Abscess Question - Are TNF Blockers the Cause or Reaction?

[M30]

I've seen many members referencing Remicade & Humira as remedies to their abscesses and/or fistulas.

In my research, I was under the impression that these TNF blockers weaken the immune system and actually increase the risk of infection (which is why they explicitly say not to start biologics if you have an infection)

The biologics reduce the inflammation which I can see preventing new complications.. but how can it help rid an existing abscess?

Thanks

 

[Sailorluna]

I don't think they(biologicals) can help with abscess only the fistula. I had to treat my abscess with cipro/flagyl first. After they worked their magic I went on humira for the fistula. In fact if you get an infection while on it you may be told to stop taking it until the infection is gone.

 

[M30]

I don't think they(biologicals) can help with abscess only the fistula. I had to treat my abscess with cipro/flagyl first. After they worked their magic I went on humira for the fistula. In fact if you get an infection while on it you may be told to stop taking it until the infection is gone.

Thank you for the input and the last point you made is precisely the situation I face.

Was your flagyl intravenous or oral? And how long did it take to clear up the abscess? I have one pushing into my psoas muscle and probably a nerve as my entire upper-right quadran on my right thigh is numb to the touch.

The pain is excruciating and I'm not sure I can ride this out for more than a week. Two days ago I could barely put on my right sock, or lift my right let to put on trousers. Now I can barely lift it to take steps DOWN the stairs (I.e., the weight of my right leg pulling down is like death)

Ok, I am going to stop before I have a breakdown here. I'm at a loss for words with Crohn's.

 

[Sailorluna]

My antibiotics were oral and apologise for not being more clear. I should have said that they also drained the abscesses. I generally had a 10 day course of them and they kept things from spinning out of control. Sometimes they were enough on their own and sometimes I would end up having to have the abscess drained. After they scraped the abscess out they would immediately stop the antibiotics saying that they had removed the infection in the act of cleaning it out.

Have you been talking to a colorectal surgeon? Can they drain your abscess? Some people have success with just the antibiotics but if they are not helping you it really needs to be drained.

I was also told that if you have fevers or bad pain to go to the ER. It sounds to me like you should consider going in. When I went to the ER I just had to say that I had crohns and thought I had an abscess, I was in a room pretty quickly. At my hospital they take them seriously. Whatever you do, if you get drained be certain it is a colorectal surgeon and not a general surgeon.

 

[Tenacity]

M30 - I agree that you ought to go to the ER and not wait another week for some medical help. I think the sooner you get this taken care of, the better it will be for you. Can you soak a couple times a day in a very warm sitz bath? Is that possible? It would promote the abscess to open up and drain on its own. Otherwise, you should let them knock you out, and have them lance it.

Also, it sounds like it might be a good idea to get on some more meds for your crohns other than the Canasa. I would have them lance the abscess and after a course of antibiotics, put me on some biologic like Remicade. It really is not worth suffering like this.

I really hope you find some relief soon! Let us know you are doing.

 

[M30]

Here goes:

- Last Sunday, I went to the ER w/ pain
- The CT showed abscesses (perhaps one, perhaps more, was hard to make out for some reason)
- The abscess causing the pain was wedged into my psoas muscle..
- The options were:

1. surgery - Location is risky and the abscess was not well defined enough in the CT to warrant surgery just yet.
2. drain via catheter - Location is risky and the abscess was not well defined enough to justify what they described as an extremely painful process? (going into muscles etc?)
3. antibiotics - Bought them time and was the least intrusive

- Of course they chose antibiotics and after three days the pain began to go away.
- The day before being discharged they performed another CT and noted that the abscess had not improved, but was in fact more 'well-defined' now.

I have a follow-up in the AM with the surgeon because the pain is getting worse despite all the drugs I'm on. Again, my upper right quadrant of my thigh is numb to the touch which is worrisome..

How long will I be stuck in the hospital after It's drained?

 

[M30]

The other thing that perplexes me is.. most posts I read hear seem to refer to the abscesses as if they are visible, and externally accessible?

I've only seen mine on a CT and was caused likely by inflamation of the illium.

I did take an epsom salt bath tonight actually after reading that recommendation from other posts.. will it still be effective being that my abscesses are internal? Or is everyones abscesses internal and I'm just misunderstanding? Sorry.. don't forget I'm doped up

 

[Sailorluna]

I think that the ones closer to the skin are more common but you can certainly get them internally as with you. I don't know if the heat will reach it where yours is for a bath to help draw it out but it may make you feel better on its own, relaxing at least I hope.

How long you stay in the hospital after the draining can really vary. I have been let go same day and held for a few days. I am not sure how different the proceedure is when it is internal.

Good luck in the morning. let us know how it goes.

