C Diff treatment - no improvement

Hi all, I'm writing in to get some support and perhaps hear from others who have been in my boat. In 2004 I was diagnosed with rheumatoid arthritis and have been successfully treated with Enbrel and methotrexate since then. I've been in remission largely the entire time. In June 2013 I was diagnosed with UC via sigmoidoscopy after seeking treatment for bloody stools and urgency. I was managed only somewhat successfully for a year (was on enemas and switched to suppositories, switched to Humira hoping that would help, etc.). I sought a second opinion. The new doctor ordered a colonoscopy, suspecting that the origin was infectious in nature - he was surprised that I had developed a second autoimmune disorder while on powerful immunosuppressants. Stool samples tested negative for C diff, but the colonoscopy revealed a pseudomembrane throughout the entire colon and my doctor is convinced this is the cause of the colitis.

I completed a 30 day course of vancomycin two weeks ago and the bleeding in the stool promptly returned, so I'm on another 30 day course. The problem is the morning diarrhea. During my year and half with colitis, I'd had some morning diarrhea, but nothing terrible, and then I'd usually feel pretty crappy in the afternoon after lunch (pain, tenesmus, etc.). Never crampy except during a flare, at which point the cramping was debilitating. Due to the colonoscopy prep, all of my symptoms quieted down entirely (because you're not eating much). I started the vanco immediately after the colonoscopy, and they said I'd see improvement within two weeks.

However, once I started eating again and my system kicked in, I've been experiencing severe morning diarrhea. It usually begins upon waking, and continues for one to two hours. I get bad cramps - not as bad as a full-on flare, but the kind you get when you have a really bad stomach bug. Often the cramps are so bad I salivate like I'm nauseous. Some mornings the diarrhea holds off until I eat or drink something, but then always kicks in. Eventually it just stops and then I'm usually okay for the rest of the day, but may have one more very short bout of cramps and diarrhea around mid-afternoon. I had hoped that it might be a symptom of the vanco itself, since these symptoms were so different than what I was experiencing with the colitis, but they did not go away in between courses.

At the advice of my doctor, I did a liquid diet for a day and am now on a bland diet (which is pretty much what I've been eating anyway for the past year). I've also recently started Florastor, hoping that would help (I don't notice a change). The diarrhea was significantly reduced the day after the liquid diet but has returned once I started eating real food again. The doctor remains convinced that this is C diff and that the diarrhea is a symptom of bacterial overgrowth and will go away any day now once the vanco starts working. I trust him that this is C diff but I don't know what to think about the diarrhea. I'm exhausted from having to reschedule my entire day to wait it out and just generally feeling so ill for several hours each day.

Anyone else had this morning diarrhea problem? Any advice?

Meds:
Colazal 3x/day
Humira
methotrexate (10mg)
Canasa suppository
Vancomycin 4x/day
Florastor 1000mg/day

If you have pseudomembranes, then that is very characteristic of c diff, so I would bet it is in fact a case of c diff. UC can be mixed in but it would be hard to tell until you are cleared of c diff. C diff is also a recurrent infection, so if the conditions are right, you can relapse with it for a while until it goes away. Fecal transplants are 90% effective for c diff infections, so I would definitely look into that or ask your doctor about it. Did your first doctor see pseudomembranes when he did the sigmoidoscopy? If not, you might have developed c diff after you were diagnosed with UC.

Do you think your immunosuppressive meds are making it hard for c diff to clear? I would ask your doctor about that as well.

I've had cdiff only once and was on vanco for 7 days in the hospital and it didn't help at all. Finally, my dr suggested fecal transplant and within 2 days the cdiff and diahrrea were gone! Even tho it sounds gross,the fecal transplant was performed both orally and rectally. I would ask your GI if I were you.