GREAT appt with surgeon, also bittersweet

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Lindseyw4

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Cameron and I met with the surgeon today to discuss whether or not he may need surgery to close up his perianal fistula. We were both pretty sure he'd tell us Cameron needed surgery, since the GI made it out that way, but he spoke with us about Cameron's symptoms, looked at his bottom, and suggested we try more medicine first! We were so relieved! Cameron even got a cool new toy from the office after the visit. I was so glad to see him so happy.

The surgeon said the fistula remains superficial, and since its not bothering Cameron we just need to check back in in 3 months after possibly starting some new meds, including Remicade and a new antibiotic.

Now, even though I'm still very happy we don't need to worry about surgery at this time, I'm afraid for the meds. I know a lot of kids of parents on here use Remicade, but reading about it online is scaring me even more than reading about 6mp did. I'm scared of the risk of t-cell lymphoma with my son being 10 years old and taking both 6mp and Remicade, which the Dr. said we'd have to do till he got to therapeutic levels with the rem. How do you guys do it? I'm a bit aghast with how poorly medicines are designed to treat Crohn's.

Also, the surgeon mentioned trying a new antibiotic to treat the fistula. Cameron is currently on vanc to treat c-diff, after a failed round of flagyl. I'm afraid the antibiotic to treat his fistula though may lead to him getting the c-diff infection again.

I'm so tired of these games. It feels like a game of choosing the lesser evil.

We also met with a therapist for the first time today to work on some of Cameron's emotional responses to his diagnosis of Crohn's this summer, which was harder for him than I expected. Tomorrow we're meeting at school to consider eligibility for 504 services (which I got from the sticky here!). Damage control.
 
Aw, I know it is hard. Nothing comes easy with this disease. I am chomping at the bit to get Remicade for my daughter... The risk is very low for cancer. I hear even lower than the risk of dying in a car accident, which chance we take every time we get in one. I hope the new meds work quickly for him and that you see what it means to be one of the success stories with Remicade.

Hugs,
Carol
 
Hope the meds work. My son ended up having to have surgery on his fistula. I think it worked as he doesn't seem to be bothered by it any more
 
I'm glad you don't have to worry about surgery! :) But, it is hard to come to terms with the meds. Unfortunately, we are all in a position of only choosing the lesser evil as un- or undertreated crohns brings it's own risks. :( However, as was said above, there are risks all around and we accept them because they improve quality of life (driving, swimming, skiing, sunburns on the beach, etc., etc.). Once you see your son feeling and looking great, the worry re the meds does lessen. :ghug:

My son is on remicade and has done very well (will post update in his thread). So far (knocking on wood, throwing salt over my shoulder, etc., etc. :ack:), he hasn't had any negative side effects. :)

Also, I believe/hope the current meds are only temporary... new and better treatments are being studied every day... treatment options are much better today than they were 10, 20 years ago... hopefully, new and better ones will come along soon. :)
 
I'm glad he doesn't need surgery.

My Grace is on Remicade and she loves going to get it and we all love how well it makes her feel.
It was scary for us to decide to put her on this drug at 5 but her ending up in a wheelchair because of her arthritis was a sure thing if we didn't treat it aggressively.
We also are trying to keep her from getting scare tissue in her GI track or her stomach getting even more damaged then it already is.

So I'm glad that these drugs exist but hate that we have to use them.

HUGS
 
Remicade has a great success rate with perianal disease.

This is my favorite resource regarding risks and it has helped me come to terms with each decision I have had to make.

http://www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf

Turns out the biggest risk associated with Remicade is the three hour round trip drive I have to make for each infusion. My daughter was in ICU at dx so I have seen what untreated disease can do and I never want to go back there. Even undertreated disease is a dangerous thing.

I'm with Tesscorm. These meds are temporary and I really do believe that better treatments are in the pipeline.

Good luck with the antibiotics.
 
Thank you, everyone. I know my fear of the medicine is annoying. I will check out CCFA's info on the risks. The thing about the car accidents, drowning, etc. is that I have control over perverting them. There is, to my knowledge, no way to prevent cancer from the meds. I'm actually going to inquire about how I could prevent it from happening, should we use rem, today at our supplemental GI appt. I'm also going to ask about all the best ways to treat perianal disease, since at this time that seems to be our bigger problem. What does bring me comfort is the idea that the medicine is temporary and something better will come along.
 
