surgery question

How do you know when it's time for surgery?  I'm on Humira and Asacol right now but I seem to have many more bad days then good.  I've also tried Remicade and Cimzia with no luck.  I've had Crohn's for 9 years and never have had surgery.  When is it the right time to discuss surgery when medications just aren't working?  Any advice/comments would be helpful! Thanks!

My first criteria would be just how much Crohn's activity where. If your Crohn's is confined to one or two small areas and your quality of life sucks early surgery may well be a good option and wise choice.

IF on the other hand there are multiple areas of disease activity skipped thru out a good share of the intestines .... and quality of life sucks I'd wouldn't be as quick to agree to surgery. I'd have to know a whole lot more about my disease activity, sites of activity, narrowing and stricturing and whether disease activity at the sites of narrowing and stricturing or whether they were due to scar tissue. Whilst the doctors can't guarantee what they feel they are seeing via the various tests they can get a pretty darn good idea if they've run the gamut of pertinent tests. And I would be wanting them to go over the films w/me and point out the areas involved, every one of them. And have to be satisfied we had done all the tests that could best identify the problems.

I know, altho my quality of life was pretty darn good, I would have AGREED to a second resection 9 years ago IF the surgeon would have been willing to concede to leave one area alone that was somewhat narrowed but displaying NO SIGNS of active disease. And that is what we are disagreeing about now. We both agree on the one area at the old anastomosis site, we don't agree on another area below that partial obstruction. When I return to Mayo in October and if we still don't agree - there still will be no surgery done. My quality of life does not warrant surgery yet.

Thanks again everyone. Although I have only been dealing with Crohn's as such for a year, it amazes me when you are pondering a certain situation, there appears some answers.

Next colonoscopy, hopefully they will get to take a look at everything before making the decision as to whether or not to have surgery. And comments about quality of life will be considered as well as I feel pretty darn good and is why I haven't done anything as far as meds or surgery yet.

Good luck lirpamh!

Bammer, you are missing the point. Is your Crohn's in your colon? Or in your colon and small intestine? Or just in your small intestine? Or just the ONE area at the terminal ileum/ileocecal valve/cecum area? If there is no colon involvement except at the TI/ICV/cecum area that the scope can reach do you KNOW if there is active disease elsewhere in the small intestine as well? A scope isn't gonna tell you that!

CrohineToo,

Last July I had colonoscopy, SBFT, gastroscopy and CTScan. Two more colonoscopies since and colorectal surgeon did sigmoidoscopy in June 08 and found  the same, 2 inches of stricture in sigmoid colon which is inflamed and no evident disease on either side of the stricture. Yes I would like to know what is going on everywhere and one reason why agreed to the methotrexate. Previous tests showed one other area of ulceration. Does that make sense?

Yup, as long as it is "just" in your colon. If I had small intestine involvement as well "just" another scope wouldn't be satisfactory to me. I'd insist on knowing as best we could, what was going on in the small intestine beyond the scope's reach as well. And that is in regard to surgery, not about our choices of meds.

GOOD LUCK!!! I hope the methotrexate works wonderfully well for you!!!!!