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Question for quincy and others about Rowasa and Canasa

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Ulcerative Colitis
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Posted 7/26/2009 11:44 AM (GMT 0)
quincy,

I noticed in one of your recent posts you suggested that the person try "Rowasa before Canasa". Did you mean to use both, just use the Rowasa first, then insert the Canasa. Or to have the doctor prescribe Rowasa first to see if that works before going to the Canasa. I am asking because I was put on Canasa last week. Have never been on Rowasa. I'm not sure if it's helping or not. Yesterday I had a fairly inactive bowel day (only 6 episodes) but I hardly ate a thing. Today I'm going to go back to a bit more substantial, though colon-friendly, diet.

Tofu
Posted 7/26/2009 7:45 PM (GMT 0)
Hi...I mean to use Rowasa initially rather than the suppositories. The suppositories (to me) aren't enough medication to be used in the most difficult place to heal UC.

It is good, however, that you're using them twice a day.

Where exactly is your UC....limited to the lower part of the rectum? If it's higher, you should be on an oral 5ASA such as Asacol plus an enema which can get the entire rectum plus into the sigmoid.

If one needs an extra amount of meds, the Canasa can be used during the day after the majority of morning bms and the enema at night.

I'm biased, however, but with most UCers on this board, eventually they end up on the enemas....a waste of time with the Canasa...again..my opinion.


You should eat as normally as possible, but often during the day in smaller meals.

Do consider fibre supplements to bulk and soften the stool a bit as well..it can help slow down diarrhea or looser stool a bit.

You could ask the doc for some dicyclomine 10mg as an antispasmodic.

As well...consider a probiotic.

Are you seeing a GI for your UC?

q
Posted 7/26/2009 8:33 PM (GMT 0)
Thanks for responding, quincy,

I really don't know where my UC is. The last time I went to the GI was in 2000 when I had a colonoscopy and he diagnosed it as UC. If the told me at that time where it was located I've forgotten. He gave me a prescription for Asacol and I was also put on prednisone. I may have had one follow up appt. with him. The Asacol didn't work and I hated taking the prednisone so I quit both and lived with the effects of UC and tried to control it with diet as much as I could. I did alot of research on the internet back then on UC because my aunt (mother's 1/2 sister) had just been diagnosed with colon cancer. At that time, there seemed to be disagreement as to whether colitis sufferers had a greater increase of developing colon cancer. I went into remission for about 6 or 7 months. Then I only had it intermittently or from obvious food choices (pizza...lots of fruit, etc.) I was put on Strattera for ADD in March or April 2005 and I thought my colitis went into remission. Off the Strattera and on Adderall in June, 2009 and that's when the diarrhea, et al came back. I never followed up with my GI or my doc. about the colitis because I thought it was in remission again and am only now discovering that the Strattera may have masked my symptoms.

I've been taking the Canasa suppositories since last Tuesday (I believe). Not sure they are helping yet. I'm also having lower back pain and alot of cramping and I feel swollen. Joints hurt, headache, no energy.

I'm a grazer when it comes to food and always have been. It's just that now I'm kind of afraid to eat, though it's not so bad on the weekends when I'm home. I've got a piece of chicken cooking in the oven now and I'm going to have a plain baked potato with it.

I have an appt. with my GI on 8/24/09. And I'm going to talk to HR this week about short-term disability since working has become extremely difficult.

Thanks for your insight and suggestions quincy.

Tofu
Posted 7/27/2009 12:41 AM (GMT 0)
Quincy can definitely get to the heart of the matter where flares are involved. I agree that you're overdue for monitoring by an experienced gastro, who will hopefully determine the extent of your inflammation. It's not a good idea to self-medicate for long periods of time. Also, if your inflammation is higher up than the rectum, Canasa won't help because it doesn't get that far. / Old Hat (30 yrs with left-sided UC; taking brand-name Colazal)
Posted 7/27/2009 1:52 AM (GMT 0)
One of my GI specialists had recommended taking 2 canasa suppositories, one inserted immediately after the other and pushing the first suppository further up, so that hopefully some of the canasa would reach higher up.

So, that would be 2 x 500mg suppositories for a 1 gram nightly dose.

I'm not sure how much higher up it gets, if at all, but that's the way I have been using canasa.
Posted 7/27/2009 6:08 AM (GMT 0)
I used to think that Canasa was a waste of time and never consistently used them. However, since growing resistant to Remicade and only using the Lialda 4 pills once in the morning I decided to use the Canasa suppositories nightly to supplement the Lialda. I didn't think the Lialda would be enough on its own after being on Remicade for 3 years. I have been SOOOO surprised with how good I've been feeling by taking the Lialda the last 33 days and using my Canasa every night. WHAT A DIFFERENCE!! I am not having urgency anymore and no more blood or diarrhea. What a relief after flaring so bad. I even made it to Maui for a week and got back last wednesday. My canasa saved my behind-literally. Coming from a former non-believer, trust me this stuff works. Maybe not by itself, but certainly complements my Lialda nicely.
Posted 7/27/2009 3:08 PM (GMT 0)
Interesting, Ashley O! If you read Rey's thread re "6-MP & cervical dysplasia"-- her daughter's gastro said recently that she'll probably need colon surgery if she has to get off immunosuppressant meds, due to repeat bacterial infections -- because a 5-ASA alone would not keep her from flaring.  / Old Hat (30 yrs with left-sided UC ... [etc.])
Posted 7/27/2009 3:46 PM (GMT 0)
I use the enema's only when really flaring but my UC is proctitis so it is lower and easier to reach with the Canasa...however it is very stubborn at times!

