. This diet is the one Dr. Myers outlines in portions of The Autoimmune Solution. I've started my course of antibiotics and should be moving along with new probiotics soon. 

Overall, what I've gained from all of this is just a general understanding that IBS (what my GI doctor was previously using as a diagnosis of exclusion) and SIBO have very overlapping symptoms. There are many differing studies and scientific opinions on whether one causes the other, or whether they are opposing diagnoses in patients with identical symptoms, with the differential factor being the outcome of the breath test results. I'll want to follow the anti-inflammatory diet as I tried to before (of course, for longer than three days this time), but also follow the SIBO guidelines that are included. My doctor also mentioned having me start the FODMAP diet, which I believe is rather similar in nature. FODMAP, or the Low F.O.D.M.A.P. Diet, simply implies the elimination of foods in the following groups: Fermentable (foods that are fermented in the colon), Oligosaccharides ("few sugar" makeup), Disaccharides ("two sugar molecule" makeup), Monosaccharides ("single sugar" molecules), And Polyols (sugar alcohols). Dr. Myers' book simply has a much more step-by-step (less scientific!) and holistic approach to the diet, but I believe it has the same general structure: get rid of carbs and sugars--the little breeding grounds for bacteria. However, something I will be keeping a very close eye on, and will discuss with my rheumatologist, is that SIBO and Scleroderma actually have a researched connection. My positive Scl-70 factor has been on and off over the last few years, but according to my latest research, it may be the cause of my intestinal issues as I originally suspected.

"Scleroderma (systemic sclerosis) is a chronic connective tissue disease that affects the gastrointestinal tract in more than 80% of patients. Severe small bowel involvement by scleroderma can present as SIBO. The reported prevalence of SIBO in scleroderma was 43% to 56%." (Bures)

My non-GI autoimmune symptoms have been worsening gradually since I last saw my rheumatologist as well; I think I'm finally starting to develop Raynaud's syndrome. It started in a single toe, around April-May, and has now spread to all my toes and occasionally the fingers on my left hand. I've been seeing a lot more spider-veins in my legs as well, and the hand pain is only worsening. Thankfully, my PCP gave me a topical anti-inflammatory that I've been using on my hands and wrists that works better than any cooling cream I've previously tried.

In all, I'm ready to start being serious about the connections between all of my symptoms. I originally thought that my autoimmune symptoms and GI symptoms must have a connection, and now I'm slowly starting to receive results confirming that suspicion.

I really appreciate all the encouragement I've received from friends and coworkers about my health condition. Hopefully all these new discoveries will lead to some positive results!


Sources


Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., … Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology: WJG, 16(24), 2978–2990. doi.org/10.3748/wjg.v16.i24.2978

Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology, 3(2), 112–122.

www.amymyersmd.com/2018/04/10-signs-small-intestinal-bacterial-overgrowth-sibo/

Gastritis

For those of you who have been following my health journey, you may understand the reasoning behind my excitement when I say that finally, maybe, I have something going on with me. I met with the GI clinic’s PA about 2 weeks ago, a fantastic gentleman who was really helpful, considerate, and understanding. A week ago, at his suggestion, I had an EGD (the prep was so much better from this end), and I called today to see if the results were back. I couldn’t hear the receptionist too well when she gave me the results besides the word “negative”, but she said that the PA wanted me to schedule a follow-up appointment and some additional blood work, so I did.

Fast forward to 15 minutes later, when I checked the mail and—lo and behold—a letter from the clinic with my scoping and biopsy results. I actually read the first sentence of the letter wrong, and thought that once again, everything was negative—force of habit. After reading halfway through, however, I learned that they discovered chronic gastritis in my stomach mucosa (stomach lining).
It took me reading the sentence over a few times before I finally understood that it was not a negative result again. The biopsies showed that I am negative for H. pylori, so thankfully there’s no bacteria swimming around in there. There’s nothing going on in the section of the small intestine that they scoped either, so it’s all just in the gastric region. The letter outlines a couple of more tests that they need to do at my follow-up appointment as well, just to rule out bacterial stuff. It also mentioned that, although it was a long shot, I did not show positive signs of celiac either, so that’s good.

I did a little bit of research, but have decided that I will just wait to talk with Spencer, the PA, about treatment courses and such (probably a smart idea, since I sometimes end up researching a bit too deep and needlessly stress myself out). He mentioned at our appointment that we would likely end up building a new diet for me, to help with symptom control and now, I guess, inflammation as well. Even if this ends up being just part of the overall problem, I’m glad we finally have something to work with.

Stay tuned for more to come.

Bowel prep is the worst thing that has ever existed.

After a recent Emergency Room visit (at the ER I work in, no less) I ended up having my GI tract scoped again. This was preceded by the most horrific bowel prep imaginable. Last time around, it was not so bad—the previous clinic had me just use MiraLax . But this time, the prep consisted of a nasty, bitter, gag-inducing clear liquid that I was instructed to mix with water. If any of you have ever had a colonoscopy or EGD, you may understand. If not... consider yourself lucky. My innocent self did not have the good sense to try mixing the stuff with a flavored drink the first time around, and boy was that just a wretched experience.

As weird as it may sound, I was hoping and praying that maybe something might’ve been found. Immediately after the procedure, the doctor told me that they found random losses of vascularity throughout my bowel (in simple terms, the veins disappeared) and slight nodularies (or bumps) along with some varying redness. They took some biopsies and said they would call with the results.

I finally got ahold of the nurse today, who told me that my results were all negative. She mentioned something about hyperplasia, but she said that unless my condition worsens, I should be fine to continue my current course. Hyperplasia is defined as “the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells”, so naturally I am a bit anxious and still slightly confused, but all of the doctors I work with highly recommended the doctor who performed my procedure and received the results, so I will try not to worry too much.

So I suppose next on my list of self-health-care is to find a new primary care doctor up here in Ogden, since my previous one is now 60 minutes away. I see a new Rheumatologist at my hospital later this month, so hopefully that will all go smoothly as well. My hands and elbows have been stiff and hurting more than usual as of late, and I’m hoping it is just due to the current cold spell. 

Hopefully another update to come soon. Staying positive!

Please hold...

Well, I kind of feel like my health has been on hold for the last bit. I tried the Autoimmune Solution for 3 days, went and had an EGD and colonoscopy, and was told that there is not even a hint of inflammation in my GI tract. Even gave me pictures to prove it. So let’s just say I gave up on the “Anti-Inflammatory Diet”.
I’ve been continuing to see my new rheumatologist, and that’s been going okay. Just a lot of changing meds around. I did, however, start seeing a new pain doctor, after my rheumatologist told me that for now we’re just going to call this “fibromyalgia” pain for the purposes of diagnoses (we’re also calling my hand pain “arthritis”). The pain doctor took x-rays of my back and found out that I do have mild scoliosis, which may account for a bit of my back pain and recent SI joint locking.
So long story short, it’s been recommended that I see a chiropractor again (hopefully one that won’t make it worse this time) and another physical therapist. But of course, these are not covered very well by my new insurance (turns out you lose TriCare when you get married). So.... I guess I’m just on hold for now!