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IBS and Doctors

Published by tummyblogger July 23rd, 2007 in Gastrocolic Reflex, Medical, IBS, Irritable Bowel Syndrome, IBS therapy, IBS-C, IBS-D

“The doctors don’t know what’s wrong with me, so they say it’s IBS.”
“I’m fed up with the doctors who keep sending me for tests and don’t seem to find out what’s wrong. They don’t know anything more than when they started and they don’t understand that I’m in pain.”

And I read many more similar complaints on the forums.

Medicine starts with the principle “First do no harm.” Now that there are many tests for many ailments, that principle may mean that a doctor does not reach for a prescription pad until after many tests have been done.

Halfway through the testing you say “Do something!” So s/he tells you to start taking fiber, but not what fiber to take, or worse, says “Use Metamucil ™” of which there are many flavors and roughnesses, and citric acid, and artificial sweeteners like Aspartame ™, and perhaps other additives.

This kind of desperation is very familiar to me, since I’ve been going through a series of tests for something else in the past few months. Along the way we found out that I have reduced my cholesterol level from 276 to 167 (fantastic!), that my heart ultrasound and heart stress tests are both terrific, and my liver function by blood tests and ultrasound is normal. In the meantime, I’ve been desperate for the doctor to give me something that helps the primary complaint, of a peculiar kind of fatigue. And I insisted on getting a second opinion, only to find that he agreed with my doctor, on one level, and had a question on another. In the meantime, I continue without any what I would call medical help.

It’s the same situation with developing a diagnosis for IBS. The doctor is not going to prescribe before s/he has ruled out a number of problems.

In an ideal world, once that has taken place, there is one obvious medicine to prescribe that will take care of the problem. If the diagnosis is Irritable Bowel Syndrome, that is not the case. Here is what the ideal doctor will discuss with you when he or she has excluded all the other options and concludes that you have Irritable Bowel Syndrome (IBS).

A. Incidence of IBS symptoms in the general population and its relevance to the patient
B. Gastrointestinal physiology including gastrocolonic response, production of gas, gut sensitivity to certain stimuli, and possible
C. The potential impact of stress in triggering or exacerbating symptoms, with reassurance that symptoms are not psychosomatic
D. Any anxieties, including concerns about underlying disease and major symptoms
E. The need for the patient to accept responsibility for condition management
F. The recognition that no panacea exits, but that therapies can greatly improve quality of life and significantly reduce symptom severity

Well informed patients are more apt to make choices and changes in lifestyle and diet that can reduce the severity and the frequency of their symptoms. It is recommended that physicians discuss new information during patient visits, and build on previous information by disseminating any new educational materials that may have become available since the patient’s last visit.

The source of the above is a paper published on the Gastro-Enterology pages of the Johns Hopkins Institute. The paper describes a number of levels of consideration of the problems of diagnosing and treating Irritable Bowel Syndrome (IBS).

Realistically, your PCP is going to fall short on several counts in the just-quoted lists. I hope that s/he fulfills at least some of them. Where this blog can help is in the last two elements of the above list, which are:

“E. The need for the patient to accept responsibility for condition management [, and]
F. The recognition that no panacea exits, but that therapies can greatly improve quality of life and significantly reduce symptom severity [.]”

“Accepting responsibility for condition management” does not mean that the condition is your fault, or that if it is hard to manage, that you aren’t trying your best to manage your IBS. It does mean that you have a considerable role to play in achieving a greater degree of comfort in living with Irritable Bowel Syndrome (IBS).

Also note that item “F” uses the term “therapies” rather than “treatments.” Does that make a difference? Let me know what you think.