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My remission has ended

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In 2002 at age 26, I had a real pain in the booty :D !!! Literally..... a perianal abscess and fistula. I had surgery, it recurred a week later, so had a 2nd surgery. I had also been having diarrhea. Around that same time, I went to a GE and had a sigmoidoscopy and was told it was IBS.

By late 2005, I was in almost constant discomfort and was having diarrhea 15-20 times a day, every day, for real. I was sent to a new GE, THE BEST DOCTOR IN EXISTANCE!!

I was 86 pounds by the time I was finally diagnosed with Crohn's disease. I had anemia also. Have I mentioned how much I love the GE who took me in and saved my life? As he put it, I have colitis and Crohn's disease in my.... well... everywhere. He started me on Asacol, Mercaptapurine, Nexium and prednisone. Oh - that prednisone. I was finally able to eat. And eat. And eat. While 86 pounds was definitely unhealthy, why could that predisone have not allowed me to stop at 120 pounds? I gained and gained. But, that's far beyond the scope of this post. I digress. In the spring of 2006, I also did Remicade infusions. I was officially in remission by that summer!! :dusty:

It was then Pentasa and Nexium alone for maintenance. I had my 2nd child in 2011. You cannot take Nexium while breastfeeding, so from then on, Pentasa only. Thankfully, to this day, my acid reflux hasn't reared it's head, so I've been able to stay off Nexium.

So, all has been decent since mid 2006 - until now. Don't get me wrong, I have what I call my "Crohn's days". Maybe once a month or two, I'd have days of horrible cramping when I could barely move. But, I'd always be better the next day.

In the meantime, my son was also diagnosed with Crohn's in 2009 at age 12. His first symptom was also a perianal abscess and fistula. He had surgery for that, and his Crohn's was attacked with Pentasa, Mercaptapurine, Prednisone and Nexium. That Prednisone got everything under control. It's a miracle drug, really, but the side effects are HORRIBLE - I know you all agree with me, right? His Crohn's has also been kept in remission with maintenance drugs - Pentasa, Mercaptapurine, Nexium. Once in a while, he will get an anal abscess that is treated with antibiotics alone, no further surgeries have been necessary.

Back to me. I had the worst cramping of my life 1 1/2 weeks ago. I have an extremely high pain tolerance. I can take just about anything. But, this almost had me in tears - easily a 9 on a 1-10 pain scale. I was close to waking my husband to have him take me to the ER, but did not. Was a little better by morning. I had some cramping on and off that whole week, but nothing as intense as that entire night (lasted from about 8 pm to 2 am). I've also been feeling super bloated lately after I eat. Also, the past couple of weeks, I have the constant urge to clear my throat.

So, I made an appt with my AWESOME GE because of that horrible, debilitating cramping. Blood work showed inflammation. He scheduled an abdominal CT scan, which showed inflammation in my terminal ileum. So, just a few short days later - which was yesterday - a colonoscopy / upper endoscopy. This showed a stricture in the end of my small intestine as well as one in my duodenum. He said that he couldn't get past the one in end of my small intestine with the scope. I don't know the details yet of either stricture (length and diameter). He specified it was from scarring. However, he told my husband that right now, surgery is the furthest thing from his mind, and that he's hoping we can handle it with meds alone.

He did also prescribe omeprazole. He said that urge to clear my throat is from reflux and that the omeprazole will take care of that. Thankfully, this wasn't the old fashioned heart burn from hell that I used to get. Just clearing my throat all the time. I can't wait until this little annoyance is gone!

Now, I have to have an upper GE with small bowel series. It will be next Monday morning. This is where I start having questions. Anyone with knowledge or past experiences, please help!

1 - It sounds like the CT scan, colonoscopy, upper endoscopy gave GE a large amount of info. So why an upper GE with small bowel series? What's the need?

2 - From all that I have read, medication is only successful in inflammatory strictures, not ones that are due to scarring. So, what might he be thinking in stating we should be able to handle with meds alone and not surgery?

SO SORRY for such a long post!!! Thank you for reading about me! Any input you have is greatly appreciated :Karl:
 
Hi Meredith!

Sorry for your flare...As for the upper scoping, it shows the doc any potential damages from the throat through the upper small intestine. Basically, it works the same as the upper endoscopy but will continue through the first portion of your small intestine so he can look at the possible strictures, and damage from acid reflux. I suspect doc is going to try treating with anti-inflammatories before resorting to surgery. Best of luck, and welcome to our *sh!tty* club!:ylol:
 
Hi! Welcome to the forum!

Sorry to hear that you and your son are dealing with Crohn's.

In regard to question 2, yes, there is currently no treatment other than surgery to get rid of scar tissue and so strictures caused by scar tissue will, if they are causing severe enough symptoms, require surgery. So what your doctor said doesn't, at least on the face of it, entirely make sense.

I can only guess that he actually thinks that your strictures are partially from inflammation and partially from scar tissue. If that's the case and you can reduce the inflammation then you can widen the stricture - not to the diameter of normal bowel as it'll still be narrowed by scar tissue but perhaps enough to make the stricture asymptomatic. It's common to try meds first before moving to surgery.

I hear that you really like your GI and that's great but I would question why you were only on Pentasa for maintenance and why your monitoring in terms of bloods, fecal calpro, MRI and scopes was such that you have developed two strictures before your GI is considering escalating treatment.

Best of luck. Hope that medication and/or surgery get you back into remission :ghug:
 
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