Been on Azothiprine for 3-4 months, how do I know that it's working?

[superbloop]

Hello everyone, just thought I'd get your opinion seeing as I'm lacking some. Anyways I've been diagnosed with crohn's 3-4 months back and was put on azothiprineto treat it with predisone to reduce flare ups. I'm happy to say that I'm off predisone now but am still on azo and the predisone has been replaced with budessonide. I am only 18 but am so confused as my parents seem to have different opinions about what's best for me, I can't decide on my own what to do. My mother's sister knows a GI in Switzerland whom recommended that my doctor should've put me on remicade right away to treat my crohn's and then start living normally, however my current GI in Canada insists I try azo first to see if it works then go to remicade if needed. My father sides with our GI. I need your help everyone. What do you think I should do? Should I tell my GI I want to go to remicade (or go to another GI who will) or should I wait it out with the azo. (I'm 6'1 and 110 lbs by the way). My mom has the sense of urgency believing the remicade will help me gain back the weight but she isn't a doctor and is annoying me to no end about this. How am I supposed to think straight with her breathing down my back? I need your help. How do I know if azothiprine is working, I'm having soft bowel movements every second day but have yet to gain any weight, I'm slowly losing weight. Should I try remicade or is it more of a calorie issue with my diet. I'm at my wit's end

 

[MapleLeafGirl]

I don't think the Remicade will help you gain weight any quicker than aza. It is likely a calorie issue with your diet.

Aza takes at least three months to kick in so in reality it is just starting to work. I think you need to give it more time. My doctor has me on it as well but it is not fully doing the trick for me. So I was given the choice or remicade or surgery. I have chosen surgery - for a multitude of reasons (see JayJays post about surgery).

As to weight gain, there are many threads on here with tips and you might find a few of these helpful.

 

[DustyKat]

I will relate this to your other post. OK so you have 2 conflicting opinions here. Perhaps to help you decide and settle your parents seek the opinion of another GI and see which way he leans. Just a thought but it might clarify things for all of you.

Dusty

 

[superbloop]

Thank you everyone, I really appreciate your input, it should help with my decision.

 

[scifi-enthusiast]

After I was put on azo (imuran) in January I had another bad flare up that happened when I went down to 15 mg of pred, so I was put in the hospital in May which made me miss my college finals. My doctor said it was because the azo takes awhile to start working. So now I'm up on the pred once again, and now the doctor says that if I have another flare up when I get to 15 or 10mg of pred that he'll see about putting me on remicade or Humira.

So looks like you and I are in the same predicament. See how it works for you before making the leap to an injection or an I.V.

 

[Indy]

Imuran took 3 months to kick in...

Was on Prednisone, Sulfasalazine, Pentasa, Asacol and finally Imuran (Azothioprine). Additionally, I was on other pain meds (namely Panadeine F which has codeine) as well as Iron, Vitamin and Calcium supplements. Had severe lower abdominal pain, nausea, vomiting, severe diarrhea, an anal fissure, bleeding and severe joint pain. The latter affected my jaw leading to painful ear aches and the inability to open my mouth making eating difficult. The worst was the inflammed ankles (joints) which left me barely able to walk. Prednisone was effective initially but it was the Imuran that eventually sent the symptoms into remission. I did have two flare ups which took months to get under control. Currently, I'm supposed to take 50 mg Imuran every 2 days but I don't because I realised I could manage without it. I am always wary of a possible flare up though and I do get tired easily.

 

[dreamintwilight]

Well...I started out on Humira by itself and I ended up having to take it every week, as opposed to the every other week that is typical, on top of having Imuran (azathioprine). My point is...everyone is different. Some people do better on the anti-TNF medications like Humira and Remicade and some people do very well on azathioprine on its own.

GI doctors tend to have certain methodologies when it comes to prescribing medicines. Some use the top down approach, meaning they start you on the most powerful medications for your level of disease and taper it down to a maintenance dose as your condition improves. Others adopt the bottom up approach, where they start with some "weaker" medicines and add on as needed to control the disease. Sounds to me like your current GI has the bottom up approach and your mom's sister's GI uses the top down approach.

My doctor uses the top down approach, which is why I started with the Humira right away. There's no right or wrong with either of these approaches, but ultimately you have to be comfortable with how your doc decides to treat your disease. Unfortuantely, Crohn's is so unpredictable that it may take some trial and error regardless of which method your doctor uses. It also depends on how aggressive your doc thinks your Crohn's is on which medications they think you should start on. Perhaps your mother's sister's GI doesn't know all the details to your case, so it could be hard for them to provide an accurate opinion.

Don't get too caught up in what someone else thinks your doctor should be doing for you. Listen to your heart and pay attention to your body. If you start to feel symptoms come back or notice any change in bowel habits, then don't wait to call your doc.

Is there someone in your life, other than your parents, that you trust to take with you to the doctor that could provide an unbiased opinion? That may help you as you make decisions in the future and avoid any pressure from either parent

I agree with Dusty as well that a 2nd opinion couldn't hurt and could give you more perspective on your situation

It's always tough in the beginning. Lots of confusing information and medications and stuff to try and figure out. Feel free to keep asking questions and seeking advice and support from the boards!