JOURNAL ENTRY/RANDOM RANTS:
So i realised that i've never made an actual journal entry, and i'm so upset today that i feel i need too. What may be like nothing to some people is a big deal to me so i apologise if i bore you.
Ok, so i'm on Facebook as much as i'm on here and i just found out another of my high school friends gave birth today, but too make matters worse, she gave birth to twins, which is what i desperately want...
Don't get me wrong, i'm so happy for her, it just really hit me hard thats all.
Most of you don't know me that well as we are new friends, but i'm 25 and i desperately want children with my fiance, but i have Crohn's Disease. For those of you who don't know what is ive pasted a cut below:
Crohn's Disease
Introduction
Crohn's disease causes inflammation of the bowel. It most commonly affects the lower small intestine (ileum) and the large intestine (colon), but may involve any part of the digestive tract from the mouth to the anus. The inflammation extends through the entire thickness of the bowel wall. Such inflammation can cause abdominal pain, diarrhoea and a range of other symptoms including fever and weight loss.
The disease occurs about equally in men and women and usually appears for the first time in patients <30 years old with peak incidence in those aged 14-24 years. A much smaller proportion of patients may develop Crohn's between the ages of 50 and 70 years but the disease can occur in people of any age. The cause of Crohn's disease is unknown, although a family history of IBD has been associated with increased risk of an individual developing the disease. About 20% of people with Crohn's disease have a blood relative with some form of IBD, most often a sibling and sometimes a parent or child. Cigarette smoking has also been shown to contribute to the development or exacerbation of Crohn's disease.
Causes
The inflammation in Crohn's disease has in the past been thought to be related to abnormalities in the body's immune system. The immune system is composed of cells and proteins that normally protect the body from infections and foreign bodies. In healthy individuals, there is usually no immune response directed against food, 'good' bacteria or other normal bowel components. In patients with Crohn's disease however, the immune system seems to overreact to substances and bacteria in the intestine. White blood cells invade the intestinal lining and produce inflammatory toxins causing chronic tissue swelling, injury and ulceration. The precise cause of this abnormal immune response is unknown although the existence of a specific infectious agent has not been disproved. There also seems to be a genetic or inherited predisposition to develop Crohn's disease. First-degree relatives (brother, sister, parent or child) of patients with Crohn's are more likely to develop the disease. Furthermore, certain chromosomal markers have been found in the DNA of patients with Crohn's disease. Crohn's disease is not caused by stress.
For years, scientists have been searching for an infectious cause of Crohn's disease. A growing body of evidence suggests that a bacterium called Mycobacterium avium subspecies paratuberculosis (MAP) may infect a genetically susceptible subgroup of the population resulting in Crohn's disease. Researchers here at the Centre for Digestive Diseases have been instrumental in revealing this possibility and remain at the frontline of international research into this area.
Symptoms
The most common symptoms associated with Crohn's disease include abdominal pain, often in the right lower quadrant, and diarrhoea. Rectal bleeding, loss of appetite, fever and weight loss may also occur. Bleeding may persist and cause anaemia. Because Crohn's is a chronic disease, patients will experience periods of aggravation of symptoms and other periods of remission. During periods of active symptoms, patients may experience fatigue, joint pain and skin problems. Some patients may experience symptoms ranging from mild to severe. Children with Crohn's disease may suffer delayed development and stunted growth.
People with Crohn's disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with Crohn's disease are able to hold jobs, raise families, and function successfully at home and in society.
Complications
Complications may develop as a consequence of the chronic inflammation in Crohn's disease. These are usually only manifest in severe disease. The most common complication is blockage or obstruction of the intestine. Stiffening and narrowing of the bowel wall causes obstruction, which may result in constipation and poor absorption of nutrients leading to malnutrition. Some patients may develop tears in the lining of the anus (fissures). Inflammation may, in some cases, cause a fistula to form. This is a tunnel joining different loops of the bowel or connecting a portion of bowel to the bladder, vagina or the skin near the anus.
