# Sister's 10 year old boy



## Catherine

My sister and her family live in UAE.

Her 10 year old son has hospitalise twice in 5 weeks due to severe gasto.  He has anemia.  He was referred to a specialist due to Sarah's history.

One of his tests has come back positive for IBD marker.  Any one know what this test would be?. The specialist will be do scopy but is concerned if scopy is done now with no symptoms they will return a false negative.  

Wants them to watch for weighloss and pain, contact him direct if they occur.

His symptoms to match Sarah prior to dx. (eg up to about 6 months prior when things turn bad).

Does this sound like reasonable plan?  Could an mri show anything?


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## Farmwife

I have no idea but sorry to hear it.:hug:
How's your sister doing with all this.
This has to be bring up bad memories for you.
Thankfully she has a sister that understands.


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## Crohn's Mom

Would it be the Prometheus blood panel that he had done ?

I'm sorry about your nephew ~ I hope your sister gets some answers for her son soon!


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## my little penguin

:hug:
Sorry to hear about your nephew.

MRI did not show much anything for DS.
His disease is still inflammation ( pure) no stricturing due to his age.
We did wait to scope until DS was actively flaring since at the time we thought he had EoE and wanted to "catch" it.
We did not wait at ALL to have my older son scoped when he started to show signs...
which kinda leaves us wondering whether we scoped too soon KWIM.


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## upsetmom

I'm so sorry about your nephew.....:hug::hug::hug:


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## DustyKat

The only test I can think of is what T has suggested. 

Do they know that his presentations to hospital were gastro or could they be exacerbations of queried Crohn's? 

It's hard to say with the scope. My son had just about zilch overt physical symptoms and the ones that were present had only been apparent for one week. The GP was able to palpate a mass in his RLQ though. All that said he was scoped and he did receive his diagnosis. 

To me if the presentations could at all be IBD then they are pretty severe to require hospitalisation and so I think scoping would be worthwhile. I do fully understand the desire  and reasoning to wait but even if it does return a negative result that doesn't negate continued monitoring and documentation by both the doctors and his parents and if the need does arise then scoping and further testing could be repeated. 

I wish your sister and your nephew all the luck in the world and that what he is experiencing is easily treated, bless him. :hug: 

Dusty. xxx


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## Catherine

Dusty

My sister and her family in the Middle East.  My sister said has if anything they are too quick to test.  She does not believe he would have end up in hospital in Australia.

I am not sure he even lefted the ER.  They were sent to the ER due doctors querying appendicitis.

My conversation with my sister have been via private messaging on facebook.  And things are getting missed or coming across the way different to what we intend.

The test was faecal calprotectin she thinks, she does not know the number, but it had note recommending retesting in 6 weeks.  The specialist does believe this is necessary as he will do scoping if the symptoms return.

His symptoms appear to be dizziness, stomach pain and mouth ulcers.  All blood tests appear clear.

My sister says that even if he was dx with crohn at the moment, there would be no treatment as he has almost no symptoms.  She believes if it is crohn, he like Sarah was 4 years ago, eg three years before dx.

Decide to leave any discussion regarding treatment options, until they know one why or another.  Hopefully this is not crohn's.


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## DustyKat

Hey Catherine, 

I see what you are saying about the system there and the hospital visits. 

The querying of appendicitis may raise some flags though but then I am assuming that perhaps they were seeing/feeling something in the RLQ. Stomach pain can relate back to ileal issues and the mouth ulcers could relate to a B Vitamin deficiency or an EIM. 

The blood tests, as you know, may just not be telling the story. 

I hope more than anything that your nephew doesn't have Crohn's Catherine, :hug:, but if these issues continue to persist I think there is enough to go on to at least rule it out, but that is just me.  

I would advise your sister to start keeping a diary if she isn't already doing so. 

Dusty. xxx


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## DustyKat

PS. If they were to diagnose him with Crohn's via a scope then he would have evidence tof active disease and therefore something to treat. 

Dusty. xxx


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## Catherine

I get the impression that their Gi, who is the head of surgery, believes its crohn's.
Before the GI worked in the UAE he worked for 20 years in Ireland.  His is gut is telling him this is very early crohn's.  His concern is that testing now will give only give false negative and confuse the issue further.  He has already mentioned a pill camera if he need to see the small bowel.

I have asked for a list of all blood test done.


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## DustyKat

Oh Catherine...:hug: 

It sounds as if the GI is well on the ball hun. With that in mind, and with your knowledge and experience, your sister has two very capable to help her through this uncertain time. 

Again, I hope more than anything that it is not Crohn's but rather a passing anomaly. 

Dusty. xxx


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## Catherine

I am going to have that discussion about the need to treat even very early crohn's if found.  I just happy there is a action plan.

They got to this point after only two months, it took us three years to get to this point.

Will ask them to start keeping a diary.


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## DustyKat

I hear you load and clear Catherine on both the need to nip in the bud early and the quick diagnosis! 

Dusty. xxx


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## Tesscorm

Just want to add my hope that this is not Crohns for your nephew!!  I hope they are able to come to a more easily treatable diagnosis! :ghug:


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## Catherine

My nephew has had stomach pains again after 3 months.  They plan to do a fluoroscopy.  Dr believe pain is too high for a colonscopy to be helpful.

Calprotectin is either 617 (husband heard) or 670 (my sister heard).

670 is higher than Sarah has ever tested.

Their GI has gone to the Uk for treatment advise while they wait test results.


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## DustyKat

Thanks for the update Catherine. :hug: 

I wish they would do a colonoscopy just the same. I can't help but think of my Sarah, that was one of the reasons they didn't suspect IBD with her. All her pain was high in the abdomen and yet all her disease was in the terminal ileum. 

I hope your nephew has solid answers and a treatment plan very soon. 

Dusty. xxx


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## Catherine

Dusty

Their specialist believes it is Crohn's.  Is now testing to prove he is correct.

Do you how any other causes of high calprotectin?

This specialist believes the high calprotectin and family history all point to Crohn's.


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## Catherine

The specialist is saying that it looks like small bowel crohn's only, that why he wants to do other testing first.


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## DustyKat

Since it is a measure of inflammation then anything that has the potential to cause inflammation of the gut may produce elevated results. Gastritis could, the use of aspirin and NSAID's could, neoplasms could etc. 
With those things ruled out and in the context of presenting symptoms then elevated levels of FC can be a very reliable indicator of IBD. Now the thing is they are not a diagnostic tool and are usually used as a way of predicting whether to perform more invasive tests. So an elevated FC should be a justification for scopes for the GI. 

I can see what the GI is saying but since about 70% of all those with Crohn's have some sort of ileal involvement it seems logical to at least visualise the TI and just beyond via a scope. 

Dusty. xxx


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## my little penguin

They need to to do an upper and lower scope which is now the standard in children since most have crohn's in their upper as well.
Obviously an mre with pillcam would be the best after the scope.
Hope they get to the bottom of it.


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## Niks

Hope your sister and nephew get answers really soon, it does seem that the GI is on the ball.

x


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## Sascot

Sorry to hear about your nephew.  At least they are taking it seriously because of the family history otherwise he could have been simmering away for years without being treated.  Sounds like the GI is very thorough.


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## Tesscorm

Agree with Sascot that it's good his symptoms are being taken seriously and looked after quickly.  Just sorry to hear that it does, in fact, look like crohns. 

The nephew of my friend whose daughter has crohns, was also recently diagnosed with UC.   He is also around 10.  Due to his cousin's diagnosis, his symptoms were also taken seriously and diagnosis was fairly quick.

Not sure if IBD is, in fact, becoming more and more common or if it's just my awareness that's grown but just seems like so many people are affected by IBD!  

Hugs to your sister and nephew :ghug:


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## Catherine

Hi Maree just calling you to this thread.

Welcome to the forum.    Maree is my sister and this is thread is about her son.


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## Maree.

Hi, just found this forum, Catherine has done a good job of updating you all on Liam’s recent health adventures, but I’ll run through again, from the first hand perspective.

In Sept Liam had two visits to GP’s with severe stomach pain.  Each time they ran lots of tests including an abdominal ultrasound, which all came back clear and then was treated for gastritis.  We discussed Crohn's at the second visit and the GP said that if the pain reoccurred again he would refer him to a GI.  A few days later we had a call from the GP to say that he’d discovered there was a new test that was a strong marker for Crohn's at which point Liam had the Calprotectin test and based on the result (I thought he said 670 my husband thougth 617 )was referred to the GI.

By the time the Calprotectin results came back Liam had, had no symptoms for a couple of weeks and the GI was uncomfortable running scans as he felt there was a high possibility of false negative results,  so a clear result would not actually tell us anything.

He told us to come back as soon as the stomach ache recurred.  The stomach pain recurred over the weekend.  When I contacted the GI's office on Sunday morning (Sun - Thurs work week here) for an appointment it was clear he’d marked Liam’s file as urgent and the office girl apologised for the 2 hour wait before she could slot Liam in.

At this stage the GI has redone the Calprotectin test and scheduled a Barium Meal Follow through X-Ray (Fluroscopy) for Thursday.    He says this is a very old school test that isn’t commonly done anymore, but that it gives a good overview of the whole digestive track, which can be good in working out where to focus attention with more invasive tests.  He has requested that I ring him on Thursday morning to remind him that he needs to talk to the technician to make sure they are focused on what they are looking for.

He did discuss the idea of a PillCam, for general overview but decided that he thinks Liam is a little too small for that.   

Apparently due to Liam’s age scopes will require a General Anaesthetic and there is a chunk of the digestive system that they don’t show (which the location the pain suggests might be the problem area).  My understanding is the GI hasn't ruled out doing scopes but he’d simply prefer to start with a less invasive overview of what is going on.

(Hopefully this time I'll manage to post this in the correct spot, not sure what I did wrong on 1st attempt)


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## Farmwife

Hi and welcome.
Just let me start by saying what a wonderful sister you have. She's been a great support to all of us. OK brown nosing is over.

Your GI sounds like a good GI.
(I'm about to state the obvious)
 However, as I am sure your sister has said scopes are the only way to really see what's going on. My Grace has normal labs, test and even her scopes looks clean but on a microscopic level she has problems.
I'm just so happy to hear that your doctors are taking this seriously and want to help.
 I hope your child doesn't have this but if he does it sounds like your in good hands.
Plus you have a big advantage....you have a sister that knows what your going through.

Hugs to you both.


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## Farmwife

I forgot.....
I feel Grace has damage in her small intestine that can't be seen with a scope also.
My GI is also reluctant to do and MRE because?????? I'm not sure why? I think it's becuae of her young age.


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## Jmrogers4

Welcome Maree
I have to agree with scopes but either way I hope you get answers soon and Liam starts feeling better.
I have to agree with farmwife you have an amazing sister who provides lots of support here.


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## Clash

I just wanted to welcome you to the forum, Maree. I do hope they are able to determine the source of your son's issues. I agree with the others on the scopes but my son didn't go straight to scopes either. I think we had a SBFT(small bowel follow through) then endoscopy and sigmoidoscopy(which was useless imo) then MRI(which showed thickening at TI) then colonoscopy. Of all the testing, the colonoscopy was the easiest for my son as the drinking of contrast/barium for the others made him extremely ill.

I also wanted to chime in and say your sister has been a source of great support on this forum!!


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## upsetmom

Hi and welcome Maree....:hug:

I agree he definitely needs a scope . 
.


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## Tesscorm

Hi Maree,

Welcome to the forum!  I'm sorry that it seems your son is having this problems!   Hopefully, you will have some answers soon!

You do have a wonderful sister with tons of knowledge to help guide you through this!  Between your sister and the support and advice you'll find here, hopefully, getting through this time won't be so overwhelming for you! :ghug:


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## kimmidwife

Hi Maree,
Welcome, as the others said your sister is great and you are lucky to have her. I also agree with the others about pushing for scopes. How old is your son? By the way I love the name Liam,my oldest was almost Liam but we decided on Sean for our favorite actor Sean Connery.


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## Maree.

Barium Follow Through Scan essentially clear, only unusual thing it shown was intestinal hurry in the small bowel loops.

