Newbie - Pentasa enema

Dr has given me predsol instead but maybe I should give the Pentasa another try. I'm really nervous of taking prednisolone because the Dr thinks I either have ulcerative colitis or possibly diverticulitis. They think it's more likely I have UC but I am nervous of taking the prednisolone in case it makes me worse if I do have diverticulitis sad

Did he give you tablets or enema or both?

Pred is good at reducing inflammation, the pentasa is normally for maintaining UC rather than solving it so I'd say the Pred is a good idea.

Normally works best when the tablets are taken with the enema together to blitz the inflammation.

I took predsol this time and the Pred foam the time before. Predsol is a lot of liquid to enema but it did help somewhat.

Yes they gave me 300g prednisolone tablets and the 250mg enema. The thing is I'm nervous of taking them because they haven't yet completely ruled out diverticulitis although they said this is unlikely.

Sorry 30g, not 300g

Phew!

Don't be nervous, the colonoscopy will show what is wrong. Pred at 30mg is typical, oh should see results quickly. When I take both tabs and enema together it blitz's the inflammation quickly. Remember to take the tabs after food!

NB. We share the same second name

It's a good second name

That's reassuring about the prednisolone, just want to feel better now.

Funnily enough I had a slightly better bm this morning less bleeding and mucus so wondering if although I had some side effects to the Pentasa it may have actually helped somewhat. Thank you for your advice. I am trying my best to be patient, I think at least when I have a date set for the colonoscopy I will feel better about it all. Having a look at the crohns and colitis website now.

Thanks

Lou

Managed to get through to Endoscopy and although the Consultant in hospital said I would have a colonoscopy within 1 - 2 weeks the Endoscopy department have overruled and said 8 weeks I've asked that they keep me on the cancellation list.

Glad you are feeling a little better. They do get busy but if it's all in he same hospital (is it?) it's likely to be the consultant or a colleague doing the procedure so worth a chat to him or his secretary. He should be able to decide if someone needs to be seen quickly. A lot of people cancel colonoscopies through fear so you may get lucky and get a cancellation.  I read your other posts about the Prednisolone. Although it's standard treatment for UC you might want to hold off until you know for sure. It is a very powerful drug but it can have some unpleasant side effects and the withdrawal period and beyond can be very difficult.

Yes it's all the same hospital. I'll give them a ring on Monday to see if I can speak to one of the Secretary's or failing that my GP wants to see me on Monday and she used to work in the gastroenterology department so she might be able to get in touch with them on my behalf.

Oh, sounds like I've done the right thing then by holding off from taking the prednisolone orally, I was going to try the predsol enema last night but thought I'd wait and see how things are today. There is less bleeding although the pain is still bad, but I'll see how I go. If I can hold off from using the enema I will.

Is there still withdrawal and side effects when using the predsol enema, or is it only when you take the prednisolone orally?

Thank you for giving me advice, it's been really helpful. How long have you had ulcerative colitis for? Are you keeping well at the moment?

I took a look at the info sheets on the crohns and colitis uk website, they are really helpful. I downloaded the ulcerative colitis booklet and could see they referenced some alternatives i.e. omega 3, curcummin so I've started taking just small amounts of them just until I get a diagnosis.

I don’t know about withdrawal symptoms when cortico-steroids are administered via enema. The drug will still be entering the blood stream but one would imagine in smaller quantities to target the rectum and lower part of the colon rather than the whole colon.

The issue with taking steroids is that they override the function of the adrenal glands whose job it is to produce the hormone under normal circumstances. That’s why the drug has to be withdrawn slowly, so that the adrenals start to do their job again. It’s very common for people to suffer extreme tiredness during and after the withdrawal period while adrenal function re-normalises. It had taken a good three months for me to get my energy levels back after each course of Prednisolone.

I was diagosed with mild to moderate UC in 2015, was getting back to normal by March last year but a course of antibiotics for an infection made it flare again in June. However I am now feelng a lot better and have been drug free since October. My GI consultant seems to find it odd that I am doing well without drugs - he wants me to be on a holding dose of Mezalasine - but I dislike the side effects - it makes me dizzy and I am not convinced it doesn’t make diarrhea worse. I don’t take anything or do anything special diet wise. I’m a vegetarian and eat a very plain diet with minimal wheat, gluten and diary and only drink the occasional cup of tea or coffee so that may help.

