About Hepatitis C

Hepatitis C is an infectious disease affecting the liver, insidious in that its symptoms don’t often show themselves until the organ has sustained major damage. Liver scarring and the more advanced scarring known as cirrhosis which this infection causes, often has taken place before the disease is discovered. For years, this form of hepatitis was known only as non-A, non-B hepatitis. It was not formally identified until 1989.

The hepatitis C infection is caused by blood-to-blood contact. In about fifteen per cent of the exposed population, the infection will pass on its own. For the other eighty-five per cent, the infection remains and sometimes will cause further complications such as liver cancer and advanced cirrhosis.

Symptoms

Once a patient is symptomatic, hepatitis C often presents itself with flu-type symptoms such as nausea and vomiting, fatigue, abdominal pain, joint pain and lack of appetite. There may be itching and jaundice. The skin may appear yellow, or jaundiced.

Other indications of more advanced hepatitis can be swelling in the abdomen, and a tendency to bruise and bleed more readily. Some individuals are first diagnosed with hepatitis C when they have had excessive nosebleeds. Sometimes a person may seem slower mentally than they have been. This is due to toxins not being processed by the liver as they normally are. Veins may have become enlarged in the esophagus and stomach regions.

Diagnosis

Blood tests will be done to determine the presence of the hepatitis C virus in the bloodstream. There are several genotypes of the virus, and it is important this type is determined in order to know which treatment the virus will be most responsive to.

A magnetic resonance elastography will often be done in place of the more invasive biopsy. This test uses sound waves to produce images of the liver, and can show liver damage, color, and consistency. Where the elastography is not practical, needle biopsies will be done. Either of these tests can confirm diagnosis and monitor liver damage.

Treatment

Treatment for Hepatitis C is individualized for each patient depending on how far the disease has advanced and how much damage to the liver has occurred.

Treatment for most hepatitis C patients includes a weekly injection of a drug that combats the virus and oral doses of broad-spectrum antivirals. If the infection is genotype I, this treatment may completely clear it. There are chemical agents that can be used to relieve the depression and boost the lowered blood counts which are side effects of the antiviral medications.

In most hepatitis cases, the diet will be revised to avoid fat, alcohol, and other substances that could further damage the liver.

Patients with genotype II or higher whose liver disease is more advanced may require further care such as radiation, surgery, or liver transplant. Even following transplantation, hepatitis C will often recur in these advanced cases.

The best chance for hepatitis C survival is to prevent it in the first place. Hepatitis C can be spread through tattooing, sharing drug products and personal items, rarely through sexual contact (in cases of a bleeding sore) and through invasive procedures such as injections. In the United States, medical blood transfer or blood product procedures done prior to 1992 also presented the possibility of hepatitis C transmission.

Anyone who feels they may have been exposed to the hepatitis C virus should seek medical attention from the best clinic in order to be tested. If the virus is found in an early stage, chances of cure are much higher.

 

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Blood in the Stool Not Uncommon for Crohn’s Patients

When I saw it, I screamed.

I tossed my jacket on the back of a chair on a warm afternoon in March and headed for the bathroom. The familiar abdominal cramping from Crohn’s disease hit a few steps later.

When I finished in the powder room, I was shocked to spot patches of bright red blood on a piece of bathroom tissue. I just sat there for maybe 30 seconds, already convinced I was dying of cancer.

Blood in the stool is actually pretty common for Crohn’s patients. While the most frequent signs of the disease patients first notice include abdominal pain, cramping and diarrhea, loss of appetite and rectal bleeding are also high on the list, according to LivingwithCrohn’sDisease (LWCD).

Information from the Mayo Clinic suggests that one of the problems in determining whether a patient has Crohn’s or ulcerative colitis is that both diseases can cause intestinal bleeding. Other conditions that are culprits are colon polyps, peptic ulcers, colorectal cancer, constipation, diverticular bleeding, infection and lack of blood supply to the bowel.

The initial question at every visit I’ve made to the best gastroenterologist for treatment is the same: Have you experienced any bleeding? My usual answer has been that I had isolated episodes. Being able to provide the dates only reinforces the need for all Crohn’s patients to record their symptoms on a calendar they bring with them to all medical appointments.