I agonized and agonized over putting my older daughter on biologics and then they turned out to be the best thing for her. Then when my younger one was diagnosed, I spent many sleepless nights worrying even though I knew they would help her - and they did. Then when we added Methotrexate/Imuran to the biologics they were on, I worried AGAIN.

It's natural to worry - sometimes I think it's what we moms do best ;). But my girls have been on biologics+immunomodulators for years and I can honestly say I have never ever regretted putting them on these meds. At some point, the disease becomes much scarier than the medications and now I'm grateful every single day that we have these medications.

The presentation Crohnsinct posted is really very helpful for understanding the risks and benefits of these drugs.
Good luck!
 
My son was on Azathioprine for six months and developed a fistula an abscess while on it. His GI said, in his opinion, it meant the Aza wasn't strong enough to control his Crohn's. That's when we made the switch to Remicade. It's been 17 months now and we haven't seen any abscesses, fistulas, or Crohn's since.

I think 6MP/Aza scared me more than Remicade. The cases of t-cell lymphoma are so rare and after seeing my son hit rock bottom with this disease, the benefits outweighed the risks in our mind. Remi has been the best thing for him and I kick myself for not getting him on it sooner.

Good luck with your decision.
 
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Thank you for sharing, Mehita. I'm also kicking myself for not doing something different sooner! I feel terrible the fistula has gotten this bad. When we met with our new GI yesterday, he suggested i make my choice quickly because he's concerned about Cameron's growth. So now I'm worried he won't go into puberty or he'll be 4'4" all his life.

The new GI seems to prefer humira over Remicade. We will probably go with humira, but I'm trying to see if the fistula will clear up from the vanc Cameron is on for c-diff. We definitely like this GI better than the one we've been seeing--even though he practices at a highly preferable and rated hospital.
 
Remicade can grow with the child . Meaning as your kid gains weight the amount of remicade given can be increased to keep the dose at 5 mg/kg or 10 mg/kh etc....
Humira only has two doses kiddie (20 mg or adult 40 mg)
So what hold your kiddo at bay at 50 lbs typically doesn't work at a higher weight
Kids outgrow Humira faster due to this .
Good luck fixing the fistula quickly
 
Humira is also a very painful shot that is given every 2 weeks (or can be given weekly). Both my daughters much preferred Remicade because it wasn't painful really (just an IV) and was much less frequent (can be anywhere from every 4 weeks to every 8 weeks).
 
Yes but Remicade carries the risk of allergy, right? Along with developing mouse antibodies? The Dr. said once he takes Remicade, he cannot use other medicines.
 
That's not really true - most kids don't go back on Remicade but other meds aren't out. Most go to Humira, Cimzia or more recently Simponi. All are Anti-TNFs. Not all kids react to Remicade either- my younger daughter has been on Remicade 3 separate times and has never had a reaction.
 
How painful is the shot? I was thinking humira would be a better choice since it's faster and can be done at home by me. The doctor did not mention doses.
 
Remicade has the risk of allergy to murine ( modified mouse protein ).
But it's a very small risk.
Once you start remicade you can't stop it ( or any other biologic including Humira ) with increasing the of developing antibodies . Antibodies increase the risk of reaction and/or the risk of the med no longer working .
If you have an allergic reaction to remicade ( DS did this -after 8 infusions ) then you can no longer take remicade but that doesn't stop you from taking any other biologics ( including Humira ) or other meds .
 
Humira really burns - both my daughters hated it and they were much older than your son. It was convenient though.
 
I'll tag some parents who have or had kids on Humira: Farmwife, Clash, Pilgrim, kimmidwife
 
The Humira shot is basically like a wasp sting that you are holding in for 10 -30 seconds.
The scream that came out of my kiddo was horrid . My DH had to leave the room it was too hard to listen to. We currently add lidocaine to the Humira syringe to help some but he still screams . This is a kiddo who has been getting allergy shots since age 4 so the shot/needle part is not the factor.
 
Yeah what the doc might have meant was that if you make the decision to go on Remicade you probably can't stop, try something else and if it doesn't work hop back on Remicade. Some people like Maya's daughter can but a lot can't.

P.S. lots of kids take Remicade and another drug at the same time. My daughter is on Remi and Mtx.
 
