Any New Cures coming for Colitis?????

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cra43
Regular Member


Date Joined May 2008
Total Posts : 172
   Posted 8/21/2008 1:35 PM (GMT -6)   
Ok,  I was wondering if there is anything new coming that people may know about.  I know that NIH was doing a trial test with Interferon shots and they have completed them.  Also,  I read something about a missing enzyme in the intestines that may be causing colitis and when they did tests with mice, and took this enzyme out, they got colitis.  When they put it back, the mouse got better.  Does anyone know anything about any new treatment coming.  It seems to me, instead of pumping people full of drugs that do more damage, they need to figure out just what causes this, and then fix it.  My son was perfectly healthy until he was 34 years old, then BAM,  he started with this bloody diahrea and they decided after colonoscopies that it was universal colitis.  What the???   How does this happen?
His whole colon is affected and he is so depressed, that I get scared he may do something stupid.  It has been 6 years and he is still fighting this.  The only time he feels better, is when he is taking prednisone.   I sure hope, for all your sakes that some new treatment is soon coming.

bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 8/21/2008 1:52 PM (GMT -6)   
Ours and all the other serious diseases could benefit from uninhibited stem cell research here in the US.

I'd imagine in 5+ years the current forms of remicade etc may be modified etc to lessen side effects etc and at 10 years there may be something new and exciting that get s approved.

If your son's entire colon is involved it's referred to as Pancolitis (I have the distinct pleasure of having that too).

Try to keep his stress levels way down if you/he can.
Mild to Moderate Pancolitis
Dx'd 05/2007
3 Lialda per day
Generic Rowasa daily or every other night
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5698
   Posted 8/21/2008 2:26 PM (GMT -6)   
I just attended an IBD meeting where this question was asked and the doctor hosting it said there were no known miracle drugs in the works for UC at this time.

Your son is not alone, ALL of us were smacked with UC at some point in our lives. UC has a genetic (not hereditary) component so your son had the UC gene in his system and whatever factor (biological or envrionmental) triggered it is unknown.

Your son needs to get off prednisone. Prednisone is not a maintanance drug and has terrible long term side effects. You should encourage him to get more active in combating his disease by either participating on this board or going to local CCFA meetings. There is hope out there and some of the best comes from UCers sharing with each other.

If his quality of life is poor and it's compromised work and activities he ought to research surgery. That's about the best fix for refractive disease.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1190
   Posted 8/21/2008 3:53 PM (GMT -6)   
My GI told me today that University of London Hopsital have found a link with taking Viagra during remission that keeps Crohn's and Colitis at bay and that's the new line of thinking - boosting blood cells in a particular area.

Diagnosis Oct 07 and then Aug 08: 2 Patches of Mild Chrohn's Colitis (unconfirmed)
Medication: 4000mg Pentasa a day, 5mg Clipper Steroid (Beclometasone dipropionate)


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 8/21/2008 5:49 PM (GMT -6)   
LondonRed said...
My GI told me today that University of London Hopsital have found a link with taking Viagra during remission that keeps Crohn's and Colitis at bay and that's the new line of thinking - boosting blood cells in a particular
 
Here's an article from 2006...wondering if your doc's info is new? It appears the researchers are saying a WEAK immune system is the cause vs. an overactive one...
 

Viagra May Help Crohn's Disease

Researchers Say Weak Immune System May Trigger Disease
By Salynn Boyles
WebMD Health News
Reviewed by Louise Chang, MD

Feb. 23, 2006 -- Researchers in the U.K. have a new theory to explain the cause of Crohn's disease, and they say medications like the erectile dysfunction drug Viagra may prove useful for treating the bowel disorder if they are right.

In Crohn's disease, chronic inflammation causes ulcers within the digestive tract that can lead to severe gastrointestinal symptoms, including abdominal pain, persistent diarrhea, and rectal bleeding.

The most widely accepted theory is that an overactive immune system causes the damaging inflammation. But researchers from the University College London say the opposite appears to be true.

They believe a weaker-than-normal immune response triggers the bowel inflammation that leads to Crohn's disease. Their research appears in the Feb. 25 issue of The Lancet.

1 Disease, 2 Theories

The prevailing theory of Crohn's disease is that the body's immune system reacts abnormally in people with the disorder, producing chronic inflammation that leads to bowel injury.