Every physician who has laid eyes on me since I was finally diagnosed with Crohn’s after 20 years of suffering has reiterated that those with the disease are at higher risk for intestinal cancer than individuals in the general U.S. population. However, just because you have rectal bleeding doesn’t mean you have cancer.

What causes blood in stool for Crohn’s patients? There are several possibilities, according to the Mayo Clinic.

Foods and supplements: You might see blood if you’ve ingested beets, licorice or blueberries. Other potential causes include medications such as bismuth subsalicylate, which is sold over the counter as Pepto-Bismol. Any of these can temporarily change the color of solid waste to red, maroon or even black.

Crohn’s disease: Either inflammatory bowel disease – Crohn’s or its first-cousin, ulcerative colitis – can result in intestinal bleeding. Crohn’s disease itself causes tissue in the digestive tract to inflame, ulcerate and bleed on occasion. Food passing through your gut can also aggravate the inflamed areas, causing them to bleed. The blood in stool you notice could be either bright red, meaning it’s from a lower part of the gut, or darker, indicating it probably originated higher in the digestive tract.

Hemorrhoids: Let’s just say they’re not rare among Crohn’s patients, especially those who have had surgery for anal fistulas or fissures. You might notice small drops or smears or bright red blood in your stool, in the toilet bowl, or on the tissue.

Other than scaring you half out of your mind, what are the effects of blood in the stool? The National Digestive Diseases Information Clearinghouse (NDDIC) states that rectal bleeding can indeed be serious and might not stop without medical intervention.

The most common side effect from prolonged bleeding is anemia, which makes the patient feel tired. Anemic individuals have lost too many blood cells and can also experience weight loss, issues with their skin and fever.

Not all blood in stool is visible to the naked eye. Your medical practitioner might conduct repeated lab tests to reveal minute quantities that you can’t see, according to NDDIC. Finding microscopic quantities is often a diagnosis indicator for Crohn’s.

The Clearinghouse suggests the first mode of treatment if the bleeding is actually tied to Crohn’s is to bring the disease under control with medication. The typical drugs used include anti-inflammatories, steroids and immune system suppressors. However, some patients might need surgery to treat blockages, fistulas, infections and bleeding if medication cannot resolve them. Most commonly, this involves removal of the smallest part of the affected areas of the bowel.

What should you do if you have Crohn’s disease and see or suspect blood in your stool? First and foremost, don’t panic and head to the nearest emergency room unless you’re bleeding profusely. Under most circumstances, isolated episodes warrant a call to your physician’s office within 24 hours for advice on how to proceed.

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How I’ve Learned to Live a Normal Life with Crohn’s Disease

This article is the first time I’ve spoken or written about having Crohn’s Disease to anyone other than my doctors and the support group I attend. I’ve spoken openly about having Chronic Fatigue and Immune Dysfunction Syndrome, Fibromyalgia, and even about clinical depression. So why not Crohn’s? Maybe because it’s mostly a bowel disease, and I was raised in a family where all bathroom functions were avoided in conversation; they were considered private, and to some degree that has stuck with me.

Maybe because my father died in part from intestinal cancer, and if I admit I have an illness that can make me more likely to have intestinal cancer than people who don’t have it, I’ll get it (yes, it sounds silly – but women with a family history of breast cancer often do the same kind of thing). Maybe because it’s just plain embarrassing. But it’s a serious illness that affects over 500,000 people in this country, according to the CDC, and one that can be a precursor of cancer, so maybe now is the time for an open discussion.

Crohn’s Disease (CD) is one of two major chronic inflammatory diseases that affect the digestive system; the other is ulcerative colitis. The two of them are both Inflammatory Bowel Diseases, or IBD. While ulcerative colitis affects only the colon, Crohn’s can affect everything from the anus to the mouth, although it mostly manifests in the large and small intestines. It is named, as many illnesses are, after the doctor who first defined it.

Although the cause of Crohn’s is unknown, it may be in part hereditary. A gene called NOD2 has been identified as being associated with Crohn’s, and first degree relatives (parents, children, brothers and sisters) of Crohn’s disease are more likely to have it than the general population. One of my sisters has colitis, and her doctors are watching it closely in case it develops into Crohn’s or ulcerative colitis.