Ashley-O, I also did not think that the Canasa was working well and stopped using it...now I use it nightly and also take four Lialda in the morning...the two together do seem to help control my UC to where it is very manageable...either one alone does not do the trick. It seems you and I are on the same treatment regimen. Glad to know it is helping you as well!
Posted 7/27/2009 4:54 PM (GMT 0)
Old Hat- I read Rey's thread and feel for her daughter. However, I think she should exhaust ALL her options before surgery. Why take out a colon that can be saved? I believe that rectal and oral mesalamine can keep flares away if we are diligent about taking our medication consistently and correctly. However, there are some people who are worse off than others and surgery is certainly necessary part of the time.

thatfield- I'm so glad the Canasa and Lialda are working for you as well. We just need to believe in the treatment and think positively that we can make ourselves better. UC is all about control and once you can get control of your body again it's a wonderful feeling.
Posted 7/27/2009 5:20 PM (GMT 0)
["Rio in Maryland"]
One of my GI specialists had recommended taking 2 canasa suppositories, one inserted immediately after the other and pushing the first suppository further up, so that hopefully some of the canasa would reach higher up.

I have read about doing this so called stacking of canasa from numerous posters and it seems to me that physiologically/ mechanically it wouldn't work very well at all. It would assume that the bottom of the rectum is constricted and narrow enough to hold the suppositories in place vertically and that they would stay there to provide topical treatment over a long period of time. This would seem a nearly impossible "balancing" act particularly given that the elasticity of the rectum and that the suppository will melt in order to release its medication. IMO if the affected area is more then a few centimeters above the anus use the enemas.
Posted 7/27/2009 6:20 PM (GMT 0)
Ashley O, I agree with you re surgery. Maybe you can post a reply in Rey's thread. She was asking about alternatives if a UCer has to get off immunosuppressants & you're the same age as her daughter. / Old Hat (30 yrs with left-sided UC ... [etc.])

Posted 7/27/2009 6:29 PM (GMT 0)
Old Hat-thanks for the agreement. I will post on Rey's thread.
Posted 7/27/2009 6:35 PM (GMT 0)
stacking of the Canasa would work and I as well as others have suggested it as Rio has. Good to hear it comes from a GI as well..lol!

But I think that it would be still better to use the higher dosage of enemas for concentration of medication to the area.

rdm...there's no reason that the meds wouldn't say in....unless urgency is an issue and the medication triggers a bm.

I didn't think there were 500mg Canasa made any longer and that they were 1000mg. Could be wrong or not remembering if they're being made again.

Keigel exercises would help...


thatfield...you can use the enemas and concentrate more of the med to the lower part of the rectum as well....
the lowest part of the rectum is definitely the most stubborn part to treat.

q
Posted 7/27/2009 7:21 PM (GMT 0)
rdm - as you've mentioned, I don't know if stacking has been proven to work, but some people find that it is more effective, and just in case it is I'd rather stack them up.

Quincy - I've got a stash of medicines from the different GI specialists that I've seen, so I got the names mixed up. I'm not sure if there is 500mg Canasa as it's not Canasa that I've used most recently, but 2 x 500mg Mesacol suppositories.
Posted 7/27/2009 7:24 PM (GMT 0)
stacking makes more sense if the inflammation is higher....especially with 500mg supps.

Rio...they would be the same as Canasa...different brand that offers 500mg.

Thanks for clarifying that.

q
Posted 7/27/2009 7:35 PM (GMT 0)
Quincy

My point is not that they would not stay in but that they would not stay "stacked" but would sit side by side at the bottom of the rectum and thus only topically affect the same areas that a single Canasa would affect, granted it would have twice the meds and volume which might cause it reach a little higher. While it may be possible to stack them I believe it would be very unlikely as once the suppository enters the rectum it would have to stay in perfect alignment so that the next suppository would push it up. The only way I can see it possibly working is pushing the first one partly in and inserting the second one before the first has completely entered the rectum and with a single thrust pushing them both through the anus and into the rectum. I would speculate that this might give a 50 50 chance of actually stacking them, otherwise they sit side by side. I doubt if anybody uses this method of "stacking" but I could be wrong.

Post Edited (rdm) : 7/27/2009 2:03:56 PM (GMT-6)

Posted 7/27/2009 8:57 PM (GMT 0)
I don't think there would be a problem keeping the meds stacked initially since the rectum will close upon itelf securing them in place....maybe as they melt they will slide. There are women who stack tampons...same thing applies..although they don't melt..the vagina secures them in place.

Maybe one needs to maintain some muscle control initially?

I would think one after the other with some lubrication would be no problem...but interesting perspective.

There are a few on here who have used it....from what I remember...successfully.

But...I'm all for the retention enemas.....

q
Posted 7/27/2009 9:24 PM (GMT 0)
Yep, Canasa MELTS-- then it oozes out within a couple hours. Yuck! That's why 5-ASA foam should be marketed in North America!!!!! / Old Hat (30 yrs with left-sided UC ... [etc.])
Posted 7/28/2009 3:32 AM (GMT 0)
I use rectal medicine every night, either Entocort enema, Salofalk enema or Salofalk suppositories. When I use Salofalk suppositories I always use 2 together, each of 1000 mg, without any problem.
My doctor said one bottle of Salofalk enema has 4 gm of medicine and so I need 2 suppositories (altogether 2 gm) to do the job.
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