Tough situation... :ghug:
Can you just have an 'unemotional' discussion with him and simply lay out the pros and cons of each path? ie explain the risks of untreated and undertreated crohns, even the possibility that, perhaps, things won't worsen but that while nothing is impossible, it's very unlikely that the disease won't worsen. Explain what the possible outcomes will be - the consequences of fistulas and/or abscesses, the subsequent need for surgery, the 'downtime' while he's recovering from treatments/surgery, how this will impact his plans for school and travel and complications/scarring left after surgery. The upside of 'not' treating is simply skipping the act of not taking his medication (but quite a small 'upside' compared to the consequences of under treatment). Also, this 'upside' will be temporary because, eventually the disease will worsen and he'll then have to agree to his meds anyway.
As far as choosing meds - I don't have experience with imuran but also discuss the requirements of imuran - it is daily (at least once a day??), this will always have to be a factor in planning (ie away for the weekend - take the meds), carry extra meds always in case of a last minute decision to stay at a friend's place, etc. (If not planned for and meds are missed, you're back at the consequences of un/undertreated crohns.) What does his doctor say about using imuran only? It may be that imuran will be enough??? But, I don't know as my son has never used it nor has he had perianal issues. If imuran is sufficient, there are benefits as well... it is easy to carry, convenient in that it can be done anywhere, etc.
And, also truthfully discuss the pros/cons of remicade - it's success rate is improved when it's used as an initial treatment and when used soon (1-2 years) after diagnosis. So, if you're going to use it eventually, why not when you can get more 'bang for your buck'?
He only needs to 'think' about it every 6-8 weeks, he doesn't need to worry about dosage, etc. - he walks in, they prep him and he can sleep, watch a movie, listen to music, do homework, etc. for the two hours. However, he does have to make time for the infusions on a regular basis and he does have to plan ahead to make apptmts that will fit his schedule as best as possible. Another benefit with remicade is that they will do blood work at the same time, so no need to go to a lab to have blood drawn on a regular basis (as will be required with imuran).
There's also humira? Similar to remicade but without the need to go to an infusion centre. He will learn to self-administer the injection so again, transportable, convenient, etc. but, have heard it is painful and must be done every one or two weeks (so, again something that must be planned to a degree).
In the end, I would tell my son that given his age, he certainly deserves to be part of the decision, however, if he intends to take on the responsibility of making the decision, he must also take on the responsibility of making an 'educated' decision as he will be the one who will suffer the consequences the most (although, we know as parents, we will be suffering right along!
)
This is pretty much how I have dealt with my son in his decisions re treatment. He had been on only supplemental EN when we moved to the adult GI (when my son was 18) and his adult GI wanted him to go on remicade. To be honest, the med scared me and I would have preferred he tried another less traditional treatment first, however, the GI and I discussed all of the above with my son and it was my son's decision to move to remicade as he didn't want to risk undertreated crohns. I believed my son had made the best decision he could with the available information (as I was doing) and, as neither of us have crystal balls
, I couldn't fault him for not making the same decision as mine would have been.
I hope this helps... it's a tough situation for him to come to terms with and very tough for us, as parents to accept and watch our children deal with it. :ghug: