Managing Diarrhea
 

I thought I'd pass on what I've figured out about managing diarrhea, and ask others for their "best practices."

Since starting on Herceptin and Perjeta I've had diarrhea or at least cramps/gas pains just about every day. Immodium always helps, but if I overshoot, then I can have constipation. I've hit upon a few strategies that seem to help:

• Probiotics. I started taking one formulated for people over 50. It has three kinds of bifidobacterium and four kinds of lactobacillus. I also eat yogurt just about every day. I make my own Greek yogurt.
• Fiber. I know some folks think fiber exacerbates intestinal distress, but for me it helps a great deal. I eat whole grains, fruits, and vegetables every day. I'm considering adding some psyllium husk too.
• Water. I'm not a big water drinker, but diarrhea can make you dehydrated, so I try to be mindful.
• Taking Immodium defensively. As soon as I notice my stomach hurting or my intestines gurgling I take one pill (Loperamide HCL, 2 mg.) Most of the time, that stops it before it starts.

What about you? What helps?

Re: Managing Diarrhea
 

I agree with the fiber, water, and probiotics (although I was advised against it by a NP because she said that sometimes when immunity is down the probiotic can encourage growth of bacteria - not sure I agree with that). I don't use Immodium because it gave me horrible stomach pains. Instead, I took L-glutamine powder - 30 grams (yes grams) a day. It worked miracles for me and also prevented neuropathy. I just finished my 12th taxol and walked away neuropathy free, thankfully. It may have been the glutamine, or maybe it would have worked out that way anyway. Regardless, I'll take it!

Re: Managing Diarrhea
 

Mtngrl,
I'm only dealing with diarrhea that results IF I don't maintain a consistent intake pattern (due to using very low-dose metformin), but your post interested me because you and I are using exactly the same strategies. Mine are targeted in part not just to deal with occasional diarrhea but mainly to address the constant weight gain I have if I don't do all of those things. The one other thing that I have to do that you might think about in some way is to add in some kind of daily exercise if you aren't already doing that. It does actually help me somehow to reduce the diarrhea -- maybe through some fluid elimination, I don't know. It kind of fascinates me that we are doing the same things, even if for somewhat different reasons.

I'm using Nancy's organic yogurt, but would also like to try making my own.

A.A.

Re: Managing Diarrhea
 

After I stopped the chemo and was taking only Herceptin, diarrhea wasn't much of a problem for me. However, when it was a problem I would take 2 Imodium's (2 mg loperamide HCI each) and that took care of it.

Re: Managing Diarrhea
 

Linzer,

I hadn't thought of Glutamine for diarrhea. I used it for neuropathy to good effect (though not consistently while I was on Kadcyla). I'll try it.

Of course probiotics ARE bacteria, and the reason for taking them is to support the immune system, so your NP was right but drew the wrong conclusions from it. Most of what's in our gut is microorganisms. The theory is that the "gut biome" is an important part of keeping us healthy--both immune system and metabolism. The reason for taking probiotics (and ingesting foods that are good "prebiotics" that the friendly bugs like to eat) is to maintain an optimal gut environment. Some people actually get "fecal transplants" to restore their gut biome when all else fails in treating certain illnesses. (Google that--it's fascinating.)

AA--I live in Boston and don't have a car, so my life includes at least a half hour of walking most days. I'd like to add some weight training and yoga, both of which I've done before but not right now. I agree that exercise seems to be a magic bullet for all kinds of maladies.

I'm about to start on Xeloda (on top of Herceptin and Perjeta.) One of its listed side effects is diarrhea. Wish me luck!

Re: Managing Diarrhea
 

Hi Mtngrl -

I am also on the Herceptin/Perjeta combo, having dropped the taxol in late May. The big D is a struggle and was horrible at first, with the help of the nurses where I get treated, I worked out the following which is similar to yours:

Immodium: One daily in the AM right before breakfast. I take 2 the morning of an infusion and for a couple of days afterwards.

Food: I eat 3 meals with small snacks in between. No spicey food. Limit 1 cup of coffee daily, no other caffeine. (I really miss the coffee!). I also have fiber in my diet through whole grains.

Probiotics: I was doing good belly drinks, but I have switched to yogurt with live cultures about a month ago. This works well for me.

Exercise: daily walking 30 - 45 min. I am planning to start doing elliptical machines in the next couple of weeks - my onc just gave his approval and the area I live in is not conducive to the walks in the winter due to rain.

This works for me most of the time, but not 100 percent so I am very interested in others tips of the trade so to say... Thank you for starting this thread and to all that responded.

Re: Managing Diarrhea
 

my experience is you are on track with adding psyllium husk. I used it when D was an issue for me. It soothes the stomach and does provide relief from D as much as it would seem otherwise.

Re: Managing Diarrhea
 

Lizz -

Did psyllium husk ever cause constipation? On chemo, I swung dramatically from one extreme to the other, and now I want to just maintain good "biome" health. My natural state tends more to constipation, so I want to do the fiber, but without the C.

Re: Managing Diarrhea
 

Hi Katherine,
No, not for me. Nearly 20 years ago, i started putting a heaping tablespoon of psyllium (metamucil sugar free smooth texture orange, which I could get at Costco) in a big shaker bottle, with cold water and lots of ice. I would chug it on my way to work. It was recommeneded by one of my docs when I was dealing with an acid/ulcer-prone stomach, because it coats the stomach. It never gave me diarreah nor was I ever constipated. Regular like clockwork each morning. But moreso, no raging stomach aches.
(The shaker bottle and ice help keep the mixture liquid while you drink it. Of course otherwise, it starts to thicken jelly-ish if it stands too long -- a lovely thing in the tummy, not so lovely in a glass.) :)

Re: Managing Diarrhea
 

For those who had good results with Glutamine, can you tell me what brand and techniques you used? I originally bought the powder to mix into water and drink. It didn't go well with my post-chemo mouth. Then I bought chewables, and I must admit, they are not so yummy to chew. Would be interested to know what form of Glutamine worked for others! :)

Re: Managing Diarrhea
 

I just use Glutamine gel caps from one of those "fitness" stores. Body builders use it. I had some around from a previous bout of neuropathy, which mostly went away. I started taking them again (though 10 gms a day, not 30) and it certainly couldn't hurt. I have a son who has Type 1 diabetes, and he takes it for diabetic peripheral neuropathy.

Re: Managing Diarrhea
 

I'm on Perjeta, Taxol, Herceptin. Thanks Ladies for all the wonderful info. I have found it helps to eat several small meals a day instead of larger meals. Whenever I eat a "regular meal" it goes right thru me. As my Mother would have said, "Like a goose eating liver" I will try all of your suggestions - sounds like good advice!