One solid and the mucus and blood...it seems it is low...but you do need stronger meds 5ASA mgs rectally.
1) When you are flaring how much oral Asacol and how much rectal meds would you use? (mg per day)
When I was first diagnosed (18+ years ago), I was put on Asacol.. 4 (2 - twice daily). After the colonoscopy, I was then also put on the Salofalk enemas nightly. In total that was 1600mg oral + 4000mg.
Eventually, the asacol was upped to 6 (3 - twice daily), still on the nightly 4000mg Salofalk enemas...and eventually tapered them to off, then to on again..up and down..etc.
My meds consist of the constant 6 asacol daily and the enemas used nightly for treatment and then tapered to whatever. My symptoms rule.
Only once did I increase the Asacol to 8 daily....that was for about 8 months, then tapered back to 6 daily...where I still am.
My med regimen is a constant -- be it increase/decrease. My goal isn't to go off the meds. I'm a lifer, and as long as the 5ASA meds are working, I'll use them properly and to the advantage of keeping inflammation to the minimum.
I actually deal with flares by leaving the asacol at 6 daily (unless the salofalk isn't enough -- and as I mentioned, I only did that once)..and increase the rectal meds to nightly. I start to taper once I'm back to "normal". I hadn't bled with flares for over 14 years. This past flare I bled....yes, it was a shock....but I had major hormonal drains after going off the estrogen patch. Wasn't surprised, however. But, the nightly enemas stopped the bleeding completely after a week. I've has a few minor ups and downs regarding rectal pain since back on the estrogen patch, and have increased the enemas to nightly and then tapered....It's whatever my butt needs at the time. No biggie, but a bit different than I was used to dealing with. A tad humbling.
2) When you are in early remission how much oral Asacol and how much rectal meds would you use? (mg per day)
Early remission (I rarely would use that word)...would be when you are feeling normal and are able to taper the meds. I do NOT consider anyone on pred to be in remission when symptoms are normal...because there will always be increase of symptoms once the pred is reduced. That's why I would encourage them to use oral and rectal 5ASA meds as well...to stay on the rectal until off the pred. If they maintain the same state for at least a week or two, then I would say one is in early remission and can start to taper the rectal meds. The oral meds should stay the same if they're lower. If higher, such as 12 ...that could maybe be tapered at a slow pace to maybe 10 or 9 or 8...depending on how often they're taken during the day.
The rectal meds and oral shouldn't be tapered at the same time.
So, during early remission....that would mean to me, normal....I would stay at 6 asacol (because for me that's the constant and it's not considered high), and stay on the enemas nightly for another week. If everything is still "normal"...I will start to taper them to every second night for about 2 - 3 weeks. If all is normal..then I will go to every third night..etc. *
Just to let you know, this is a process I've come to use through a lot of trial and error. I also had deaths in the family, deep emotional issues, periods, surgeries, career schooling/change....etc throughout the years. So, the rectal med regimen tapering was fast, slow, slower, faster..etc. Until I realised my colon is what rules...I followed that and have just made it part of my life.
As i've mentioned in the past...I'm hardcore 5ASA meds. I think they're the very best discovery since aspirin, make-up and hairspray! I'll use them till I cannot any longer...I will NEVER use prednisone longer than a 2 week taper process -- but I've never been on it as of yet. I'd do the topical steroids firstly..so, I have many options if the 5ASA starts to fail.
My plan is to keep my colon/butt at its quietest. I treat (nightly enemas) at the very earliest symptom that is constant. It all takes patience, and I'm not in a hurry to get off my meds, for they are still the safest for long term.
Hope this makes sense.