Why would GI say that?

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Scottishcammy
Regular Member


Date Joined Nov 2007
Total Posts : 124
   Posted 1/22/2008 1:01 PM (GMT -7)   
Ok, mentioned in other post that I seen my GI on 15th and he said my meds (4 x Pentasa, 15mg Pred) weren't working (going to toilet 4 x day, D, blood 1 in 3 movements, lots pain/wind/no control). He took me off Pentasa (a week to see if urgency & D got better), and put me on azathioprine (Imuran).

Well, a week later and I've been going to toilet around 6 times a day, blood pretty much every time, still pain/no control.
I phonmed the IBD nurse yesterday who told me she'd speak to consultant 1st thing this morning and phone me back. She also told me to start on the enemas (Salofalk Mesalasine) again.

The IBD nurse phoned me and said the consultant said to go back up to 25mg Pred, if no improvement by w/end 30mg. I've to phone again on Monday morning to check how I am.

The strange thing is the IBD nurse said consultant specifically said NOT to use the enemas. Anyone know why that would be?

(That aside, hope the increase in Pred' gets this under control mad)
Diagnosed Indeterminate Colitis 25/11/2007 (update: told by consultant 15/01/08 in his opinion definitely UC). 1 x Solofalk Enema/day 40mg Prednisolone 35mg Prednisolone 30mg Prednisolone 20mg Prednisolone 25mg Prednisolone 20mg Prednisolone 15mg Prednisolone 4g Pentasa/day

Taken off Pentasa and now on 15mg Prednisolone, Omeprazole 20mg, 2 x Calcium Adcal D3, and started 50mg Azathioprine/Imuran.


quincy
Elite Member


Date Joined May 2003
Total Posts : 30091
   Posted 1/22/2008 1:41 PM (GMT -7)   
Who ever knows why....I think he's playing too much and you're not waiting long enough to let the decrease of pred to level out.

Adding the Salofalk could have helped during that time...but he clearly has a plan.

What do you think since you're taking all the meds? Are you in a feeling of desperation?

Have you been improving since this flare and were at a plateau?

quincy
*Heather*Status: mini flare Dec 28... increased enemas to nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....bromelain 1 - 2x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!


Scottishcammy
Regular Member


Date Joined Nov 2007
Total Posts : 124
   Posted 1/22/2008 1:54 PM (GMT -7)   
To be honest I feel pretty down about it all. I was diagnosed in Nov and it's never got better. It's also got markedly worse over last few weeks, hence the azathioprine, which I really didn't want to go on.
I can feel (and see objectively) that it's getting worse. The increase in bleeding is back like it was several weeks ago.
I really like the GI and has a lot of time for my questions (all the nurses speak highly of him as well) I feel he genuinely is concerned for my well being.
From the meeting on the 15th he certainly said he was concerned how the disease was going and that we need to get it under control, which it isn't so far.
I'll have to ask him what his plan is!
Diagnosed Indeterminate Colitis 25/11/2007 (update: told by consultant 15/01/08 in his opinion definitely UC). 1 x Solofalk Enema/day 40mg Prednisolone 35mg Prednisolone 30mg Prednisolone 20mg Prednisolone 25mg Prednisolone 20mg Prednisolone 15mg Prednisolone 4g Pentasa/day

Taken off Pentasa and now on 15mg Prednisolone, Omeprazole 20mg, 2 x Calcium Adcal D3, and started 50mg Azathioprine/Imuran.


tooth fairy
Regular Member


Date Joined Jan 2008
Total Posts : 98
   Posted 1/22/2008 2:18 PM (GMT -7)   
My GI told me that Imuran takes about 6 weeks (and up to 2 months) to begin working, which may be why you're still having symptoms.  Good luck!
Diagnosed July 2006, 3 days after birth of second son via colonoscopy/upper endoscopy at age 29
Currently doing well with:
125mg imuran
Asacol as preventative for cancer (does not ease symptoms)

Now in a prednisone taper (20 mg until next week)
And on flagyl until tomorrow

Experimenting with:
a modified low residue diet
live culture yogurt and probiotics


Scottishcammy
Regular Member


Date Joined Nov 2007
Total Posts : 124
   Posted 1/22/2008 2:58 PM (GMT -7)   
Thanks. I like the sound of your GI, mine told me 12 weeks!:-)
Diagnosed Indeterminate Colitis 25/11/2007 (update: told by consultant 15/01/08 in his opinion definitely UC). 1 x Solofalk Enema/day 40mg Prednisolone 35mg Prednisolone 30mg Prednisolone 20mg Prednisolone 25mg Prednisolone 20mg Prednisolone 15mg Prednisolone 4g Pentasa/day

Taken off Pentasa and now on 15mg Prednisolone, Omeprazole 20mg, 2 x Calcium Adcal D3, and started 50mg Azathioprine/Imuran.


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 1/22/2008 7:15 PM (GMT -7)   
I would just ask for a script of cortifoam...rectal meds can take time to kick in, for me the cortifoam kicks in faster than anything.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


dakotagirl
Veteran Member


Date Joined Apr 2006
Total Posts : 3402
   Posted 1/22/2008 7:32 PM (GMT -7)   
I agree with pb4 about the steroid enema. Get the 'roids to the point where they're needed most - treat BOTH ends like Quincy's doc says.

Imuran can take 2-3 months (on average) to kick in - hence sticking with the pred to help control symptoms during that time.