You can still react to Humira as well. DS has . But we give an allergy med prior to administering it and limit the area of injections - arms cause multiple hives in him for some reason
Remicade was the best for DS
He tells other kids who start rejicade on how lucky they are.
DS is extremely atopic - it wasn't a question whether he would react to remicade but when
He is allergic to all contrast dues , barium sulfate , glucagon ,foods, bees, pollens etc
He has had anaphylaxis as well not to remicade
Gets hives just because it's Tuesday
 
Remicade infusions are typically administered by nurses in an infusion center or hospital - the nurses have plenty of experience with infusions reactions and are well-equipped to handle them.

Some doctors like to add MTX, 6MP or Imuran to prevent your child from building antibodies to the drug. Antibodies increase the likelihood of having a reaction or can make the drug less effective. You can build antibodies to both Remicade and Humira.
 
Yes i have a serious problem with using the combo therapy. Even the doctor acknowledged how dangerous rem + 6mp is.
 
The risk of a reaction due to antibodies is there for all of the tnf alpha blockers, remicade, humira, cimzia.

If your son has already been on 6mp then the risk you speak of is already there. The drugs don't have to be taken concurrently for that risk to be present. Some GIs choose mtx + biologic bit still the risk remains.

My son took remicade for 2 years. He had to stop remicade for surgery and afterward when he started back he quickly developed antibodies. He is now on humira. He is 18 and if asked he will tell you that he'd choose remicade over humira any day.
 
Paging Dusty
She can chime in on what can happen when crohns goes under or not treated properly .
That can be scarier than the potential and I do stress potential side effects.
 
My son (16) started Humira at the beginning of this month. He is also on 6mp although will hopefully stop taking this soon. Yes these treatments are scary but, as has already been said, so is untreated Crohn's. J was given the choice between Humira and Infliximab - he chose Humira as it means he doesn't have to go to hospital and it's over and done with in a few seconds. I was quite concerned as I'd read that the injections are really painful but this had to be his decision. J uses the pens and says that although they are more painful than regular jabs they're not that bad and he did the last 2 jabs himself with no problem at all. These decisions aren't easy and we all wish we didn't have to make them. Good luck with whatever path you choose.
 
FW: is it the CCfa transcript you read? That one usually puts people at ease.

I can chime in on under controlled disease. We didn't know my daughter had crohn's until her first big flare. Oh she had some small signs but nothing to set off alarms. Her first flare was at dx. Violent diarrhea with bleeding. For about two weeks. By the time we got in to gi it was an immediate admit, she was jaundice, malnourished and suffering injury to her organs. She was moved to icu for two days. Placed on tpn, received blood transfusions, iv steroids and fluids. They told me in her state she wouldn't survive a scope. They also said if I had delayed one more week she wouldn't have survived the week at home. So when they said remicade I took it. I knew the risks but after what we went through I knew I wanted to get control and get it quickly.

I often wondered if I would make the same decision if the situation was less dire. Unfortunately, I didn't have to wonder long because my youngest was recently dx'd with crohn's. And yes I was prepared and hoping he would say remi because honestly mtx scares me more. But alas the recommendation was mtx and even scared I said yes.

Stinks that we have to make these decisions. Helps to know I am not alone and that I have a community here supporting me.

In the end you have to do what makes you and your family most comfortable
 
Lindseyw4 said:
Thank you for sharing, Mehita. I'm also kicking myself for not doing something different sooner! I feel terrible the fistula has gotten this bad. When we met with our new GI yesterday, he suggested i make my choice quickly because he's concerned about Cameron's growth. So now I'm worried he won't go into puberty or he'll be 4'4" all his life.

The new GI seems to prefer humira over Remicade. We will probably go with humira, but I'm trying to see if the fistula will clear up from the vanc Cameron is on for c-diff. We definitely like this GI better than the one we've been seeing--even though he practices at a highly preferable and rated hospital.
Click to expand...

Great, it makes all the difference to have a GI that is on the ball, doesn't it?
 
I know the choices suck, Lindseyw4. Just keep asking questions, listen to your momma gut, and watch your kiddo very carefully. At the same time, try not to get too dead set against anything, whether it's surgery or a medication or whatever in the future. Right now it sounds like you still have a choice in meds, but at some point you may not. And I don't mean that in a bad way or anything... it's just the nature of the disease. Unfortunately, IBD is a disease where under treatment (been there, done that!) is almost as bad as no treatment, especially in our growing, pubescent kiddos. So if something isn't working or your GI is wanting to try something else, it's probably best to move on.

