Crohns treatment effect on slow healing wounds?

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Crohns treatment effect on slow healing wounds?

Postby seattlesounders » 27 Aug 2011, 09:58

Hey guys,
Would love some advice from fellow post-op slow healers -
I had LIS, fissurectomy and hemorroid banding done 2 months ago. Due to the slow healing I went in to see the CRS for an exam under anesthetic to see the state of the wounds. As expected the doc said to me that the hem would were healing terribly. This prob explains why after all this time I still have some pain with bowel movements and sitting after a BM hurts. He thought there was some kind of inflamation happening higher up the gastro tract and referred me back to my gastro doc.
The theory they both have is that the extremely slow healing wounds I have could be caused by Crohns. (IMPORTANT POINT - Few people have Crohns and some folks are just slow healers so i don't want to cause anybody unecessary alarm, you poor guys have enough to deal with). Anyway, I'm trying to psych myself up for a colonoscopy given the state of my backside and wondering the following -
1. For those of you that were diagnosed with Crohns, did the treatment help heal your wounds?
2. If it isn't Crohns what alternative treatments/explanations have you guys discovered for slow healing?
I'm sorry that you are all going through such tough times, and wish you all good healing and positive energy my friends.
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Re: Crohns treatment effect on slow healing wounds?

Postby PaulsPain » 27 Aug 2011, 19:44

There are several cases on the board of people healing slowly.
I was finally diagnosed with Crohn's after 5 years of fissure hell last fall. My CRS thought my fissures looked more like ulcers verses a typical fissures. He still performed the LIS which I am thankful for everyday. I did heal very slowly and still have a fissure/ulcer that is raw. I was referred to a GI doc after I developed an abscess and high fistuala. This happened about 8 months after my LIS. During the colonoscopy they found indications of chronic inflammation in my ileocecal valve. So that kind of helped confirm the diagnosis. I have my disease mostly in my peri-anal area which is more rare and I think prolongs getting diagnosed. For me all my blood work was normal, biopsies were done in my peri-anal area 2 times looking for granulomas - those tests were always negative, etc. Getting a concrete diagnosis can be a long process.
There are lot of various drugs for treatment and it all depends on what area is being impacted.
I have fistulizing crohn's so the main drugs used are the immune suppressants. The high fistula has a draining seton - the goal is to get this healed with medication. I first started on Azathioprine (Imuran). It can take 3-6 months for the drug to kick in. I did have abdominal pain off and on in the location of the ileocecal valve and that went away. But it didn't do anything for my rear. So I have now added Remicade (biological drug) to the mix. I have had 2 out of the 3 loading doses. The loading doses are given at 0, 2 and 6 week intervals. After the loading dose then you go to a 8 week maintenance interval. The drug is infused so I have to go sit for about 3-4 hours. I get my last loading in another week. I think it has started to help me. My fistula doesn't seem as swollen/tender and the drainage is reducing. The fissure is also feeling less raw. I am sooooooo tired of drainage. I basically have to wear pads and use cotton balls to catch everything. So until all drainage has ceased I am not declaring victory and neither is my GI.
Here are two good resources on Crohn's:
Crohn's Foundation
Crohn's Forum
Best of luck. I hope that your tests are ok and you are just a "slow" healer.
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Re: Crohns treatment effect on slow healing wounds?

Postby val » 28 Aug 2011, 09:45

Paul,
do you think non healing fissures and reoccurring fistulas would be crohns?
I had my first fissure in 2007, LIS and a fistulotomy in 2008, then the fissure kept retearing until in june this year another fistula, a high one this time, formed. Now I have symptoms of yet another fistula - pain, intense itching and discharging/bleeding.
My CRS hasn't mentioned it, just says its one of those things, but it seems strange that it keeps coming back.
Is there any specific test I could be asking for?
val
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Re: Crohns treatment effect on slow healing wounds?

Postby PaulsPain » 28 Aug 2011, 16:24

Hi Val-
Yes, I basically have non-healing fissures and fistula's. My last fistula is in 1/2 sphincter muscle.
Having Crohn's only in your peri-anal area is rare. My CRS told me less than 10% of the people have it only isolated the peri-anal area. So this is where the problem is for getting diagnosed - if you don't present with typical GI symptoms the docs blow it off. I asked several other CRS's in the group about IBD early on and they said nope - which means it didn't get investigated further. I was lucky the CRS I now see has a lot of experience with IBD patients. So right away when he saw my fissure and the inflammation he thought something was not right. I now see a GI doc that only treats IBD patients so I have a lot of trust in him.
There is no one test that can confirm Crohn's. So it can be a long road to getting diagnosed. I was basically diagnosed mainly by site. My CRS liked to use the saying "If it looks like a duck, and quacks like a duck, then it probably is a duck." This was when I was skeptical about things since all the biopsies he had done so far were normal. When I finally had the colonoscopy that finally confirmed things. Both the CRS and GI said most of the time if someone has peri-anal disease they find it at the end of the small intestine. That was the case for me since he found inflammation on my ileocecal valve. The GI used a longer scope to ensure he could reach that far - he even went up my small intestine a little ways. That is why I am always baffled when I read people only have a sigmoidoscopy (sp?) to rule out IBD. IBD can impact any area from mouth to anus.
I am not sure how it works in the UK. But clearly if you continue to develop fistula's the "bad luck" excuse seems lame like the doctor doesn't really want to investigate. Can you seek a second opinion from a CRS that maybe treats IBD patient's? Or can you go to a GI? But a second opinion would seem worthwhile if you continue to have issues.
Remember that you are in control of your health. I always tell myself that I am paying for their service and expect to be treated like a paying customer. Even though I have insurance I am still paying a premium and out-of-pocket costs. If I loose trust, I find another doctor.
I hope that you find some answers soon. These rear end issues get really tiring. At least I feel like I have a little hope now that I have some explanation of what is causing all my issues - Crohn's. Both my CRS and GI told me Remicade works the best for peri-anal disease. I was hesitant to go onto it since it has a list of side effects a mile long. So I really hope it works since I finally took the plunge.
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Re: Crohns treatment effect on slow healing wounds?