I found the people at Crohn’s and Colitis UK extremely helpful when I was first diagnosed. Their helpline staff are incredibly supportive and provided me with lots of information about how to manage the disease.

Keep in touch and let me know how you get on with phone calls and GP next week.

Oh I can see why it's important to wean off the steroids slowly then. Glad to hear you are feeling a lot better now and that you are managing medication free. I'm vegetarian too. Going to try cutting out dairy and gluten to see if it might help.

That's interesting what you said about antibiotics because the first flare I had (although wasn't half as bad as I am now) was after taking amoxicillin for a dental infection. I then went on numerous courses of antibiotics last year for a dental abscess before eventually having the tooth removed. Im wondering if all the antibiotics havent helped along the way.

Thank you for all your advice. I'll let you know how I get on.

Lou

Thank you. It wouldn't surprise me at all if all those antibiotics weren't the culprits triggering your immune system to respond my attacking the colon. Antibiotics destroy good as well as bad bacteria. I know some people find taking probiotics helps. Good luck with the docs tomorrow.

Went well at the Docs today. I've had less bleeding again so Dr said stay off the steroids and take the enemas if I need to. She's happy to see if this will settle down a little now at least until I have the colonoscopy. In the meantime she's got in touch with the hospital and I might be able able to get a flexible sigmoidoscopy done quicker than the colonoscopy so she's given the Consultant there my number to see if they can try and get me in sooner.

So it's sit and wait at the moment, hopefully will get a diagnosis soon. I'm sticking to bland low fibre foods which seems to be helping.

Lou

That sounds right. If things are settling down a little after administering drugs rectally it does suggest that the problem may be confined to the rectum and/or sigmoid colon - the lower horizontal section of the colon before it turns and runs up the left hand side of the abdomen. A flexi-sigmoidoscopy only takes around 10 minutes  compared to 30-40 minutes for a full colonoscopy so it may help get a quicker appointment. That’s what I had at first and it was enough to diagnose UC and get me on meds to start treating it. The GI doc had me back a weeks later for a full colonsoscopy to determine the extent of the inflammation and ulceration so you may need another endoscopy but it’s a start in finding out what’s wrong. Good luck.

Bleeding is back this morning, don't know whether to just try the predsol enema just to settle it down. Think I might have to.

A shame but not surprising. If this is UC then it's likely to need oral steriods to get it under control but, yes, maybe try the predsol to see if helps while you wait for the flexi-sig. Easier said than done but try not to worry.

Thanks for being so reassuring

Tried the Predsol earlier with not much luck. Lost half of it. Got myself in a right state but never mind. Will try again tomorrow night.

Might be worth asking doc if you can have suppositories instead. If you look up Predsol on here it confirms they do exist. I have used mesalazine suppositories which my GI doc says works if you can keep it in for at least 10 minutes to let it dissolve and be absorbed. So I insert it, waddle to the bed and lie prone for a while. Too much information but hope it helps.

Oh yes I think that might be better, will ask my doc if I can try the suppositories instead.

The predsol seems to have really helped. I still have the pain but I've stopped bleeding, the only thing is now I have become constipated. I'm worried that this might open up any sores/ulcers again, do you think it would be ok to use laxido to try and help? Don't want to do anything that might cause me to bleed again.

That’s not something I’ve experienced but I looked it up and found a site that said it’s ok to use lactulose based laxatives but those based on docusate sodium must be used with much more caution. I’ll cut and paste the text and see if this site accepts it without throwing the post into moderation.

“For people with colitis constipation is something that should be avoided. It usually occurs when going into remission and the bowels are not used to handling the more solid matter after months of persistent diarrhea. The type of laxatives used are generally of the mild variety.

Lactulose is fairly safe to use with colitis - and is the laxative of choice.

Lactulose is known as an 'osmotic laxative'. It is made up of sugar molecules which are broken down by the bacteria that live in the lower part of the gut. This leads to the contents of the gut becoming more acidic. The acidification of the contents of the gut causes a reduction in the absorption of a chemical called ammonia. The presence of ammonia in the gut causes water to be drawn into the lower bowel, which causes an increase in the water content and volume of the stools, therefore relieving constipation.

Docusate sodium must be used with much more caution than lactulose. In particular it must not be used if there is the risk of the bowel being either obstructed or damaged/torn.

