Flaring Up and Prednisone Question - Please respond

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happyliving
Regular Member


Date Joined Mar 2008
Total Posts : 163
   Posted 5/18/2008 5:55 AM (GMT -7)   
Hello All,

Currently I'm flaring and I'm on Pred 15mg , tapering from 20mg(10 Days).
Previously(suffering from 2006) I'm on Asacol/Lialda 4 pils/day and canasa suppository occasionally.
One morething I use to notice while I'm on Asaco/Lialda is the freqeuncy of going for toilet(not bathroom). It use to happen excalty 1.00-1.30 hours after i take some food and medication.
Have you guys had this kind of symptoms with Asacol/Lialda? Not sure if this is happening to me or everybody have the same.
I had my colonoscopy 3 weeks back,confirmed left sided UC and my Doc kept me on Pred.
Flareup started after i recovered from synus infection like cold and cough last month.
Even i noticed some white color blisters (like cold sores) on my head and they use to come and go away before the flare started.
Did anybody ever noticed these kind of symptoms?
I'm confused about the prednisone medicine. how exaclty it works?
I mean if I'm taking prednisone will there be any usage of taking Lialda during that time. I'm asking this because if Prednisone reduces inflammation from the inside what is the usage of Liadla while taking prednisone?
Today after tapering to 15mg of Pred(7th day at this dosage) I noticed some brownish color in my bowels(stool is solid), not sure if it is blood or it is the color of Lialda (not dissolved properly).
Is there any possibility that could be blood?
How long the power of prednisone works once we take the medication?
Can somebody please answer my questions...I'm eagerly awaiting for somebody responding to my queries.

Thanks in advance

Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 5/18/2008 7:11 AM (GMT -7)   
lialda is a maintenance drug and should be taken while on pred so that when you taper off of pred you already have something in your system helping you.

You should talk to your GI about flaring as you are tapering down.

Sorry I can't help w/the other stuff.
Beth, 32 ~ Major Flare Sept/Oct 07 ~ in remission
UC dx'd 03/00 (Proctosigmoiditis); Pancolitis since 09/07
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd 09/07 - partial remission since 03/08
Prednisone 5mg 1xday (tapered from 60 = ), Simvastatin 20mg 1xday, Diovan 160mg 2xday. Enalapril 20mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.  Do you have edema? If so, check your blood protien level!
 


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 5/18/2008 7:15 AM (GMT -7)   
Prednisone is very similar to cortisone, a natural hormone produced in your adrenal glands. It decreases inflammatory responses by suppressing the immune system.

The urge to use the toilet 1-2 hours after eating is normal. The act of eating stimulates our digestive system to increase the rhythmic contractions that push food through, and this leads to the urge to eliminate. In a bad flare, this would happen to me so quickly that I had to leave the table during the meal to go.

You do need to continue taking your Asacol while on Prednisone. Asacol is one of the 5-ASA medications, along with others such as Colazal and Pentasa. They are actually considered topical medications, which means they work by direct contact with your colon as they pass through and dissolve. Usually they are used up before reaching the recto-sigmoid colon, which means they're not terribly effective at treating those areas. For that reason, you really should be on a rectal medication - preferably Mesalamine (Rowasa or Salofalk) enemas regularly. Usually you start with one or two a day, then decrease to a maintenance dose as symptoms get better. This is a very important part of your treatment, and you should contact your doctor to discuss it.

Prednisone is used short-term to achieve remission. It won't maintain remission and has very nasty side effects if used for too long. As you decrease the Pred, you may see some mild flare symptoms. If they get worse or last for more than a few days, let your doctor know as you may need to taper more slowly. Be sure you are taking your Asacol and check into those enemas; those are the medications that should maintain the remission as you withdraw the Pred.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Avascular necrosis in both shoulders is my "forever" gift from steroid therapy.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


happyliving
Regular Member


Date Joined Mar 2008
Total Posts : 163
   Posted 5/18/2008 7:59 AM (GMT -7)   
Hi Judy,

Thank you for your detailed reply.
Actually I'm doing very well at 20mg of Pred and I'm at that dosage for 10days and then doc asked to taper 5mg every 10 days. So now I'm at 15mg of it and at Day 7th..Now i see a very small change in my bowel movement today and very little bit of blood.
Not sure if i need to continue with 15mg for rest of the days(3 days left) and taper down to 10mg and 5mg slowly or need to stay back at 20mg.. Can i wait for few more days on 15mg and see if things continue with out any issues and continue on Lialda 4/day.
Is staying at 20mg of Pred for longer days create any problems? Little bit concerned about that.
Is it good to add Canasa Suppository every day night and see how it goes..
Will Suppository will be effective for Left sided UC?
When i met Doc last time he said Canasa is not required.
Before calling Doc all your suggestions are appreciated.

Once again Thanks to everyone for guiding the sufferers of UC

jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 5/18/2008 8:12 AM (GMT -7)   
When you get to the change point, if you're still seeing blood, you may want to continue the 15 mg. for another week. If the blood is decreasing, it may be gone by the end of the three days. Check, though, because if you're taking Asacol, the casings from the pills often come out whole or in pieces and can easily be mistaken for blood. So, gross as it sounds, check closely to be sure it's really blood.

