Dr recommends no meds? Need opinions..

Crohn's Disease Forum

Help Support Crohn's Disease Forum:

Joined
Oct 16, 2014
Messages
11
Dear people,

I was diagnosed in 2013 with crohn's disease. Now it's 2016 and I've had 2 periods of flare-ups.

I've tried the meds Imuran/aza, 6mp and thioguanine (which is basically what aza and 6mp are broken down too).
I always experienced severe hair loss, which even after 8 months didn't stop, folic acid/biotin didn't help either. It did help my crohns.

For the last two weeks I've tried methotrexate, but cannot tolerate it since I'm really nauseous for 4 days and then soon I've get to get my second injection.

So now my dr is recommending just not taking anything, and getting a stool test every four weeks.

Is it logical to take no meds?
And what would you do?

I'm feeling hopeless..
 
Hello,

How are you feeling at the moment? What sort of symptoms are you getting? Have they given you the levels of your most recent test results? When was your last colonoscopy?

I apologise for all the questions, I am just trying to figure out where exactly your doctor is coming from and how stable things are for you.

Personally, I would be reluctant of being without any medications at all, as Crohn's disease can resurface at any time, so I can understand how it could be daunting to be faced wit that prospect.

You say you have only been on the MTX for two weeks, often people find they have issues with nausea in the early days of this medication and with aza and 6mp too, but usually these side effects start to settle after about a month. Is there any chance they could just lower your dose for a little while so your body gets used to it rather than taking you off it completely? Also, I know where I am it's common to be given a folate acid supplement to take the day after the MTX injection, and this can help to make the side effects easier to deal with, have they offered you this to see if it makes any difference?

Personally I haven't taken MTX as my crohn's team didnt want me on it, but I did try aza and 6mp. Neither were suitable as my body was hypersensitive to them so they just made me more unwell.

The next option for me was a medication called infliximab which is a biologic. It's quite a step up, so they won't give it to you if there isn't active inflammation, but it may be worth discussing biologic treatments with your doctors to see if its something they are considering and what point they would offer them at.

If your test results are showing that you have active inflammation, then I think it would be unwise to stop treatments completely and personally would discuss either making the current options more tolerable or what the alternatives are. It may even be that you need to get a second opinion.

If your tests results are showing that you are currently in remission, then it is a slightly different prospect and an entirely personal choice. If it was me I think I would be weary as my Crohns does come back quickly when I'm not on preventative treatment, but if you had good monitoring then they would hopefully catch it early. I would say that if you go ahead and come off treatment, you must keep in contact with your team and I would make sure that they will act fast if you start to experience symptoms or your test results show signs of deterioration. In addition, I would directly ask them what they plan to do if/when the inflammation returns, i.e. what treatment would they start you on and why is that treatment not considered an option at the moment.

I hope this helps a little, its a very difficult position to be in, whatever you choose to do know that you can come here for support whenever you need it, you won't be judged and there is never a need to feel embarrassed as we are all in the same boat.
 
I'm guessing you must be in the UK for this line of thinking. Really, you need a colonoscopy to assess the health of your bowel. Crohn's can do silent permanent damage and being on no meds is generally not recommended, especially as you say yourself - you have experienced flares. There are other drugs that your doctor is not telling you about most likely due to their expense. And unfortunately in the UK the costs of meds are more important than your health (until you end up in complete crisis). These include remicade, humira, entyvio.
 
I second valleyangel's post - talk to your doc about biologics if you still have active disease. If you have had two flares, the chance of it spontaneously disappearing is pretty low. It's possible a small dose biologic will work wonders for you. Check it out - you don't want the disease to go unattended and I am not sure that a stool sample alone will do it. Active crohn's isn't diagnosed based on that.
 
Hello,

How are you feeling at the moment? What sort of symptoms are you getting? Have they given you the levels of your most recent test results? When was your last colonoscopy?
QUOTE]


Hi, thanks so much for your reply. :kiss:

Well, I had my MRI and stool test about 1,5 months ago.
It didn't show any active inflammation.

