Another Colonoscopy, Sutab, and Zofran Round

Recently on March 11th, 2025 I had a colonoscopy as a follow up from last year since I had had a polyp that my gastroenterologist found a little concerning. I have the same routine as last time with taking the Sutab along with a anti nausea medication Zofran (I got the generic) and everything seemed to go well. 

The directions for the bowel prep would have me take the tablets first at 6:00 PM the night before the procedure and then again at 1 A.M. (the morning of the colonoscopy). However I started taking the pills around for the first round 4:30 PM. One difference that I did compared to the previous time I did the bowel prep was to take more pills in a shorter. I took the pills I would space them out every five or 10 minutes. My procedure was scheduled for 7:00 AM the next morning and actually my father had a colonoscopy scheduled right after me at 7:30 A.M. 

I began to take the second round of pills at 9 PM and probably had my last bowel movement around close to midnight. 

In the past I have have had some issues with leakage in my underwear and went ahead and wore about 3 adult diapers for protection. Previously I had used Depends however I had noticed that they riped very easily so I switched to LivDry and they felt more comfortable. When I woke up the next morning I was shocked I didn't feel any leakage. My guess as to why this happened is recent I have been doing pelvic floor exercises and in trying to do that I may have improved my anal sphincter muscle as well. 

Overall the night before the colonoscopy I slept pretty well. I didn't have to get up in the middle of the night either. Again just a guess is because I started the bowel prep earlier than the last time I did it. 

The morning of the colonoscopy we got up a little before 5:00 A.M. and I took a hot shower which was very nice as it helped with some of the pain near my rear. My energy levels the morning of the colonoscopy were fairly good even though I may have only got 6 hours of sleep. We ended up getting to the medical facility a little bit before 7 A.M. and even though I had the first procedure of the morning the actual procedure time was scheduled for 8:00 AM. The nurse who was in my station was very nice and ran an IV to give me fluids and my favorite part is when they give you a hot blanket as you're sitting there waiting (if I could have only had milk and cookies I would been in heaven!). Luckily I brought a book to pass the time as it would be roughly an hour before I would actually go back. The last time I got my colonoscopy I was told to bring my glasses but this time I was able to wear my contacts 

The actual colonoscopy is fairly cold. The nurses move you into position on your side and then the anesthesiologist injects Propofol (350 mg) to be exact and you think you can continue to stay awake and then you feel a burn in your arm and then you are knocked out. 

My actual procedure was roughly 30 minutes and I felt pretty good after the colonoscopy and recall the gastroenterologist coming by and told me that everything looked good and we would have to wait and see in terms of how long my neck colonoscopy would be. My father had a colonoscopy right after me and the gastroenterologist had mentioned that his bowel prep wasn't as good as it could have been. My father didn't hydrate for the colonoscopy until it was time to do the bowel prep. In addition to this he also had white wine and coffee which of course will dehydrate you. Me on the other hand I insured I drank blue Pedialyte throughout the day (and day before) and enough water so I felt hydrated. I do believe that hydration is a very important key in terms of bouncing back after they colonoscopy. The gastroenterologist had mentioned that next time my father would need a more caustic bowel prep. When my father woke up from his colonoscopy he actually thought he was in his home but the nurse had to point out that he just had his colonoscopy (they gave him more sedatives since he moved around during his procedure).

After my dad was good to go we ventured to a local restaurant for some omelets, hash browns, and biscuits which were really good considering it had been most a day and a half since I had eaten. I think in hindsight though I probably ate too much leading up to the colonoscopy. For example the colonoscopy was scheduled on a Tuesday and I saw my parents on Sunday for dinner and we ended up having Tex-Mex food. Before the colonoscopy I was trying to eat a couple days worth of food. My weight after the colonoscopy of course declined and I was roughly 164 pounds which is lighter than usual. After we had breakfast we ended up going to a local coffee shop and getting flat whites for both me and my dad shared one with my mom as well. The rest of the day went pretty smoothly and I didn't have to take a nap or anything. The night of the colonoscopy I went to bed very early and slept for over a 9 and 1/2 hours and it was some very amazing sleep.

The colonoscopy overall was pretty smooth and I only had a 3mm polyp in my cecum (which ironically is the same size and location that my father had his polyp as well). The pathology report showed that everything looked good so I won't have to go back for another three years which is the same schedule my father is currently on. Overall beforehand I was a little bit nervous about the colonoscopy since it only had been one year since the last colonoscopy. I was worried that the colonoscopy would show something detrimental however everything looked very good and glad that my colon is in a good place and more important way that I continue to be in remissions with my Crohn's disease. 

