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Canasa vs Rowasa for apparently very low inflammation

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Ulcerative Colitis
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Posted 12/27/2019 3:28 AM (GMT -6)
I think I am repeating myself, but may be you can help me as I am really losing sleep and turning into a mess as we cannot get rid of minor symptoms for my son's UC. Facts again:

Get into no-symptoms state in May 2018 with nightly enemas (Rowasa).
Calprotectin just 15 in Oct 2018. Switched to Canasa from Rowasa gradually and on Canasa only starting March 2019.
Calprotectin 300 in mid-September. No symptoms. Switched to Rowasa.
Mid-November 2019 - minor symptoms (blood spotting on TP, and 3 bms instead of usual 2). But, Calprotectin down to 150.
I thought about going back to Canasa or alternating Canasa/Rowasa, but our GI recommended Cortenema for a week and oral Uceris. Just completed a week of Cortenemas, very minor improvement, but more or less the same symptoms.

Got my family to Israel for Christmas and met with one of the big names for Crohn/UC here and in the world. He gave me a couple of advises on diet. As for our current situation, his advice was to get a scope to see where the inflammation is. He believes that is might be very low and then supps would make sense.

I asked my son to do enemas at night and supps during day time. "Promised" him that this is just for 2 weeks and then we will alternate at night time.

Too much text. Sorry. As you clearly see, I am not in the best shape.

Has anybody had a better experience with Canasa for stopping minor symptoms (bloody spotting and a feeling of not an empty bowel after bm)?
Posted 12/27/2019 9:59 AM (GMT -6)
What does your son want to do? He's almost an adult. I think you're worrying way too much about very minor symptoms.
Posted 12/27/2019 10:13 AM (GMT -6)
Before you can decide, you need to find out the extent of the inflammation. It makes all the difference. Canasa might cover 10 to 15 cm, which is mostly just the rectum, and a little bit of the sigmoid. Rowasa will treat all that and go most of the way up the descending colon as well, which may be needed if that area is inflamed too.
Depending on where you live, you can also get mesalamine in a foam that will go a lot higher than the suppository. Unfortunately the foam is not available in the United States yet.
Posted 12/27/2019 10:36 AM (GMT -6)

C_G_K said...
Before you can decide, you need to find out the extent of the inflammation. It makes all the difference. Canasa might cover 10 to 15 cm, which is mostly just the rectum, and a little bit of the sigmoid. Rowasa will treat all that and go most of the way up the descending colon as well, which may be needed if that area is inflamed too.
Depending on where you live, you can also get mesalamine in a foam that will go a lot higher than the suppository. Unfortunately the foam is not available in the United States yet.

No pain, no blood in stool, just spotting on TP. Is it fair to assume that his inflammation is in the rectum only? may be very low? If it would be higher, he would probably had stool somehow mixed with some blood, right? We will request colonoscope or a lighter version right after NY.

We are in California. So far, were not able to get foam version...
Posted 12/27/2019 10:43 AM (GMT -6)

Sara14 said...
What does your son want to do? He's almost an adult. I think you're worrying way too much about very minor symptoms.

You are right... already scheduled a session with a therapist. Never used shrinks before. But so far I was only able to get into normal mental state when my son is in remission. Cannot control it, so need to learn how to take it "easier".
Posted 12/27/2019 11:09 AM (GMT -6)
A sigmoidoscopy can be done without sedation. That may be all he needs. Even though his symptoms are extremely mild, having a good maintenance regimen can keep it that way.
Posted 12/27/2019 11:24 AM (GMT -6)

C_G_K said...
A sigmoidoscopy can be done without sedation. That may be all he needs. Even though his symptoms are extremely mild, having a good maintenance regimen can keep it that way.

I think he is on a pretty decent maintenance regimen already.
yes, we will request sigmoidoscopy... Till then, we are flying a bit blind...just thought somebody had similar symptoms...
Posted 12/27/2019 11:58 AM (GMT -6)
Why would YOU promise him it will only be 2 weeks?

q
Posted 12/27/2019 2:18 PM (GMT -6)

quincy said...
Why would YOU promise him it will only be 2 weeks?

q

He obviously does not like rectal meds. He is on nightly enema and now it will be daily supp... Told him that we would try it for 2 weeks.
Posted 12/27/2019 2:41 PM (GMT -6)

Crazydad said...

Sara14 said...
What does your son want to do? He's almost an adult. I think you're worrying way too much about very minor symptoms.

You are right... already scheduled a session with a therapist. Never used shrinks before. But so far I was only able to get into normal mental state when my son is in remission. Cannot control it, so need to learn how to take it "easier".

