Lynn wrote:Should I try the pep to protocol? Or begin the Entocort?
I guess I'm reluctant to take yet again another prescription.
That's a tough question, because based on efficacy trials, they are about equally effective for controlling the symptoms of MC. The problem is that some of us cannot tolerate Pepto-Bismol (bismuth subsalicylate), and some of us cannot tolerate budesonide (Entocort EC), and there is really no way to predict ahead of time how we might respond.
One possible clue is salicylates. Someone who is sensitive to NSAIDs, will probably react adversely to any mesalamine-based drug (such as Asacol), because of the fact that they are all derived from salicylic acid. That implies that there may also be an increased probability that they will react adversely to bismuth subsalicylate, as well. There isn't necessarily a 100% correlation, but clearly there is an associated increased risk of an adverse reaction and/or efficacy failure.
Entocort EC will not assist healing, per se (because corticosteroids actually retard healing), but if it is effective for you, then it will help to control your symptoms by reducing the inflammation level, so that you don't have to deal with all those symptoms while you are waiting for the diet to changes to take over to prevent future inflammation from developing.
So in reality, the Entocort will just control the D (and other symptoms), by temporarily masking your symptoms. The actual healing will be done by the diet changes, because they will prevent the inflammation from developing in the first place. IOW, the diet changes will address the cause of the problem, while the Entocort will treat the symptoms.
That said, if Entocort works for you, it can make life much easier for you during the early months before the diet changes have had time to bring substantial improvement. It can mean the difference between being able to get out and go to work without extreme fatigue and without fear of having an embarrassing accident, or being a virtual prisoner in your own home.
Of course, if the Pepto treatment works for you, then it can do the same thing, so the choice really boils down to personal preferences (and whether or not either treatment is personally effective). Both treatments have about the same average time to begin showing substantial benefits — roughly 2 weeks, but some people see improvement in a few days, while others take longer (for either treatment).
If I were in your shoes, I would take my choice and begin trying it, and if it doesn't seem to be helping after a couple of weeks, I would consider trying the other treatment. There is no obvious medical reason why both treatments cannot be used concurrently, but the problem with that approach is that if you happen to have a reaction against one, the other will not be able to control your symptoms, and you probably won't be able to figure out which one is causing the problem.
Good luck with this, whichever treatment you choose to try, and please keep us posted.
Tex
