Why the resistance to rectal meds?

In the last month, I switched GI doctors (on my 4th within one year.) I feel really good about the new office. They are at a research hospital, and my GI specializes in IBD. I have been for three visits within the last month 1) initial visit with dr. 2) flex sig by doc 3) visit with PA for treatment options. I have been thoroughly impressed by the office, how efficient, the time spent with me, the modernness of the facilities, etc. I am traveling 45 min to the new doctor, versus 10 min from the last three. I really feel like it's time well spent.

That being said, they still won't prescribe me any rectal meds. They say it won't do any good since I have at the minimum left-sided colitis from the most recent flex-sig. I know many of you are big proponents of rectal meds. So, I'm a little puzzled why none of the docs will prescribe this for a try still!

The new doctor has prescribed me VSL #3 DS (1 packet/day), which I have been taking for one week. I haven't noticed radical changes yet. Perhaps starting to get a bit more solid at times, but not always -- and that has fluctuated anyway in the last 2 months. The PA made a comment that the VSL is a bit more helpful for Proctitis, and she didn't think it would help me that much...but they are completely willing to prescribe it. And they have been great working with me for a prescription that helps minimize my insurance co-pay, since the boxes of DS come in 20.

The new doctor's office is also encouraging to do the FT. I am happy that they are on board with this new approach. However, they recommend that I get into remission before starting the FT. To achieve that, they have prescribed 150 mg Imuran (generic). I will start with one week of 50 mg, then go up to 150mg. Of course, I'm a bit bummed that I have to go to the next level of meds. Reading this forum has calmed some of my fears to see so many people on Imuran for a long time, without dire side effects. They checked my enzymes, and feel that I would handle Imuran well. In addition, they reassured me that it is safe to continue breastfeeding (or even to get pregnant on...which I'm not sure I feel comfortable about that yet...but that's another topic.) I called the Infant Risk Center, and they confirmed that the Imuran is a L3 breastfeeding med and that it peaks in my milk 1-2 hours after taking it. Since I'm only nursing 3x per day now, that's totally doable. I've nursed my daughter while on 40 mg of Pred and 4 tablets of Lialda. She is completely healthy.

Hubby went to the appt yesterday to hear the info about the FT. I didn't realize it isn't administered via enema bottles , but a bag. I'm still a bit confused about the specifics of the procedure, but I know that will come later. From my only experience with enemas (2 Fleets for flex-sig prep), I'm concerned about being able to hold the FT in. I couldn't even hold the Fleets for 5 min. The PA said if I wasn't flaring then I should have better results with retaining the FT. The plan is for me to start Imuran, continue VSL and Lialda and wait 6 weeks for the Imuran to kick in. Meanwhile, get my hubby into his PCP and get all the blood & stool tests for the FT completed and evaluated by my GI clinic. Hopefully the Imuran will kick in and we can start the FT in June. They said that we would complete 10 concurrent daily treatments at home. Then 2-3 months later do a couple of follow-up treatments. Then, if I'm in remission, I could come off Imuran, and likely lower my Lialda dose. Sounds like they advise taking a melamine for life, because it coats the intestine and provides some protection against cancer. They said they have had approx 50 patients complete FT with quite good results. That's so encouraging. I'm just a bit bummed that I do have to start Imuran.

Having between 3-5 significant D Bm's per day, plus another 5 of gassy/sludge. Waking at night 2x. Not nearly as bad as it once was, but would love to live without fear of running to toilet.

Makes no sense to me. I have left sided colitis and am on Lialda and the Rowasa enemas from day 1 of diagnosis. They are extremely helpful.

Rectal meds DO help with pancolitis, though - sure, they don't treat the entire colon, but they do a fantastic job of treating the distal colon, which oral meds don't treat all that well. Oral + rectal is the best line of defense, no matter the extent of the UC!

My clinic is the USA. I'm hesitant to give too many details. They won't be administering the FT in the office, but will help with the at home instructions and donor testing. They told me that it was not really a proven method, but they have had more than 50 patients perform the FT at home, and 2 patients travel to Australia to Dr. Borody.

I tried to use the terminology that they told me, but I took it to mean that I had inflammation throughout the entire area that the flex-sig reached. Since I was diagnosed via colonoscopy with pancolitis and that was my only colonoscopy, I thought it meant that they didn't truly know where the inflammation stopped. Thank you everyone for your responses. It's always good to hear other thoughts and encouragement!!

I would see another GI. That's cool they're pro-FT though so maybe you should stick with them...not many GIs are offering that.

It seems the clinic/GI has their/his own agenda regarding treatment...maybe outcome, etc.

And the same old crap about pancolitis and rectal meds not helping...don't know why those of us who understand this part, you all should.

My GI, too, says no rectal meds with pancolitis.  Since I too am 'newly' diagnoised, I am wondering if there is a medical reason not to prescribe. 

When dianosed I only had inflammation up 25 cm. I was not prescribed rectal meds. After I was on them I asked why they weren't brought up to me. He said because so many people have an aversion to them he doesn't even bring them up.

He's not my GI anymore.

Of course I prefer the pills. And of course I don't like sticking things up my ass.

But I MUCH prefer using an enema over flaring and pooping 25 times a day.

"red hot poker", hahaha, nice one!