Part II What is Chron’s Disease actually?

Chron’s Disease can cause other parts of the body to become inflamed (due to chronic inflammatory activity) including the joints, eyes, mouth, and skin. In addition, gallstones and kidney stones may also develop as a result of Crohn’s disease.

Moreover, children with the disease may experience decreased growth or delayed sexual development.

Crohn’s Disease is far more common than a lot of people think, and it can be a serious disease with life-threatening complications if it is not properly treated. The best way to treat Crohn’s disease is to speak with your doctor regarding Crohn’s disease symptoms and diagnosis. The more you know about the issue, the more likely you will be to recognize it in your own body.

Crohn’s disease symptoms can include:  Frequent and recurring diarrhea with,rectal bleeding,Unexplained weight loss, Fever, Abdominal pain and cramping, Fatigue and a feeling of low energy, & Reduced appetite.

Crohn’s can affect the entire GI tract — from the mouth to the anus — and can be progressive, so over time, your symptoms could get worse. That’s why it’s important that you have an open and honest conversation about your symptoms, since your doctor will use that information to help determine what treatment plan is best for you.

It might be helpful that you understand the differences between mild, moderate and severe symptoms, since your doctor may ask your similar questions in S/S your having to distinguish it you are in mild to very severe symptoms.

Crohn’s Disease Symptom Severity

Mild to Moderate

You may have symptoms such as:

• Frequent diarrhea
• Abdominal pain (but can walk and eat normally)
• No signs of:
  • Dehydration
  • High fever
  • Abdominal tenderness
  • Painful mass
  • Intestinal obstruction
  • Weight loss of more than 10%

Moderate to Severe

You may have symptoms such as:

• Frequent diarrhea
• Abdominal pain or tenderness
• Fever
• Significant weight loss
• Significant anemia (a few of these symptoms may include fatigue, shortness of breath, dizziness and headache)

Very Severe

Persistent symptoms despite appropriate treatment for moderate to severe Crohn’s, and you may also experience:

• High fever
• Persistent vomiting
• Evidence of intestinal obstruction (blockage) or abscess (localized infection or collection of pus). A few of these symptoms may include abdominal pain that doesn’t go away or gets worse, swelling of the abdomen, nausea or vomiting, diarrhea, and constipation.
• More severe weight loss

Once you and your doctor have discussed your symptoms and created a treatment plan, it’s important to follow directions and take your treatment as prescribed. If you ever have any questions or concerns about your treatment, you should contact your doctor before making any changes or adjustments.

Crohn’s disease is unpredictable. Over time, your symptoms may change in severity, or change altogether. You may go through periods of remission—when you have few or no symptoms. Or your symptoms may come on suddenly, without warning.

Complications:

Crohn’s disease may lead to one or more of the following complications:

• Bowel obstruction. Crohn’s disease can affect the entire thickness of the intestinal wall. Over time, parts of the bowel can scar and narrow, which may block the flow of digestive contents, often known as a stricture. You may require surgery to widen the stricture or sometimes to remove the diseased portion of your bowel.
• Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum).
• Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula — an abnormal connection between different body parts. Fistulas can develop between your intestine and your skin, or between your intestine and another organ. Fistulas near or around the anal area (perianal) are the most common kind.When fistulas develop inside the abdomen, it may lead to infections and abscesses, which are collections of pus. These can be life-threatening if not treated. Fistulas may form between loops of bowel, in the bladder or vagina, or through the skin, causing continuous drainage of bowel contents to your skin.
• Anal fissure. This is a small tear in the tissue that lines the anus or in the skin around the anus where infections can occur. It’s often associated with painful bowel movements and may lead to a perianal fistula.
• Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. It’s also common to develop anemia due to low iron or vitamin B-12 caused by the disease.
• Colon cancer. Having Crohn’s disease that affects your colon increases your risk of colon cancer. General colon cancer screening guidelines for people without Crohn’s disease call for a colonoscopy at least every 10 years beginning at age 45. In people with Crohn’s disease affecting a large part of the colon, a colonoscopy to screen for colon cancer is recommended about 8 years after disease onset and generally is performed every 1 to 2 years afterward. Ask your doctor whether you need to have this test done sooner and more frequently.
• Skin disorders. Many people with Crohn’s disease may also develop a condition called hidradenitis suppurativa. This skin disorder involves deep nodules, tunnels and abscesses in the armpits, groin, under the breasts, and in the perianal or genital area.
• Other health problems. Crohn’s disease can also cause problems in other parts of the body. Among these problems are low iron (anemia), osteoporosis, arthritis, and gallbladder or liver disease.
• Medication risks. Certain Crohn’s disease drugs that act by blocking functions of the immune system are associated with a small risk of developing cancers such as lymphoma and skin cancers. They also increase the risk of infections.Corticosteroids can be associated with a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes and high blood pressure, among other conditions. Work with your doctor to determine risks and benefits of medications.
• Blood clots.

