hydrocortisone suppositories -- do they have side effects like the oral version?

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emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 8/27/2008 5:19 PM (GMT -6)   
Hi -- my doctor wants me to try hydrocortisone suppositories along with Canasa for a week or so to try to bring this proctitis flare to a close. He said they don't get into the bloodstream like the oral steroids. But I'm really scared of steroids because I'm already struggling with insomnia and anxiety. Anyone have any experience with these and can offer advice?

Thank you!
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous)
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 8/28/2008 2:38 AM (GMT -6)   
They're a very, very low dosage of steroid and aren't considered "systemic". Will you be doing the steroid supps in the morning and the Canasa at night?

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 !!!


chere2000
Regular Member


Date Joined Jul 2006
Total Posts : 110
   Posted 8/28/2008 4:48 AM (GMT -6)   
Just met my GI today. Will be trying salofalk enemas from today and Ill let you guys know the progress.
My doc told me that regular use of cortisone enemas cause the lining of the colon to become thin. So, worth doing some research on that before starting out
Thx chere
Best remission strategy- positive attitude and optimism
Diagnosed in Feb 2006
6 asacols a day, probiotics, hydrocortisone enema, vitamins, folic acid.
Headed towards remission. Wish me luck


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 8/28/2008 7:13 AM (GMT -6)   
Thanks, guys!

Yes, steroid in the am and Canasa at night. I'm feeling bummed because after meeting with my doctor yesterday, for the first time in a couple of weeks, I saw definite mucous. Rats! Hoping the steroid really will help clear things up.

He did mention that regular use could thin the walls of the colon, but just wanted me to try it for a week to start. We'll see how it goes..
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous)
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 8/28/2008 7:15 AM (GMT -6)   
Quincy, by the way, did you happen to see my earlier post about Effexor? I see you have it in your signature, and wonder if you have any advice on how it's worked for you. Thanks so much!
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous)
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid


bookworm21
Veteran Member


Date Joined Mar 2008
Total Posts : 1766
   Posted 8/28/2008 8:34 AM (GMT -6)   
I used proctofoam for over 2 months and I never had any side effects (but it also didn't help b/c I think most of my bleeding was from the upper colon).
Female, Age 19, Dx w/ UC August 2007
9 Asacol, Rowasa1000 mg Canasa, Proctofoam, Rifaximin 2/day
Digestive Advantage (Crohn's & Colitis)1 Florastor, 50 mg 6MP,1 Primadophilus reuteri, Remicade (3rd infusion 07/08), 2.4 g Lialda, 1 Forvia, 6 Colazal/day
*Step 1--09/08


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 8/28/2008 12:20 PM (GMT -6)   
emory.....your next progression should actually be to the 5ASA enemas with a higher dosage of medication .... as well to help the proctitis from spreading upward.

I didn't read your posting about it...will do and maybe answer you there.

I've been on low dosage of Effexor for about 7 years...it's awesome for me since the depression/anxiety cycle is tough to deal with sometimes.
Therapy was also amazing. I did therapy long before I had to make the decision to go on Effexor. Coping was too beyond what I was able to deal with.

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 !!!


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 8/28/2008 3:52 PM (GMT -6)   
Hi Quincy,

If you had a chance to read my Effexor post, you'll know a little more of my history. My doctor wants me to try Lialda again (yep, treating from both ends!), but my two brief experiences so far have ended so badly that I'm gunshy. Both times it was right around my period,and maybe that was really what was making me sick, but man, was I sick. Totally ruined our 16th wedding anniversary.

So anyway, when I talked to him yesterday, symptoms seemed to be very much on the mend -- had been taking Canasa for 37 days, stopped seeing blood on a regular basis on day 21 (with blood once on day 24 and 26), then nothing up to the time I saw him. So he said some people had really good results with the hydrocortisone suppositories within a few days, and to try it for a week. And that if I wanted to try skipping nights with Canasa, I could try that around now as well. Of course, that evening, I saw what seemed to be definite mucous for the first time in a long time...so I'm going to try cort in the morning, Canasa at night for a week and see how it goes.

I really feel the mesalamine is contributing to sleeplessness/anxiety. I've been really sensitive to medications (and caffeine, etc.) since brain surgery. But I know I have to get this proctitis under control. It's a conundrum, but everybody with UC seems to be facing one of their own.

Hormones may not be helping either; I think I'm in perimenopause, and like I said, these last two periods (while flaring) have been doozies. But I'm really starting to ramble. Just wanted to lay out the logic behind my current treatment. (Though I admit my doctor always seems a little vague on the specifics of what he wants me to do.)

