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Is my doctor Prednisone happy?

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Posted 12/28/2012 11:10 PM (GMT 0)
After being diagnosed with UC after a colonoscopy 8 days ago, I have been on 40mg Prednisone daily. I've been reading a good bit about Prednisone recently and it's scared me a bit. The good news is that my symptoms have pretty much cleared up and I haven't had any noticeable side-effects from Prednisone. It looks like most people get hit with side-effects pretty early in treatment? So far there's been no insomnia, altered mood, or anything for me.

But I've also read that Prednisone is generally only prescribed for severe flairs or when other drugs don't work. I'm not sure my flare could be characterized as severe. I was going about 6-8 times per day and there was almost no pain. However, there was a LOT of blood. I was turning the water pretty much opaque every time. I couldn't see half an inch below the surface. It looked like tomato soup. But besides that I wasn't really in that bad of shape. Hospitalization was never discussed and I was pretty much functional.

Do you think prescribing Prednisone was appropriate? I know most people here aren't doctors and yada yada but I appreciate the experience and opinions nonetheless. Right now I am seriously considering starting to taper off of Prednisone without my doctor's go-ahead (he's on vacation until I see him next on the 8th of Jan). Bad idea? I have been completely symptom free since the day after Christmas.

EDIT: I am also taking Asacol HD

Post Edited (Lacaille) : 12/29/2012 9:33:36 AM (GMT-7)

Posted 12/28/2012 11:20 PM (GMT 0)
if you aren't having symptoms, then i think it's fine to taper.

it sounds like your bleeding was pretty bad so i would call that a flare which requires prednisone. i'd say doctors use prednisone when a 5asa doesn't work so it's usually the second option, then imuran/6mp, and then remicade/humira. it's definitely one of the first few drugs used but it causes the harshest side effects in my opinion. good thing you haven't had any. you lucked out.
Posted 12/28/2012 11:25 PM (GMT 0)
I turn to prednisone when I flare because it works! For me the side effects have always been temporary, annoying but not horrible. You may still experience them in the coming weeks. Mostly the appetite/weight gain and moonface, in my experience. And needing less sleep, which can be cool actually.

I was only hospitalized once, for dehydration, in the early 1990s. They can't really do anything for you that you can't do at home (medicate, hydrate) and it is so much more comfortable to be at home. I know the blood is shocking, but that's a flare and it seems the prednisone is working.

If you decide to taper on your own (I do it all the the time but I have had decades of experience and my doc knows it) do so very slowly. Maybe 5 less, maybe reduce every other day at first, for a week before reducing again.
Posted 12/29/2012 2:53 AM (GMT 0)
Hard to say...did the Dr mention the severity after the colonoscopy? If it was mild/moderate, and you weren't having too many probs, than oral/rectal asa would be a good first go to drug combo. If it was more severe, than pred may have been appropriate. Hopefully you are also taking something along w/ the Pred to hold remission after you achieve it (such as Asacol, Lialda and Rowasa etc...) Some Dr's do seem to jump to pred very quickly and just know that it does lose it's effectiveness over time so you probably want to save it for more severe/painful situations.(not to mention side effects)

I would def. ask for copies of your colonoscopy report and that should help you shed some light on what you are dealing with from a clinical point of view. Oh, and I'm sorry about the diagnosis, this disease does suck. I would read alot of info about UC and check out this board alot (very knowledgable people who are really helpful) and than you can go to your follow up armed w/ good information. Good luck and keep us posted!
B
Posted 12/29/2012 5:02 AM (GMT 0)
with that much blood, a Pred taper make sense. hopefully 5-asa will kick in and you will not need another taper.
Posted 12/29/2012 10:44 AM (GMT 0)
I was always given pred for flares. They expect that only pred can get rid of a flare and other meds can only keep you in remission.
Posted 12/29/2012 2:03 PM (GMT 0)
I think the blood and frequency should qualify as a bad flare. As for pain I never had any but had the blood and lost a ton of weight before getting on the Pred. I don't see a problem with starting a taper now for you. I was told by my GI to drop down 5 mg per week. I am at 5 mg now and I will be going down to 2.5 mg next week and then hopefully 0 mg the week after. I am only a little ahead of you having been diagnosed just a few months back.
Posted 12/29/2012 2:14 PM (GMT 0)
Are you on any other meds? Prednisone is not a cure. UC is an autoimmune disease where your immune system is attacking your colon, causing inflammation. All prednisone does is weaken your immune system to TEMPORARILY stop the attack and heal your colon. Once you taper back and get off you will be right back where you started from. That is the reason you should be on other meds like Asacol or some other 5ASA. The prednisone can heal your colon and the 5ASA's can hopefully keep you in remission after tapering off the prednisone. You should take them forever. You absolutely have to have a maintanence therapy in place (like 5ASA's) or you will have another flare. Future flares often get harder and harder to treat so the goal is to never have another flare. If you get off the pred and don't have a maintanence therapy in place you will get worse and the next time it will be harder to treat. I would not taper down the pred yet. You may be better but I guarantee your colon is not totally healed yet. Usually the effects of tapering down the pred can be worse than actually being on it so you have to go slow. Wait for the doctor and make sure you have a maintanence therapy in place.
Posted 12/29/2012 4:20 PM (GMT 0)
Good call Gary. I think most of us assumed that all DR's would give out Pred along with Asacol or another maintanence drug. But of course we should not assume this since there is no telling what a Dr might do.
Posted 12/29/2012 4:33 PM (GMT 0)
Thanks for the insight all. I should have mentioned, I've also been prescribed Asacol HD 4800mg/day, and I've been religiously following SCD as well. Trying to nip this thing in the bud if that's at all possible.
Posted 12/29/2012 4:59 PM (GMT 0)
     Prednisone was the first drug I was prescribed when first diagnosed with UP in 1998, along with Rowasa and Asacol.  So, I think it's the norm.  However, he should have given you a taper schedule.  By all means, never stop prednisone cold turkey, but you probably are aware of that fact.
Posted 12/29/2012 7:26 PM (GMT 0)
I would stick with the pred at full dose then until you talk to the doctor again and begin to taper off. More than likely you will suffer more side effects from the pred while tapering. I would stay at full dose asacol until you are completely pred free and then maybe go down to 2.4 on the asacol, forever. Please don't get complacent and get off the asacol, no matter how good you feel or for how long. You need to stay on it forever because if you get off your UC will return at some point and then it will be even harder to treat than it was this time. Good luck.
Posted 12/29/2012 9:09 PM (GMT 0)
At first I read that as "8 years" and I was freaking out for you! 8 days isn't out of the ordinary. If you were bleeding that badly, then I personally don't think prednisone was out of line. Once the bleeding is gone and your stools are formed, then your doc will probably have you taper.

People start to get concerned when they are on 40 for a month or longer. A couple of weeks at 40 shouldn't bring out the serious side effects (I think hunger, sleeplessness, and emotional roller coasters tend to be the problems that show up short term).
Posted 12/29/2012 9:17 PM (GMT 0)
I've taken prednisone twice and the first time I had no side effects with it and I was on it for 2 mths. The second time I took a year later I had some pretty bad side effects. Shaking, high blood pressure, high blood sugar and a couple of other minor side affects! But that was after 3 mths of taking it. i didnt have side affects the first mth of taking it. I'm still new to this disease but as long as there is blood I would stay on the steroids. When I get scared of the side affects of a drug I just have to tell myself that it could be a lot worse if I wasn't on this drug. The damage that could be caused by not taking the meds are worse than the side affects! Sometimes!
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