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Mesalamine (Rowasa), heart rate, and performance
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So....about 6 weeks ago, I got diagnosed with a mild version of ulcerative colitis based on a colonoscopy+biopsy analysis. My GI doctor put me on Rowasa - the topical version of mesalamine - and I've been administering that every night.

I noted a lot of positive things after starting the Rowasa - my Raynauds attacks vanished and so did a lingering bit of hip pain. And of course, the GI issues improved.

But....I've also note that my heart rate seems to have increased all around - a bit higher when I'm sleeping, higher for the same effort in yoga, pool-running, swimming, running. I also just feel warmer all around and less heat tolerant. And I also feel like my peak performance has decreased a bit - no longer hitting quite the same speed for the same effort. It's a bit surprising to see what appears to be a systemic effect from a locally applied medication.

I'm going to mention all of this to the GI doctor at my next visit - but I'm not sure he will have much insight, since what I'm noting is small, subtle, and really goes more to performance than to health.

So...I thought I'd post this here as well, since I know there are quite a few athletes with IBD of some sort on these boards. Any one have any insight or similar experience with Rowasa?
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Re: Mesalamine (Rowasa), heart rate, and performance [darkwave] [ In reply to ]
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I started taking mesalamine after being diagnosed with a form of UC in 2016. Its hard to say if the condition itself has caused performance decline or the medication, or both. For me though I definitely noticed a drop off in my running around the time my issues started. I'm also not as heat tolerant anymore. Dehydration can be an issue with the medication as well. I havent noticed the HR issue though, maybe only during major flareups.

For me the biggest link has been with sleep. I've noticed that I go through sleepless at the start of flareups and its hard to know which is causing which. Is it lack of sleep contributing or the other way around? Either way, the condition sucks and has definitely made my athletic life a lot harder. Its been a tough adjustment that i simply cant go as hard for as long as used to, since stress, both and physically and emotionally contribute to the condition. Diet has also become even more of an issue as the fibrous foods and protein sources that are mostly considered 'healthy' and were the cornerstone of my diet can also contribute to irritation of the condition.
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Re: Mesalamine (Rowasa), heart rate, and performance [TPerkin2000] [ In reply to ]
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Thanks - really helpful.

My experience is a bit different, in that there was a substantial gap between when I first became symptomatic nearly a decade ago, and when I started the mesalamine this year.

Essentially, I started having significant, essentially uncontrollable issues around 2007-08. Colonoscopy showed stuff consistent with "indeterminate colitis" - meaning "we know something's going on but we're not quite sure what." It took a lot of work, but I figured out a diet that basically controlled the symptoms AND allowed me to train and compete - the only issues were when I strayed from that diet. Or if I got scoped. I get several more flex-sig exams, but they never find anything determinative.

[if you're wondering - that diet is no gluten, lactose, nuts, or chickpeas/lentils/peas]

Fast forward to this year, and I accidentally eat something I shouldn't, which triggers several weeks of issues culminating in a March half-marathon that goes spectacularly and embarrassingly poorly. That performance earns me another colonoscopy in May.

Between March and May, sticking carefully to my diet, I get stuff back under control and set a major 10 mile PR. A few days after that PR, I go in for another colonoscopy, which finds ulcers. After the colonoscopy, I feel drained and have some mild symptoms again. 10 days later, the pathology has confirmed Ulcerative Colitis, and I start the Rowasa. The drained sensation and mild symptoms vanish within 36 hours after starting the Rowasa, and I note the other benefits I listed above.

But.. I also noted the very mild performance/heat perception issues. Which could be caused by other things - training errors, warming temperatures, but sure do seem to be correlated with starting the med, and not with the UC itself.
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Re: Mesalamine (Rowasa), heart rate, and performance [darkwave] [ In reply to ]
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as a longtime user of Mesalamine (different delivery type), I can't speak of any negative side effects. Given its intent/formulation (addressing gut inflammation at the site vs. via the bloodstream), i dont really see how it would affect much else, but definitely worth bringing up. Best of luck - These things can be tough to figure out!
Last edited by: dmagic17: Jun 28, 19 14:19
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Re: Mesalamine (Rowasa), heart rate, and performance [darkwave] [ In reply to ]
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I’ve been taking a small dose of oral mesalamine for 5 years, which has kept me in remission from my initial flare up of mild crohns disease when I was 18 years old. I wasn’t doing triathlon then, but I was a marathon runner before the flare up, and took a couple years off running to get healthy again. I don’t believe that mesalamine has any negative impacts on my athletic performance, although I can tell you that it’s intended effects (I.e. getting me back to a healthy weight, allowing my body to absorb nutrients properly) have greatly benefitted my performance. It is possible that your body may still be out of whack from the colonoscopy, but the mesalamine is masking some of the lingering effects. I know that when I had one, it took me a long time to feel normal again.
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Re: Mesalamine (Rowasa), heart rate, and performance [bullmoose] [ In reply to ]
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Thanks to all for your insight - much appreciated. Everything I've read about mesalamine indicates that it's a fairly well-tolerated drug, especially if taken topically. I do have asthma, and had some concerns about the mesalamine affecting that, but no issues there.

As noted, it's always hard to determine what is caused by the disease versus what is caused by the medication versus what is just a random fluke (or may not exist at all).

Bullmoose - in your experience, how long does it generally take you to recover from a colonoscopy? Mine was just about 8 weeks ago now, so it's interesting to me that I might still be experiencing some effects.
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Re: Mesalamine (Rowasa), heart rate, and performance [darkwave] [ In reply to ]
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So I’ve only had the one, 5ish years ago, but iirc I didn’t feel ‘right’ for a couple of months after. Granted, I had just experienced a big flare up which caused a lot of unwanted weight loss and severe anemia, so I didn’t exactly feel good before the procedure either. That’s another thing - has your condition caused nutrient absorbtion issues that could lead to iron deficient anemia? That could also be a contributing factor. You are right though, it can be hard to parse out whether what you are experiencing is a result of your diesease, the colonoscopy, or the medication.
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Re: Mesalamine (Rowasa), heart rate, and performance [bullmoose] [ In reply to ]
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I definitely have a history of nutrient issues - need 9 gels to get through a marathon (and I'm a sub-3 marathoner, so I'm not out there forever). I have always had to consume massive, almost comical amounts of salt. I've never been anemic, though. Low ferritin at times, but not recently (including last bloodwork 5 weeks ago).

One thing that did occur to me is that I've more or less figured out the proper electrolyte consumption for someone with a large intestine that doesn't work very well. So...perhaps now that the large intestine is working better, my electolyte consumption no longer works and I need to rethink things.
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