A strategy for a limited supply of rectal meds

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Hans C
Regular Member


Date Joined Dec 2006
Total Posts : 89
   Posted 9/18/2008 3:23 AM (GMT -6)   
Hi as one or two of you with excellent memories may recall I'm living in Vietnam and I have no access to rectal meds.
 
Mine's left-sided and at home the rectals worked quickly for me. I've been in a flare for about a year - it's possibly come and gone slightly. flare has been characterised by lack of discomfort and consistent blood. The blood has always been present to some extent.
 
I have access to a generic asacol tablet of which I take 3x400mg 3 times a day.
 
Over the last couple of weeks the blood in my stool has become somewhat darker. My stool has gone from diarrhea consistency to mushy cottage cheese consistency. My bms over recent months begin with liquid (possibly undigested bile) and since my bm has become mushy I only notice the blood is mixed in with the toilet water and apparently not the stool itself.
 
Anyway my friend is visiting from home and he's going to be able to bring me some unused rectals from my home. There will be 6 (only! mad ) salofalk enemas and maybe 10(or more) prednisolene enemas.
 
In the past I've used salofalk enemas with great success - I'm not sure of the prednisolene's success.
 
So I would love to hear any suggestions on an optimal strategy for using these enemas.
I was thinking the preds first then the salofalks. One a night of the preds and I'll try to stagger them out.
Maybe introduce the salofalks when staggering the prednisolenes so that it becomes an alternate night thing.
 
Oh yes and I will be in Bangkok and India in November so I have some hope of tracking down rectals there then.
 
Thanks for reading - best wishes to all
age 26  ------------- diagnosed 2004 (probable left sided)

Multi-vitamin                                       Lactobacillus acidophillus sachets
Aloe vera - Omega3 fish oil                    Asacol (8x400mg)                     
Iron, folic acid and b12 supplement__________________________________________________ 


quincy
Elite Member


Date Joined May 2003
Total Posts : 30603
   Posted 9/18/2008 9:49 AM (GMT -6)   
Hi....I would do the steroid enema one night....skip 2 nights, then do the Salofalk. That'll give you twice a week until you're able to track down the other meds.

My suggestion anyway.

You could increase fibre supplements.

Vitamin D up to 800 - 1000 IU daily

No artificial sweeteners...

quincy
*Heather* Status..Asacol 6 (3 twice daily); enemas every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 4(Natural Factors Protec) bedtime + Primadophilus Reuteri Pearls occasionally
~multi-digestive enzymes as needed
~Ranitidine,Pariet (reflux);  Effexor XR 75mg(depression);  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 !!!
 


Hans C
Regular Member


Date Joined Dec 2006
Total Posts : 89
   Posted 9/18/2008 10:21 AM (GMT -6)   
Thank you Quincy-

so... steroid e. first night, nothing second and third night, salofalk fourth night, nothing fifth and sixth night, steroid e. seventh night... right?

And from my symptoms would you say that sounds like rectal inflammation? I know the blood's a bit darker but I kinda feel the blood's mixing with some other fluid. This evening I had dripping blood...
age 26  ------------- diagnosed 2004 (probable left sided)

Multi-vitamin                                       Lactobacillus acidophillus sachets
Aloe vera - Omega3 fish oil                    Asacol (8x400mg)                     
Iron, folic acid and b12 supplement__________________________________________________ 


quincy
Elite Member


Date Joined May 2003
Total Posts : 30603
   Posted 9/18/2008 9:24 PM (GMT -6)   
Hi....you can mark the proposed schedule in a lower corner of a calendar..in pencil or have white-out. I plan all my tapers that way...written because I don't remember. It also serves as a reference in the future if you have to look back. The schedule can always change based on symptoms and if I evaluate a faster taper..etc.

So, it would basically be an enema every third night. The night you do it....count the next day as one, the day after as two, the next day third and enema night.

So, two nights in between with no meds....and that's all because of your limited supply making a suggestion to stretch it out.

Every second night would work as well but for not as long...enema (5ASA), skip, enema (steroid), skip..etc..

I would be remiss to not suggest a proper treatment to do the enemas every night, one night 5ASA, the next steroid.

quincy
*Heather* Status..Asacol 6 (3 twice daily); enemas every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 4(Natural Factors Protec) bedtime + Primadophilus Reuteri Pearls occasionally
~multi-digestive enzymes as needed
~Ranitidine,Pariet (reflux);  Effexor XR 75mg(depression);  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 !!!
 


Hans C
Regular Member


Date Joined Dec 2006
Total Posts : 89
   Posted 9/19/2008 3:56 AM (GMT -6)   
Ok I understand thanks for you suggestions
age 26  ------------- diagnosed 2004 (probable left sided)

Multi-vitamin                                       Lactobacillus acidophillus sachets
Aloe vera - Omega3 fish oil                    Asacol (8x400mg)                     
Iron, folic acid and b12 supplement__________________________________________________ 


quincy
Elite Member


Date Joined May 2003
Total Posts : 30603
   Posted 9/19/2008 10:53 AM (GMT -6)   
You're welcome...keep us updated....

q
*Heather* Status..Asacol 6 (3 twice daily); enemas every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 4(Natural Factors Protec) bedtime + Primadophilus Reuteri Pearls occasionally
~multi-digestive enzymes as needed
~Ranitidine,Pariet (reflux);  Effexor XR 75mg(depression);  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 !!!
 