Next step colonoscopy and biopsy.
Currently waiting on Insurance Company approval before we can schedul.e


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## my little penguin

Glad the sbft was clear.
DS was completely clear on his except the TI which they couldn't see -
Get this the radiologist at the time was quite adament that at least we didn't have to worry about "it " being crohn's since the TI didn't light up at all.
Crohn's was not on any ones radar at the time and we had no idea what Ibd was.
Hope the scope is quick.


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## CarolinAlaska

Maree, is your dear son feeling better now?  I know he had "gastritis" as a prelim diagnosis and seemed to get better with treatment for that.  Perhaps that is what made his fecal calprotectin level high.  Did his fecal calp test come back better after that?  Have they done any other tests like ASCA (I don't remember what it is), sed rate, vitamin levels?  Is his weight stable?


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## Catherine

My daughter is Liam first cousin.

Her early presentation was "gastritis" as well.  With the gastritis events no one else in the family ever got sick.

This is why the events are being taken so seriously.


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## Farmwife

Gastritis is one of the first signs Grace had when she was younger.


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## my little penguin

Yeah that
DS had gastritis too.


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## CarolinAlaska

I know Jaedyn did too, but I was thinking that someone said the F C test could be elevated by that, and that he got better with treatment, so I am offering hope...


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## Maree.

Liam has had stomach aches again for the last fortnight, following School Beach Run. He finished 2nd but was doubled over in pain for about 20 min at the end and his stomach has not settled down again since, but it's been a demanding fortnight.  My feeling is all 3 episodes of pain seem to have been triggered by particularlly intense sporting things.

In between the bouts our main issues we're mouth ulcers and dizzyness, disorientation & headaches.  The later 3 occuring multiple times a week and always triggered by sport. My guess has been dehydration.  I've taken to giving him gatorade when he trains or competes which he likes, and pediatric electrolyte afterwards when if he looks bad or complains about feeling unwell.  He believes both of these help and visually they do seem to make a positive difference.   Until this last bout that combination seemed to keep things contained but not really at a point I was happy with.  It just doesn't seem to be possible to get enough fluid into him.  It also worries me that it is Winter here and that he might get worse again when it heats up.

Liam is a very sporty kid, he trains at football 3 days a week and is on school squad & elite U12 school (for set of a dozen schools).   Since the two bouts at the start of the year, I make sure I attend all after school sport and any inter school sport, keep a close eye on him and pour fluid into him at every opportunity.


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## Catherine

Caroline

I hope more than anything my nephrew does not have crohn's.

But the way he is presenting is so much like Sarah early on it scares me.

By the time Sarah was dx, she was severe anemia and lost 14kgs in two months.  Her specialists believe that she had activie crohn's for least 3 years prior to dx.  Her inflammation was already chronic.

My daughter's crohn is mostly silence and she developed a fistula while appearing to be in clinical remission.


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## Catherine

Maree

I don't know whether you remember this, Sarah had two faints while exercising before dx both occurred while running.  Plus other faints not related to excercise.  Went to neurologist, had an ultrasound of the heart and echo done both clear.  

She only told me in the last fews days that she was often dizzy at swimming training.  This does not occur anymore.

She hadn't fainted in the last 9 months.

If Liam has dehydration when blood in taken, his hemoglobin levels could be appearing normal when they are in fact low.


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## Maree.

The GI is with you Catherine.  He's not at all comfortable with what is happening and has emphasised repeatedly that if all the scans come back negative we shouldn't rule out Crohn's it might just be too early to see.

He has only treated patients with fairly advanced Crohn's, where it's obvious on scopes.  He really doesn't know what it looks like in early stages.


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## Maree.

Will add to my system list - loud, painful burps, that visually look quiet dramatic (often seemed to be accompanied by a spasm of pain that will double him over momentarily but then he bounces back to normal fairly quickly.

The burps only happen at times when the stomach pain is present.


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## Farmwife

Yes Grace gets those but her tummy doesn't seem to bothered by it.
 I was told gastritis or it also could be reflux at the same time?

HUGS


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## Sascot

Hi, haven't popped on to say welcome Maree.  Hope your son gets some treatment that helps!!  When you mentioned pain coming on after sport, I only just remembered my son had that problem a couple times.  Thought he had pulled a muscle in his tummy at first, but it lasted for ages afterwards.


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## Maree.

Thanks for the welcome Sascot.  Each of the episodes has lasted two to three weeks.The first time they thought appendicitis then end up treating for gastritis, current episode is the third one (all this school year), he is now in his third week of stomach pain.  His GI hasn't even tried treating it as gastritis this time as he is convinced that isn't the problem.  He has short blocks when the pain is clearly intense (can tell my his body languages & facial expressions) but most of the time it's moderate pain that panadol is able to get down to levels that he can cope with.   Hopefully it will settle down again soon.

As of yesterday afternoon we now have insurance company approval for the Colonoscopy.  So currently chasing the hospital for an appointment.


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## Maree.

Just heard back from the hospital, the GI has scheduled the Colonoscopy for 9 am on Saturday morning.  I'm actually quite impressed that he's coming in on the weekend to do this as I know he doesn't work Saturdays.


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## upsetmom

That was quick ..... good luck


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## Maree.

Amusing anecdote I need to share.

When I explain the Barium Follow Through X Ray to Liam I told him that the stuff he'd have to drink was a little like liquid chalk.  Turned out he didn't know what chalk was and I had to explain it.  The next day he told 13 year old big brother (Owen) they we're going to make him swallow a white board marker, which my oldest one thought was hilarious.

A week later Owen just had to say the words White Board mark to wind Liam up.  I can't help being amused and have had to work hard to resist fits of laughter, because Liam does not see the funny side of this at all.


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## Maree.

Colonoscopy Prep going well.  GI gave him Fleets Phosphosoda which Liam says tastes worse than White Board Marker but he drank the first lot (half a standard dose) with only moderate level of face pulling and fuss.

I've let him spend the day playing computer games and watching movies with big brother, (not normal in my house) it's been good that it's a weekend day and Owen's home.    Liam's has been drinking really well (has had about 3.5 ltrs of fluid so far today) and my impression is the process is going fairly well.  He had one more half dose of fleets due later this afternoon.  

I commented that I thought it was going really well and Liam rolled his eyes at me and told me "it's been really really pleasant."  Which made me laugh, he pulls the best faces.


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## Tesscorm

LOL  I hope it continues to go really pleasantly!  Good luck with the scope and I hope you get definitive answers!


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## Sascot

Have to say pleasant is never one I've heard associated with the prep :ybiggrin:.  Good luck for tomorrow!


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## Jmrogers4

Oh the sarcasm of a 10 year old, glad it's going well.


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## CarolinAlaska

Glad its going well.


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## Maree.

Second dose of fleet has hit him much harder, but he's still smiley and entertaining despite 2 hours of fairly constant diarrhea.  Could be a long night (currently 11:20 pm) here but I think he'll be fine. 

Purely by chance this has concided with my husband being home for 4 days, one of two 4 day stints he's with us during a 6 week block working fulltime on a project in KSA.  Nice to have someone to share the load with other than my 13 yr old (not that I'm complaining about my 13 yr old who's fabulous.)


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## Jmrogers4

Nothing like a little family time around the loo


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## Maree.

Colonoscpy showed no inflamation.  GI took a set of random biopsies.

We go back to see GI on the 20th when he should have results of the biopsies and the 2nd calproc test.


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## Farmwife

Grace had microscopic inflammation. What was seen by the scope look clear and we were sent home in despair However, what wasn't seen showed a very different world. 
Hang in there!


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## Maree.

I like the GI had he warned us in advance that he was concerned the scopes wouldn't show anything and that he would not view a clear result as ruling out Crohn's.

My current plan is to take a very positive attitude to the results around Liam, to reduce any anxiety he may be feeling.  Then see how he goes and what the other results look like.  If the pain we're to settle down by itself (as it has on previous occassions) and the test results looked alright I'm definitely open to a wait and monitor approach.


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## CarolinAlaska

That is the way I felt at first, but then I decided that we had been doing that too long - for us it had been years of trying to jump through hoops to get our daughter to eat, crossing our fingers that she wouldn't have a reaction to the food, etc.  I finally realized (we'd been given a diagnosis of Crohn's) that I couldn't control it any longer, that my own efforts had failed, and looked to the treatment options.  I think then I accepted the diagnosis and the hope (as well as the heartache) that comes along with it.

I hope your doc is very thorough and that your wait and see approach doesn't prolong his suffering.  I know your son is not my daughter and that you don't have a diagnosis yet, which would at least let you know what you are dealing with.  That is the hardest thing, isn't it!

Keep us informed on any new developments.  You are in my thoughts.  :hug:


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## my little penguin

Hugs it is very hard when the scope shows normal but they are in pain.
Fwiw at dx DS had a clean scope. Gi warned us it was functional.
Biopsies came back showing acute and chronic inflammation consistent with crohn's from stomach to anus.  

He had the a biopsy clean scope of just upper Gi tract the year before.
Good luck


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## Catherine

While waiting and seeing.  I would monitor iron, folate and b12 via blood tests.

Sarah's iron studies were the first thing that showed problem.  She also had falling b12 and rising folate levels.

There is know problem in mum side of family with b12 levels and multiple cases of dx of ibs.


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## Crohn's Mom

Hi Maree, 
I just wanted to say welcome 

I'm glad the scopes went well, and I love that you have such a great sense of humor while going through trying times.
Sometimes, laughter is the best way !

I'll be waiting anxiously, along with the others, until you get the biopsy results.
I suppose there is some relief in you to know that there wasn't any visual damage ~ I hope you get some solid answers soon!


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## Maree.

GI's office rang today to say test results back.  We we're able to move our appointment that was booked for Thursday to tomorrow morning (Sunday is a week day here).

I know it would be a positive sign if the biopsys result are clear and the Calcproc has gone back to normal levels. 

However I'm concerned that the stomach pain seems to be getting worse not better.  He wokes sobbing last night complaining about vomiting into his mouth and sharp pain just above his sternum.  Which is new.  He was in sobbing pain and so distressed I thought about taking him into our local 24 hour GP clinic & we all got up and dressed only to have him burp loudly and the pain disappear almost immediately.

So if the answer is watch and monitor I'm also going to be looking for some ideas on how we get him feeling better.


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## Farmwife

Has he ever had GERD or acid reflex. If he burps does it hurt?


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## Maree.

The burps are extremely painful and have only been present for about a fortnight.  It's not something that he's had in the past.  Got to agree the incident last night does sound like acid reflux but it's new, has not happened to him before.


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## Farmwife

Yes Grace gets that. She's on Zantac and it helps but doesn't stop it all the way.
Did your son have a pill camera done?


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## Maree.

No has just had Barium Follow Through X Ray and Colonoscopy.  Given his symptoms are high, (stomach pain around the belly button) I suspect he probably does need more imaging done.  I'm definitely feeling if the Calproc test comes back high again, that we need to keep looking.


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## Farmwife

Good idea. Please keep in mind some of our kids have normal calproc in the stool. Even though we know their active inflammation happening. Also some think the higher up the inflammation (sm. bowel) the less likely you'll see high counts in the stool. I'm not sure if theirs a study about that, I'll have to look.
I think my Grace has problems in the small bowel and thats why she backs up and get acid reflex. Her stomach upon scoping show no damage. I'll be pushing for an MRE or pill camera at her next GI meeting.

HUGS


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## Catherine

Good luck with appointment today. Does Liam have any diary?

I know he had a problem with it as baby.  Sarah and I have a problem with lactose it gives Sarah stomach ache.  I get reflux from it.


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## Niks

Good luck with results today!!

:goodluck:


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## CarolinAlaska

I hope the appt goes well.  I don't know if you've done it yet or not, as it is 3:36 pm on Saturday here...  I hope you can get some solid answers soon.


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## Tesscorm

Good luck at the apptmt!  Before being diagnosed, Stephen also complained of heartburn and said it felt like there was something 'blocking' when swallowing food.  It went away once he started EN to induce remission.  

HOWEVER, as the NG tube leaves the 'flap' between the esophagus and stomach open, he was prescribed nexium to alleviate problems if acid was released into his esophagus (which likely helped his initial heartburn symptoms too).


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## Maree.

GI appointment still a few hours away.  

Liam does have some moderate amounts of dairy we reintroduce when he was 2, we've not seen any clear link between food and symptoms.  

