[MOL] NOT TRYING TO OVERWHELM YOU!!!!

["MICHAEL C WHITE" <THEBRATUSER@prodigy.net>]

Lillian, This isn't ment to overwhelm you, just to keep in your files, if ever you come across anyone with crohns disease, this will be helpful. This is the rest of that last page I sent you... xo Dean

 

You probably have already experienced the most common symptoms of Crohn's disease; abdominal pain (often in the lower right area) and diarrhea. These may have been the first symptoms that led you to see your doctor.

You may also experience rectal bleeding, weight loss (typically up to 10% of your body weight may be lost), fatigue, and fever.^1,2 Bleeding may be serious and persistent, leading to anemia (lower than normal amount of circulating red blood cells or hemoglobin).¹

Patients with Crohn's disease may experience complications not often seen with ulcerative colitis, such as narrowing of the intestine, obstruction, abscesses, and fistulas (abnormal channels connecting two loops of intestine, or between the intestinal wall and other organs, including the skin).¹

Although Crohn's disease primarily involves the bowel, it may manifest in other organs as well, including the eyes, mouth, skin, liver, kidney, and joints.<sup>2

Your doctor will need to perform a thorough physical exam and order a series of tests in order to diagnose your Crohn's disease. Crohn's disease is often suspected if you have abdominal pain, weight loss, fever, and/or diarrhea, but sometimes these symptoms may appear for other reasons.

Your blood tests will tell your doctor if you have anemia (lower than normal amount of circulating red blood cells or hemoglobin), which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count (a sign of inflammation somewhere in the body), or vitamin deficiencies, which may occur in the course of Crohn's disease. By testing a stool sample, your doctor can tell if you have bleeding or infection in the intestines.

Your doctor may do an upper gastrointestinal (GI)/small bowel series to look at your small intestine. For this test, you drink barium, a chalky solution that coats the lining of your small intestine, before X-rays are taken. The barium shows up white on X-ray film, revealing inflammation or other abnormalities in the intestine.

A CAT scan of your abdomen (a special type of X-ray in which the contents of the abdomen are seen in a cross-sectional view) may be necessary to assess the extent of inflammation and help clarify your diagnosis.

Your doctor may also do a colonoscopy. For this test, the doctor inserts an endoscope (a long, flexible, lighted tube) through your anus to see the inside of your large intestine. Your doctor will be able to see any inflammation or bleeding via a computer or TV monitor. During the exam, your doctor may do a biopsy, which involves taking a tiny sample of tissue from the lining of your intestine to view with a microscope.

If these tests show Crohn's disease, your doctor may order more X-rays of both the upper and lower digestive tract to see how much tissue is affected by the disease.</sup>

Goals of treatment
There are a variety of treatments available today for Crohn's disease, and researchers are continuing to develop exciting new options. The location and severity of your disease, complications, and your response to previous treatment will all influence your doctor's choice of therapy.

There are several important goals of treatment recommended by the American College of Gastroenterology:¹

	Induce and maintain remission
	Heal mucosa
	Restore and maintain nutrition
	Maintain quality of life as it relates to Crohn's disease
	Select optimal timing for those requiring surgical intervention

The treatment plan that's right for you may include drugs, nutrition supplements, surgery, or a combination of these options. At this time, treatment can help control the disease, but there is no cure.

Some people may experience long periods of remission when they are free of symptoms. These periods can last for years. However, the symptoms usually recur at various times over a person's lifetime. It is not possible to predict when a remission may occur, or when symptoms will return.

Because of the unpredictability of Crohn's disease, medical care may be needed for as long as your doctor deems necessary, with regular office visits to monitor your condition.



Drug therapy
 5-ASA agents
 Corticosteroids
  Immunomodulators
 Monoclonal antibody
 Antibiotics
 Antidiarrheal medication

5-ASA agents
Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. If you do not benefit from sulfasalazine or cannot tolerate it, you may be put on other drugs that contain mesalamine, generally known as 5-ASA agents.

Possible side effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and headache. However, 5-ASA agents are usually well tolerated. These drugs are frequently effective for mild to moderate, but not severe, inflammation.

