When is it time for a Resection?

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....

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. 

 

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......

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

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