Medical Rock and a Hard Place
 

Hey all,

My life has suddenly got very shitty, and I've been given a choice that sucks all kinds of balls. Some of you are aware that I have Crohn's disease, and I have a pretty severe case of it.

The drugs I've been taking for the past 8 years, the wonderful side-effect free drugs, are no longer working which means I must start on a new drug. I have a choice of three different types of drugs, all with incredibly shitty side-effects.

Type 1: Steroids - increased chance of osteoporosis, abnormal weight gain, hypertension, blindness, heart disease, and dementia.

Type 2: Immunosuppresant A: increased chance of my partner miscarrying my child, and its a mild carcinogen. Requires blood-work every 2 weeks the rest of my life to ensure I don't develop a lymphoma.

Type 3: Immunosuppresant B: increased chance of any infectious disease, X-level teratogenic (meaning any woman I impregnate will more often than not get a highly deformed child).

Honestly, steroids are a short-term option (and I'm currently on them until I can choose which treatment I want to stick with for the rest of my natural life). The risks associated with long-term steroid use are quite high so I'd rather not go that route.

So I'm stuck between a mild carcinogen that could cause miscarriages, and a drug which will ensure that I probably will never be able to have kids. Needless to say, both me and my fiancee is very unhappy with the options, but its either one of these drugs or I'll probably end up needing to get my whole intestine removed.

So what say you, NPFers? Which would you choose?

You're quite right; this sucks balls.

However, I'd go with the type 2 choice. Why? First off, less of a chance of malformation. Secondly, with blood testing that frequently, your chances of detection (And therefore a successful treatment) are that much greater.

If I never planned to have children, I'd probably still go with type 2. While I'm assuming that Immunosuppressant A does increase your chance of infectious disease, B is much more severe. Losing your immune system is pretty debilitating at a much more frequent level then cancer, and while I'd hate to have to go through rad and chemo, I think I'd dislike having to be hyperparanoid about possible viral and bacterial contamination. Speaking of which, you're in Toronto, correct? Remember how things spread in the winter.

I wish you and your fiancée the best of luck, Swordchucks.

Ah, geez. Crohn's is shitty. Sorry to hear about it.

I would have to say go for the second option provided that it doesn't increase your chances of infection as much as the third. I've known people whop went with option 3, and I think even with cancer their quality of life probably would have been better than it was being so susceptible to infection. Also; at least with option 2, you don't have to worry about what might happen if you do manage to conceive. That's my two cents, anyway. You probably already know more about the options available to you.

Is it possible for you to freeze some of your sperm now so that you can use it later if you want to conceive? I've heard of that being done.

For that pun, you shall die a horrible, alimentary canal-related death. :p

In all seriousness, though, my advice would be to go with treatment 2, then switch to treatment 1 while trying to conceive, if that is possible. Since treatment 2 requires bloodwork every two weeks, it's going to require your doctor to monitor your condition closely, which is a good thing, especially since you and your fiancee would like to have kids.

Talk to your doctor. I'm sure that if he or she is aware that you want to have children, your doctor will work with you to create a plan of treatment that will help you and your fiancee to have healthy children without compromising your health.

I wish I'd stayed in contact with a friend of mine from high school. His dad had Crohn's, and he was one of several very intelligent, healthy children.

If all else fails, maybe your and your fiancee could visit Nebraska and adopt some abandoned children.

It does sound like option 2 is the least horrible out of those three. What would the consequences of getting your colon removed be, though (especially compared to permanent 'roid side effects, possible cancer, a shot immune system, reproductive problems and having Crohn's)?

Primarily the fact that Crohn's disease isn't like colitis that removal of the colon solves all problems. When a colon is removed form a patient with an aggressive form of the disease, it often spreads into the stomach, throat, mouth, and eyes. Its really hard to treat then, and can even result in death. Because of this, surgeons try to take as little bowel as possible in Crohn's whereas they might actually suggest removing the whole thing in colitis.

I'm actually in Halifax, and to be honest I've made worse puns than BitVyper. My favorite one is when I'm off to a treatment or the drug store or the bathroom to say "I'll be back. I've just got some crap to take care of."

I would personally take option 2. Some things can be worse than getting blood work done often, and if you are just very careful to prevent pregnancy with your significant other, then miscarried offspring isn't a problem. If you want a child, adoption and donations are still a solid possibility. Sorry to hear the bad news.

If you plan on having kids with your fiance, then 2 is the obvious choice. If you end up wanting to adopt or not have kids then #3 seems like the best choice.

If you do go with #2 and try to have kids, you'd better do some emotional bracing.

Honestly, I'd go with option 2. Unless your family has a strong history of cancer or you're already being exposed to other carcinogens, I'm sure the risk is rather low. Or maybe not, considering it would require monitoring on a biweekly basis. If you were in America, I'd be more confident about your safety, because we're ready to sue if so much as aspirin is found to make one in a zillion people not stop having a headache. The rest of the world's drug industries aren't quite so paralyzed, but you guys have a much better notion of informed consent when it comes to the dangers of medication.

Frankly, I'd be better able to help if you named the drugs in question. In pharmacy school, I learned about a few good places to find info on drugs and various other chemicals, so I might be able to remember a few of them if I think long enough and pull up some detailed info. If nothing else, there's Medscape.

Drug 2 is Azathioprine. Drug 3 is Methotrexate.