I carry the guilt of protesting 6MP for so long - because it scared me - that my son ended up needing surgery. Then when we did finally try 6MP, it didn't work anyway. There went another 6 months of being sick, waiting for 6MP to work.

When we switched to Remicade, yes, I was still scared. He'd failed two other meds and this was the next one in the line. I stared at DS the whole three hours watching for a reaction. Not sure I even blinked! About halfway through he asked for food. A month later he was up 7 pounds. Then he outgrew his pants. Then he joined the tennis team at school. It's given him his life back.

Long story short, don't let your fear overpower the need for treatment, whatever that may end up being. My kiddo paid the price of my fear and I carry that with me every day. A bit less so now that I see him healthy as a horse... but I know I've definitely learned a lot from this experience and hope it helps some to read it.
 
Hi LindseyW4,

I think those of us who have gone to a biologic have done it reluctantly.

My daughter started Humira 3 months ago. She was diagnosed at 3 years old and because of her age there wasn't any research that could tell me what could happen to a little body (not enough kids that young to experiment on!). We really wanted to find a more "natural" way to treat her disease and had some success with Enteral Nutrition, but in the end the inflammation was still there.

After some very poor test results, we opted to try Humira. I don't do the injections myself, I like to hold her while she is given them by a nurse at our local clinic. They do hurt. It lasts about 10 seconds. When the injection is done, the pain is gone except a little soreness where the injection was. We are in and out for the shot in only a couple of minutes. I like that it's quick and we can get on with our day.

She has been so much better. Her energy level is amazing and she can eat without bleeding. I don't think about the side effects much now but I do remind myself how exhausted she was and how there were many weeks where she had to be on a formula only diet. I also see her inflammation levels decreasing by leaps and bounds.

Because she was sick so young, I literally had no idea that she could be this energetic. A forum friend reminded me that I once admitted to wondering that she might just be "lazy". When our kids get so sick and it's every day, we have no idea what the normal really is.

Anyway, I know it is so hard to make these decisions. I admit that I would find it hard to do the biologic/6-MP combo with a boy that age because of the added risks but the benefits could be so great for him. It's tough.
 
I’m so sorry for the late chime in Lindseyw4 and so very sorry that you are faced with these very hard decisions. There really is nothing harder in this life than having to make decisions on behalf of the ones we hold most dear. :ghug:

As mlp has said, I have faced what untreated/under-treated Crohn’s is capable of and in our case it resulted in us coming within a whiskers breadth of losing our daughter. Less than 24 hours and we would surely have lost her. On the background of this I went to the other extreme and accepted medication with open arms with nary a question in sight! :eek2: This isn’t exactly a good position to be in either as asking questions and researching is never a bad thing but with it comes unending worry. The worry will never leave us but we must somehow temper it with the courage to move forward and the understanding that there are no wrong or right answers when it comes to choosing medication just different ones. We must look at what is in front of our eyes, our children, and truly see what is there. Are they happy and thriving, full of energy and bounce? No? Then it is up to us to provide them not only with quantity of life but also with quality of life.

I know I speak for every parent here when I say that as you transition through this disease you will find yourself making medication decisions more than once and before you know it you are replacing one fear with another. For example, when was son was diagnosed I was comfortable with Imuran as I was used to it with my daughter…this was progression…Imuran, not a problem, Prednisone!, ugh not Prednisone!, Humira!!! mega freak out!!!, Surgery!!!!!! No not surgery!!!!!!. It soon became apparent that surgery was our only option and then I was wishing we still had Humira as an option!

remission is a blessed state for our kids to be in and once there you realise how the abnormal crept so insidiously into your life and made itself at home. Do what you can to get your lad into remission and keep him there and you will never regret it mum and remember that every decision you make on his behalf is borne out of love and that can never be wrong. :heart:

Dusty. xxx
 
Well, I still haven't decided on any meds. Right now, I'm not thinking of what my kid would like best...rather, what is most effective and safe? I'm done thinking about how much time remicade will take, or how much humira hurts. I just want to be done thinking about this disease. It's really ripped the both of us to shreds. My son is depressed now, threatening suicide at 10 years old, because he is guilty toward himself about having the disease and pities himself for the treatment. I am looking for a new therapist right now since the last one we saw made him cry asking him about his Crohn's on the first meet.

