Oh there's always the "what if's" to haunt us (the little red devil on our shoulder). You really have to try and be pragmatic about
it all, and separate the emotion from it as best you can. Ask yourself "how much time can I schedule to try the next treatment and have a bad QOL?," draw it on the calendar. Ask yourself what would the surgery schedule be like, and recovery times and compare them. You just need to determine how much time you can loose suffering/recovering and not let the years go by in a whirl waiting for a miracle. As the next miracle treatment you are waiting for may never work for you.
In the end, it depends on your current quality of life (QOL) on how long you can wait, if you're absolutely miserable then it is much easier to make a leap into a big change like surgery. If your QOL is good then it is harder to make drastic changes and you have more time to experiment and try more things before going to that nuclear option. Just don't put off a surgery forever due to fear, as the grass might truly be greener on the other side of the fence should we be brave enough to look/see/do it for ourselves.
As far as the actual scientific research goes, if you've failed two different classes of biologics (like remicade and entyvio) then the odds of a 3rd or 4th biologic working for you are fairly remote/small. After failing a second class of biologics, you're often refractory (that is non-responsive) to all medications and only prolonging the inevitable. Given, there are a few success stories where a third class of biologics worked brilliantly (suzyq's husband was considering surgery after failing 3 biologic classes and xeljanz worked a remission miracle), so nothing is impossible and no rule is absolute. On the other side of the coin, we had a poster die during surgery in 2018 because he putt off surgery for so long partly due to fear and the hope that the next treatment would ultimately work. So there is that word of caution too, if your underweight/anorexic and in poor health going into a surgery then the odds of troubles are much higher (believe he had a heart attack under anesthesia). So, it is important to weigh all options, be as pragmatic as you can, and make your best leap of faith to whatever is your best choice. There will always be some uncertainty to your next move (whatever that is), but you just make you best educated guess and leap for it.
In your situation, I would ask for a surgery consult, a no obligation question and answer session with a colorectal surgeon. Ask your doctor for a referral to see one. There you ask a surgeon all of the questions that worry you about
a surgery (how long till I recover, what complications are possible and at what odds, I'm athletic when can I jog/bicycle/play basketball again, etc etc). It's all part of homework, due diligence, and truly understanding all of the options presented in front of you, and whether or not you are ready for each option. You might not ultimately need it, but knowing is half the battle. Often misconceptions feed fear, and once you turn the light on with knowledge to see what's really banging in the dark outside, it's nothing but a trivial worry (an unlatched door banging in the wind and not a monster our mind brewed up).
Post Edited (iPoop) : 1/2/2019 11:57:25 AM (GMT-7)