Tony Segal, professor of medicine at University College London, explains the weak immune system theory like this: "The wall of the bowel is normally an effective barrier against the bowel contents, but sometimes the barrier is broken by an infection or injury and the bowel contents, which include large numbers of bacteria, penetrate into the bowel wall.

"Normally, an acute inflammatory response would kick in to remove the bacteria and return the condition of the bowel to normal. But in Crohn's disease, we think that the acute inflammation fails to kick-start, leaving bacteria to fester in the bowel wall which, in turn, triggers chronic, secondary inflammations."

Segal and colleagues conducted a series of small experiments that measured white blood cell production in response to intestinal and skin trauma in both Crohn's patients and healthy patients. With inflammation, white blood cell numbers are expected to rise. In one experiment, researchers injected a killed gut bacteria into the forearms of patients and healthy participants to study blood flow and immune response.

They found that the Crohn's patients produced unexpectedly lower levels of white blood cells and proteins involved in inflammation, compared with people without the disorder.

Segal tells WebMD that people who carry a gene that has been linked to Crohn's disease may be especially vulnerable to getting the disease if they have weak immune systems.

He added that drugs like Viagra, which open the blood vessels and increase blood flow, may help.

The Viagra Response

The researchers tested this theory by treating 10 Crohn's patients with 50 milligrams of Viagra after injecting them with the killed gut bacteria. They found that blood flow to the infected area improved.

"Increasing blood flow is an important part of the inflammatory response, and that is why this drug may work," Segal says. "But we don't yet know if this will give rise to successful treatment. We need to study this further to find out."

The Viagra Response continued...

Segal and colleagues are among a growing number of researchers suggesting that a weak immune system, rather than an overactive one, is largely responsible for Crohn's disease, says University of Chicago associate professor of medicine Sunanda Kane, MD.

She adds that the new research adds credibility to the theory but does not prove it.

"This is a little more evidence that maybe we have been barking up the wrong tree," she tells WebMD. "The idea that we should be strengthening the immune system -- rather than suppressing it -- sounded a little crazy at first, but the evidence continues to come in. But we still have a long way to go to really understand what causes Crohn's."

Biologic agents that stimulate a specific part of the immune system are now being tested in Crohn's patients. If such treatments prove effective, Kane says doctors would have an effective alternative to steroids, which work well for many patients but have many side effects.

"For decades now suppressing the immune system [with steroids] has worked, and we will continue to do so until we find alternatives that work for everybody and are risk-free," she says.


Mild to Moderate Pancolitis
Dx'd 05/2007
3 Lialda per day
Generic Rowasa daily or every other night
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!

Post Edited (bbc) : 8/21/2008 5:55:08 PM (GMT-6)


kazygirl
Veteran Member


Date Joined Sep 2007
Total Posts : 955
   Posted 8/22/2008 12:23 AM (GMT -6)   
my doctor told me that the more studies they do on UC (IBD) that the more confusing the disease becomes.

not very promising.
steph - 32 - female - UC since 2000
currently flaring again..  grrr! (triggered by stress - grrr)
mesalazine granules 3g x1 a day (much nicer than a million tablets a day)
enteric coated fish oil -omega 3 (so they get all the way to my colon)
vitamin D3 x1 a day
prednisolone 25mg x1 a day (ick ick and did i say ick?)
tumeric capsules x3 a day
 
 
 


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 8/22/2008 12:33 AM (GMT -6)   
suebear said...
 UC has a genetic (not hereditary) component so your son had the UC gene in his system and whatever factor (biological or envrionmental) triggered it is unknown.

Sue

Genes are tiny particles that determine all hereditary
traits. They are carried on the chromosomes. Each
chromosome bears hundreds of genes, arranged in a line
along its length. Every person inherits two genes for a
particular trait -- one from his/her mother and one from
his/her father. But in many traits, the action of one gene
completely overpowers the action of the other. The powerful
gene is called dominant and the other recessive. For
example, suppose a dark-haired father and a red-haired
mother have a dark-haired child. In this case, each of the
child's cells contains a gene for dark hair and a gene for
red hair. But because the child has dark hair, it is
apparent that the gene for dark hair is dominant over the
gene for red hair.

Recessive genes do not visibly show up when there is a
dominant gene present. A hybrid is a person who has both a
dominant and recessive gene. Their appearance is that of a
person who has no recessive gene, but they carry the
recessive gene, and it is possible their children will also.

