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Is my GI right?

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Ulcerative Colitis
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Posted 11/24/2009 3:48 AM (GMT 0)
He bounces me down fast on predisone, halving the amount each taper. The first time, I might have cried wolf and not stayed the course because of it, but I knew what I could handle. And at 10 things went sideways. And I got myself back on 40.

This has happened twice at 10.

I know he wants me off it so desperately, been on it since Sept. 15 and for asacol to be my backup. Now he thinks asocol may not be working.

Is it possible his tapers are too quick... I went up to 15 (at my suggestion). He always says stay the course. I'm, like, experiencing buckets of diarrhea all over the floor when I hit 10... What was I to do?
Posted 11/24/2009 4:00 AM (GMT 0)
I do think it could have been too quick.
But I also REALLY think you need to be on mesalamine enemas in addition to Asacol.
Posted 11/24/2009 5:44 AM (GMT 0)
If you google Prednisone taper methods, even online resources will mention that the usual taper is no more than 5 mg at a time, minimum weekly. You are not in remission yet, tapering is not a good idea.

I'd be getting a second opinion from another GI about drug therapy. It's a red flag for him/her to want to taper you down so quickly and with such drastic dosage amounts. Keep asking questions and doing your own research...
Posted 11/24/2009 7:26 AM (GMT 0)
i had one dr who wanted to give me 75 mg of pred then taper down by half every 2 days.
crazy!

i told my gastroenterologist and he was like "no way".
first thats too high and 2nd, you need to taper much much slower or it will just throw you into a tail spin.
make things worse i think.

usually taper by 5mg or 10mg every 4 days to a week.
thats what i was told anyway. but lots of dr's have lots of different opinions.

either way, it obviously isnt working what he/she is currently doing, so definitely get another opinion or try tapering slower.
Posted 11/24/2009 1:37 PM (GMT 0)
Tapering too quickly can not only make your Uc symptoms reappear but it can be a shock to your adrenal gland. By tapering slowly, it gives your adrenal glands time to catch up and start producing cortisol and adrenaline on it's own again.
Posted 11/24/2009 2:14 PM (GMT 0)
Getting below 10mg of prednisone is tricky; especially if you are steroid dependent. It really doesn't matter how slow your taper is, you can get symptoms of UC when you taper. I could never distinguish between the pred taper and the faux UC symptoms because of the taper. Yet I was also one who never successfully got off prednisone. I think you need to have a serious discussion with your GI about the next level of treatment. You definitely don't want to stay on prednisone.


Sue
Posted 11/24/2009 4:22 PM (GMT 0)
Your GI is crazy, that's way to fast of a taper. And honestly, being on pred for 2 1/2 months isn't that long either! I understand he wants to get you off, but in general, the thinking is "stay the course" at a higher dose until you are symptom free for a month or so, then taper ever so slowly. My tapers always lasted forever, like months & months & months. 5 mgs a week or 2 here & there, then slower & slower, 2.5 mgs a week or 2, etc. It sucked! But- i was able to get off it ok, with the help of Remicade. It's unebelievable that such a low dose, like 2.5mgs, can actually do something, but it does! Can you get a 2nd opinion?

Posted 11/24/2009 7:03 PM (GMT 0)
I bet he has an angry patient who had a bad response to the prednisone, so it makes him nervous to have you on it.
It seems, like us, different doctors have different philosophies about it.
Posted 11/24/2009 7:11 PM (GMT 0)
     I had a dear friend who had Crohn's Disease and took herself off prednisone too quickly.  She developed Addison's Disease.
Posted 11/24/2009 8:28 PM (GMT 0)
Hey Ellen..

Yes, your GI is crazy to have you taper that fast... My GI would NEVER Suggest to taper that quickly. In fact, he's the one who slowed me down because he thought I was tapering too fast...... I have been on Prednisone since June and I won't be completely off of it until another 7 or 8 weeks... I was going down at a rate of 5mg a week till I hit 20mg.. Now I'm down to 17.5 now and going down to 15 on Friday and will continue to taper at 2.5 a week until I'm off completely.. I want off this drug really badly, but I'm not rushing it so I have to taper only once.. Now that I'm on Remicade, it should be way easier.. :)

Good luck Ellen and don't be afraid to stand up to your GI..and from what we've discussed before, it sounds like he might be a bit pushy to me... Being on Steroids since September is not that terribly long...
Posted 11/24/2009 8:44 PM (GMT 0)
I did a relatively quick taper, though and it worked. I was on 40mg for 5 days, 30mg for 5 days, 20mg for 5 days, 15mg for 5 days, 10mg for a little over a week (while waiting to see my GI to discuss the next step), then 10mg every other day for a few weeks while I was waiting to get through an interview.

So, I guess it just again highlights how individualistic we all are in our responses. It wasn't so fast that I was at risk of developing adrenal shock...the drop has to be more drastic than that.
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