Imuran? Help!

So I went in the this morning with my November calendar and it was decided pretty quickly that the Lialda is what threw me into my massive flare. I'm about to taper down to 30mg pred, and since my colitis is limited to my rectum, the PA thought that we should stop the Lialda, try Rowasa, finish the pred and meet back in January to touch base. This sounded great to me, and minimal. We also agreed to try some diet changes and see how that affected things.

THEN, she calls me about 20 minutes ago and tells me that my GI is saying that he thinks I need Imuran or Remicade as soon as  the pred is done, so that I'm using something to maintain the disease. I understand that, but to my feeling, both of those are "down the road" drugs to me. I've had blood and mucus for years, but I've only been seeing him for two weeks and it feels like he's jumping past a lot of alternatives and going straight to the big guns. I feel stuck. I'm supposed to meet with him in a couple of weeks, and I'd like to have some ideas to give him rather than just signing on for one of these heavy-hitters. What would you do?

If you don't tolerate mesalamine, there aren't that many other main stream medical options before Imuran. I was on Asacol for over a year along with rectal mesalamine and I was in a good remission. When I began to flare, I tried a course of prednisone but was unable to taper off without stronger medication to maintain my remission and I began 6mp. I tried Colazal, Lialda and antibiotics but none did the trick. It's a big step to go to immunosupressants but as far as treatment options go, there really isn't much a GI will offer between Lialda and Imuran. YOu could try steroid enemas and see if it gets you in remission but even if they do, they aren't maintenance medication and if you don't tolerate mesalamine, rowasa may not be an option for you so that leaves you with Imuran/6mp/Remicade. Some people here on HW have gone with alternative methods such as diet, fecal transplant or LDN but these are not options that a GI will offer. Please check out our resources thread on the top of the UC forum main page if you're interested in learing about some alternative therapies.