Treatment:

There is currently no cure for Crohn’s disease, and there is no single treatment that works for everyone. One goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. Another goal is to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission.

Anti-inflammatory drugs

Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

• Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in your body, but they don’t work for everyone with Crohn’s disease.Corticosteroids may be used for short-term (3 to 4 months) symptom improvement and to induce remission. Corticosteroids may also be used in combination with an immune system suppressor to induce the benefit from other medications. They are then eventually tapered off.
• Oral 5-aminosalicylates. These drugs are generally not beneficial in Crohn’s disease. They include sulfasalazine (Azulfidine), which contains sulfa, and mesalamine (Delzicol, Pentasa, others). Oral 5-aminosalicylates were widely used in the past but now are generally considered of very limited benefit.

Immune system suppressors

These drugs also reduce inflammation, but they target your immune system, which produces the substances that cause inflammation. For some people, a combination of these drugs works better than one drug alone.

Immune system suppressors include:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection and inflammation of the liver. They may also cause nausea and vomiting.
• Methotrexate (Trexall). This drug is sometimes used for people with Crohn’s disease who don’t respond well to other medications. You will need to be followed closely for side effects.

Biologics

This class of therapies targets proteins made by the immune system. Types of biologics used to treat Crohn’s disease include:

• Vedolizumab (Entyvio). This drug works by stopping certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Vedolizumab is a gut-specific agent and is approved for Crohn’s disease. A similar medication to vedolizumab known as natalizumab was previously used for Crohn’s disease but is no longer used due to side effect concerns, including a fatal brain disease.
• Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Also known as TNF inhibitors, these drugs work by neutralizing an immune system protein known as tumor necrosis factor (TNF).
• Ustekinumab (Stelara). This was recently approved to treat Crohn’s disease by interfering with the action of an interleukin, which is a protein involved in inflammation.
• Risankizumab (Skyrizi). This medication acts against a molecule known as interleukin-23 and was recently approved for treatment of Crohn’s disease.

Antibiotics

Antibiotics can reduce the amount of drainage from fistulas and abscesses and sometimes heal them in people with Crohn’s disease. Some researchers also think that antibiotics help reduce harmful bacteria that may be causing inflammation in the intestine. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Other medications

In addition to controlling inflammation, some medications may help relieve your signs and symptoms. But always talk to your doctor before taking any nonprescription medications. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following:

• Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.These medications could be ineffective or even harmful in some people with strictures or certain infections. Please consult your health care provider before you take these medications.
• Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others) — but not other common pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). These drugs are likely to make your symptoms worse and can make your disease worse as well.
• Vitamins and supplements. If you’re not absorbing enough nutrients, your doctor may recommend vitamins and nutritional supplements.

Surgery

If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your signs and symptoms, your doctor may recommend surgery. Nearly half of those with Crohn’s disease will require at least one surgery. However, surgery does not cure Crohn’s disease.

During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.

The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.

Up to 20% of people with Crohns have a blood relative who has IBD!

Approximately 700,000 people are affected by Crohn’s disease in America.

Can occur at any time, but most often starts between ages

15-35 years old!

Symptoms range from mild to severe (listed above).

“Crohn’s disease and ulcerative colitis are both inflammatory bowel diseases with many similarities. Nevertheless, there are some key differences between the two conditions that affect how they are managed. Both Crohn’s diseases and ulcerative colitis cause digestive distress and inflammation in the gastrointestinal tract. However, unlike Crohn’s disease, ulcerative colitis is linked to a response of the immune system.

Cancer Surveillance

You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it. People with inflammation of the rectum, also known as proctitis, are not at increased risk of colon cancer.

If your disease involves more than your rectum, you will require a surveillance colonoscopy every 1 to 2 years.