Thanks, Quincy, and anyone else with the patience to read this. Be well --
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous)
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid


NMcP
Regular Member


Date Joined Mar 2008
Total Posts : 212
   Posted 8/28/2008 4:15 PM (GMT -6)   
I can't keep enemas in. I have good luck with Canasa and cortifoam. Neither one bugs me at all.
Age: 48
location: Seattle, Wa
currently in small flare, tail end of colon
Diagnosed with UC in June 2006
Medications: Asacol 3 pills 3 x/day, Cortifoam at bedtime, Canansa in the morning
No. of colonoscopies: 1
Originally diagnosed with moderate UC, pancolitis


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 8/28/2008 11:31 PM (GMT -6)   
emory....totally sucks when an event is taken over by being sick. Happy belated 16th!

Regarding the Lialda...what is the dosage the doc wants you on?
Were you ever on Asacol? how many?

Regarding the enemas, which would be worth for you to try if your UC is limited to the rectum...the Rowasa comes in a 2g dosage..something to try rather than the 4g which is mostly prescribed.

The hydrocortisone comes in foam form enema as well...something else to consider.

Regarding hormones....oh yes!!! bigtime fluctuations can definitely affect flares.

How are you eating? What other supplements are you taking?

You do have special considerations regarding medications...the anxious feelings can be from the meds or can be from the hormone fluctuations as well.

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 !!!


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 8/29/2008 4:19 PM (GMT -6)   
Thanks, quincy -- 16 years is a milestone worth celebrating! I hope we'll have reason to celebrate soon enough. I have to say my husband isn't having the easiest time with my illness.

Re: Lialda, on the first try, the doctor said take one the first week, two the next week, three the next to avoid headaches, so I guess he wanted me at 3.6 mg. The next try, he just said try one pill for a week, then go to two if you do okay. I only made it to day 4.
He told me there are new studies showing that Lialda works better than the other oral mesalamines and than suppositories on proctitis, so he really wants me to give it a try.

I've never taken Asacol. I was wondering if it might have less amounts of mesalamine in the system at a time, and thus be more tolerable. My brother also has UC (13-15 cm since 2004, which is actually when I had my first small flare), and he says Asacol always worked for him within a week. He hasn't had to take meds in two years. I am so jealous of him right now. (And so grateful for his experience.)

I'm doing my best to eat. The nausea/food revulsion, during the periods it strikes, makes things really hard. I'm trying to stick to a low-residue diet, but that's totally the opposite of how I've always eaten -- tons of whole grains, raw fruit and vegetables, and salads. I'm 5'8", was 148 in late June, and just weighed in at 127.5. It's getting worrisome.

Not taking any other supplements right now because of the nausea, but am planning on a B vitamin complex and fish oil. Also interested in FiberCon and probiotics.

Saw my psychiatrist today; after looking at my sleep/medicine/BM logs, she thinks the nausea/anxiety is from the meds, not so much from my period since I've never had that problem in the past. My gastroenterologist thinks the nausea symptoms are just anxiety (and not the kind from meds), not UC related since I just have proctitis. Me? I don't know what to think. I just want to get past this flare in the hope that I can start eliminating at least a couple of meds from my life.

Thanks for any thoughts. It's such a relief to have this forum...
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 8/29/2008 4:23 PM (GMT -6)   
Oh, by the way, since I saw mucous on Wed. night, my gut has been doing tons of rumbling and gurgling. I suspect that means my flare is kicking back in.
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 9/1/2008 9:14 AM (GMT -6)   
Saw a tiny smear of blood last night. Feeling quite anxious down. Before that, I'd thought the hydrocortisone suppositories were really helping; maybe they still are.
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1190
   Posted 9/1/2008 12:43 PM (GMT -6)   
The blood and mucus could be hemmies....

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)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 9/1/2008 12:44 PM (GMT -6)   
Hi...I think you should just stick to a LOW dosage of Lialda...2 daily is a good amount, that's all I'm on.

Add the 5ASA enemas 2gram dosage instead of the suppositories.

Worth a try because less is best and you've clearly got a tolerance level well defined.

My opinion on it.

quincy
*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 !!!


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 9/1/2008 1:37 PM (GMT -6)   
Hi, and thanks for the replies --

LondonRed, I asked my GI about hemorrhoids, and he said he didn't see any sign during the scope in June.

Quincy, I may not be understanding your advice properly. I never even managed to take more than one Lialda a day for four days. !I'd love to be able to take two a day and hope to get this under control.)