I was diagnosed with Crohn’s Disease as I was being tested in the fall of 1983 for an intestinal disorder I’d contracted during a summer spent in Jordan. Amoebic dysentery had caused most of my gastro-intestinal misery while I was in Jordan, and it was treated, and ultimately cured, with antibiotics. The Crohn’s disease was probably not caused by the dysentery; the actual cause of CD is unknown.

My doctors at that time felt that the CD had probably been a pre-existing condition, manifesting like Irritable Bowel Syndrome, a less-inflammatory and easier to treat condition that I’d had for a few years, but was exacerbated by the amoebic dysentery. That was the first time I’d had a colonoscopy, which allowed for the diagnosis of Crohn’s, but it certainly wasn’t the last.

My early symptoms were frequent diarrhea, which I could associate in some cases with specific foods, like apple peel, celery, and cabbage, but which in other cases seemed to have no obvious cause, and nausea. They made driving any distance impossible, unless I knew there were plenty of places for a “rest stop” on the way. The first thing I would do when entering a restaurant, shopping center, or even one store, was to scope out the bathrooms, so I’d know where to go if I needed to in a hurry.

My hiking became almost a thing of the past, and that trip to Jordan was the last archaeological dig I worked on. The diarrhea was generally preceded and accompanied by severe abdominal cramping. Back then, some of the newer medicines I mention below, like Remicade, weren’t available; I used prescription lomotil, an anti-diarrheal, and good old Pepto-Bismol (R) for what relief they could provide. Later, Immodium became available, and at this point I can still use it for most diarrhea episodes.

When I was diagnosed, the Crohn’s disease had caused small erosions on the inside surfaces of my intestines, called “aphthous ulcers” by my doctors. Over time, even with treatment, these erosions have deepened into “true” ulcers, with some scarring, and my small intestine has narrowed.

Some researchers believe that CD is caused by bacteria, but no conclusive evidence has been found linking the cause to infections. Because the ulcers can spread, however, they can cause infections to other nearby organs. This means that one of the treatments for me, and others with CD, is periodic courses of anti-biotics, to stop the spread of infection before it can damage other organs.

One of the problems caused by CD is activation of the immune system. The immune system is supposed to react to “strangers” in the body, such as bacteria and viruses, but with CD the immune system just acts, causing inflammation in the intestines. The inflammation leads to swelling, which further narrows the small intestine, and increases the ulceration process. That leads to a second course of treatment: corticosteroids to reduce inflammation.

As the severity of my own Crohn’s has increased, I’ve been put on a daily dose of prednisolone, one of several steroids used to treat CD. There is no known cure for CD yet, but as the title of this article indicates, it can be managed.

Crohn’s disease, like many auto-immune diseases, is a relapsing/remitting illness. That means that some of the time I feel better, and have few symptoms. At other times I relapse, and have more, and more serious, symptoms. Some of the symptoms of Crohn’s disease that I’ve had, and still have to varying degrees, are abdominal pain, abdominal distension, nausea, vomiting, diarrhea, rectal pain, swelling of the anal sphincter (the muscle at the end of the colon), and inflammation of the small intestine, also called Crohn’s enteritis.

Other possible symptoms, ones that I haven’t had but watch for, are poor appetite, fever, night sweats, rectal bleeding bloody diarrhea, anal fistulae (a sort of tunnel between the anus or rectum and the skin surrounding the anus), and peri-rectal abscesses. If you have diarrhea that persists for more than two days, or any bloody diarrhea, you should see your doctor immediately, as this can be a sign of IBD or something even more serious. Abdominal pain or rectal pain that lasts for more than three days are also indicators of potentially serious illness, and should be treated immediately.

When I was diagnosed with Crohn’s disease, I was given a colonoscopy, in which the entire colon is examined with a lighted scope, or viewing instrument. Most people under 50 haven’t had a colonoscopy, but may have had a sigmoidoscopy, which looks at just the first two feet of the colon. I also had X-rays using a barium enema, which allows more of the intestinal tract to be viewed. More recently, I’ve had both an MRI (Magnetic Resonance Imaging) and a CT scan (computerized tomography), newer diagnostic tests that allow a clearer view of soft tissue.

These two tests were done to determine the extent of my colitis and enteritis, and to see if anything more serious had developed. I have stool samples examined twice a year; they look for blood, bacteria, or the presence of white blood cells. If you are first being diagnosed, they will also look for parasites, which are a possible cause of the same symptoms; stool examination was one of the tests that identified the presence of amoebas in my system back in 1983.