There are also times when there is a compromise. If two
genes are both dominant, the resulting offspring will have
a blend of those genes. For example, a black rooster and a
white hen mate, and the resulting offspring are gray. The
same can be said for people.

Genes are made of deoxyribonucleic acid, or DNA for short.
DNA is a threadlike molecule with a diameter of only about
one ten-millionth of an inch. The thread is actually
double, and resembles a tiny twisted rope ladder. A DNA
molecule contains two kinds of purine bases. They are
adenine (called A) and guanine )called G). It also contains
two kinds of pyrimidine bases called cytosine (C) and
thymine (T). A and T fit together and C and G fit together.
No other combinations work. In other words, there are only
four kind of base-pair combinations in a DNA ladder: A-T
and C-G, or T-A and G-C. All genes in every cell contain
these same four bases, A, T, C, and G. The difference
between one gene and another lies in the arrangement of
pairs of bases along the DNA molecule. There are at least
several hundred pairs of bases in each gene. For this
reason, a vast number of arrangements is possible, and
countless kinds of genes can be formed.

Another aspect of genetics is mutation. A gene is an
extremely stable structure. It may remain stable through
thousands of generations, copying itself correctly in
between each cell division. Occasionally, however, a
mistake occurs in the copying process. This mistake may
upset the ordered sequence of base-pairs in a gene and
cause a mutation.

Some mutations are helpful and may change an animal or
plant so that it is better equipped to live in its
surroundings. For example, once ducks had no webbing on
their feet. Only mutant ducks had webbing at the time. The
mutant ducks were better swimmers, so they survived attacks
from predators while ducks without webbing did not. Thus
only ducks with webbed feet survived, and we have the
modern duck.
:)
My bum is broken....there's a big crack down the middle of it! LOL :)


cra43
Regular Member


Date Joined May 2008
Total Posts : 172
   Posted 8/22/2008 12:55 PM (GMT -6)   
Wow, you guys gave me a lot to read and learn. Yes, being my husband has a mild form of colitis, my son may have inherited this.
As far as surgery goes...he refuses to even think about that. Especially since he has NO medical insurance and it would cost a small fortune. He is turned down whenever he attempts to buy insurance due to this preexisting condition. He pays for all his meds, lab work, doc. visits and colonoscopies now, out of pocket. Costs him a lot, but what can you do. I hope Obama wins in this election, and gets us a better method of medical insurance.
Thanks for all your replies. Caring mom.

mudua
Regular Member


Date Joined Apr 2007
Total Posts : 459
   Posted 8/22/2008 12:56 PM (GMT -6)   
I dont think that genetics is the only cause of IBD.

I don't have anyone else in my family sufferng from this diseases

suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5698
   Posted 8/22/2008 1:06 PM (GMT -6)   
Genetics doesn't necessarily mean hereditary. Hereditary is familial.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 8/22/2008 2:40 PM (GMT -6)   
It's estimated that if one parent has IBD their offsrping has a 10- to 15- fold increased risk of developing IBD compared with those who do not have a parent with IBD.

Genetic influences have long been suspected to play a role in IBD based on the following...

A significant percentage (~20%) of IBD patients have a relative that also suffers from IBD

Certain ethnic groups are at substantially higher risk for IBD than the general population.

There are extream cases of familial IBD where nearly every family member suffers from the condition.

In studies of identical twins, if one twin has crohn's disease (for example) there is a 40-60% chance that the other twin will also have the disease.

In sorting out how disease is inherited, two questions are relevant, 1) what gene is involoved, and 2) how is that gene passed on from parent to offspring.

In a disease like cystic fibrosis, there is a single gene defect involved and the pattern of inheritance is such that the affected person must recieve two defective genes -one from their mother and one from their father. In contrast, in IBD it appears that many different genetic defects may be simultaneously necessary to produce disease. The mathematical pattern of inheritance that is the case in cystic fibrosis is simply not known in IBD, so transmission to offspring is highly unpredictable.

Several different genes have been identified that are associated with IBD and it is very likely that many more IBD genes exist and await discovery. In general, these genetic alterations cause the immune system to respond inappropriately to triggers such as intestinal bacteria, resulting in uncontrolled inflammation.

In order to get an IBD one must be predisposed to getting it (genetics) then it's a matter of it being triggered...
 
