My email to my GI and his response:
I am leaving on vacation today. I will be back on Oct 8.
I have heard anecdotes about
the nicotine before. The Commit lozenges are better than smoking again.
I would recommend trying to set a taper goal of no sooner than 2 months to get off. Any quicker than that increases the chance of a relapse.
Call the clinic for a follow-up appt on my return.
----- wodin wrote: -----
To: wodin's GI@wodin's.hmo
From: wodin
Date: 09/18/2009 02:07PM
cc: Lisa A Camara/HI/KAIPERM@KAIPERM,
[email protected], wayne swanson <
[email protected]>
Subject: UC flare up
Dr. wodin's GI,
Regarding my current UC flare up, I need to bring you up to date on my condition.
Around the middle of July it became apparent that I was in full flare up, I had been concerned for a few weeks before that, but I have often been on the edge of a flare up before and have it not develop further. This time it did.
My symptoms around the first on August were: I would get up in the morning and have several bowl movements within the first approximately 60 to 90 minutes during which I would pass nothing but liquid blood and blood clots. It is difficult to measure the amount of blood passed, but I have heard it described as “a bowl full of tomato soup”. Then the amount of blood would diminish and I would pass a small amount of feces (~50 grams) with entrained blood every 30 to 60 minutes until around noon. Then it would change to bloody mucus about
once an hour until bed time. There was some pain and cramping but not debilitating, and the urgency was not enough to require a diaper, but it sure kept me off the golf course.
During the first week of August, I began taking 9 mg/day of Entocort, and called you to renew my prescript
ion. I saw little or no relief from the Entocort. Late in the third week of August I called you again and asked to be switched to prednisone, which you did. I was surprised to see that you had prescribed a rather heavy dose at 60 mg/day.
I guess I was expecting more dramatic results based on the first severe flare up I had in June/July 2007. That time I saw dramatic relief after just a couple of days of 40 mg/d. This time I saw some lessening of symptoms in terms of less blood and fewer and more productive BMs but I was still in full flare up after a week.
A few weeks ago I had found a UC on line support group at https://www.healingwell.com/. I read with interest and surprise one thread having to do with a well established relationship between UC and nicotine.
I followed the
cookie crumbs and found several peer reviewed double blind studies at Mayo, UK and elsewhere that indicated a significant contributing factor to developing UC seems to be long term nicotine withdrawal, and that there is as much as a 50% better remission rate for prednisone and nicotine therapy than there is with prednisone alone.
Since my UC was diagnose a year or two following withdrawal from a lifetime of heavy nicotine addiction, I fitted the profile exactly. I determined to conduct my own very limited experiment. The studies were done using transdermal nicotine patches, but since I had not tolerated the patches well in the past, I decided to use the 4 mg Commit lozenges, and I bought a package of them from Costco. I started at 8 to 12 mg/day for the first week and saw a significant reduction of my symptoms, but remained in mild flare up.
Last Sunday I was able to get a round of golf in, and during that very enjoyable afternoon I consumed more lozenges than normal, perhaps 20 to 24 mg, although I honestly lost count. Monday I saw even more dramatic relief; after increasing my daily dose of nicotine by about
double, I am now either on the edge of, or cautiously in remission.
I realize that for you these results may be anecdotal, but to me they are experience, and all I really know is that I feel better.
I am currently in my fourth week of heavy prednisone therapy, and I have not seen many serious side effects yet (I’ve actually lost almost 10 pounds), but I am concerned about
tapering from it as quickly as possible before the side effects become manifest.
If you would like to discuss these matters in person, please ask you nurse to schedule an appointment for me. If not, please advise regarding when and how much to begin tapering the prednisone.
s//wodin