My last GI would tell me his plan straight out. It sure helped me (mentally/emotionally) to know what that plan was. So definitely ask your doc!
Pan-colitis and GERD diagnosed May 2003
 
Asacol 12 per day,  Azathioprine 75mg, Aciphex, Effexor XR, Forvia and a Probiotic
Osteopenia (hip and spine) from prednisone use.  Started Azathioprine because I was steroid dependent.
 
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UCinNC
Veteran Member


Date Joined May 2007
Total Posts : 528
   Posted 1/22/2008 7:47 PM (GMT -7)   
Imuran can take 4 - 6 months, so give it time. You do need to find something to keep the flare in control while Imuran kicks in. I was on pred the first three months I was on Imuran, and Imuran took about 4.5 months for me.

no opinion on whether or not to use rectal meds, but I think that if your bleeding increases whenever you taper on pred, then your GI is right to switch you to Imuran, as you may be steroid dependent.

Hang in there, it will get better. You just have to find the right meds, which is hard, but doable.
29/Female/NC
Pancolitis dx 3/07
9 Colazal a day (used to be on 12 Asacol, don't think Asacol helped)
150mg Imuran/day (steroid dependent, reached this dose 9/07)
Various vitamins, bit of fish oil, a probiotic.


quincy
Elite Member


Date Joined May 2003
Total Posts : 30091
   Posted 1/22/2008 10:20 PM (GMT -7)   
SC...it's awesome you like and respect your GI and that he takes the time for you.
I like the idea to ask the doc about the plan. He clearly has one, but it's offered you more confusion than comfort.

Do make a list of some questions regarding meds, why, what now and what then? for when you see him next.
I saw my doc a lot the first two years.  I was only on 5ASA oral/rectal meds, but him taking the time to explain and to reassure me went a very long way. 

quincy


*Heather*Status: mini flare Dec 28... increased enemas to nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....bromelain 1 - 2x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!


Scottishcammy
Regular Member


Date Joined Nov 2007
Total Posts : 124
   Posted 1/23/2008 1:22 AM (GMT -7)   
Thanks guys! Do you think that having pancolitis, he maybe thinks the enemas would only be treating a small proportion of the affected area?
Diagnosed Indeterminate Colitis 25/11/2007 (update: told by consultant 15/01/08 in his opinion definitely UC). 1 x Solofalk Enema/day 40mg Prednisolone 35mg Prednisolone 30mg Prednisolone 20mg Prednisolone 25mg Prednisolone 20mg Prednisolone 15mg Prednisolone 4g Pentasa/day

Taken off Pentasa and now on 15mg Prednisolone, Omeprazole 20mg, 2 x Calcium Adcal D3, and started 50mg Azathioprine/Imuran.


Red_34
Forum Moderator


Date Joined Apr 2004
Total Posts : 23551
   Posted 1/23/2008 6:04 AM (GMT -7)   
My GI explained to me that taking an oral 5-ASA will treat only so far down into the colon while the rectal meds will treat from the bottom up to so far. I have left sided extending to the upper bend of the colon (forgot what that was called), so the problem that I was having is that the oral med wasn't reaching to above the sigmoid and neither was the rectal meds. I always had that small portion that was ulcerated. But I think that my going on an rectal med that it can offer some relief to the rectum/sigmoid area.
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~Left sided Uc -'92 - Colazal (9 daily), 6mp (50-100mgs), Colocort, Prilosec, Biotin, Forvia, Pro-Bio**Unable to tolerate Asacol, Rowasa or Canasa** ~Allergies - Allegra & Singulair
~Secondary Reynauds Syndrome - '04 - Norvasc~Fibromyalgia - '06~No meds
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Scottishcammy
Regular Member


Date Joined Nov 2007
Total Posts : 124
   Posted 1/25/2008 10:56 AM (GMT -7)   
From 'precautions for use' with regard to Imuran:

"There are individuals with an inherited deficiency of the enzyme thiopurine methyltransferase (TPMT) who may be unusually sensitive to the myelosuppressive effect of azathioprine and prone to developing rapid bone marrow depression following the initiation of treatment with Imuran. This problem could be exacerbated by co-administration with drugs that inhibit TPMT, such as olsalazine, MESALAZINE or sulfasalazine. Also it has been reported that decreased TPMT activity increases the risk of secondary leukaemias and myelodysplasia in individuals receiving 6-mercaptopurine (the active metabolite of azathioprine) in combination with other cytotoxics (see section 4.8 Undesirable effects)."

Maybe that's why he wanted me to hold of the mesalazine enemas? Until he knows my TPMT results.
Diagnosed Indeterminate Colitis 25/11/2007 (update: told by consultant 15/01/08 in his opinion definitely UC). 1 x Solofalk Enema/day 40mg Prednisolone 35mg Prednisolone 30mg Prednisolone 20mg Prednisolone 25mg Prednisolone 20mg Prednisolone 15mg Prednisolone 4g Pentasa/day

Taken off Pentasa and now on 15mg Prednisolone, Omeprazole 20mg, 2 x Calcium Adcal D3, and started 50mg Azathioprine/Imuran.


quincy
Elite Member


Date Joined May 2003
Total Posts : 30091
   Posted 1/26/2008 9:25 AM (GMT -7)   
makes sense....considering you're also on pred..which could maybe mask some symptoms or results.

Thanks so much for the information SC..good to know.

But, there are also steroid enemas..still something he could offer you.
q
*Heather*Status: mini flare Dec 28... tapered to every second night
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....bromelain 1 - 2x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!

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