Twice since being diagnosed with Crohn’s I’ve had biopsies taken during colonoscopies to be examined for cancer; the test is painless because I’m already under anesthetic for the colonoscopy. The worst part of the colonoscopy are the days before it is done, when I have to take medication to clear my system of everything that might be in it, so I have serious and uncontrollable diarrhea for at least a day and a half, while taking in only fluids.

Those days I am definitely at home, and unable to leave. Don’t let that discomfort stop you if you have persistent symptoms, though; it’s much more comfortable to have a colonoscopy than it is to die of colon cancer.

Other tests that may be done during the initial diagnosis are blood tests and urinalysis. They check for anemia, which can result from intestinal bleeding, inflammation from an over-active immune system, or malnutrition, which can result from the inability of your colon to absorb nutrients from the food you eat.

I’ve already said that I take a daily dose of prednisolone, a corticosteriod which reduces inflammation. There are side effects from long-term use of steroids, which include “moon face” or swelling and rounding of the face (and it isn’t pretty), acne (I’ve mostly been free of that), increased body hair, diabetes, weight gain, high blood pressure, cataracts, glaucoma, muscle weakness, irritability, depression, fatigue, insomnia, and thinning of the bones. I am currently on a low-dose, and stop taking it when I can. I also am annually tested for diabetes and glaucoma, and monthly tested for high blood pressure. Since all three of those conditions are in part hereditary and already exist in my family, they are a concern for me.

I also have taken anti-biotics, including Flagyl (the brand name for metronidazole) and Cipro (ciprofloxacin), both of which are used for the infections that can be caused by Crohn’s disease. I haven’t had to take them for extended periods of time. That’s a good thing, because Flagyl, taken over a long period of time, can result in damage to the peripheral nerves.

Other medications used are 5-ASA compounds, anti-inflammatory drugs which are similar to aspirin (aspirin itself can make Crohn’s disease worse) and immuno-modulators like Imuran (azathioprine) and infliximab (Remicade), which reduce the number of immune cells. Because of the side effects of steroids, some patients are better off with 5-ASA compounds than drugs like the Prednisolone I take; drugs like Remicade, which interfere with the immune system, can increase the risk of infections, but when your Crohn’s disease is moderate to severe, the benefits (like far less diarrhea) can outweigh the risks, as long as you watch closely for infection.

So, other than medication, what do I do to live a reasonably normal life? First, I eat several small meals a day instead of two or three larger ones. With less food in my intestinal tract at a time, there is less likely to be blockage of my small intestine, and that means less cramping, less abdominal distension, and less diarrhea. I’ve also kept a food journal since I was diagnosed: I now know what foods make me worse, and what doesn’t irritate my digestive system, and eat accordingly.

I don’t smoke, and I avoid alcohol; both those things make my symptoms worse. I get regular exercise; for me, that means daily walks with my dogs. Because I have other health problems, the walks aren’t always the hour that is my goal time, but any exercise, especially done outdoors, helps to reduce fatigue (that may seem counter-intuitive, but it works), and helps me to sleep better at night.

I drink lots of fluids – mainly purified water. Crohn’s can cause dehydration, and drinking more fluids prevents that. I drink more in hot weather than in cold. Despite the heart-benefits of a high-fiber diet, I stick to a lower fiber diet, and eat only types of fiber that I’ve learned my body can handle without “complaint;” these are mainly soluble fibers like oatmeal, because insoluble fiber like that in apple peel and celery worsen my diarrhea. I’m on an anti-depressant; my depression may be partly caused by Crohn’s, and partly by the daily use of a cortico-steroid, but it is very real (there is also a history of depression in my family, which makes it more likely that it is not connected to Crohn’s) and with an anti-depressant, I function better.

They aren’t “happy pills,” although I wish they were; they simply make me able to cope with the stresses in my life. I go to monthly meetings of a Crohn’s support group held at one of the hospitals in my town. I take all my medications as prescribed, and when my diarrhea symptoms get worse, I use an OTC anti-diarrheal like Immodium. If I travel, I make sure to have enough of my medications and my OTC medications with me, and keep the phone number of my gastro-enterologist in my purse.