Cramping Last Couple of Weeks

Overall my health is doing overall well. Recently I have noticed within the past couple of weeks I have had some cramping in my stomach (near the belly button). On October 19, 2024 I went out to dinner and had some burger sliders and a brownie sundae to celebrate passing a designation and had some loose bowel movements. What is odd is I felt the cramping the day of October 19 when I had my exam. I wasn't stressed about the exam or anything and was strange that my pain occurred at the same time. My sleep has been fairly decent, although maybe once a week I wake up in the middle night to take a hot shower and go back to bed. For me what usually keeps me up is looking at my cell phone (I think even though I wear protective blue light glasses) it can create issues with my sleep. A couple of days this week I had some exceptional sleep and slept for probably 9 hours. Even with the extended sleep I had some minor cramping but not super noticeable. What is interesting is I wrote a blog post almost 10 years to the day of cramping and a mini flare up here. 

As I write this I feel just a tinge in my stomach and really nothing really to complain too much about. My bowel movements are still solid and able to still eat well without any issues. After my bowel movements the cramping does go away. My weight this morning was 166 pounds (recently it got as high as 170 pounds). My nutritionist would like to see me get down to 162 pounds which is on the low end but I think is doable. 

My usual path will be to continue trying to get to sleep and not eat anything too heavy and should be fine. I am always grateful I am still in a good position and am grateful Humira is still working after 12+ years of being on it! My nephew who will be 3 soon is ready to go Trick-Or-Treating tomorrow night so we will have fun and I rarely eat candy on Halloween too. 

One Long Night, Weight Loss, and Flare

Last night was probably one of the roughest nights with Crohn's I had had in a long while. I was in and out of the bathroom almost a dozen different times. I actually went through a whole roll of toilet paper in one night. My bowel movements have all been close and I consistently have stomach cramping around my belly button. In the past couple of days if I recall when I last weighed myself on Wednesday I was 172 lbs. and now I am closer to 168 lbs. My appetite is also fairly low as I continue to have cramping in my stomach so I don't have the sensation of feeling hungry at all. Compared to flares I've had before they only last a couple of days and then they resolve themselves. This seems to be is there some type of infection or a major Crohn's flare. Last night my sleep also wasn't that great even though I went to bed around 10:00 PM I woke up at 2:00 AM, 6:00 AM, and then finally at 10:00 AM. I had more stomach pain when I woke up at 6 A.M. vs. 10 A.M. (the power of sleep!). To be proactive I had ordered some adult large Depends because I was worried about having some possible fecal incontinence overnight period look unfortunately they did not arrive yesterday as I had anticipated however they showed up this morning. I was lucky because last night I did not suffer from any type of fecal incontinence however I wore all layers of underwear and some sweat shorts. I don't have a fever poor am I stuffed up. I seriously wonder if this was all started when I had my allergy issues and then somehow that spiked my immune system to create some type of Crohn's flare. The only thing I remember was when I had Sudafed I had some stomach cramping however when I switched out the medication to Claritin and it seemed to do better in terms of my GI system. I haven't taken any antibiotics or other medications in the past couple of days. 

My overall energy levels are pretty low and I constantly feel fatigue and tired. Even getting up I feel a little lightheaded. My game plan for today since it's Saturday is to just rest, relax, and stay hydrated to the best of my ability. Also I will try to eat very light food OK then high stomach is quite upset. Although at the rate I'm going if I lose 1 LB per day in another week that will be underweight compared to where I should be.

I called my internist before even though it was the weekend and she mentioned to take electrolytes and stay hydrated. She will send my GI as message as well. This morning I have sent my GI a message as well to explain my symptoms as well. Hopefully between both of our messages I can see my GI earlier than the following Monday. I feel like I have seen this movie before and don't feel like I am at death's door just not feeling well. 

Allergies and Potential Crohn's Flare

The past week has been interesting health wise. First I had allergies for the past week were I was stuffed up and congested however never had a sore throat or fever at all. Previously three weeks before that I had some allergies as well but it lasted only for a couple of days. Within the past couple of days I am no longer stuffed up however have been really tired with fatigue. Yesterday was probably the worst day in terms of how tired I was (even though I slept 10 hours the night before-however I did wake up multiple times during the night. My last workout was Wednesday morning and I felt as if I was really dragging during the workout. 

Last night I probably slept a little over 9 hours and when I woke up was still tired even though I had a good night's rest. My stomach was also cramping and I had to go to the bathroom maybe half a dozen times and all the bowel movements was liquid, however there wasn't much cramping. Also the past couple of days I haven't been super hungry either. Last night I did have some baked ziti and fried cheese which could have potentially contributed to the mini flare this morning. My stomach seemed a little angry and ever I had my bowel movements seemed relieved. I decided to skip my usual flat white this morning since I was worried the caffeine may accelerate the diarrhea. 

