Beginning to think my GI doc doesn't get it

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Beginning to think my GI doc doesn't get it

Postby fissure for sure » 29 Apr 2011, 14:49

Well, after having issues for weeks with side effects from Nifedipine cream, I asked my
gastroenterologist to switch me to diltiazem. I actually think that the Nifed cream was
just too high of a concentration (2%). Instead of switching to diltiazem, he has decided to
prescribe nitroglycerin for me....also at a 2% concentration. From what I understand, this is
way too high a concentraton for fissure treatment and will result (again) in side effects. So, my question is, how can i "cut" either of these so that
they are lower concentrations? It seems like the amount that I need of the nifedipine cream
is so small, that it is difficult to deliver to where it needs to be.
Any thoughts?
Thanks.
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Re: Beginning to think my GI doc doesn't get it

Postby Deleted User 579 » 29 Apr 2011, 15:29

Hey fissuerforsure - sorry - in my original reply I thought you were getting 2% nitro and I was pretty concerned about that!
I'm not sure about your meds, but I've heard of people cutting 2% nitro concentrations with hemorrhoid ointment (10:1). I wouldn't recommend that for any ointment, though, because it's hard to know if the hemorrhoid ointment would help or harm the fissure, especially because many of them have hydrocortisone, which can thin the skin. You could cut it with petroleum jelly, but I would want to know more about chemical interactions before I put any home-made concoctions in that area. Also, if you dilute the concentration that was given to you, you might delay or even prevent healing. Personally, I wouldn't mess with the meds. If you're having side effects, I think the doc needs to address them.
Do you have access to a Colorectal Surgeon (CRS) where you are? I think that CRSs handle fissure more often than GIs do - probably because the 'gold standard' treatment for chronic fissures is surgical. I'm dealing with a surgeon and he gave me the diltiazem. Most surgeons will try a non-surgical option first and so will know more about the proper ointments. I really think you should find a different GI and see a CRS rather than stay with your current GI - but that's just me.
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Re: Beginning to think my GI doc doesn't get it

Postby fissure for sure » 29 Apr 2011, 15:41

Your following my thought pattern here Hope. What I'm thinking is that I'm going to cut the nifedipine with petroleum jelly. It's already in soft paraffin wax, which i
think is basically petroleum jelly with more water in it.
And, yes, I agree that I need to get to a CRS. I'll have to
travel about 40 miles, but I think it will be worth it.
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Re: Beginning to think my GI doc doesn't get it

Postby fissure for sure » 29 Apr 2011, 15:47

hopetoheal wrote:Hey fissuerforsure - sorry - in my original reply I thought you were getting 2% nitro and I was pretty concerned about that!

That's right Hope, he gave me 2% nitro....the kind that they use for angina patients.
Yes, that is 10X more concentrated than the stuff that I hear people using for AFs.
The 2% Nifedipine that he prescribed is 4-10 times higher than what I have read people
on this board talk about using.
The nifed was working, but giving me some serious chest pain...possibly from an acid reflux
response. So now i'm using a smaller amount, but it is such a small amount that it is
difficult to apply well.
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Re: Beginning to think my GI doc doesn't get it

Postby Deleted User 579 » 29 Apr 2011, 15:54

Yes - definitely a 40 mile commute is worth it to see the right kind of specialist.
I really strongly feel that you should avoid modifying your meds without a doctor's approval. I should also clarify that I've only heard of people cutting nitro, not nifed. I am very puzzled (and concerned) that your GI prescribed 2% nitro! (the proper concentration is 0.2%) If I were you I would only use the diluted nifed until you get to a CRS and get the right meds.
Good luck!
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Re: Beginning to think my GI doc doesn't get it

Postby Deleted User 579 » 29 Apr 2011, 16:07

hey we posted at the same time! :D
I definitely share your concern about your meds. And please, please, don't just assume that your chest pains are acid reflux. I'm sorry, I don't mean to alarm you, but I'm sure you've thought about the possiblity of cardio reactions. Don't mess with that!
To clarify: Did you get nitro and nifed at the same time??
If that's the case, then it seems to me that you've been prescribed two meds that at very high concentrations that can have heart-related side effects. hmmm
I don't mean to be alarmist - I could be wrong, and others can chime in here, but this just doesn't sound right to me and I really don't like the side effects you are dealing with.
Yup, my friend ... please get to a different specialist and talk to your family doctor about your side effects asap too.
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Re: Beginning to think my GI doc doesn't get it

Postby alpinestrawberry » 29 Apr 2011, 16:55

Hey...I was prescribed the 2% as well. I think that's just what you get when you don't live somewhere where there's a handy local compounding pharmacy. The stuff is intense, but it won't kill you. It has to be safe because cardiac patients stay on it forever! But I can understand being worried about the chest pains!
I think you should be fine cutting it with petroleum jelly. Sometimes the base of the nitro ointment is petroleum jelly, although the stuff I was given was lanolin based. Good thing I wasn't allergic.
I did adjust to having such a high dosage, BTW, even got to a point where it didn't give me a headache.
But this being said, I think you should find a CRS too. Especially if you'd like to stop having fissures. Sorry to be blunt, but no other type of doctor can work with you to eradicate this like a CRS can. I had to go 60 miles one way to see the surgeon/get the surgery. Others have traveled much farther.
Good luck!
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Re: Beginning to think my GI doc doesn't get it

Postby Elphie » 29 Apr 2011, 17:05

My nifedipine says it's 0.3% powder in lidocaine 5%
what you've got is definitely too high. Don't mess with that stuff, nitro especially! You definitely need a CRS, the drive might b he'll but he can get u on the right track for sure. I was lucky, I already had one when my AF occured but the other docs just aren't aware of all your options. I hope you can find someone to give you a proper ointment, is it possible to ask your pharmacist to look into it for you?
Good luck I hope you find some relief.
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Re: Beginning to think my GI doc doesn't get it

Postby Elphie » 29 Apr 2011, 17:08

Oh and by the way, I experienced no side effects whatsoever with that compound but did get some relief from it.
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Re: Beginning to think my GI doc doesn't get it

Postby fissure for sure » 29 Apr 2011, 18:01

Thanks for the kind words Elphie and Alpine. I'm definitely going to look into a CRS. I'm clearly going to have to talk
to my GI doc about this, and being the shy type is not going to help me. He is a really nice guy though.
Fortunately (ha ha), my pain is generally of the constant "slow-burn" type, so making the 40 mile drive shouldn't be too tough.
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