The most important thing that I’ve done for myself is to educate myself about the disease, because knowledge is power. I understand what my doctors are talking about because I’ve studied it, and I’m not afraid to ask questions about everything. I know there will come a time when I may need more medications, like Remacade or a 5-ASA compound, and I’ve read about those as well. My illness is in a “remission” phase right now, but I know that can change. Using the things I’ve described above, I can go out, leave my house, without fearing that I’ll need to race to a restroom every five minutes.

Before I developed Chronic Fatigue and Immune Dysfunction Syndrome (see my AC article, “Living with Chronic Fatigue and Immune Dysfunction Syndrome and Fibromyalgia”) I was able to return to hiking, and leave bathrooms behind for several hours at a stretch — on most days. My diarrhea is under control, which doesn’t mean I never have it; as long as I’m careful about what and how I eat, it’s infrequent and controllable with OTC meds. I have some abdominal cramping, but it isn’t as usually as severe as it used to be. I can eat in a restaurant because I know what will make me sick and what won’t. The medication I take keeps the inflammation, or “-itis” in my intestines and colon from blocking my intestines. I can do pretty much everything that someone without IBD can do.

If you have Crohn’s disease and want to find a support group or a Dr. in Fort Pierce, check with your local hospital or with the Crohn’s and Colitis Foundation of America (CCFA). If you suspect that you may have the illness, go to the CCFA and read about it, and see your doctor. Make sure you take a list of all your symptoms and all your questions, because it’s easy to forget things in a doctor’s office. If you do have an IBD, whether it’s Crohn’s or Ulcerative Colitis, learn everything you can about it, and take charge of your life. You, too, can live a full life with this illness.

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My Practical Advice on Inflammatory Bowel Disease

My twenty-something newlywed life was imposed upon with a diagnosis of inflammatory colitis, first appearing as Chron’s Disease, a form of inflammatory bowel disease. Influenced by the doctrine that real “ladies don’t pass gas,” (you know, the F-word), I was a bit reserved about my irritable bowel symptoms. I believed in a level of decorum that happened to clash with my intestine’s motives.

Following are some of the non-textbook insights I learned about inflammatory bowel disease diagnosis and how to discuss colitis.

Social Views on Inflammatory Bowel Disease

Discussing symptoms that occur below the waist, such as inflammatory bowel disease, is beyond some individuals’ comfort zone. And now, with the “Butt Bandit” running loose (acquiring stool samples from unwitting celebrities) on Nip/Tuck, I’m not sure that we’ve matured much. The lower GI tract remains just taboo enough to be comical fare.

What I learned: Humor is an asset for inflammatory bowel disease sufferers, to include: one is not evil to fantasize about a virulent strain of stomach flu on the insensitive. Humor aside, inflammatory bowel disease is a serious illness and the diagnostic process a bit unnerving.

Inflammatory Bowel Disease Tests or Why I Kicked My Doctor

The key word to remember about tests for inflammatory bowel disease, such as a colonoscopy, is anesthesia, and sufficient amounts of it.

Having experienced the put-your-intestines-on-camera series twice, I found colon competency varies. My first GI doctor was of male chauvinist bent, and the second appeared to better recall his Hippocratic Oath.

Dr. Oink berated me during the first consult for taking pain medication, nothing heavy, for fibromyalgia, inferring the stomach pain was self-induced. The red siren went ignored. Ultimately, he performed a colonoscopy to rule out inflammatory bowel disease and grossly under-sedated me.

My payback, during biopsy, was to kick him in an area he deemed rather valuable. Too bad I only have a vague recollection of the event.

Versed, one of the sedating agents utilized, is not conducive to good memory. He retorted in my medical records that I had a low pain tolerance. So did he I imagine.

This IBD experience was relayed to GI doctor number two, whom I solicited when colitis symptoms returned. He addressed my tolerance to anesthesia and therefore Dr. Feelgood was spared Taebo action. Under Versed influence, however, I did say some embarrassing things.

What I learned: On the first visit, determine if the doctor’s philosophy and approach for diagnosis and treatment of inflammatory bowel disease is compatible. Also, if your doctor gives you a strange look in recovery, it’s not likely fatal illness, you probably gave up a juicy true confession.

Discussing Inflammatory Bowel Disease and Colitis Symptoms

Frankly, most people do not wish to hear the details of illness and especially undesirables like diarrhea and constipation. While frank talk is admirable, too much information may damper romance and lighter hearted relationships.