Postby seattlesounders » 29 Aug 2011, 00:17

Paul thanks for the fantastic info! You mentioned you healed slowly after LIS. What were you like at around 2 months after surgery? Also do you think my surgery could have kickstarted potential crohns or is it just one of those things that is bound to develop at one time?
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Re: Crohns treatment effect on slow healing wounds?

Postby PaulsPain » 29 Aug 2011, 08:27

seattlesounders wrote:Paul thanks for the fantastic info! You mentioned you healed slowly after LIS. What were you like at around 2 months after surgery? Also do you think my surgery could have kickstarted potential crohns or is it just one of those things that is bound to develop at one time?

I had a lot done at my LIS surgery - LIS, 2 fissurectomy, a fistula layed open and a skin tag removed. So at two months I was still in a lot of pain. The incision healed very quickly. The fissure at the 6 o'clock position and skin tag area (same area) caused me grief for awhile. The LIS did not rid me of the spasms right away either....... So I was taking a low dose of Advil for many months. My rear still feels raw at the 6 o'clock position. My GI said I still had a "suspicious" looking fissure. So I believe this never healed fully but I don't have the spasms anymore so it is more bearable. I still have daily pain but after so long(6 years) you just get used to it.
Crohn's is an auto-immune disease. They really don't know the exact cause. It has been shown that some genetic link may exist. The first words out of my surgeons mouth when I woke up was "Do you have a family history of Crohn's disease?". Ummmmm, No. The cause I currently believe is at some point I was exposed to some microbe that caused my immune system to go haywire. There is a lot of research currently in studying the microbe colonies in peoples gut and seeing how they differ. One thing interesting that I just read recently is the microbe colony profile of a person is very similar to their parents. A co-workers wife has Crohn's and it all started when she went camping and got really sick. It hit her hard - she lost her colon.
It is good that you have a doctor that is going to investigate things now. If you do have something more going on the sooner you start treating it the better. I had fissures for years and then it progress to abscess and fistuala's. I have had a draining seton in now for almost a year now. I always wonder if I would have been diagnosed earlier if I could have avoided my fistula adventure...... That of course is assuming the meds work for me.
Good luck.
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Re: Crohns treatment effect on slow healing wounds?

Postby val » 29 Aug 2011, 10:03

Thanks for all the great information Paul.
I might wait until my next CRS appt, but might go to my GP and ask for a GI referral. It takes soooo long here in the UK, for any kind of appointment, so it might be quicker just to see my CRS.
At the moment I'm waiting for an appt to come through for an MRI to see if it is another fistula, and where it's tracking.
I know what you mean by just getting used to the pain! It would feel strange (but very very nice!!) to wake up without it!
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Re: Crohns treatment effect on slow healing wounds?

Postby of all the places to hurt » 29 Aug 2011, 12:07

Val, reading those informative post by Paul, definately get your GP to refer you to the GI. Also, about waiting for your MRI scan. You can ring them and ask if they have any cancellations. Well, you can up here so imagine it's the same down south??
Paul, brilliant posts!! I really hope ur new meds work! And, I agree about the sigmoids first! All of that after pain and then like me, waiting for what they should of done in the beginning, a colonoscopy. Never mind! Fingers crossed for you both
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Re: Crohns treatment effect on slow healing wounds?

Postby Deleted User 579 » 29 Aug 2011, 13:34

Hey Val - I agree with Andrea. Why not ask for a referral to a GI? It'll take long enough and you might need one down the road. I have my CRS and my GI doc. I got referred to a GI in January and just got to see him in early August! I don't know if I still need the GI doc now, but it's nice to have him and if something happens in the next year, I won't have to wait for a referral. Couldn't hurt, eh?
Paul - I also agree with Andrea that your posts are brilliant. They are so helpful. It is wonderful of you to stay around this forum and be so supportive and helpful to people. It's great to have you here. You really deserve every break and I defintely hope the meds work!
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Re: Crohns treatment effect on slow healing wounds?

Postby seattlesounders » 05 Sep 2011, 17:10

Okay guys prepping for the colonoscopy. ETA till Magnesium Citrate 5 minutes :( sigh. Let's hope I can survive the prep given how tender my backside is. The odd thing is given that I haven't gone to the loo today, I feel almost pain free - so sad that this is the way I used to be. Tomorrow at 9, I'll find out if there are still ulcers in my Illeum, and samples will be sent off for biopsy to test for Crohns. Would be grateful if you guys would keep me in your prayers. Healing prayers to you all
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