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Why the E.R???

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Ulcerative Colitis
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Posted 7/22/2014 3:13 PM (GMT 0)
Please help! I have a 12 year hx of U.C. proctitus. I have had remicade and Humira. I went into remission and did REALLY well for about 2 years. I started flaring June 10th. My Dr put me on rowesa and prednisone. I had a horrible reaction to the prednisone for the 1st time and stopped. Was not doing well and went back to Doc. He put me on Lailada and uceris with the rowesa. Told me I might need to be hospitalized for iv pred if no better. Scheduled a colonoscopy for Thursday. Felt awful….nausea, throwing up, dizzy, brain fog. Called Dr who said stop the uceris and go to er if no better (this was yesterday). I feel just as bad today :( throwing up, dizzy ect… and Im still running to the bathroom about 5 to 6 times a day with bloody mucus. SO….my question is…if he wants to admit me, why do I need to go through the er??? I hate having to explain everything to the er and paying the copay. Why doesn't he just have me admitted?? I don't know if I should go to er, wait until my colonoscopy Thursday or call back…again. I feel so crappy and feel like such a pain to all. Please….advice!
Posted 7/22/2014 3:28 PM (GMT 0)
Interesting question. I do not know why you would have to go to the ER to get admitted. I've never done it so I don't know much about it. Five or six times a day doesn't sound too bad unless it's extremely uncomfortable, which it sounds like it is. I wouldn't go to the hospital unless I was in awful pain, which in my case usually comes with twenty trips to the toilet and loads of blood loss. Have your symptoms improved at all with the treatments you've tried? If you're in pain, you may have to just go to the ER as the dr said. What did he say is your next option? Are you still taking the lialda and rowasa?
Posted 7/22/2014 3:46 PM (GMT 0)
Pooping a lot due to a uc flareup, seeing blood or mucus in one's poop, or having mild pain treatable with over the counter meds doesn't necessitate you to be admitted to the hospital. Rather, you'll find the ER will refer you to your specialist in those cases as they are not things they consider to justify a hospital stay. However, one can get admitted to the hospital due to severe dehydration, anemia, or severe pain as the ER looks for those sorts of things as potentially life threatening (those things would happen in a really bad uc flareup). It really depends on how bad things are for you and how miserable you are. It is a judgement call on your part, your GI cannot tell you to go or not, and yes there are expenses involved.

If you fail the oral prednisone, higher dosages can be given via IV under nurse supervision in a hospital. Usually one is in the hospital for less than a week in that case. IV steroids are given in excess of 60mgs a day, the max I've heard oral pred taken at for uc, and some respond quite well to it. Your GI can admit you in this case but would need evidence to ask for it, like your upcoming colonoscopy results.

Good luck and I hope you feel better soon.
Posted 7/22/2014 4:04 PM (GMT 0)
That is a good question. Maybe you should call the doc's office and ask them for the answer.
Posted 7/22/2014 4:33 PM (GMT 0)
I don't think he wants to admit you until the need for IV pred is determined - which would have to be a pretty strong need since you reacted to the oral pred.

I think since you report lots of fluid loss and dizzy, that he is concerned about dehydration. ER are very good at treating dehydration and sending home.

Most insurance waive ER-copay if you are admitted. My last several policies have anyway.
Posted 7/22/2014 4:53 PM (GMT 0)
Thanks all. I was in the ER 2 weeks ago for dehydration. The Doc said that as I can not tolerate prednisone, he saw the hospitalization for IV prednisone as a way to get the flare under control. I have had several flares and have always had an issue getting them under control again. The remicade was great until I eventually reacted to it. I have been very lucky and have not flared over the last 2 years under the guidance of a naturalpathic doc and her supplements….until now. The prednisone was helping with the flare, the melamine not so much this time and lialda is the maintenance drug. I just don't understand why he keeps telling me to go to the ER and to tell them to call his office for consent to admit for the IV prednisone. Why doesn't he admit me himself if needed? If I call his office, I can't speak to him, I have to leave a message. Based on your comments I think I will wait to Thursdays colonoscopy and talk with him. He can see for himself then where I am at with my flare. I have avoided the colonoscopy since 2005, so we will see….
Posted 7/22/2014 7:53 PM (GMT 0)
There are probably procedural reasons that we non-doctors are not aware of, my best guess on why he wants you to go to ER not by his admitting you.

Sucks that you cannot ask your doctor this question, that he is so unavailable.
If you are dizzy, nauseous and possibly dehydrated how are you eligible for a c-scope with sedation?
Posted 7/22/2014 8:11 PM (GMT 0)
Didn't know the c-scope would be an issue…..Its very stressful dealing with my gastros office. It takes months to get an appt. The guy doing the c-scope is a different gastro doc than my usual. I couldn't get in to see him in time, so the gave me an emergency appt with this guy. He wanted to know why I hadn't has a c-scope since 2005…no one told me to!! The why I hadn't been seen since 2012…..because I hadn't had a flare since then. He said i should have still been monitored. Gave me meds, said about the er thing and scheduled the c-scope for asap. Does this all sound right to everyone?? Its so hard to be on the ball when you feel so bad...
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