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Ulcerative Colitis
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Posted 1/29/2019 4:14 PM (GMT 0)
I was diagnosed 7 years ago with UC. I am now going through my first flare of any magnitude or duration since diagnosis (Lialda has kept me largely in remission). This flare I guess is relatively mild...relatively formed stools except the latter part of a bowel movement is very mushy and there is blood in it. No urgency, 1-2BM's per day.

I am on 4 Lialda a day, and after doing mesalamine enemas numerous times in the distant past, these seem to be giving me explosive diarrhea now after recently filling a generic mesalamine enema (not sure if generic makes a difference here)?.

My biggest concern is the blood as I haven't bled since I started Lialda. Any tips on what I should ask the doctor for? Drugs I should inquire about? Or what else should I be aware of before going to the doctor. I haven't been to a doctor for this condition in 7 years since I was originally diagnosed so I am not certain what I should ask about.

Thank you in advance for any responses.
Posted 1/29/2019 4:28 PM (GMT 0)
First, I would see if you can get yourself an in office consultation scheduled with a gasteroenteroligist-specialist who can assist you.

Second, I understand that getting into a GI isn't a quick or easy process in some areas. So in the interim, I would ask your Family Doctor (or General Practitioner) if he/she can order a stool test to check for possible infectious causes to your symptoms (bugs like c diff that mirror UC flare symptoms). I would also ask him/her to order a stool test for intestinal inflammation. A UC flare is negative for infections. An inflammation test will tell you the severity of what you are contending with. You might have said doctor check you for hemorrhoids (another blood causer).

Ideally, you should be on 4,800mgs a day of oral mesalamine (that's 4 Lialda pills), plus a 4.0 gram mesalamine enema a day.

Try one again and see if you have the same reaction this time to the enemas. If you have explosive diarrhea from the mesalamine enemas, then it is possible you had an allergic reaction to the sulfite (a preservative) within those enemas. There are sulfite-free versions available in some countries. You could instead ask for a mesalamine rectal-foam, or suppository as I believe those are absent the sulfite.
Posted 1/29/2019 5:18 PM (GMT 0)
Thank you!

I should have included in my initial post that I do have an appointment with an IBD specialist tomorrow morning so I am set there.

Maybe I should ask them for sulfite from mesalamine enemas? Stool test is a great idea, I will inquire about that.
Posted 1/29/2019 5:25 PM (GMT 0)
That's good you have an appointment. Pretty much standard flare protocol is the stool test for infectious causes, and an inflammation of some sort: A Fecal CalProtectin (FCP) stool test, a C-Reactive Protein (CRP) blood test, and/or endoscopy (that is a colonoscopy or at least a flexible-endoscopy). Endoscopy is always the most accurate test, FCP is second place, and CRP is last place (as it is body-wide).

Yes, I would mention a possible sulfite allergy with the mesalamine enemas. There are non-sulfite options, like sfRowasa in the USA.
Posted 1/30/2019 8:32 PM (GMT 0)
Just curious who is prescribing Lialda and generic mesalamine enemas if you have not seen a GI for 7 years? I have to see prescribers once a year under state law.

Trying the sulfate-free enema does seem like a good idea.
Posted 1/31/2019 12:26 AM (GMT 0)
Must be a different state then. My previous GI is in California. The last time he renewed, he only gave me 3 months and told me he won't refill again until he sees me in person.
Posted 1/31/2019 12:48 AM (GMT 0)
"Just curious who is prescribing Lialda and generic mesalamine enemas if you have not seen a GI for 7 years? I have to see prescribers once a year under state law."


ya, I was kinda wondered at that too - wherever thou art, I wanna be therest too ?
Posted 1/31/2019 1:21 PM (GMT 0)

TroubledTurds said...
wherever thou art, I wanna be therest too ?

Some serious Shakespeare going on here... ha!
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