Stopping Imuran and gastroenterologist appointment

Back in September 2016, my gastroenterologist called me and had me decrease my Imuran dosage because my lymphocyte count was low, so instead of taking two pills a day, I would starting taking only one. I have bloodwork done every three months so that my doctor can keep an eye on how my body is reacting to the medication. After my next bloodwork results came back, she called again and told me my lymphocyte count was still low. I hadn’t experienced any negative side effects after decreasing the Imuran, so she told me stop taking the Imuran completely. At that point, I had been taking Imuran every day for almost four and half years, and Imuran is the only drug I was taking for my Crohn’s. I didn’t need to taper off at all, and I didn’t notice any side effects after stopping the Imuran.

Stopping the Imuran was actually really nice. I can’t swallow pills, so every morning, I would need to crush up the Imuran and mix it with juice, and the whole procedure just takes a very long time. It was so nice not having to go through this routine every morning any more. Especially nice was going on vacation and not having to bring a bottle of juice with me and my pill crusher and my pill glass and my stir stick and worrying about is it okay to take the Imuran in the hotel and then have breakfast at a restaurant since I’m supposed to take the Imuran with food.

I’ve been keeping an eye on my online bloodwork results, and my lymphocyte count has been slowly climbing. It was 0.4 in November, when my doctor had me stop taking the Imuran, and in my last test in May, it had gone up to 0.7.

I had an appointment with my gastroenterologist today. She asked how I was doing, and I said good, and I told her haven’t had any side effects since coming off the Imuran. She noted that my lymphocyte count is rising, and by now, the Imuran would be out of my system. She said they usually look for the lymphocyte count to be around 1.2 or 1.5, and it could be that I just have a low baseline lymphocyte count. She looked at my old bloodwork results back from before I started on medication, and my lymphocyte count was around 1.1 then, so it seems that normal for me is a bit on the low side. She explained that lymphocytes are very important and help fight off disease, and if your lymphocyte count is very low, it can be very bad, and she mentioned sepsis. The problem was that the Imuran was working too well, so that’s why she wanted me to stop taking it.

She told me she wanted to have me in for a colonoscopy. My last colonoscopy was in 2012, so I’m not sure if she wanted me to have one because it’s been five years or because I was coming off the Imuran. I’m usually a little nervous going to my gastro doctor thinking she might send me for a colonoscopy, but it had been so long since my last one, and I’ve been doing fine, so I’d been kind of lulled into a false sense of security, and the thought hadn’t even crossed my mind today. She gave me a pamphlet and started explaining the prep. I asked if it was with Pico-Salax, and she said no, it was with Peglyte. I don’t remember what she asked then or what I said, but I mentioned I’d done Klean-Prep before, and it didn’t go well, so she quickly got me a new pamphlet for the Pico-Salax prep. She asked what it was I didn’t like about the Klean-Prep, and I said it was the amount — it was a lot to drink. I’m very glad I asked to change the prep; it wasn’t any problem at all. From the pamphlet, it sounds like the same routine as last time.

She said depending on the results of the colonoscopy, they might put me on Entocort, which I had taken previously but I had forgotton that at the time. She said it seems like I’m in remission, but I guess they’ll know for sure when they do the colonoscopy. She also asked about any other medications I was taking, and I said just the vitamin D, since my rheumatologist said I got enough calcium from my diet. She read something in my file that said I have a low risk of fracture.

The doctor gave me the prescription for the Pico-Salax and Dulcolax, some papers to book the colonoscopy and a follow-up in six months (although she would contact me sooner if they find anything from the colonoscopy), and a new bloodwork form since my old form had expired.

When I went to book the colonoscopy, the receptionist gave me a date in about two weeks, and asked if it would work. You need to do the prep the day before, and you need to have someone drive you home after the procedure, and you aren’t allowed to exert yourself, so no mowing the lawn or anything like that. I checked my calendar and saw I had a dentist appointment booked to get a filling the next day, so I asked if that was okay, which seems like a dumb question, but I know there are sometimes weird medical and dental things that conflict. She said she’d had people ask about that before, and it was probably fine, but she asked if I wanted the next week instead, so I said sure.