Did discuss at the last appointment and the GI was reluctant to exclude any foods that he was happily eating.  

I'm cautious about food avoidance diets having endured years of them as a child, which always seemed to make me sicker and definitely made it impossible for me to stay at a healthy weight during my teens.   I remember clearly the sheer joy & massive relief of leaving home and being able to throw away all the rules on what I could and couldn't eat.


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## Maree.

Everything clear - biopsy clear, calproc totally normal
GI will talk to lab about whether first calproc test could have been an error.

Prescribed Pariet & Motileum for 10 days to treat symptoms

GI ordered another ultrasound, which was done while we we're there (I think to look at gallblader) and another stool tests (something different not previously tests, but I don't remember what).


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## my little penguin

Has he ever had a proton pump inhibitor such as Prevacid?
I know for my older child lots of similar issues clean scope etc but only really needed a ppi.
A standard h2 blocker ( Zantac) was just not string enough.
It did take a few weeks though before things improved.


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## Maree.

Pariet is a PPI.  Will be interesting to see how that goes.


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## CarolinAlaska

Glad to hear the good report.  I hope the new meds work and he doesn't have any more symptoms.


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## Jmrogers4

^^^^ yes that.  Keep us posted on how he is doing.


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## Maree.

Day 1 with on PPI & Motileum Liam looked much better, first day in weeks with no pain, burps still there after meals but minus the pain.  He was also ravenous and ate more than I think I've ever seen him eat (he's always had moderate to small appetite).  Not sure if increased appettite normal symptom with these medications.

Day 2 (Today) he looked good in the morning and I just got an email from his teacher to tell me how much 'brighter' he's looking.


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## Sascot

That's great news.  Hope things get better from now on!


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## Niks

Such good news. Really hope he continues improving :ybiggrin:


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## Maree.

Liam's ultrasound and additional stool test came back fine.

He's still feeling fabulous and eating everything in sight, he commented yesterday that he felt like himself again, for the first time this school year.

Yesterday he got through a football session without any ill effects -first time this year he's not sufferred afterwards, even during the months when the stomach ache disappeared he was always looked wretched at the end, and sufferred from headaches and dizzyness following all his training sessions. 

We go back to see the GI on Wednesday next week, I'm hoping that with this increased appetite Liam might put on some weight.


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## Tink572

Woohoo!!! :dance:  So glad he's had a good couple of days.  Hope it continues for a long time!


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## CarolinAlaska

Ditto Tink's comment!


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## Maree.

Liam has now had a week on PPI & Motileum and feels and looks great.  During this week he has put on 2 pounds after not gaining weight for 6 months.  His BMI has jumped from 14.5 to 15.0

We go back to see the GI on Wednesday, will be interesting to see if he recommends stopping one or both medications.  Although I'm thrilled that Liam is looking so great, I think there must be an underlying issue of some sort or he wouldn't have responded as strongly as he has to these medications to treat the symptoms.


----------



## my little penguin

Hugs glad you saw such a good improvement.
We saw something similar with my other child.


----------



## Maree.

MLP did they eventually work out what the issue was with your other child?


----------



## my little penguin

Gi is still following him.
Current dx is uncontrolled reflux.
Gi said when the stomach is inflamed from reflux/gastritis it can sometimes cause pain lower in the Gi tract , disrupt sleep, make you not want to eat etc...
All these things combined makes for a kid in pain, losing weight and fatigued.
Cure the reflux with a ppi 
- new kid.

Given DS history of Ibd - we are still keeping a close eye as is the Gi but hoping a ppi is all he will ever need 

Good luck Wednesday


----------



## Catherine

Maree, for your information only I have been taking medications on and off for heart burn/reflex for 18 years.  Remember as a kid i would have mum to write notes saying I didn't eat anything with cream as it would make me feel sick.  Within 3 days of removing lactose from my diet the heartburn when away.


----------



## Maree.

Liam's GI is happy with the improvement, has stopped the Motileum but said keep the PPI going.  Has suggested that we keep it at daily for a month then see if able to cut it back to every 2nd day.  

Has suggested we bring Liam back to see him in 3 months if he's still needing the PPI.  

So it really is wait and see.  Will continue to keep a close eye on whats happening with his weight and height.


----------



## Tesscorm

So happy to hear Liam is feeling so well! :banana:

My husband and BIL have the same issue...  both have constant reflux issues.  My husband takes nexium daily, has for years now.  But, do be sure you control it - my BIL was much more lax about it than my husband, regularly ate foods that caused more acid for him, careless re the meds and, his esophagus became so damaged from the years of abuse, he had to remove a large section of his esophagus (at about 50+ years old, so I do mean 'years' of neglect)!   They had to 'stretch' his stomach upward to connect to what was left of his esophagus and his stomach now sort of acts as part of his esophagus.  Incredibly, he is doing very well but, as you can imagine, it has left him with some issues - no heavy meals, no large meals, easily digestable foods, etc.


----------



## Maree.

I will definitely keep an eye on things, I looked up the list of food that cause acid following you mentioning it reads like a list of things Liam makes a fuss about eating
-- High fat foods
-- Junk food
-- Chocolate
-- Eggs
-- Citrus
Will need to watch the tomatoes though as that creeps into lots of things.

He is the sort of child who has claimed since pre school age that junk food made him nauseous and that McDonald's is child abuse.


----------



## my little penguin

Yep same here for my older son...

But Prevacid has him eating us out of house and home now. 
Good luck


----------



## Maree.

It’s been a month since I posted last so thought I’d update you on how Liam is doing.   At the same time Liam stopped Motileum we introduced some diet changes to try to reduce reflux.  The first couple of weeks we’re pretty tough with lots of several bouts of stomach pain & reflux, but he has steadily improved (I think partially because we’ve managed to identify and remove several trigger foods, I’ve listed diet changes at the end.)

Stomach aches & reflux have been gone for about 10 days.  He no longer gets dizzy or suffers from headaches and his appetite and energy levels are back to the level they we’re 12 months ago.

Continuing Issues:  Mouth ulcers (3 this month, 1 at present), Rash looks like Molluscum-Contagiosum, he’s had this for 18 months and no new patches in last 8 weeks.

- Weight back down to 29.1 kg, similar to when he started medications.  But he’s tracking nicely on height, grew 1 cm in last month.  He’s been between 29 – 30 kg all year for weight but grown 8 cm.  Current BMI 14.4 which is 5% percentile.  

Next Step:  Due to cut back PPI to every 2nd day as of tomorrow but will wait until next week as we are heading to India for 5 days from Thursday.
Although he’s feeling great on current diet & med combination and eating well, I’m conscious that at 10 ½ he should be entering a major growth period and that not losing weight isn’t good enough, he needs to be able to gain weight, so feeling that need to consider supplementary EN. 

Diet Changes:  Trying to reduce some things which might be causing issues while not attempting any of the very difficult/demanding diets.
-	Removed all high acid foods, the few times he’s had these it’s been clear they cause issues
-	Have got very fussy about fat on meat, even the smallest amounts seem to cause issue
-	Replaced sugar in baked items with agave/stevia.
-	Swapped to Lactose Free Milk initially & then to Homemade Yoghurt (non SCD compliant)
-	Swapped his water to bottled mineral water with PH 7.8 or higher as our water slightly acidic, this seems to have resolved the dehydration issues he’s been having all year.
-	Reduced his breakfast cereal intake, (this is the thing he misses most) but high fibre cereals seem to consistently trigger pain.  I’ve been making fruit & nut breads multiple morning a week, plus making lots of breakfast smoothies.


----------



## Tesscorm

Glad he's doing well!  But, yes, if he doesn't begin to gain some weight, I would also consider supplement EN...  it certainly can't hurt. 

In the Diet for Kids thread, there were lots of smoothie/shake recipes recently posted and, at least one or two, included Boost/Ensure. :thumright:


----------



## Maree.

With impecable timing Liam stubbed his toe on a corner this morning (while kicking a football inside grrh), and gave himself a cut between two toes, which required 6 stitches.

So as well as the anti milaria tablets he started yesterday, he's now on heavy duty antibiotics for the toe.  The doctor also prescribed a NSAID for the swelling which I'm very relucatnt to give him am keeping a close eye on the swelling and hopeing we can get away without it as I've read lots of bad things about impact on the digestive system, but whether or not we can avoid will depend on how much the toe swells.

Liam has struggled to eat today and had bad stomach aches following lunch (my guess is caused by the combo of new medications) but he assures me he's totally fine!

We head to the airport this evening to catch our flight to India, we're spending 5 days at a lodge in a tiger sanctuary near Chandrapur & the boys are incredibly exited about the trip, here's hoping that the stomach ache will settle and his appetite return.


----------



## Clash

Hope his tummy setttle any your family has a splendid time in India!!


----------



## araceli

Have FUN! Hope everything goes great.


----------



## upsetmom

Have a great time in India!


----------



## Niks

OUCHHHHH with the toe!  Must have hurt!  Hope his tummy settles.

Have a fantastic time :emot-waycool:  xx


----------



## Sascot

Have a great time.  Hope his toe is ok and tummy settles.


----------



## CarolinAlaska

For inflammation:  rest, ice, elevation and compression (ace bandage).  I too would steer very clear of the NSAID.

Have a great trip!  Don't become tiger food!


----------



## DustyKat

Wow India! I hope Liam is okay, both toe and tummy wise, and you all have a fab time! 



Dusty...


----------



## Jmrogers4

Catching up, Hope you are having a fabulous time in India.  What a great adventure.


----------



## Maree.

We had a fabulous trip.  Liam's stomach didn't worry him while we we're away and he ate well.  On the first night a tiger attached a bison about 30 meters from our room and we we're warned not to walk between building except in a group. 

My oldest informed Liam that tiger go for the small ones and the injured ones and he was both, then proceeded to call him 'tiger bait' for the rest of the trip.

It turned out to be the perfect trip for a small boy with stitches in his foot as it was two 4.5 hour safari's a day through the national park in small open top jeeps (not allowed to get out of the vehicle), so the foot got a lot more rest than it would have normally.

We saw tigers on every trip, we're lucky enough to get to see a Slothbear reasonably close which is very unusal and saw lots of other small mammals and birds.

Liam lost a little bit of weight while we we're away and is now the lightest he's been since I started tracking his weight closely late last year,  BMI 14.3 (which is 4th percentile).  This is the first time my BMI calculator has given me a figure under 5 so will head out today and see what EN products it's possible to buy here and get him started on that.

Today is also when we reduce the PPI to every 2nd day, it will be interesting to see how that goes.


----------



## CarolinAlaska

Maree. said:


> We had a fabulous trip.  Liam's stomach didn't worry him while we we're away and he ate well.  On the first night a tiger attached a bison about 30 meters from our room and we we're warned not to walk between building except in a group.
> 
> My oldest informed Liam that tiger go for the small ones and the injured ones and he was both, then proceeded to call him 'tiger bait' for the rest of the trip.
> 
> It turned out to be the perfect trip for a small boy with stitches in his foot as it was two 4.5 hour safari's a day through the national park in small open top jeeps (not allowed to get out of the vehicle), so the foot got a lot more rest than it would have normally.
> 
> We saw tigers on every trip, we're lucky enough to get to see a Slothbear reasonably close which is very unusal and saw lots of other small mammals and birds.
> 
> Liam lost a little bit of weight while we we're away and is now the lightest he's been since I started tracking his weight closely late last year,  BMI 14.3 (which is 4th percentile).  This is the first time my BMI calculator has given me a figure under 5 so will head out today and see what EN products it's possible to buy here and get him started on that.
> 
> Today is also when we reduce the PPI to every 2nd day, it will be interesting to see how that goes.


Sounds like a great trip.  I'm glad he was able to eat, etc.  Sorry he's still losing weight.  Keep us informed...


----------



## Maree.

Stepping down the PPI to every 2nd day didn't work.  By his 3rd day without Liam had severe stomach pains.  I'm giving it to him every day again and will wait until he's been feeling well for a while before trying again.

Have added 2 boost smoothies per day to his diet and he is enjoying these.

