Question about dr's

[Jison0612]

So I've been seeing a specialist for every Crohn's visit for years now. Well it's way to exapensive the insist on doing a lower colon scope every visit and I'm paying well over $300 a visit!!!!! My question is do I hae to continue to go to a specialist every visit or is this something my physician can take over now?

 

[nogutsnoglory]

I'm not sure I understand. They want a colonoscopy every visit? Are you visiting annually?

If you need medication for IBD you will really need someone who specializes in IBD mgt.

 

[ronroush7]

You need a gastroentologist.

 

[Jison0612]

Not a colonoscopy it's called a lower colon scope it's just a procedure they do to examine my lower colon/rectum i have some fistulas and such. But it's really exapensive seeing a specialist every time it's a colorectal specialist they speacilize in all colon diseases but I was just wondering can I go to just a regular physician to be treated now since I know I have Crohn's and understand I have to do colonoscopy's every three years should I keep with the specialist or maybe look for a cheaper route to get treated like maybe a physician who can Handel a Crohn's patient and our crazy needs?!?!

 

[nogutsnoglory]

A regular doctor doesn't know the ins and outs of crohn's management. You would be better off finding an affordable GI at a low cost clinic.

 

[Clash]

I agree with NGNG, most IBD'ers have a GI(gastroenterologist) some also see a colorectal surgeon if there is a need due to chance of surgery. And even when you are looking for a GI it is important to find one that handles Crohns regularly(specializes) so to speak.

A regular GP doesn't really have the background to manage IBD nor do they have the time and inclination to stay up to date in a a certain diseases latest treatments. That is why a GP refers you to specialists when it goes beyond their scope of general issues, such as cardiologist, urologist, neurologist.

 

[Jison0612]

I guess it's time to start looking for a good GI then cause my colorectal specialist is way to exapensive my concern is the GI well be just as exapensive!!! And I thought gastros were only upper gi?

 

[Clash]

No, a gastroenterologist is a physician that specializes in diseases of the gastrointestinal tract. That is the entire tract.

A colorectal surgeon is a specialist that specializes managing colorectal disease–eg, hemorrhoids, cancer, perianal CD etc.

A colorectal surgeon isn't usually the doc that manages the treatment of CD. Since, you have a duodenal ulcer that would be something the GI would manage as well as the rest of your GI tract. Since you do have CD then there is a good chance that ulcer is CD related in which case you should be on CD maintenance meds in order to get it under control.

Are you on maintenance meds for CD? If so do you get regular lab work to determine all is well with the maintenance med and your inflammation markers? This would be something the GI would be in charge of. My son is on Remicade and MTX, because of this and the fact that he is not yet in remission he has regular blood work to ensure the CD meds aren't causing problems and to check his inflammatory markers.

 

[Jison0612]

I'm on entocort 9mg daily an several x
Vitamins and i do get blood work but not regularly and I'm sure I'll eventually be on a maintenance med as soon as I end my entocort I'm just having upper stuff along with my backside too so I know I need to get them both checked but can a GI check my back side as well

 

[Clash]

Yes, a GI manages perianal CD as well, but will send you to a colorectal surgeon if surgery is indicated.

Since most maintenance meds take some time(up to 3 months) to reach therapeutic levels then they need to be started before you end your entocort otherwise you may start flaring again while they reach those levels. Waiting until you finish your entocort to start the maintenance med may not be a great idea.

 

[Jison0612]

Well my dr has me tapering down to 2 pills a day next month maybe that's when they'll start the maintenance meds? And do u guys have any experience in who long it takes before a ulcer heals? And I drink coffee a lot!! Could this be slowing down the healing process?

 

[Clash]

It depends on the type of ulcer it is I would think, if it is just a peptic ulcer then that is one thing but if it is CD related then when your CD is under control it will heal.

 

[Jison0612]

It's a duodenal ulcer and all I'm on is prilosec 40mg and entocort but my indigestion and upper abdoman discomfort is beginning to be very frustrating

 

[ronroush7]

Caffeine/dairy can aggravate Crohn's.

 

[Clash]

Some times duodenal ulcers are due to H. pylori:

Infection with Helicobacter pylori (commonly just called H. pylori) is the cause in about 19 in 20 cases of duodenal ulcer. More than a quarter of people in the UK become infected with H. pylori at some stage in their life. Once you are infected, unless treated, the infection usually stays for the rest of your life. In many people it causes no problems and a number of these bacteria just live harmlessly in the lining of the stomach and duodenum. However, in some people this bacterium causes an inflammation in the lining of the stomach or duodenum. This causes the defence mucus barrier to be disrupted (and in some cases the amount of acid to be increased) which allows the acid to cause inflammation and ulcers.

source

But can also be due to this:

Peptic inflammation is inflammation caused by stomach acid. Inflammation may be in the stomach, the duodenum (as acid flows in with food), or the lower oesophagus (if acid splashes up to cause 'reflux oesophagitis'). (The most common type of peptic ulcer is a duodenal ulcer.)

Source

Also due to CD you can experience gastritis(excessive acid production) which can cause the duodenal ulcer.

There is also this, which includes duodenal Crohn's disease:

The five types of Crohn's disease and their symptoms are:

Ileocolitis: Ileocolitis is the most common type of Crohn's disease. It affects the small intestine, known as the ileum, and the colon. People who have ileocolitis experience considerable weight loss, diarrhea, and cramping or pain in the middle or lower right part of the abdomen.

Ileitis: This type of Crohn's disease affects the ileum. Symptoms are the same as those for ileocolitis. In addition, fistulas, or inflammatory abscesses, may form in the lower right section of the abdomen.

Gastroduodenal Crohn's disease: This form of Crohn's disease involves the stomach and duodenum, which is the first part of the small intestine. People with this type of Crohn's disease suffer nausea, weight loss, and loss of appetite. In addition, if the narrow segments of bowel are obstructed, they experience vomiting.

Jejunoileitis: This form of the disease affects the jejunum, which is the upper half of the small intestine. It causes areas of inflammation. Symptoms include cramps after meals, the formation of fistulas, diarrhea, and abdominal pain that can become intense.

Crohn's (granulomatous) colitis: This form of Crohn's disease involves only the colon. Symptoms include skin lesions, joint pains, diarrhea, rectal bleeding, and the formation of ulcers, fistulas, and abscesses around the anus.

Source

Duodenal Crohn's disease alone is very rare but does happen as well:

The commonest pattern of involvement was contiguous disease of the proximal duodenum and distal stomach. Endoscopically, diffuse granularity, nodularity, and ulceration are seen accompanied by lack of distensibility of the involved area

Crohn's disease of the duodenum is uncommon, occurring in approximately 2% of patients with Crohn's disease.

source

You should speak with your doctor to see what type of ulcer he thinks you are dealing with.