When is it time for a Resection?

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Doc2007
Regular Member


Date Joined Oct 2007
Total Posts : 294
   Posted 10/19/2007 9:12 AM (GMT -7)   
I have had Crohns since 14 Im in my late 20's now...my Crohns has always been mild with 3 really bad Flares in the 14 yrs I have had the disease. I usually have very long periods of remission a year or longer at a time. Living a normal life is something I am very much acustomed to. This past summer I have had 3 flares with the latest on starting two weeks ago. The first two I treated with Entocort, and Flagyl I take Asacol for Maintnance. The first two flares lasted all of 3 or 4 days. The one I am having now has been going on for two weeks. I am a bit nervouse that my days of long remission periods and normalcy are over. Does Crohns progress over the years and get worse for people? Is my body rejecting the regimine I have used for years? Should I start considering a resection since the disease is in the last s to 7 inches of my Colon?
 
Any feed back would be helpful....

CP64
Regular Member


Date Joined May 2007
Total Posts : 69
   Posted 10/19/2007 9:20 AM (GMT -7)   
Resection to me is your last resort!!  I have had my crohn's for 23 years having a colostomy done 11 years ago.  At that time, I had no choice - the rectum had to come out!!  Sounds to me you just need to try a new medication.  Talk to your doctor about different treatments!!

JudyK89
Veteran Member


Date Joined Dec 2006
Total Posts : 1986
   Posted 10/19/2007 9:31 AM (GMT -7)   
First off, you're only on the first tier drugs so far. You still have lots of medications that you can still try to control your disease. If you're experiencing progressively worse flares, it may be time to upgrade your medication.

You don't mention that you've tried the immunosuppresants like 6MP or Imuran along with other drugs. Then you still have the biologics Remicade and Humira. There's new drugs in the pipeline also that could be approved soon.

Surgery for Crohn's disease is usually reserved for when nothing else works, or for complications such as abscesses or fistular disease or obstructions that won't resolve. Most surgeons won't perform the surgery unless you've tried all  other treatment avenues (medications) if it's not an emergency.

I don't know if CD progresses over the years, mine started out severe and every flare has been severe ending up in surgery because the drugs haven't worked for one reason or another. There are many people that have never needed to have surgery and have stayed on the first tier meds all their lives. Then there are the people in between, some with surgeries, some on the higher tiered drugs.

For this flare, your doctor may have to bump you up to Prednisone as it can be given in higher doses which may get you over the acute stage. If not, there's many other meds you can try.

Read some of the posts, but don't let them frighten you. Everyone's disease is different and everyone reacts to the treatments differently. Try to educate yourself so that you can work along with your doctor to find the treatment that works best for you whatever that may be.


Judy
49 years old, CD since I was a child.    
Six resection surgeries, permanent ostomy, adverse reactions to Remicade finally off of Prednisone, back on 6MP for maintenance, hoping for a long remission from this last surgery. 
 
 


auntkay
Veteran Member


Date Joined Apr 2004
Total Posts : 1199
   Posted 10/19/2007 9:31 AM (GMT -7)   
I'd have to agree with cp64 you may just need a med change. Welcome to healing well you'll find alot of caring people here and great info too.Wishing you the best!




Kay

Doc2007
Regular Member


Date Joined Oct 2007
Total Posts : 294
   Posted 10/19/2007 9:36 AM (GMT -7)   
Thank you all so much for your comments. To be honest the immunosuppresents scare the crap out of me and the biologicals seem so extreme. Basically I am scared about the quality of my life changing for the worse. I also know that the perscriptions for the next teir are more expensive as well. Even Entocort cost me an $80 copay!!! I cant imgaing Remicade or Humira......

Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 10/19/2007 9:53 AM (GMT -7)   
I have had Crohns for over 30 years. My first two flares lasted approx 3 mos each and were controlled at that time with Prednisone and Pentasa. Then I enjoyed a 20 year remission. I had one small flare that lasted about a month in 1999 and it was once was controlled by the same meds. I had no further problems until one day in early 2002 I had horrible stomach pains that drove me to the ER, ended up having the first of my two resections.

I tell you this to help you understand that I too enjoyed mild Crohns most of my life that were always controlled easily with the basic meds. I really think you need to try some of the other meds available such as Imuran or 6mp. You will have to start with your typical meds to control this flare, but will need to add one of the meds above to help kick you back into remission. There are many meds you should try before you even think about surgery. As CP64 said surgery should always be your last resort. Since having my two resections I have had more extraintestinal problems with my Crohns because of the surgeries. I have to really watch what I eat now more than I ever had to before. The Crohns is in remission, but because of the surgeries life isn't as good as before. Talk to your GI and see what he/she says. Good Luck!
Been living with Crohn's Disease for 32 years.  Currently on Asacol, Prilosec 60 mg, Estrace, Prinivil, Diltiazem, Percoset prn for pain and Calcium.  Resections in 2002 and 2005.  Recently diagnosed with Fibromyalgia and doing tests to see if I have Inflammatory Arthritis or AS.


ozonehole
Veteran Member


Date Joined Dec 2006
Total Posts : 559
   Posted 10/19/2007 3:40 PM (GMT -7)   
I've had three resections. The first two went smoothly, but the last one took a long time for recovery. I believe that I'd be dead now had it not been for these surgeries. There is the likelihood that you'll need one or more resections during your lifetime, but you're still at a young age so don't rush into them. However, if you're almost always sick with frequent obstructions (resulting in trips to the ER), then you might want to consider a resection. Remember that a resection is not a panacea - you'll still need to watch your diet, take some medication, exercise, and try to avoid stress.
Crohn's since 1988
3 resections


ATM
New Member


Date Joined Jun 2003
Total Posts : 7
   Posted 11/1/2007 2:27 PM (GMT -7)   
If your disease is limited to one area of your intestines and has not changed since your diagnosis I'd say go for the resection. My disease was limited terminal ilium and did not involve the large intestine. After 11 years on low dose steroids (12mg every other day is the lowest dose I could get down to) I eventually developed an abscess and ended up having surgery. Best thing that has happened as I've been in remission since with no symptoms for 4.5 years now. My father who is a physician was an immense help as he advised me on my disease and knew which GI docs to see in town. He even came into the hospital when I had a fever of 104 for 24 hours and gave me IV methelprednisolone to bring down the fever (surgeon was adamant about not giving steroids to bring down the fever even though there was no evidence of infection and the symptoms were consistent with me getting off steroids in the past). Find a GI doc who understands your condition and is willing to listen to you and work with you on the course of your disease. Too many just look at you blood count and chemistries and never listen you what you have to say. Best of luck.

Mormor Vicky
Veteran Member


Date Joined Mar 2007
Total Posts : 684
   Posted 11/1/2007 3:40 PM (GMT -7)   
I think I'm the exception to the rule. I too only had Crohn's in my last part of my colon but didn't know it. Until I developed a fistula to my bladder. I had to have surgery to repair it. My surgeon, not knowing I had Crohn's even though I told him about my daughter, decided to removed all the diseased part of my colon. That is when they discovered Crohn's. He thought it might be diverticulitis. So far, so good. I lost about half of my colon. I still have problems and still have to watch what I eat but I do feel better then I have in years. It's only been a little over a year.
Vicky / 47 years old
DX'd with Crohn's during a resection August 2006
DX'd with Steriod induced Diabetes November 2006
Considered in Clinical remission but have minor signs of disease activity
 
Daughter (26) also has Crohn's since she was 12.
 
Currently on 4000mg of Pentasa only for Crohn's
No longer able to take 6-MP because of Bone-Marrow Suppression
Cymbalta, Metformin, Lipitor

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