New low weight this morning 28.3 kg  which is 12 pc weight 14.0 BMI 3 pc BMI
My husband has suggested the weight loss over the last fortnight might be due to him not coping with his anti malaria tablets.  He finished the course of those this morning so hoping weight will pick up during the next few days.

He is scheduled to go back and see his GI in 6 weeks.


----------



## Kimberly27

Keeping my fingers crossed!

Kimberly


----------



## Catherine

How much weight has he lost?  Liam doesnot have any weight to lose.


----------



## Maree.

In the last fortnight he's lost just over a kilogram. Seeing the GP this afternoon to have the cut on his foot redressed.  Will ask him what he thinks.


----------



## Catherine

I'm sure you understand why weigh loss scares me.


----------



## Maree.

The amounts are small nothing like what you experience with Sarah which was really scarey and I'm aware that I've got rather obsessive about what he weighs (I've been recording daily weights for him for months). 

But I'm feeling the same way that there is so little of him that any weight loss worries me.  Back on 24th Feb after a week on Motileum he was 29.9 and a full cm shorter than he is now.  I'm feeling like if he doesn't start putting on weight again by start of next week that I need to see if it's possible to get him an early GI appointment.


----------



## Maree.

Didn't get a chance to speak to the GP about weight this afternoon as he was frantically busy but should get a chance to talk to him during the next few days as sounds like we are going to have several more visits.

When he first cut his foot, the doctor put him straight on antibiotics because we we're heading to India.  We took Liam to the GP the night we got back from India and the foot was looking really good.

Turns out the foot is now infected and the wound isn't healing as it should so the GP has prescribed another 10 day course of antibiotics and wants to see Liam every 2 days until it starts improving.


----------



## Dexky

It sounds as though you have a very pro-active GP!!  I hope his foot begins to heal this go round!  

Has his stomach issue settled since ending the anti-malarials?


----------



## Maree.

GP has been excellent.  When we see him tomorrow it will be the 5th time he's examined Liam's foot in a fortnight.  Because the cut is very badly positioned he prefers to have the staff at the hospital wash and dress the wound rather than have us do it at home.   

He warned me yesterday that he thinks it will take a long time for the foot to heal, the stitches were in for 10 days but had to be pulled out due to the infection and the wound immediately opened up completely.  Although they've bandage it to try to hold it together, he thinks will need to be restitched when the infection heals.

Stomach is still hurting (more than the foot).  But we've now got the Augmentin (Penicillin based antibiotic) which Liam is taking at twice the standard dosage to further complicate the picture.  (The hospital pharmacist double checked the dose with the doctor as it was outside the normal range & I've checked the online Drug Information sheets - both of which state that it can be given at that higher dosage level in the case of severe infection.)

Suspecting that it might be too much to hope for to expect him to gain weight until he gets over this infection and finishes the antibiotics.  I just hope that he doesn't lose anymore weight as I know I'd find that really worrying.


----------



## my little penguin

typically you wean from something like the ppi(prevacid ) to an H2 blocker then to nothing.
SOMetimes you need to very slowly reduce the dose.
Can you call the GI and ask for recommendations on how to do a much slower wean???

I know with my oldest it just didn't work but the wean was not an issue at all for DS.


----------



## Maree.

Thanks MLP will ask if he can suggest something more gradual.

At the moment I've put stepping down the PPI totally on hold.  I want Liam to start putting on weight again first.  The antibiotics he's taking for his foot infection has really knocked his appetite about.   Conscious I'm probably being terribly neurotic here given his body is fighting an infection but really not coping well with the fact that every time I weigh him he seems to be lighter.

The GI prescribed 3 months worth of the PPI when we saw him last, in case the stepping down didn't work.  Which is part of why I'm feeling like stepping it down is a lower priority for now.


----------



## Farmwife

Grace had NO appetite on antibiotics.
I'm sorry if I've miss it.....
Are you/can you have him do EEN?


----------



## CarolinAlaska

FW, Liam isn't diagnosed with IBD yet.  I'm not sure that is an option yet.

Maree, Augmentin can cause diarrhea with normal doses, I imagine with high doses it could be bad.  Just want you to have a heads up.  Sorry his foot got infected .  I hope he is healed up and back to his whole self soon.


----------



## Farmwife

CarolinAlaska
Hi, I know he's not dx yet but neither was Grace when she started doing Boost 1-3 times a day. I knew from this forum that keeping the weight on was just as important as getting a dx.


----------



## Maree.

I've been giving Liam 2 Ensure's a day to supplement what he is eating. 

At the moment Liam's GI isn't sure that there is anything wrong beyond Acid Reflux (as his 2nd calproc test and colonoscopy came back normal so he thinks the high calproc test that made him think Crohn's might have been a lab error.  Acid Reflux is being treated with the PPI, until we started to step that down (now stopped trying) his GI symptoms had totally gone away. 

His weight losses worry me but I'm not sure this is a valid concern, when we saw GI last on 24/2 (after a week on Motililum and PPI where he'd gain weight) Liam's height was 141 cm and his weight 29.9 giving him a BMI of 15.0 and BMI percentile of 13.  As of today his height is 142 cm and his weight is 28.1 (BMI 13.9 BMI percentile <3)

He's lost most of that weight in the last two weeks but during that time he has had two courses of heavy duty antibiotics plus antimalarial tablets, so perhaps the weight loss just relates to the sore foot & the meds and isn't a sign of anything significant.  

What I've read about untreated Crohn's flaring is that you get dramatic weight loss, not these small drops in weight?  Really not sure if I have any reason to be validly concerned here but ...


----------



## Farmwife

Hugs, it's so easy to feel paranoid. :yrolleyes:Welcome to my world.:lol2:
Grace's weight NEVER wavered much until the downhill turn. That was after 2-3 years of trying to get answers. Not all IBd'ers (not that he has this) loses drastic amounts of weoght!


----------



## CarolinAlaska

Maree. said:


> I've been giving Liam 2 Ensure's a day to supplement what he is eating.
> 
> At the moment Liam's GI isn't sure that there is anything wrong beyond Acid Reflux (as his 2nd calproc test and colonoscopy came back normal so he thinks the high calproc test that made him think Crohn's might have been a lab error.  Acid Reflux is being treated with the PPI, until we started to step that down (now stopped trying) his GI symptoms had totally gone away.
> 
> His weight losses worry me but I'm not sure this is a valid concern, when we saw GI last on 24/2 (after a week on Motililum and PPI where he'd gain weight) Liam's height was 141 cm and his weight 29.9 giving him a BMI of 15.0 and BMI percentile of 13.  As of today his height is 142 cm and his weight is 28.1 (BMI 13.9 BMI percentile <3)
> 
> He's lost most of that weight in the last two weeks but during that time he has had two courses of heavy duty antibiotics plus antimalarial tablets, so perhaps the weight loss just relates to the sore foot & the meds and isn't a sign of anything significant.
> 
> What I've read about untreated Crohn's flaring is that you get dramatic weight loss, not these small drops in weight?  Really not sure if I have any reason to be validly concerned here but ...


There is no real answer to that question.  It is different with different children.  If the child doesn't have much weight to lose, it isn't going to be as dramatic.  (I'm now putting my bubble-popping pin back away).:emot-cop:


----------



## DustyKat

I know it is difficult Maree but try not to place too much emphasise on his weight right now. As you have pointed out, there are are too many variables at play...antibiotics and antimalarials, not to mention the fighting off an infection. 

Dusty. xxx


----------



## Tesscorm

Just catching up...  sounds like you had a fabulous trip!! 

I also think that the weight loss could be the result of medications, infection, trip, etc.  I would certainly continue with the shakes (and, of course, do what we all do best...  watch, watch, watch! :lol but I wouldn't be overly worried until all else settles a bit. :ghug:

I'm not sure if you're giving him just the Boost shakes but I happened to find a site that gave recipes for smoothies that included the boost shakes as an ingredient along with fruits, etc.  Just suggesting in case he starts to get bored with just the shakes.

http://www.boost.com/boost-in-your-life/boost-recipes


----------



## Kimberly27

My 17 year old son was on Augmentin ES for almost a month.  That stuff is strong.  He too did not have an appetite and lost weight.  He was 117 (at a lean cross-country running weight), dropped to 103 and is now up to around 110.  

Once he was off Augmentin, within hours, he was eating his new normal amount.

Good luck!

Kimberly


----------



## Maree.

Liam has four more days on this course of Augmentin.  The foot was checked yesterday and it's still infected but is improving, so fingers crossed won't need another course of antibiotics.

Other than the Ensure smoothies, which I'm still managing to get him to drink (sometimes) he has completly stopped eating.  How many Ensure's a day day do you think I should be aiming for if he is not having any other food?


----------



## my little penguin

I can tell you DS was on 1700 calories at age 7 and 50 lbs when he was no food.

not sure how much for your child.
What does your GI say??


----------



## Maree.

Thanks MLP.

I haven't spoken to Liam's GI about the supplementary Ensure's I've been giving Liam.  He's not a pediatric GI (I don't think there are any pediatric GI's in UAE working outside Public Hospitals).

His GI hasn't been overly concerned about weight beyond saying to bring Liam back if he loses lots of weight, however his weight does make me uncomfortable which is why I decided to try the supplementary ensures.    

I've been wondering if I should find a pediatrician for Liam, to discuss his weight issues with given that his BMI has dropped so low.  Feedback from his GP has been not to worry at this point as the appetite/weight issues are probably just a side effect of the antibiotics.  So perhaps I should hold off on this to see how quickly his weight bounces once he finishes up on the antibiotic.

Despite the reasurrance and knowing that it probably is all down to the antibiotic, I'm still really uncomfortable with him completely stopping eating.  Which is why I was curious about the Ensure volumes needed.


----------



## AZMOM

Maree - I think supplementing to keep his calorie count is fine too.  And yes, everyone is correct that while Augment is VERY effective, it is also a direct GI irritant.  I probably wouldn't flip too far out unless his appetite doesn't return to normal after he stops taking it.  

Poor little man :-(

J.


----------



## CarolinAlaska

How much does Liam weigh?


----------



## Catherine

Maree, I would be aiming for least 3 ensure per day, if that's the only intake.  

I would look for a pediatrician.


----------



## Catherine

Liam weigh is  28 kgs.


----------



## Maree.

Thanks Catherine.  Will see if I can get that into him for the rest of his time on Augmentin.  Will ask his GP about a referral to a pediatrician to talk about weight (we are scheduled to see GP again on Wed for next review of foot.)

Carolin -- Liam is 62 pounds.  He is 4ft 8 and 10 3/4.


----------



## CarolinAlaska

Jaedyn is still doing 8 cans/day and she is 34 kg (75 lbs).  I believe boys require more than girls.  I would consider asking for a referral to a nutritionist.  They can help you know how many calories/day he needs, as well as may have some ideas of how to beef him up with foods...


----------



## my little penguin

try my fitnessmypal
it is free and will let you track how many calories he is truly eating- fat carbs etc....
we used this for ds prior to dx- at one point he ate 2600 calories a day without gaining weight.
so it is important to track so they will know if its an intake issue or absorption issue.

good luck


----------



## Maree.

Some days things just go much better than you expect.

Took Liam in to have his foot checked today, hoping to speak to the GP about a pediatrician referral.  When we got to reception we found out his GP was sick and huge back log for appointments to see the other GPs.  Receptionist asked if it was ok if they got the pediatrician to look at instead as she had a cancellation.

So without a referral we saw the Pediatrician (cost the same amount out of pocket as if we'd seen GP - $13) so I got a chance to tell her directly that I was concerned about his weight.  

The pediatrician spent an hour and a half with Liam.  She gave him a thorough checking over, looked through his file in detail and asked lots of question.  She has ordered a set of blood tests (waiting on insurance approval to get those done) and referred him to a Dermatologist for his rash and to another GI for a 2nd opinion on his stomach issues.


----------



## Catherine

Maree, sounds like a good appointment.


----------



## Maree.

Yeah very positive, after a week on Augmentin he really was looking dreadful, so it was probably a perfect time for her to see him for the first time.


----------



## Farmwife

WOW!!!!!!!!!!!!!!
I think you had fantastic luck! I think most of us wish we had more days like that.
So will she be Liam's new doctor or will you be sticking with the other one?


