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Could this be an ulcerative colitis flare or something else?

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Ulcerative Colitis
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Posted 8/26/2018 12:54 PM (GMT 0)
Hi everyone, I’m in a real situation right now and hoping someone can shed some light on it.

So basically I’ve been having perfect BM’s for months by taking the oral Pentasa 2g.(I was diagnosed about 6 months ago with mild pancolitis)

about 1 month ago I got bronquitis, they gave me a 3 day antibiotic course then I went on a 7 day cruise around Greece.

During the cruise I was having normal BM’s with the exception of maybe a day or two. I started having muscle pains half way through the trip and that lasted right until the end.

Since I got back, 13 days now, I’ve had nothing but diarrhea, the last 6 days have been intense and I’m going 12 + times a day, Ive only been awake today 7 hours and been 12 times.

I was actually in hopsital Thursday because I went to the emergency room to try and see someone. They kept me in and did blood tests, stomach xray an ultrasound.
The next day a digestive specialist basically said I can go home as its not hospital urgent according to what they see.

Diagnosis was possibly either gastroenteritis or mild UC flare.

They gave me the following to take (these are the Spanish names):
Ciprofloxacino 500mg
Metronidazol500mg
Probiotics
And a bland diet


My symptoms are:
Diarrhea for almost 2 weeks
Going 10+ times during the last 6 days
I see no blood ( is it hard to see in diarrhea? Would I defintely know if I did?) it just seems to look brown/yellow
Stomach cramps
Night sweats for at least a month
I started getting weird wrist and finger pain and swolen fingers which seems to have gone now but the doc dismissed that as carpal tunnel maybe, Ive never experienced that before.

No temperature


Does this look a normal UC flare or seems like all of a sudden the UC got extremely worse? Or could it be a nasty bug Ive got?

Like I mentioned I dont see blood which was the sign for me before when I had constipation before starting Pentasa.
At times the diarreah seems “sticky”. Sorry for the details but I’m really lost right now.


I appreciate any feedback
1Wish
Posted 8/26/2018 3:34 PM (GMT 0)
Hi...did the doctors do stool samples To check for invaders?

For the pancolotis....is it UC or CD?

Regardless of either...you were quite undertreated.

Yes, could be a UC flare, if that is what you have.....your pains could be UC related, but I suspect fever or from the meds.

q
Posted 8/26/2018 10:23 PM (GMT 0)
having a UC flare after ABX is very common. but so is getting an infection like c-diff.

you will need to gets test to see if it points one way or the other.

good luck
Posted 8/27/2018 12:34 AM (GMT 0)
You definitely need stool samples. Your symptoms could be IBD... but in response to your question about the blood, in my case, no, it wasn't difficult to see, it was usually quite red and prominent. The things you mention about frequency and consistency, are inline with IBD, but it's not necessarily IBD because of those symptoms. You definitely need stool tests and a colonoscopy to rule out other causes. You would think that a pathogen would have been treated with the abx you took, but that's not always the case, so definitely be diligent and recheck.

Do you have other symptoms, like tenesmus (repeated need to go, coupled with pressure in the rectum), urgency, mucous?

No one can say what it is, you need pathology to know, and even that can be incorrect or undetermined, but that will get you closer to an answer. Have you ever had any symptoms in the past? or past experiences that were similar, but cleared up?
Posted 8/27/2018 10:52 AM (GMT 0)
Thanks for the replies. To answer the pancolitis question, its UC.

The antibiotic I initially took for bronquitis was before the trip and was a 3 day course. I actually still had it after that..

No stool tests have been done, I’m trying to see my doctor who knows my case asap. Even a stool test can take a week or so though right?

Yesterday I only went 6 times and thought this may be a good sign but today Ive been awake 3 hours and already been 7..