CDC states the following:

• “Influenza (flu) and the common cold are both contagious respiratory illnesses, but they are caused by different viruses.
• Colds and flu share many symptoms, so it can be difficult to tell the difference between them based on symptoms alone.
• Cold symptoms are usually milder than flu.
• Special tests can tell if a person is sick with flu.”

Centers for Disease Control and Prevention (https://www.cdc.gov/flu/about/coldflu.html)

FLU FACTS:

-Both colds and flu usually last the same seven to 10 days, but flu can go three to four weeks; the flu virus may not still be there, but you have symptoms long after it has left. Allergy can last weeks or months.  The CDC states regarding the rise of the flu since the past 40 years from the date provided in this sentence with updating this article from Sept 20, 2022 the following: “During this 40-year period, flu activity most often peaked in February (17 seasons), followed by December (7 seasons), January (6 seasons) and March (6 seasons).”

-The winter flu epidemic will be coming around us again and in a given locality it reaches its peak in 2 to 3 weeks and lasts 5 to 6 weeks. Then is disappears as quickly as it arrived. The reason for this is not completely clear. The usual pattern is for a rise in the incidence of flu in children, which precedes an increase in the adult population.  Know this it repeats again certain seasons as listed above by the CDC.

-The flu virus can lead to serious complications, including bronchitis, viral or bacterial pneumonia and even death in elderly and chronically ill patients. Twenty thousand or more people die of the flu in the America each year. Know this that the frequency of human contact across the world and the highly infectious nature of the virus make this explanation difficult to accept. Moreover there is no evidence of persistent or latent infection with influenza viruses. In any case, this idea is not really very difficult from the notion that the virus circulates at a low level throughout the year and seizes its opportunity to cause an outbreak when conditions allow.

-Even harder to explain is why the flu disappears from a community when there are still a large number of people susceptible to infection. Than even harder than that is why flu is a winter disease, which is not fully understood or known. However, flu is spread largely by droplet (aerosol) infection from individuals with high viral level in their nasal and throat secretions, sneezing, and coughing on anyone close at hand. The aerosol droplets of the right size (thought to be about 1.5 micrometers in diameter) remain airborne and are breathed into the nose or lungs of the next victim.

-Situations in which people are crowded together are more commonly in cold or wet weather and so perhaps this contributes to spreading the flu at these times. It is interesting that in equatorial countries, flu occurs throughout the year, but is highest in the monsoon or rainy season. Enough about facts but onto logical thinking for when we or someone we know has it and what questions we might be asking ourselves.  

LOGICAL QUESTIONS YOU MAY ASK YOURSELF:

Are the treatments for these illnesses the cold or the flu different?

For any of these things, if it affects the nose or sinus, just rinsing with saline that gets the mucus and virus out is a first-line defense. It’s not the most pleasant thing to do, but it works very well.

There are classes of medicines that can help the flu — Tamiflu and Relenza — antivirals that block viruses’ ability to reproduce and shorten the length and severity of the illness. But they have to be taken within 48 hours or the cat is proverbially out of the bag [because by then] the virus has done the most of its reproduction.

For a cold or flu, rest and use decongestants and antihistamines, ibuprofen, acetaminophen, chicken soup and fluids. Zinc supposedly helps the body’s natural defenses work to their natural capacity and decrease the severity and length of a cold. Cells need zinc as a catalyst in their protective processes, so if you supply them with zinc, it helps them work more efficiently.

You should also withhold iron supplements. Viruses use iron as part of their reproductive cycle, so depriving them of it blocks their dissemination. The majority of these infections are not bacterial and do not require [nor will they respond to] antibiotics. My rule of thumb is that a viral infection should go away in seven to 10 days. If symptoms persist after that, you’d consider if it’s bacteria like Strep or Haemophilus.  Those bacteria cause illnesses that are longer lasting and need antibiotics for ranging 3 to 14 days, depending on the med used.

Is that treatment approach the same for kids versus adults? In general, the same rules apply: Most children will have six to eight colds a year in their first three years of life, and most are viral. Adults have 3 or more a year. It’s very easy to test for strep and for that you should have a [positive] culture [before treating with antibiotics]. The principle behind that is knowing the organism the doctor will know what antibiotic to use to fight off the bacterial infection and you won’t build up antibodies from the antibiotic that you didn’t need in the first place if you are given the wrong antibiotic in the beginning.

