Prednisolone and Afternoon Colonoscopy

[Songbird69]

Hi there,

Hoping you can help, as always.

I am due to have a colonoscopy on Monday afternoon - admission at 1pm. I have had several colonoscopies in the past, but this is the first time I have had to take half the Moviprep in the afternoon of the day before and the other half in the morning of the day of the procedure.

I am thinking of taking my Gastro resistant Prednisolone with either my light breakfast tomorrow or with my early light lunch. The reason is because I also have to take omeprazole (acid reflux) and the Instructions say not to take Pred two hours before or after the PPI.

I need sufficient time for the Gastro Resistant Pred to be absorbed before I take the Moviprep, starting 4.30pm - 5.00pm.

On the morning of the colonoscopy, I think I have to start taking the Moviprep at about 5am - otherwise it will not have the chance to work before I get a lift to the hospital (an hour’s drive away).

I need advice as to when to take the Pred on both days to avoid it just going straight through me and not doing it’s job.

As it is, I am anxious about not making it to the hospital without accident as there is nowhere to stop en route. 😳

Any advice or tips, or experiences would be really welcome.

🤗

[PMRpro Ambassador]

Breakfast would probably be better on the day- g/r pred takes at least 4 hours to be absorbed, sometimes longer. Have you ever tried taking g/r pred before bed? That way it is working nicely by the morning and really can make mornings better.

I know how you feel - my colonoscopy was done in the late morning but I had to take the second lot of Moviprep in the morning AND get to the hospital for a blood test as I was on warfarin. There are plenty of toilets at our hospital but you can't guarantee there will be one when you need it!!

[Songbird69 in reply to PMRpro]

Thank you Pro, I’m not allowed breakfast on the actual day. I was thinking about leaving taking the Pred until after the procedure when I could have it with food, and perhaps take a double dose (currently on 3mg) the day before. But that would probably mean around 3pm. Too late? Do you think that would work?

My PMR is stable. I would normally be reducing, but other health issues as a result of the Covid jab means that I cannot reduce right now. All complicated!

😊

[PMRpro Ambassador in reply to Songbird69]

In that case I think if it were me, I would take the double dose the day before but with the second half before bed to carry you over until after it is done. A bit of irregularity for a couple of days won't hurt! It is always a bit complex with the g/r version, knowing it has to be in the gut longer. Plain pred is so much easier - takes a whole hour and then you know it's fine!

[Songbird69 in reply to PMRpro]

Thank you. That sounds like a very good plan. Good thinking Batman! I’m glad you got to the hospital when you had it done, without mishap!

A friend is driving me - and with no stopping places, unless you count the hard shoulder on the motorway, or amongst residential estates, I fear she may never speak to me again if called short!!

I was also sorry to read about your husband’s passing, and send you love and hugs. I know you have some great friends on this forum and no doubt, because of the lovely person you so obviously are, you have friends in Italy to support you too. 🤗😍

[Songbird69 in reply to PMRpro]

Hi PRO,

I did it. It worked! And I have been stuffing my face ever since too!!

In view of your previous comment about trying to switch to night time dosing. I am thinking that would be a really good idea. How would you recommend I do that? Another lot of double dosing to get on track?

Hope you are enjoying our December mini heatwave too?!!

Sally

[PMRpro Ambassador in reply to Songbird69]

No mini-heatwave here! Overnight temps have been colder than -5C for the last couple of weeks - andabout double figures until this last week! Only had one day where it crept above freezing in the last 2 weeks as well. Lots of lovely sunshine though - and it doesn't feel unpleasant in the sun

If you have taken your usual dose in the morning, you just take the next day's dose that evening and then keep to that time. That little bit of extra for that day will just give you a boost for a day!

[Songbird69 in reply to PMRpro]

Well - our heatwave only brings temperatures of 12 degrees and we have had a LOT of rain - so instead of suggesting you come here, I might wind up on your doorstep!! 😂

Thank you. I will try that today - I could do with a boost, but guess I won’t feel it as will hopefully be asleep once the second dose comes into play!

Have a good day in your wondrous sunshine!

Sally

[PMRpro Ambassador in reply to Songbird69]

It is the rain, in combination with the wind, that makes me determined to stay here! In the UK I had awful SAD, no problem here at all as we rarely get more than a few days of gloom at a time and even when the low cloud at the cold valley air/less cold mountain air interface persists, you can always get in the car and drive up to escape it!