Corticosteroids
Corticosteroids help control inflammation and are very effective for active Crohn's disease, even if severe. If you respond to steroid treatment, your doctor will usually try to gradually lower the dose of the steroid in order to avoid some of the significant side effects of this class of drugs, which include premature osteoporosis and a greater susceptibility to infection.

Immunomodulators
Drugs that modulate (alter) the immune system are also used to treat Crohn's disease. Most commonly prescribed are 6-mercaptopurine (6-MP) and a related drug, azathioprine. Immunomodulators work by blocking the immune reaction that contributes to inflammation. You may experience side effects such as nausea, vomiting, and diarrhea, as well as:²

  Lowered red blood cell count
  Lowered white blood cell count
  Lowered platelet (another type of blood cell) count
  Lowered resistance to infection

If you take these drugs you need to have your blood count monitored on a regular basis. It often takes several months of treatment for immunomodulators to take effect.

Monoclonal antibody
The U.S. Food and Drug Administration has approved the drug infliximab (brand name, REMICADE™) for the short-term treatment of moderately to severely active Crohn's disease that does not respond to standard therapies (mesalamine substances, corticosteroids, and immunomodulators) and for the treatment of open, draining fistulas. Infliximab inhibits a substance called tumor necrosis factor alpha (TNF), a protein produced by the immune system that plays a central role in the inflammation associated with Crohn's disease.

Infliximab has been associated with hypersensitivity reactions that differ in their time of onset. Some people noticed itching or stinging of the skin and, rarely, other reactions such as chills, difficulty in breathing, or low blood pressure. Some patients reported other side effects that did not last long, such as fatigue, fever, headache, nausea, and dizziness. TNF mediates inflammation and modulates cellular immune response, including response to infection. Therefore, patients treated with infliximab may have an increased risk of infection. There are insufficient safety and efficacy data for the use of infliximab beyond the recommended duration.

Antibiotics
Antibiotics are used to treat bacterial overgrowth in the small intestine caused by strictures, fistulas, or prior surgery. They are also used to treat any bacterial infections that are also present, including abscesses. Antibiotics may also have a direct effect on Crohn's disease, especially Crohn's disease of the large intestine. Your doctor may prescribe one or more of the following antibiotics: ciprofloxacin, metronidazole, ampicillin.

Antidiarrheal medications
Diarrhea and abdominal pain are often relieved when the inflammation subsides, but you may need additional medication. Several antidiarrheal agents may be prescribed by your doctor, including diphenoxylate, loperamide, and codeine. If you are dehydrated because of diarrhea, you will be treated with fluids and electrolytes.



Nutritional supplementation
Your doctor may recommend nutritional supplementation, with special, high-calorie, vitamin-rich liquid formulas that are sometimes used for this purpose. A small number of patients may need periods of intravenous feeding (through a vein). This can help if you need extra nutrition temporarily, when your intestines need to rest, or when your intestines cannot absorb enough nutrition from food.



Surgery
The decision to have surgery for Crohn's disease is made only after careful review of your situation and treatment history with your doctor. You may require surgery either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, bleeding in the intestine, or fistulas. Surgery to remove part of the intestine can help. However, at some time after the surgery, inflammation may return next to the area of intestine that has been removed.

In most situations, only the diseased section of intestine is removed. In this operation, the intestine is cut above and below the diseased area, the diseased section is removed, and the two ends of the intestine are reconnected.

Some people who have Crohn's disease in the large intestine need to have their entire large intestine removed in an operation called colectomy. In this operation, a small opening is made in the front of the abdominal wall, and the open end of the intestine is brought through a small opening at the skin's surface. This opening, called a stoma, is about the size of a quarter and is usually located in the right lower part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, which is emptied as needed. The majority of people with colectomies go on to live normal, active lives.

Because Crohn's disease often recurs after surgery, you should carefully weigh the benefits and risks of surgery compared with other treatments. Surgery may not be appropriate for everyone. You should get as much information as possible from doctors, nurses who work with surgery patients (enterostomal therapists), and other people who have had the surgery. Patient advocacy organizations, such as the Crohn's & Colitis Foundation of America (http://www.ccfa.org/links/) can suggest support groups and other information resources.

You may feel well and be free of symptoms when your disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations and possibly surgery, most people with Crohn's disease are able to hold jobs, raise families, and function successfully at home and in society.

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