Are there strategies for avoiding cold and flu different? Avoidance is very similar for both: Strict hand washing, not sharing drinking cups or utensils, and avoiding direct contact with people who are sneezing. Their transmission is similar. As long as someone has a fever, they have the possibility to transmit infection. After they’ve had no fever for 24 hours, they’re not infectious anymore.

The U.S. Centers for Disease Control and Prevention (CDC) now recommends that just about everyone get the flu shot: kids 6 months to 19 years of age, pregnant women, people 50 and up, and people of any age with compromised immune systems. Is the shot beneficial to anyone who gets it? Unless you have a contraindication, there’s no reason not to get it=PREVENTION. Contraindications include egg allergy (because the vaccine is grown from egg products), any vaccines within a last week or two, and active illness at the time of your vaccine.

The best to do is PREVENTION so you can avoid the cold or flu in its active phase or post phase, so doing the following will help prevent it:

Get vaccinated yearly if your a candidate and live a healthy lifestyle overall=Good dieting, living good healthy habits and maintaining exercise with rest daily or 2 to 3 times a week including get a vaccine yearly for the flu with maintaining good clean anti-infection habits like as simply as washing the hands as directed above.

****Recommended is to check with your MD on any changes with diet or exercise especially if diagnosed already with disease or  and on medications especially; for your safety.****

References on The FLU and The COLD:

1-Wikipedia “the free encyclopedia” 2013 website under the topic Influenza.

2-Kimberly Clark Professional website under the influenza.

3-Web MD under “COLD, FLU, COUGH CENTER” “Flu or cold symptoms?” Reviewed by Laura J. Martin MD November 01, 2011

4-2013 Novartis Consumer Health Inc. Triaminic “Fend off the Flu”

5-Scientific American “Why do we get the flu most often in the winter? Are viruses virulent in cold weather? December 15, 1997

“Influenza has a long history of devastating epidemics throughout human history, most notably the 1918 Spanish Flu pandemic which infected a large portion of the world’s population and caused millions of deaths; today, the influenza vaccine is crucial because the virus constantly mutates, requiring annual vaccination to prevent widespread outbreaks and reduce the severity of illness in individuals, especially those at high risk of complications. The flu pandemic lasts from 1918 to 1920. From spring of 1918 to spring of 1919, the flu causes more than 550,000 deaths in the U.S. and more than 20 million deaths worldwide.

In the fall of 1918 at Mayo Clinic, people with the flu and other contagious illnesses are cared for in the isolation hospital. Keeping patients with these illnesses isolated and keeping high standards of cleanliness likely prevented infections and saved lives.

 From 2020 Flu vaccines prevent about 7.5 million illnesses, 3.7 million doctor visits, 105,000 hospital stays and 6,300 deaths.”

MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/history-disease-outbreaks-vaccine-timeline/flu)

“Flu viruses are divided into four types: A, B, C, and D. During flu season (October through May), you’ll mostly hear about flu A and flu B. Flu C viruses only cause mild illness in humans and are not linked to large outbreaks. Flu D viruses do not appear to infect humans at all and are mainly found in cattle.

Now that we know there are two main types of flu viruses that affect humans, you may be wondering: Which flu is worse, A or B? Answering that question starts with learning more about their differences and how they affect us.

While flu A and flu B both cause seasonal flu, there are several differences in terms of their structure, behavior, and who they impact.

Flu A is the more common of the two main flu types, making up about 75% of all cases.”

National Council on Aging – NCOA (https://www.ncoa.org/article/whats-the-difference-between-flu-a-and-flu-b/)

The CDC states the following:

“There are four types of influenza viruses: A, B, C and D. Human influenza A and B viruses cause seasonal epidemics of disease (known as flu season) almost every winter in the United States. Influenza A viruses are the only influenza viruses known to cause flu pandemics, i.e., global epidemics of flu disease. A pandemic can occur when a new and different influenza A virus emerges that both infects people and has the ability to spread efficiently among people. Influenza C virus infections generally cause mild illness and are not thought to cause human epidemics. Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.

Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: hemagglutinin (H) and neuraminidase (N). There are 18 different hemagglutinin subtypes and 11 different neuraminidase subtypes (H1 through H18 and N1 through N11, respectively). While more than 130 influenza A subtype combinations have been identified in nature, primarily from wild birds, there are potentially many more influenza A subtype combinations given the propensity for virus “reassortment.” Reassortment is a process by which influenza viruses swap gene segments. Reassortment can occur when two influenza viruses infect a host at the same time and swap genetic information. Current subtypes of influenza A viruses that routinely circulate in people include: A(H1N1) and A(H3N2). Influenza A subtypes can be further broken down into different genetic “clades” and “sub-clades.” See the “Influenza Viruses” graphic below for a visual depiction of these classifications.