----------



## Maree.

The pediatrician we saw today, said she'd give me a call as soon as gets the tests results to discuss what next, hopefully they'll be something in there that helps workout where to look or what to try next.  Will definitely take him back to see her again.  I'm also going to take him to see the other specialists that she's recommended to see what they think.  

I'm not going to cancel the followup appointment we have with his current GI in 5 weeks time until I see how we go with exploring other avenues.  The next followup appointment for his foot is on Saturday with his normal GP.


----------



## Dexky

Maree and Catherine, does your family have any other immuno issues other than your kids?  Maree, I'm sure you are mentioning your niece in Liam's appts..  Are the docs receptive to the increased likelihood?


----------



## Johnnysmom

Maree. said:


> What I've read about untreated Crohn's flaring is that you get dramatic weight loss, not these small drops in weight?  Really not sure if I have any reason to be validly concerned here but ...


Johnny's weight loss was extremely subtle.  At 9 year check up he was 101 lbs. at 10 year he was 97 lbs and at 11 he was 95 lbs.  Keep in mind that kids his age should be gaining about 12 lbs per year.  So even staying the same weight over the course of a year is a concern.  My son would usually gain 12-14 lbs per year before age 9.


----------



## Maree.

For Liam the main things that there are family history of are my side family; Crohn's (Sarah) & Thyroid conditions (lots of cases).  From my husband's family Ulcerative Colitis (multiple cases).

Both the Pediatrician & GI we're receptive to the idea of increased likelihood of Crohn's.  The Pediatrician has run some broader tests (including thyroid) as she felt that the GP & GI  had been too focused on his stomach and there hadn't been enough exploration of other potential health issues which could be causing the problem.  All the doctors he has seen so far work out of the same hospital so she was able to look through the complete list of all the tests he's had done to date.

When I raised the issue of his weight with the pediatrician yesterday she checked hi file and said he'd grown 3 inches & only put on 4 pounds in the last year.  That the height gain was good but the weight gain was a concern.  She then put him on the scales and discovered he'd lot of all that extra weight in the last 3 weeks at which point she decided there was definitely reason to be concerned and gave him a thorough checkup.


----------



## Catherine

I have rosacea, ibs and low vitamin b12.

Our mother side, first cousens, 
-lupus 
-very low vitamin b12 levels tested at under 100 with stomach issues and asthma


----------



## Maree.

GP checkup this morning.  The Bacterial infection in Liam's foot is gone, but it now has a fungal infection.   For now we are trying topical antibiotic and anti fungal cream on the wound.  Checkup in a fortnight if the fungal infection doesn't clear up by then the GP said he'll prescribe an oral oral anti fungal medication.  

Blood & urine tests ordered by the Pediatrican we're also done this morning so hopefully we'll hear back on those in a few days. 

Dermatologist appointment this morning and she's requested insurance approval to remove Liam's Molluscum Contagium as she does not believe will heal by itself.


----------



## DustyKat

Thanks for the update Maree. 

I hope the fungal infection responds to treatment and oral meds aren't required. 

Good luck with the results! :goodluck: 

Dusty. xxx


----------



## CarolinAlaska

Thanks for all the updating.  Sorry I haven't seen it for a few days.  I hope the pediatrician will have a follow-up time after she does her research...


----------



## kimmidwife

Maree,
Just catching up. So glad you were seen by that pediatrician. She seems really on the ball. It is nice to have a proactive doctor for once.


----------



## Maree.

Pediatrician rang to say that I can collect the test results this afternoon.  She said mostly they are all normal the one exception being that he has a low white blood cell count.

As he's not had any viruses she suggested I ask the GI who she has recommended if this is likely to be caused by his stomach problems.  I'll pick up the test results this afternoon and have a better idea then of exactly what was tested and what the results we're.

Is anyone aware whether reduced white blood cell count is associated with IBD?


----------



## Maree.

White Blood Cell Count 
20 Apr  3.68
16 Oct 5.48 
Reference Range 6 - 12 yr old: 5 - 13

Everything else that was tested seems to be within the reference ranges.


----------



## Catherine

I don't think so.  I see what I can find.


----------



## Catherine

Some antibiotics lower white cell count.  What was the antibiotic he was taking?


----------



## Maree.

Augmentin, just looked up the side effects and lowered White Blood Cell count is there.  Having a likely explanation does make me feel better.

Will mention it to the GI when we manage to get in to see him (still trying to sort out insurance details).  Wondering if I should ask to have this retested in a couple of weeks time to see if it's settled down.


----------



## Catherine

I would get retested


----------



## Dexky

You guys are awesome sisters!!


----------



## DustyKat

^^^^ I agree Dex! 

I'm with Catherine, Maree.  

I would get a retest, if no other reason than my own sanity! 

Dusty. xxx


----------



## Maree.

Liam is really struggling stomach pain & reflux are bad, despite it being a full week since he stopped the antibiotic. He is very muddled and emotional and his short term memory is dreadful. 

I took him back to the Pediatrican on Wendesday, who sent him to Emergency. The Pediatrician at the hospital decided he needed a full work up and to be seen by a Senior Consultant but that he was stable so didn't need to happen that day.  They booked him an appointment to see a Pediatric Neurologist on 5th May. 

We have an appointment on Sunday 28th for him to see new Gastroentrologist (who is a pediatric specialist). This specialist isn't on our insurance network so not sure yet if we'll end up paying the full price of appointments with him or be able to get our Insurance Company to reimburse, have been chasing Insurance Company for answer with no response, but have decided we aren't prepared to wait on an answer. If that means we end up out of pocket that's what happens.


----------



## Dexky

I don't know anything about your system there Maree but if it's your only chance to see a ped GI, I'd go for it and fight the insurance co. later.

How's Liam's foot?


----------



## Maree.

Yeah thats what we've decided to do.  As this is the only Pediatric GI our Pediatrician is aware of in country.  Even if Insurance company decide not to pay it's worth seeing what he thinks.

The foot seems to be healing reasonable well, still some signs of fungal infection but really hoping that will clear up before we get in reviewd next week.


----------



## Maree.

New GI felt sure that it's a nutrient absorbtion problem of some sort and that at this point we need to get to the bottom of it sooner rather than later (so no more waiting).  His gut feel is the blood results aren't what he'd expect for Crohn's, felt that his iron levels are too good.

Today he ran celiac tests (have been done before) & liver function tests.  He said unless obvious answer in these next step will be upper endoscopy, followed by pill camera & MRI.

On a positive note, despite his recent weight drop, Liam continues to grow today when they measured him he'd grown another centimeter.


----------



## Catherine

What test have Liam had done for iron.  Is iron studies or just ferritin?

Prior to dx during the last 6 months we were supplementing Sarah iron with the ferritin levels increasing and the hemoglobin dropping.

This is when they decide to test for beta thalassemia, and later they test for alpha thalassemia.  Beta was rule out and all common alpha were excluded.

Sarah's ferritin level in December 2011, was 162, she ferritin level was acting as a marker of inflammation.  At dx they decided her levels were close zero with ferritin was in normal range.


----------



## Maree.

He has not had alpha & beta thalassemia tested. 
Liam's Hemoglobin is 12.4 (RR 11.5 - 15.5)  & Ferritin 77.45 (RR 7 - 140)  

Below Ferratin there is also something called IRON Test Methodhotometric Method where his result is 26.2 umol/L (RR 5.5 - 25.8)


----------



## Maree.

Pediatric GI rang today to say that blood and stool tests look very normal and to get my approval to book Upper Endoscopy.  He is  stilltalking about doing Upper Endoscopy follwed by MRI followed by Pill Can but sounds really at a loss at to what is wrong.

He commented that if this was Crohn's he'd expected abnormal blood test results to show long before we had saw level of weight loss.  

He's still talking about trialing some sort of broad spectrum antibiotic kill any paresites/bacteria in stomach if nothing shows up on any of the scans.


----------



## Dexky

I'm glad to see the GI is being very determined.  I'm not sure I like the sound of that antibiotic trial considering the issues Liam had with the ab's for his foot.  It's always a roll of the dice it seems.  Good luck!


----------



## Maree.

I definitely hope we find something on one of the scans.

Augmentin made him Liam sick enough, the idea of giving him something that's stronger or  broader in what it hits worries me a lot.


----------



## my little penguin

Why not a lower scope ??
I would ask


----------



## Maree.

Liam has already had a Colonoscopy with biopsies, 2 months ago which which was totally clear.


----------



## my little penguin

But he is doing another upper scope or wasn't that do e at the time ?


----------



## Maree.

This will be his first upper scope.


----------



## my little penguin

Ok makes more sense
Make sure they check for EoE ( egids disorders )

Good luck


----------



## Twiggy930

FWIW my son's CRP levels were never very elevated even when he was in full flare and lost 16 lbs in about 3 weeks.  I was even told by one ped that it couldn't be Crohn's because his inflammatory markers would be higher...they were wrong.  

:hang:  It is so frustrating to have to advocate so hard all the time


----------



## Maree.

Interestingly it was the nutrient levels the GI kept commenting on.  That if it was Crohn's there should be signs of anemia and his vitamin D level should be low.  The doctor did his pediatric GI training in Canada perhaps all the Crohn's kids there are Vitamin D deficient.

But we live in Dubai and he's a very sporty outdoorish 10 year old, who is way browner than I'm happy with, how could he be deficient in Vitamin D?


----------



## my little penguin

He still could be low in vit d since crohn's inhibits the absorption of vit d( per one theory)
Or is used in excess due to the increased inflAmmation( another theory)
Either way some are low. DS was borderline low vit d.


----------



## ChampsMom

My son's CRP also was never crazy off, even when his symptoms first went crazy and he dropped 20 lbs.  His iron and Vitamin D were low though (and his D continues to be low - during the winter time he was inside alot).

More tests = more answers (crossing fingers!!)


----------



## Catherine

Sarah vitamin D levels are consider to be on the low end of normal.  The only reason her vitamin d is supplement is due to pred use and the believe the calcium supplements work better when taken with vitamin d.

Two thirds of our GI have very low vitamin d levels, she was surprise at how high Sarah's levels were.


----------



## Maree.

Will have a better idea when I see the actual numbers.   Clearly the blood work looks too healthy for the level of weight loss but, which is confusing the GI but then I'm guessing for the first 3 years Sarah was sick her blood numbers probably looked great too.

Pete is chasing up on the bookings/insurance approvals today (to make sure all the proper steps in progress.)  I'm hoping it won't be a long wait as I've got to the impatient point.


----------



## Catherine

The only one off was iron.   The ferritin was low normal, haemoglobin low normal, b12 dropping over time but alway in range.

When we change doctors in August 2011, when her ultrasound has already show damage which also appear in the same location on a later MRI (we were told this ultrasound was clear).

Amenia appeared for the first time hemoglobin 106 (110-160)
Ferritin was 30 (30-200)

Two months later after supplements of iron
Hemoglobin 91
Ferritin 71
This caused our detour with testing for thal beta.
At this point Sarah was still swimming 8 times a week.

So blood test pretty normal until 6 months prior to dx.  Ferritin levels were consider just to be caused by amount of exercise.

She has  now had parent of a friend she met in year 7 say that she never seen she look better in the time she known her.  We had a slow decline that we didn't even notice in the beginning.


----------



## Maree.

Liam like Sarah is a really sporty kid.  He plays football every day at lunch and recess, trains 2 - 3 times per week and generally has one or two matches a week. All done in a really hostile climate.

I like to think (maybe denial but sticking with it for now) that perhaps whatever is wrong with him isn't that servere but is just enough that his body can't cope with the combination of growth & exercise levels.  I find it really encouraging to hear how well Sarah is doing with treatment.  I'm hoping she'll continue to keep getting better & better and that Liam will follow in her footsteps.


----------



## Maree.

Dropped by Liam's GI office to sort out some Insurance details and was able to get a copy of blood tests. 

White blood cells back in normal range which is great.

Looking at the test results really don't understand Liam's GI's point about his Vitamin D level being TOO HIGH for this to be Crohn's. 

25-OH Vitamin D Total   27.7 (RR Insufficency 10-30 Sufficiency 30-50 Optimal 50 - 100)

He is an outdoorsy child in Dubai who gets lot of sun exposure (is browner than I'm happy with).  Plus he currently takes a daily Omega 3 & Cod Liver Oil Supplement liquid (recommended by Pediatrician and it contains 200 IU of vitamin D3.  Plus there is also Vitamin D3 in his Ensure, did some rough calcs and he is probably getting another 200 IU of vitamin D3 from there.  