Consequently, synonyms or analogies may prove helpful when referring to inflammatory bowel disease and colitis related symptoms. A traffic sign makes a decent analogy. “It’s a red day,” could mean constipation or that you’re not feeling well enough for intimacy. A green light day is just the opposite.

Whichever jargon is used to relay inflammatory bowel disease symptoms, the goal is to communicate the bottom-line, as it relates to you and your loved ones. Otherwise, if your relationship thrives on in-depth discussions of bodily functions that works too.

What I learned: Don’t suffer with inflammatory bowel disease symptoms in silence. Consider the comfort level of your audience for best results. Take advantage of a dedicated inflammatory bowel disease support group, if needed.

Bathroom Fan – A Friend to Colitis and IBS Patients

Perhaps not for the expected reasons, a fan is useful to help inflammatory bowel disease patients…relax.

Patients may be concerned about others overhearing eventful bathroom trips or moans of inflammatory bowel disease pain. If a patient is tense, the discomfort may increase. Sound may also be used as focal point, or diversion, to better cope with colitis cramps and pain. Most any noise maker will work and meditation is even better.

What I learned: Pain and colonic symptoms are not shameful, but are preferably given on a need-to-know basis. Times occur when less conspicuous inflammatory bowel disease symptoms are desired.

Inflammatory Bowel Disease Diagnosis for Women

Aside from pain, one of the worst things about colitis and inflammatory bowel disease is obtaining an accurate diagnosis. For women this is particularly true. Namely because common gynecological disorders can present with similar symptoms as both inflammatory bowel disease or irritable bowel syndrome (IBS).

Endometriosis is a prime example whereas the pain is mistaken for inflammatory bowel disease or vice-versa. Some less fortunate patients suffer both.

What I learned: Pain is a warning sign and frequently an unclear one. Utilize a symptom diary, if necessary. Women with lower abdominal and/or pelvic pain may do well to solicit the help of a gynecologist in conjunction with a gastroenterologist.

Closing Words on Inflammatory Bowel DiseaseUnlike many patients who suffer from inflammatory bowel disease, my colitis was cured (it was not Chron’s) when the causative agent was discovered. Albeit, I have no difficulty recalling the practical difficulties of both irritable bowel syndrome and colitis.

IBD issues are plentiful: from medication to complications, as well as life-threatening aspects of inflammatory bowel disease. Stay informed and listen to your gut, as they say. And, solicit best doctor referrals from experienced patients or organizations dedicated to inflammatory bowel disease or colitis issues.

 

 

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Learning About Crohn’s Disease As a Sunday School Teacher

As a Sunday school teacher it is normal to meet children from all walks of life. If you are fortunate enough to belong to a congregation where diversity is encouraged, the children of carpenters and mechanics are learning about the deity next to the children of bankers and welfare recipients. As such, it is not unusual to encounter children who at first glance seem to act a bit odd. Perhaps they come across as stand-offish, seek to keep to themselves, and rarely speak. Conversely, considering that even children engaged in religious training tend to act their ages, these so called “odd” children may be whispered about as they come in; sudden giggles abound; and I am left wondering what I’m missing.

This is what happened one fine November morning when I met Thamsyn. A small 13-year old with a shy smile that all but hid behind her mother, she took a seat far away from all the other kids. Snickers went up but other than that all was quiet. As we were about ten minutes into our discussion about Old Testament prophets, Thamsyn asked to go to the bathroom.

So far so good, I thought, and gave her permission. Over the course of our two hours together, Thamsyn excused herself about five times – earning more and more snickers behind her back as she went along. Not one for being taken advantage of by a child, I asked her if she was okay when she returned after bathroom break number five, only to be greeted with a burst of tears and near hysterical laughter by the rest of the class.

Seeing that I was clearly missing something, I asked Thamsyn’s mom’s to stay after class to discuss what happened. What I thought would be a quick Q and A session turned into a three hour discussion about the life of a child who not only struggles to be accepted by her peers and do all the things kids her age do, but who is starting from a disadvantage; Thamsyn, you see, has Crohn’s disease.

Crohn’s disease is one of the many conditions lumped under the umbrella of inflammatory bowel disease. As such, any part of her gastrointestinal tract is subject to inflammation. Sufferers will deal daily with abdominal cramping, diarrhea, and also gassy smells.

