Prednisone - Healed all symptoms in Day 2... but Diarrhea Persists Day 17?

So the prednisone stopped the bleeding, but the other problems you have (frequent diarrhea) is obviously a symptom of continuing inflammation, as your scope confirmed. Are you still taking the Rowasa and Asacol? Are you still on 40 mg of pred?

I would stay on the pred and the mesalamines. Seventeen days is not so long, really, especially for pancolitis. It can take a long time to reduce inflammation and induce remission, but it is something you should discuss with your DR.

Are you able to care for your baby alright? Are you able to get any sleep? What would be your DR's opinion on the longest time to wait for improvement? If the steroids start to really affect your mood, or sleep, or other issues you should consider alternatives to induce remission.

Pred works fairly quickly. At this point it is just holding the bleeding at bay so the Asacol has a chance to work. IF it is going to really work, that can take 6 weeks. For some, me included, 5-asa helped a lot and seems to be giving very slow but steady improvement - but after 3 years I still have multiple loose stools/day, and occasional urgency.

I think if you want to get to well formed stool 1/2 times daily, you are going to need something else. Possibly massive probiotics could shift you to a better place. Many people use 6mp w/o problem, but I am a little scared of immune suppressors.

I ve been on Asacol for almost two years and recently my Doctor gave me a three week trial of Pred. It worked ok but still had diahrreah attacks, cut down my urges and cramping however. As soon as a I stopped the Pred i was bleeding again and having the same bathroom urges. He has put me on another three week trial of pred and has taken bloodwork to bump me up to 6MP, which I am leary of taking.

Fruitgirl, I've been on Prednisone 2 1/2 weeks.

I think you could give the pred some more time to work, if you're game, because your symptoms HAVE improved. And both the mesalamine drugs and prednisone might be "causing" some slow improvement.

If you do decide to stick with the pred, I'd also not jump straight to 6MP, but see if you can maintain remission on Asacol + Rowasa. I think it's possible you could. I was in a pretty severe pancolitis flare (15-20 BMs a day) and I've been in remission for over three years on that combo (well, Apriso instead of Asacol).

What is your history before the events of your post? Was your proctitis in remission from the Canasa? Was it just the Canasa which put you into remission before or did you use other meds as well? Obviously the pred must be doing something or you wouldn't have gotten better. You may have to be on it at the highest dose for a while and then taper back and then just maybe use the Canasa again. What your doctor said kind of doesn't make sense in that your two options are a slow taper on Prednisone and then 6MP or going straight to Humira. You really shouldn't be tapering the pred at all until your symptoms are better and then begin the slow taper. Also, 6mp can take several weeks or even a couple of months to kick in so most doctors that go this route have you on pred at the same time as 6mp so that the pred can be working on you and then taper back after several weeks after starting the 6mp. It doesn't make sense to taper off the pred first, be in bad shape, and then wait 2 months for the 6mp to start working, assuming that it ever does.

Sometimes you have to be firm with the doctors. Just because he says those are your only two options doesn't mean he is God and you have to listen. If you would rather do Remicade than that should be your choice. Did you know that with Remi that it is an infusion lasting some time in an office whereas the Humira is a shot you give yourself and it's done and over? Have you tried any probiotics, natural treatments, or diet changes?

My proctitis symptoms were only blood and mucous in otherwise normal stool. A 2 month treatment of Canasa put it into remission, and I only had to do "spot treatments" of a few weeks when I sensed some symptoms coming on, but they were always managed quickly. Any proctitis symptoms practically disappeared while I was pregnant.

However this all changed post-delivery. This recent episode which has been diagnosed by colonoscopy a couple of days ago as pancolitis is much different in the addition of diarrhea, stomach cramps, and urgency and frequency as well as the fact that the inflammation is throughout the colon. Actually, the areas of the colonoscpy that looked the best were where the Rowasa and Canasa could reach! 

I do understand that the Prednisone has helped me significantly. I think though that perhaps I have reached it's healing plateau which I can stick with while waiting to see if the Asacol can continue to make small improvements (I've been on Asacol 3 weeks); or say, "this just isn't working, we need something more" in which case there's 6MP or biologics.

I'm so grateful for the feedback, folks. Wondering if you're doing all that you can do, and wondering if your doctor is really looking at all the pieces can be maddening if you think you're alone.

 

Update: A few days ago, the diarrhea is finally started to go. Fruitgirl, I'm sticking with your advice and keeping up with the Rowasa enemas; no fun, but I do think they help in conjunction with Asacol. Doctor advised continuing tapering down to 30mg today and a sigmoidoscopy next week to check on how well the inflammation has gone down before deciding to jump on 6MP or biologic bandwagon. Oh, and I'm definitely getting a second opinion the next day too! Thanks for your help, all.

I hear you on the flex sig. On one hand, I think they want to see if there is enough inflammation that we'd want to start 6MP now so it has "kicked in" by the time I'm off the prednisone. But I am nervous about irritating a colon which has just started to heal. Perhaps I can put off the flex sig until I get a second opinion next week. I've never had a flex sig before so I don't have a sense of how invasive it is.