[Songbird69 in reply to PMRpro]

You are making me jealous! Italy is my most favourite place - not least the language - I don’t speak it - but I love the sound of it. Even when people are rowing, it sounds romantic to me! In the good old days, pre Covid, Italy was my “go to” place for holidays.

Maybe it will happen again one day. I hope so!

[PMRpro Ambassador in reply to Songbird69]

I actually live in a German-speaking region - because we already spoke German. Italian is a minority language here so I don't get much chance to practise!

[Songbird69 in reply to PMRpro]

No good for me then. Failed my German O’level!!

[PMRpro Ambassador in reply to Songbird69]

There is a lot of Italian spoken here, just over 90% of the population identfy as German speakers, But you are unlikely to get a job even in a shop unless you can speak both competently. However, increasingly our big supermarket has staff who speak no German - which infuriates me!!! It is our legal right to have our chosen language spoken to us!

[Songbird69 in reply to PMRpro]

I totally agree. That must make life very difficult for you. Fight for your rights I say!

[SheffieldJane]

Good luck Songbird69! Ensure your doctor is fully informed about what you’ve done about Pred. X

[Songbird69 in reply to SheffieldJane]

Hi SJ, Good point. Another thing to add to my list!

Hope you are OK and doing well. X

[SheffieldJane]

Thank you! Muddling through. Let us know how you get on. I think the meds have taken their toll on my digestive system . Very unhappy bowel.

[Songbird69 in reply to SheffieldJane]

Hi SJ, I’m sorry to hear that. As I have Crohns and am on biologic infusions, I can relate to your comment. ☹️

Have you tried good quality probiotics? I find that helps me. Might be worth a try if you haven’t already? I also take grass fed collagen hydrolysate before bed mixed with a tiny amount of milk.

I probably rattle with all my various supplements!!

x

[SheffieldJane in reply to Songbird69]

Yes, just, odd you should say that. I imagined that it was going to go away like a stomach bug, but no. I have been wondering about IBS, Crohns and Diverticulitis, an ulcer, a stomach tear - they all, bar Crohns appear in my med side effects. I will have to look up grass fed collagen hydrolysate. Does anything ease the pain and diarrhoea etc.?

[Songbird69 in reply to SheffieldJane]

Hi SJ,What a nightmare for you. ☹️

Well, they do say that autoimmune diseases start with the gut. I believe too that Pred (possibly biologics too although I haven’t researched that yet) can cause a leaky gut, which is why I started taking the collagen hydrolysate. It does seem to help.

For me, it’s a multi faceted approach. When I am in a flare, I eat low residue foods - and if really bad, I take to having Complan to replace one of my meals. Both of these, give the bowel a rest and helps it to heal. I am currently following the CDED (Crohns exclusion diet) the principle of which is to eat “clean” foods. Nothing processed - all fresh with no additives.

I am not suggesting for one minute, that you have Crohns - very unlikely to show it’s face for the first time in older people, but that kind of diet could do you no harm, whilst waiting to be diagnosed.

When I originally presented with my symptoms, they insisted it was my gall bladder causing my issues - and removed it! It was only the surgeon doing an MOT as he called it at the same time that my Crohns was discovered!

I firmly believe that my issues were originally caused by several rounds of antibiotics, damaging my microbiome, and subsequently uncoated Pred caused sores on my stomach. What a life!! All that is why I take probiotics religiously.

Have your specialists carried out an endoscopy or proposed a colonoscopy- depending on where your pains are? I would have thought that would be the first step for you. At least once you know what you are dealing with, you can begin to sort it. Do you think that long term use of Tocilizumab could have caused this? Do your symptoms improve between infusions? I am on a biologic too and it certainly affects my intestines.

I don’t know if any of this is helpful for you, so sorry if I have gone into too much detail.

Happy to help all I can with my limited knowledge.

Let me know how you get on and good luck. xx

[SheffieldJane in reply to Songbird69]

The detail is very welcome. My digestive system already felt damaged on Pred so I had switched to Entric coated which seemed to help. I do think Tocilizumab has probably compounded the problem. I always get stomach cramps and diarrhoea after food, these days. I too have had more antibiotics this past year or so than ever before in my life. New Years resolution to address this. In the meantime I will move to fortnightly Tocilizumab.

[PMRpro Ambassador in reply to SheffieldJane]

While Crohns may not be dx'd at our age - coeliac disease is. Have you ever tried keeping a food/symptoms diary?