I convinced our original GI not to switch to rem at this time, since his bottom appears to be healing and he appears to be feeling better. While he said the perianal disease is not usually affected from c. diff, it seems like the vanc he's on for it may be treating it. My guess is that the 6mp couldn't be absorbed well while he had the infection. So I'm really hoping this is it.

If it's not, I'm still trying to decide which GI to continue seeing. I felt more comfortable with the "other", or newer one we met with. Our original GI is from Lurie Children's Hospital, formerly Children's Memorial, here in Chicago--which many people come from across the country to be treated at. However, he seems to have taken the long way for a lot of things and hasn't seemed to trust me before. I had to beg for labs to be repeated after his first round of flagyl for c. diff. He is young, likely just completed his fellowship within the last year or two, and seems to like the tried and true way of going about treatment.

The other GI that we met with for a second opinion is from a local hospital--which actually used to be a part of a health care system in conjunction with Lurie, until Northwestern (med school that feeds into Lurie) got mad that Evanston (local hospital) was accepting residents outside of Northwestern. He is a little older, and seemed to like to try new things. He seemed to listen to me pretty well, and the nurse was also nice and helpful. Huge office.

How do you decide? For the most part, I'd say they are equally competent, or that the local GI may be more competent (I hate to tie that to age but really, they do a residency in peds then 6 months to a year of fellowship in GI, or vice versa, so a person who has been practicing longer must know his stuff). The GI at Lurie has lost my trust a few times, and is farther from us--but not by much. It is a 30-45 min trip to Lurie, plus $10 parking, or a 10-20 minute drive to the local hospital, and $0-$5 to park. What do you guys think? The Lurie guy wants to try rem and the local guy wants to try humira.
 
You have to go with who you feel comfortable with and with who you trust! This is going to be a long term relationship. You can't spend time with someone you are always second guessing, who doesn't listen to you etc. This is a team and you are a very important part of the team.

I didn't go to world reknown hospitals close to my home or world reknown docs within a reasonable distance. We went to a local hospital with a doc who I have come to regard as amazingly awesome. Some really great docs are at local hospitals. Their decisions to practice in any one particular place over another are based on a lot of different personal factors so I never discount the local guys.

Both docs probably really know their stuff but I do think experience with the disease and number of patients treated plays an important part in the care they deliver. Also, the way they care for families really matters. Not everyone clicks with every doctor...go with your gut on this one.
 
Second the go with your gut on this one
We have done the top Ibd centers in the us for a fresh set of eyes more than once
Our Gi welcomes that
He was not an IBD specialist at the beginning of caring for Ds but has slowly added more Ibd stuff on his lost in part due to DS
Add in DS is not your typical Ibd kid so that type of experience wouldn't help him much

But in the end I like a doc who includes parents as part of the team for GI
So you need to realize this is going to be a 8 year relationship at least some see them til age 22 .

One last thing to consider
How do they handle inpatient
Is there an inpatient GI from your practice that rotates through the hospital or is it your go that handkes his own inpatients?

Also even if you pick doc x you can change in a bit or a year rtc if your not happy
Good luck
 
Go with your gut. Like the others have said, it's a relationship that needs to work. And just because you go with one or the other doesn't necessarily mean you have to go with their favored treatment. Essentially, you've gotten a second opinion and whoever you choose should respect what the other doctor has recommended and then you can discuss the options. You and your kiddo need to feel comfortable.
 
You can see someone for a second opinion once or even twice, but only one of the doctors will be your primary GI and will prescribe meds and make decisions. I agree with Mehita, go with the one your most comfortable with. If you aren't comfortable with either, then it might be time to see if you can find a third GI.

I would imagine most ped GI's are fairly comfortable with Remicade or Humira and will let you go with either if they think your son needs biologics. So I wouldn't use that as one of the criteria.

Good luck!
 
Yes, they both are comfortable with either. The one from Lurie likes Remicade because it's been studied a lot. The local one likes humira because it's not human
 
Doesn't matter
You need one doc -as captain of the ship
They make decisions on what meds tests etc
When to increase decrease etc..,,
Too many cooks on the kitchen is not a good thing
It's ok for a second or third opinion but....,
That's about it .

Trust me
We have Gi and Rheumo co managing things since his JSPa is secondary to crohn's and the meds are the same
It gets a little tricky at times
 
I think you should go nearby to the one you trust more. That said, I REALLY had a tough time trusting my daughter's GI at first.

