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Prednisone for flare-up?

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Ulcerative Colitis
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Posted 2/3/2011 7:36 PM (GMT 0)
Been stuck in a flare up for about 2 months now - have some good days but some bad days (bad days outnumber the good ones by about 2 to 1).  Occasional blood/mucous, other times just have plain diahrea, ranging from 3-5 times a day.

Currently on colozal (9 pills a day), mesalamine enemas (2x a week), and taking probiotics and fish oil daily. 

My doctor didn't seem to want to put me on prednisone, his comment was something to the effect that it would weaken my immune system.   3 years ago when I was first diagnosed (and had much worse symptoms), i did a round of prednisone and it helped immensely.  Not sure I understand why he won't try the prednisone again but he mentioned that if my symptoms don't get better we may have to go to the next step of meds which I understand signifcantly impact your immune system?  

Doesn't make sense to me but was wondering in general, shouldn't prednisone be attempted to help snap somoene out of a flare??

Posted 2/3/2011 8:20 PM (GMT 0)
The long-term side effects of steroids are nasty, so your doctor is hesitant to use them too much - that's great, actually! so many docs seem to push prednisone. (Because, as you experienced, it can be a very good medication.)


I was on pred when I was first diagnosed, and I had trouble getting off it - about 2 years. My symptoms kept coming back when I tried to taper off.

So, since then, when I've had a flare that won't respond to the oral and rectal 5-ASAs (as you've been taking) I have asked for steroid enemas. They've done well for me, and have a lot less side effects than the oral steroids. Even when I was flaring well up into the transverse colon, the steroid enemas eventually took care of it.

As with anything else, they don't do the trick for everyone, but if you have not tried them, maybe ask your doc what he thinks of trying them?

There is also rectal steroid foam available... I used that some, years back, but generally my issues go further than that can reach (I have pan colitis.)
Posted 2/3/2011 11:05 PM (GMT 0)
     Prednisone was the only drug which helped me into remission but I became dependent on it.  Your doctor probably knows this and wants to try other meds.  My GI doctor told me he would rather me be on Remicade than prednisone.  Long term use of prednisone gave me osteoporosis, high blood pressure and  type 2 Diabetes.

     I had a total colectomy with end ileostomy on June 28th because all the drugs failed.   Off all meds except for only 25 mgm of Toprol for blood pressure.  While on prednisone, I had to take 3 different blood pressure meds and medicine to regulate my blood sugar..off that.  While I will always have osteoporosis, at least everything else is functioning a LOT better.

Posted 2/3/2011 11:16 PM (GMT 0)
I agree with Christine and Songlady. My doctor would rather me be on Imuran than pred. Pred. does often help and help quickly but it is just a quick fix but not a very long term fix and it has documented long term health risks as Christine has experienced first hand.
Posted 2/4/2011 1:18 AM (GMT 0)
I agree with the others. I don't think 3-5 movements a day is enough to warrant prednisone. I would try steroid enemas, hopefully they help. Actually, before steroid enemas, i would try give the Rowasa a better try. Use rowasa every night, suppository in the morning. I wish I didn't try prednisone and opted for somethiing else in the beginning. prednisone has caused me awful side effects. I hope I don't stay this puffy forever!!
Posted 2/4/2011 2:11 AM (GMT 0)
You should be on the mesalamine enemas nightly..why are you only on them twice a week?

q
Posted 2/4/2011 2:48 AM (GMT 0)
If you are not bleeding, then I see no reason to go on prednisone. It has some very nasty side effects.

This song is great. It's about prednisone:

Prednisone by Carla Ulbrich

http://www.carlau.com/music-32.html
Posted 2/4/2011 3:51 AM (GMT 0)
I echo what everyone else had said. I am currently on Pred and the side-effects have been worse than the actual flare I have been having. Hopefully doing nightly rectal meds will put you into remission.
Posted 2/4/2011 3:28 PM (GMT 0)
I'm joining the Quincy chant. More enemas! More enemas!

I wouldn't jump to pred yet either. It's really just so hard on the whole body! ;o)
Posted 2/6/2011 3:02 AM (GMT 0)
Thank you all for the advice.  What's really sad is I'm at the point of listening more to all of you then my doctor.  What I really don't get is I'll have about 2-3 decent days, then 1-2 bad days.  I was just starting to feel better and then again today I had a little bit of blood and went 5 times this morning (none in the afternoon thank goodness).

Since I was feeling better I slacked off on the enemas again.  I think I'll just take your advice and start doing them every night.  I guess my concern is when I had my colonscopy last November, the inflammation - which my doc said was "mild" - was in my transverse colon.  Will the enemas really work that high up?

I don't really have many issues with urgency so is that an indication that left side and rectum are okay?

Posted 2/6/2011 5:31 AM (GMT 0)
I don't think one has UC with only transverse involvement. Do you have a copy of your last c-scope?

No, the enemas won't go that high.

I think you need to formulate questions for your doctor to get the right answers of what's actually going on.

q
Posted 2/6/2011 5:38 AM (GMT 0)

cpaarchie said...
Thank you all for the advice. What's really sad is I'm at the point of listening more to all of you then my doctor.

The western approach to treating IBD has failed. That's why the UC and Chron's forums are so popular. If western treatments were working, then we wouldn't be here.
Posted 2/6/2011 5:43 PM (GMT 0)
     If it weren't for this forum, I wouldn't have had the surgery.  My GI doctor wouldn't refer me to a colorectal surgeon!!!  All he wanted to do was keep trying different meds.  As a matter of fact, get a load of this one, which actually came directly from his mouth...."We can try putting you into the hospital, repress your entire immune system and put you in isolation.  Then we can try jump starting your immune system and see if the ulcerative proctitis returns."  In the meantime, what if I caught some bug?  Did that ever cross his pea brain?  I wouldn't stand a chance!  What a moron.  He is known as one of the best GI doctors in this area too...scary.  Needless to say, I have not returned to his office since a month before my surgery.  He actually wanted me to come in post surgery.  I asked my colorectal surgeon and he said, "no need to go to the GI doctor unless I have some upper gastric problems."  Thank God I don't but I will find another GI doctor anyway.

     You condition sounds like how I suffered. One or two good days and then BAM...urgency, blood, cramps.  My ulcerations were confined to the rectum but even the enemas loss effect.

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