Surgical Options for Crohn's Disease/Ulcerative Colitis

Alright so we talked about many of the different treatment options available for people suffering with Ulcerative Colitis or Crohn's Disease including immunosuppressants, steroids, anit-inflammatories, and probiotics; however I thought that I would post about the surgeries available for these people. The problem with surgery is that the Crohn's & Colitis Foundation of America have found that about 50% of patients that have surgery will see a recurrence of the disease, but they do state that medication (like the ones listed before) taken after the surgery can help the patient avoid, or at least delay, a recurrence.

There are really three options depending on the severity of symptoms. The first surgery is called a strictureplasty. This procedure is used to widen the narrowed diseased areas of the small intestine. FYI the diseased areas are called strictures and are a result of scarring brought on by the chronic inflammation of the disease. The surgery is as simple as cutting open the stricture then sewing it back up crosswise.

The second option is called a resection. This surgery is used when strictures are very long or there are many of them within a close vicinity and simply cuts away the diseased section then the healthy ends to the intestine are reattached. Finally if the damage done by Crohn's is really bad then a colectomy or proctocolectomy may be needed. The colectomy procedure removes the whole colon while the proctocolectomy does the same but also removes the rectum which means that another procedure (ileostomy) would be needed to create a stoma that would allow the patient to pass stool.

There are two quality of life issues that are presented to a patient; especially with a surgery like the proctocolectomy. The first is that a colostomy bag is needed when the rectum is removed; which means that it will have to be emptied multiple times a day and obviously would have to be worn all day. Also if too much of the intestine is taken it is possible to end up with short bowel syndrome. Essentially this can lead to malnutrition/dehydration and diarrhea. This happens because the decreased length of intestine does not provide adequate room for absorption of nutrients, minerals, and water. To counteract this people with short bowel syndrome have to take supplements and eat very small meals at a much more frequent pace then normal.

All in all it may seem as though surgery is a bad option; however it is essential when medications no longer control the symptoms.

Here are the websites where I found this info:
http://www.ccfa.org/info/surgery/surgerycd
http://digestive.niddk.nih.gov/ddiseases/pubs/shortbowel/
http://www.umm.edu/patiented/articles/what_surgical_procedures_crohns_disease_000103_10.htm

IBD in Children and the Difference Between IBD and IBS

As a volunteer in the Pediatric Unit at the Tucson Medical Center over the past year something I find interesting is the communication between doctors and their child patients. It made me think about my topic this week and how I would go about explaining to a child who has IBD exactly what was going on inside of their bodies. The most common age range for this disease is 15 to 30, however, there are reported cases of even younger children who are affected. So how do you bring up a “sensitive” issue like this to a child? I have seen some pretty interesting techniques from the use of puppets to doctors addressing a child as if they were another doctor. You would be surprised what some kids can remember! So I found a couple of internet sites dedicated to the discussion of IBD in a way children would understand. The links are below:

http://kidshealth.org/parent/medical/digestive/ibd.html#

http://kidshealth.org/kid/health_problems/stomach/IBD.html

Here is also a site where kids explain their disease in their own words:

http://growingupibd.org/

The last link is important in that it shows the diversity of the symptoms present in a population of children. Each kid’s story is different and so are their needs as a patient. That is probably the biggest thing I have learned as a volunteer. What might work on one child may totally backfire with another. I have seen the puppet trick give a child a better understanding of their illness in one case while bringing a different child completely to tears. This is an important aspect of medicine to keep in mind for anyone in the field. The needs of patients both young and old should be examined on an individual bases. There is no one correct way to address a child about their illness.

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I also thought it would be good to address the difference between IBD and IBS for those of us who needed clarification. Both IBD and IBS have similar symptoms that may cause confusion to a patient. Symptoms of both include: alteration of bowel habits, pain, discomfort, bloating and increased urgency to use the restroom. The difference between the two illnesses is that IBS does not involve inflammation of the GI tract where IBD is identified by the inflammation of the mucosal tissue in the intestines. IBS is also known as a spastic colon or bowel and is an example of a functional disorder. A functional disorder is defined as “a disorder of physiological function having no known organic basis.” (http://medical-dictionary.thefreedictionary.com/functional+disorder). In other words there is an abnormality in the function of the GI tract but there are no physical signs of a problem. All in all, IBD is a more serious illness than IBS, The physical toll that the chronic inflammation can take on the GI tract can lead to ulcers as well as anemia from stool blood loss.

Probiotics

One of the lay articles assigned for this week had said that Americans consume fewer fermented products that any other developed country and I agree with that author. Americans tend to turn to drugs when dealing with health issues, while Asian and European cultures stick to the more "natural" remedies. After reading that lay article that talked about probiotics in things like yogurt and fermented milk, I was curious because we had recently done an experiment to isolate microbes from yogurt in micro lab. So, I decided to try and search for the "best" brands of yogurt to eat. Instead I came across another article which talks about Kimchi, which is a spicy Korean dish that contains a strain of the probiotic Lactobacillus that was found to help reduce cancer cell growth. I'm not saying you should go and eat lots of Kimchi (because it's definitely not for everyone. I personally don't like it), but I just found this pretty surprising and interesting that such unexpected foods have promising health benefits, so I decided to share. Enjoy!


The full article can be found here:
http://www3.interscience.wiley.com/cgi-bin/fulltext/123206305/HTMLSTART.

Stroke Symptoms

Hey guys! Here is a great way that I found from the National Stroke Association to remember the symptoms of a stroke! It's called "Act F.A.S.T."

FACE	Ask the person to smile. Does one side of the face droop?
ARMS	Ask the person to raise both arms. Does one arm drift downward?
SPEECH	Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?
TIME	If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.

An additional method that can be used when one suspects a stroke is as follows: SUDDEN numbness/weakness of the face, arm, or leg, especially one side of the body. SUDDEN confusion, trouble speaking/understanding. SUDDEN trouble seeing in one or both eyes. SUDDEN trouble walking, dizziness, loss of balance or coordination. SUDDEN severe headache .

I also found some surprising statistics including the one which stated that twice as many women die from stroke every year than from breast cancer. I also found it interesting that strokes are preventable. Here are the guidelines offered on how to prevent a stroke:

Stroke Prevention Guidelines

Know your blood pressure. Find out if you have atrial fibrillation. If you smoke, stop. If you drink alcohol, do so in moderation. Find out if you have high cholesterol If you are diabetic... Exercise. Enjoy a lower sodium (salt), lower fat diet. Circulation (movement of the blood through the heart and blood vessels) problems. Know the Symptoms of Stroke.

All this information came from www.stroke.org.