I have no pressure in my rectum. These are my current symptoms:

Still going 7+ times a day
Dont see any blood, its brown/yellow and and at times lumpy and sticky, sometimes more watery
I think there may be mucus mixed which is why it seems a bit slimey
Cramps
Weird muscle and joint pains are back, today Ive woken up with a stiff shoulder and my thumb is aching, it alternatives between thumb, fingers, sometimes forearm. Its almost like if Im in a position or doing an activity for a short period of time, it locks up and becomes stiff. Ive never had this happen before and believe it must be related.

If it was an infection wouldnt the meds have kicked in by now? Also I have no fever.

Im on ciprofloxacin and metronidazole for 15 days.. annoys me that they put me on this without doing stool tests but I guess its the standard for them..

Thank you again,
1Wish
Posted 8/27/2018 12:22 PM (GMT 0)
Ditto get a stool test for possible infectious causes, and get a fecal calprotectin stool test to check for inflammation. Could be a C Diff could be a flare, and those tests will help sort out exactly what it is. Good luck!
Posted 8/28/2018 8:15 AM (GMT 0)
Thank you.

I have an appointment with my GI today, hopefully some tests can be done.

One thing I didn’t mention that I get every single night including last night are night sweats, like the whole pillow will be soaked, this happens wherever I am. But when I take my temperature in the morning, its fine.

My upper left arm today is hurting as if somebody punched it. These are the types of other pains Im randomly getting.

1Wish
Posted 8/28/2018 1:56 PM (GMT 0)
Just to update, my GI had a peak with the scope and initially believed it to be infectious as there was no UC activity, however after looking more he did find a bit.

So he suggested and prescribed taking 30mg of Prednisone every morning until Friday and call him to update then.

Meanwhile he said to keep taking the cipro, metronidazol and pentasa

1Wish
Posted 8/28/2018 6:22 PM (GMT 0)
So he found rectal inflammation? Why no rectal steroid meds instead of pred? Maybe by friday you can just cease the pred and use them if you have improved.

Keep us updated!

Feel better soon,
q
Posted 8/30/2018 11:41 AM (GMT 0)
Yeah straight on the Prednisone Quincy.

So far, this is the 3rd day I’m on Prednisose aswell as the other 2 antibiotics and Pentasa 2g oral. And so far I’m seeing no difference with the Pred.

I went only 3 times in the morning yesterday but its already been 6 today. Still diarreah, nothing solid.

I still see no blood, some mucus I think.


I’m not sure what to think...

I want to get a stool test done as my GI didnt..I assume I need to be off the antibiotics before doing this test?

If there is no blood, can it still be an ulcerative colitis flare?


Thanks,
1Wish
Posted 8/30/2018 2:29 PM (GMT 0)
Absolutely call today and request a stool sample kit.

Pentasa should be increased.
When were you out on it?

Yes, can be a flare with no blood.....inflammation happens in increments.

Are you on probiotics?

q
Posted 8/30/2018 3:39 PM (GMT 0)
Hi Quincy, for me to hand in the stool test at the lab nearby wouldnt I have to have stopped the antibiotics? Also how long after?

Pentasa at the moment is still the 2g twice a day, morning and night. My GI hasnt mentioned increasing yet.

Im taking 250mg daily of probiotics as recommended however my antibiotics is 500mg each one (taking two) twice a day.


1Wish
Posted 8/30/2018 3:59 PM (GMT 0)
It's interesting. If you're not seeing results with steroids, it is more reason to do the stool test. You don't have to stop antibiotics for the stool test, at least i've never heard of that. If you're not getting better, whatever you're taking might not be the right treatment for whatever is going on. I'd just get moving on getting the tests done. Still no blood?

Did he take biopsies of whatever he found? That's a very important piece of the puzzle.
Posted 8/30/2018 4:02 PM (GMT 0)
I may go ahead and just get the stool tests done if thats the case and just do it again after tje antibiotics to confirm maybe.

No blood.

He hasnt taken biopsies no, 5 months back he did and that confirmed Pancolitis but I was put on Pentasa after that and loving life, now this..