In retrospect the reason for that was mostly that a. I hated the disease b. I hated the treatment options c. I was scared for my daughter d. one of our first med choices put her in hospital.

None of that was his fault. A lot of what they have to do is trial and error. Also, sometimes they work their way up the med ladder for insurance reasons.

Now that she's doing well on her treatment and we get 6 months between visits, I think he's fine.

ETA: It is going to help your son's depression if he can get treatment that works so he can feel like a kid again. I wouldn't wait. This comes from having been there and seen an amazing change not only in the well being of our child but also the stress levels of the entire family.
 
Lindsey...does your son prefer one GI over the other? My son is also 10yrs old and after a year on Imuran his scopes showed that we also had to choose a biologic. He has been terribly depressed this year as he really feels like he is never going to get better and feels like he has no control. I have found that it helps to include him in the decision making process once it's been narrowed down. It's his body after all and it makes him feel like what he wants matters. He ended up choosing remi over humira because it was less shots and he wouldn't (for the most part) need any additional bloodwork sticks because they draw them at the infusions. He also chose oral MTX over the injections as a combo drug because our GI didn't want him on the Imuran/remi combo. Even simple things like choosing gummy Vit D over chewable tablets helps.
Both R and I LOVE his GI...even though R is still not in remission even after switching to remi. Unfortunately there are no guarantees with these drugs and this stupid disease.
 
Thank you guys. We'll probably pick one or the other this month (rem or hum) at our next visit and I'll ask Cameron who he wants to see again and leave it at that. Thank you all for your help. It hasn't been easy. I was looking at my very first thread, when i thought it was still probable my kid would take his meds and feel better, and I'd never think of this board again 😳 how wrong i was
 
O just another question has anyone ever done a scope before switching meds? Our regular GI wants to do one before switching meds to see if there is any inflammation that his labs aren't picking up (while the fistula has gotten worse, his labs have been normal, symptoms none to mild). He also wants to examine the fistula with the surgeon to be sure it truly is superficial. How does that sound to you all? I personally think he's just talking about the scope because he really wants to look at the fistula which i don't think is a priority.
 
Scoping before a med change is standard
So they know exactly where the kiddo is starting from and can tell later if the med actually is working or not helping at all.
I know is sounds confusing but after a while it will become second nature .
DS was scoped prior to every med change.
 
R has also been scoped before every med change. It used to be that they would do an MRI after a couple of months to judge the efficacy of his treatment but our GI now feels that scopes are a better indicator of R's disease severity. He is actually getting scopes again May 1st...only 2 1/2 months after his last set.
 
Sending hugs:ghug: Hope scopes go well. We found that the second one was much easier than the first, just because we knew what to expect.
 
Good luck for the scopes and decision on med. I believe if a med change is felt necessary our GI does prefer to do scopes first.
 
We didn't have a scope with our med change. In our case I think the GI was just happy I agreed to something, and didn't want to push it. :)

I think a scope can be really helpful in this type of situation because there could be one heck of a lot going on in there that he can't discern from labs. A lot of kids here had labs that were pretty good and then when they got scoped it was a shocker. It's good to have info to work with. The labs don't tell the whole story and in a lot of cases you're not even getting a glimpse.
 
DS has either been had a scope or MRE before all med changes, sometimes both because his disease is in the small intestine where scopes can't reach. It does get easier as you learn the tricks for each procedure.
 
Mehita, was there always abnormal findings before changes, or did they ever change meds for other reasons?
 
Yes, he always had something abnormal. Well, abnormal for his normal. A lot of his early stuff was to monitor the stricture he had, but there were times when they'd take a peek to see how bad his inflammation was.
 
We have a follow-up appointment scheduled with the surgeon Monday. I'm not sure if it would be worth the time, since he wanted to conduct an exam under anesthesia, an MRE, and/or a scope to get a better look at the fistula. We have done none of those things. At best, he could see if the fisutla has gotten better or worse since 3 months ago, or stayed the same. I'm pretty sure it's the same. I spoke with the surgeon's nurse, who said since it is a follow-up appointment I should come. However, I'm just not sure. We've got a lot of other stuff going on. What do you guys think?
 
Based on the nurses advice, I would go in. I know it is a pain but with me Murphy's Law would reign..I would cancel the Monday appointment and later that same week something would come up to make me wish I kept it.
 

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