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At what point do I go to the emergency room?

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Ulcerative Colitis
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Posted 5/6/2009 4:56 PM (GMT -5)
I have had UC on and off for years however over the past two years it has become increasingly worse. My family and friends are shocked when I tell them I am in great pain when I have a bowel movement and most of it is blood. I have a GI I see every few months and to me this blood thing, while incredibly painful, is normal to me. If I go to the ER, what are they really going to do for me? Asacol made my symptoms worse. I was in remission for several months and just had a flare up again last week. I am currently taking Prednisone, although I don't think it is helping much. I just wondered if anyone else could shed some light on when it may be time to just go to the ER. Thanks.
Posted 5/6/2009 5:17 PM (GMT -5)
The ER will do less than your GI will. Most GI docs don't have extensive knowledge of UC, so unless you think you're dehydrated and could use a bag of IV solution, have toxic megacolon (a rare life-threatning complication of UC), or are loosing a dangerous amount of blood, I wouldn't go.

What are you taking right now besides prednisone and how much prednisone are you taking? Have you seen or spoken to your GI since this flare began?
Posted 5/6/2009 5:18 PM (GMT -5)
I'm an advocate for staying out of the ER if at all possible. It's not the right place to get care, it's expensive, you may wait in discomfort for hours and hours. Trust your instincts, but try to get in to see your doctor if you are not improving, or see if you can get some advice over the phone (like a bigger dose of prednisone).

I always just asked for meds from my doc over the phone, if she wants to see me about it she finds a way to fit me in. Only when I was due for a colonoscopy or wanted to explore new treatments like Remicade did I make an appointment.

Until Remicade, I would bleed every time, it was my "normal." Urgency and Pain meant flare for me, but prednisone always got me out of it.
Posted 5/6/2009 5:21 PM (GMT -5)
I did call my doctor and that is when I got more Prednisone. I am taking 80 mgs right now and will taper each week. I am going to request Remicade. My sister has Chron's and lives by her infusions.
Posted 5/6/2009 6:15 PM (GMT -5)
Before you run to Remicade - have you asked the doctor about Rectal meds?  I see you are allergic to asacol but there are still the steroid enemas you can take - like cortifoam or Cortenema.

Posted 5/6/2009 6:24 PM (GMT -5)

I am amazed at the people here who seem to consider bleeding "normal" or normal for them.  I had IBS for years which was certainly no fun but never bleeding until a year ago.  Colonoscopy showed ulcers in my rectal area and inflammation 30 cm. up my left side.

My GI told me that bleeding is really bad - not normal - I could not live with it because it could spread, bigger chance of cancer, megacolon, etc.  He will not stop finding treatments for me until the bleeding and inflammation is GONE  - remission.  In fact, as I said in another post - he is referring me to a specialist in Albany if the 6MP and prednisone don't do it soon.  I felt that being 69 I could live a long time with just "some" bleeding or inflammation like I have now but hope I don't have to make that decision. I still have time to get relief from 6 MP as it takes a while.  I am also going to try the hydrocortisone enemas for a week again - they only made it worse before but I said I would try it again!

ElaineNY

Posted 5/6/2009 6:25 PM (GMT -5)
I will ask. As much as I am not thrilled about enemas, I am willing to try anything. I just thought Remicaid was a more viable option since it is not an everyday thing. Thanks for the advice.
Posted 5/6/2009 6:51 PM (GMT -5)
im a little confused why people are saying to stay out of hospital. that was the only thing that made me better. they gave me morphine for the extreme pain i was having and gave me intravenous steroids and antiobiotics and i was in there for 5 days it kicked the hell out of my uc and when i went home i still take 6mp and prednisone until dr weaned me..so yes the hospital can help....i had bleading and extreme pain so listen to your body.....
Posted 5/6/2009 7:02 PM (GMT -5)
I am thinking that if the extreme pain lasts for more than a day or so next time, I may consider the hospital. I just don't know what is "normal" for this stuff yet I guess!
Posted 5/6/2009 7:05 PM (GMT -5)
The hospital I was at helped me. I did although get sicker while in there. But... they started me on medicine that I would respond to. I called my GI before going into the hospital and didn't to much. I didn't know what was making me worse, but a year ago I realized that it could've been the Asacol I was on when being diagnosed. When I was in the hospital, they made drastic changes food wise for me, kept me off solids for about a week, gave me IV steroids, and an Ensure type drink. They started me on Remicade and I got out in about 25 days. I was still bleeding, but it wasn't as bad as before I was in the hospital. I guess it depends on you health plan.
Posted 5/6/2009 7:19 PM (GMT -5)
Yea in what I have learned from reading other peoples experiences is that if they are bad enough to require a hospital trip, in almost all cases they got IV steroids. Being that you are taking 80mg of pred orally with no changes, I would lean that way - maybe not to the ER, but maybe through a referral from your GI to be admitted for IV roids...
Posted 5/6/2009 10:50 PM (GMT -5)
I go to the hospital when I can't stop throwing up and feel like I am getting weak and dehydrated. I just need a shot to stop the puking and if it is after hours at the docs I go to the hospital. It never occured to me if I called my doctors answering service if someone would be on call to give me the shot or if they would just send me into the hospital. Also if my pain was so bad I couldn't walk I would go for pain management but that has yet to happen yet. Remember, even though you have UC that doesn't mean you couldn't still have an appendix or kidney stone emergency. Pain is pain and 7+ pain probably requires a trip to the ER.
Posted 5/7/2009 8:05 AM (GMT -5)

