My wife has fears and I need advice please.

Without knowing your disease status and history it is impossible to say. There are two schools of thought in Crohns treatment -- one saying go big and aggressive early with Remicaid, Humira and the other biologics, the other saying take it slow and climb the ladder from less potent to more potent treatments until you find one that works. The proponents of the go-slow approach say, with some justification, that while you piddle around with less effective drugs, Crohns is doing permanent damage that can lead to surgeries and other major complications.

I sincerely doubt that the motivating factor here is insurance payments. Gastroenterologists have plenty of patients and make most of their income from procedures like scopes, not remicaid infusions, which are usually done at a facility somewhere else anyway.

In your place i would ask the doc why he wants to go to the big gun now and what he expects your future disease course to be with or without it.

Correction: the OPPONENTS of the go slow approach say that . . .

To answer MikeB's questions.........Looking back at things I guess I have been dealing with problems for 15-18 years, but not so bad and constant that I thought there were bigger issues.  I thought I had things traced to certain foods like food allergies.  I am more of an atypical crohnnie, I get episodic pains such.  I am not a constant suffered with mega bathroom trips per day, unless I am going through a spasmodic time.  Last year it got to be almost daily, which got me concerned enough to go to a doc.  So now after dx with mild/moderate crohns and being on the latest go round of pills since march, my GI feels I should have made more progress by now. My ulcerations are throughout the small intestine, the most being at the terminal ileum.  The episodes are getting more painful, although 2 weeks apart vs. daily, and lasting longer.

Since Remicade is designed to put you in remission and maintain remission, I'd do it now. I messed around an entire year avoiding my doctors advice to try Remicade. It makes it less likely you'll get worse and have to pull out the drugs I consider much more dangerous, like stronger steroids, and risk blockages.

 

I've been on Remicade 3.5 years and although I'm not in remission completely, my quality of life is 100 percent better than before. 

Nanners makes a good point; why not propose 6 months of 6mp or Imuran, then consider remicaid if that does not induce a lasting remission. From your description of your disease state, with widespread ulcerations and increasing symptoms, I would wager money that you are experiencing some major damage in there (especially in the narrower small bowel) that could have you headed for a stricture and surgery in a few years or sooner. The bottom line is that what you are taking now is not doing the job. The only question is, do you jump on up to the top of the ladder or climb halfway and see how the view is from there.

My old GI put me on Remicade AS SOON as I was diagnosed.  It took 8 years to diagnose me and I'm sure there was a lot of damage done during that time.  Remicade put it in remission within a few months and it's been in remission since.  We have tried other lesser meds since then, but have always gone back to the biologics.  I am glad that we didn't mess around any longer and got it in remission asap, even if that required the more expensive meds.  And I agree with snappy...many of the other lesser meds messed up my liver enzymes and required me to have liver biopsies, etc., so the biologics aren't necessarily any risker.