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Update on 3 week use of M Enema and need some advice!

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Ulcerative Colitis
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Posted 4/16/2013 12:54 AM (GMT 0)
about 4 weeks back when I tried suppositories along with 10mg Pred, it didn't seem to help at all. I was panicking and people on this forum asked me to try out Mesalamine enemas. I visited my GI then and he was ready to put me on Imuran (Azathioprine) / 6mp, when I asked him we give the enemas a try.

He prescribed me enemas and asked me to taper 10mg to 5mg in a week and after taking 5mg pred for another week, STOP.

For the first week when I was on 10mg Pred, no blood when I used the enemas. Second week on 5mg, no blood. Now I have been free of Pred for a week and had seen no blood for 5 days. I have been taking the enema. HOWEVER, yesterday I saw a tiny dot of blood on my toilet paper when I went to the toilet. And today, I saw a bit more blood on the toilet paper. Still, couldn't really see any in the stool. And today, I also have a periodic pulsating pain in my abdomen. My stools are normal, I would say. Going to toilet 3 times a day. Some days 2.

I have my next appointment with the GI on next monday, april 22. And he might force me to move onto 6mp, which is not something I want unless really needed.

These are my questions for your guys:

-Should I persist with the enema longer and not take the 6mp option?
-Are the enemas working? I feel they are since they worked when I was continuously bleeding with evem 10mg pred.
-What could be the reason for my bleeding to start?

Full disclosure:

-I slept at 4am day before night. Got 9 hrs of sleep. But slept that late. I have heard that sleeping pattern does affect the immune system. I slept 13 hrs last night.

-I also have a midterm this friday which I don't think I'm too worried about but I guess it still plays on your mind. I have been studying for it last couple of days.

-I missed my Mesalamine dose this morning. Can this have an effect? I wouldn't think so. I'm not sure.

I'm taking Pentasa 100ml enemas nightly.
Posted 4/16/2013 1:35 AM (GMT 0)
Are you taking any oral medicine along with using the enemas?
The purpose of pred. is to stabilize you and then transition to a maintenance med (which is not steroidal like prednisone).

Really hard to give suggestions not knowing what you've tried in the past. It could be that since the enemas work (yes keep using them since they work) you could possibly take a mesalamine oral med to maintain rather than 6mp.

The thing is you need to transition to something in the oral med choices because most people can't reach remission just using enemas (although there are some that do it).
Great that you're sleeping well, that's a good sign and helps healing.
Posted 4/16/2013 1:52 AM (GMT 0)
Sorry I should have mentioned:

I have been taking 4.8g Mezavant since I was diagnosed. Which is mesalamine delayed release tablet.

I have tried and stopped pentasa suppositories.

I have maintained a dairy free and no-fried food diet. Low oil. In general, low fat, low fibre. Potatoes and bread give my cramps and subsequent bleeding.

Haven't tried anything else.

I haven't tried VSL#3 because I dont have money for it. I dont have a health insurance and I am student so as it is I'm paying out of my pocket for the medicines right now.

Post Edited (attaboy) : 4/15/2013 7:55:15 PM (GMT-6)

Posted 4/16/2013 3:22 AM (GMT 0)
Here are my comments.

You should try adding some fiber. Slowly.

The enemas seem to be, at least, not making you worse. I'm confused about the size of the enema though. Here in the US the enemas deliver 4 g of mesalamine. How much medication is in a 100 ml Pentasa enema?
Posted 4/16/2013 6:02 AM (GMT 0)
1g mesalamine in the Pentasa enema...from what I read.

q
Posted 4/16/2013 1:14 PM (GMT 0)
Nope it is 4g Mesalamine in 100ml Pentasa enema.
Posted 4/16/2013 3:47 PM (GMT 0)
oh, great to know. I just checked it again and I see it has 1g and 4g.

My advice is to stay on the enemas until you're completely off the pred and are stable. Then once "normal"..stay on them for another week and taper to every second night.

q
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