Muda, just because no one eles in your family is suffering with IBD doesn't mean they don't have it, it just means theirs may not have been triggered yet....my mom got sick with UC in her mid 60's, I was already sick with crohn's in my early 20's, duh, I had CD before she had UC, but clearly it was passed from her to me since she is my mother afterall...why does everyone always seem to think that because they are the only one that "has it" in their families that no one eles in their families will likely get it...it's been proven time and time again that one must be genetically predisposed to getting IBD in the first place and then a trigger is involved.

:)


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


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 8/22/2008 3:06 PM (GMT -6)   
pb4 said...

Genetic influences have long been suspected to play a role in IBD based on the following...

A significant percentage (~20%) of IBD patients have a relative that also suffers from IBD
Suspicion does not a fact make. I'm glad they're continuing to do research on this, perhaps we'll have an answer sooner than later. And remember, 20% of IBD patients have an affected relative. That means 80% don't, so if genetics is a factor, there are other factors that clearly have even more to do with whether a given person develops IBD or not.
Judy - Southern US 
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from Entocort.
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.


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 8/22/2008 3:23 PM (GMT -6)   
"affected" is the key word...20% have an "affected", that simply means that 80% have a relative(s) that are not affected yet, doesn't mean they won't be...not to mention, not everyone will speak of their bowel habits, some people have bowel issues and live in denial.

Ya, the other factor of whether a person will develop it or not is the matter of it being triggerd for them....there are millions likely walking around that are predisposed to getting an IBD but unless it's triggered for them they won't get it, doesn't mean they don't have the potential to get it because if they are predisoposed to getting it and it gets triggered for them then they'll have it.

But in general it seems like most look at their disease with narrow vision especially if they're the only ones in their family at the moment that are suffering with it.

It's easy to prove that someone, somehwere in every one of our families (even just one relative) had/has it becuase if they didn't then you wouldn't have it, but try proving that everyone you've ever been related to NEVER had it (predisposition). No one here can possibly know all the detailed health issues of every family member they're related to, especially those in the distant past...IBD has been strongly suspected to have been around alot longer than what most people realize, and back then how often do you think people discussed their bowel habits of all things, compared to nowadays?
My bum is broken....there's a big crack down the middle of it! LOL :)


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 8/22/2008 3:28 PM (GMT -6)   
Gee, why do you think this is going on....



Michael J. Howorth
The CCFC is delighted to announce funding for The Michael J. Howorth IBD GEM Project: A Human Study on The Genetic, Environmental and Microbial Interactions that Cause IBD led by principal investigator Dr. Kenneth Croitoru. This exciting project is a multi-disciplinary multi-centered prospective study of healthy subjects at high risk for developing Crohn’s disease. The Foundation is proud to name this landmark study in honour of its late National Executive Director Michael J. Howorth, who passed away in November 2006.


Researchers plan to recruit 5,000 healthy subjects (between the ages of 6 and 35 years), identified as being at high-risk to develop IBD as they have siblings with Crohn’s disease. When recruited, biographical and environmental information of subjects will be collected, baseline intestinal permeability will be measured, and stool and blood studies will be collected and stored. Researchers expect some of these at-risk subjects to develop Crohn’s disease during the follow up period, which is when the stored biological material will be studied in parallel with matched controls for defined genetic, immunological and microbial features.

NEW! If you have been diagnosed with Crohn's disease or if you have a full sibling who has been diagnosed with Crohn's disease and you are between the age of 6 and 35 years old, you are invited to participate in this study.


Because they know there is potential risk for other family members that are not yet AFFECTED.

And I'm well aware they are speaking of crohn's but they have to start somewhere and I'm sure they'll discover plenty that are linked to UC even with having a CD relative in the study...afterall, my mom has UC and I have CD so they know that this GEM project is about IBD and they're not ruling out finding UCer potential I'm sure.
My bum is broken....there's a big crack down the middle of it! LOL :)


damo123
Veteran Member


Date Joined Jul 2007
Total Posts : 714
   Posted 8/22/2008 3:30 PM (GMT -6)   
Two comments:
 
The more "genetic" UC is in nature the faster a "cure" will come. Genetic research is progressing at a very fast pace. The less "genetic" UC is nature the less chance of finding a cure.
 
Most research is not centred at finding a cure for UC but rather at finding ways of prolonging remission. Meidcal discoveries very rarely come as "eureka" type moments as per the hollywod movie!. Rather they come as gradual pain-stakingly slow discovery upon discovery. The cure for UC will ultimately be a form of prolonging remission for most from an avergae of 5 years to 6 years to 7 years to......to 20 years to 25 years....to 35 years...to...with the stress on the phrase "on average".
 