Thamsyn’s mother relates that she often suffers from severe cramping that is so bad that it forced her to quit swimming class since the water pressure only made things worse. Since she has to use the bathroom almost twice an hour when she is awake, he teachers decided to place her in the back of the classroom by the door, so she could slip in and out as needed; unfortunately, she wears glasses and this has made it very hard for her to see the board. Of course, the alternative is running the gauntlet of snickering peers to leave the classroom when she is sitting in the front of the room, so Thamsyn has chosen the rear of the classroom.

Before her disease got more pronounced, she used to be a ballet student with her best friend Leisha. As the disease continued onward, she was no longer able to continue with ballet, since some of the postures made the urge to use the bathroom unbearable and even led to smelly and embarrassing accidents during class – she has quit dance as well. Leisha’s mom got wind of the problem and thought that Thamsyn had some form of microbial disease and forbade any further contact between the girls. She was afraid that Leisha would catch whatever it was that made Thamsyn have such bad diarrhea.

Within the course of about six months, Thamsyn’s life as a vibrant, happy and healthy student shifted and she became withdrawn, shy, and accustomed to living life from the back of the room. At her last doctor’s visit, Thamsyn was discovered to be developing sores around the mouth; a normal manifestation for children with Crohn’s disease, but the kiss of death for a teenager. The doctor also discovered that her growth which thus far was pretty much in keeping with the course charted on the growth curve had sharply dropped off.

As I listened to Thamsyn’s mother recount her daughter’s sudden introduction to a disease that would rock her world, I cannot begin to imagine what it must be like to start out on a journey that would promise pain, discomfort, embarrassment, potential surgeries and aggressive treatments with medications which might make her just as sick as the disease itself – all at the tender age of 13. As we spoke and frequently lapsed into silence when Thamsyn excused herself for another bathroom break, I began to wonder how I could help her in the confines of my Sunday school class.

The first choice, of course, would have been the direct approach of talking to the kids about Crohn’s disease and help them to understand – make that browbeat them into understanding – that laughing behind her back was unkind and rude. The second choice, however, seemed a much better one. Here is what I did: the next week at Sunday school class we took a departure from the Old Testament prophets. Instead, I told them there would be a price for the person who could name this prophet I would describe. At the mention of a price, it became so quiet that you could have heard a pin drop.

I then talked about a man who at a young age was noticeably different from his peers. His behavior set him apart. When his friends hung out together to go and whistle at girls, he stayed in his dad’s shop to help with the work. Friendly but a bit of a loner, he prayed a lot and once even caused his parents to worry about him because he lingered behind in the temple. As he got older, the weight of his mission became heavier and one day he dropped all he did and went for it – with God’s help he changed the world. Yet even before he started, he knew that the road ahead would not be fun-filled.

It would cause people to get embarrassed by him; they would call him names and make fun of him; he was frequently uncomfortable because he did not have a house and with his few friends he would frequently camp out. He also knew that before he was done, he would have to undergo pain and suffering at the hand of his friends, causing him to weep bitterly. After a bit of deliberation, finally a hand went up – Jeremiah was the first guess (after all, he was called the Weeping Prophet).

A good guess, but not quite. Finally the right guess came in: Jesus! Speaking to the kids about what it must have been like for Jesus the teen, it soon became apparent to each and every one that the odds are good that they, too, would have laughed and snickered about Jesus and the way he was acting weird and different from other kids.

Bringing the story to full circle, I explained about Thamsyn’s condition and asked them if they thought they could see some parallels in their treatment of her and the way they might have treated Jesus. To their credit, they realized how their behavior had been dismal.

I wish I could tell you that Thamsyn’s life has changed – it has not. I would love to say that all the kids in Sunday school class are now nice to her and no longer snicker when she goes to the bathroom three or four times during our time together, but that is not true either. What I can say, however, is that with a bit of education on my part, the willingness to ask some questions, and a heart to heart talk with the kids involved, Thamsyn feels more secure with herself.

One little teen girl has made it a point to sit next to her and to take notes when she has to run out of the room. And Thamsyn has come up with a great one-liner: when kids snicker behind her back at Sunday school class she just lifts up her pointer as she leaves; when asked what this means on her return, she quietly says that those who were laughing will see who has the last laugh when she walks across the swimming pool in the summer.

