Newly diagnosed - need help understanding when ready to return to work

Welcome.

The best combination of medications for new patients is 4,800 milligrams of asacol oral, and 4,000 milligrams of rectal-route enema (rowasa or pentasa enema). If you're not receiving both medications at those doses then bring it up to your gastroenterologist specialist in your next visit. Rectal medications are key, as inflammation in that area causes the most annoying symptoms of urgency and frequent bms, heal it and those symptoms will go away.

Yes, prednisone shouldn't be discontinued until you're completely healed. Prednisone is a good rescue medication that buys you time while your other medications have time to work. But, removing prednisone requires your other uc maintenance medications to sustain your desired quality of life. So, getting that right is key to being successful.

When can I go back to work is a very difficult question to answer as it is highly variable on a person-to-person basis. As it's key to give you the correct medications and dosages to get your uc under control. And, sadly, it's a trial-and-error process: try this for a few weeks and we'll talk again and make sure it works. If it doesn't work, then we'll try different medications and doses. Mix and repeat.

You should be in regular contact with your gastroenterologist during your initial treatment, and make sure to be vocal and tell him/her if something isn't working. If it is working, you should see a week-to-week improvement in your symptoms (expect daily fluctuations). Often by 3-4 weeks, you should be a lot better if the medications are right. If not, move on to the next treatment.

Uc can be quite frustrating and difficult to tame. But once you do, you can live a nearly normal life. My uc is currently in remission (an absence of symptoms), I have 1 bm a day without urgency or any sign of uc.

I think it's weird that your doctor doesn't want you to taper until the bleeding stops. It took a year for the bleeding from my first bad flare to stop.

On work: I've have an office job too and have also gone to work in diapers. My best advice there is to tell your supervisor what's up and to think about ADA accommodations that could help you. I had my doctor sign off on paperwork that gives me a flexible start time because my symptoms are significantly worse in the morning. Often, starting at 9:30 or 10 am is feasible when starting at 8 am simply wouldn't work. Then I just stay late to work a full 8 hours.
I know a lot of people move their offices or desks closer to a restroom, stipulate that they won't be able to travel for work during flares, etc... Can you ever work from home? I switched from teaching face-to-face to online classes during the semester of my worst symptoms.

Other options which are terrible, but have definitely helped me: Not eating or drinking during work hours or fasting prior to important events. An Ensure liquid diet works for a few days at a time. Wearing diapers under clothes (be aware that diapers only buy you time to get to a restroom without making a mess). Packing an "emergency kit" with wipes, a change of clothes, garbage bags.

I kept a change of pants in the desk, and just made many restroom trips. some days really sucked.

The note at the bottom of your report says that the biopsies alone aren't enough to give you a diagnosis of ulcerative colitis. The biopsies are inconclusive. That the doctor must rule out other plausible causes as part of his/her official diagnosis. As these biopsies could be from a patient who has just an infection, a reaction to a medication, etc.

And I agree, nothing here screams ulcerative colitis (no cryptic distortion, no vascular pattern disruption, no frailability, no granuloma).

Here's what I understand:

FINAL PATHOLOGIC DIAGNOSIS:
A. ILEUM BIOPSY:
Looks normal/healthy at the ileum, where the large intestine attached to your small intestine.

B. COLON BIOPSY, TRANSVERSE:
The transverse colon goes horizontal, from your left to right side (just above your belly button). The thin mucosal tissue layer was noted as swollen/inflammed, which is characteristic of infectious colitis, plausibly uc. It was noted that the color was off in the biopsy, it was dyed or stained a different color than is normally seen. Have you used a lot of anti diarrhea medication (as that can stain the color darker)?

C. COLON BIOPSY, 30 CM:
This biopsy was taken within the sigmoid colon (higher up than the rectum). There was no sign of distortion (common with a chronic disease that repeatedly goes through heal, inflamed and back to healed again, repeat cycles...). It says mildly active colitis was seen, although it doesn't say what, exactly made that judgement.

about 25 percent of uc patients have a relative with a similar condition (uc, crohn's, ibs).

Crohn's is patchy in appearance (areas of normal tissue, followed by inflamed tissue, followed by normal, repeat), biopsies would show deep tissue damage, and inflammation can be anywhere in the digestive tract from mouth to anus. Uc always starts at the rectum and spreads continuously upward, biopsies show very shallow tissue damage, and it's limited to just the large intestine. There's also crohn's-colitis and indeterminate-colitis (both crohnic) for cases where it's inconclusive, exactly what it is. I'm not sure what your doctor saw during the colonoscopy, but that might add more certainty to a diagnosis.

My recommendation is proceed with the prednisone and asacol. You might want to add a meslamine suppository (canasa) or enema (rowasa) as much of your inflammation is near your anus, and the pills don't reach that far, consistently. If it doesn't improve things, then insist on an antibiotic as you might have infectious colitis which could respond to antibiotics and not the stuff you're currently taking...a misdiagnosis might be possible given the inconclusive pathology. But even that'd be great news, as you might not have a chronic, lifelong disease, after all, at least in that situation