You can try the Canasa daily or twice a day to see if that helps. Enemas are usually more effective for left-sided UC, as they treat both the rectum (where Canasa works) and the sigmoid colon (where suppositories can't reach.) But since you've got the Canasa, try it every day or twice a day to see if it helps.

A lot of GI's underestimate the importance of rectal medications. Shame on them! If they do their homework, they should know that Colazal and Asacol don't reach the rectal area effectively. Be polite but don't be afraid to advocate for yourself. If your GI isn't willing to let you be an active partner in your own healthcare, you may want to consider seeing a different doctor.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Avascular necrosis in both shoulders is my "forever" gift from steroid therapy.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


quincy
Elite Member


Date Joined May 2003
Total Posts : 30076
   Posted 5/18/2008 1:12 PM (GMT -7)   
Definitely do the Canasa twice a day....and continue it until you call the doc and request Rowasa.

You need the rectal meds.

q
*Heather*Status: mini flare Dec 28... tapered to every 4th 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 ....zymactive 3 - 5x 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 !!!


happyliving
Regular Member


Date Joined Mar 2008
Total Posts : 163
   Posted 5/18/2008 2:28 PM (GMT -7)   
Hi Judy,

All this is happening after i tapered from 20mg of Pred to 15mg of Pred..I mean a small change in the Bowel movement and some inconvinience. By the way I'm taking Lialda 4 pils/day as one dosage and not Asacol.
And from the bowel i noticed small change in color(little brownish, not sure if blood is there..)..Just wondering if it is due to Lialda..But surely i noticed a change after tapering down to 15mg on the 7th day from 20mg (for 10 days)..Docter advised me to taper down to 10mg and 5mg in one week instead of 10days.
Yes i wil try to add Canasa suppository and see how it goes..
Is it advisable to stay at 15mg even i noticed small change in bowel movement or call doc and request
for increasing it back to 20mg. Lots of confusion and pain with this disease...We are really lucky
that the people in this forum are responding very actively and helping people like me.

quincy: I will check with my doc about the enemas.. How touch it is to use enemas..? I did tried Canasa and it is very simple process to keep it.
I don't have any idea to use enemas.

Thanks for all your responses.

happyliving
Regular Member


Date Joined Mar 2008
Total Posts : 163
   Posted 5/19/2008 4:17 PM (GMT -7)   
Hi Judy,

Is staying on 20mg of Pred for long time advisable?
If my Doc says goback to 20mg and stay there is worth doing or request him for Rectal medications
Looks like today i feel the difference in my symptoms. Some kind of inconvinience after tapering down to 15mg.
What do you suggest?

Thanks in advance

happyliving
Regular Member


Date Joined Mar 2008
Total Posts : 163
   Posted 5/20/2008 3:24 PM (GMT -7)   
Helo Judy,

Yeah i started noticing a small amount of blood and mucus in the stool today morning.
Looks like symptoms are coming back.
I called my Doc and left a message. Waiting for hi call.
If he calls tomoroow and asks to go back and stay on 20mg for some days..is it advisable?
is 20mg of Pred is high dosage?
I'm very much concerned about this Pred dependncy....is it normal that this can happen in some cases or is it happening only for me?

Please do respond ..I'm very much scared of this...Your advise is very helpful for me

Thanks in advance...

happyliving
Regular Member


Date Joined Mar 2008
Total Posts : 163
   Posted 5/20/2008 6:10 PM (GMT -7)   
Hello !!

Can anybody please respond to my previous questions?

Thanks for all you time

princesscolon
Veteran Member


Date Joined Apr 2006
Total Posts : 733
   Posted 5/20/2008 8:24 PM (GMT -7)   
Hi Happy.  My advice is if you found the Canasa helpful, stick with them.  I personally did not like Canasa because it seemed to make me have more diarrhea than before, but the enemas take some getting used to and I wouldn't quit something that seemed to be helping.  I don't think 20mgs of Pred is that much, from what I understand, the very highest doseage is 60mgs.  I was steroid dependent for about a year, the only way I got off the steroids was by myself and my UC got worse.  At the time, I could not stand the side effects of the drug and didn't care (as much) about my UC.  I do not reccommend you changing any doses of meds without your doctor's approval. 
 
Ok about the scalp; it may be Psoriasis, I have sores on my scalp when I am flaring, to me it means that my inflammation level is high.  I saw a dermatologist and she gave me a medicated foam which worked for a short while.  Have you shown them to your GI?  I used to only talk about my butt to my GI, but now I know it's useful to tell them everything else going on as well, some things are UC related and I would have never guessed.  If you have any other questions, just ask.
Diagnosed with Left-sided UC in 1995 at age 15, Prednisone, Rowasa & Hydrocort. Enemas, Proctofoam, Sulfasalazine, Asacol, Probiotics, Fish Oil, Aloe Juice, Canasa, Enotcort, Colazol, Anamantle, Remicade, etc... had 1 inch deep rectal ulcer 2004, put on Remicade, August 2007:Increased Remicade dosage-700mg every 6 weeks,diagnosed w/ Psoriatic Arthritis & Fibromyalgia Current meds: Clorazepate, Lomotil,  Tylenol pm, Lyrica started 1/17/08,  Humira started 4/4/08

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