Docusate is known as a 'stimulant laxative'. It acts on nerve endings in the gut wall. These nerves then make the muscles in the intestine contract with more force and more often. When the gut contracts, it moves the contents along faster, and so it reduces constipation. It may also act by softening the feces. The muscle contractions move the feces through the bowel faster, meaning that there is less time for water to be absorbed from the feces in the gut into the blood. As a result, the feces contain more water and are softer and easier to pass. As docusate increases the activity of the muscle in the gut, it often causes stomach cramps. The tablets take about 1 to 2 days to work.”

Thank you for looking that up. I'm definitely going to steer clear of anything with ducosate sodium in. I just checked the laxative I've got called Laxido and it's an osmotic which sounds like the lactulose laxative that you've referenced. Going to see how I am tomorrow and then maybe just take one to see if it helps.

I'm not sure if it's the predsol enemas have caused this. The beginning of the week everything was going through me and now I can't go so it's gone from one extreme to the other. I need to do something though because it's making the pain worse.

Hiya,

I'm 33 and have suffered from UC for about 4 years now. Initially I was diagnosed with UC proctitis which is the lowest part and some left side. I had suppositaries which I used for a short while and oral 5-asa (mesalazine). I remember experiencing constipation too and doing the whole researching of laxatives and trying some out. So I know where you're coming from and feel your frustration. Eventually my sympton cleared up and and since I have remained on daily dose of Octasa 400mg x6 a day. This has kept my sympton at bay although to be honest I do often wonder if it was the drug or just that I was in remission and would have had the same outcome without the drug.

Anyway 3 weeks ago I started and really bad flare, and im 25 wks pregnancy, and barely ate since last week. It's not good. I was at my gp y.day and return today, with an emergency consultant app booked for Fri. Basically I don't know what route to take medication wise either. I think this is typical of UC. You just want to take the least possible, but with something that can take so long to get under control yet is the most hideous thing to live with you end up in despair really.

I have to chose to start steroids orally, which I don't want to do, or to start 5-asa enemas on top of the 5 as a orals I'm now on (12 a day). Thing is I'm questioning if the oral 5 asa has made me worse, and if the enema (which I'm dreading) won't do anything either. And I'm in so much pain and now off work I feel as though I don't even have the time to trial this before turning to steroids!.

It's just hideous, and I wish you all the best with getting this under control. How asllre you finding the suppositaries? Have you had your sigmoid yet?

Hiya,

Yes I think mine might be ulcerative proctitis and a bit of the left side of the colon because the burning heavy pain is specifically there.

Sorry to hear you are in a flare, it's horrible because like you I don't like taking medication either. Good that you have got an emergency appointment with the Consultant this week. When I tried the mesalazine enema I had a horrible reaction the following day with horrendous pain and even worse diarrhea. Cleared up by the end of the day but I don't ever want to try that again or take them orally if that's what they suggest. I tried the predsol enemas and they do work really quick for me the only thing is I stopped after a few days because of the constipation. The bleeding came back a few days later along with the horrible pain. I actually went to my GP today and she explained that because I only took the enemas for a few days it only took care of the superficial inflammation and to get to the deeper inflammation I need to take them for several weeks. I explained about the constipation after taking them for a while and she agreed that I could take laxido as well. So I'm going to give that a go. The predsol enemas do work for me and although the gp recommended taking oral steroids as well I wanted to just try the enemas first because they are not absorbed so much systemically so less side effects. Have you tried the predsol enemas? If you do need to take oral medication, I've read about an oral steroid that works better for people with ulcerative colitis as it is not absorbed so much systemically as it is time released to take effect in the colon only. It's called "Clipper time released tablets" and the type of steroid is called beclometasone. You can find it on the Patient Info website. Might be worth asking your consultant about. It's something I'm going to ask about when I have a diagnosis.

My colonoscopy is on the 10th March, not looking forward to it but I know I need a diagnosis. GP has told me to stop the predsol enemas a week before so that there will be inflammation there for them to see when they do the scope.

Congratulations on your pregnancy by the way!

Let me know how you get on with your appointment on Friday.

Lou

Hi Lou

Well I'm already on oral mesalazine, and that's been fine for the last couple years, but it just doesn't seem to be working now I'm in a flare. Im wondering if the double dose has made worse actually as my sypmtons have actually got worse never mind even stabilising.

