Passing along some information to you all

[Guest guest]

To all,

I didn't report back on our visit to Dr. Kaplan at New England Medical Center in

Boston several weeks ago. It was a one time, second opinion type vist. Our

hometown gastro said he was " world renouned " and was surprized we got an

appointment. I really didn't care for the aura of NEMC compared to all the

other great Boston hospitals we visited in our years in this area however. Dr

Kaplan was alright however and made a good impression. His renoun may come as a

result of his lectures and writing. He was telling us that he just gave a

lecture at Harvard Medical School that morning.

With regard to our concern that Imuran causes various types of cancer as spelled

out in several drug books we bought: He said he believes that the incidences of

cancer for imuran patients are no different than for patients not on imuran.

This was hard for us to believe, and we were not sure it was not just a " feel

good " visit, but Geri's point is good in that AIH is a definite trend of

deterioration, whereas imuran's possible cause of cancer is a long term maybe.

Anyhow, we agreed to start on imuran soon after this second opinion.

Our other concern was that our gastro did not use the weaning process that we

heard about on this website to bring my wife down from her initial high dose

more gradually. He said he saw nothing wrong with the decreased rate our doctor

used. He said he never had to use weaning except with one patient. My wife after

her initial hospitalization for bleeding varices had her AST and ALT brought

down at one point by bigger dosages to the lowest ever AST and ALT of 72 and 79,

but after the dosage reductions had them climb back up to the current 141 and

162. My wife thought our gastro dropped them too fast and that this could have

caused the spike up to the present levels. The initial dosage after the hospital

visit was 40 mg of pred daily to get the low results stated above. Then she was

(abruptly?) dropped to and had to alternate between 20 and 10 mg every other day

and one 10 mg tablet of Inderol daily. After that, the doctor dropped the

dosage (abruptly?) to 10 mg daily and simultaneously doubled the Inderol to

twice a day, the AST and ALT shot up to the 168 and 172 whereupon the doctor

upped the prednisone dosage to 15 mg per day and suggested if there was not a

turnaround he would introduce Imuran on a subsequent visit.

When the dosage had been alternating between 20 and 10 every other day, my wife

felt hyper every other day accordingly. Why couldn't he have just prescribed 15

daily instead of 20 alternating with 10?

Dr. Kaplan also said he was able to get about 80% of his patients completely off

prednisone and on to imuran. Some of the others he said he was not able to get

completely off the prednisone.

[Guest guest]

,

It is good news to hear some doctor say that Irmuran is not a big risk

for cancer. My doctor said the cancers were of a specific type and can

be looked for - but he didn't tell me what type.

Prednisone - my doctor dropped me from 60 to 40 mg then to 20, then 15

as I recall. When he got to the lower levels, he did the reduction from

10, 5, 2.5. I could feel some swelling in my throat when the reductions

to 5 and 2.5 occurred. They look at the reduction as a percentage so

going from 10 to 5 is a fifty percent reduction. The body normally

produces 7.5. One method is to alternate days from 10 to 5 so that the

body does not quit producing prednisone entirely. This year I was again

going off prednisone and reduced at 1 mg per month from 7.5. Now I will

be going to 2 mg tomorrow. I do take 100 mg of Imuran daily.

Schneider wrote:

> To all,I didn't report back on our visit to Dr. Kaplan at New England

> Medical Center in Boston several weeks ago. It was a one time, second

> opinion type vist. Our hometown gastro said he was " world renouned "

> and was surprized we got an appointment. I really didn't care for the

> aura of NEMC compared to all the other great Boston hospitals we

> visited in our years in this area however. Dr Kaplan was alright

> however and made a good impression. His renoun may come as a result

> of his lectures and writing. He was telling us that he just gave a

> lecture at Harvard Medical School that morning. With regard to our

> concern that Imuran causes various types of cancer as spelled out in

> several drug books we bought: He said he believes that the incidences

> of cancer for imuran patients are no different than for patients not

> on imuran. This was hard for us to believe, and we were not sure it

> was not just a " feel good " visit, but Geri's point is good in that AIH

> is a definite trend of deterioration, whereas imuran's possible cause

> of cancer is a long term maybe. Anyhow, we agreed to start on imuran

> soon after this second opinion. Our other concern was that our gastro

> did not use the weaning process that we heard about on this website to

> bring my wife down from her initial high dose more gradually. He said

> he saw nothing wrong with the decreased rate our doctor used. He said

> he never had to use weaning except with one patient. My wife after her

> initial hospitalization for bleeding varices had her AST and ALT

> brought down at one point by bigger dosages to the lowest ever AST and

> ALT of 72 and 79, but after the dosage reductions had them climb back

> up to the current 141 and 162. My wife thought our gastro dropped them

> too fast and that this could have caused the spike up to the present

> levels. The initial dosage after the hospital visit was 40 mg of pred

> daily to get the low results stated above. Then she was (abruptly?)

> dropped to and had to alternate between 20 and 10 mg every other day

> and one 10 mg tablet of Inderol daily. After that, the doctor dropped

> the dosage (abruptly?) to 10 mg daily and simultaneously doubled the

> Inderol to twice a day, the AST and ALT shot up to the 168 and 172

> whereupon the doctor upped the prednisone dosage to 15 mg per day and

> suggested if there was not a turnaround he would introduce Imuran on a

> subsequent visit. When the dosage had been alternating between 20 and

> 10 every other day, my wife felt hyper every other day accordingly.

> Why couldn't he have just prescribed 15 daily instead of 20

> alternating with 10? Dr. Kaplan also said he was able to get about 80%

> of his patients completely off prednisone and on to imuran. Some of

> the others he said he was not able to get completely off the

> prednisone.