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Does your dr change your meds for each flare?

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Ulcerative Colitis
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Posted 2/20/2012 1:31 AM (GMT 0)
I'm wondering if anyone can share their experience with changing meds when flaring. I'm currently on alternating 75/50 mg of 6mp and I'm pretty sure I'm at the beginning of a flare. The last time I flared (about 6 months ago) my gi upped my dose to 75 from 50 (although we recently reduced it because my liver enzymes were slightly elevated). ANyway, he really wanted me to switch to one of the higher level drugs, but I resisted and got the flare under control with antibiotics. I'm anticipating that when I call him tomorrow about this flare he's going to want me to change my medication. I'd rather stay on what I'm doing now and control any flares with rectal meds and antibiotics. Is this reasonable? Do some people just stay on the same medication and then troubleshoot when there are flares - or is it more standard to change medications and doses each time there is a flare?
Posted 2/20/2012 1:50 AM (GMT 0)
I would think if you can use rectal meds to get it under control you should try that route first.

I think if you are having flares every few months it may mean that your current med regimen is not controlling your UC. If the flares stay around for a long time you may need to think about switching meds because it is not good to have your UC out of control- uncontrolled inflammation is not good for your body.

Are you using Probiotics? You can also try increasing that and see if it makes a difference.
Posted 2/20/2012 7:24 AM (GMT 0)
I have only used oral and rectal mesalamine (asacol pills and salofalk retention enemas).

I increase to nightly enemas when I flare.....then do a tapering process to stay at twice a week.

q
Posted 2/20/2012 3:41 PM (GMT 0)
     Since there is no known cure for this disease, I believe it is sort of a hit and miss situation for the GI doctors. 

     When first diagnosed my GI doctor placed me on Asacol and prednisone.  Second flare, two years later, switched me from Asacol to Colazal and prednisone.  Two years later at third flare added the 6MP.  I then started to flare yearly, then twice a year and after my second hospitalization in 08...boom...never really out of a flare until I had surgery in 2010. 

     I was on rectal meds constantly as my condition was proctitis.  In the beginning, they worked pretty well.  But, as time went on, my rectum just would not hold them in.  I tried Remicade but it failed after my 3rd infusion.  Humira also failed.

     Other things I tried...SCD diet, probiotics, glutton free diet, chiropractic...just about everything.  My GI doctor would not even discuss fecal implantation.  He told me I was really asking for problems if I went that route.  I didn't know about LDN or I would have given that a shot too.  Oh well.  I have no regrets about the surgery.  I have a permanent ileo and it is not bad at all.  I had a great surgeon and had a few post surgery blips, but no major complications...I feel terrific and only take one pill a day and that is for my BP.

Posted 2/20/2012 7:01 PM (GMT 0)
You don't mention taking probiotics. They are essential to balance the destructive effects of taking antibiotics.
I learned that the hard way. My Dr never mentioned using them or anything but drugs. I totally refused to take prednisone but just stopped eating things that caused problems.

Have been on the same meds for 10 years.
I'm now convinced this was not necessary and I might have dealt with a lot of the symptoms if I had known about using stronger probiotics and supplements such as slippery elm and l-glutamine years ago.
There's a lot of good info about supplements on this forum and on the website: cureforulcerativecolitis.com
Posted 2/20/2012 7:39 PM (GMT 0)
I think that's typically what GIs do when a person flares. If you flare up on your current medication, they see it as that medication isn't keeping you in remission and you need to add something else to get your immune system to calm down. Do you know if you're in the theraputic range for 6mp? You can be on 50 or 75mg and not be in the range and it's not very effecitve if you're not in the range. I was like you, on 6mp and not responding quickly, my GI recommended Remicade but I pushed through and continued with 6mp and finally I was able to stabilize. It wasn't fast but eventually it worked. Are your liver enzymes consistently elevated or was it a one off result? I've had my labs be off here and there but overall, they are normal. I get labs very often to try to stay on top of these issues.
Posted 2/20/2012 11:56 PM (GMT 0)
Thanks for all the advice and thoughts on this everyone. My concern is that there is just this forward march with surgery inevitable at the end - at some point there's no higher dose, no stronger medication, so you just cut. But why even bother with all the risky medication if it's just going to lead to surgery at the end anyway? I have real doubts that my body will go into a final remission on any kind of drug. My flares are not that bad, I've never been hospitalized, or even stayed home from work when I'm in a flare - although the few I have had are horribly uncomfortable/painful.

Notsosickly girl - 50 mg is in the therapeutic range for me (tested in the lab during the first year) and I've been getting labwork every three months. The last time I went in my liver levels were slightly elevated (I think 40 is the top range of normal and they were something like 45) and then a month later were still slightly elevated. I have been on 6mp for a couple of years and had one other bout of much higher elevated levels. I had one other flare on it and that was when he raised my dose from 50 to 75 (and then reduced to alternating 50/75 with the liver levels too high). At that time he pushed for remicaid and prednisone to get me out of that flare, but I refused and did the antibiotics and upped the 6mp dose.
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