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Third flare help

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Ulcerative Colitis
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Posted 7/1/2021 11:26 PM (GMT 0)
Hi everybody,

I first got diagnosed with pancolitis 4 years ago. I was put on Mesalamine and Predisone to get me out of my first flare and it worked. Then I got into my second flare about a year in. This time I was put on 6MP and hydrocortisone enemas. Took about a month to get into remission. Since then it's been over 2 years of remission but now I'm flaring again.
I got a c scope done and the doctor told me it is Ulcerative (chronic) rectosigmoiditis w/o complications.
He told me to stay on oral mesalamine, 6 mp, hydrocortisone enemas and add in mesalamine suppositories.

I've been taking the hydrocortisone enemas for about a month and the mesalamine suppositories for 10 days.
My symptoms are starting to feel like it's getting worse. I still have formed and semi formed stools. Blood in the stools turned into blood when I wipe. If i strain really hard from the tenesmus there is blood in the toliet. Lots of mucus. And the worse tenesmus. It feels like the tenesmus is getting worse everyday. I go around 5-7 times a day. In the beginning of the flare it was only a couple and it gradually increased. I can pass gas 80% of the time without having an accident. Extreme fatigue. Quality of life is down alot. All I think about is this disease all the time and it doesn't help>

My question is. Should I give the enemas and suppository more time to work? Am I on the right medications? Should I call the doctor to give me a round of prednisone? Is 6MP not working anymore? Will i have to switch to biologics?

Thanks everyone.
Posted 7/2/2021 6:09 PM (GMT 0)
Dosage of 6mp is by weight and there is a blood test to see if you are at therapeutic levels. I would ask the doc about that first. Your dosage may need to be adjusted.

If you are at the right dosage then 6MP isn't working for you anymore and you may need a biologic.

You should have seen improvement by now on the steroid enemas so you definitely need a new plan.

I always try to avoid pred because it's really just a band aid until a medicine can kick in. By the time I say I need pred I am also so bad that we have to switch to a new medication anyway. That is really an individual decision though. Your flare sounds like it's getting nasty so maybe you should ask now. Just keep in mind that if your current meds aren't working you will be right back in a flare as soon as you get off pred so in my opinion it's always best to have a plan in place so that you can remain stable without the pred.

Keep us posted on how you are doing. Good luck!!
Posted 7/6/2021 1:27 AM (GMT 0)
An update-

I called me GI doctor and told him about my situation. He raised my 6mp dosage from 50mg to 100mg (I currently weigh around 187 lbs. currently 4 days into it and I have naseau) . He switched my generic Apriso to 4x generic Lialda tabs. And told me to continue with the hydrocortisone enema and mesalamine suppository. He also gave me a script for Predisone in case it gets worse. He wrote a script for 60mg with a 10mg taper every week.

I’m trying to decide if I should start the Prednisone or not. I got out of my last proctitus flare without it but can’t remember how long it took. Would it be better to shock the body with some prednisone? Isn’t 60mg a high dosage? Should I start with a lower dosage like 40mg?
Posted 7/6/2021 6:05 AM (GMT 0)
6mp dosing is usually 1.0 to 1.5 mg/kg of body mass. 187 lbs = 85kg, so your dosing would be 75mg or 100mg on the low side, most likely 125mg, and possibly 150mg on the high side. The 50mg you had been on probably hadn't been doing anything - it's too low.

As for pred, yes, 60mg is a high dose, but not unusually so. There's not much difference to a patient between 60 and 40 - side effects and effectiveness of the drug are pretty similar at those two doses. If 40mg works for you, there's no need to start at 60mg. 60mg is only better than 40mg for a small % of patients. For most people, it's not much if any more effective.

Whether to take pred or not is always a tough call. But you're clearly flaring, and pred should help that while the 6mp at higher dose is given time to work (because it's not gonna work immediately - it can take weeks or even months to kick in).

If you find you can't tolerate the higher 6mp dosing, you should jump to biologics.
Posted 7/6/2021 6:07 AM (GMT 0)
You could also ask to try uceris instead of prednisone. It costs more and isn't as effective, but it works for some people and generally has far fewer side effects.
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