Feb 06, 2012 - 7:21 pm (MST)
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Asked by Anonymous123 (Female; 59; 78686; GERD, mild hiatel hernia, interstitial cystitus, fibromyalgia, sleep problems, reactive hypogylcemia,
thyroid nodules & goiter, vaginal bacterial infections & yeast (not candida), & a burning sensation on my
tongue with a reddish area for 3 months.; Relevant drugs:Elmiron for interstitial cystitis, trazadone 50 mg.
at bedtime for sleep, probiotics & digestive enzymes to help GI problems, have taken prilosec for about 3
months but have been weaning off that. (down to less than 1/2 of an OTC 20 mg. pill, so under 10 mg a day at
this point), D-3, Omega-3, multi vitamins, calcium/mag. ) on Thu 17, Jun 2010 02:55pm for $9.00:

I have been working with Dr. Kokil Mathur, so if possible would like to continue to do so. Otherwise, a gastroenterologist would be very helpful as well. About 6 months ago I had a bacterial overgrowth of enteroccus and klebsiella vaginally. I was prescribed oral vancomycin. Following that I developed a reddish area on my tongue that burned,& my gastrointestinal problems flared. I took Prilosec OTC, & it improved, but I know I can't stay on that long term. (I have had gastritis, GERD & a mild hiatel hernia for many years, & have used Prilosec off & on)It usually clears things up for long periods after one or 2 rounds of the prilosec, but this time I stayed on it for too long, & without taking the required breaks. I saw an ENT for my tongue & he said that he did not think it is cancer & didn't feel that a biopsy is really needed or that it is anything serious, & to just continue to watch it. My internal medical Dr. also didn't seem alarmed by it & said many people have this, but if it continues to be a problem he will refer me to an oral surgeon for further evaluation. He said that twice on visits. I also saw an integrative medical Dr. She said to begin by doing a Comprehensive Digestive Stool analysis. That showed that my lactobacillus is gone, NO GROWTH, as is the Escherichia coli. The Bifidobacterium was at a 3+ & should be a 4 or more. Then there was a high count of Citrobacter Youngae & Citrobacter braaki (listed as "possible" pathogens), & alpha haemolytic streptococcus & gamma haemolytic strep listed as "non" pathogens. She recommended tha I take "uva ursi" for the citrobacter, but I was unable to do so because it caused my IC to flare & made me ill. I also couldn't take plant tannins to help with the citrobacter due to my interstitial cystitis. She said that she rarely prescribes antibiotics for these imbalances,& that they would wipe out any remaining good bacteria along with the bad. She feels that if I take a potent "probiotic" it will hopefully crowd out the bad bacteria. She also feels that my tongue problem is likely a result of the imbalances in my GI flora & poor nutrient absorption & digestion. I have taken 50 billion cfus of lactobacillus daily for about a month now along with digestive enzymes. My GI symptoms seem a little better, but I have had a great deal of excess gas & cramping, & sometimes a little nausea. The product contained FOS, & I think that has caused problems with the gastric upset. It also can feed bad bacteria like klebsiella along with feeding good bacteria, so yesterday I asked for a probiotic without FOS or inulin. She had only one without it, but if taken twice a day as she recommended, it will be only 8 billion lactobacillus organisms & 2 billion bifidobacterium organisms. It is a professional formula combination of lactobacillus & bifidibacterium,& pharmaceutical grade from a company called XYMOGEN. The product is Probio Defense. How much is enough to restore the missing lactobacillus? How much is safe? My tongue has improved quite a bit. The redness is barely noticeable, & the tiny patch has moved to the other side (making me suspect geographic tongue.) It was on the tip & a tiny ways back on the left side, but now on the tip & a tiny ways back on the right side. It's barely visible, but still burns somewhat. It improves sometimes for a day or 2 & then comes back. I am weaning off the prilosec because I know it isn't supposed to be used long term & can cause some serious side effects and digestive problems etc. I think much of my current problem is acid rebound from stopping it. The digestive enzymes are helping. I used it for about 2 1/2 months daily 20 mg OTC, & for the past 3 weeks have used 1/2 , & then less than 1/2. I would like to continue with a natural approach if possible. I just want to make sure it is safe. Also, how accurate are these comprehensive digestive stool analysis tests, and how much stock shold one place in them? It showed some absorption problems in fecal fat digestion. & triglycerides, & that I was low in n-butyrate. For digestion, the chymotrypsin showed normal enzyme production.Long-chain fatty acids were within the reference range suggesting adequate absorption of fats. Cholesterol was in the reference range. Phospholipids are normal. Total fecal fats are in reference range. Fecal pH is in ref. range. Beta-glucuronidase was normal. I had a 1+ yeast (not candida)& considered an acceptable amount, & so was the putrefactive SCFA's. Meat fibers & vegetable fibers were normal. Immunology fecal lactoferin was negative,& mucous & occult blood were negative. I had low levels of e.coli & lactobaccillus, & the bifidobacteria should be higher. I would like recommendations from Dr. KokilMathur &/or a gastroenterologist as to if you think it is okay to proceed with the probiotics & digestive enzymes, or if I should investigate further with a gastroenterologist or get other tests. I can't take any sedatives containing a benzodiazepine. I am allergic to them all, so if I have an endoscopy test done I don't know what I would use. Possibly just a barium GI would be needed, or no tests? I need your opinions. Thank you so much & blessings to you. anonymous123
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Answer by Dr JS Anand (doctor) on Fri 18, Jun 2010 04:05am:

