Crohn’s more insight you’ll gain into your doctor’s treatment

  Crohn’s is a lifelong condition requiring continued management and monitoring. It’s for this reason that you should feel comfortable when talking to your gastroenterologist. You are a part of your own care team, and your appointments should leave you feeling empowered. Finding a doctor who is the right fit for you is an important step in successful disease management.   It’s important to ask questions. Keep a journal for recording questions as they arise, and bring it with you to each appointment. The more knowledge you have, the better equipped you’ll be to manage your condition, and the more insight you’ll gain into your doctor’s treatment approach.   1.  What are my treatment options?  Your doctor should be able to give you information about the various treatment options available for Crohn’s disease. Crohn’s is not curable, so the goal of treatment is to put the condition into remission by reducing inflammation. This can be done several ways: Medication There are medications you can take to treat Crohn’s. They include: Aminosalicylates (5-ASA) – to decrease inflammation in the lining of the colon Corticosteroids – to suppress the overall immune system Immunomodulators – to reduce inflammation by suppressing the immune system Antibiotics – to treat infections like abscesses Biologic Therapies – to target and reduce the inflammation response Each medication has advantages and side effects which your doctor can explain. Diet Food and Crohn’s disease have a complicated relationship. Certain dietary items can trigger flares, making them items to avoid. Examples include diary, fat and fiber. Sometimes temporary bowel rest is a treatment approach for Crohn’s. These challenges combined with intestinal inflammation that can interfere with nutrient absorption make malnutrition a complication of Crohn’s. Your doctor should have strategies for dealing with the Crohn’s dietary puzzle.  Surgery Sometimes surgery is required to treat Crohn’s. This is done to repair or remove diseased sections of the gastrointestinal tract, or to treat an emergency such as a bowel obstruction. Ask your doctor for the criteria that should be met for surgery to be an option.  2.  What can you tell me about biologics?  Biologics are the latest treatment innovation for Crohn’s. They are medications made from living cells and they work by targeting the inflammation process. Some of them target tumor necrosis factor (TNF) to reduce the inflammation it creates. Others block the movement of inflammation properties from moving to inflamed areas of the body like the gut, giving it time to rest and recover.  Biologics come with side effects, primarily relating to suppressed immunity. Ask your doctor about the pros and cons of this treatment approach to see if it’s a good fit for you.  3.  Do you favor a top-down or step-up treatment approach?  Typically, biologics are used in a step-up approach, after conventional approaches don’t produce anticipated results. Sometimes, however, doctors opt for what’s known as a “top-down” strategy in which biologics are introduced sooner than later with the hopes of avoiding damage to the intestinal walls.  Your doctor can discuss with you the merits of risking infection with biologics to prevent intestinal damage, or taking a more conservative approach and starting with topical steroids and working your way up.  4.  How do you manage remission?  Managing remission involves monitoring your condition and protecting you from new flares. Ask your doctor what kind of regular assessments you will have, ranging from clinical observation to blood and stool tests.  Traditionally doctors have relied on symptoms alone to determine if you’re in remission. Sometimes symptoms don’t match the level of Crohn’s activity, and further testing provides better information.  Ask your doctor about continuing with medication during remission. This is typically the recommended course of action with the goal of protecting you from experiencing new flares. Your doctor will likely advise you to stay on the same medication that put you in remission, and to continue taking it as long as you encounter no adverse effects.  5.  Can alternative treatments help?  Research has yet to demonstrate that alternative therapies can effectively replace conventional treatment. As such, complimentary approaches shouldn’t replace your medication. If you do decide to try things like fish oil, probiotics or herbal supplements, check with your doctor first to make sure that they don’t interfere with your medication.  6.  What lifestyle advice do you have?  Lifestyle has a tangible impact on any condition and Crohn’s is no exception. Ask your doctor about stress reduction, exercise, and other helpful changes you can make such as quitting smoking.  The Takeaway The success of your treatment hinges upon your involvement, as well as the working relationship you have with your doctor. Prioritize asking questions, and try to learn as much as you can. The more you know about Crohn’s, as well as your doctor’s treatment strategies, the more equipped you will be to effectively manage your disease.