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Posted 9/3/2015 4:56 PM (GMT 0)
Hello there!

I have been reading the forum for a while as I have worked through a few different flares. I am 21 years old, diagnosed about 2 years ago with UC. This is my fourth flare since I have been diagnosed.

I have been on 60 mg of prednisone for 3 weeks now, along with 6 asocial a day and a steroid enema at night. I started out with bloody diarrhea (typical flare stuff) but have improved some since i started pred. I will only go to the bathroom 5-6 times a day, but all in the same day I can have bloody diarrhea and then a few hours later have soft, formed stool with less blood. Or, one day I will have mostly formed stool with mild bleeding, and wake up the next morning with bloody diarrhea again. I have been following this pattern for a week to a week and a half now. I am worried that the prednisone is not working. Is it normal to have these ups and downs, or should I consistently be seeing more improvement? Do I just need to hold steady and give it more time to work?

I have had plenty of experience with flares before, but never had a pattern like this. Had me a little worried
Posted 9/3/2015 5:11 PM (GMT 0)
The more damaged your colon is the longer it takes to heal and the longer it takes prednisone to work. What meds and dosages do you take when in remission? Whatever you are doing at that time is not good enough and that's why you keep on flaring. It's a bad idea to just let yourself flare over and over and then try to treat it afterward, especially if you keep relying on prednisone to get you out of flares. You should have a good enough treatment plan when in remission where hopefully you don't flare again because future flares often get harder and harder to treat.
Posted 9/3/2015 5:31 PM (GMT 0)
I take 6 asscol a day when in remission. i have been in remission for 8 months, then 5, coming out of remission every 5-6 months. I do try to watch my diet and take asscol regularly when not flaring, but prednisone is the only thing that calms my flares. This one just seemed to be taking forever to get better, without seeing truly consistent improvement
Posted 9/3/2015 5:41 PM (GMT 0)
Healing is full of ups and downs, and bms are almost never consistent on a day-to-day basis. However, there should be a week-to-week improvement. Your prior flares might've been quite similar, however, all flares can be different in severity. One can become resistant to steroids over time. Four flares in two years seems like quite a lot. To me, it seems like your maintenance medications are not sufficient. I'd recommend asking about stronger uc medications. The next step would be either immunomodulators (Imuran, 6mp, or aza) or some doctors go straight to biologics (remicade, humira, or simponi).
Posted 9/3/2015 5:55 PM (GMT 0)
My doctor has mentioned trying stronger medicines. I have discovered a few triggers over the past couple years (coffee, taking heavy doses of ibuprofen) that I am hoping if I cut out will help. The stronger meds make me very nervous
Posted 9/3/2015 6:13 PM (GMT 0)
You've got to somehow have a better mtnc program than just Asacol only because that is not working to keep you flare free. Instead of taking steroid enemas you could do both mesalamine enemas and mesalamine suppositories once or twice weekly while in remission in addition to the Asacol. You cannot take prednisone long term or rely on it to continually pull you out of flares. Flares do often get worse and worse and you really don't want that to happen because colon damage can take a long time to heal and sometimes it never heals. On the course you are going now it will reach a point where you won't have a choice anymore in taking the stronger meds, unless you want surgery instead. Don't take Ibuprofen at all. The doctors should have warned you about that.
Posted 9/3/2015 7:26 PM (GMT 0)

cat1211 said...
My doctor has mentioned trying stronger medicines. The stronger meds make me very nervous

What you've been doing isn't working, 4 flares in 2 years. I was scared of progressing to immunomodulators and biologics as well, as the side effects sound scary. I've now been both immunomodulators and biologics for two years, I have yet to have one side effect, and I've stayed in remission.

It really helps to weigh the risks against the benefits. What are the odds these medications will help improve you uc symptoms? It's 60+ percent.
What are the odds these medications will give you the scary side effects? It's less than 1%. It's 0.04 percent for immunomodulators and 0.06 percent for biologics. Those are hardly numbers to loose sleep over. The Crohn's and Colitis Foundation of America is the source for these statistics:
Webcast: programs.rmei.com/CCFA139VL/presentation/player.html
Transcript: www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf

The odds of untreated uc inflammation causing cancer far outweigh the risks of immunomodulators and biologics. Prednisone is a rescue medication that should be used as infrequently as is possible, since repeated and long-term use of prednisone will cause irreversible side effects to your body (such as glaucoma, type ii diabetes, or osteoporosis). All good reasons to get into a long, solid remission.
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