Here we go again

My 11 year daughter seems to be starting to flare again. this would be her 3rd flare in 3 1/2 years
She was put on Remicade during her initial diag, it failed after year and a half. She's been on Entyvio for the past year and seemed to really work wonders for her, but now, the symptoms are coming back, D and some blood.
We are getting the stool tested, but while we are waiting for the results, I am hoping for some suggestions from the community before her GI starts talking about surgery again.
I understand that entyvio could be done monthly (her schedule now is every 8 weeks)
Any additional meds that could be take with entyvio? she will not take rectal, don't know how to force her.
If entyvio fails, what's next?

Thank you all

Is entyvio the only medication she is on?

You can get an antibody test for Entyvio (also known as vedolizumab) from Prometheus labs to see if she has developed any, and it also measures the concentration of Entyvio, just before her next infusion. It's the Anser® VDZ test /www.anserifx.com/. Helpful in dosing and in diagnostics for possible loss of response.

The posters above have given great suggestions. Especially about testing for antibodies. It may be an expensive test your insurance doesn't cover but it will tell you right away if you are wasting your time with Entyvio or if this is just a blip.

Re: rectal meds. Has she tried suppositories or just enema/foam? If she hasn't tried suppositories, I'd encourage you to push that. They are WAY easier than the enemas. Literally you feel it for 5 seconds while inserting it and then you can't feel it after that - it's much like inserting a tampon: you feel it until it is past "that point" and then you can't feel it at all.

Another option is adding a mild steroid like Uceris (assuming she isn't on prednisone at this time). Usually a course of Uceris is only about 2 months.

Thank you all for your comments. We go the stool test back and my daughter has C-Diff, funny that made me very happy, but I'll take C-Diff over UC flare.

@MarjieKay - the GI do the levels test for the 2nd time already (not sure about antibodies, will ask her later) so far the insurance did not say a thing. Her levels are somewhat low, the GI is moving up the schedule to 6 weeks.

@noodlesnoodles - we've tried the foam when she was diagnosed 3 1/2 years ago, she was 7 and it was a total nightmare. We will look into suppositories if she ever needs them, but keeping fingers crossed..

@Casey_LB - entyvio worked like a charm for my daughter, we were able to get her off pred during the loading doses. hope it stays that way, but good to know there are other options.

@iPoop - Entyvio is the only medice she is taking, besides probiotics and multivitamins. She was on methotrexate for 3 years, but was taken off last fall due to elevated liver test.

@CodyB - GI said that since she failed remicade, Humira would not work. I do understand that it is somewhat different and maybe worth of trying anyway. I just do not see myself sticking her with the pen, but if there is not choice..

Thank you all for your help. Hoping to take care of C-Diff and move on with our lives for the time being.

She's been on antibiotics for C-Diff for 4 days now, I understand that it is a 10 day treatment and that it actually may not work the first time, but anyone can tell me how long it may take to see improvements? She had C-Diff about 2 years ago and I usually keep a journal of her problems, but can't find it now. She is improving a bit, but can't help to worry that a UC flair may be lurking under C-Diff.

Thank you