As a senior - old enough to be Mom to most of you guys - you have to remember that your pain or symptoms could be so many things - not just UC which is bad enough.  My husband went to emergency once with what felt like kidney stones (which he had before) - same kind of pain, etc. and it was his appendix burst and he was in bad shape.  I know ER is no fun but sometimes it could save your life!

ElaineNY

Posted 5/7/2009 9:32 PM (GMT -5)

nymomof3 said...
im a little confused why people are saying to stay out of hospital. that was the only thing that made me better. they gave me morphine for the extreme pain i was having and gave me intravenous steroids and antiobiotics and i was in there for 5 days it kicked the hell out of my uc and when i went home i still take 6mp and prednisone until dr weaned me..so yes the hospital can help....i had bleading and extreme pain so listen to your body.....

It's going to the Emergency Room that I advise against, not being admitted to the hospital (through your GI).

But, again, trust your instincts.

 

Posted 5/8/2009 12:51 AM (GMT -5)
I go to the emergency room when I don't know what's wrong, medical clinics are closed, I'm not well enough to get out of bed, and I can't wait until morning. E.g. pneumonia, severely anemic, giving birth, high fever.

I go to the clinic when I need to see a doctor ASAP but I'm still able to walk or wait until morning. E.g. most infections.

I make an appointment to see my doctor for checkups.
Posted 5/8/2009 8:14 AM (GMT -5)

I wouldn't go to the ER unless I was losing a ton of blood and running to the toilet every 10 minutes. That's just me though. What kind of pain are you having? Cramping?

I agree with some of the other posters, maybe it is not from UC pain and you need to get checked out? It could probably be a lot of things.

Posted 5/8/2009 3:32 PM (GMT -5)
     I've only been hospitalized twice for UC.  The first time was when I was first diagnosed over ten years ago.  The symptoms were: bloody diarrhea (in excess of ten times per day), loss of 15 lbs in one month, couldn't hold any food in...pooped it all out, and temp of 102.  I had my husband take me to the ER at 2 am.  I was hospitalized and on IV feed only for eight days.  That is when they performed the colonoscopy and found out I had UC.  The next time I had to be hospitalized was last year.  Basically the same symptoms but blood pressure was 210/110 and my meds just wouldn't bring it down.  Last year I spent ten days in hospital.  Now in remission....since Nov 1st and loving and enjoying each day the good Lord gives me.

     I would suggest if your symptoms are extreme and the meds just are not doing the trick to go to the hospital.  You may have to have complete colon rest as I did.  I was fed through a pic line last year too.

Posted 5/8/2009 10:52 PM (GMT -5)
I have travelled with my 17 year old son twice to the emergency in the last 1.5 years. We are fortunate that the clinic, in which he sees his regular doctors, is in the same hospital. Both times that we have gone to emerg ( on the weekends) we have first spoken, on the phone, with the "GI fellow on call" and he/she has been able to look up my son's complete history and then been able to tell us to come into emerg where he/she has met us and admitted us immediately (if necessary...one time was necessary the other was not). Compared to what some you describe, this is a really great set up....no waiting around for hours and then seeing someone who knows nothing about your condition.

As others have said, I agree that you should follow your "gut" feeling. If you think you need to be seen then you should be at the hospital.
Posted 5/9/2009 10:32 AM (GMT -5)
It is so comforting to see so many others with the same problems. In the past few days I have gotten better with the prednisone. I have decided that if the severity lasts for more than a day or two next time, I am going to the ER for some of the good IV stuff! Thanks for everyone's imput. This will be a lifetime of trial and error!
Posted 5/9/2009 4:27 PM (GMT -5)
You can get an IV if you need it at the doctor's office, you don't need to go to the emergency room (and should not, if it is not an emergency) or be admitted into the hospital.
Posted 5/9/2009 5:02 PM (GMT -5)
I was sent to the ER by my GI when I had severe abdominal cramps, dehydration and a fever of 102. I spent 2 days there and it was a HUGE improvement for me. The IV fluids, potassium, and IV steroids. A few weeks later I landed in the hospital again (sent by my primary care doctor) and after 6 days there I am finally in remission. I do think there is a time to go to the hospital. They know that sometimes you need the IVs.
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