To answer your questions:
I have tried digestive enzymes and didn't see any appreciable help from them.
SFS made my symptoms go crazy, even at very low doses. I could never work up past a tsp a day, which is not a dose that can really do much of anything. My poor intestines just writhed, spasmed and cramped and I had horrendous D. These all cleared up when I cut the fiber back out. I tried Citrucel, Metamucil and Acacia...in fact, didn't I send you my practically full Acacia can? 
I think my doc is being overly apprehensive one, because he is an uber thorough doc, which has been actually very good. I have never had another GI who knew all the tests to run and would do them without me having to argue my case. Because of him, I know 100% for sure I have true IBS-D.
On the downside, he's a little scared about me taking this med since he hasn't prescribed it since it got all that bad publicity back in 02. I think he listens, but perhaps missed the fact I was still quaffing lomotil. As a stressed out professional with tons of clients myself, I have to understand how small oversights are possible, even though they're never really justifiable to the client/patient.
Yes, I have D practically every day. For me, D is not a ton of liquid, although it definitely can be at times. It is most often just very loose fecal matter that comes out in large volume, always precipitated by urgency, pain and cramping. I go several times every morning...on a good morning. If I didn't take lomotil every day, I don't know that I'd stop going and I"m sure the liquid would be more common.
Interesting test my doc did: I had to collect my stool for 48 hrs and he weighed it. A normal person produces about 250g of poo in 48 hours. My poo weighed 140g. This is indicative of functional diarrhea. While the volume is a lot, the weight is severely below normal because of the high liquid content. That's how we know for sure I have D.
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