I've never used enemas. I picked some up today (mesalazine) and my gp has prescribed steroid ones for me to collect tomo. So i have that joy to look forward to tonight. The plan is to try mesalazine ones for a few days then if no good start the steroid ones. Unless the consultant has a different game plan on Fri.

I thibk the last option is oral steroids coz the baby, and tbh even without the baby I'm really not keen and actually quite scared to start them. Ill ask about the clipper ones though. So although I don't believe the enemas will help (my sympton are a lot higher) I'm praying to god they do!

It will be good to have your colonoscopy. Not a nice experience but it's just reassuring to be able to see what you're dealing with. Once I've had the baby I hope they give me one.

I know, the enemas aren't pleasant to do. I was really daunted the first time I tried it the week before last, not top of my list of ways to spend the evening! Especially when hubby's outside the bathroom door asking if I'm finished in the bathroom yet!

I leave it right up until I'm about to go to bed now because it's easier to just go lie down afterwards and go to sleep. It helps to take your time as well, do 1/4 of bottle first and let it settle then 1/2, then the rest. They seemed to have really helped me though and because it's the enema and quite a lot of liquid I think it does get quite a fair bit up the colon. Really hope they work for you. I understand why you wouldn't want to take the steroids orally especially being pregnant. Hopefully you won't have to if the enemas work.

Lou

Yeah I felt so self concious i suggested I sleep in the spare room! I done it just before bed too, but within 2 minutes I dashed to the loo and it was game over. Considering I've been dashing to the loo anytime between 10/20 times in 24hrs, with a constant urgency to push I just don't know how I'll hold all that in!

I came to bed dissapointed to be honest, and checked my phone which is when I read your message. I thought I cant give up this easily coz it will mean oral steroids and times running out. I need to get this this under control for baby, work and myself :-(

So I tried it it again. I done it a lot more slowly this time as you suggested. If I'd stopped at 3/4 I think I'd of been successful. But I used the whole thing and i even think there was air in it at the end which was really not helpful.

I'll try again tonight and may go straight to the steroid one. Do you have to taper off them and did you say yours worked pretty quickly? How are you feeling now? I've heard foam ones are easier to use so I'm wondering why they aren't prescribed.

Sorry for too much info today, You're the first person I've spoke to who goes through the same.

Chrissy

I know what you mean about being self conscious, it's just become my nightly routine before going to bed now though. Hubby don't know any different either when he's busy watching TV ?

Yes exactly the same happened to me too, I get the odd night where I've had to go to the toilet after 1/2 hour to an 1 hour and lose it but I think even if it's been held in for an hour it will have done something. Now I seem to hold it in better, I find that after the first 15 minutes or so the feeling of needing to go settles and after an hour or so you can't feel it at all. I find if I can hold onto it for the first 1/2 hour or so and stay lying down you've got a good chance of retaining it. And even if you don't after an hour or so it's bound to have done something in that hour anyway. Some nights if I feel like I can only hold 1/2 to 3/4 in I'll just do that and I've found it still works.

Oh yes, I always leave the last bit in the bottle, I don't use the last bit because like you I find it just inserts air rather than liquid which doesn't help at all. So I leave like a cm or so in the bottle and throw it away. The other thing is once you've done it stay where you are lying down on left side for a good 10 minutes or so. It helps the urgency pass, if I get up straight away then the urgency comes back.

Don't be disappointed, you did really well managing to use all i didn't even manage using a little bit on my second go so it's a sign that you will be able to do these enemas, it's just probably after a few goes you will find a way that works best for you. Key is not to rush, take your time and try and let the urgency pass if you can. Some nights that will be easier said then done but if you do end up losing it, it will have had some effect anyway.

I find the steroid ones stop the bleeding within 2 days and the urgency decreases but then in my case I get a bit constipated. I've learnt that's still inflammation though so I'm carrying on with the enemas. I've taken the steroid enemas for 5 days and have no bleeding now, I still have pain but I think I just need to keep taking them for a week or so. Yes I've heard about the foam ones, the only thing is I think the liquid has.got a bit of a better chance of getting further up the bowel which is why I haven't asked about them. But definitely worth trying them if you can't get on with the enemas. Dr didn't say I have to taper them but I think I might do just in case.

Don't worry about too much information, I feel exactly the same as you. I'm such a private person normally but now that I've got this I feel talking to others like yourself who are in the same boat (others who have UC) really helps me because on my own I just end up in despair. You can get so much good advice and tips from others who have experience in managing this condition.

