6mp-cervical dypalsia

I am sorry you have having to go through this with your daughter. I would suggest getting a second or third opinion to make sure everyone is in agreement with the idea of discontinuing 6mp.

If your daughter cannot maintain remission on 5ASAs you might want to consider surgery. I know it sounds scary but it would put an end to UC as well as to the cycles of drugs. She's got a lot of life yet to live and having dyslpasia of the cervix and UC is lot to deal with for anyone much less a 20 year old. While you are trying to digest this news you also might want to consider a consultation with a CR surgeon. Find the best one in a metropolitan area; or go to www.j-pouch.org for a recommendation. Having a consultation with a surgeon does not commit you to having surgery but will answer questions and help you to understand the process in the event you have to go that route.

Sue

her white count was in the normal range a few weeks ago , i'll find out the new one today-they went up with the staph
but came back down- gynocologist found dysplasia-

does everywoman with cervical dyspalsia end up off immunosuppressants, what about cancer patients on chemo?

thanks

hi sherry,
thanks- it was her gi who said the 6mp is not good for her - with the infections (staph this summer-but gone now) but the dyspasia was the icing on the cake
she needs the colposcopy to dertermine the degree of the dysplasia , i know it doesn't come from 6mp, and like you said
the treatment even if it's mild can cause complications because of the 6mp- she also needs her wisdom teeth out so while this
is all unfolding the gi lowered the dose of 6mp - so she can have the dysplasia testing and teeth out - but if it's even mild dysplasia it's hard to treat on 6mp.

thanks your answers keep me going
i

Sorry to read that your daughter tested positive for cervical dysplasia at her young age. What does the gyno recommend: repeat testing or further procedures soon? RE GI issues: Let me just tell you that I've never been on 6-MP, but got a dilly of a staph infection while on Cortenemas ca. 1992. I've been on Colazal most of the time since 2003 with good results until my health insurance obliged me to use the generic last yr. (A disaster that gave me very unpleasant headaches + D!) Colazal is balsalazide disodium, which breaks down to mesalamine within the colon-- different delivery than Asacol or Lialda, but still a 5-ASA med. My most recent experience with return to brand-name Colazal leads me to think Salix removed something from the original formula that helped to solidify bms-- but also caused side effects like dry mouth. Alas, none of these meds are ideal & we patients react differently, which is why UC is so hard to treat!!!! Has the gastro suggested an alternative to 6-MP for your daughter? It seems that, if she recommends quitting it, she has to come up with a recommendation for another med to back up the 5-ASA (mesalamine in one or another form). There aren't a whole lot of choices, but hopefully what is available currently will be of help to your daughter. It seems that you need to stay calm (always hard in these circumstances) & get the best possible information on available treatment-- both GI & gynecological.  Also, think about the wisdom teeth extraction in terms of one side at a time rather than all 4 at once, to minimize discomfort/dietary changes.  Best wishes as you sort all this out & keep us posted as to how she's doing. Her many accomplishments of the past yr should carry her thru these new trials-- reasons to stay positive. / Old Hat (30 yrs with left-sided UC ... [etc.])

Rey-- you also mentioned your daughter's lactose intolerance. That shouldn't be a major threat to her colon-- because many lactose-free dairy products are available in the supermarkets now. Low-fat, low-salt yellow cheeses like Emmentaler & Gruyere would likely agree, too, or she could try soy cheese. / Old Hat (30 yrs with left-sided UC ... [etc.])

Old Hat you have a good memory, it wasn't long after her vaccination for the hpv that her uc began-within a couple of months.
what do you mean by a back up to messalamine, if the colazol is a messalimine?

there will be another test to detemmine if it's precancerous -not atypical cells, but can you tell dyslasia from a pap?-
or not but he did say dyplasia, and that if it wasn't precancerous it (colposcopy will be friday to determine)
could be followed, but i don't know what that would mean for the 6mp-now lowered

as for the wisdom teeth -they all hurt and are crowding her small mouth and she wants them all out at once-is this really bad-we figured
that it's probably best in case she ends up staying on 6mp for now to do it while her dose has been lowered? but we're waiting for the
oral surgeons approval-and she is having it done after her job ends befor going back to school (fingers crossed).

as for the lactosse- iwas just surprised that we weren't told early on since it's a dietary concern-dr is always in a hurry!

