blood is back ?about pred ? about biologics

I have stringy blood in my BM and I'm guessing it may have been hidden in there all week but not sure.

So I've been on 15mg of prednisone since last Thursday and I have had left side pain all week which I reported to my doctor. He said he had no clue what the pain is and that I should continue to decrease the prednisone by 5mg per week. I asked about doing the 15/20/15 and slower wean idea but he said there was no data to prove that prevented a flare. This flare started out with 3-4 bms a day with urgency(mild) due to my lower half being so well controlled with Rowasa. I have a feeling he is going to push for Humira or entyvio. I have read some of you taking more time with weaning prednisone but I am so confused at this point. My doctor hates prednisone and likes to do a lot of sig scopes to manage my disease. He thinks I should be all healed by now as I've been on 9 balsalazide for almost 6 weeks and prednisone.

I never had 10-20bms per day or tons of blood etc. yet my UC has caused pain and with that pain showed worsening with each sigmoidoscope. The last inflammation was 50-70 mild/moderate. I hate prednisone but am wondering if I should go take another 5mg now (I have already taken 15 this am). I have only been having 1 bm a day.

I've had C Diff in the past and am concerned about Entyvio and or Humira bringing that back on.

What would you do at this point? request to go back up on the prednisone and wean slower? if doctor says biologics just go for it?

wow don't know where else to go from an IBD specialist at UPenn , Harvard degree etc. but he wants me to get another scope tomorrow . God I am so confused .. I am at my wits end and don't know where to find another doctor from here. I would have to go out of state etc.

I agree with iPoop. Bumps are par for the course with a pred taper. Also the location of your inflammation is when stool can be on its way out so as you heal and stool rubs you may see some streaking.

If the generic colazol isn’t going to hold you it’s better to know now. Can you add aza/6 mp before going to biologics?

I too get pain when I’m healing and tapering steroids. I look at it as when you heal and have new skin (like a scab in my head) things get tight.

If it were me I would continue to taper. If things were still bumpy then I’d get a flex sig and see what was going on before stopping pred or adding anything.

Also I’m in south jersey. I know a bunch of great gi’s in the area. I also have a second opinion gi at upenn that I really like...she’s a woman. I have also met a couple gi’s at Jefferson. Let me know if you want names. A second gi is good to discuss treatment options with. Nothing is cookie cutter with uc.

It doesn't sound like you have c diff.

Biologics, like Humira or entyvio, seem unnecessary from the symptoms you describe. That said, you are still on 15mgs of pred, which is a wildcard. Can you get off of pred without flaring and your current medications is an unknown. Continue the taper and see if you start having increased frequency, urgency, less formed, or the toilet water turns into a bloodbath which would necessitate stronger meds. If, however, you have no reoccurrence then you do not need a biologic. 50/50 odds of a guess being right *shrug*.

My New Hampshire gasteroenteroligist was very scope-happy, seemed I had at least a couple flex-sigs a year. In Vermont, I have been seeing this new doctor for for 7-months and no scope has been mentioned lol. I hate scopes, but understand that sometimes they do provide the best data. Just a matter of whether a recent FCP or CRP with your/my narrative is enough to tell what's going on without a darn scope (often it is I bet).

If you do get a scope, and it sees severe inflammation at 15mgs then stronger meds are a definite. Frankly, I'd be surprised if you had anything more than a very mild inflammation, right now. Based on what you describe.

No idea what the pain is from. Pain appears to be unrelated to UC inflammation, as high doses of pred won't touch it. Have you tried Dicyclomine/Bentyl for spasms? Spasms are painful, and Bentyl is often given to IBS patients who experience it. Do you have diverticulitis as that can cause pain?

Quincy, John
no the doctor advised me against increasing the prednisone! I am not sure what a spasm feels like. I assumed it would be cramping.. This is burning. Can a spasm feel like a burning pain? I have no diverticulitis or anything else. Tylenol and heating pad takes the edge off.
I guess I will find out tomorrow and if its gotten worse then I have decisions to make. Why can't they make enemas that have a special rocket shooter to get it all the way up the left side?? I responded so well to Rowasa. Why wouldn't I respond to balsalazide????

I didn’t get that pain either until my last flare. I never had any pain before that. Well except when going with cramps tenemys etc.

It’s not really about what the doctor wants. It’s about what you want. If your being rational and want to try logical medications that have a chance of working before going to a biologic than your doctor should work with you on that.

Colozal didn’t work for me. Neither did apriso. Lialda worked when I was on mesalamine but I see that doesn’t agree with you. Are you mesalamine intolerant? There are others like Pentasa or delzicol if you want to try that before trying an immunosuppressant or biologic. Also bentyl helps the pain when I have it. It’s an anti spasmodic but it mainly calms the intestines. It helps a great deal.

I would take a deep breath and see how things go tomorrow. Healing isn’t linear. I know waiting is awful and we are always trying to be ahead of a flare if we think it’s going backwards.

I’m a unique case too. 99% if my colon looooves remicade. Then I have 4 cm around 20/25 cm up that won’t heal. I’m pregnant right now and on steroid enemas every other night. So I can’t change anything until after the baby comes. I understand how you feel.

can you explain the problem you have with probiotics ?

i'm not always a big fan of them, but just curious as to what they do to you ?

all probiotics ?