Nutritional complications are common in Crohn's disease, including deficiencies of certain proteins, calories and vitamins. Other complications associated with Crohn's disease include arthritis, skin problems, inflammation of the eyes and mouth, kidney or gall stones and liver disease. These problems often resolve with appropriate management for the inflammatory process, but sometimes require separate treatment.
Diagnosis
Crohn's disease can be difficult to diagnose because its symptoms are similar to those of other GI disorders such as ulcerative colitis irritable bowel syndrome. To determine a diagnosis of Crohn's disease, the Gastroenterologist must first obtain an accurate medical history from the patient, then perform a thorough physical examination and a series of other special investigations. Laboratory tests and x-rays are useful, often to exclude other forms of intestinal inflammation. Blood tests may be performed to check for anaemia, or high white blood cell count, which may indicate inflammation. Stools may be examined for occult bleeding or infection with a specific pathogen. The small intestine may be viewed with an upper GI x-ray after the patient swallows a chalky solution containing barium. The barium reveals areas of inflammation and other abnormalities in the bowel.
Colonoscopic procedures specifically aid diagnosis by allowing the doctor to visualise the bowel directly using a long flexible tube inserted into the anus equipped with a miniature camera. The doctor is able to see inflammation, ulceration and bleeding. A biopsy may also be taken, which involves the removal of a sample of intestinal tissue, for pathological testing to further confirm the extent and severity of inflammation.
Treatment
Treatment for Crohn's disease depends on the location and severity of disease, complications and response to previous treatment. The goals of current treatment strategies are to control inflammation, relieve symptoms and correct nutritional deficiencies. At this time, treatment can help control the disease, but there is no cure. Patients with Crohn's disease may need medical care for a long time with regular doctor visits to monitor the condition.
Nutritional supplementation
Nutritional supplements may be recommended, especially in children with impeded growth and development. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients with absorption problems or malnutrition may require feeding by vein.
Anti-inflammatory agents
The class of drugs known as aminosalicylates (5-ASA) are used to treat mild to moderate inflammation in Crohn's disease. By controlling inflammation, these drugs are generally effective at inducing and maintaining remission of disease. They include sulphasalazine, mesalazine, olsalazine and balsalazide. Possible side effects of 5-ASA preparations include nausea, vomiting, heartburn, diarrhoea and headache.
Immunosuppressive agents
Some patients take corticosteroids to control inflammation. These drugs non-specifically suppress the immune system and are used to treat moderate to severe Crohn's disease. They treat the acute stages of disease by dramatically reducing fever and diarrhoea, relieving abdominal pain and tenderness, and improving appetite and general sense of well-being. They include prednisone in oral and rectal forms, i.v. hydrocortisone and budesonide, oral or enema. Long-term corticosteroid therapy can induce serious side effects, most notably skin and bone changes and greater susceptibility to infection, and should be avoided if possible.
Other immunosuppressive agents work by specifically blocking the immune reaction that contributes to the inflammation in Crohn's disease. Azathioprine and 6-mercaptopurine improve overall clinical status, decrease the need for corticosteroids and help to maintain remission. Their action may not take effect for 3-6 months however and their use must be closely monitored for side effects such as nausea, vomiting, diarrhoea, allergy, decreased white blood cell count and pancreatitis. Other immunomodifiers such as methotrexate, cyclosporine and infliximab are sometimes used to treat severe Crohn's disease that is non-responsive to other forms of treatment.
Antibiotic agents
Accumulating data suggests that the bacterium, Mycobacterium avium paratuberculosis (MAP), may be involved in the development and persistence of inflammation in Crohn's disease (www.crohns.org). Antimycobacterial agents specifically targeting this potential causative pathogen have shown success in inducing remission and even possible cure of severe disease. The Centre for Digestive Diseases is a leader in this area of research and recently an Australia-wide trial has been completed against MAP, the results of which will soon become available. Certain clinical trials have also shown that broad-spectrum antibiotics such as metronidazole, ampicillin and ciprofloxacin drugs also have some short term benefit in the treatment of Crohn's disease. The true value of these antimicrobial drugs is yet to be determined.
