Wednesday, June 18, 2008

Diagnosing Crohn's Disease - What are the Symtoms (for newbies :-)

I have had quite a few emails and comments regarding symtoms of Crohn's Disease. Here they are:

Signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly, without warning. They include:

Diarrhea. The inflammation that occurs in Chron's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. In mild cases, stools may simply be looser or more frequent than usual. But people with severe disease may have dozens of bowel movements a day, affecting both sleep and ordinary activities.

Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of intestinal tract contents through your digestive tract and may lead to pain and cramping. Mild Crohn's disease usually causes slight to moderate intestinal discomfort, but in more serious cases, the pain may be severe and occur with nausea and vomiting.
Blood in your stool. Food moving through your digestive tract can cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult blood). In severe disease, bleeding is often serious and ongoing.

Ulcers. Crohn's disease begins as small, scattered sores on the surface of the intestine. Eventually these sores may become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers in your mouth similar to canker sores.
Reduced appetite and weight loss. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.
Fistula or abscess. Inflammation from Crohn's disease may tunnel through the wall of the bowel into adjacent organs, such as the bladder or vagina, creating an abnormal connection called a fistula. This can also lead to an abscess, a swollen, pus-filled sore. The fistula may also tunnel out through your skin. A common place for this type of fistula is in the area around the anus. When this occurs, it's called perianal fistula.

Other signs and symptoms. People with severe Crohn's disease may experience fever and fatigue as well as problems that occur outside the digestive tract, including arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts. Children with Crohn's disease may have delayed growth or sexual development. The course of Crohn's disease varies greatly. You may have long periods without signs and symptoms, or you may have recurrent episodes of abdominal pain, diarrhea, and sometimes fever or bleeding.

Monday, June 9, 2008

A Funny Perspective on the Colonoscopy

This is from newshound Dave Barry's colonoscopy journal:

.... I called my friend Andy Sable, a gastroenteritis, to make an
appointment for a colonoscopy. A few days later, in his office, Andy
showed me a color diagram of the colon, a lengthy organ that appears
to go all over the place, at one point passing briefly through
Minneapolis Then Andy explained the colonoscopy procedure to me in a
thorough, reassuring and patient manner. I nodded thoughtfully, but I
didn't really hear anything he said, because my brain was shrieking,

I left Andy's office with some written instructions, and a
prescription for a product called 'MoviPrep,' which comes in a box
large enough to hold a microwave oven. I will discuss MoviPrep in
detail later; for now suffice it to say that we must never allow it to
fall into the hands of America's enemies.

I spent the next several days productively sitting around being
nervous. Then, on the day before my colonoscopy, I began my
preparation. In accordance with my instructions, I didn't eat any
solid food that day; all I had was chicken broth, which is basically
water, only with less flavor. Then, in the evening, I took the
MoviPrep. You mix two packets of powder together in a one-liter
plastic jug, then you fill it with lukewarm water. (For those
unfamiliar with the metric system, a liter is about 32 gallons.) Then
you have to drink the whole jug. This takes about an hour, because
MoviPrep tastes - and here I am being kind - like a mixture of goat
spit and urinal cleanser, with just a hint of lemon.

The instructions for MoviPrep, clearly written by somebody with a
great sense of humor, state that after you drink it, 'a loose watery
bowel movement may result.' This is kind of like saying that after you
jump off your roof, you may experience contact with the ground.

MoviPrep is a nuclear laxative. I don't want to be too graphic, here,
but: Have you ever seen a space-shuttle launch? This is pretty much
the MoviPrep
experience, with you as the shuttle. There are times when you wish the
commode had a seat belt. You spend several hours pretty much confined
to the bathroom, spurting violently. You eliminate everything. And
then, when you figure you must be totally empty, you have to drink
another liter of MoviPrep, at which point, as far as I can tell, your
bowels travel into the future and star t eliminating food that you
have not even eaten yet.