Curious to know what other peoples kids Vitamin D levels looks like.


----------



## Catherine

We need to work out what scale there using but it seems too low.

My vitamin d tested at 28 which resulted in the gp putting me on 3000mg per day.

Our scale is nmol/L

Sarah vitamin D
August 2010 106
March 2012 60

As you can see if it the same scale Liam's levels are very low.


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## Maree.

Full details from the form

25-OH Vitamin D Total 27.7 ng/ml

Ref Ranges shown:
< 10 Deficiency
10 - 30 Insufficiency
30 - 50 Sufficiency
50 - 100 Optimal
> 100 Excess
> 150 Toxicity


----------



## Catherine

Ok David the person to ask.  Try looking up his vitamin d thread.

The are different scales Liam's levels are not that low.


----------



## Maree.

Found a conversion table.  I think we are looking at about 68 on the scale you use.  So his numbers aren't that different to Sarah's in March 2012 not long aftr she was diagnosed.  So looks like Crohn's is still possible with that sort of Vitamin D level.  

I'm still suspicious that the reason that Liam's GI expects really low Vitamin D levels is because he did his pediatric GI training in Vancouver where the level of sunlight is very different to what we get on the Arabian Peninsular.


----------



## Catherine

I have give lots of reasons why Liam shouldn't be low.
- plenty of sun exposure
- fair skin
- blue eyes

Reasons for low
- sunscreen use
- ?


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## Dexky

The last time EJ's was tested (April '12) it was  36 ng/mL (25-80).  He's a pale kid so he can't stay in the sun too much.  We do supplement his vit. D with an otc supp.


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## Catherine

Do you have calcium level?


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## Dexky

I don't know if that was for me or Maree but…

as of Dec. 12…. Calcium Blood: 9.1 mg/dL (8.5-10.5) 

I also found a more recent D level from those labs… 30 ng/mL


----------



## Catherine

It was for Maree,  the reason i ask is because of all the thyroid disorders in our family.

Dexky what's you climate like.

Where Maree is it s like summer all year around.


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## Maree.

Calcium 2.46 mmol/L (RR 2.15 - 2.57)

Catherine's right about summer 365 days a year.  It's virtually never overcast here.  In mid Winter our average daily hours of bright sunlight gets down to 8.  This time of year avg hours bright sunlight is 11.

Liam plays outside every recess & lunchtime plus has 2x 45 minute sports classes and 3 x 1 hour of football training outside per week.   I know there incredibly slack about sunscreen at school (so I doubt any of that is with sunscreen.)  He also plays out in the yard most afternoons after 3pm I don't worry about sunscreen.  I suspect he's averaging close to 2 hrs sunlight most days.


----------



## CarolinAlaska

Maree, all it takes to keep a normal vitamin D level is 20 minutes of exposed skin to direct sunlight.  Jae's vitamin D was about 27 and we live in Alaska with very little sun exposure.  I agree that your doc isn't looking at it from a Dubai perspective.  Jae's labs have always been normal except on two occasions when her joints were flaring then her inflammatory markers were a little high.  The pill cam is the only test that reasonably showed her Crohn's with inflammation and ulcers throughout - and that was 9 days after upper and lower endoscopy.  I think the stress of all the testing finally made it flare enough for confirmation.  Keep knocking, keep looking.  I hope Liam's tests are more conclusive this time.  I can't remember, did he have a fecal calprotectin recently?


----------



## Maree.

Liam's Fecal Calprotectin was 694 back in October but the test done in Feb was back totally normal.

New GI doesn't agree with the previous one who said 1st test probably a lab error as too different.  He thinks there probably was inflammation back in October. 

New GI didn't run fecal calproc in last set of tests, he said it wasn't necessary at this point as regardless of results unless liver or celiac tests showed an obvious problem he was need to run Upper Endoscopy, MRI and pill cam anyway due to Liam's weight issues.


----------



## Dexky

Catherine said:


> Dexky what's you climate like.
> 
> Where Maree is it s like summer all year around.


Kentucky is fairly moderate.  We're not far enough north to have bad winters.  We're far enough south to have long, hot summers but not like the deep south.


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## Maree.

Still waiting on news about insurance approvals for Upper Endoscopy.

Took Liam to the dermatologist this morning:
-His foot is improving but fungal infection not gone, we have a new cream to try for 5 days.
-She removed 3 very small new Molluscum Contagium spots which have appeared in the last week and gave us a cream to put on the worst of the ones that have been treated.
-Next appointment with her 5 days if any redness still in foot otherwise 7 - 10 days to have the MC spots checked again & for her to do a thorough check for new ones.

Feels like progress on the foot/rash front but it is painfully slow progress.


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## Kimberly27

Just catching up.

I'm glad you're finally moving towards getting some answers.

Is there a clause in your insurance that states that if there is no specialist in your network (ped. GI), that it would be covered?  

Best of luck.  I'm sorry your son is in so much discomfort.

Hugs to the mommy!

Kimberly


----------



## Maree.

As well as the specialist not being on our network.  He does endoscopies at a hospital where we only have partial coverage so we are waiting to see if the insurance company will cover the hospital costs (not just issue with the specialist costs, which I think there is a good chance they'll cover some of).

The hospital he uses has a small set of insurance companies that provide full cover, compared to most private hospitals here (this is the only hospital I'm aware of where we aren't fully covered).  So I'm guessing there fees are comparatively high too.


----------



## Kimberly27

Ouch!

Good luck on the insurance.

Kimberly


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## Maree.

Colonoscopy & Upper Endoscopy scheduled for tomorrow morning.

Different GI & different prep scheduled, which we don't like at all.  Split across day before and day of precedure.

Clear liquid diet from lunchtime.  
Fleet at 5pm
Dulcolax at 6pm
Fleet at 5 am
Check in at hospital at 7:30,  GI said if needed they will do a enema at hospital to finish cleanout.
Procedure scheduled for 9:00

Liam's last prep was just two doses of Fleet but medications started earlier in the day.  
With the last prep he had diarhear after first dose of Fleet which got intense following 2nd dose.

This time around we are at 1:45 am currently he had two BM during the evening both still formed.  Really starting to feel concerned that this isn't going to work.


----------



## Farmwife

Maree, Grace was also a hard clean out. Keep in mind she could go days with out going poo even with meds trying to help her. By the time she went in for the scopes she was cleaned out. I asked the GI if she was total cleaned out and he said yes. It will be ok, if not they will help at the hospital.

Is he drinking enough?


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## Maree.

I forced lots of drinks & clear jelly into him all afternoon/evening, but have to say I wasn't as successful at getting the fluids in as last time.  By late evening drinking had got very painful.  I think because nothing much was coming out he just ran of space for more fluid. 

Have been wondering if I should wake him and give him that 2nd Fleet dose early in a hour or so (say 3 am rather than 5 am), so we've got more time for it to work prior to the drive to the hospital, given nothing much moving yet.


----------



## my little penguin

Hugs
Never had to do enemas here 
For clean out only miralax and ducolax 
Good luck on the scope


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## upsetmom

Good luck with the scopes


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## Maree.

5:30 am now we gave him 2nd lot of Fleet at 4.00am.
Which triggered severe pain but nothing else.  
He's finally resting quietly again.


----------



## Farmwife

Sorry to hear that. What does he think of all this? I mean does he get why he's going through all this?


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## Maree.

At 10 he understands that he's not been well and he knows that he needs these tests to try to work out what's wrong.

He doesn't understand it hurts so much this time, his last colonscopy prep (about 10 weeks ago) was completely different.  He hated drinking the Fleet and it was nothing like this level of pain.


----------



## CarolinAlaska

Wow.  I can't imagine all those enemas and fluids and NOTHING coming out!  Poor boy!  I hope they are able to help at the hospital!


----------



## Dexky

I guess it's probably over by now.  I hope the scopes went well.  Sorry to see L had so much trouble with the cleanout


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## araceli

Hope everything went good. Hugs


----------



## Maree.

Thanks everyone.

The day was a bit of an ordeal, and in the end the cleanout ordeal was probably more enlightening than the scopes as to what might be wrong, which we'reclear other than a small nodule in the wall of the stomach with the GI is fairly confident is harmless (he thinks it's a clump of pancreas cells growing in wrong place.)  We will get biopsy results in 10 days.  At which point we'll have followup appointment to discuss next steps.

Liam had small amounts of diarrhea before getting to the hospital.  Then after an enema more diarrhea which although liquid was still brown.  GI used suction to remove fluid from  colon and was able to complete colonoscopy, however there was still material in the small bowel.  (Colonoscopy & Upper Endoscopy took over an hour).

Mid afternoon a few hours after the procedure was complete, when they gave Liam something to drink it triggered another bout of bad diarrhea followed by passing of chunks of undiagested food (tinned fruit which he'd eat with breakfast the previous day.)   He also had several bout of vomitting which mean't that it was 7pm before he was discharged (we we're at hospital from 7:30 am & procedure started at 9:30am)

GI says that although Liam has daily BM he thinks they are old stool & that this looks lika a motilty issue.  He has prescribed Liam Domperidone and would like us to try a diet which he thinks might help with the motility problem.  Haven't seen details of this yet.

And as an aside that I probably didn't need to know the GI admitted after the scopes that the reason he'd insisted on repeating the colonoscopy so soon after it was last done was that he was concerned that Liam might have lymphoma, apparently he'd explained that to my husband on the phone.  I'm so glad neither of them decided to mention it to me until after the test had shown no sign to support that idea!


----------



## Mehita

Oh, Maree! What a day you've had!


----------



## Sascot

Glad it's all over!  Good there was no sign of lymphoma.  Hope the new med and diet helps with all the issues!


----------



## Niks

:ghug:  Poor Liam!  Sorry I missed all of this..  Enemas and clearout producing nothing sounds familiar!!  

Would be really interested to know what diet they think will help.  All J has been advised is lots of small meals, low fibre!    Hope domperidone works for him.

((hugs))  :ghug:


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## Catherine

Since you hard day I will let you get away with forgetting what yesterday was.

Glad Liam ok.


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## ChampsMom

Oh Maree!!  I'm with you - sometimes I'd rather not know!  Glad your home - what a day you all had... Praise the Lord no lymphoma!!  You're an awesome Mom!!  Praying the new med does the job!!


----------



## Catherine

On a more serious note, we received a visual dx of Crohn's after the colonscopy, but had a ten day wait for treatment while they did a MRI and rule out cancer.

A good GI/GP will rule out the most serious causes first.

We saw first hand with Sarah's class mate Tim that wrong dx of Crohn's and wrong treatment plan can be the most heartbreaking of things.


----------



## Farmwife

HUGS, I hope you all can rest tonight.


----------



## Maree.

:birthday2: for yesterday Catherine.


----------



## upsetmom

Happy Birthday Catherine.
I hope you had a great day.


----------



## Dexky

Catherine said:


> Since you hard day I will let you get away with forgetting what yesterday was.
> 
> Glad Liam ok.


Oh!  Happy late Birthday Catherine!!


----------



## Jane and Nick

My heart goes out to you. I know how challenging it can be to be an expat and have to deal with all the issues that go along with that, from having to decipher cultural and language issues to having to be very independent and self sufficient.
I am hoping it all went smoothly and you are both resting comfortably. Sending lots of positive thoughts and good luck your way.


----------



## Maree.

14 days on from treatment of Liam's Molluscum Contagium, we saw the Dermatologist and she prescribed a different cream to treat the worst of the sores which are mildly infected and got her to check on the fungal infection on his foot.

She asked does he eat properly?  and told us she thought there was something very wrong with the way his body heals wounds and sores.  We explained at length where we are at with his stomach problems.  She said that she thinks his stomach isn't absorping vitamins appropriately and that's why his sores aren't healing.

Will try to get the GI to check some more of his vitamin levels at next appointment.