1Wish
Posted 8/30/2018 4:45 PM (GMT 0)
Another thing Im seeing happen often is if its an afternoon BM, after eating, its still diarreah but kind of lumpy-ish as if some stuff is just going straight through..

Sorry for the details, I’m just a little lost right now and this seems the best place to talk about this.. sad

1Wish
Posted 9/2/2018 11:03 AM (GMT 0)
Hi, so this is the 3rd day I’ve been on Prednisone 60mg in the morning, 3 days prior to that I was on 30mg but the doc called me and apologized as it should have been 60.

After upping to 60mg, I’m going 2-3 times a day, its not solid BM’s though, still diarreah just not as watery I guess, somewhere in between like my previous post.

Is this normal? Shouldnt I be seeing solid formed BM’s by now, I’m a little concerned about that.

Still seeing no blood. I’m off all antibiotics since yesterday, only taking Prednisone. Pentasa 2g oral and a probiotic.

1Wish
Posted 9/2/2018 1:26 PM (GMT 0)
It's going to take more than 3 days on 60mgs of pred to see solid stool. Pred stops the immune attack, but your body must still heal on it's own. Give pred a couple weeks time at least before drawing conclusions on it's effectiveness smile
Posted 9/2/2018 4:37 PM (GMT 0)
Thanks iPoop, understood!
Posted 9/6/2018 4:43 PM (GMT 0)
So I talked to my GI today and he said to stay on the 60mg until Sunday, then I may possibly be tapering down.

Something is happening because Im starting to get formed, not exactly solid but formed BM’s that break apart easily, but one thing has been concered and its that they always float... is this normal or a sign I’m not absorbing nutrients still?

Thanks,
1Wish
Posted 9/6/2018 5:02 PM (GMT 0)
Ah yes, Houdini poops, I remember those well. Come out solid, and then poof they're no longer solid; magic lol. Mine floated too. I think it has a lot to do with them being so porous, and gas being within them.

It's a sign that you're healing, but you're not all of the way there. Your transit time is slowing down and the intestinal lining is healing, enabling some of the liquid to be extracted from the stool (as normal large intestine's are intended to do). However your transit time is still a bit fast and there's still remaining inflammation, thus they're not quite normal yet.

Ideally, you should be 90%-ish healed before tapering down the pred to low dosages for optimum affect. I think you're in the 60%-ish healed category, and I'd be willing to bet that you'll regress as soon as you start this fast taper and get much below 40mgs.

I'd reach out to your gasteroenteroligist and mention that things are starting to become more solid, and ask if a few more weeks at 40-60mgs makes sense before getting down too low in dosage. As that higher dosage range enables the most healing. When it comes to pred, the slower the better. Racing is a pointless waste of your and their time.
Posted 9/7/2018 10:19 PM (GMT 0)
Thanks iPoop for the feedback! I appreciate it.

I was under the impression being on Pred for too long is not very good for you, I dont feel right still though. The floating stool is still happening, it seems orange in colour and quite foul/strange smelling. I’m also getting some abdominal pains on the left side, almost like gas and bloating quite a bit too.

Going between 3-4 times a day.

Its almost like the diarreah isnt there but now a there’s a bunch of other issues I’m experiencing. Could it be part of the healing process you think?

I guess I thought after 10 days on Pred I would see normal BM’s again but seem to be mistaken.

1Wish
Posted 9/12/2018 6:44 AM (GMT 0)
Hi 1Wish,

How are you now? I read through your posts and though I've yet to be fully diagnosed your symptoms are very similar to mine atm. I don't know if mine is a flare or not and I have an appt with GI tomorrow, but the consistency, smell, floating stools, I'm having all of this (the last few days were bad cramps and watery diarrhea). I also saw no blood in the stool. I'm wondering if mine is c diff though as I haven't been tested for it. Did you manage to get stool tests in the end?

I hope you're feeling better by now!
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