I find it amazing how little it took to change things for the better in the two hours Thamsyn and I spend together each week. Yet I wonder about the adults she gets in contact with on a daily basis and who are embarrassed by her behavior or who because of a false sense of modesty will not ask any questions. Do they not realize how much they could help this child deal with her illness while still participating in a majority of the activities she enjoys?

Additionally, parents who are reluctant to allow their children to play with her because of her condition should take the time to learn more about it – rather than engage in the knee-jerk reaction of ending friendships over something they do not understand. If you are in a position to deal with a child suffering from Crohn’s Disease, please make the time to visit a doctor in Serbing Florida.

 

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Remicade: A Treatment for Crohn’s Disease

I don’t know about cure, but this is a WONDER drug! For many people with Crohn’s disease, this was their last hope. They had tried the traditional route of treatments from Prednisone to 5-ASA’s to even immuno-suppressants. When these offer no help, it is Remicade or surgery. I’d personally choose Remicade.

Remicade (Inflixamab) is a biologic agent. The FDA approved this drug in August 1998. It is given intravenously. The infusion takes between 2 to 3 hours. During the infusion, the patients heart rate, blood pressure, oxygen levels and temperature are monitored. Some patients have experienced itching, hives, joint pain, lowered pulse or blood pressure. If these occur, the infusion is stopped for a few minutes then continued at a slower rate. For most patients, this alleviates the symptoms.

Remicade is not without side effects though. The most common is joint pain in the next couple of days following the treatment. Many patients say that they have flu like symptoms that begin about 1 to 2 weeks after the treatment. A few experience bronchitis. This may begin as early as the same day of the treatment up to 3 weeks after.

This treatment is usually given in these dosages:

1st treatment – 5mg per kilogram of body weight. 1kg is about 2.2lbs

2nd treatment – 10mg per kilogram

According to the patient’s reaction to the higher dose, the doctor will make the decision as to go back to the 5mg, stay at 10mg, or increase to 15mg. In the clinical trails, the patients were given these dosages in a double-blind study. Neither they nor the doctors knew if they were getting the real thing or the dosage. Most patients responded at the 5mg at the first treatment then increase to 10mg. The subsequent treatments back at the 5mg.

The first two treatments from the best gastroenterologist are given 1x per month or 1x every other month. The subsequent treatments are given as the patients needs, but nor more that six months apart. It has been noted that patients waiting longer than six months are having serious side effects such as excruciating joint pain, pneumonia and asthma.

If given correctly, the Crohn’s patient can have a normal healthy life. I have seen a patient come from taking 43 pills a day to 3 pills since taking Remicade. It is well worth a consideration. 

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GERD: Risks of Halitosis Development in the Elderly

Halitosis among the elderly is quite common. In many cases, the complications with halitosis are a result of metabolic disorders, complications with poor oral hygiene, or even complications with a gastrointestinal infection. For some aging adults, however, there is a risk for developing halitosis when complications of GERD are not well managed.

GERD, or acid reflux, is an ailment that affects adults of all ages. In elderly adults, after many years of unresolved acid reflux, there is a risk for complications associated with voice changes, esophageal pain, and even the development of halitosis. If you are caring for an aging parent who seems to have chronic bad breath, you may want to consult a physician about the possible need for GERD treatment.

When food is eaten, and then only partially digested as is the case with GERD, particles of consumed food and enzymes reflux back into the esophagus. When this type of health condition is chronic, there can be a mixture of food particles left in the esophagus, which leads to a complication with bad breath.

While most elderly adults may attempt to rid the halitosis by brushing their teeth or even using breath mints, the complications of GERD-induced halitosis will not dissipate until the food particles in the esophagus are permitted to be digested, and until the complications with GERD are resolved. In some cases, breath mints or excessive use of toothpaste may actually worsen the halitosis if these items are swallowed and then also refluxed back into the esophagus.

A doctor can prescribe medications to reduce the frequency of GERD and to reduce the complications with acid reflux. So, if you are concerned about the health complication, be sure to ask your doctor to prescribe medication. With proper treatment, and good oral hygiene, the complications with GERD and halitosis can be resolved without further significant incidences. The key to your parent’s optimal health lies in getting the condition diagnosed properly by visiting the best clinic in your area and then actively treating the condition with medications rather than home remedies.

 

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