Questions and Answers
The surgeon is saying that Dad has Crohn's disease (although he has had no symptoms whatsoever for 74 years). Most unfortunately, my youngest sister felt Dad "needed to know" the horrible story of her 28-year old friend with Crohn's who has to have a surgery annually to remove a foot of her colon, is in a wheelchair, and on dialysis, and insisted on "sharing" that horror story with him while he was in ICU.
We went in for a post-surgical check this afternoon. His surgeon is saying that the chances of another surgery of this kind are 50-50. The gastroenterologist and the other staff surgeons in the hospital told me that Crohn's was a difficult diagnosis at best because of a lack of previous symptomology. I'm confused, and my father is panicked. Short of ordering the pathology report (which I have done), I need to know if 1). any other condition could mimic Crohn's (i.e. possible adhesions from prior abdominal surgery); 2). the possibility (within reasonable medical certainty) of Dad having any more problems or surgery like this again (should we hope that, since it took 74 years for this to manifest that it will be another 74 years before there is a like problem?); and 3). if it is indeed Crohn's - can it be managed pharmacologically with any sucess at his age? As a side note, Dad is having no nausea and regular BM's ever since his release from the hospital last week and has gained 4 pounds back.
Question 1 sorry, I'm not competent to comment - however, I would have thought that such a diagnosis, admittedly difficult, would only result from the surgeon's examination of the resected small intestine and the pathologist's report (and you say you're getting a copy of that). In the absence of any symptoms, the diagnosis must have been based on physical evidence.
Incidentally, most cases occur before age 40 with the peak incidence in the 20's. The most common presenting features are chronic diarrhea associated with abdominal pain, fever and anorexia (and your dad has none of these). Some may occur without prominent gastrointestinal symptoms but have perianal fistulas or abscesses, or with otherwise unexplained arthritis, erythema nodosum, fever, anemia. Question 2 Surgery is usually necessary only when recurrent intestinal obstruction or intractable abscesses or fistulas are present. Resection of the affected segment of bowel may result in amelioration of symptoms indefinitely, but is not a cure. In some cases another operation is required.
Question 3 There is no specific therapy, however there is pharmacological help. Should there be cramps and/or diarrhea, several remedies are available - loperamide, codeine, diphenoxalate to mention a few - methylcellulose or psyllium preparations will help prevent anal irritation by increasing stool firmness. In the acute stage of the disease, corticosteroid therapy may dramatically reduce the distressing symptoms, increase appetite and sense of well being. Oral prednisone is used in a carefully designed program. A very recent study on chronically active Crohn's disease has shown that the drug methotrexate, originally used to treat tumors and now being recognised as effective in osteoarthritis, can reduce the symptoms as well as decrease and in some cases, eliminate, the need for prednisone.
Trust this has been of some help - if he needs it, there's lots of help out there.
Best wishes to you and your Dad.