Is this IBS? Metamucil?

As you folks know, my husband's c-diff infection came back the first week of september. We caught the infection before he even had any real symptoms - he basically had a sharp abdominal pain, and he started the vancomycin before he even had any diarrhea. The diarrhea started only after he started a course of vancomycin. After 7 days on vancomycin, he started forming stool again, and stopped the antibotics after a 2 week course on Sep 17th. So, we thought, great, this time, c-diff didn't do any damage really because he got the antibiotics before really he had any symptoms. And through the 2 week course of antibiotics, he slept through the night, had no urgency, etc. Basically very very mild symptoms.

Day 6 after stopping the antibiotics, I gave him something to eat that may have caused IBS,and for the next 5 days after that, his stools went back to being loose, and he sometimes had to wake up at night to go, and couldn't pass gas easily (was afraid of sharts). Then, things got better again, got to mostly formed stool (not solid, but not diarrhea either). Again 5 days after that, he was back to diarrhea and having to wake up at night to go. Then, over the next few days, things improved, and again, he got to mostly formed stool. This continued for almost 2 weeks, and again now, he's back to diarrhea and some abdominal discomfort for gas and a slightly bloated feeling.

And I'm going, what the heck? I've kept his diet very very stable, not changed anything, and definitely not added anything. It seems it happens when he gets a little wound up emotionally . . . but really, only in the very slightest sense . . . day before yesterday, he was having difficulty dealing with the insurance company over something, that's it. And starting that evening, things went south. Does this sound like IBS?

Before when he had the crohn's flare up, he had cramping, urgency, blood, etc, and it definitely didn't teeter totter like this (he went straight downhill) . . . so I am wondering is this really IBS? Or is his crohn's acting up mildly, and remicade and Lialda are keeping things in check somewhat? I'm confused.

We have a doctor's appt on Nov 4th. The last time we consulted his doc, he thought even though the c-diff seemed mild, it could be that he has post infectious IBS, and told us to call him if symptoms persist 3 days or more. Well, what we've found is that around day 3, things start getting better, and continues for a little while, and then, we're back here again. It's very frustrating. He's taking VSL, SCD yogurt, florastor . . . and is basically eating plain rice, plain baked chicken, and green beans for every single meal.

So, basically these are my questions:
1.) Have other people experienced this see-saw symptoms? Is it possible to tell if this is Crohn's or IBS without a colonoscopy? I intend to ask the doc about the SIBO breath text next time we see him. Is there anything else that can be done to determine if this is IBS or Crohn's without a colonoscopy? When it flares up, he has diarrhea anywhere from 2-7 times a day. If this continues, I also intend to get another c-diff test (but I don't think this is c-diff).

2.) Metamucil or other fiber supplements - he's on a low residue diet now really. Will slowly adding a fiber supplement like metamucil help? I don't want to cause him any pain . . . I know that metamucil can cause gas . . . what's the safest way to start him on metamucil? If this is a crohn's flare up, will metamucil make it worse?

3.) If we can't tell if this is Crohn's or IBS, what should we do to make his life a little better? Should we ask about a steroid taper?

Your opinions and insight will definitely help. pb4, I know you take something very similar to metamucil - can you give me some advice on how to slowly start him on it? How much every day, when it step it up to more etc?

Thanks for your help!
PV

PV,

I'd like to sound optimistic and say that you'll be able to get a straight answer on the IBS vs. Crohn's riddle, but in my experience - there's not really any definitive way to tell the difference when it comes right down to it. I have both, as well as the emotional/stress triggers, and it's next to impossible to tell.

With how cyclical your hubby's symptoms are, I might be inclined to think it's still a bacterial issue. Gut bacteria go through ups and downs when they're trying to get re-established... and with that whoop-booty round of vancomyacin there's no telling if any of the good bacteria are left. I noticed VSL is one of the things your hubby takes - that's supposed to be a really good probiotic I think. Is he taking those daily as directed? Make sure he's not skimping on the probiotics. Like PB4 said - they can really help. If symptoms don't improve, you might consider a different probiotic. I personally didn't along well with VSL3 and do better with over the counter capsules. In defense of VSL, though, it caused one night of nuclear green diarrhea and I've been too chicken to try it ever since.

Fiber supplements are a tricky business, and often a touchy subject with us crohnies. My surgeon told me to take Metamucil for YEARS. Every so often I would try - and the pain was just insane. I could NOT tolerate the psyllium to save my life. I recently found a different fiber supplement made of organic acacia fiber (Heather's Tummy Fiber for IBS), and it's working wonderfully. There's definitely more gas and bloating at first, but it's worth starting once your hubby gets to a point where he's a little more stable in his symptoms maybe. I too would be hesitant to introduce fiber right now if he's still bouncing up and down.

At the doc appointment on the 4th, they can run a blood test to check for markers of inflamation that might indicate that it's crohn's. Then again, if your hubby is like me, his statistics might be perfect even though he's miserable. You might consider running another stool test to check for other bacterial issues... either way - I would definitely stress the cyclical/rebounding nature of the symptoms to his doc. I hope you guys get some answers soon! Sorry I couldn't help more.

Thanks folks for your input. My husband is definitely not skimping on the probiotics. He has 2-3 cups of SCD yogurt, plus 2 packets of VSL, plus florastor (yeast to prevent c-diff) every day. Is this total overkill? Could this be contributing to his problems? He's been taking this since the first week of September . . . should I have him back off his probiotics a bit? I've read about die-off, but surely given that he's been taking these now for almost 2 months, that shouldn't be a problem anymore, right? Should we cut down the probiotics and see if he improves?

My husband doesn't want to do metamucil. Instead he says he'd like to do some dietary modifications, and maybe add some oatmeal. That scares me more than the metamucil, because it has insoluble fibre too, and if there is inflammation it can cause problems. I guess it's his body, I should let him try what he wants to.

Another thing he wants to try is bee propolis - if there is bacterial issues, given that it is a natural antibiotic, maybe it'll help kill some of the bad bugs. I bought some online yesterday - the "YS Royal Jelly/Honey Bee - Propolis Ultra Mega Strength, 1000 mg" (500 mgs per capsule) variety. He's going to put some under his tongue today to make sure he's not allergic, and then start to take maybe 1 cap a day for a while, and then bump it up to 2.

I'm not sure what else to do to help my husband get off this bumpy road and onto a smoother one. I am willing to try the SCD, but my husband is resistant, because he thinks it'll be very hard to follow 100%.

Again, your input is appreciated.

PV

PV, I'm really glad he's taking probiotics (VSL is the top one to date that I know of) I didn't see it listed in your sig so I didn't think he was taking any...

He can definitely try getting in fibre via diet but speaking from my own experiance, although foods never really had a noticable impact for me I did notice that once I started taking the supplements (at the time I wasn't eating fibre everyday as I hadn't altered my diet at that time either) I found that once my system adjusted to the fibre supplements that eating fibreous foods did not cause me any bloating/gas which I think they did before taking fibre supplements, of course it could also have been that I wasn't eating fibre everyday before and the funny thing with fibre is in order for your body to adjust and stay adjusted you need to be sure to eat it everyday.

I've had noticable improvements with bee propolis that I take (online from puritans pride) by the next day it halted my bleeding and stopped my severe lower back pain and cut back on daily BM's...when I first started with BP I used liquid form cuz I was quite severe at the time and for better absorption went that route before switching to 500mg caps. My GI encourged me to continue with them cuz he said "whatever works stick with it and it's 100% non toxic anyways".
Of course that said, what works for some doesn't work for all and for some it takes longer since we're all different, but I hope he finds relief, this disease is so frustrating and controlling.

:)