Mine was Elective. I was on all the basic stuff, Asacol, Lialda, Prednisone, Imuran, steroid enemas, there were a few more pill names i forget. none worked except prednisone but we all know you cant stay on that stuff. I moved on to Remicade, was good for a few months, then i started have an allergy to it, alot of itching for days at a time after infusion, came off that, went to humira, that worked for almost a year but then it gradually started to work less and less. next stop was either methotextrate that was not approved yet so i would wait or talk about surgery, so we talked and i researched a few doctors, found one, did a consult, he made it exceptionally clear he doesnt recommend the J-pouch and that an Ostomy is best but that he would do J-pouch if i wanted to try it, so with the feeling that he would do it half-ass with that kind of attitude i looked for another and found a wonderful doctor, Dr Kerry Hammond at MUSC to this day shes my go to for gastroenterology, weve become good friends, she was at my wedding a few months ago. only thing i wish i would have tried first before surgery was VSL3-DS, it may not have done much or anything but something just says i wish i would have tried that first.