As I write this my cramping seems to have gone away however I am still fatigued and tired (however my energy levels have improved from yesterday). When I get home from work I look forward to resting. My game plan is to take a hot bath, get some good sleep tonight (since tomorrow is Saturday and I don't have to be anywhere), have a light dinner, and stay hydrated (usually with water and Pedialyte). 

On Monday I have an appointment with my doctor who will do some blood work. As a back up plan I have an appointment with my GI the following Monday just in case things don't improve (given his next appointments aren't until June). Personally I feel as if this is a minor setback and backed on history I generally bounce back.  

Another Round of Subtab, Zofran, Colonoscopy, and Day of Relaxation

Recently on February 9, 2024 I had my most recent colonoscopy. Overall the report was good and I had a 10 millimeter polyp in my descending colon however all other areas were normal. This makes sense given I rarely have had issues with my Crohn's since my last colonoscopy which I discussed here. 

Just like the last time I had my colonoscopy I decided to use Sutab bowel prep. Overall, I have been happy with the Sutab bowel prep given the other bowel preps leave an awful taste in your mouth that you literally never forget! 

I started taking the Sutab pills around 4:30 P.M. (even though I was instructed to take them at 6 P.M). Before I took the Subtab pills I took one Zofran pill for any anti nausea possibilities.  My view is "hey as long as it gets through the system right?". There are two rounds for Sutab (one the day before) and the other round is the day of the procedure. Each round has 12 pills that you take with 4 16 ounces of water. 

Around 8 P.M. is when I started to feel the salt water storm in my stomach and was in the bathroom off and on for about a dozen times between 8:30-10:30 P.M. Since I had the second round early in the morning I decided to wake up at 12:45 A.M. (again recommended time was 2 A.M.) however since my appointment was at 7:30 A.M. I was well within the 8 hour window Sutab recommends. Before I took my second round of Sutab pills I took two Zofran pills which really helped me out and felt good after that. I was up for probably an hour and at that point consuming more water was a little more of a challenge but still fairly easy compared to the alternative. Overnight I probably went through two rolls of toilet paper and for protection had 3 layers of Depends underwear to protect any leakage (it did a fairly good job in protecting me) I actually slept fairly well given all this and woke up around 5 A.M. to get ready, shower, and hop into the car. The interesting thing is at the beginning of the night my rear hurt a little but throughout the night it didn't hurt as much as it had in the past. Taking that hot shower in the morning before the colonoscopy always feels amazing. 

My procedure started around 9 A.M. and I was out by 10 A.M. After the colonoscopy I went to a local diner for a CLT (cheese, lettuce, and tomato) sandwich with some fries that had seasoning on them! I opted not to have dessert just given the amount of calories. After lunch I got a flat white coffee and felt pretty decent. Compared to my last procedure I felt as if I wasn't as tired and not sure if that is because I started the process earlier, in better physical shape (since I have been working with a personal trainer), or more accustomed to waking up earlier (since I have some personal training sessions at 7 A.M. during the week (so usually am up 6 A.M.). Also my last colonoscopy was at 10 A.M. so the hunger pains truly set in and messes with the body. I remember after the last colonoscopy I slept for a couple of hours and was still tired and was sleepy for the next couple of days. 

This past weekend was pretty relaxing and I didn't do too much. On the night after I had the colonoscopy 7 P.M. felt like midnight! Overall for the weekend I felt I slept really well. On Saturday (one day after my colonoscopy) I was able to work out without any issues. I did notice some lose bowel movements which for me is pretty rare. My weight got down to 168 pounds (mostly due to the bowel prep and just losing water weight). My appetite was in full force and I had a burger on Saturday afternoon and Tex-Mex on Sunday so I am sure I have gained all the water weight back.

FDA Approves For Rinvoq for Crohn's Disease (My Take As A Patient)

Recently on May 18th, 2023 approved Rinvoq was finally approved for Crohn's disease. The study was published in the  New England Journal of Medicine and can be found here. In terms of clinical remission in one trial 39% of patients received clinical remission when taking the 45 milligram dosage. In the same trial 35% of patients achieved endoscopic response compared to a placebo response of only 4%. In a another trial 49% of patients received a clinical response and 46% of patients achieved in endoscopic response. For both studies this was the end point measured at week 12. Currently there are 8 drugs approved for Crohn's disease (this includes RINVOQ). 

