Both Sides of the Bed Rail
A nurse's perspective as patient and caregiver

Ulcerative Colitis Blog

This blog is about my experiences leading up to a diagnosis with Ulcerative Colitis, living with U.C., having a complete colectomy (large intestines removed), and life after surgery.  Hopefully I can provide insight and hope to others dealing with similar issues.

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More Medications for Ulcerative Colitis

10/24/2012

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I wasn't off of the Asacol very long before my symptoms returned worse than before.  They then put me on Colazal.  Colazal also has mesalamine as its active ingredient.  In other words, different brand, same medication.  After about a week on the Colazal, my head began feeling tingly again, as it had on Asacol.  I stopped taking it and my neurologist agreed that I should ever taken Asacol or Colazal again.  The physician's assistant at the gastroenterologist's office wasn't as convinced.  He seemed angry at me, talked down to me.  He told me that if they couldn't get my ulcerative colitis under control I may need surgery and could have a colostomy for the rest of my life.  

I asked him, "if you had to choose between thinking straight or pooping straight, what would you choose?"  He never really did answer that question.  We disagreed on the fact that flagyl had given me diarrhea, my position was that it was a poor drug to choose since my symptom (bloody stools) was not likely caused by giardia.  I pointed out to him that flagyl can actually cause pseudomembranous colitis.  He said it couldn't.  I told him to read the package insert from the drug manufacture and learn more about the medications he prescribes.  It was the last time that office ever told me that I couldn't have a visit with the actual MD because he was too busy.

Thereafter my visits were with a doctor.  I think the physician's assistant didn't want to see me anymore.  Each visit, the doctor would sit with his legs crossed, rarely making eye contact.  He would pay the most attention to my record on his tablet computer.  Eventually he would say in a therapeutic voice, "You have what we call Ulcerative Colitis."  What a joke!  Did he think he was so stupid I couldn't remember that diagnosis in-between my visits which occurred at least monthly?  It seemed as though he was treating me like a small child.  He would review my blood work.  He would ask about my daily activities, and then sometimes declare that most people with blood work that looked like mine were unable to work, on disability, and in the hospital.  Maybe so, but how could he help me.  I was an active person, and very stubborn.  Other medications were tried.

I was given mercaptopurine, a 6-mp drug.  The doctor told me it was so safe that they prescribed it to pregnant women.  I later discovered that it was commonly used for chemotherapy for cancer patients.  I was also put on prednisone.  The plan was to decrease the dose after the mercaptopurine started to work.  This drug never seemed to work for me.  Each time the dose of prednisone was decreased my symptoms returned worse than before.    I began to experience joint pain, primarily in my hips and shoulders.  Sometimes when I went to the bathroom, I wasn't sure if I passed anything, but blood.  I definitely was not getting any better.  I sought a second opinion.

The next doctor I went to was very worried about the joint pain.  Apparently some people are genetically predisposed to a bad joint problem, and should not be given mercaptopurine.  He ordered blood tests and x-rays to check my hips.  Everything checked out o.k., but it still seemed reasonable to stop taking the mercaptopurine since it had worked after several months.  I was now on high doses of prednisone.  Initially it did help my ulcerative colitis, but its effect seemed to be ever decreasing.  Weight gain was the only good side effect I experienced from prednisone.

I experienced psychotic side-effects.  At the time, I was unsure if this was due to seizures, seizure medication, or what.  I didn't talk about them until they had been gone for about a year.  I heard voices.  At first the voices seemed like a dull mumble.  I could be sitting alone in a room alone at home, and think I heard a person or two speaking softly in the other room.  Of course, if I went into the other room nobody was there.  I would check outside, but nobody was there either.  The voices usually came when there weren't people talking or other sounds.  They got louder as time went on.  Sometimes it seemed they were talking in the back seat of my car when I was driving alone.  They became more audible with time.  They spoke clearly, and never said nice things.  Mostly the voices just had insults or told me to go do bad things.  They would taunt me.  I pretended not to hear.  

