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So confused anal fissure/sed rate?

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Posted 4/2/2012 6:38 PM (GMT 0)
Hello there

Well today was day 10 on 40mg of Prednisone.  I think I see slight changes but nothing major so I called my new GI.

He had done blood work and a lactoferrin test.  He said all was normal.  No anemia, no leukocytes?, sed rate was great..like a 2.  I asked him what to do.  He said said that he thought I was getting more risk from Prednisone and to drop to 30mg tomorrow.  If I am still having a ton of sxs he wants to do a flexible sig in like 2 weeks.  He said some of what I describe sounds like IBS (or a motility disorder) with outlet bleeding from an anal fissure or hemmroids.  I know I have internal hemmroids. 

What are the sxs of an anal fissure.  Could the cort enemas have caused that?  Does any of this make sense?  CAn you have a low sed rate and be bleeding with procitis?  I am worried about tapering.  He said if he saw any evidence of inflammation in the bloodwork he might have considered going up to 60mg.  He said I am also not dehydrated or anything else....  He also thought it was unusual for me to have a break during the day where the bms seem to slow down a lot.  

I am soo confused and can't imagine what is going on up there. 

Anyone have an anal fissure?  What were you sxs? 

Thanks

Posted 4/2/2012 6:43 PM (GMT 0)
It's not uncommon to have normal bloodwork while IBD is not in remission. What are your symptoms? I think it's probably a good idea to have a sig to establish what's going on before tapering if possible. If he was willing to let you go up to 60 I don't think waiting a 40 for another couple of weeks is too bad.
Posted 4/2/2012 6:53 PM (GMT 0)
He was pretty clear that he wanted me to try and drop to 30. He said it's not helping on the 40. He didn't want the sig for a few weeks though. I am just starting with him and feel I've already called like 3x. He was very nice but he mentioned that he laid out his theory in the office with me. When I told him sxs he said it sounded like that to begin with. But he said lets try Cipro and stay on the 40 for 7 days.

Symptoms are formed stool in the morning. This morning I had formed stool 3x. Pain on passing them. Before they come out though there is some liquidy stuff I pass. Kind of b and m mixed. There wasn't tons of blood today but still some and it was separate from stool. Blood on tp. Then I passed some brownish/pink liquid later. More urgent feeling. That was this morning. It's now 3pm and haven't done it again. I also have pain afterward. Then tonight I'll probably start passing some liquidy b and m again.

He said nothing is 100 percent in medicine but that he thinks he would have seen something in the labs to indicate inflammation.
Posted 4/2/2012 7:15 PM (GMT 0)
I know how that goes. I'm often annoying our GI or so it seems but if you have questions you need them answered. I don't know, it's your body and you know if you are having symptoms or not. I do know several people who have had active disease with no sign in blood work. Having said that, lactoferrin is usually a pretty good indicator for my daughter. I personally don't believe that so many people with IBD also have IBS - I personally think it's usually simmering IBD. Unless clean scopes exclude IBD I would not accept and IBS explanation. WHy is he giving your CIpro if you don't have any inflammation? It might help but just curious?
It's tough having to go back and forth with these docs. I totally understand.
Posted 4/2/2012 7:28 PM (GMT 0)
Thank you killcolitis

I just switched to him and yes I feel so vulnerable because I don't want to be annoying but I always have a million questions. When I called the nurse she connected me right to him so that was good. But I forgot to ask if he wanted me to continue the Cipro. So I had to call back again :/ and I don't know what the answer is on that yet. I don't know if I need to finish it or taper or what. He wanted to try it because he said in some people it works. I had not tried any antibiotics yet.

I do think I have IBS though. Just my opinion. That didn't start till years after my diagnosis. I don't want the sig because honestly I'm afraid of what the heck is going on in there. But now I'm wondering why we are even waiting the 2 weeks. I have a very busy week this week. Holy week for Catholics and I have to stand in front of a church at the Easter Vigil. I'm so afraid of what is going to happen next at this point. I hate making these decisions. If he is wrong then...I'll be in a mess. But perhaps he is the only one that has been right? Maybe I started in a flare but now am dealing with a fissure because of passing so much stool? I just have no idea anymore. I just don't know if I should drop to 30 tomorrow. I feel like I need to listen to somebody though because I have no idea what is right

I see that many have had good blood work with a flare but I think his point was that something would show inflammation. WBC, sed rate lacto ferrin..something. Nothing showed anything at all.

