Stubborn Flare

Hi all,
I have a stubborn flare that i just can't seem to kick and it's starting to worry me.
Alittle background about me....
Age 31
Sex: Male
Colitis duration: 4 years
Severity: Mild Colitis
Current maintenance meds: Pentasa 1gram split in two doses AM/PM
I'm very fit and have a passion for the bodybuilding, outdoor activities and just general fitness
In the past i've taken some bodybuilding supplements that have worked wonders but also the reason for my flares... This last one i did a pro hormone cycle (oral tabs) which kicked this STUBBORN flare off.
I've been trying to get into remission for over a month now and nothing seems to be working.
My GI upped my pentasa dose to 4grams a day and 1 x steriod enema in the morning and 1 x asacol enema in the evening. My problem with that was, I couldn't hold the enema in the mornings... so i feel i did not reap any benefits of that!
Although i felt slightly better and bleeding stop, i was still going to the toilet 8 time a day and having bad cramps along with that urgency feel.....
After 2 weeks of this method the GI decided it was time to go on Prednisone (this is my second time to take it) 30mg for a week then taper down 5mg every week.
I'm reaching my 3rd week and still no releif. I worried the dose and duration was not high/longer enough, what are your thoughts?

Also he has suggested that i go on Imuran for 3 years to keep me in remission however i told him i'd like to avoid that route now as i want to try a more natural approach. Natural approach meaning clean diet, amino acids, l gutamine and VSL #3 Probiotic
I feel he just wants me to go onto something stronger to keep me in maintenance range....

What are your suggestions on killing this flare and advise about Imuran....

I'm worried about the Imuran as we live in Dubai and it's constantly sunny (skin cancer), my mother has had cancer and osteoporosis which makes wonder if I'm going to get it.

Tx

I was thinking the same thing... Previously i went on pred at 40mg for two weeks then tapered down which seemed to work perfectly. Now the doc only put me on 30mg and every week i reduce the dosage by 5mg and suddenly stop at 15mg. so in total i'm on it for 4 weeks only. I'm not on any enemas
But the doc wants me to go on Imuran which i think is a harsh decision since this is only my second course on pred...

The product was a pro-hormone it's similar to an anabolic steroid but you take it orally. The main ingredients are Dymethazine, Methylstenbolone, Alpha-1
I think next time i try something like that i'm better off with equipoise or growth hormone

Andrina said...
Well you can either do a round of pred, taper and risk to flare again without any maintenance meds or start the imuran and stay in remission. Good luck on your natural approach. By the way, have you heard of sun screen?

he's using pentasa = maintenance

Obviously pentasa isn't cutting it anymore hence he's flaring...

If the 4 grams of pentasa, asacol enema, and steroid enema haven't produced results after 3 plus weeks, then I'd agree with your gastroenterologist. I would go on the Imuran. Ulcerative colitis has a tendency to get worse over time, and it's essential to keep pace with the proper medication to match your current disease severity to have the least uc symptoms and best quality of life.

Being natural is always a nice aspiration but you need to be realistic regarding your current uc symptoms and disease severity. You can combine some natural treatments with Imuran for the best results. I wouldn't rule Imuran out though.

Everyone is a bit nervous to go on new classes of medications. I was too. I was in 6mp for two and a half years (Imuran and 6mp are similar medications). I didn't experience any side effects from 6mp during that time. I found it greatly helpful to look at the actual risks versus the benefits. Their are statically rare side effects (less than 1 percent odds) and a 70 percent odd that Imuran will improve your uc symptoms.The Crohn's and Colitis Foundation of America has some good risks versus benefits information:
Webcast: programs.rmei.com/CCFA139VL/presentation/player.html
Transcript: www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf

Update is the doctor has changed my pentasa to asacol and I'll have the asacol enema for two weeks while I reduce my dose of prednisone. Fingers crossed this beats my flare

Well 4800 is usually the max dose, so I'd increase to that. I would also use the rectal meds 2x a day. Unfortunately with this illness, the meds work differently for everyone. Some people have luck with pentasa indefinitely, others jump from med to med and nothing works. it's great to think you're going to take some amino acids and keep this controlled forever, and I hope you can, but I think it's wishful thinking.

So, the hormones, can you do another round of that?

I agree with the others that maybe 30mg wasn't high enough to start. At the time time, I agree with Andrina and iPoop, if you're not getting where you want to with the 30mg and tapering, it's likely that if you go back up to 40 or 60mg and start over, you may be in the same shoes when you get down to 10mg, because the pentasa isn't cutting it for maintenance.

The asacol plan is a hopeful one, but one that might work. I'd definitely go up to the max and increase rectals.

Have you been scoped to see where this is active? Have you had stool tests to check for pathogens?

Well here's an update:

I'm on 25mg of pred now and will be reducing it 5mg every 3 days. So far my bm have decreased and I'm only going 2-3 times a day 😉
I'm feeling better but I done some blood and stool tests last week and the result for my FC were >1000 which is HIGH. I'm not sure if this is because I'm still on pred and not 100% out of a flare up???

Old doctor requested the tests and suggested I take imuran again

On a side note: I will be starting an anabolic steroid cycle when I'm off the pred. It's a low dose to test and hgh. This will be for mass and get my sense of well being back.