Friday, December 23, 2011

Getting Off of the Meds!

On September 6, 2011, I recall being taken home from the hospital after having a colonoscopy. I was also scheduled to have an upper endoscopy, but Dr. Sigmon felt it wasn't necessary based upon what he saw in my colon. To me that wasn't really very good news. Meaning, my colon clearly had something very wrong with it and all of my symptoms could be explained based upon whatever it was that he thought he observed with my colon.

If you've ever had a colonoscopy, you might remember that the drugs they put you on pretty much keep you from being able to remember much. So although I had a discussion with Dr. Sigmon, I don't recall anything he might have said in regards to my diagnosis. At this point, I have no clue what he thinks I have, but he did have a discussion with my friends Stephanie and Richard who are the ones that took me home.

They told me that Dr. Sigmon had taken several biopsies of my colon and that he thought he knew the diagnosis but preferred to wait for the biopsy results which he expected in about a week. He gave them two prescriptions for me, which were supposed to help my symptoms if his suspicion was correct. At this point I felt like the walking dead. I was only drinking fruit juice and not eating or drinking anything else but water due to the uncomfortability associated with having a bowel movement, and because I believe it is the best way to cleanse your body of toxins. 

I had already been taking other medications. One was for an infection that was identified from a stool sample, and the other was for my upset stomach, or at least that's what it felt like. Later of course, I learned, that it was my intestines that were upset, not my stomach.

Ultimately, beginning on September 7, I was taking four types of medications:

Flagyl:  It's an antibiotic that eliminates bacteria and other microorganisms that cause infections of the reproductive system, gastrointestinal tract, skin, and other areas of the body. In my case, of course, it was to clear the infection in my gastrointestinal tract. Dr. Signmon had identified an infection from a test of my stool the week prior. This is one of the medications I had already been taking for about a week. It was a ten day prescription that I completed.

Dolasetron: I believe that this is the medication I was given to settle my upset stomach. In addition to the diahrea and painful hemorrhoid, I felt like I was going to vomit all the time, but never did. This was another reason why I felt that drinking fruit juices was better for me, than eating. If I already had an upset stomach, what would eating have done to it. So the juices I'd drink were not as acidic as others. For example, I drank a lot of white grape juice and apple juice, instead of orange and tomato juice.In any regard, I had the worse upset stomach for weeks and had been taking this drug for a couple weeks prior to the colonoscopy. Dolasetron is used to prevent nausea and vomiting. It works by blocking the action of serotonin, which is a natural substance the body makes that may cause nausea and vomiting. This seemed to give a little relief but not much so I stopped taking it immediately upon getting some minor relief from the healing diet.

Mesalamine:  This is one of the prescriptions that Dr. Sigmon gave after observing the inflammation in my colon. Mesalamine is an anti-inflammatory. If you look up this drup on the Internet, you will see that it is an anti-inflammatory drug used to treat ulcerative colitis and Crohn's disease. It is a bowel specific drug that acts locally in the gut. Therefore, before I was even told the diagnosis, I had a good idea it was either ulcerative colitis or Crohn's.

Mesalamine is thought to work by inhibiting the production of inflammatory chemicals in the lining of the colon. Mesalamine decreases the production of cyclooxygenase and lipoxygenase, which are enzymes that produce prostaglandins and leukotrienes. Prostaglandins and leukotrienes are chemicals that lead to inflammation. It is believed that the cyclooxygenase and lipoxygenase enzymes are over-active in people with ulcerative colitis and Crohn's and Mesalamine is believed to work by blocking the activity of these enzymes, which then reduces the production of prostaglandins, which reduces inflammation in the colon as well as the symptoms.

One issue with stopping the production of prostaglandins is that they are useful for many things other than inducing inflammation, including the construction of muscle cells around blood vessels, aggregation of platelets during blood clotting, and they deliver and strengthen pain signals. 

The side effects of taking mesalamine can be mild or severe. Mild symptoms can include headaches, muscle or joint pain, back pain, nausea and vomiting (as if I needed this right now),  heartburn, gas, constipation, dry mouth, sore throat, coughing, flu-like symptoms, runny nose, stuffy head, ear pain, anxiety, sweating, hemorrhoids (oh no...too late, I already had this), rectum pain (had this too), difficulty sleeping, acne, and hair loss. Now these are only the acceptable side effects. You could also have more serious side effects such as chest pain, shortness of breath, tarry stools, bloody vomit, vomiting material that looks like coffee grounds, increase in your need to urinate, blood in the urine, confusion, and swelling of other body parts. 

Now, according to Dr. Sigmon's P.A, Tanya Williams, mesalamine is safe for long term remission of Crohn's. Candidly, with the little bit of research I have done on mesalamine, I knew I didn't want to have to take this medication for a long time. But if you think this medication sounds bad, just wait for the next...

