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Left sided colitis please HELP

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Ulcerative Colitis
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Posted 8/16/2008 6:31 AM (GMT 0)
I just got out of my trial for golimumab and had not had bleeding for a long time. i got put on lialda and immediately had a ton of bleeding. i think i have been having allergic reactions to asacol and lialda. Does anyone know a better way to treat left sided colitis. mine is so tricky... i'd rather not do prednisone. and i do not want to take anymore lialda unless it is normal to bleed alot at first? any advice?
Posted 8/16/2008 7:35 AM (GMT 0)

Hi.  I also have left-sided colitis.  My advice is rectal meds, rectal meds and more rectal meds (Quincy will be so proud!).  But also oral 5ASA (lialda, asacol).

First of all, don't just give up on lialda or asacol because you think you are allergic.  The Dr should be able to test to see if you are actually allergic or showing signs of bad side-effects.  If that's all ok, my advice is to up your lialda to 3 or 4 grams and day and blast your colon with nightly 5ASA enemas (Rowasa) until you are out of this flare (checking with your Dr firstly, of course).  At least a month's worth of enemas with some tapering after that.

Then for maintenance, find a daily dose of Lialda that works for you and throw in a few (2-3) enemas a week.  That's your maintenance routine.

There is a lot of evidence from studies that left-sided colitis benefits greatly from 5ASA enemas both to control flares AND for maintenance.  Here are some links to studies I posted in a thread about maintenance rectal meds a few months ago.

You also have the option of steroids via enema (liquid or foam) if the 5ASAs don't work for you.  But personally, I'd give the 5ASA oral and rectal combination a serious try before going to steroids.  You may need to be patient with them but a few of us here have had great success with the 5ASA.  Since I've put 2 5ASA enemas a week into my maintenance routine, I've been flare free - going on 15 months now.

Best of luck!

Effect of weekend 5-aminosalicylic acid (mesalazine) enemas as maintenance therapy for ulcerative colitis: results from a randomized controlled study.

http://www.ncbi.nlm.nih.gov/pubmed/17455207

Trouble maintaining remission in ulcerative colitis? give 'EM an enema!?

http://www3.interscience.wiley.com/journal/113522504/abstract

Long-term intermittent treatment with low-does 5-aminosalicylic enemas is efficacious for remission maintenance in ulcerative colitis

http://www.informaworld.com/smpp/content~content=a713799767~db=all~order=page

Medical Management of Ulcerative Colitis

http://www.bjhm.co.uk/cgi-bin/go.pl/library/article.cgi?uid=2360;article=hm_64_12_703_707.

here's the html version as I couldn't get the above link to load

http://209.85.141.104/search?q=cache:JZugpDRIU3QJ:www.bjhm.co.uk/cgi-bin/go.pl/library/article.cgi%3Fuid%3D2360%3Barticle%3Dhm_64_12_703_707+ulcerative+colitis+maintenance+enema&hl=en&ct=clnk&cd=14&gl=au&client=firefox-a

Posted 8/16/2008 9:40 AM (GMT 0)
I have left sided and I can not take mesalamines. They increase my bleeding too in addition to causing severe abdominal pain and a flu like feeling. I do better with Colazal. Have you ever tried that? My GI said that Colazal is the better of the 5-ASA's to treat left sided. So normally when I treat my flares, I use Colazal (and 6mp) as my maintenance and steroid enemas. The steroid foam will not reach to the area that we need to get treated with left sided since the foam primarily targets the rectal area. Left sided can be very stubborn to treat according to my GI because some of the 5-ASA can not reach to a certain area in the colon if the ph level is off in the colon as well as the transit period. And even enemas can't reach to a certain area. I always feel that there is one part in my colon that doesn't get treated.
Posted 8/16/2008 1:09 PM (GMT 0)
I also get increased D, bleeding and severe cramping from mesalamine. Colazal is my 5-ASA also. It seems many of us who can't tolerate mesalaming are able to tolerate Colazal.
Posted 8/16/2008 3:01 PM (GMT 0)

I also have left-sided but mostly rectal gastro doctor says.

I have a questions also.  Colazal seems to be working.  No diarrhea, less cramping and less blood.  Then my doc added (after using proctofoam for a couple weeks) Rowasa enemas and 3 more Colazal pills a day.  I have used three enemas - only could get about 1/2 to 3/4 in and stay there all night.  Feel better - first day after new meds.  Second day a little more cramping but feel good.  Today after three enemas and 9 pills for 3 days - I woke up with that terrible nausea again (which I had had for months about 4 a.m.), then cramping but not too bad.  Three BMs later - I did not see any blood - just residue from enema.  That has been the goal - no blood.  Hardly any left-sided discomfort.  BUT - that nausea, sweating and then yucky feeling all morning is like the old days.  I think I will have to cut back some on meds.  Planning on calling NP Monday.  Having company this weekend so cutting back again and taking Imodium until Monday.  Anyone else have the reaction from the Rowasa or max Colazal.  I am very sensitive to medication so I am thinking that is what is going on.

