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Stronger Suppositories than Canasa

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Posted 4/3/2018 9:23 PM (GMT 0)
I was just wondering what other suppositories are out there besides Canasa. Quick backround been in remission for 3 years after being diagnosed with ulcerative proctitis and have been bleeding for about 5 weeks on one side of stool and occasionaly on the tp. My bms are fully formed and i go once a day. My GI finally is telling me to come in on the 17th because he is unsure if it is a flare or hemmys. Im on 2 lialda and 1 canasa daily. So i asked him can we go to a stronger suppository other than canasa. His response was there is nothing stronger than canasa and the next step would be a different class of medicine. I was wondering whatinfo i can say back to him because this board is full of info from very informed people. It just scares me my symptoms are very minor to me at least and the thought of changing medication classes makes me think he would do biologics which i do not want to do. Any advice or info i should ask him at my appt would be great.
Posted 4/3/2018 9:27 PM (GMT 0)
People on here have had a lot of success with enemas. They also contain 4000mg of mesalamine as opposed to the 1000mg in canasa, and reach a bit higher in the colon

Post Edited (albear99) : 4/3/2018 3:34:01 PM (GMT-6)

Posted 4/3/2018 11:42 PM (GMT 0)
Definitely enemas. There are steroid supps too if you think it would work better for you.. Then there is uceris foam and cortifoam, some places make a mesalamine foam too.
Posted 4/3/2018 11:49 PM (GMT 0)
Yup....steroid supps for the very bottom and also Cortifoam is a possibility for a bit stronger yet. Also can add mesalamine enemas to the mix.(which can cover more ground---but for me the supps do the best for the very bottom)
B
Posted 4/4/2018 2:55 AM (GMT 0)
So my GI saying there is nothing stronger than canasa should i assume he wont consider those options. Him not even thinking this is a flare and taking a wait and see approach has already got me nervous.
Posted 4/4/2018 3:00 AM (GMT 0)
First of all, if you are in a flare, 2 lialda is not enough.

Re: suppositories, if I were you I'd either do 2 Canasa (1 in morning and 1 at night) or do a steroid supp (such as Anusol) in the morning and Canasa at night. The steroid supp will help whether it is hemmies or a flare.

As others have said, enemas are another option. There are mesalamine enemas (same medicine as Canasa) and steroid enemas (usually they come in a foam you spray up there).
Posted 4/4/2018 3:23 AM (GMT 0)
The problem is he hasnt talked about upping the lialda. Hes already talking about different medication. The symptoms i have now have always been my symptoms. If this is just mild im hoping to stay off the harder ones for now but it doesnt sound like hes going down that road.
Posted 4/4/2018 12:02 PM (GMT 0)
the bigger issue seems to be your dumb-ass doc -
Posted 4/4/2018 12:30 PM (GMT 0)
Yeah it is which has me worried. Thats why i came to get the boards advice so i can ask him why cant we try so and so medicine first. So for such mild symptoms would asking for the enemas be a smart move or the steroid suppositories?
Posted 4/4/2018 12:33 PM (GMT 0)
my vote would be to add mesalamine enemas -
Posted 4/4/2018 1:13 PM (GMT 0)
You can:

1.) Take multiple Canasa suppositories a day. We have had posters take 2 canasa a day with luck.
2.) Insist on rowasa retention enemas, which are 4.0 grams as opposed to much lower dosage 1.0 gram canasa suppositories.
3.) Ask for steroid suppositories, foams, or enemas.
4.) Try combinations of the above. Take an enema at night, a suppository in the morning.

Sometimes proctitis does require stronger medications than mesalamine. Certainly try the above first, but don't be afraid to take immunomodulators or even biologics when the mesalamines are not enough. There's posters on here who have proctitis and needed much stronger medications in order to control their UC and enter a remission.
Posted 4/4/2018 1:40 PM (GMT 0)
Thanks for the response. I have no problem taking the stronger medicines just thought it was a big jump without trying all that you mentioned. Id love to take 2 canasa a day but id run out of my prescription quickly.
Posted 4/4/2018 1:41 PM (GMT 0)
Ask your doctor for a trial increase in canasa to allow 2-per day. Tell him/her you want to trial it for 2-months and see if there is an improvement, if not discontinue. That's worked with my doctor before!
Posted 4/4/2018 1:50 PM (GMT 0)
I just emailed him asking about upping the lialda or canasa. I also asked him about enemas or steroid suppositories. Im hoping since it is so minor of a flare he will consider. I really appreciate all the input. Been in remission for 3 years and now a month till my wedding im flaring or its maybe a flare if you ask my doctor
Posted 4/4/2018 6:04 PM (GMT 0)
Remember.....if asking doesn't get you anywhere, request.

