After reading most of the posts on various Vitamin deficiencies and malabsorption, I still have questions. I'm considering giving up my pouch and wonder how many of the current problems will still be present with an end ileo.

I understand the terminal ilium's role in absorption of some vitamins. I wonder why, after so many years with my pouch, and so much of my small bowel missing as a result of various reconstructions, a Vit. D deficiency would show up at this point? What's different to be causing malabsorption at this point? (I have cuffitis and perhaps pouchitis - being scoped 6/25) I've taken a two month course of prednisone, and am now on Cipro.

I sunburn in a moment, and blister, sometimes even with sunscreen, but most often when I miss a tiny patch of skin. Is burning associated at all with the Vit D deficiency? While I understnad that one must avoid sun exposure on Cipro, no past course of Cipro has resulted in burning with blisters, regardless of time of day of exposure or care with sunscreen. Before, long sleeves and a sun hat were enough protection, even on Cipro. I'm on a higher dose now - amplifies response?

Leg cramping that's pretty severe has usually indicated potassium deficiency. Can it also be associated with Vit D deficiency? (I'm having blood work done this week, CBC including ferritin, B-12, and D2.)

Do I need to review the surgeon's report to find out if I have the terminal ileum remaining, or should I just assume it's been removed since I have only about 12' of small intestine remaining?

Can I expect other malabsorptive problems to surface whether I remain with my J or have it removed?

My stools are only about .3" in diameter now, and from 1-5 hours after I eat almost anything I have ferocious cramping, bloating, gas, and have difficulty pooping. I've ahd gas and cramping on Cipro before, but these symptoms came up about two weeks into this course of Cipro (that's happened before, too) and are pretty severe. Maybe it's the higher dose of Cipro that's responsible for the intensity. Feels like the beginning of an obstruction, but then breaks loose. It's so painful don't think I can make it on this regimen til the end of the month when I go to UCSF again. Could this be strictures, adhesions, or??? If it is either strictures or adhesions, will I be likely to have this problem with an ileo?

Of course I'm eating very little or not at all for some meals just because of the pain. I know I"m dehydrated, too, and am working on that.

Any advice anyone has would be welcomed!

thanks,

Barbara

Barb - have you tried Hydralyte? It's great for dehydration and for leg cramps. (I'm assuming you have since you've tried everything.) If you haven't, here's their site: http://www.gookinaid.com/

And just in case you didn't see it, Jan is out of town for a few days. If she doesn't get right back to you, that's why.

kathy

B-12 is absorbed in the terminal ileum, which is about the last two feet or so. With about 20 feet of small bowel to begin with, you have most definitely lost your terminal ileum, unless a significant portion of that loss was from other sites in the small bowel.

It can take years for malabsorption syndromes to manifest because unless you are not absorbing any and not storing any, you will absorb enough and store enough to get by for quite some time. It is when you are at a suboptimal absorption that problems will creep up on you. Having bouts of pouchitis will hasten the malabsorption during those times. Plus, chronic inflammation can interfere with both absorption and metabolism.

There are a number of things that can contribute to leg cramps. Low potassium is one, calcium and/or magnesium imbalance is another. Vitamin D is closely tied to calcium and magnesium metabolism. Still another is lactic acid build up in the muscles from deconditioning and not enough stretching during the day. Let's not forget dehydration.

If most of your problems are associated with a problematic pouch, then you can assume that going to an ostomy would improve things. However, if your issues are more global in terms of your GI tract, this may be a life long thing.

Drug side effects are generally related to the dose, so yes, they would become more pronounced with higher doses.

Jan

Thanks to both of you, Jan and Kathy. I'll check the Hydralite, Kathy. Pedialite and the Gatorade type stuff usually runs right through me, making things worse, but I"ll try anything.

Jan, your answers are succinct and thorough - I so appreciate your taking time to answer while you're away! I'll print your post and take it with me as a prompt for lots of questions the end of the month at UCSF. I have a contrast study, scoping, and appts with the surgeon, GI, and two ostomy nurses just to cover all the bases. Had the blood work done today, so I'll soon know more.

Again, many thanks - it's so reassuring to have information. Counters a lot of "what ifs."

Barbara