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Gerd, IBS, and Urinary Incontinence secondary to NSAIDS

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flores97

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I am getting ready to file an FDC claim for IBS-C, Gerd, and Incontinence secondary to NSAIDS and wanted to see if anyone has any opinions or suggestions, if i might have missed anything. So here goes. I have been on a high daily dose of NSAIDS to treat my sc systemic lupus for well over seven years. About two years ago, i began having moderate gastro problems, that has worsened to the point that these conditions are almost as bad as the lupus, which leaves me bedridden about a week a month. Every time i go to urgent care for the lupus, i complained of the constipation, abdominal pain, nausea, and at times, vomiting. After about a year of these symptoms worsening, i was diagnosed with gerd(i thought i was having a heart attack twice, was admitted for severe chest pain, began vomiting/diarhea both times shortly after), and of course, IBS with constipation predominant. Around the same time frame-2 years ago, i began leaking urine frequently when sneezing, coughing, bending, etc, now i leak continuously and must wear pads. I was told by several VA Docs that the NSAIDS were more than likely responsible for the ibs and gerd. Then i was told that constipation also causes urinary incontinence. I am getting an IMO for all three conditions, from my triple board certified gastroenterologist, as well as submitting all relevant treatment records for past three years, medications side effects lists on the meds i take, some medical articles discussing how NSAIDS can cause/aggravate ibs and gerd, and more articles on how constipation can cause incontinence. I am also submitting the IMO(I will upload copy as soon as its complete), and the doctors resume/certifications. I do wear pads due to incontinence, usually go through three a day unless im bedridden, then its more like five a day. If anyone has suggestions/opinions i would really appreciate the input. I wouldnt have filed fir these conditions, but its to the point i only leave the house for med appts. I have daily abdomial pain, nausea, have trouble swallowing(especially meats), and i vomit if i eat more than small portions of food. The cramping feels like food poisoning, this is with taking omeprazole, pantoprazole?, ondasetron, and ranitidine. Thanks again

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As to your FDC claims it sounds like you have things well in hand. For your GERD/Acid Reflux you may want to raise the head of your bed about six to eight inches and try not to lay down at least two hours after you eat.  I found that sitting in a recliner after I eat is a lot better for me.  Please keep in mind that most people don't know that acid reflux can cause serious problems if you eat and lay down.

Hope the best

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Pete992, thank you for the response. I generally do not eat a meal but once mid day, and snack on crackers or yogurt briefly throughout the day. The Radiologist performing the Upper GI asked me if I had ever been out in the field while on Active Duty, I said" Yes Sir, at least 90 days a year", he responded with " Good, then you know what I'm talking about. When you go to bed, sleep like your sleeping against a tree." I also don't eat or drink anything at all two or more hours before going to bed, but I still get up at least 3-4 times a night to use the bathroom. I usually also only eat mashed potatoes, rice, oatmeal, boiled eggs, things like that, as I have a hard time swallowing,  and still get pretty severe abdominal cramping and nausea on an almost daily basis. One more question I forgot to ask, my IMO/IME Gastro Doc(I guess it is an IME as the doc examined me beforehand), stated in his opinion the NSAIDS prescribed for my SC Systemic Lupus are aggravating the IBS and GERD, and the Incontinence is being caused by the IBS-C(constipation). I was wondering if I should wait to submit the claim for incontinence until I am hopefully service connected for the IBS-C? Any thoughts or advice would be appreciated, thanks in advance!

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I agree with Pete.

A while back I won SC for GERD/IBS due to NSAIDs used for treatment of SC joint conditions. GERD will likely be assigned diagnostic code for hiatal hernia, but there is a separate code for IBS. The VA will consider these conditions as pyramiding, so you will not get two separate ratings for them. Instead, they will assign the higher of the two. I'm not sure about incontinence, but I do recall seeing a code for it. That would likely be a separate rating.

For me, it started out with the Army giving me ibuprofen all the time. After I got out, the VA gave me naproxen for years. I was switched to celebrex/celecoxib a couple of years ago and it seems to produce less GERD problems, but I still have the IBS. I guess that our bodies either disagree or have to get used to the medications. It might be worth switching to a different NSAID. Every couple of years they rotate me to a different GERD medication, but one that has stayed the same was ranitidine because it also blocks histamine. Sometimes it takes some trial and error to find the right combination.

You probably have already done this, but with all the GERD it is a good idea to get an EGD (esophagus/stomach scope) procedure done periodically to make sure that no erosions are forming. Like you, I have been admitted for chest pains which mimic a heart attack, only to learn later that it was GERD. The VA did an upper GI on me, but I was scoped by a private physician.

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18 minutes ago, flores97 said:

Pete992, thank you for the response. I generally do not eat a meal but once mid day, and snack on crackers or yogurt briefly throughout the day. The Radiologist performing the Upper GI asked me if I had ever been out in the field while on Active Duty, I said" Yes Sir, at least 90 days a year", he responded with " Good, then you know what I'm talking about. When you go to bed, sleep like your sleeping against a tree." I also don't eat or drink anything at all two or more hours before going to bed, but I still get up at least 3-4 times a night to use the bathroom. I usually also only eat mashed potatoes, rice, oatmeal, boiled eggs, things like that, as I have a hard time swallowing,  and still get pretty severe abdominal cramping and nausea on an almost daily basis. One more question I forgot to ask, my IMO/IME Gastro Doc(I guess it is an IME as the doc examined me beforehand), stated in his opinion the NSAIDS prescribed for my SC Systemic Lupus are aggravating the IBS and GERD, and the Incontinence is being caused by the IBS-C(constipation). I was wondering if I should wait to submit the claim for incontinence until I am hopefully service connected for the IBS-C? Any thoughts or advice would be appreciated, thanks in advance!

Flores, I know that some may disagree but yes. IMHO, It would help if you had service connection for IBS before filing a claim for secondary.  Just make sure that the wording on your IMO/IME stated that your GERD/IBS is cause by or the result of you taken NSAIDS medication for your service connected conditions.

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Vync, thank you for the great advice! And Pete also! I have noticed it seems to be difficult to get the VA to request testing, i have been complaining of these symptoms for a little over two years, and just recently had the stomach xray and Upper GI/Swallowing test performed.I wilwill definitely take your advice and ask for a scope as well. The odd thing is so far, they have kept me on the same NSAIDS. But then again, Ibuprofen 800 works better for the joint pain/swelling from lupus than anything else I have tried. I probably mentioned that to them and that is the reason they have not rotated the drugs. 

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3 minutes ago, pete992 said:

Flores, I know that some may disagree but yes. IMHO, It would help if you had service connection for IBS before filing a claim for secondary.  Just make sure that the wording on your IMO/IME stated that your GERD/IBS is cause by or the result of you taken NSAIDS medication for your service connected conditions.

Pete992, thank you for the excellent advice as always. That is what I was thinking as well. I already did an "Intent to file" on all three conditions, so I will wait till right before the expiration to submit the Incontinence claim. I actually used a nexxus request template that was posted under IMO forum, I can't remember who posted it but I am very grateful, for all three conditions. The doctor is filling out the forms as well as writing letters for the rationale portion for eavh form. I also put on the intent to files that the claims were secondary to Lupus Eruthematosus to include the NSAIDS and other medications prescribed for the lupus. I will post the Drs IMEs as soon as i receive them.

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