Citadel Cadet with Crohn's Disease - Great Article

Great Article by Jill Coley From the Charleston Post and Courier. I love his quote in the fourth paragraph. That is pretty much they way I look at the good days and bad days with Crohn's.

Cadet James Lewis, a 20-year-old sophomore at The Citadel, doesn't define himself by Crohn's disease. But the digestive disorder can strike any time.

Crohn's disease is an inflammation of the digestive tract lining. Symptoms vary and can be embarrassing. Many suffer severe abdominal pain, weight loss and fatigue.

Cadet James Lewis carries on his life as a cadet at the Citadel even though he suffers from Crohn's disease, a disorder that causes inflammation of the digestive tract and can have embarrassing symptoms.

"It's a random disease. You do not know if you're going to have a good day or a bad day," the Columbia native said. "I always expect to have a good day, and if it's a bad one, I deal with it."
Lewis manages his Crohn's with bi-monthly shots to his stomach and daily maintenance pills. When he started at The Citadel last year, he struggled with whether to tell his peers about the disorder.

"Everyone has something different about them, something they have to deal with," he said. "It's a big part of my life, but I'd not go so far as to say it defines me." With a 3.9 GPA, the business major is on track to graduate in three years. Playing for the tennis team is a bright spot for him, he said.

In October, he was recognized in Orlando, Fla., along with 30 other winners of the UCB Crohn's Scholarship Program. The pharmaceutical company awarded 31 $10,000 scholarships.
After The Citadel, Lewis is eyeing a dual graduate degree program in law and international business administration.

Col. Mark Bebensee, associate dean of the school of business administration, said of Lewis' disorder, "You would never know. It hasn't kept him from being the brightest in the class."
At the beginning of Bebensee's microeconomics course, Lewis filled out an introduction form where he mentioned he had Crohn's. If it wasn't for that, Bebensee said he'd never know. "He's learned to cope very well," he said.

Lewis was diagnosed with Crohn's disease during his freshman year in high school.
Although the cause of Crohn's disease is not fully understood, many experts say the immune system plays a role, attacking the gastrointestinal tract.

While there is no known cure for the disease, there are treatments, including medication and surgery, that can offer relief from symptoms.

About 20 percent of people with the disorder have a relative with it, too. But in Lewis' case, he is the only one in his family, he said.

At first, Lewis suffered from cramps, but didn't think much of the disease, he said. Then the flare-ups began. A flare-up is an eruption of ulcers, leading to painful cramping.
During flare-ups, digestion is disrupted, and the body fails to extract nutrients from food. Lewis once lost 20 pounds during an episode.

Freshman year at The Citadel can be a particular challenge for someone with Crohn's. The rigor and stress might trigger flare-ups.

Lewis had about eight last year, more than twice what he averaged before starting at the military school.

Infusions of a steroid and immunosuppressive medicine can treat his flare-ups, he said, but slowing his immune system leaves him open to colds and sinus infections.
"If I was in any other school, I'd stay in bed all day. At The Citadel, I can't," Lewis said.

Common Drugs Used in the Treatment of Remicade

Anti-Inflammation Drugs. Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine-containing drugs include nausea, vomiting, heartburn, diarrhea, and headache.

Cortisone or Steroids. Cortisone drugs and steroids—called corticosteriods—provide very effective results. Prednisone is a common generic name of one of the drugs in this group of medications. In the beginning, when the disease it at its worst, prednisone is usually prescribed in a large dose. The dosage is then lowered once symptoms have been controlled. These drugs can cause serious side effects, including greater susceptibility to infection.

Immune System Suppressors. Drugs that suppress the immune system are also used to treat Crohn’s disease. Most commonly prescribed are 6-mercaptopurine or a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person’s resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteroids may eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.

Infliximab (Remicade). This drug is the first of a group of medications that blocks the body’s inflammation response. The U.S. Food and Drug Administration approved the drug for the treatment of moderate to severe Crohn’s disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas. Infliximab, the first treatment approved specifically for Crohn’s disease is a TNF substance. Additional research will need to be done in order to fully understand the range of treatments Remicade may offer to help people with Crohn’s disease.

Antibiotics. Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.

Anti-Diarrheal and Fluid Replacements. Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.