I did try the methotrexate at a lower dose, really low (10mg) along with an increased folic acid, which didn't help with the nauseous and full feeling. Besides only the 15mg dose did help give me a better stool.

In the past three years I did have a few flare ups. I can do a few months without medication, but even then I experience a loose stool every day, exhaustion, joint pains, burning sensation in the gut and can't eat properly.
With the Aza it was all well, except for the ongoing hair loss.

Well biologicals are really out of the question, since they don't prescribe it when you don't have active inflammation & they just find my type to be less severe to prescribe it. I live in Europe, and costs also play a huge role in doctors prescribing it and getting allowed by the insurance.
 
I'm guessing you must be in the UK for this line of thinking. Really, you need a colonoscopy to assess the health of your bowel. Crohn's can do silent permanent damage and being on no meds is generally not recommended, especially as you say yourself - you have experienced flares. There are other drugs that your doctor is not telling you about most likely due to their expense. And unfortunately in the UK the costs of meds are more important than your health (until you end up in complete crisis). These include remicade, humira, entyvio.

Yes, I'm in Europe (Holland).
the costs are a huge issue. But they also tell me that the side effects are worse and are not willing to prescribe it to my type of crohns just yet.
I have crohns in my small and large bowel, with no obstructions/fistulas and scar tissue. 'Just' a lot of ulcers and crp of around 1400 when I get a flare up.
 
I second valleyangel's post - talk to your doc about biologics if you still have active disease. If you have had two flares, the chance of it spontaneously disappearing is pretty low. It's possible a small dose biologic will work wonders for you. Check it out - you don't want the disease to go unattended and I am not sure that a stool sample alone will do it. Active crohn's isn't diagnosed based on that.

You can read my above posts .. like mentioned, biologicals are unfortunately out of the question....
 
Hello,

How are you feeling at the moment? What sort of symptoms are you getting? Have they given you the levels of your most recent test results? When was your last colonoscopy?
QUOTE]


Hi, thanks so much for your reply. :kiss:

Well, I had my MRI and stool test about 1,5 months ago.
It didn't show any active inflammation.

I did try the methotrexate at a lower dose, really low (10mg) along with an increased folic acid, which didn't help with the nauseous and full feeling. Besides only the 15mg dose did help give me a better stool.

In the past three years I did have a few flare ups. I can do a few months without medication, but even then I experience a loose stool every day, exhaustion, joint pains, burning sensation in the gut and can't eat properly.
With the Aza it was all well, except for the ongoing hair loss.

Well biologicals are really out of the question, since they don't prescribe it when you don't have active inflammation & they just find my type to be less severe to prescribe it. I live in Europe, and costs also play a huge role in doctors prescribing it and getting allowed by the insurance.

Sometimes MRIs will miss active inflammation, they have totally missed a flare twice in my case. Stool tests are usually more sensitive, but can miss low level inflammation, so aren't 100%.

From the symptoms you are describing, I would be really reluctant to say its a good idea to come totally off all medications, as its sounds as though there is something going on in the background.

Have they ever told you the actual results of the tests in numbers etc or do they tend to just tell you that they are "ok" as I've had one doctor tell me I was fine and then had another doctor tell me I'm in a full flare. Different doctors will have different thresholds that they worry about and they don't always adapt them to the patient. My consultant knows my inflammation markers never show in my blood, so even a .1 raise is a lot for me, and time for action, whereas doctors who don't know me would say its nothing.

I agree with other posters that a colonoscopy needs to be done or at least considered.

I live in the UK, where things are very cost dependent, but am lucky that I have a very determined team on my side. They refused to accept no for an answer and ordered me a scan called a white cell scan.

This scan is very sensitive, more than an MRI, and is done by extracting white blood cells from your blood, tagging them with a mildly radioactive isotope and then reinjecting them. They then do a scan and see where the white blood cells have gone, if there is one area with a high concentration of them then that area has inflammation. It's a very old school scan, and isn't used as much any more, but my IBD team knew I was sick, and were determined to prove it so I could get the best meds. I'm not sure how easy it would be to get a scan like this where you are, but there can't be any harm in asking them if its a possibility.