Old hat are you getting better back on the brand? i always wonder if it's the colazol or 6mp that's been holding her?
maybe finding out soon.

sorry thisi is so long.
thanks!

You're welcome-- it's not a long post considering all the issues you're contending with. By "back-up to mesalamine" I was referring to the immunosuppressant meds, which are drugs like 6-MP, Imuran, Remicade, & Humira. Steroids are also immunosuppressant at high dosage, though. From what you wrote above, the gastro presented a worst case-scenario whereby your daughter would flare after being taken off 6-MP and could not use other immunosuppressants due to her experiences with bacterial infections such as strep & staph-- therefore, she thought colon surgery would likely become necessary. (That's what I arrive at from re-reading your explanations above.) Probably the gastro "freaked out" a bit on hearing the word "dysplasia", even though it's gyno-related in your daughter's case. In recent yrs the topic of dysplasia in colorectal tissue has come up for debate in IBD gastro circles, where there was major disagreement over how to consider & treat it. (There's a Mt. Sinai gastro named Ullmann who views it as a mandate for colon surgery, but other top IBD gastros have disagreed.) Anyway, what all doctors agree on with regard to possible dysplasia of any tissue wherever is that it requires very skilled & experienced pathology for accurate evaluation. That's hopefully what will result from your daughter's colposcopy specimens. You ask in your post how can they tell the difference between dysplasia & "atypical pap" -- it takes a lot of expertise. (Which is why patients sometimes pursue 2nd opinions elsewhere.) My hope is that her colposcopy shows no sign of dysplasia, which is a possibility. I also wonder if a reaction to Yaz or the anti-HPV vaccine could give her atypical pap readings over time-- because I'm generally skeptical about gyno issues, due to the complexity of hormone biochemistry. RE wisdom teeth: at age 20 I had all 4 extracted at once. It gave me trismus on both sides, locking of the muscles that enable one to "open (the mouth) wide"! For 10 days post-surgery I could not really deal with solid food as a result, but had to get by on liquids sipped thru straws. Then I graduated to scrambled egg. It was a crummy experience, and a friend who did one side extraction at a time fared much better than I. FINALLY, RE brand-name Colazal: I had to go back on it because the generic gave me ugly headaches at the base of my skull. But, as I wrote above, I think that Salix recently took something out of it-- so I react to it differently now (to brand-name) than I did 2003-2008. The anti-inflammatory part of it works the same, but it doesn't solidify bms like it did before. (Could be, though, that my body has changed as well-- that's always possible with UC, too.) BEST WISHES! Please keep us posted & take care. / Old Hat (30 yrs with left-sided UC ... [etc.])

Post Edited (Old Hat) : 7/26/2009 6:10:25 PM (GMT-6)

Hi Rey,

So sorry to hear about your daughter's troubles. I am your daughter's age and have had UC since 2005. Remicade recently stopped working for me so I was switched to 5-ASA the Lialda 4 pills each morning. My doctor recommended I not only do this oral mesalamine but a rectal mesalamine as well. That is why I do a canasa suppository each night as well.

I used to think that Canasa was a waste of time and never consistently used them. However, since growing resistant to Remicade and only using the Lialda 4 pills once in the morning I decided to use the Canasa suppositories nightly to supplement the Lialda. I didn't think the Lialda would be enough on its own after being on Remicade for 3 years. I have been SOOOO surprised with how good I've been feeling by taking the Lialda the last 33 days and using my Canasa every night. WHAT A DIFFERENCE!! I am not having urgency anymore and no more blood or diarrhea. What a relief after flaring so bad. I even made it to Maui for a week and got back last wednesday. My canasa saved my behind-literally. Coming from a former non-believer, trust me this stuff works. Maybe not by itself, but certainly complements my Lialda nicely.

I think your daughter should exhaust ALL her options before surgery. Why take out a colon that can be saved? I believe that rectal and oral mesalamines together can keep flares away if we are diligent about taking our medication consistently and correctly. However, there are some people who are worse off than others and surgery is certainly necessary part of the time.

Best of luck to you and your daughter,
Ashley O

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