Give it another go tonight and let me know how you get on. Even if you just manage holding onto 1/2 or 3/4 for an hour or so it will still help.

Lou

Thanks Lou, that's really helpful. My partner picked up my second prescripton today which I knew would be steroid enema, but was suprised to see its the foam. Its prednisolone which Im assuming is the same as predsol you have, but yours is liquid and mine is foam.

The liquid one i have is mesalazine. Im unsure which one to go with tonight. I must say the pred foam looks far less daunting than the mesal liquid. I know you didnt get on with the Mesal one, but as the oral meds have worked in the past im wondering if i shoukd give them a good go before the steroid pred one. Having said that i believe the steroid pred would work much faster. Arrghh its flipping mind field isnt it!!

Im really glad to hear your bleeding stopped, and hope the pain goes away soon. Did your gp recommend oral steds too? I could be wrong but i feel as though my pain is higher up and enemas wont sort it. But because my mesalazine orals dont seem to be sorting that im wondering if she will start me on steroid orals friday. I really dont want that but if needs must. I too think i may end up constipated like you if im successful with the enemas. I remember having that in the early days, and i used suppositaries then. Tbh i feel a bit like that now. Its really odd, i have terrible pain and urgency like diarrhoea, then i get on the loo and feel really constipated, and it hurts, but when something finally happens after a lot of straining, its blood and/or diarrhoea. So I feel both ar once. And I get to the point where i know theres nothing more to come but my gosh the feelings take longer to subside making it hard to get off the loo. Its just hideous. We really have a horific disease and i wish they could just find what triggers a flare!! Or find a cure.

Oh yes if it's the prednisolone foam that's the same as the predsol enemas I use. That's good they've given you the foam you might find it easier to use. For me the steroid enema stops the bleeding really quickly but then I couldn't get on with the mesalazine enemas. That's a bit of a dilemma for you, which one to use. I suppose you could try the mesalazine enema a go again to see how you get on and if you don't have any luck then go for the foam and stick with that. Or if you find the liquid enema too daunting give the foam ago I imagine the foam would feel a bit lighter and therefore might be easier to retain.

You're right it is a nightmare knowing which to choose, I was like that when debating whether to take the oral steroids as well as the enemas. My GP prescribed me the predsol enemas and 30 mg of oral prednisolone but when she told me the potential side effects and how I would have to taper off them I decided to give the enemas a go first and she agreed that I could try the enemas first. I got the impression she thinks to really settle this flare I might have to take the oral steroids as well but I'll see how I go first and what the GI Consultant says in March. If I'm no better in a few weeks or so I'm going to try the oral steroids.

At the moment I can't seem to decide on anything especially when it comes to food, I don't feel like eating because of the pain but know I need to eat because after being in hospital I've lost over a stone. But then I worry that whatever I eat is going to make me worse. For now I'm sticking to bananas, yoghurt, veg soup and fish in small amounts. Meanwhile my hubby is enjoying doughnuts and biscuits with a cup of tea 😡

That sounds so painful for you, feeling the constipation type pain but then having the bleeding/diarrhea. I think I know what you mean about that horrible feeling though I had that when I was in hospital, after going numerous times through the day with diarrhea and blood and feeling like I had nothing left in me I'd have the horrible urgency feeling all night but when trying only blood and mucus. It's a horrible feeling. Hopefully when you give the enemas a go it will helps stop the bleeding for you quite quickly.

Let me know how you get on with the enema tonight.

Hiya Lou,

Sorry for the delay, yesterday was busy frantically trying to arrange little suprises for my partners 30th today, all from home! Then my step mother visited me in the afternoon before i headed to the gp's. Hope youve been well? Any progress or regretion? Or just coasting?

So youre on the foam steds. So when you tried the mesalazine was that foam or liquid? In the end even though I got the sted foam on Wednesday, I did opt for giving the mesalazine liquid one more go before giving up on. I done it real slowly again like you said and at about 2/3rds or 3/4 I decided to stop as i thought to retain that would be better than using all and losing all!! I actaully managed to keep it in til 5am, which i was really pleased about. I actually only woke up for a pee, lost half of it, but retained the rest and went back to bed quite happy with progress. Im not sure if when ive gone to the loo in the night for the colitis if it has been earlier or not as not been checking times, so at this point I wasnt sure if itd actaully started to help already or not. But felt positive. Anyway, the fact I woke up and was now thinking about it all wasnt ideal. Before i could back to sleep i was up again and off we went. So no more enema for me! But still a progress. The following day, yesterday, my 'episodes' were definately no better. I think i was feeling more pain and more constipated, although i cant work out if i did or was imagining it because i was already thinking about feeling more constipated and that the enemas may do that. Last night I managed another one, and started to drift off thinking this is going well, i felt like i was getting used to it. Unfortunately just as i was drifting off then felt pains, i needed to go to the loo. I lost the enema and what was so frustrating was that it wasnt because of the enema! Its so disappointing to lose a nights dose when you feel up against a clock to get it under control!

