Newbie needs advice from the gurus

Experts I need some advice.  I was diagnosed with left sided UC about a month ago and went into a severe flare (heavy bleeding, 25+/day) about a week after diagnosis that required pred to get under control.  I saw my GI today & am starting a very slow pred taper tomorrow.  I'm still not 100% - still some intermittent, mild mucous.  Stool is formed but going 1-4 times/day. 

GI is optimistic, but was honest that he's not convinced the pred taper will work, but finds long term pred use "unacceptable" - which I'm great with.  The next drug will be Imuran in combo w/ Lialda.

At the end of the visit, he mentioned rectal meds as another option.  Should I have him add in rectal meds while tapering off the pred?  Think that might help solidify "remission?"  I'd really like to be on Lialda only as a maintenance drug. 

Any advice would be greatly appreciated!

yes try the rectal meds, rowasa. and follow very strict diet devoid of dairy and whatever else might cause increased bleeding and urgency.

i've tried all the rectal meds and none of them helped me. they only made my bleeding worse. it seems they have helped some people though and i'd definitely try that over immunosupressants. i'd also take high doses of probiotics while you are tapering, if you aren't aleady.

I don't know why he shouldn't be optimistic about the pred taper. Plenty of people have success.

Anyway, like others, I can't emphasize it enough, you should try the rectal mesalamines. I credit my nearly year-long remission to Canasa, the suppository. The only two times I've had breakthrough bleeding have been when I slacked off or tried to taper down the medication. Other than that, complete remission. My UC is pretty low in the colon. In your case, involving the whole left side, the enemas would probably be better. Or do the enema one night, the suppository the next night. Never have tried the enemas myself, but the suppositories are really not a bother at all.

The suppositories are for really low inflammation. You can try enemas nightly and Canasa twice daily for major arsenal to carry you through the prednisone taper. When I got below 10 mg. the Canasa (suppository) cut the pain, meaning inflamation, and I got off pr.ed easily. Without Canasa I kept bouncing back to 40 mg. and starting over. My second flare, I added enemas and was able to go into remission no problem.

It's good your GI suggested them and you are asking the right questions here. I was at a crossroads having a second attack and my GI assuming the orals/rectal mesalamine didn't work and he was gunning for 6mp. I got recommitted to mesalamine, rejected 6mp against his wishes, and dosed up with high orals, rectals and suppositories. Now I'm fine, managing everything topically. It's a drag, but so worth it.

Rectal meds should definetely help. I was put on Rowasa enemas and Lialda when I was first diagnosed and I was in the bathroom as many times as you per day with tons of bleeding. Those two drugs alone put me in remission. No nasty pred was needed so give it a try. But give it time to work. Every person is different with how long it will do its job but since you are already doing better it should help quickly I would think.

Call your GI back and tell him you want the rectal meds, that you don't want to screw around. There is NO REASON to not go ahead and start them, other than you (and apparently, your GI) being averse to sticking an enema applicator in your bum. It's really not a big deal. Really. You have the absolute right to request a med from your doctor.

Plus, you obviously still have some active inflammation based on your bowel habits right now. The enemas will help get rid of it completely.

I get that you only want to be on Lialda for remission. But the rectal meds will very, very likely keep you in remission for longer if you just use them twice a week. It's absolutely 100% worth it to me. Agagin, it's really not a big deal to use them.

I'd also go ahead and start the probiotics. There's a very, very tiny chance they'll make things worse. And if things get better, and it's hard to tell if it's the probiotics or something else, who the heck cares? I mean, you can find reasonably-priced ones, and I think it's wise to ALWAYS take a probiotic if you have UC, whether or not you have UC.