 

[M30]

Thanks so much, will keep you posted.

 

[Tenacity]

Ok so what u saying is the abscess is not just beneath the skin where hot baths would encourage it to rupture, but rather that it is deep inside? If that's the case, then the only treatment I can think of if the antibiotics have not resolved it, would be to surgically drain it.

Depending on the extent of the abscess and the depth, patients have been discharged the same day, and others have to stay for a few days.

I'm really sorry you are having to deal with this. I know how frustrating it is. The reason why I suggested thinking about going on a stronger med is because if we can take careof the underlying disease activity, it would help put an end to these abbesses.

Please let me know what happens tomorrow. I really hope they can take care of this for you.

 

[DustyKat]

If it is an intra-abdominal abscess then you will need to have antibiotics commenced as well as drainage performed.

My son had a psoas abscess that originated from the ileum and he needed to have a drain inserted via CT. It turned out he also had a fistula so for him the drain (percutaneous) stayed in for 3 months until surgery. If no fistula is invloved then the abscess is normally either drained and left at that or you may have the drain in for a few days and removed when the drainage slows to nil or near to it.

Dusty. xxx

 

[M30]

If it is an intra-abdominal abscess then you will need to have antibiotics commenced as well as drainage performed.

My son had a psoas abscess that originated from the ileum and he needed to have a drain inserted via CT. It turned out he also had a fistula so for him the drain (percutaneous) stayed in for 3 months until surgery. If no fistula is invloved then the abscess is normally either drained and left at that or you may have the drain in for a few days and removed when the drainage slows to nil or near to it.

Dusty. xxx

I just wanted to say thank you so much for the information you post.

Last night I stumbled on a post of yours containing the detailed timelines for both of your children's battle with Abscesses.

I ended up emailing it to my spouse and myself as it is a good reference for what to expect. I will put it below for anyone else.

Sarah:
had a right hemicolectomy 5 years ago and has been in remission since that time. Her surgery was an emergency, she was undiagnosed, and so was performed as an open procedure. This is an outline of her post op recovery...

Surgery day - She was in theatre for approx 4 hours. When she returned to recovery she had oxygen, two IV's, two drains, an NG tube and an IDC (urinary catheter). She was in ICU overnight. She asked to go back to the ward the next morning. I think the surgeon wanted her to stay another day but she couldn't get out fast enough! Oxygen therapy ceased.

Day 1 post op - Moved to the ward and spent the day on bedrest. IDC removed. NG tube on free drainage and morphine IV remained on PCA (patient controlled analgesia).

Day 2 post op - No change with drains and tubes. Physiotherapy commenced. Up out of bed and gentle ambulation commenced twice a day. Although Roo refused to use a pan so started walking to the toilet that day.
Started eating ice chips.

Day 3 post op - One IV removed and condensed IV morphine and fluids into one. NG tube removed. Increasing mobilisation. Ice chips.

Day 4 - Bowels open. Commenced on clear fluids. Mobilising.

Day 5 - Tolerated fluids from previous day and throughout this day so commenced on light diet at tea time. Both drains removed and IV removed. Oral analgesia and antibiotics commenced.

Day 6 - Discharged home.

I don't know if being paediatric made a difference but each day she was visted by the surgical team twice, the physiotherapist twice, the pain management team once and the dietician once.

Sarah was in very poor condition prior to surgery so I felt that she didn't truly recover for a number of months. I would say she was running on about 80% for the first few months and reached full recovery after about 6 months. She returned to school 3 weeks after the operation and has now been in remission for 5 1/2 years.

Over time she moved to a vegetarian diet and has now been vegan for about 18 months. The most recent change she has made to her diet is to cut out most sugar. She has stated that these changes to her diet have made given her a greater feeling of "wellness" and leaves her more energised.

Matt:
had a right hemicolectomy in April. It was planned surgery that was required due to an existing fistula and abscess. He had a pigtail drain in for 3 months prior to surgery.

Surgery day - He was in theatre for about 4 hours and recovery for 2 hours. When he arrived back on the ward he had one IV that consisted of the PCA (patient controlled analgaesia) and other IV fluids for hydration and IV medication. He also had one wound drain, a urinary catheter and oxygen.

Day 1 post op - No change with IV's or tubes and drains. Started mobilising and about an hour sitting in the chair.

Day 2 post op - Still no change with the tubes and lines. Commenced on clear fluids and continued with gentle mobilisation.

Day 3 post op - Urinary catheter removed, still on clear fluids, mobilising well.

Day 4 post op - PCA removed and started on oral analgaesia, remains on clear fluids, started farting, only one IV now left.

Day 5 post op - Last IV removed, commenced on free fluids, bowels open.

Day 6 post op - Commenced of light diet.