There was no way I was going to start arguing with those voices.  They got more frequent and even started talking to me at work, whenever nobody else was talking.  When I wasn't listening to somebody or some music, the voices were there.  It was so bad; I had to listen to music as I went to sleep at night to keep the voices from disturbing me as I tried to fall asleep.  I became somewhat paranoid of many coworkers, neighbors, and close friends.   
In the past I had to be close to a bathroom, but now sometimes close wasn't close enough. 

There isn't much as humiliating as suddenly feeling such a strong urge to defecate that your only choice is to crouch down on the sidewalk and try with all your might not to use the bathroom, while your body cramps and you lose all control.  I didn't recognize that the psychotic side-effects were due to the prednisone until I went off of it.  I did go off of it.  I was at my wits' end.  I spoke with yet another doctor about tapering off the prednisone.  A taper schedule was written and approved by the doctor.   I now knew I needed surgery, but it was the holiday season and I didn't want to disrupt anybody's plans.  I waited until the holidays were over.  
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Test results and waiting

10/19/2012

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The colonoscopy was scheduled to take place in about a week and a half. My test results for parasites came back. I had giardia. This didn't really explain much. Giardia is more of a small intestinal bug and I was obviously bleeding from the large intestines as the blood was bright red. Upon researching giardia I found that in the U.S. approximately 5% of the population may be positive for giardia at any given time. Most people just don't have symptoms and it will usually run its course after about 3 months. In fact, giardia wasn't always considered a bad bug, they used to consider it normal flora (normal bacteria and such for your gut). In any event the physician's assistant called in a prescription for me to pick up. Oh yeah - I was also reported to the state health department, giardia is a reportable disease apparently.

The prescription was for metronidazole, brand name Flagyl. According to the FDA this drug is NOT specifically approved for treatment of giardia, but is prescribed for that. How is it that the FDA knows this drug is commonly prescribed for the treatment of giardia, but they haven't approved it for that use? I have no idea. Remember that I was having more frequent stools with blood in them. I was not having diarrhea when this started. I took the Flagyl and diarrhea started within 24 hours. It continued to worsen and I also noticed that my throat seemed to be getting irritated and swollen as well. Could this be my first allergic reaction to a medication? After 3 days I decided I couldn't endure the full 10 days of treatment and called the doctor's office.

An actual doctor was on call and he seemed confused that I had been prescribed Flagyl without having diarrhea and more confused that the medication had actually given me such bad diarrhea. I explained to him that I was so sick now I would end up in the hospital with severe dehydration in a couple more days. He instructed me to stop taking the Flagyl, which I gladly did. Testing several months later would show I no longer had giardia anyway. Another interesting development occurred during this few day period.

I remembered that one of my aunts had colorectal cancer when she was very young. I called and talked to her. I know that many diseases can have similar symptoms, but I was scared after speaking with her. I was 30, and she had cancer in her late 20's. When I described my various symptoms to her, she got very upset and said that was how she presented with cancer. She told me she wished I did have cancer. Now there’s something nobody had ever wished on me before.  Her reasoning was that after 1 operation she was cured and some intestinal diseases aren't so easily cured.  I called my doctor's office and told them about my aunt. They seemed a little upset with me for not telling them at the office visit that I had a family history of colon cancer. I apologized and simply said, "I forgot". It's not like we all sit around keeping carefully logs of all the ailments that have ever affected any member of our family tree. Maybe we should. Maybe such logs could come in handy sometimes. My appointment for colonoscopy was moved up.

Waiting seemed to be the hardest part. I really wanted to know what was going on with me. I had seen colonoscopies as a medic, so I kind of knew what to expect. But, it is different being the patient. There was something I had not anticipated that goes along with the colonoscopy - the bowel prep.


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    Clip Holverson Jr. was diagnosed with Ulcerative Colitis at the age of 30.  Follow this blog to read about the treatments, including surgery, he eventually had to treat it.

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