Budesonide:  Now this is a nasty drug. It's a corticosteroid that works by decreasing inflammation in the digestive tract. When budesonide is taken, it is released in the ileum, which is the area at the end of the small intestine, right before the large intestine. Budasonide is absorbed into the cells of the intestines. Here it works by preventing the release of certain chemicals from the cells. These chemicals are important in the immune system and are normally involved in producing immune responses that result in inflammation. By decreasing the release of these chemicals inflammation is reduced. 

The budesonide that slips away and is absorbed into the blood stream is about 10 to 15%:( This is actually very low for a corticosteroid in relation to the other options for treatment during a flare up, and therefore, budesonide actually has fewer side effects than most. The biggest concern I have with this drug works by weakening the immune system, which may lower your ability to fight infections. This most likely will make you more likely to get a serious infection or make any infection you have worse. 

In regards to the side effects, other than weakening your immune system, well they pretty much are as bad as any other drug:  nausea, heartburn, headache, oral thrush, yeast infection, tiredness, vision problems, easy bruising/bleeding, puffy face, unusual hair growth, mental/mood changes (such as depression, mood swings, agitation), muscle weakness/pain, thinning skin, slow wound healing, rash, itching and swelling, severe dizziness, and trouble breathing.

So Ultimately, the mesalamine and budesonide I began taking on September 7. I began the healing diet on September 14. I stayed on the healing diet for about two full months as I reduced the medication to be off of all medication within two months of my diagnosis. 

Date Mesalamine Budesonide
7-Sep 2 Pills 3 times per day 3 Capsules each morning
27-Sep 2 Pills 2 times per day No Change
4-Oct 1 Pill 2 times per day No Change
11-Oct 1 Pill each morning No Change
18-Oct No Change 2 Capsules each morning
25-Oct No Change 1 Capsule each morning
1-Nov Eliminated 1 Capsule each morning
8-Nov Eliminated Eliminated

It was quite funny when I had my first follow up with Tanya and Dr. Sigmon on October 25 as I explained I had reduced my medication. Ironically it was Tanya, the P.A., that basically lectured me explaining that I really need to stay on the mesalamine to ensure remission. She explained that it was a safe medication I can take for the rest of my life.

Go re-read the paragraphs above about mesalamine and help me understand how it can possibly be safe???

Dr. Sigmon on the other hand seemed genuinely happy. They both complimented me on how healthy I looked. But remember that the last time I saw them I was the walking dead, so I certainly hope that I was looking good compared to then. Haha.

I really do like Dr. Sigmon. He inquired about what I was doing that allowed me to progress so quickly. He knew it was predominantly diet related and already knew that animal products and sugar were no nos. Mostly, he was just happy for me and said as long as I was feeling good he was happy for me. He hoped it continued, but reminded me that if I ever begin to feel like I did, that he would be there for me. 

Regarding getting off of the medication, it would not have been so easy for me if I had not already been on a cleansing juice diet. For things to go as smoothly as it did for me, I believe that the body must be cleansed of toxins. During this period, I was consulting with Dr. Azar and she guided me as to what to do. 

So far, this will amaze you, I have saved about $800 in medication. And this is only my portion of the costs, not that of my insurance company.  You see these medications are very expensive. The Mesalamine was a prescription of $1,000 and the budesonide was over $700. My co-pay for a 30 day supply was $150 each. I think of this every time I have to bear the cost of buying organic foods. Haha.

Finally, it is very important when taking a corticosteroid that you don't simply just stop taking it. Your body naturally makes steroids. When you take steroid pills, your body may stop making its own steroids especially if you are on steroid pills a long time.So it was very important to me to get off of the budesonide as quickly as possible, because long term use of it could make it impossible to live without some form of steroid treatment in the future. Meaning your body may never be able to produce the amount of steroids it needs in the future if it is long term relying upon oral steroids. 

Therefore, don't stay on any steroid any longer than you must. Secondly, wean off the steroid, instead of stopping it all at once. This gives your body enough time to learn to produce steroids again.  While your body is getting used to making its own steroids, you may feel dizzy, lightheaded, tired, have stomach pain and body aches. All of which I had, but only mildly.  I was only on the full dose of budesonide for a few weeks, so there wasn't too much risk for me, but still, reducing the dose slowly and under a doctor's supervision is the safer way to go.

I look forward to returning for my follow up appointment with Dr. Sigmon and Tanya, his P.A. Tanya insisted that I stay on the mesalamine until my sediment rate is 20 or lower. Two weeks following that visit, certainly prior to even knowing if there had been any change in my sediment rate, I had eliminated that drug from my daily routine. I'm sure I'll get another lecture from her, but I expect Dr. Sigmon will again be happy for me :)

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