From what you've said, I'm not convinced you are stable enough to be without medications. I know there are side effects from the biologics, but the side effect from Crohns being allowed to go out of control are much worse. I'm not saying this to scare you, but to show that the doctors need to pay attention to you.

I would recommend at least enquiring about the alternative scan. You mentioned in another post that you have ulceration, and that means active disease, those ulcers can turn into scar tissue and cause blockages and ruptures. The worst they are able to do is say no. I know its a difficult system to feel with, I know in the UK you need to have a great doctor who is willing to push the system or you hit a glass ceiling when it comes to expensive treatments.You also need to have a strong will and be willing to stand up for yourself and not just do what they say. We can ask for second opinions when we aren't convinced that a doctor is doing the right thing for us. I changed doctors about 2-3 years ago and it is honestly the best thing I have ever decided to do. I strongly believe that if I had this doctor when I was first presenting symptoms I would have avoided the major surgery I needed to deal with strictures and scar tissue. Most countries have a similar system so you should at least be able to talk to a different doctor and see i they would recommend the same course of action.
 
Sometimes MRIs will miss active inflammation, they have totally missed a flare twice in my case. Stool tests are usually more sensitive, but can miss low level inflammation, so aren't 100%.

From the symptoms you are describing, I would be really reluctant to say its a good idea to come totally off all medications, as its sounds as though there is something going on in the background.

I agree with other posters that a colonoscopy needs to be done or at least considered.

I live in the UK, where things are very cost dependent, but am lucky that I have a very determined team on my side. They refused to accept no for an answer and ordered me a scan called a white cell scan.



From what you've said, I'm not convinced you are stable enough to be without medications. I know there are side effects from the biologics, but the side effect from Crohns being allowed to go out of control are much worse. I'm not saying this to scare you, but to show that the doctors need to pay attention to you.

I would recommend at least enquiring about the alternative scan. You mentioned in another post that you have ulceration, and that means active disease, those ulcers can turn into scar tissue and cause blockages and ruptures. The worst they are able to do is say no. I know its a difficult system to feel with, I know in the UK you need to have a great doctor who is willing to push the system or you hit a glass ceiling when it comes to expensive treatments.You also need to have a strong will and be willing to stand up for yourself and not just do what they say. We can ask for second opinions when we aren't convinced that a doctor is doing the right thing for us. I changed doctors about 2-3 years ago and it is honestly the best thing I have ever decided to do. I strongly believe that if I had this doctor when I was first presenting symptoms I would have avoided the major surgery I needed to deal with strictures and scar tissue. Most countries have a similar system so you should at least be able to talk to a different doctor and see i they would recommend the same course of action.


Well I already changed docs, since the last one didn't want to proceed either with biologicals. They were too expensive and my disease wasn't active.

So now that I changed docs, I just feel this one is even more passive.
She also thinks that biologicals are not necessary and I can do with the aza, and just accept the hair loss. After the MRI & Stool test, she didn't find the necessary to do a colonscopy or videocapsule. They just only do it when you have diarrhea and a high crp.

I do stand up for myself. But it's getting harder.
Since I feel that there are not many options for maintenance meds..
 
Speaking from personal experience here...

I was first diagnosed with UC in 2013. I lost about 20 lbs, went on Lialda and felt good so my doctor (not a GI, a GP) told me to go off the meds. I felt great for a couple years and then earlier this year had a horrible flare, lost 60 pounds and spent close to a month in the hospital. New doctors (GI Specialists) diagnosed Crohn's and said that going off meds before was one of the worst pieces of advice they've heard a doctor give someone.

That being said, I didn't have the severe side effects you did so you might want to look at a risk/benefit analysis as in, what's better for your quality of life and long-term health but for me I would recommend staying on the meds and finding ways around the other side effects provided they don't mess with your psychiatric health.
 