----------



## my little penguin

Hugs
Fwiw DS aslo had poor wound healing before the right meds.
Hope the GI can help


----------



## Maree.

Day 4 after colonoscopy and still no BM.  Yesterday Liam struggled to eat or drink as feeling too full.  This morning the same.  Like during the colonoscopy prep it feels like things are banked up high up rather than in his colon, pain around belly button and water causing pain and bloating.

Stopped in at the school doctor this morning and discussed how the tests went and that nothing is coming through his system at the moment.  She said he should be at school but no sport and that he is to spent recess & lunchtime in the medical office where she can keep a watch on him.  

Liam isn't scheduled to go back to his GI until the biopsy results come back which probably will be the start of next week, but I'm feeling like if he's no better when I pick him up this afternoon I probably should ring the GI.  Thoughts?


----------



## upsetmom

Maree I'd ring that doesn't sound right to me.

They might even have the results back....Farmwife had them back the next day.


----------



## Maree.

My understanding is the biopsy samples have to go to Germany for testing which is why it takes so long.  School doctor thinks I should push the GI to do an MRI next, she thinks a pill cam would be a bad idea as it might get stuck.

Will have a good chat with her when I pick him up from school on her thoughts about how he's been today & then if he still hasn't passed a BM will ring GI.  She hasn't rung me yet which is a good sign.


----------



## Jane and Nick

Oh my goodness, I am often heard to say, what ever I did in a previous life to deserve all of this I damed well hope I enjoyed it ! Maree you must of really been up to no good :smile:
For what it's worth our GI doesn't want to do the pill cam until she knows there are no kinks or narrowing, however this is new territory for Nick. They have never seen this part of his GUT as they love to call it.
I do hope you get results fast. I know sometimes the local GP's here in KL send things to Australia for testing but the bigger hospitals seem to have there own facilities. This does not mean they are well versed in IBD as it is VERY rare here, may be Germany is a good thing. Fingers crossed.
:ghug:


----------



## Maree.

Predictably my husband left this morning for two week work trip to Saudi so I'm here minding the fort on my own again.  Which just reinforces your point Jane.:evil:


----------



## Jane and Nick

Isn't that just lovely ! I know it's their job and that's what pays the bills and they feel really bad for not being here and its what we signed up for etc....don't you just love it when they call just before they are going out for dinner, yes you know dinner when some one else cooks it serves it to you AND clears up! No one complains or wants 3 different things or is,not feeling well has a fever, OK now I am ranting. I REALLY do feel your pain.
This is a blog post I think you would REALLY enjoy please check her out she is a great distraction 

4 kids, 20 suitcases and a beagle: It's Not A Journey
http://shamozal.blogspot.com/2013/05/its-not-journey.html


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## Jane and Nick

Me again LOL, please look at her other posts, this one not so prevalent but her other stuff is super funny from a expat moms point of view.


----------



## Maree.

Still no BM but he looks a little better at the end of the day.  School doctor thinks he's fine at this point but said to let the GI know that we still haven't had any BM.


----------



## Maree.

Spoke to GI he says constipation normal following an endoscopy nothing to worry about at this point.  Colonoscopy/Endscopy results we're back, GI said everything looked really good. 

The lump in the stomach wall is not showing as malignant but not pancreas tissue either so will need annual biopsies.

At the moment Liam's GI wants to treat this as IBS for the next few months then re-evaluate in Sept based on how he is doing.  I don't like the sound of this at all but not sure we've got a lot of choices at present other than to go along with recommendations and make meticulous notes regarding food consumption and symptoms.

He's given us a diet for Liam main changes are it reduces dairy, and takes out most carbohydrates and cuts back on fruit juice.  He's also requested I stop giving Liam Ensure's as he thinks they may be part of the problem.  He's scheduled next checkup for 3 weeks.

My gut feel is Liam will lose weight on this diet but perhaps at this point that's necessary in order to get any further investigation done.


----------



## my little penguin

So sorry 
Wish there was a real diagnosis
Hope the lack of shakes doesn't cause him too much of an issue.


----------



## Maree.

Liam has a BMI of 13.8 at the moment so I hate the idea of him losing more weight but short of that I don't think we are going to find any real answers.  

GI says he wants to understand what happens to Liam's weight and symptoms with normal calorie input as he thinks the current high calorie diet has been confusing matters.


----------



## my little penguin

We had that problem as well with DS.
It wasn't until we decreased his kids boost shakes and we saw a slow weight loss did things start to move a little quicker from a Gi standpoint.


----------



## Mylittlesunshine

So sorry Liam is still having problems
Wish you had a quick answer, but
Unfortunately for I have learnt about this 
Disease is it is never simple. 
Hugs


----------



## Farmwife

Keep pushing when you need to.
I hope the diet works wonders.

HUGS


----------



## Niks

It is so frustrating when there are no clear answers!! I really feel for you both.  :ghug:


----------



## Maree.

Have now looked at the diet and its basically a low carbs diet, with restricted dairy.
It feels like it's a weight loss diet.  

I sent a copy of the diet and details of what has been suggested to my husband and he's really uncomfortable about what's being proposed.  Will take the diet in to school tomorrow and see what the school doctor thinks.  I've got a lot of trust in her opinions, and she knows Liam better than any of the other medics who he deals with.


----------



## my little penguin

Does it look like this
http://stanfordhospital.org/digestivehealth/nutrition/DH-Low-FODMAP-Diet-Handout.pdf

http://www.health.arizona.edu/health_topics/nutrition/handouts/FODMAPs diet.pdf

http://www.webmd.boots.com/digestive-disorders/features/fodmaps-diet

Good luck
It never worked for DS but we never took him off peptamen jr while on it 
Plus he still was on his Ibd meds as well.


----------



## Maree.

No.  The restrictions in that diet seem to make a lot more sense.  

There are less restricted items on the diet Liam has, but some things that are restricted are ok on FOODMAP:
- does not allow rice including brown
- does not allow pasta or noodles of any sort regardless of ingredient made from.
- restricts potato and eggs and fatty fish (eg salmon)
- dairy restriction doesn't differentiate between lactose free and other dairy

Major limits on what foods can eat after 2pm.  

Also oddly excludes banana's the only reason I've come across for not allowing banana's is High GI and I don't understand why that would be relevant.  

25% of Emirates are diabetic & the clinic where he works specialises in diabetes.  My gut feel is that it's a generic diet he gives to patients with gastric issues and the bulk of patients he treats have problems with diabetes and obesity as well as stomach issues.

The message I'm hearing is cut his carb intake, cut his calorie intake, cut the quantities of food he eats and his digestive system will heal and he'll get better.  Which isn't a message I'm feeling very comfortable with.


----------



## Tesscorm

Very frustrating!  Maybe I missed the explanation but did GI say how he thought this diet would help?  What is he trying to remove from Liam's diet and how will that help him, ie what is he expecting to happen after Liam is on this diet for a while and what does it mean if he sees this 'result' or if he doesn't see it?

I can understand that the GI doesn't want to 'cloud' the issues by having Ensure, in a sense, forcing the weight gain but I think you may feel more comfortable if you knew what milestones Liam should be meeting while on the diet and what would be a red flag if he doesn't meet them.


----------



## Maree.

He said this was a baseline diet to give a starting point in terms of symptoms & weight change, prior to looking at excluding foods.

GI doesn't seem overly concerned about Liam's weight says perhaps I've been worrying too much about it, and in the process have been contributing to or causing his stomach problems.  That he might just be a naturally very skinny child and be healthier with a lower food / calorie intake and a lower body weight.


----------



## my little penguin

Good luck we had a ped once tell us that about DS.
We no longer see the ped for obvious reasons


----------



## Josephine

Goo luck to Liam, not sure what to said. xxxxxxxxxxx


----------



## Johnnysmom

A boy his age should be gaining 12lbs a year.  Dr.'s tried to tell me it wasn't a big deal that my son was losing weight either.  :voodoo:

I wish I had some good advice for you.  (((hugs))))


----------



## ChampsMom

I'm confused why the doctor would do anything that would decrease his calorie intake...  I would want more of an explanation of "why" that is a good idea, not a "let's see what happens to his weight if we don't give him extra calories."  

I hope he's able to "go" soon - that's miserable


----------



## Catherine

Sorry you haven't got the answers you were looking for.

What are Liam's current symptoms:-

- Lack of weight gain
- Stomach Pain
- Acid Reflux

I will make some just in case enquires:-

I will be at our GI office tomorrow and will check into the referral process for a non Australia resident.

I will also try and find out whether a MRI with contrast, can be order by a GP in Australia.


----------



## Catherine

Maree

I have rang the GI rooms, no referral needed.

Both pedi GI booked up to end of July already.  One works at Monash medical centre and 
 the other Royal Children's.  They both have parients comming from Western Australia and New South Wales to see them.

To get an appointment in August we would need to book next week.  They only see private patients once a week.


----------



## Maree.

Catherine, have forwarded this to Peter.  Will discuss with him later in the day.


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## Twiggy930

my little penguin said:


> We had that problem as well with DS.
> It wasn't until we decreased his kids boost shakes and we saw a slow weight loss did things start to move a little quicker from a Gi standpoint.


I think we have this problem too.  Every time we go to GI they are happy with my son's weight.  I try and stress that it is a struggle to keep him at this weight and that we give in 1 - 2 shakes a day and I constantly shove food in his face.  I have wondered what would happen if I just backed off on all those extra calories.  The mommy in me can't do it though.

We tried the FODMAP diet last year.  It didn't work.  But we probably cheated a little too.  It was very hard for my son to cut out bread.  The one thing I have kept up is I have kept his diet low in lactose.  I feed him lactose free milk, lactose free yogurt, and hard cheese and I am very careful how much ice cream and soft cheeses he eats.  

I HATE the IBS diagnosis.  Our old GI liked to blame any unresolved symptoms on IBS.  :voodoo::voodoo::voodoo::voodoo::voodoo:    Have you tried giving him a probiotic?  My son's gut issues seemed to improve a bit when he started taking one daily.

:hang:


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## Maree.

I have tried probiotics.  I discontinued them because they seemed to be another of the things that exacerbated reflux.  Lots of things do.  Feels like its a huge trade off between weight/nutrition == reflux symptoms.

GI at the moment seems to be going down the path of lets manage the reflux and worry about everything else later.


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## Maree.

Currently my husband is saying no to the idea of getting an opinion from an Australian specialist.  He feels that nothing will be resolved in one appointment, so anywhere we take Liam we are signing up for multiple appointment & probably tests and Australia is simply too far away to be a viable option.

Although he’s not happy with the diet suggestion at all, he’s not yet at a point where he’s willing to give up on medical options here and want to follow up with a range of people when he’s next in country (First GI, Paediatrician, and Paediatric GI) to get a range of views on suggested next steps.


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## Dexky

I can't imagine 4 days of constipation being normal after scopes.  Does he have any appetite?


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## Maree.

Very limited appetite which isn't surprising, still waiting on BM.

Spoke to school doctor today she said don't fill the prescription GI wrote dosage on the PPI is too high for a child.

And don't even consider putting Liam on that diet, it's totally inappropriate.
She doesn't know any other pediatric GI's but recommended an adult GI who she thinks is good.  School doctor says I should insist on a MRI before we even consider diet issues.  

Have organised to see Liam's pediatrician later this afternoon to discuss what was recommended with her and get her views.


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## Jane and Nick

Well done! You are being really proactive. I realise how difficult it is with limited and questionable medical care. 
You are doing great, keep going. I hope you get some good help really soon.


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## Catherine

http://www.natap.org/2009/HIV/070409_02.htm

Maree, read the above article and see what you think.


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## Maree.

Pediatric GI prescribed twice the standard adult dosage on the PPI.  Which given Liam is 10 and 28 kg (61 pounds) is just ridiculous.


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## Jane and Nick

Thank goodness you had the foresight to check it out ! That is super scary.


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## Maree.

Pediatrician was kinder than school doctor.

She changed the meds which she didn't agree with but also suggested that we email the GI to check if he accidentally sent us the wrong diet, as she feels that it must be a mistake.

She said she'd consult with the other pediatricians where she works and see if they can come up with an alternative specialist for us to see for a 2nd opinion.  She felt the test that the GI ran and his investigative approach was appropriate but wasn't happy with his suggestions in terms of holding pattern medication or diet.


