Here is what we concluded on:
- He is going to start me on either cisapride or prucalopride for my GP. He says that cisapride is still a save and very effective medication for GP, and adverse side effects can be avoided by having an ecg and checking electrolytes before starting the medication. Cisapride is available through compassionate use in Austria. Another option is prucalopride, which is available in Germany and I might be able to get that through compassionate use as well. The only problem is that both meds promote colon transit time as well, and I tend to have diarrhea anyway.
- I am to continue with oral vitamin d and calcium supplementation.
- I am to have IV iron twice to refill my iron-stores, as I am not able to absorb iron orally anymore. Three months of high dose oral iron supplements did not change my ferritin level by even one point.
- As to the reason for my hypoalbumenia: I am already on a high protein tube feed and take in protein through dairy products orally as well. I am therefore either not absorbing the protein very well or losing protein enterally. As a next step he put me on a semi-elemental tube feed and we are to re-check my albmine levels in a month. If they are still low, he wants me to have a capsule endoscopy.
All in all a very successful appointment and definitely worth spending four hours in the car.