Hello, Welcome to the forum. Dr Kokil is currently unavailable and hence I would like to shed some light by providing an answer to your question. Hopefully DR Kokil will provide her valuable and expert option s comment to this question. L. acidophilus and bifidobacterium species are normal inhabitants of the human gastrointestinal tract and are GRAS. Probiotic formulations containing these beneficial bacteria along with prebiotic fructooligosaccharides (FOS) are considered safe and offer many of the health benefits, FOS independent probiotics like xenogen contain lactobacillus helveticus( 3 billion live organisms), lactobacillus ramnosus and bifidobacterium longum ( 1 billion live organisms each). Expert opinion suggests that a dose between 1 and 10 billion viable (live) L. acidophilus bacteria taken daily in divided doses is sufficient for most people. Higher doses may cause mild abdominal discomfort, and smaller doses may not be able to establish a stable population in the gut. So you can take this probiotic safely if your doctor recommends it. Regarding the comprehensive digestive stool anaylsis test, it provides information about digestion like enzyme level markers, stool pH, detection of undigested food particles, intestinal Absorption, intestinal metabolism, microbiology - detection of pathogenic bacteria, levels of normal/beneficial bacteria, mycology - levels of yeast, macroscopic observations - observation of fecal colour, detection of pus, mucus and occult blood and gut Immune function - sIgA levels. This test is fairly accurate except for detecting yeast as yeast can be found in the stool of perfectly healthy people and it will often give false negative results, i.e. indicate that no yeast were detected when in fact the patient does have a significant intestinal overgrowth. So it should be done in combination with candisphere test. You can talk about this test with your gastroenterologist. I hope it helps. Take care and please do keep us posted in case you have any additional doubts. Kind regards.
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Comments:

Comment by Dr.Kokil Mathur on Mon 21, Jun 2010 06:26am:
Hi Anonymous 123! I am sorry I was unable to answer your question as I was travelling, in remote areas with poor internet connection. I am glad to see that my esteemed colleague, Dr Anand, has answered your query in a very comprehensive way. Also I am glad to see that you are in better health and the patch on tongue is improving. Regarding Prilosec, I would suggest you continue to take the original dose of 20 mg empty stomach for another few days till your patch heals completely. Any acid reflux will cause a healing portion to flare up and hence until you are sure there is complete healing, please continue to take this under your doctor’s supervision. You will need this for a considerable time period. Regarding comprehensive digestive panel, this is a very sensitive indicator of gut flora and pretty reliable. Also since the patch on tongue is waxing and waning and shifting position, I tend to agree with other doctors that it is unlikely to be cancer. The dose of Probio Defense is also ideal and as I understand is helping you a lot. So continue this as this is quite safe and is almost a natural way of treating. You can also take curd and cheese if this suits you. If at all you want to try curd and processed cheese then talk to your doctor first about dose adjustment and whether at all you should try these. Combined approach of Probio Defense and Prilosec in full dose should help. You must be taking care of the food you eat. Raise the head end of bed and sleep at least 2 hours after meal. I suggest you continue with this treatment for some more days as it is already showing positive results with a lowered dose of Prilosec, so a full dose will yield a better result. If this does not help even after 2-3 weeks, then maybe other tests like endoscopy will need to be taken up (there are several other sedations apart from benzodiazepines that can be used). Hope this clears your apprehensions. Please let me know if there is any thing else and do keep me posted. Take care!
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