One of the big differences with Rinvoq compared to other drugs is it is a one daily pill (as opposed to an injection or infusion like Humira or Remicade). As a patient I have mixed feelings about a daily pill (given you could easily miss one day as opposed to taking a Humira shot every two weeks). The one positive though is with Humira has to be refrigerator which can become dangerous if there is a power failure or outage and don't have a backup generator to keep the medicine cold. Rinvoq is not approved to be taken with another biologic therapy or other immunosuppressant. 

The FDA just last year approved for Skyrizki which I covered on my blog last June. This article here does a great job of showing the drug development pipeline for Crohn's disease. What is interesting is almost every drug that was approved before 2019 was approved for both ulcerative colitis and Crohn's disease. This would make sense given they are pretty similar diseases. Remicade was approved for Crohn's disease in 2003 and then approved for ulcerative colitis in 2006. The biggest delay was Humira which was approved for Crohn's in 2007 but not until 2012 for ulcerative colitis. A five year timeline is a long time for people who are truly suffering to wait. Personally I am more of a fan if the drug was approved for either Crohn's or ulcerative colitis for it to be tried by patients who suffer from both (given some top notch GI's speculated I had signs of ulcerative colitis) and would allow for much for flexibility. If you look at the history of Rinvoq being approved it was first approved for rheumatoid arthritis in August 2019, psoriatic arthritis in December 2021, and ulcerative colitis in March 2022.  I think what this would say to the average patient is if an autoimmune drug is approved for one diseases there is a decent chance it may be approved for another disease. 

One current issue is access to the drug. The list price for Rinvoq is $6,125/month, however AbbVie the drug maker has co-pay assistance cards that can bring the cost down to $5/month (usually there are financial qualifications for this). As a GI online tried to prescribe the drug on May 23, 2023 (only 5 days after the FDA approved the drug and Blue Cross Blue Shield denied the coverage. There are people who have stories online of their insurance company not approving it or the cost being extremely high. The issue is further worsened by the fact that when individuals switch health insurance plans by either selecting a different health insurance plan, switching employers, or switching health insurance plans through their spouse they are denied access which is a real shame for people who just want to feel better! 

I am glad to see the FDA approved Rinvoq as this will give Crohn's patients another drug to try if they have failed a biologic drug. I am also enthusiastic to see the future development of drugs for inflammatory bowel disease and what the next three to four years look like. Although, there are eight drugs currently approved for Crohn's disease by 2026 it appears there may even be more options than are currently available. Also hopefully this will reduce the need for patients to make frequent visits to their doctor (and potentially keep patients out of the hospital) if they are able to maintain remission for long periods of time. The main question though is will patients have access to this drug and more importantly be able to afford it. I am grateful that I live in a time period where there are so many options available if I ever have a severe flare up and need to try a different drug. It really probably is the best time if ever to have Crohn's or inflammatory bowel disease.

10 Year Anniversary of Humira for Crohn's and Still in Remission!

Time really does fly by! This month marks 10 years since I first started taking Humira (my first shot was June 6, 2012). I posted about the experience here, a 3 month post here, a 6 months post here, a 1 year anniversary post here, a 2 year anniversary here, a 5 year anniversary here, a review of Humira literature here . 

In the summer of 2012 (around May 2012) I can remember crashing pretty bad with a major flare up with Crohn's. I can still remember waking up in the middle of night (at 2 A.M.) with blunt sharp pain in my stomach, throwing up, and couldn't get out of bed. These days I live a very normal life without any gut pain and rarely have a loose bowel movement. 

At first I can remember being anxious and nervous about having to inject something into my body for the rest of my life/the possible pain of injecting medication. If I recall correctly the drug started working within days of me taking it. I recall going on YouTube and looking up videos of other people who had taken Humira and remember this one guy saying that he really wasn't in pain and could finally eat potato chips again without having to worry about pain (I didn't think this would happen to me). The only time my dosage changed for Humira was after I had a flare up of Crohn's (post c difficile and fecal transplant). Other than that though I have stayed at 40 mg injection every other week.  

One improvement I have seen within the past few year is the Humira citrus-free version. This new version seems to have resulted in less pain when injecting. Typically I leave my Humira out for 15-20 minutes. In this post I mentioned why I don't rotate my Humira shot (per instructions). 

In conclusion Humira has been a miracle drug for me and has worked quite well! Hindsight is always 20/20 and I was initially diagnosed with Crohn's in December 2011 (but I probably had Crohn's beginning in October 2020) I wished I had started Humira earlier! At the time I was in graduate school and my family and doctor agreed to stay on Prednisone and Asacol to get me through. Humira has forever changed my life for the better.