[Songbird69 in reply to PMRpro]

That’s very true. Could be worth trying gluten free for a month to see if it makes any difference, and gluten can cause a leaky gut too. Again it could do no harm. X

[SheffieldJane in reply to Songbird69]

I more or less follow all your dietary advice. My son needs Gluten free, so I more or less am also. It does seem to be worsening. Constant pain and burning otherwise, also feeling as if I have a blockage. Laxatives were agonising. Here we go. Thanks for you advice.

[PMRpro Ambassador in reply to SheffieldJane]

Have you discussed it with the GP? You really should unless you have had all the tests already/

[SheffieldJane in reply to PMRpro]

This became more evident when I got cystitis symptoms. A GP telephone consultation, during which I mentioned the chronic lower abdomen pain, I was prescribed antibiotics for UTI/Kidney infections. No samples, no examination. I honestly feel that I have no proper GP.This is only relevant to this space because I suspect that it maybe related to Pred or Tocilizumab/ Actemra.

[PMRpro Ambassador in reply to SheffieldJane]

That is appalling - I know they are under strain - BUT that sort of prescribing is potentially creating problems, not saving them time. Have you got access to a good nurse or paramedic practitioner at the practice? If laxatives caused severe pain - that needs flagging up.

[SheffieldJane in reply to PMRpro]

Fort Knox. I am made to feel like a time waster. I have had a series of relatively minor things, seemingly unrelated, but of course they are all related to my GCA/LVV and medication. Everything is viewed, half heartedly, in isolation. I fail to understand what has happened to the U.K. GP system. Mine don’t seem to be involved with the Covid response. Big signs telling Covid sufferers to stay away. All vaccines outsourced. It tends to make me withdraw and I bet I am not alone. At least I have a brilliant Rheumatologist, part time, but you’d never guess. These things are not really her job.

[PMRpro Ambassador in reply to SheffieldJane]

I think they are - if your GP isn't taking notice and you think it might be linked to the LVV/GCA and TCZ it definitely is. She can probably arrange some checks to rule out other possible causes.

[SheffieldJane in reply to PMRpro]

I appreciate this more than you know. Thank you you are a brilliant friend to us all! X

[Songbird69 in reply to SheffieldJane]

I second that. ❤️

[Songbird69 in reply to SheffieldJane]

Hi SJ, As this has been going on for some time, you really need some action. Could you speak to the consultant who prescribed you with the biologic? I believe you are right and this is quite probably the culprit. It may need stopping and something else prescribed.

I would have suggested presenting yourself at A&E as then they HAVE to look into it. I only hesitate as a lot of the hospitals are now non black alert because of Covid. But if needs must ….

Hugs 🤗 xx

[SheffieldJane in reply to Songbird69]

Thank you both. I was hoping to make a concerted effort after Christmas but I don’t think it will wait at this rate. I have been put on to fortnightly injections of Actemra by my Rheumatologist for the abdomen pain.

[Songbird69 in reply to SheffieldJane]

Good luck. Keep pushing until it’s sorted - and let us know how you are doing. 🤗 xx

[Nagswoman]

I had to take all of the moviprep the day before. I still took my meds in the morning of the colonoscopy last Feb.

[Songbird69]

Hi. Yes - that’s normally what happens to me, and I take the Pred immediately after the procedure with food. This time, it’s more complicated because of the two day dosing.

Finished the first lot of Moviprep now - yuck - and hoping I can get a decent night’s sleep!

Can’t wait for a proper cup of tea and FOOD!!

[PMRpro Ambassador in reply to Songbird69]

Don't tease yourself! Have as good a night as you can

[Songbird69 in reply to PMRpro]

😂 Thank you. ……. Fantasising about my missed roast with mashed potatoes and gravy!!

[PMRpro Ambassador in reply to Songbird69]

Hope there is a plate in the fridge for tomorrow!!

[Songbird69 in reply to PMRpro]

I wish! But have secreted some home made scones, courtesy of my neighbour in my hospital bag. Can’t wait!

[SheffieldJane]

Let us know how it goes. Thinking of you Songbird69!

[Songbird69]

Hi SJ, I have had many colonoscopies but this one, for some reason was the most painful that I can recall. Five days on and I still have abdominal pain, and some cramping last night.

When my bloods were taken two days later for my biologic infusion (I know how to live!) it showed a small infection.

I called endoscopy today and they don’t seem concerned. But I am!!

Bet you wish you hadn’t asked!!

How are you doing? xx