q
Posted 4/4/2018 7:24 PM (GMT 0)
Being your own best advocate for what you need to be well is an essential skill to have, and lesson to learn, as a UC patient. Your doctor's office is crazy busy with many patient requests, not an excuse but a reality. If you are persistent and insistent then you'll get what you need to be well. Your doctor isn't the one suffering from a flare, but you are (so no pooh poohing your concerns when you're the one poo pooing too much and too painfully). You hate to be hornet in somebody's ears but if that's what it takes to get what you need to feel better than so be it smile
Posted 4/4/2018 7:33 PM (GMT 0)
I appreciate the responses. Ive been emailing him once a week keeping him updated. Still waiting on today's response. The fact that he keeps saying wait and see till my appointment because hes not convinced its a flare has me a little nervous. Just feel bad saying my concerns when many on this board have way worse symptoms. If it wasnt for the blood that only seems to be worse on pebble stools i wouldnt even think im flaring. Just hoping this waiting doesnt cause it to spiral out of control.
Posted 4/4/2018 9:05 PM (GMT 0)
I'm sorry but I have to call Lame on this doctor. There is no reason I can think of to with hold extra Canasa, Anucort , or Rowasa for now. It could possibly help and then he can re-evaluate once he sees you for the appointment. It is best to hit a flare hard so it doesn't gain steam and the meds mentioned (supps/enemas) aren't very hardcore or dangerous. So if it is something else, you can discontinue with no issue.

Seriously, I would consider trying out a new doc as soon as you can. You need one that will partner with you. I hope this isn't too harsh, but this type of thing really irks me. It is bad enough to have a chronic disease without having to deal with a chronically annoying doctor.

Also -- your symptoms from what you describe at this point don't sound like a higher class of meds is necessary at this point. (unless a scope shows different) Also you held remission for 3 years. I would be very leary of docs who push the stronger meds (although I know there is some school of thought for a "top down" approach--but I prefer the least amount to get the job done well.) Also not to be cynical, but just to cover all bases, there is a sight like dollarsfordocs or something like that that can inform you if your doctor is given any money as an incentive to prescribe their drugs. I always like to know.
B

Post Edited (hateuc) : 4/4/2018 3:10:22 PM (GMT-6)

Posted 4/4/2018 10:20 PM (GMT 0)
Well I just got some good news my doc said to up the lialda to 4 a day and 2 canasa and if that doesnt work he wants a short pred run. My question is if anyone knows is should i take them all at once or split morning and night.
Posted 4/4/2018 10:43 PM (GMT 0)
I would try canasa split, am and pm if possible. As far as the Lialda goes, I take two in the am and two in the pm, but others take all 4 at once, I'm not convinced that one way is better than the other, but my doctor wants me to split the dose to keep a "more even" level of medication.
Posted 4/5/2018 4:32 AM (GMT 0)
Sheesh.....canasa to pred? Nah, request the rowasa before doing pred.
Split the dosage....night and day after majority of bms.

Yep, the issue is with the doc and he's enemafobic.

q
Posted 4/5/2018 2:48 PM (GMT 0)
Yup, big jump from Canasa not doing it all the way to pred. Especially if you are at one bm a day-formed. There are so many more benign things to try before the big jump in my opinion. I would think to save pred for more dramatic situations--it is a mixed bag drug and gets less effective over time. Heck if he won't try any more/different enemas or supps at the very least I would do Uceris before pred (also a steroid -oral, but not as systemic as it releases in colon only...also not as strong. New Doc.
B
Posted 4/5/2018 3:38 PM (GMT 0)
Always try rowasa/mesalamine enemas or steroid enemas before systematic pred, especially with mild symptoms.

When is pred appropriate? Pred is like launching a nuclear warhead, only used in a worstcase scenario when everything is FUBAR (Fouled Up Beyond All Recognition/Any Repair/All Reason) and that's the best way to win. When your flare is pure misery (nearly incontinent due to crazy urgency and frequency, each bathroom visit is painful and involves blood), as then you can justify pred's side effects like insomnia, weight gain, moonface, etc. When I need pred, I am a hot-mess and desperate for improvement. If that isn't you, then I'd hold off on pred.

We all have a love/hate relationship with the pred as pred is rocketship fast in making us feel better, but the side effects are pretty much guaranteed and awful. I call pred "the devil's tic tacs" for ample reason, relief but at what cost? smile
Posted 4/5/2018 4:12 PM (GMT 0)
I've never been on pred....even at the worst of 15+ bloody razor diarrhea a day.

If it's not warranted....don't use it. Just to add a short course could be months and months.

q
Posted 4/5/2018 4:33 PM (GMT 0)
If this doesn't clear up before my appointment I will mention all this to him. Thanks so much everyone really appreciated. I do always have anxiety about worst case. If my colonoscopy was 3 years ago is there any chance the bleeding could be a tumor or do they take years to develop.
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