Trouble reaching remission. Is doctor going too far?

Its been a month on 40mg of Prednisone a day. I saw some improvement in the beginning but it seems to be getting worse each day. I called up my doctor yesterday and he wants me to come in for a Sigmoscopy. He says he doesnt want me to suffer long time at my age so he will see if I need remicade or Surgery. Ive only had UC for about 2 years. He was pondering imuran earlier this month but he doesn't seem to want to go there and just shoot to the strong stuff.

I also recently switched from Colazal to lialda. this might be a factor if Lialda isnt working and slowing things down. The steroids helped my bowl movements early on but recently its all night long constantly waking up. I want to get better. Im struggling with my weight and am under considerably.

On a side note. Has anyone ever experienced better healing with fast/junk food? Most the time on my last flares I would eat fatty and greasy foods to fill my colon and make my poops harder. It didnt seem to work untill earlier today when 5 taco bell tacos came out with little blood. Still diarrhea though.

Only you will know what is right to do, so follow your instincts and information you gather. And be sure to talk with family/friends about all the details, it will help give you clarity. And yes, commonly it is Imuran, then Remicade, then Humira (depending on your reaction to remicade) then surgery. That was how my medicine flow went - humira was my last chance medicine.  The thing is that this process took me about 7 years to go through all the medicines, and I was just getting sicker and older, but I was trying all the medicines so there wasn't any surgery regret. Now, in retrospect I realized the doctors were really just going through the medicines b/c I had to go through them, but I think in my case they all knew it was inevitable (4 opinions).  The other thing is that we have to be honest with ourselves when we are living predinisone dependent which for me I learned was: 40mg for a month, then a taper, then get sick again, then back on predinisone while I try the next new medicine, taper, get sick, etc......The longer you are on pred. the more tissue damage it could be doing and is probably the reason why drs. talk surgery when meds seem to be failing.

mark

http://ucstory.wordpress.com

This following webcast that was just on Colitis Health Talk, gets the doctors perspective on Whether to Wait for Surgery or Not. This may help you understand the full picture. It is really well done and objective, so they aren't saying you need surgery, just htat they explain the medicines and the process.

http://ucstory.wordpress.com/2008/06/23/discussion-on-to-wait-for-uc-surgery/

Yeah, its a long long process to decide on the "elective surgery" and if you think its too early then its likely too early. That was how I felt for many years, my doc told me at year 3 to have surgery and I waited to till year 7, so I hear you. And when we finally decided surgery was for me, it felt so right, so I do think people know (as much as we can).

Can't help you on the imuran and remi BM thing since they didn't work for me.

hang in there and clarity will come with time,
mark

My last remission was 8 months with only colazal 3x3 daily. I took a prednisone dose pack like usual to see if it worked. two failed. I have never been on pred long term and do not want to be. The highest dose i was on was for 50mgweek tapering 10mg a week. I too am praying for a good nights sleep one time. As a 17 year old in summer time, its just rough. Thank you flare-up on my graduation day...

Also is imuran a daily pill or is it like steroids where you taper off to just using a maintenance drug?

uh, no mention of rectal meds....have they never been offered to you?
q

Hmm, usually a GI will try Imuran or 6MP and then Remicade before thinking about surgery--or at least that's what my GI did. He didn't even bring up talking to a surgeon until my last appointment (even though I had brought it up in previous appts and he just dismissed it) when I said Remi wasn't helping much. However, if you listen to the webcast leemega posted, the doctor says to begin talking to a surgeon as a precaution when the first-line meds (I'm assuming 5-ASAs) fail.

I can't comment on how much Imuran will help b/c it only took two days of 6MP (which is similar to Imuran) for me to get side effects and have me hospitalized. I've had two Remi infusions so far--there have been a couple good days but the rest have been normal flare days. My GI says that if Remi doesn't work in a week or so (4 weeks since I started), surgery is going to become a definite option. My GI isn't willing to have me try Humira if Remi doesn't work since they're both very similar--so whether that's an option for you will depend on your GI.

I personally think your GI is jumping the gun, but it still wouldn't hurt to talk to a surgeon even if you decide on meds like Imuran and Remicade.

Here is the link to the webcast that ComedyDork mentions in her above post.  The doctor does explain the point at which GIs and patients should start the "surgery conversation" - doesn't mean surgery is needed, but that while medicines are being tried coping with the possible idea of surgery should begin.  It is actually a good approach b/c it will give those who have to have surgery time to cope with the idea:

http://ucstory.wordpress.com/2008/06/23/discussion-on-to-wait-for-uc-surgery/

Brian,

How did your doctors visit go? 

Also, I tried all sorts of alternative medicine, I discuss all my attempts in the following post. But the post also links to an article by the Mayo Clinic, and a Video on IBD and alterative treatment.

http://ucstory.wordpress.com/2008/06/25/alternative-medicine-for-uc/

How are you taking the 40 mg of Prednisone?  Are you taking it all at once, one time a day or twice a day?  I found that my body almost crashed when I took it once a day because when I was within a few hours of my next dose, I would get all my symptoms back. I started taking 10 mg. 4 times a day and it worked.  It kept the Prednisone constant in my system. I did this as I tapered too.  My doctor thought I was nuts (I guess they haven't heard this from other patients).  Anyway, I would give it a shot.  It could also be the Lialda giving you issues.  I've started Prednisone and a new medication at the same time and it made the Prednisone not work.  It seems like the "typical" UC meds like Asacol, Colozal, etc make me worse. 

I'm not surprised that your GI has suggested surgery.  The day I was diagnosed with UC, the idiot GI brought up surgery as an option.  Every doctor I've been to since has always brought up surgery.

i 'm not very experienced here as i'm the mom not te patient or the dr, but it seems like the rectal meds may be something for you to try, along with the colazal my daughters dr was very heavy on the rectal meds also other things listed below, but for now things are quiet for her,for the most part.
i think the combination bomb worked.but another opinion dr. might be good too