Are you saying 5ASA enemas instead of Canasa suppositories, or hydrocortisone suppositories, or both? The 2 gram enema would be twice the dose of 5ASA as I'm currently getting.

In case my GI was right and anxiety is my main problem, I upped my Effexor to 75 mg as of last Friday night, and am waiting for that to settle in.

Is proctitis supposed to be this tough to treat?
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1190
   Posted 9/1/2008 1:59 PM (GMT -6)   
I need something to soothe me, I feel sore after each bowel movement - and I am fed up of seeing fresh blood dripping into the toilet pan and on the outside of my stools. It's like they bleed on their own after a bowel movement and pool up in time for my next BM. I hate it.

I am certain steriod suppositiories can help the piles and the inflammation at the same time.

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)


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 9/1/2008 2:08 PM (GMT -6)   
I would give it a try, LondonRed -- my steroid suppositories say "hemorrhoid suppository" right on the outside.

I need something to soothe me, too, but it's my mind and heart that seem to hurt the most today. (4.5 hours sleep doesn't help.)

Best to you, emory
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 9/2/2008 1:47 AM (GMT -6)   
Oh emory, I didn't read your original correctly...oops.

Did you ever take Asacol?

I would still suggest a retention enema.....yes, the 5ASA to start...if you cannot use 5ASA meds, then go to either the foam steroid or the liquid steroid enemas.

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 !!!


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 9/2/2008 9:32 AM (GMT -6)   
Thanks, quincy --

Haven't ever taken Asacol or tried enemas. Every medicine I add to the list seems to make me sicker. And now I'm seeing a little bit of blood again on a regular basis. So discouraging. But I'm so grateful for your input, and will talk to my doctor about those options.

emory
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 9/2/2008 10:14 AM (GMT -6)   
Hang tougn...maybe the increase of Effexor will help your moods.

Are you using the steroid supps daily and the Canasa nightly at this time?

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 !!!


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 9/2/2008 2:44 PM (GMT -6)   
Yes, I'm using the rectal meds day and night (steroid am, Canasa pm). I'm afraid the Effexor increase is actually making me more agitated and sleepless; might not be able to stick with it (though dropping back down to 37.5 worries me too). What a mess! I hope my GI calls back soon.

It's not helping things that my husband is leaving Thursday for 5 days, so I'll be on my own with our 5-year-old. Thank heaven I have some friends lined out to help with childcare. Now I mostly have to worry about me-care.

Quincy, I'm grateful for your support!

emory
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 9/3/2008 2:12 AM (GMT -6)   
Hi...you're welcome!

Why exactly are you taking Effexor? For depression? Are you taking it at night or in the morning?

If you just started the 75mg, I would think it would be no problem to go back down to the 37.5.

Do you take the clonazepam at night as well?

Hope the doc calls you today!
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 !!!


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 9/3/2008 7:30 AM (GMT -6)   
I'm taking the Effexor for anxiety and depression that emerge after I have a bout of insomnia (like now). Since I had brain surgery three years ago, I have crazy insomnia where I simply don't go to sleep. The past few nights, I've been taking my medicine at night, falling asleep for three or four hours, then finding myself wide awake at two or three in the morning. This is a new pattern for me, and I'm having a hard time combating it combined with worry about my flare coming back and my husband leaving town for a few days.

The past two times I've taken Effexor, it helps me get regulated so I sleep fine. Clonazepam is just a stop-gap that I then have to taper off. Anyway, I've always taken Effexor right after dinner, then clonazepam just before bed. Last night I took another clonazepam in the middle of the night, and it did nothing. I am exhausted.

I did drop back to 37.5 last night; I think 75 was having too much of an excitatory effect on my system, and I don't have the energy to wait a couple of weeks to see if it levels out.

Just hoping the next night will be better -- can't expect the flare to improve on no sleep! Not to mention life just feels like an endurance test.

Take care, quincy --
emory
40 years old and female
Dx ulcerative proctitis June 2008 (after 5 weeks of blood and mucous) and still flaring
Canasa 1000 mg suppositories nightly, 25 mg hydrocortisone suppositories in a.m.
Effexor 37.5, Clonazepam .5 mg and Trazodone 50 mg for sleep
2.5 mg methimazole for thyroid
Osteopenia (and I haven't even taken steroids!)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30614
   Posted 9/3/2008 9:09 AM (GMT -6)   
Hi....I've not heard of Effexor helping with the sleep patterns, interesting. What if you took it at breakfast instead of at supper?

I can totally understand the stress and anxiety you're having at this time.

Oh, what about calcium with vitamin D...do you take that? that could help possibly?

quincy
*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 !!!

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