As promised, I’d like to spend a few posts talking about some of the Crohn’s treatments that my doctors have been discussing, in the hopes of starting to understand my options a little better.
Before even beginning to think about treatments, however, there was another choice to make. As my MD described it, I have 3 choices right now.
- Do nothing until the next major flare occurs,
- Do nothing until testing (blood tests and colonoscopy) can be performed to determine my current level of inflammation, and then either decide on a course of treatment or choose to do nothing, OR
- Begin treatment based on what we DO know until we can get tests and pathology performed, and then adjust accordingly.
From my perspective, door #2 was really the only reasonable choice here. Yes, I *could* just wait for the next flare, but based on my experience of the last 6 weeks, I’d really prefer to avoid a flare if possible. Beginning treatment immediately, on the other hand seemed doubly ridiculous… a) we wouldn’t really know what we were treating, and b) it might throw off the tests and pathology enough to make us think that I’m healthier than I am. So, #2 it is. My colonoscopy is scheduled for the first week of October, and until then, the only treatment I’ll be employing is following the Specific Carbohydrate Diet and taking some digestive enzymes before each meal. This will allow the tests to provide a more reliable baseline on which to base not only treatment plans, but also to better gauge progress or remission of the disease.
So from what treatments might I be choosing? As far as Western, allopathic medicine is concerned, there essentially 5 types of treatment that one can use, some individually, some in combination with others. There are:
- Biologic therapies
I’ll talk a little bit today about the Aminosalicylates. These are a family of drugs used to block the immune system’s ability to create inflammation. Just so we’re clear…. inflammation is caused by the immune system to create an inhospitable environment for invading organisms. This is one of the ways the immune system helps to protect us. It’s also one of the things that goes wrong in auto-immune disorders… the immune system begins creating too much inflammation and causing damage to us. Aminosalicylates come in a variety of forms, administered either orally or rectally. I was relieved to hear that when discussing this type of drug, my MD talked only about Pentasa®, which is an orally administered drug. The idea of regular enemas or suppositories, after all, sounds less than appealing. The downside here is the regimen that goes along with it. 4 pills, 4 times daily. 16 pills a day. The side effects are no picnic either: they “may include abdominal pain and cramps, diarrhea, gas, nausea, hair loss, headache, and dizziness”. That said, it has been shown to be an effective method for limiting inflammation in patients with IBD.
I like the idea of reducing inflammation. Really, I do. But for all I know, there may not even BE any inflammation in my gut right now. If there was, and I started this medication, my tests next month might then show that I was healthy and maybe didn’t need an anti-inflammatory. We can see where this is going… I’d go off the meds and then my next colonoscopy would show my guts looking like swiss cheese!
Aminosalicyclates sound like a bit of a mixed blessing, and until I know for certain that I actually need them, I think I’d prefer to avoid them.
Tomorrow, I’ll talk a bit about the use of corticosteroids in treating Crohn’s.