The cure for UC won't come as a set of pills. It will be a form of treatment that just extends remission - gradually improved over time to work for more and more people for a longer and longer period. 
Probiotics and maintenance 5ASA's in rectal form
 
"Whatever you do in life don't berate yourself too much nor contragulate yourself too much. Your choices are half chance. So are everybody elses'"
 
 
 
 
 
 
 


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 8/22/2008 3:50 PM (GMT -6)   

like this....copy and paste into your browser...

http://www.eurekalert.org/pub_releases/2008-08/mgh-bms082008.php



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


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4236
   Posted 8/24/2008 7:31 PM (GMT -6)   
bbc - The article you posted is very interesting. Thanks for posting that. I always felt like I had a weakened immune system, not overactive, in all other regards besides UC.
Diagnosed with UC March 2007; Asacol 4 tablets 3x/day; Rowasa weekly; Canasa weekly; Viactiv; Metamucil wafers; multivitamin


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 8/24/2008 8:49 PM (GMT -6)   
You're welcome Sara...this leads me to believe that in some, its over active and others, under...perhaps that's why the immune suppresants only work for some....
Mild to Moderate Pancolitis
Dx'd 05/2007
3 Lialda per day
Generic Rowasa daily or every other night
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4236
   Posted 8/24/2008 10:42 PM (GMT -6)   
Yeah, that would make sense. I kept thinking about that while reading the article...how can the immunosuppresants work for some people if IBD is caused by a weakened immune system in all cases. But it would make sense if some had a weakened system and others had an overactive one.
Diagnosed with UC March 2007; Asacol 4 tablets 3x/day; Rowasa weekly; Canasa weekly; Viactiv; Metamucil wafers; multivitamin


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 8/25/2008 6:33 PM (GMT -6)   
I don't know if there is a test to first see if one's immune system is over or under active...and I sure as heck would want to know first before taking immune system suppresants!

Mild to Moderate Pancolitis
Dx'd 05/2007
3 Lialda per day
Generic Rowasa daily or every other night
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


men8ifr
Regular Member


Date Joined Jul 2008
Total Posts : 124
   Posted 8/26/2008 5:27 AM (GMT -6)   
I think I tolerate ASA OK but steriods were no good for me - are these supressing or increasing the immume system?
Ian

6 Asacol tabs/day
1 Pentasa Suppository / day
Fish oil 3/day (omega 3 only)
Multivitamin and mineral 1/day
Folic Acid 1/day
Aloe Vera 3/day
Specific Carbohydrate Diet SCD
Turmeric 3/day
Currently in no mans land between flare and remission


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4236
   Posted 8/26/2008 8:21 AM (GMT -6)   
bbc - There is a test (I believe a blood test) to see if you have an underactive immune system. My GI brought up the possibility of me having one last year when I kept constantly getting infections for a few months straight but said it was incredibly unlikely since I had UC (which most still think is due to an overactive immune system)
Diagnosed with UC March 2007; Asacol 4 tablets 3x/day; Rowasa weekly; Canasa weekly; Viactiv; Metamucil wafers; multivitamin


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4236
   Posted 8/26/2008 8:23 AM (GMT -6)   
men8ifr - steroids suppress the immune system
Diagnosed with UC March 2007; Asacol 4 tablets 3x/day; Rowasa weekly; Canasa weekly; Viactiv; Metamucil wafers; multivitamin


UC Mom
Regular Member


Date Joined Jun 2007
Total Posts : 146
   Posted 8/26/2008 9:46 AM (GMT -6)   
 
Check out the numbers for people posting with Crohns and UC.  Way more than any other disorder on the list.
UC Mom
Son diagnosed 10, 2006 at age 15
6MP 100 mg. per day
Vitamin Supplements
Culturelle


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4236
   Posted 8/26/2008 10:23 AM (GMT -6)   
Here's a short article about the weakened immune system theory: http://www.wellcome.ac.uk/News/News-archive/Browse-by-date/2006/News/WTX031960.htm

It's kind of scary if the immunosuppressants may actually be worsening the disease...

I may be wrong about the blood test to check for an underactive immune system..I can't remember for sure. I tried looking it up, but haven't found anything so far.
Diagnosed with UC March 2007; Asacol 4 tablets 3x/day; Rowasa weekly; Canasa weekly; Viactiv; Metamucil wafers; multivitamin

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