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Ulcerative Colitis
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Posted 10/30/2013 2:23 PM (GMT -7)
I had my scope today- 30 days medicine free (was on asacol daily)

My new doctor diagnosed me with ulcerative proctosigmoiditis. Took some biopsies and sent those off. He seemed confident in his diagnosis. He is putting me on some new medicine that's an enema I guess. I hope I can do it if that's what he decides :(
Posted 10/30/2013 2:30 PM (GMT -7)
You are now a member of the proctosigmoid society.
Posted 10/30/2013 2:36 PM (GMT -7)
An enema is not a big deal once you get used to it. It is the best treatment for proctosigmoiditis as it gets right to the area. Sorry though about your diagnosis. If you need enema tips, let us know...many of us are experts at this. I still remember my first time...ahh, memories.lol.
B
Posted 10/30/2013 2:46 PM (GMT -7)
Thank you very much. I'm sure I'll need tips :)
Posted 10/30/2013 8:13 PM (GMT -7)
I hope you're also on an oral mesalamine..
q
Posted 10/30/2013 8:31 PM (GMT -7)
The enemas, when they work, are great. Seems weird at first, but it isn't quite as uncomfortable or difficult as it appears. I remember being really scared/grossed out when I had to first try them, but it literally improved my symptoms 90% after the first day. If you follow the directions in the box for posture and placement and get the excess air out, they work wonders.
Posted 10/31/2013 6:07 AM (GMT -7)
Quincy- he told me to finish up the asacol I have and he is considering switching me to Lialda. He is going to make this decision based on my biopsy results. Then he is talking about adding Rowasa 2x / week.

On another note- I JUST GOT a letter from my insurance stating asacol will not be covered under my plan after January 1. This is just great. The cost increased ALOT if its not covered so I'm not sure what I'm going to do if he wants me to stay on asacaol...
Posted 10/31/2013 6:17 AM (GMT -7)
If your health policy does not cover Asacol then try one of the other 5ASA (meslamine-based) drugs. The least expensive of these are Sulfazine, Colazal (Balsalazide), and the Rowasa should be available as a generic as well (I take the generic myself). Sulfazine is one of the oldest uc drugs, is available in generic, and shouldn't cost much on a monthly basis even if you have to pay out of pocket. Another choice is Colazal (Balsalazide) which is cheaper than the other brandnamed drugs.

If your GI is like mine, then he doesn't care which of the 5ASA drugs you take, as long as you take one of them with the correct dosage. Other choices (probably expensive but do offer patient assistance from the manufacturer) are Lialda, Apriso, and Delzicol.
Posted 10/31/2013 8:26 AM (GMT -7)
If the disease is only affecting the very end, oral meds might not even hit it and the rectal meds should be fine.

As for enemas, they're not so bad. Protip-if your butt is sore or you have hemorrhoids, add some KY jelly, Vaseline or other lubricant to the tip of the applicator and it'll decrease your discomfort a lot.
Posted 10/31/2013 9:21 AM (GMT -7)
One should be on oral 5ASA regardless....a low dosage. Since UC can spread or be very mildly affecting the cells on a microscopic level rather than a visual, it's always a good plan to be completely covered.

I'd suggest that the mesalamine enema be taken nightly...makes no sense to take it twice a week at this point..

q
Posted 10/31/2013 10:15 AM (GMT -7)
I will keep you posted as to what he comes up with. Hopefully my results will be back in tomorrow sometime.
Posted 11/4/2013 9:11 AM (GMT -7)

A. R/O Crohn's
B. R/O inflammatory bowel and dysplasia
C. R/O ulcerative colitis

Operative Procedure:
Colonoscopy

Pre-Operative Diagnosis:
Ulcerative colitis

Specimen Received:
A: terminal ileum biopsy
B: random colon biopsy
C: recto sigmoid biopsy



Final Pathologic Diagnosis:
A. Terminal ileum, biopsy:
Small bowel mucosa with no significant pathologic change (no evidence of
Crohn's disease).