I pray your daughter is well. Thanks for all your advice as always.
Posted 4/3/2012 12:37 AM (GMT 0)
I have had a fissure and they are very painful, mine was anywa, and I've always heard eeryone who haas dealt with them describe them as painful. I doubt you would have one and not experience pain. It's basically a little cut on the edge of the anus. As you can imagine, it feels like lemon on a paper cut each time you go to the toilet and you can feel it tear. It's awful. I think the recommendations are good ones. A flex sig will show if you're experiencing something like IBS vs. IBD because with IBS you wouldn't have inflammation but you would show inflammation. Unfortuantely for me, my GI did the sig thinking it was IBS and of course, I was inflammaed. I knew I was.... Not to say IBS would have been any better, as it is difficult to treat as well. I was just hoping my inflammation was gone at that point... I hope you are able to maintain the improvement you've had when you taper down. Perhaps you're beginning to heal and you will cocntinue healing after the dose is reduced. Your GI is right, the pred is probably doing more damage and it's good to start tapering off. It's good that he feels that way. Some GIs let patietns go way too long on the evil drug.
Posted 4/3/2012 1:06 AM (GMT 0)
Thank you notsosickly girl

I am sitting here racking my brain and feel so confused. I know Prednisone can also cause delayed wound healing too so maybe it is ok to taper now. I was on 30 for like a week or so before the 40 too. I just would think I would have seen even more improvement. BTW I am having pain. I wasn't for a long time but now I do especially when I pass formed stool. It feel like it's above the edge though. I also feel like I go too quickly even the formed stool, like a painful spasm. That all started in March when I felt like I started getting tenesmus. Before that I didn't have pain. I wondered if the cort suppositories and enemas left me weaker there. I wonder if I have uc, ibs and a fissure! God knows. I had a slight panic before thinking maybe it's even worse. I'm a litte afraid to find out what is happening inside me. In early Jan I was blood free and the Pred. seemed to work. Now it's like no matter what I do there is blood and this liquidy discharge stuff.

Today was 3 formed stools with b and m ( a little less). Then I had one liquidy brown/pink discharge all this morning. Then nothing for a while. Then at dinner I didn't quite make it to the toilet and had more blood and liquid and now at 9pm some formed stool (painful to pass) with more blood and liquid. I know gross, but those are the details.

I hope that I will continue to see improvement even with the taper, it this is all from uc. And I really want the sig sooner than later so we know what we are dealing with. He said to taper and if I'm still having issues to make an appt for the sig in 2 weeks.

Thanks to all who read my posts. I'm sick of hearing myself talk about all this. I am very weary of the whole thing and sick to death of watching what I eat. I have to admit I'm getting weaker with my diet. Nothing helps anyway :(
Posted 4/3/2012 1:14 AM (GMT 0)
seasons,
Thanks for your prayers. I appreciate and need them! I can totally understand your frustration and despair, it's so difficult having to constantly evaluate and choose from a number of not great options. I do hope you get some relief very soon whatever you decide. What are your maintenance meds at the moment?
The reason I would advocate holding off of the pred taper for another couple of weeks is because it's more detrimental as per our GI to go up and down and off and on pred. It's better to be at a stabilizing (higher) dose for a few weeks (usually a month) and then taper off when symptoms are under control. If you taper now, it's probable that your symptoms will worsen and you'll have to go back up. That's been our experience unfortunately and I do understand how much you want off of this drug.
Best wishes to you, I hope to see you posting good news soon.
Posted 4/3/2012 1:27 AM (GMT 0)
I don't really have maintenance meds exactly. I am on transdermal LDN and I was tapering the cort enemas. I do them every other night. Can't do mesalmine and was holding off on 6mp hoping to see if the LDN help me after the Prednisone taper. Now I wonder if I'll ever be ok again... this has been a long time. Sxs were milder for a long time but now they are not so good.

I agree I don't want to go up and down on the Pred, but new GI just thinks he would have seen something more in labs to support the inflammation. He said nothing is 100 percent in medicine but that he thnks I'm getting more side effects than anything from the Prednisone. I'm afraid he is wrong and that all heck will break loose but I just wonder if he is right??? I am terrible at making decisions like this. Everything I am trying is just not working any way...maybe he is on to something?

And yes he was great but I also don't want to start off by not listening to him right off. This is so difficult.... I pray the right thing happens soon and that I can give you all good news for once. This is mentally exhausting...

Thanks again
Posted 4/3/2012 8:19 AM (GMT 0)
Seasons,
I'm sorry you're still going through this. I had my colonoscopy yesterday and I think you'll feel so much better knowing what you're dealing with before changing doses. I have moderate inflammation along the last 40 cm and also far along the right side. Based on this, my doctor wants to keep me on 40 mg for another couple weeks instead of bumping up the dosage. My symptoms sound just like yours. I also feel like the steroid enemas aren't doing anything so I dropped them for the generic Rowasa again. I know it's so hard to know who to trust so thats why I wanted the colonoscopy. Otherwise you're just stabbing in the dark and hoping for the best.
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