This morning i was bad. Ive noticed a couple of times over the last week when im on the loo the pain is so bad it starts to make me urge/be sick at the same time :-( because ive not been nothings ever really came up, but this morning i had a bit of cereal, so whilst on the loo, i was being sick from the pain at the same time. What a state! Makes you feel quite sad and hopeless really. I had a bit of a cry, feeling physically and emotionally drained.

Anyway, I saw the consultant at the hospital today, she wasnt doing appointments and she is the lead for IBD for the trust which covers 3 hospitals, but after my calls to the nurse and my 3 gp visits this week and pregnancy she just saw me, which was good. They have no notes from my past as I relocated here a year ago, so i dug out what i could which included my initial diagnoses letter, and the reports from the sigmoid and colonoscopy Ive had. To date ive only had those 2 procedures once. So she assessed me, and basically said I have to start oral Pred immediately, which i was sad about but not suprised. I have to take calcichew- D3 which is high strength calcium and vit d, twice a day, high strength folic acid and multi vit once a day. I have to continue taking my oral mesalazine too, 8 x 400mg a day, but she said to stop taking the enemas. She said the steds will be enough. I have my bloods on Monday, and a call from the nurse on Tues morn. If things arent improved by then she wants me admitted on Tuesday for i.v's. She said she wants to get me to 33 weeks with the baby, 36 weeks she said great no concerns at all, but the aim is to get to 33 weeks. She said ill probably have a big baby coz of the steds, but to bare in mind the steds will develop babies lungs quicker which is positive for if I have an early labour. Im absolutely dreading the steds, but i really have no option, and either way ill worry about the baby, but i think the mesalazine has had long enough and i cant continue like this. I dont think enemas are enough to get it under control even though they've not had much of a chance.

As for food and deciding what flipping approach to take with that, well, thats a whole 'notha story! And im conscious ive wrote A LOT right now, so ill just send this for now but by all means let me know if younwant me to share my thoughts/approach to yet another consideration towards this horrid disease!

Hiya Chrissy,

Wow you've had a busy few days whilst being so poorly too. I'm not so good today, quite a lot of heavy aching pain in lower abdomen, the only thing that seems to relieve it is lying down. But I've just got to keep going until I get the colonoscopy, I keep telling myself to hold on for that because I will get the proper treatment then.

When I tried the mesalazine it was the liquid enema. The steroid one is a liquid enema too and I seem to be getting better at using it which is good. Don't feel like the pain is improving but there has been less blood.

This morning sounded awful for you, i cant imagine being sick on top of the horrible symptoms that come with colitis. Sounds like you were getting the hang of the enemas but like you said you're flare isn't improving, so you need the oral steroids to nip it in the bud. I'm told that they work really quick so I hope they do for you.

To be honest I think I need to take the oral steroids too because this horrible pain doesn't seem to go away but I think I should wait until the colonoscopy.

Sounds like you've got a really good consultant to provide you with treatment. She sounds very proactive which is what you need to get you feeling better. That's good you have a plan going forward now and as much as we don't like to take steroids they will give you the best chance of nipping this flare in the bud quickly and that's going to be a good thing for you and the baby. That's good what the Consultant said about how the steroids might help your baby's lungs develop quickly, that's a positive. Maybe the side effects are not so bad for baby after all. The Consultant sounds really good, it must be a bit of a relief now you've seen her so that you have a plan for getting rid of the horrible flare and to get as far a long in pregnancy as possible. And a relief that you don't have to do the enemas anymore ? I am envious of you for that!

Yes would be really interested on your experience / approach with food and what not (only when you have spare time though, you've had such a busy and exhausting week).

For now I hope the steroids take effect quickly and get you on the road to kicking this flares butt!

I hope you manage to get a good night sleep tonight.

Lou