B. Colon, random biopsy:
Multiple pieces of colonic mucosa with no significant pathologic change (no
evidence of inflammatory bowel disease, microscopic colitis or dysplasia).

C. Rectosigmoid colon, biopsy:
Chronic colitis characterized by crypt architectural disorder, moderate
acute/active inflammation and cryptitis.
No granulomas.
No evidence of dysplasia or malignancy.
These changes are consistent with ulcerative colitis.
Please correlate clinically.





Gross Description:
Part A received in formalin labeled "Jamie Martin" and "terminal ileum biopsy"
are two pale tan to tan irregular portions of soft to rubbery tissue averaging 3
mm in greatest dimension. The specimen is entirely submitted in one cassette.

Part B received in formalin labeled "Jamie Martin" and "random colon biopsy" are
multiple pale tan to tan irregular portions of soft to rubbery tissue ranging
from minute to 4 mm in greatest dimension. The specimen is entirely submitted in
one cassette.

Part C received in formalin labeled "Jamie Martin" and "rectosigmoid biopsy" are
multiple pale tan to tan irregular portions of soft to rubbery tissue ranging
from minute to 3 mm in greatest dimension. The specimen is entirely submitted in
one cassette.

md4607/10/31/2013 Michelle Miller (Pathology Asst.)
Microscopic Description:
The final diagnosis of each specimen incorporates the microscopic examination
findings
Posted 11/4/2013 9:11 AM (GMT -7)
Indications: Rectal bleeding (569.3). Mucus pr. Abd cramps. Screening for family history of colorectal cancer (V16.0). Procedure Codes: [45380]Colonoscopy with biopsy Procedure: The CF-Q180AL-2501226 colonoscope was passed with ease through the anus under direct visualization and advanced to the terminal ileum, confirmed by appendiceal orifice, cecal strap (crow's foot), ileocecal valve, landmarks, and photographs. The scope was withdrawn and the mucosa was carefully examined. The quality of the preparation was good. The views were good. The patient's toleration of the procedure was good. Rectal U-turn was performed. Findings: 23 cm. 25 cm. The ileum appeared to be normal. Three cold forceps biopsies were taken from the ileum. The specimens were collected for rule out Crohn's disease. 0-23 cm revealed loss of vascular pattern, 3+ erythema, 2+ friability, 2+ granularity diffusely, worst in the rectum. Otherwise, the colon appeared to be normal with intact vascular pattern. 12 cold forceps biopsies were taken from the whole colon 23 cm - cecum. The specimens were collected for rule out ulcerative colitis, rule out Crohn's disease, and rule out dysplasia. Impression: Ulcerative proctosigmoiditis. Recommendations: Follow-up on the results of the biopsy specimens. PCP follow up for vaccination update - needs to be current for Varicella, MMR, diptheria/pertussis. Yearly flu shot. Pneumovax. GI office can give hep A and B vaccines if not done. Once Path back, decide about restarting Asacol HD vs switching to Lialda. Would also treat with Rowasa enemas bid x 2 weeks and then taper pending course. Pay attention as to how stress relates to symptoms. May later use Bentyl also as needed. Defer immunologic or biologic therapy at present. Colonoscopy recommended. Further recommendations pending above and course. Consent: The benefits, risks, and alternatives to the procedure were discussed and informed consent was obtained from the patient. Preparation: EKG, pulse, pulse oximetry and blood pressure were monitored throughout the procedure. Medications: Monitored anesthesia care (MAC) given. Rectal Exam: Normal rectal exam. Unplanned Events: There were no unplanned events. Estimated Blood Loss: None. Comments: Pathology Specimens: Three cold forceps random biopsies taken from the ileum. 12 cold forceps random biopsies taken from the whole colon.Version 1, electronically signed by Dr. STEPHEN DEUTSCH on 10/30/2013 at 14:24.
Posted 11/4/2013 12:51 PM (GMT -7)
So does anyone know what all of this means?
I am starting the Rowasa enemas too so any directions for a first timer would be appreciated.

Thank you!
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