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Diagnosed in later life

I was 69 when I was diagnosed with Crohns. I had had some abdominal discomfort mostly right lower area for 3 years prior. I attributed it to gall bladder disease since an ultrasound at the time reported a solitary large stone. The winter of 2012 I had maybe 4 or so episodes of fairly significant pain that would last around 15-30 minutes. Again I thought of gall bladder and saw a surgeon about it. He wasn't impressed with the ultrasound and decided to follow it and defer surgery for the time being. In August of 2013 I arrose one morning with extreme unrelenting abdominal pain. I knew this was different as it was more severe and now centrally located in my abdomin. I had my wife drive me to the hospital as I suspected a bowel obstruction. It turned out to be just that which resulted in a right hemi-colectomy and a diagnosis of Crohns. 18 inches of my colon and part of the small intestine were removed. I was shocked with the diagnosis as it is not at all common to be diagnosed at such an advanced age. My GI encouraged me strongly to begin a therapy consisting of Humira or Entyvio. I declined that idea and went 5 years with no treatment, and no symtoms other than frequent diarrhea but no cramping or urgency. It was 2018 when my new internal medicine doctor said, "the first symtom you had of crohns was a bowel obstruction and surgery. The next symptom you have may be another surgery and you are now 73. It may kill you". So I began Humira. The treatment lasted about 6 months when I was diagnosed with prostate cancer which resulted in my GI stopping the Humira. Subsequently I restarted Humira about 8 months ago. After a sub theraputic level of Humira was discovered I was placed on weekly injections. I've always felt that the side effects of the drug were not worth the risk. I feel that doubling the dose will double the risk of side effects. I am now considering Entyvio which of course has it's own vial side effects. I don't know what to do at this point. Other factors are, I'm on lifetime Xarelto for A-fib and have had 2 MOHS surgeries for skin cancer as well as prostate cancer as yet not treated.
 

Lady Organic

Moderator
Staff member
Hi, considering the severity of the main CD episode you got, I agree too that it is safer to be on a treatment. You are indeed in a delicate situation on choosing about doubling the current Humira or going on Entyvio, with the cancers going on.
Regarding possible side effects, Entyvio is known to have overall better safety profile than Humira. I found an interesting article that mentions even its specific advantages for older patients :
''BF Serious infection is a significant issue with IBD patients depending upon the age of the patient. Most patients with IBD are young, and young people treated with, for example, TNF blockers are at a fairly low risk of serious infection. However, older IBD patients are at increased risk of serious infections, such as pneumonia and herpes zoster. Vedolizumab itself is not associated with an increased risk of serious infections, so it is advantageous in older patients.''

The article is quite interesting.
However, I read in your profile that you main episode of CD involved a part of the small intestine. You would just have to make sure with your GI or maybe other members could comment on efficacy of Entivyo on small bowel or ileum. If Entyvio really can cover these parts as well, i think this could be an interesting option for you.
 

my little penguin

Moderator
Staff member
Stelara and Entyvio both have very lower risk of infection
Entivyio handles the colon but not the small intestine
Stelara is more for the small intestine
Both are very slow acting taking on average 8 months to start working for Stelara and up to a year for entyvio

Good luck
 
Location
San Diego
I was diagnosed at age 60, although I'm pretty sure I had it for more than 10 years prior to that. Like you I also have A-Fib. I'm on Eliquis for the A-fib and I've been on Stelara for 3 years now for the Crohn's. So far so good. No side effectis from Stelara and no major bleeding episodes due to the combination of Eliquis plus Crohn's lesions. IMO the key to avoiding bleeding is keeping the Crohn's in remission.
 
Thank you all for your replies. I will be changing gastro doctor soon because of a move out of state. I am going to discuss getting off Humira to another medication. I too have read an article, maybe the same one, that encourages the use of Entyvio over Humira. Stelara is also an option. Intiially I never considered myself to have a "bad case" of crohns since I never had the symptoms that I read about from many others. The urgency, the severe cramping, having to take a change of clothes whenever you left the house were never a problem for me. Thanks again folks.
 
I have severe small bowel Crohn's and it usually presents as discomfort and blockages when active so not everybody with severe Crohn's presents with extreme urgency or cramping which I think is something GI's need to keep in mind. I am on Stelara and it is working well. All the best with the new GI!
 
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