Surgery
Patients with Crohn's disease may eventually require surgery. The patient makes this decision after close consideration of information given by doctors, nurses, other patients and support groups.
Research
Crohn's disease research has traditionally focussed on effective therapeutic relief of inflammatory symptoms. Recent efforts have shifted towards identifying specific infectious agents that may cause the disease. By targeting the particular causative agent with certain drugs, cure of Crohn's disease is theoretically possible.
Anti-MAP. The bacterium, Mycobacterium avium paratuberculosis (MAP), is the best candidate for an infectious cause of Crohn's disease. Small preliminary trials using drugs that specifically target these bacteria have shown promising results in Crohn's patients. Professor John Hermon-Taylor, of St George's Hospital, London first used double therapy consisting of the antibiotics, rifabutin and clarithromycin, obtaining marked reductions in inflammation, and in clinical symptoms in patients with severe Crohn's disease. Improving on the dose and composition of the therapy, a group of researchers led by Dr Thomas Borody at the Centre for Digestive Diseases achieved remarkable and dramatic reversal of inflammation in patients with Crohn's disease, resulting in long-term regression of symptoms and inflammation in most patients. A major Australian multi-centre clinical trial of antibiotic therapy directed at MAP is now under way to formally test this radical new treatment for the disease.
Researchers continue to look for more effective treatments. Other examples of investigational treatments include:
Anti-TNF. Research has shown that cells affected by Crohn's disease contain an inflammatory protein produced by the immune system called tumour necrosis factor (TNF). This cytokine may be responsible for the inflammation in Crohn's disease. Anti-TNF (eg. infliximab) finds TNF in the bloodstream, binds to it and removes it before it can cause inflammation in the intestine. In studies anti-TNF seems particularly helpful in closing fistulas. The restricted drug, thalidomide, also has anti-TNF properties and is being carefully investigated as a possible treatment for severe Crohn's disease.
Interleukin-10. Researchers are studying the effectiveness of synthetic IL-10 in treating Crohn's disease because this cytokine may help to suppress inflammation.
Budesonide. This new corticosteroid has recently been identified. Studies are revealing that this drug may have fewer side effects than other corticosteroids.
Methotrexate and Cyclosporine. These are immunosuppressive medications that may be useful in severe Crohn's disease and appear to work faster than traditional immunosuppressants.
Zinc. Free radicals are molecules produced during fat metabolism, stress and infection among other things that may play a role in inflammation by causing cell damage. Zinc removes free radicals from the bloodstream. It is possible that zinc supplementation might help reduce the inflammation in Crohn's disease.
Basically, it's an auto-immune disease.
Everybody's body has good and bacteria, and both are vitally important.. But in auto-immune diseases the body attacks aht bad bactria that is needed making the area inflamed and causing all sorts of problems.
Crohn's mainly afects the small and large bowel but can affect anywhere from the mouth to the anus.
I don't have an incredibly bad case compared to some, but mine is aggressive and unpredictable and very hard to control.
I was diagnosed when i was 17 and had i ever since.
I spent alot of my teen years in and out of hospital and nearly died from liver complications when i was 20.
So now i have 10 tablets a day, and anywhere up to 25 when i have a flare up.
Touch wood, its mainly under control atm and i havent had a major flare in 18 months.
But to have the children i sdesperately want i have to go off all medication for 3 months so its completely out of my system before i can start trying to conceive, and this scares me.
To go off all of the meds that are keeping it in check.
If i have a flare, then its back on the medsuntil its been "stable" for another 18 months before i can try again.
IF i dont have a flare and fall pregnant, i will need weekly blood tests, and if i have a flare need to stay in hospital for the duration of the pregnancy.
And i'm desperate for twins, so i only have to go through this once, rather than twice.
As i said, i'm soooo happy fro my friend, but so envious at the ease of falling pregnant for others.
I spent an hour crying today, it just hurts so much, and i'm already 25 and i don't want to be an old mum...
Anyways, sorry if i bored you guys, i'm just hurt and needed to "vent".
Thanks for listening to my whining.