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View Poll Results: Which method did the doctor start your treatment with?
Top down 3 23.08%
Bottom up 10 76.92%
Voters: 13. You may not vote on this poll

08-13-2011, 08:15 PM   #1
RFarmer
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Ignore this thread, I am dumb.

I read a variety of different ideas on whether doctors prefer to use light drugs and go upwards, or whether they use heavy drugs first to prevent further damage... I asked my GI about this, and he said it's one of the great debates amongst GI specialists... So, I wanted to know:

Did your doctor start you with heavy drugs? (top down) Or did he/she start you with light drugs and work your way up? (bottom up)

PS: I'm not really sure why people call the heavy drugs a top-down approach. But my definition of top-down has to to with psychology, and not medication. So, I'm likely confused. Nonetheless, I defined lighter medication therapy as "bottom-up", because (when describing how a human analyzes things) that is the opposite of "top-down"...

TL;DR : I have no idea what I'm talking about.

I am also stupid, and forgot to add a poll, and now I can't, because editing will not allow for it :/

I'm going to go crawl into a cave now, and die of embarassment.

Last edited by RFarmer; 08-13-2011 at 08:17 PM. Reason: I forgot to add a poll!
08-13-2011, 08:32 PM   #2
Crohn's Mom
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Pre-surgery my daughter was "bottom up" and it didn't help.

Post-surgery it was decided that it was better "top down" since supposidly all of her disease had been "cut out" - she was immediately started on Cimzia.

Today- she is beginning to be very sick again (4 1/2 months post op - 100+ cm. Of bowel removed; and temporary ileostomy + Cimzia)

I wish I knew if it would have been better pre-surgery to take the "top down" approach. I know her disease is very aggressive, but still I wonder. :/
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08-13-2011, 08:42 PM   #3
DustyKat
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Let me know the questions you want and I will add the poll.

Dusty.
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08-13-2011, 08:51 PM   #4
KWalker
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My doctor started me with prednisone, then once that didn't work, he started "testing" me with injections, and he told me it was all trial and error because everyone is different. It seemed everything I took worked amazing, then after having it in my system, the effects wore off, and although I was on these medicines, they weren't doing anything at all. I remember the doctor putting me on methotrexate pills every Monday, and told me I wasn't allowed to go to work for two days after each pill. I wasn't sure why, but soon realized why. They did more bad then good, I was throwing up everywhere, couldn't eat, etc. His explanation was "trial and error".
08-13-2011, 08:52 PM   #5
DustyKat
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Sarah was only diagnosed during emergency surgery so went straight into remission and onto Imuran.

Matt was initially put on Prednisone, Flagyl and Imuran. His treatment ended up taking a different path due to a fistula and abscess but if it hadn't the GI was giving about 8 weeks to respond. If he didn't have good clinical and objective markers at that stage to indicate he was heading into remission he was going to apply to the government for Humira.

Dusty. xxx
08-14-2011, 12:16 AM   #6
Entchen
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Aww, the psychologist (and teacher of a cognitive psych course) loves that you know the definitions of top-down and bottom-up processing.

My GI starts light and goes heavier only if absolutely needed (and even then, only after trying everything else and waiting to see if things get better on their own).
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Dx: Moderate Crohn's in 3 locations
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Have used: 4500 mg Pentasa, 4500 mg Salofalk, Flagyl, Cipro, 50 mg Prednisone, 9 mg Entocort.
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Claim to fame: "loopy and floppy" colon
08-14-2011, 03:45 AM   #7
Grumbletum
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Lol, Ben, you'll get there. As a former EFL teacher, my definitions of top down and bottom up relate to language teaching.
My docs have taken the bottom up approach, but since getting diagnosed, I seem to be climbing the Pyramid quite quickly. GI has applied to the board for Humira.
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Previous: Prednisolone, Mesren, Omeprazole, Infliximab, Azathioprine
Current: Pentasa, Librax, Warfarin
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08-14-2011, 07:58 AM   #8
rygon
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Bottom up approach. Started on pentasa, then put on aza. Pentasa was changed to asacol, then mezavant. Had predfoam and pred when flaring. Now on infliximab
08-14-2011, 09:24 AM   #9
Ian
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Bottom up.

But it's followed the progression of my disease. It began as just proctosimoiditis so all that was needed was Asacol and Predfoam enemas. It spread to the left side so I required Pred to induce remission on 2 occassions, before a 3rd where the Pred didn't work and my entire colon was affected, so biologics and 6MP were introduced.

I've had my disease for about 6 years though. I think the top down appraoch is quite a recent development.
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Dx Ulcerative Colitis Oct 2005 (age 19)
Dx Crohn's Colitis Feb 2010 (age 23)
Dx Indeterminate Colitis (IBD unclassified) Oct 2011 (age 25)
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Currently taking:
6MP (75mg daily)
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Have taken: Humira, Infliximab (Remicade), Prednisolone, Predfoam

Last edited by Ian; 08-14-2011 at 01:04 PM.
08-14-2011, 10:13 AM   #10
RFarmer
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Wow guys! Thanks for all the replies!

Dusty: I don't remember the layout of the polling system, so if you could make it so it clearly asks which method your doctor followed (top down or bottom up) it'd be great.

Thanks a bunch!
08-14-2011, 12:11 PM   #11
kllyeve
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Bottom up

Pentasa for about one year - then when I finally got someone to listen that I wasn't really getting any better and in fact felt worse than ever - I've been "moved up" to Entocort.

My Gi said that each medicine may only work for so long - so its best to save the really powerful drugs for last if at all possible.
08-14-2011, 01:33 PM   #12
jesseiam2
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I guess I have to answer none of the above! By the time my docs got the diagnosis right, things were so damaged they went straight to surgery. Post op I had Asacol and Prednisone but that was only for about a month, then I went 13 years in remission with no meds whatsoever.

Now I am having an issue so they are jumping from 60 mg of Pred to Entocort to starting in September with Humira and 6MP. Its just my observation but I think docs now are far more aggressive now than they were 13 years ago. Not just about this, but probably everything.
08-14-2011, 01:41 PM   #13
Entchen
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Makes me wonder if we have the same GI! /jk (Although our GIs most likely are in the same city.)

Bottom up

Pentasa for about one year - then when I finally got someone to listen that I wasn't really getting any better and in fact felt worse than ever - I've been "moved up" to Entocort.

My Gi said that each medicine may only work for so long - so its best to save the really powerful drugs for last if at all possible.
08-14-2011, 01:56 PM   #14
tiloah
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Top down. I was put on Pentasa and Entocort after being diagnosed, while we waited for tests and such. My doc wanted to put me on Imuran, but I am one of the lucky 10% of the population who doesn't have the enzyme to metabolize it. So he tried to get me Humira which took months to get approved (and multiple appeals) and was very stressful.

I was on Humira for a couple of years when I had a "flare" and was put on Cipro and Flagyl. A few months after that I was diagnosed with C. diff and a few weeks after treating that (with Flagyl) I was scheduled for surgery. Now my doc wants to see how I do with no meds, which makes me very nervous.
08-14-2011, 03:12 PM   #15
RFarmer
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Everyone vote!
08-14-2011, 10:34 PM   #16
lookame
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I've slowly been adding medicines since my diagnosis. First was lialda(4pills daily) then 6mp. I'm labeled severe crohns by the inflammation and ulcerations in my colon and that it's spread throughout my entire colon. It also resembles a lot like UC by how mine spread(decending to transverse to ascending colon).
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Bloodwork is indeterminate IBD, biopsies are crohns positive, symptoms and visually it's UC

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