After an action-packed evening, I finally got to sleep. The next
morning my wife drove me to the clinic. I was very nervous. Not only
was I worried
about the procedure, but I had been experiencing occasional return
bouts of MoviPrep spurtage. I was thinking, 'What if I spurt on Andy?'
How do you
apologize to a friend for something like that? Flowers would not be

At the clinic I had to sign many forms acknowledging that I understood
and totally agreed with whatever the heck the forms said. Then they
led me to a
room full of other colonoscopy people, where I went inside a little
curtained space and took off my clothes and put on one of those
hospital garments designed by sadist perverts, the kind that, when you
put it on, makes you feel even more naked than when you are actually

Then a nurse named Eddie put a little needle in a vein in my left
hand. Ordinarily I would have fainted, but Eddie was very good, and I
was already
lying down. Eddie also told me that some people put vodka in their
MoviPrep. At first I was ticked off that I hadn't thought of this, but
then I pondered what would happen if you got yourself too tipsy to
make it to the bathroom, so you were staggering around in full Fire
Hose Mode. You would have no choice but to burn your house.

W hen everything was ready, Eddie wheeled me into the procedure room,
where Andy was waiting with a nurse and an anesthesiologist. I did not
see the 17,000-foot tube, but I knew Andy had it hidden around there
somewhere. I was seriously nervous at this point. Andy had me roll
over on my left side, and the anesthesiologist began hooking something
up to the needle in my hand. There was music playing in the room, and
I realized that the song was 'Dancing Queen' by ABBA I remarked to
Andy that, of all the songs that could be playing during this
particular procedure, 'Dancing Queen' has to be the least appropriate.

'You want me to turn it up?' said Andy, from somewhere behind me. 'Ha
ha,' I said. And then it was time, the moment I had been dreading for
more than a
decade. If you are squeamish, prepare yourself, because I am going to
tell you, in explicit detail, exactly what it was like.

I have no idea. Really. I slept through it. One moment, ABBA was
yelling 'Dancing Queen, Feel the beat of the tambourine,' and the next
moment, I was back in the other room, waking up in a very mellow mood.
Andy was looking down at me and asking me how I felt. I felt
excellent. I felt even more excellent when Andy told me that It was
all over, and that my colon had passed with flying colors. I have
never been prouder of an internal organ.

Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami

Wednesday, June 4, 2008

Stem Cell Transplant for Crohn's Back on the Table for me

Well, I guess me taking place in a stem cell transplant trial is back on the table. I went back to my doctor and am now getting reasy to schedule a sit-down meeting to see if I qualify. Last time I had to get the Humira out of my system which is done. Another update, I have been on 20mg Lexapro for the past month. I don't notice a difference but my wife says I am less of an asshole. Anyone else here on Lexapro?

Previous Post:
So I saw the Dr. Shafran and Patty today. I gotta say these guys (Winter Park, Fl) are the best gasto doctors I have come across in the 13 years I have had Crohn's Disease. Anyways we discussed a wide variety of topics. I need to be Humira free for 3 months before I can start the clinical trial that is Stem Cell Transplant for Crohn's. The trial is actually a 4 stage blood transfusion that I am going to read up on more (and report my findings tonight). It seems pretty low risk, but there is a 1/3 chance I will get a placebo, (what, red kool-aid??) 1/3 chance I get a half transplant (hopefully my right side!), and 1/3 chance I will get a full transplant. I am going for a 3-d Cat Scan next week which will allow them to better see the extend of my disease. As a bridge I am going back on Pentasa/Azulfidine (9 pills a day). I also am going to try Lexapro (10 mg). I have not been myself this past year. I am myself (HAPPY) about 2 hours a week. The rest of the time I am in pain, bummed, tired, stressed and cranky. I also have alot of anxiety issues and fear of death and dying, thought not necessarily dying from Crohn's Disease. Anyways more to come later.

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