ElaineNY

Posted 8/16/2008 3:09 PM (GMT 0)
Elaine, if you're sensitive to Asacol you're likely also to be sensitive to Rowasa because they're both Mesalamine. If that's not the case, it could possibly be the Colazal. It does tend to make some of our stools softer when we take the maximum dose.
Posted 8/16/2008 3:14 PM (GMT 0)
Thanks - I have never tried Asacol.  Colazal has been working great for a month at 6 a day. Just have not been able to stop bleeding altogether so went from proctofoam to Rowasa.  I am not sure which type of medications there all are.  I just want to stop the bleeding which looks like it has pretty much in three days.  AND - no diarrhea - pretty much normal stools.  Maybe I will just have to use less medications for a longer time. ElaineNY

Posted 8/16/2008 3:19 PM (GMT 0)
Colazal made my symptoms better but was never able to get me into remission; for that I had to move to Remicade after failing all the "lesser" meds. Now that I'm in remission, though, I only take it twice a day as that seems to help keep my stool firmer.

Asacol, Lialda and Rowasa are all mesalamine; the difference is in the delivery. Asacol is enteric coated and delivers most of its medicaton to the right side of the colon. Lialda is time release and is believed to distribute the drug throughout the colon; it can also be taken only once or twice a day. Rowasa, of course, delivers the medication directly to the recum and sigmoid. Sounds as if the Rowasa is a success for you, and good that you're able to retain it so well.
Posted 8/16/2008 3:31 PM (GMT 0)

Judiyn - thanks!  That clears up a lot.  I do have mostly left sided and rectal.

Doctor said that Lialda would be the next drug to try.  I think Colazal is doing it if I can keep using the enema - something making nausea worse - always something!  ElaineNY

Posted 8/17/2008 6:01 PM (GMT 0)
thanks for the replies. my internet has been down so i just got to read them. i think i will give colozal, and 6mp a shot because they don't have the mesalimine that puts me into an instant flu with bleeding, cramps and diahrrea. I would like to try rectal meds for a couple weeks if the did not have the mesalamine. thanks again
Posted 8/19/2008 1:34 AM (GMT 0)
Colazal's generic name is balsalazide disodium, but it breaks down to mesalamine in the colon. So-- It seems that you should avoid Colazal, too, if mesalamine causes you a bad reaction. / Old Hat (nearly 30 yrs with left-sided UC; currently on 3 Colazal daily for maintenance of remission)
Posted 8/19/2008 1:43 AM (GMT 0)
Jsanders505,
I also have left sided, well that's what I started out with 26 years ago. I went off my meds for many many years, took lots of ibuprofen and now my colon is 3/4 involved. The only drugs that have worked well for me are Sulfasalazine and the rowasa enemas. That's the combo that put me back into remission in a matter of 1 1/2 - 2 months.
Posted 8/19/2008 5:05 AM (GMT 0)
hmm, thanks oldhat i did not realize that. maybe since it breaks down different it wouldn't cause me to bleed though so I think I will give it a shot because I am running out of choices. I will also consider the combo of Sulfasalazine and Rowasa enemas like you mentioned muchkindd. thanks for the advice everyone! this site means so much to me. i will let you know what my gi prescribes wednesday.
Posted 8/20/2008 10:04 PM (GMT 0)
I got put on 4 colozal in the morning and 4 in the evening as well as imuran 100mg's a day. Finger's crossed. Im having a bad flare right now with alot of bleeding so im hoping it improves
Posted 8/20/2008 10:18 PM (GMT 0)
I have pancolitis but right now only my rectum/sigmoid is severely inflammed... My new doc put me on Lialda and I am starting Rowasa enemas tonight, but I have noticed that my bleeding has almost doubled since starting Lialda, as well as having more pain, frequency, headaches, and urgency. Colazal didn't help either though and gave me SEVERE heartburn/acid reflux. I'm going to try out the enemas for a month and see if it gets better but if not I'm going to ask to be put on something else entirely.
Posted 8/20/2008 10:59 PM (GMT 0)

That is what is so great about this forum - we find out that there are so many combinations of medications that help different people.  It scares one to think that what your doc puts you on does not work or works so slowly.  I expected Canasa to fix me right up and it didn't.  But I found out here that is not unusual and to be patient!

I have a call in to the NP - she will call tomorrow morning with the next thing for me to try.  I do believe the addition of Rowasa enemas have helped a LOT with bleeding - however with that and addition of 3 more Colazal I have more side effects like nausea, sweating and headaches.  I think it is the doseage, not the meds, for me - it just might take longer than I wish to get into remission. 

ElaineNY

Posted 8/21/2008 6:10 AM (GMT 0)
so far after taking the colozal i have experienced more diahrreawith alot of bleeding. is it possible that the colozal will make me worst for the initiall few days and then help? or am i just screwed....
Posted 8/21/2008 2:15 PM (GMT 0)
It can be either way with Colazal. When I first started, I had increased D and bleeding but it only lasted 2 weeks and then I was on my way to remission. I have a hard time with mesalamines in their true form but Colazal seems to work better for me. I have a weird system lol. I would say give it a couple days to a week and see if it is still bothering you. If it is, definately call the GI. You might want to ask about being put on a steroid enema until the Imuran kicks in which can be around 3 months or longer. It is still a steroid but the side effects are a lot less. If the Colazal doesn't agree with you, you may have no choice to be put on prednisone until the Imuran starts working unfortunately :(
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