Dr-A
Veteran Member


Date Joined Jul 2006
Total Posts : 2105
   Posted 9/19/2008 1:43 PM (GMT -6)   
Another suggestion.

Sometimes just sticking the whole enema in is a waste because you end up voiding it right back out. What I did on my cortenemas is use 1/2 to 1/3 of bottle at a time (20-30 ml). When the first bottle is empty that then becomes my prep bottle. I'll fill it up the prep bottle with some warm distilled water and put it in first. If that goes in with no problem and I feel like I could hold it for awhile, then I'll jump on the toilet and void the water, lay back down and relax a second then use 1/2 of the cortenema. Your risk of wasting the stuff becomes much less, and I have been doing this for years and years when flaring. In between that you can use another empty bottle for Vitamin E enemas which are very soothing to a flaring colon. I used 2-3 tablespoons of distilled water, 4 of the vitamin shoppes E-1000 iu d-alpha softgels, and warmed that up just a little and used it after washing the lower part of my colon once with the initial prep. Then you sorta either can do left side, back, right side, or I just propped myself up against a wall with my feet shooting up into the air to let the stuff distribute. If you are 100% sure your colitis is just in the left part of your colon then its not as important to flip onto that right side. I thought mine was all left sided till my last colonoscopy, so I have to focus on getting those meds through the whole colon.

Never used salofalk so I can't give advice on them, but hope there's something here helpful.
Proctitis DX 1999, Pancolitis DX 2008
Lialda 3 day
Starting Immuran
Hydrocort/Rowasa/Vitamin E Enemas rotated
Probiotis/MSM/GreenTea/VitD+Ca/SuperDHA


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 9/19/2008 4:19 PM (GMT -6)   
Could you call your US doc to prescribe more meds and have your friend get them at the pharmacy before he/she visits?
26 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.


Hans C
Regular Member


Date Joined Dec 2006
Total Posts : 89
   Posted 9/20/2008 12:33 AM (GMT -6)   
That's very interesting Dr. A - I think I'd check that out properly before doing it as I wouldn't want to cause any damage by being unhygenic etc... thanks for the suggestion

Fitzy that is an option - I'm from Ireland and we have a drugs payment scheme there that limits expenditure on medicine to something like 80Eur a month. If I were there in person I could use this scheme. Otherwise those drugs cost something absurd in Ireland the last time I got a supply of salofalk it came to 500eur as I recall. Can't afford that I'm afraid...
age 26  ------------- diagnosed 2004 (probable left sided)

Multi-vitamin                                       Lactobacillus acidophillus sachets
Aloe vera - Omega3 fish oil                    Asacol (8x400mg)                     
Iron, folic acid and b12 supplement__________________________________________________ 


potato
Regular Member


Date Joined Jun 2008
Total Posts : 281
   Posted 9/23/2008 1:44 PM (GMT -6)   
Dr-A said...
Another suggestion.

Sometimes just sticking the whole enema in is a waste because you end up voiding it right back out. What I did on my cortenemas is use 1/2 to 1/3 of bottle at a time (20-30 ml). When the first bottle is empty that then becomes my prep bottle. I'll fill it up the prep bottle with some warm distilled water and put it in first. If that goes in with no problem and I feel like I could hold it for awhile, then I'll jump on the toilet and void the water, lay back down and relax a second then use 1/2 of the cortenema. Your risk of wasting the stuff becomes much less, and I have been doing this for years and years when flaring. In between that you can use another empty bottle for Vitamin E enemas which are very soothing to a flaring colon. I used 2-3 tablespoons of distilled water, 4 of the vitamin shoppes E-1000 iu d-alpha softgels, and warmed that up just a little and used it after washing the lower part of my colon once with the initial prep. Then you sorta either can do left side, back, right side, or I just propped myself up against a wall with my feet shooting up into the air to let the stuff distribute. If you are 100% sure your colitis is just in the left part of your colon then its not as important to flip onto that right side. I thought mine was all left sided till my last colonoscopy, so I have to focus on getting those meds through the whole colon.

Never used salofalk so I can't give advice on them, but hope there's something here helpful.

I think your suggestions sound great, Dr A, and make a lot of sense, especially when it seems impossible to retain the enemas.  I appreciate the info on Vitamin E enemas as well. 
Potato...  Female, 58, dx 11/07 mild left sided ulcerative colitis (50 cm)
asacol 3 3x a day, cortenema (generic) am & pm rowasa every other day  culturelle, benefiber wafers  generic acidophilus, metamucil wafers, activia, primadophilus reuteri
children's vitamin, Vitamin E 400 mg, omeprazole 2xday
oxazepam when needed, lomotil or ImodiumAD (not in the same day) when needed
Yoga, meditation, The Work by Byron Katie, exercise at least 5 days a week
 
 
 
 
 
 

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