Currently circulating influenza A(H1N1) viruses are related to the pandemic 2009 H1N1 virus that emerged in the spring of 2009 and caused a flu pandemic (CDC 2009 H1N1 Flu website). These viruses, scientifically called the “A(H1N1)pdm09 virus,” and more generally called “2009 H1N1,” have continued to circulate seasonally since then and have undergone genetic changes and changes to their antigenic properties (i.e., the properties of the virus that affect immunity).

Influenza A(H3N2) viruses also change both genetically and antigenically. Influenza A(H3N2) viruses have formed many separate, genetically different clades in recent years that continue to co-circulate.

Influenza B viruses are not divided into subtypes, but instead are further classified into two lineages: B/Yamagata and B/Victoria. Similar to influenza A viruses, influenza B viruses can then be further classified into specific clades and sub-clades. Influenza B viruses generally change more slowly in terms of their genetic and antigenic properties than influenza A viruses, especially influenza A(H3N2) viruses. Influenza surveillance data from recent years shows co-circulation of influenza B viruses from both lineages in the United States and around the world. However, the proportion of influenza B viruses from each lineage that circulate can vary by geographic location and by season. In recent years, flu B/Yamagata viruses have circulated much less frequently in comparison to flu B/Victoria viruses globally.”.

Consider the FLU VACCINE!

“Enjoy a safe and happy holiday season by doing the following:

● Place candles where they cannot be knocked down or blown over, and out of reach of children
● Keep matches and lighters up high and out of reach of children in a locked cabinet
● Use flameless rather than lighted candles near flammable objects
● Don’t burn trees, wreaths or wrapping paper in the fireplace
● Use a screen on the fireplace at all times when a fire is burning
● Never leave candles or fireplaces burning unattended or when you are asleep
● Check and clean the chimney and fireplace area at least once a year

● Prepare your car for winter and keep an emergency kit with you
● Get a good night’s sleep before departing and avoid drowsy driving
● Leave early, planning ahead for heavy traffic
● Make sure every person in the vehicle is properly buckled up no matter how long or short the distance traveled
● Put that cell phone away; many distractions occur while driving, but cell phones are the main culprit
● Practice defensive driving

● Keep potentially poisonous plants – mistletoe, holly berries, Jerusalem cherry and amaryllis – away from children
● If using an artificial tree, check that it is labeled “fire resistant”
● If using a live tree, cut off about 2 inches of the trunk to expose fresh wood for better water absorption, remember to water it, and remove it from your home when it is dry
● Place your tree at least 3 feet away from fireplaces, radiators and other heat sources, making certain not to block doorways
● Avoid placing breakable ornaments or ones with small, detachable parts on lower tree branches where small children can reach them
● Only use indoor lights indoors and outdoor lights outdoors, and choose the right ladder for the task when hanging lights”

National Safety Council (https://www.nsc.org/community-safety/safety-topics/seasonal-safety/winter-safety/holiday)

Safety in the house with decorations:

Turn off and unplug decorations when leaving the house or going to bed.

Use decorations that have safety certification labels.

Use battery-operated candles to avoid shock or fire

Inspect electrical connections before use and don’t leave any lithium battery operated things in your house.

Here a few tips to stay healthy in December:

Light Your Tree, but Not on Fire: Christmas trees are reported to cause 200+ structure fires annually. Pick a flame retardant tree or a live, healthy tree with fresh green needles that don’t fall off easily. Make sure to keep all trees at least 3 feet away from all heat sources.

Deck the Halls Safely: Fires caused by decorative lights account for $7.9 million in property damages annually. Use safe lighting that’s tested, rated and stamped with the (UL)) label. Make sure your lighting isn’t frayed and that you use only 3 sets of lights per extension cord.

Cook with Care: 2/3 of all holiday fires start in the kitchen. Don’t leave your pots and pans unattended!

More tips regarding your diet:

• Exercise regularly
• Stay away from tempting foods and eat slower
• Wear clothes that can keep you warm
• Avoid sugary drinks and foods
• Drink more water
• Visit your doctor regularly to diagnose health problems before they become worse