Dear people,

I was diagnosed in 2013 with crohn's disease. Now it's 2016 and I've had 2 periods of flare-ups.

I've tried the meds Imuran/aza, 6mp and thioguanine (which is basically what aza and 6mp are broken down too).
I always experienced severe hair loss, which even after 8 months didn't stop, folic acid/biotin didn't help either. It did help my crohns.

For the last two weeks I've tried methotrexate, but cannot tolerate it since I'm really nauseous for 4 days and then soon I've get to get my second injection.

So now my dr is recommending just not taking anything, and getting a stool test every four weeks.

Is it logical to take no meds?
And what would you do?

I'm feeling hopeless..

I wouldn't go without any medication. There could be damage going on in your body you are not aware of.
 
Double check to make sure you understand him correctly, maybe he meant for a short period of time. otherwise here are other things you could do, that helped me through the years.
 
Is it logical to take no meds? .




Well if the meds are flaring you up, making you feel worse, or not working, then it makes perfect sense.

Your doctor should know what he is doing. If you are unhappy, get a second or third opinion.

I don't take any pharmaceutical meds at all these days. And I am doing just fine.
 
Get a new GI doctor right away and if you can, find one that specializes in IBD. Your doctor is out of it completely. Crohn's never goes away. Even when you think you're in remission it can be silently doing damage that in many cases is irreversible. You will need to be on some sort of immunosuppressant for life probably. You need to find out where your disease is located in the GI tract. For Crohn's it can be anywhere. I'd check a fecal calprotectin level as well which is like a CRP but more specific for just gut inflammation. If it is way over normal they will give you the biologic...you just need a test to show your disease is there and active, which it probably is. Or an MRI Enterography to look at your small bowel. Colonoscopy of course is good but only really sees the large intestine.
 
I've had hair loss since diagnosis as well. Some dietary adjustment may help you and your symptoms are avoid lactose sugar from milk and dairy, get calcium from cheese with low lactose like mozzarella. Avoid refined sugar and keep even natural sugars at a minimum like from fruit. I find traditional oats, well cooked refried beans not from a can, some wheat brands, cooked broc and cauli spinach to be tolerable. But rice and corn to be difficult to digest.

There is a book called breaking the vicious cycle written by a women (with a bachelor degree in biology) who's daughter had UC and details a diet called the specific carbohydrate diet which helped her daughter, not everything in the book was true for me, but many of the concepts i used to develop the diet i am on and it has helped alot. I find vit D 1-2000iu, C 500mg, and E 400iu or more, to be helpful in crohn's but avoid high dose b vitamins, stick with 100% daily value and nothing more vit b6 might make inflammation worse some rat studies show this. Iron can make IBD worse because it contributes to oxidative stress don't take unless you are absolutely deficient or something. I also use an herb knotweed that contains resveratrol by doctors best I use 1/8 of a pill only helps alot and very cheap. I have more advice if you are interested and science to back of most of my advice others I've discovered on my own.
 
I second the suggestion of looking at breaking the vicious cycle! you can also find a lot of info online (scdlifestyle.com, etc.)
I had worsening symptoms on steroids, bad side effects (including hair loss) on Imuran.
My health improved dramatically, almost overnight when I made dietary changes. I was able to stop taking the Imuran...been in remission for almost 3 years now. I take an anti-inflammatory as a precaution, but the initial change was due to diet.
 
I was dx'd in 2006 with Proctitis and used Asacol suppositories for years.Two years ago dx'd with Crohns Colitis and after a course of steroids went into remission. As the crohns was now higher up the colon I saw no point in continuing using suppositories.Through choice,I take no meds at all now,except Loperamide for D.and meds for constipation.But I try to do without either when I can.I trust myself to know when I need help.Of course many on the forum have serious problems and will be on meds.for life.You have to know your symptoms and your body.If you don't feel you need meds.then don't take them.But I also agree with other posters who are cautious.We're all different.
 

Latest posts

Back
Top