Aww. I just didn't want you to worry so much. I know it's hard not to though. Again, your son is really lucky to have someone who cares so much! I just hate to see you suffer. Hopefully he'll get back into remission soon. I don't have kids, but when my cat was sick last year off and on for several months and the vet couldn't figure out what was wrong, I was insanely worried. I would have done anything to take her sickness instead of have her suffering. So I can kind of relate, because she's my whole world.
Posted 12/28/2019 12:37 AM (GMT -6)
Thanks for understanding! and not to forget, I have lots of respect and sympathy for people who contribute to this forum. Sometimes feel like I am whining too much. Just still cannot understand the symptoms of this conditions fully and this drives me crazy.
Posted 12/28/2019 6:16 AM (GMT -6)
You are doing good, Dad. My daughter had a scare with some digestive issues last year and I thought it was IBD. I went into full panic mode.

I think you need to have a sit down with your son regarding the importance of the rectal meds. Give him facts and figures and take the emotion out of it. To me, the rowasa makes the most sense for an extended period of time. It will cover the greatest area and is very effective for most. I always use it until there are no symptoms for several weeks to months.

What did your doctor in Israel recommend for diet? Do you journal his food intake and symptoms?

On a side note, have you tried meditation for yourself? Great way to keep perspective. You can still help your son and lose the worry and stress.
Posted 12/28/2019 8:47 AM (GMT -6)
How does your son handle his diagnosis? It can be hard for teens to deal with. Glad to read that you are going to get some counseling, nothing wrong with that.

UC/crohns are not predictable diseases, even when a person is in remission they can have a flare up. None of these meds are 100% fool proof, unfortunately. Hopefully things will get back on track.
Posted 12/28/2019 10:55 AM (GMT -6)

Uniform Charlie said...
You are doing good, Dad. My daughter had a scare with some digestive issues last year and I thought it was IBD. I went into full panic mode.

I think you need to have a sit down with your son regarding the importance of the rectal meds.

What did your doctor in Israel recommend for diet? Do you journal his food intake and symptoms?

On a side note, have you tried meditation for yourself? Great way to keep perspective. You can still help your son and lose the worry and stress.

Thanks for your support. My son has been on rectal meds for almost 2 years now. He does not like them, but more or less ok with it. At the same time, it will probably be too much for him to go with 2 of them per day. I still cannot get my head around his only symptom (blood spotting on TP). That's it. Our GI ruled out hemorrhoids, but I think we will request colonoscopy/sigmoidoscopy when we are back.

I thought about meditation, but probably need to talk to a professional first. Just too painful.
Posted 12/28/2019 10:58 AM (GMT -6)

straydog said...
How does your son handle his diagnosis? It can be hard for teens to deal with. Glad to read that you are going to get some counseling, nothing wrong with that.

UC/crohns are not predictable diseases, even when a person is in remission they can have a flare up. None of these meds are 100% fool proof, unfortunately. Hopefully things will get back on track.

Thanks, Susie! He is more introverted than I am, so you never know. Of course it is hard on him. He was diagnosed at 14 and 17 now. I have 1.5 years of school and then may be few years of college to prepare him for his life.
Posted 12/28/2019 11:03 AM (GMT -6)

Uniform Charlie said...


What did your doctor in Israel recommend for diet? Do you journal his food intake and symptoms?.

I will write a separate post these days about the diet that was recommended to us. You can only google the name - Novel UC diet, but will not find much info other than it is on some sort of clinical trial. The doc's name is Arie Levine. He is a big name for IBD, specializing more on Crohn, but also doing research for UC. He did not give us a full description, but basically told us major principles. We've been on Mediterranean diet and no meat for some time. This is not much different with few really bad things to eliminate and few must eat foods (like apple, broccoli &cauliflower).
Posted 12/28/2019 12:12 PM (GMT -6)
Just an FYI —. I’ve been a big lifelong fan of broccoli, but quit eating it when I was flaring because it led to really painful gas and you know when you’re flaring that passing gas can lead to passing small amounts of other stuff too — which isn’t pleasant. Your mileage may vary of course. I still am wary of cruciferous veggies because of that although I suppose I should give them a try again because they are really good for you — just not sure they’re good for a flaring gut — in my case anyway.
Posted 12/28/2019 1:06 PM (GMT -6)
@FlowersGal, yes broccoli is known for causing gas under normal circumstances. I ran across an article a few years ago & was amazed to find broccoli & black pepper in the top 10. I don't eat either of them so it's not a problem for me.

@Crazy Dad, never be concerned about how much you post. There's a lot of knowledge & good tips from the members. If nothing else maybe it will help ease your mind some.
Posted 12/28/2019 1:53 PM (GMT -6)

Crazydad said...
Thanks for understanding! and not to forget, I have lots of respect and sympathy for people who contribute to this forum. Sometimes feel like I am whining too much. Just still cannot understand the symptoms of this conditions fully and this drives me crazy.

Have you seen how much I whine on this forum...? Haha. Meaning, no, you are not whining too much at all! Yes, I think this disease drives all of usa bit crazy, so you're not alone there!
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