Wednesday, March 3, 2010

Hi Ted, meet Crohn's disease - The Drugs

Continued from yesterday's post...

Well, I quickly found out that Asacol was definitely not the drug for me. Soon after I started taking it my symptoms worsened tremendously. I was having abdominal cramps so severe that I would lie in my bed in agonizing pain unable to move. I like to think I have a high tolerance for pain, but this was unbearable. The only way I've ever been able to even come close to describing the pain has been to compare it to someone aggressively pureeing your entire abdomen from the inside out. Sound painful enough? It's been the worst pain that I've ever experienced in my entire life by far. I had to skip several of my classes and stay at home and rest while the rest of my friends were being normal college seniors and going out in the city. What made everything even worse was that I didn't want to eat because eating just made everything hurt more. As a result I lost about 12-15 pounds over a period of about two weeks before my doctor told me to stop taking the Asacol.

I finally started recovering and was back to normal about a week or so after stopping the medication and being put on prednisone. Ah prednisone, the miracle drug. I say prednisone is a miracle drug because it has the ability to work quickly to stop the symptoms of Crohn's disase. However, the side effects of prednisone constitute quite a long list, including rapidly gaining weight, being excessively thirsty, breaking out with acne, hallucinations, mood swings, and many, many others. I've personally experienced all of these, with the only difference that my hallucinations were incredibly vivid dreams. I don't normally dream, nor do I remember what I dream. But these dreams, which happen about two to three times a night, are like I'm wide awake in some fantasy land living a second life. As I taper off the prednisone the dreams occur less frequently and with less detail. And the reason that I have to taper off the prednisone is because it's a steroid, and it's extremely dangerous to just stop taking a steroid after exposing yourself to a high dosage. But at least the prednisone allowed me to recover from my flare-up and get back to feeling, well, normal again.

My doctor, however, wanted me to try Asacol again because she thought that perhaps before it was just my Crohn's running its course. So even though I was feeling better and was tapering off the prednisone, I still needed to be on a maintenance medication to help keep my body in remission. Well, it turns out that it wasn't my Crohn's just running its course, because when I started the Asacol tmy symptoms came back with a vengeance. So my doctor finally switched me over to 6-mercaptopurine (6-MP), an immunosuppressant. Immunosuppressants act to, well, suppress the immune system. Basically Crohn's can be thought of as an autoimmune disease, where my body over-reacts to a pathogen or some stimulus and then starts attacking my own cells. So by kicking my immune system down a notch, my body should behave normally.

The only problem with taking the 6-MP is that it would suppress my immune system, so I would be significantly more likely to catch a cold from an ill classmate and take longer to fight it off. Moreover, I would become categorized as a “high-risk” individual when it comes to getting the flu and swine flu vaccines because my immune system would be suppressed. So while the 6-MP has been good for treating my Crohn's disease so far, it's still a dangerous drug. To let you know exactly how dangerous it is, some patients suffering from leukemia receive 6-MP as part of their chemotherapy regimen. It's also so dangerous that the drug label tells me to wash my hands before and after handling the medication.

However, so far the 6-MP has been doing its job and keeping me in remission. Well, for the most part. I've had one significant relapse since my initial diagnosis in 2008, but this relapse was so violent that it required me to go on double the dosage of prednisone just to get my body to calm down again. Also, while in my first flare-up it only took about a day or two for the prednisone to get me close to feeling normal again, this time it took double the dosage almost a full week to get me feeling almost back to normal. So in a way I'm worried that my Crohn's disease is progressing and I may have to advance to the next level of drugs, the biologicals.

The biologicals are the next class and the newest class of drugs availabel to treat Crohn's disease. I almost consider them to be the “sci-fi” drugs because these are the kinds of ideas for drug treatments that you see on the news and think to yourself, “Now wouldn't that be cool.” Well, they're starting to become real. These drugs consist of antibodies given by injections or by an IV drip in a hospital. Antibodies are proteins that are extremely specific for the things that they target, and they are so specific that they usually only target one particular thing out of the hundreds of thousands of things floating around in the cells of your body. The idea behind these drugs is that they target specific factors associated with Crohn's disease or ulcerative colitis. Not only are these drugs extremely expensive at around $1000 a month, but they still don't cure either disease. So in a way the drugs can be extremely helpful and keep many patients in relapse. But at the same time these drugs can be dangerous, expensive, and have costly side effects. But with time and further research we will improve treatments and come closer to finding a cure.

To be continued tomorrow with Hi Ted, meet Crohn's disease: Remission and Living with Crohn's.

1 comment:

  1. I promise you, the biologics are not that bad! We should talk about our autoimmune journeys sometime...but distance running has seemed to be a great help to my body in ways big and small (This is Meredith, by the way)...