Day 7 post op - Commenced on full diet, drain out.

Day 8 post op - Discharged!

Matt had no issues post op and I feel that the start of week 4 post op was the real turn around in his recovery. It was at this point that he really started to move freely and shades of his old self started to appear. His recovery has been much quicker than Sarah's. He returned to school 3 weeks after surgery, was allowed to drive short distances after 3 weeks and long distances after 6 weeks but he was driving longer distances at 5 weeks. Started soccer training at about 5 weeks as well. He is also in remission.

The life savers in hospital for them were...TV, mobile phone, iPod, laptop with DVD's, ear plugs, comfortable loose fitting pyjamas/clothes, footwear that is easy to slip on an off, like slippers, magazines/books and short visits from friends when they were up to it.

They have both been on maintenance meds (Imuran) following surgery.

Thank you again!!

 

[Tenacity]

M30 - I was thinking about you today - how did it go with your follow up appointment?

 

[M30]

well.. i just finished having the catheter put in to drain.

have not seen anyone yet .. it went smoothly I do think

will post more the doc comesfoe

<3

 

[Sailorluna]

I am glad they are taking care of you, hope it helps quickly!

 

[M30]

I am glad they are taking care of you, hope it helps quickly!

Today I have refused pain killers and am up and walking reasonably good.

For those who don't know, here's how my experience went:

1) pain before catheter = 8, dealt with for two weeks (like a moron, don't think this is cool in any way, I am stupid and hard headed, period)
2) taken down to radiology to have catheter put in, entry point was the right side of my pelvis area, at the waistline.
3) was given minimal sedative and completely aware the enture time.
4) nothing hurt whatsoever, even the initial pricks were barely noticeable. I suspect this had a lot to do with the other pain in the area. All in all, a finger prick for blood hurt worse than anything that transpired the entire time (except for the pain I was experiencing before, which was prominent when getting from hospital bed to CT scan bed and back.)
5) when it was doen I was left w/ a green hose smaller than a straw coming from my abdomen/pelvis area with a white suction bag.
6) as it stands, the bag is filled with 100ML of gunk (blood, puss)
7) as part of the process, they checked for 'communication', which was the term used to refer to fluid being passed via fistula into other parts of the body from the abscess. To do this, after draining the abscess they inject dye through the catheter into the abscess, then run you through the CT to see if the dye is visible in the intestine or anywhere outside the abscess pocket.
8) that being said, It was said that have no fistula present.
9) another thing I found interesting was the flushing process of the bag. It has two valves. One available and one going to the bag. To flush, they attach a saline injection to the nozzle and pump saline back into your abscess. They then turn the nozzle and you can watch(and feel) the cold saline coming from your abdomen through the pump and into the bag. It's pretty weird but neat.

In summary, I felt terrible yesterday (worse than before) but today I feel better than I did when I came in so.. I will play it by ear. Stay tuned

 

[DustyKat]

Good to hear you are feeling better M30.

Any idea as to how long they think the drain will be in for?

Dusty. xxx

 

[M30]

Not 100% sure but I think there was mention of removing before being discharged. Will ask and let you know.

To tie this back in with my original post, i want to mention I started Cimzia injections 2 months ago. After 4 injections, this is where I stand.

I think the injections will be postponed due to infection risk. I was due for one abt 9 days ago.

I wonder what role if any, the biologics played in 1) me having abscesses, and 2) me not having fistulas.

Time will tell.

 

[M30]

Updates:
1) Came home Saturday (yesterday)
2) Drain is still in tact but very little activity if any
3) Drain will be removed tomorrow.
4) Feeling much better, in terms of right-leg movement

 

[Tenacity]

So glad to hear you are back home and wish you a speedy recovery

 

[tots]

I am so glad you are feeling better!!


Lauren

 

[sawdust]

Welcome home! Here's to a speedy recovery. :hang:

 

[M30]

Thank you so much everyone.

Catheter out today and feeling great for Christmas.

Couldn't ask for a better gift.

I wish you all the same and a prosperous new year!

 

[Tenacity]

That is such awesome news!!

Really great to see all that worry put behind you, and everything is looking good!!

Just goes to show sometimes we just need to go in and "bite the bullet" as they say.

Merry Xmas to you and your family too!

 

[M30]

I guess this will be my abscess update thread.

So - starting yesterday I could feel similar pains in the same area as before. I was hoping it was in a different spot however after a sleepless night last night and a long day's work, I sit in pain again, probably up to a 6 when not moving, 7 or 8 when, again, lifting my right leg.

Last night I stumbled on a research paper which found that following a secondary drainage, there is still about a 50% chance surgery will be required.

The way I see it is 50% chance of not needing surgery is great!

I suspect I will be getting this drained once more. Let's just see how bad it gets.