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## my little penguin

It is typical for kids to be on really high ( higher than over the counter dosages for adults) on ppi.
Not saying his dose wasn't high just that i have seen high doses in infants/ young children.
Glad you are seeing a new doc 
Please ask the new Gi


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## Twiggy930

We were told to use twice the recommended dose of a PPI if needed to control symptoms when things were really bad.  We never did it but it was given as an option.  Not saying you should do it just letting you know it is sometimes done.


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## Maree.

Pediatric GI clearly doesn't like losing customers.  His response to my husband emailed concerns, was to say he's happy to finish the testing at this time, rather than in September as he'd originally planned.  If that's what we want, suggested nexts steps as:

- ordering a abdominal MRI, prefereably MRI enterography 
- white blood cell isotope scan of the abdomen looking for inflamed foci.
- calprotectin test.

He has come up with a revised medication suggestion but still would like to have Liam on the diet he suggested during the testing process as he feels that this will reduce the reflux and constipation and would not result in weight loss if Liam has healthy digestive system (don't think he's taking into consideration the energy output of my child with that one, my impression is he normally treats more sedentry kids).

My husband is going to follow up with the Insurance company to check status of previous claims we've made for procedures done by Pediatric GI, then will probably respond.  Currently thinking will probably go with what he's offerring as would be good to get the MRI done.

We've also organised an appointment for next Thursday with first GI to have him look at the snaps of the lump found during the endoscopy as pediatric GI seems very unclear on what sort of lump it is (benign but not what he thought when he looked at it, is all I managed to get out of him) and vague about what should be done about it.


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## Maree.

Managed to get a copy of the biopsy report today, the GI didn’t prepare a written report for the colonoscopy/endoscopy.

Verbally GI told me it was scopes we're all clear, except for one small lump on side of wall of stomach but it didn't look sinister (would need periodic checking but nothing to worry about at this point) and that the biopsies we're clear.

Thought I'd post here to see if anyone had any thoughts on it, have also added a couple of snaps of the lump.

Esophagus 
-Mid Reactive change, possibly early reflux.

-Stomach with Nodule biopsy:
-Focal superficial minimal antral gastritis with nodular fragment showing superficial hyperplasia.
-No definite pancreatic rest
-No H. Pylori seen.
Happy snaps of the unidentified lump: http://www.crohnsforum.com/album.php?albumid=685

3rd part duodenum
-Intestinal mucosa with no significant pathological changes.
-Villa and plasma cells are present.
-There is no evidence of Celiac Sprue or Giardia.

Colon, transverse and descending
-Unremarkable colonic mucosa
-No active inflammation or features of chronicity
-Borderline increase in eosinophils

Rectum:
-Unremarkable rectal mucosa
-No active inflammation or features of chronicity
-Lymphoid aggregates
-Borderline increase in eosinophils


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## my little penguin

Egid
Check apfed


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## my little penguin

http://apfed.org/drupal/drupal/index.php

It would explain his stuff


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## Maree.

Thanks MLP will take a look


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## DanceMom

A had increased eosinophils as well (though I can't remember what areas).  She was not diagnosed with an EGID and the increase was never really mentioned (I read it in the report).  

Has your son had any allergy testing?  A pill cam?  Those would be my next steps to push for.


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## Maree.

Only celiac's testing to date.
Liam has not had a pill cam or an MRI at this point.

The pediatric GI is stalling on the idea of more test, he's agreed that he thinks it's necessary but it's clear he'd really like to wait and do them in September.   I think he's already in holiday mode.


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## DanceMom

Sometimes waiting a bit isn't a terrible idea.  If symptoms persist it makes it more likely that something will show up on one of the tests.  It took 3 scopes in 3 years to find something for A.  Wish it hadn't taken that long but it did.  Hope you get answers much sooner than that!


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## Dexky

Has he had allergy testing Maree?  I know they're considered somewhat unreliable for definitively ruling out everything but something might be found.


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## Maree.

Only for celiac disease.  I'm a little cautious about intolerence testing as I've had these done several times myself in the past and always come up allergic to everything I've eaten recently.

Possibly something to consider moving forward.


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## Dexky

Yeah, they're not great.  EJ is highly allergic to shellfish but the contact test showed no allergies to anything!  Good luck!


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## my little penguin

Not intolerance but igE testing for immune system reactions 
Which is different than igG testing ( not recommended )


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## DanceMom

My girls have had skin testing for igE and my youngest also had a blood test.  Very simple tests done by a Pulmonologist, ENT or Allergy Specialist.


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## Maree.

Somtimes it feels like it's just one thing after another.

Liam got bitten by an ant this afternoon on bottom of the foot, the whole foot swelled including up past the ankle.  Rash went all the way up his leg and across his chest.

We've been in to the on call doctor, who gave him a antihistimine injection & intravenous corticosteroid.  Other than the swelling and rash he is totally fine, no other symptoms.  

He now has another week of oral antibiotics.  Different antibiotic to last two courses, really hoping it doesn't knock him around as badly.


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## Johnnysmom

Johnny was prescribed a PPI from his Pediatrician and once we saw the GI he doubled the dose.  I don't know how it compares to the adult dose but it worked much better for him at the higher dose.  

Johnny also had increased eosinphils.  I asked his new GI about EGID.  He said the specialist at Cincinnati who deals specifically with EGID's reviewed Johnny's biopsy and scope report and didn't feel EGID was a concern.  I know high eosinphils are a marker but I am not sure what else they look for.


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## CarolinAlaska

Sorry to hear about the new bite.  What is the antibiotic for?  Are his bowels moving?  If he thinks it is a motility disorder, why isn't he doing more testing along those lines?  Sometimes these docs make me crazy!  I think your peds GI went to school with Niks' Jamie's GIs!!!


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## my little penguin

Please make sure your gp or ped gives you a script for a auto injector
Of epi 
Reactions like your sons was systemic allergic reaction and next time it could affect more than the skin.
If you can get to an allergist all the better.


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## Maree.

When Liam cut his foot it was on the top side of his foot so although he was ok in flip flops and could walk on it.

The bite is under his and it is still too swollen to put a shoe on.  He is desperately hoping that the swelling doesn't go down overnight, as I've said if it's still this bad in the morning, I'll take him to get crutches for school tomorrow.  He'll really excited about the possibility he might get to have crutches.  Would it be wrong to hope the swelling stays up for another day so he can get to have them?  Thinking I won't change the bandage in the monring, if he tells me in the morning it's too sore to stand on I'll choose to believe him and let him have his crutches at least for the day.


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## CarolinAlaska

Maree. said:


> When Liam cut his foot it was on the top side of his foot so although he was ok in flip flops and could walk on it.
> 
> The bite is under his and it is still too swollen to put a shoe on.  He is desperately hoping that the swelling doesn't go down overnight, as I've said if it's still this bad in the morning, I'll take him to get crutches for school tomorrow.  He'll really excited about the possibility he might get to have crutches.  Would it be wrong to hope the swelling stays up for another day so he can get to have them?  Thinking I won't change the bandage in the monring, if he tells me in the morning it's too sore to stand on I'll choose to believe him and let him have his crutches at least for the day.


:lol2: Oh the things we do for our kids' happiness!


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## Twiggy930

Kids are so funny.  I think he deserves some crutches.    Although I'll warn you the allure of crutches wears off fast.  :ybatty:


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## Maree.

In the end he decided he wanted to play football more than he wanted crutches.  Has gone off to school limpy very badly (it's clearly still incredibly sore) in his astro turf football boots, which we're for some reason the only shoes that we're comfortable enough to wear.:ybatty:


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## Dexky

Twiggy930 said:


> Kids are so funny.  I think he deserves some crutches.    Although I'll warn you the allure of crutches wears off fast.  :ybatty:


Yes!!  Only slightly faster than the allure of eye glasses!


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## Maree.

The swelling went down further by this afternoon, which mean't he was fine for football at 2pm and fortunately it was a cool day only 36 C / 97 F.

Thankfully this is the last 2 pm game for the year.  Only 6pm training sessions from now on.


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## Twiggy930

Maree. said:


> fortunately it was a cool day only 36 C / 97 F.


OMG!!!!!!!!!!!!!  That would be classed as a heat wave here!!!  How do people function in such heat?


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## CarolinAlaska

Ick!


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## Maree.

By the time school wraps up our minimum temps will be 30C/86F and it'll be mid 30s by 9 am every morning and not drop below that until the sun sets.  In June everyone will be fed up with Dubai in Summer and ticking off the days until school ends and they can leave.

By the end of Summer even the water temp at the beach gets to 36C/97F and its way too hot to even consider going to the beach.


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## Niks

Sound heavenly when it is so damned cold over here!!!

Glad he managed his football!!    xx


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## CarolinAlaska

Nasty weather!  I'd take cold over those oven temps...  Will you vacate the area soon too?


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## Maree.

Four and a half weeks of school to go, not that I'm counting or anything.


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## Farmwife

Give me the cold weather!
I love being able to bundle up on a cold day.


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## Amy2

When I was 10, I bought a pair of crutches at Goodwill and my friends and I had fun with them all summer.


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## Sascot

Glad the swelling has gone down.  It's funny the things kids look forward to.  When my son thought he might need an operation, he was just happy to go to the hospital because apparently they "have the best fish and chips ever" :yfaint:.
Don't know how you cope in that heat!!  We have had one day of sunshine in the last week and a half - pity we can't combine our weather - you could send some sun and we could send some rain and bring the temp down.  20 degrees C is a roasting day for us!


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## ChampsMom

Sascot said:


> It's funny the things kids look forward to.  When my son thought he might need an operation, he was just happy to go to the hospital because apparently they "have the best fish and chips ever" :yfaint:.


That's so funny!  I thought my kids were the odd balls on this one.  Every time we head up to Children's Hospital (it is an hour drive there) everyone wants to go - for the food!  Yesterday we went to the ER for my youngest (he's the one with the benign mass/lesion in his right humerous) because he fractured the arm again - everyone jumped into the car.  When I told them it might be closed by the time we get there - I could see them eye each other as if to say, "hmmm, is it worth the risk?"  laughs... Then went.  They ate.  :ylol:


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## Niks

How's Liam doing Maree? X


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## Maree.

Adding Domperidone to the PPI seems to be helping.  We also stopped the Ensure, which the Pediatric GI was strongly opposed to, he claimed it can make reflux & motility issues worse and Liam does seem to be healthier when he isn't having it, so I'm reluctant to try it again.

Liam is feeling better than he has in months.  We visited the Adult GI who we like and trust and he advised to use the dosage rates given by Pediatric GI as max levels and to experiment within those to find the minimum dosages that would keep him symptom free.  

He also gave us the name of another Pediatric GI to try.   Liam strongly dislikes the First Pediatric GI and wants nothing to do with him, and our Insurance company feel the same way (our claims for reimbursement on his bills are either pending or have been rejected, I think because they are too high.).

At the moment as Liam is feeling relatively good, we've not pursued another opinion yet, it feels like he needs a break from doctors.  Our main ongoing concern is weight but if he stays feeling reasonable well might pursue why he isn't putting on weight after the holidays.


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## Farmwife

Grace also got worse on Boost (like Ensure). She can only drink a broken down formula.
There's nothing wrong with a brake from docs. I hope to be joining that idea some day.:smile:

HUGS


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## Niks

Good news that he's feeling better,! 

Hopefully Liam (and you) will prefer new GI.  While things are good, giving doctors a miss sounds like  good plan!!  xx


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## Maree.

Liam has now had a month on 40 mg p/day PPI & 30 mg p/day of Motileum. On this combo he is gaining weight but still has bad bouts of upper stomach pain each week.

We saw a new pediatric GI earlier this week who we liked. We went in simply expecting him to review where we we're at and issue new prescriptions for medications however he really wasn't comfortable with Liam's ongoing symptoms.

He has ordered prometheus testing for indicators of IBD and UC but said he has seriously doubts this is a gastric issue.

He was concered that Liam was still having severe heartburn at this medication level and said that he is concerned that this isn't reflux. He talked about needing to check out other organs more carefully.  

We gave him a summary of Liam's history to date and he asked us to come back next week when he's had time to absorb the information and consider what the next steps should be.


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## my little penguin

http://my.clevelandclinic.org/head_neck/patients/voice_center/vocal_cord_dysfunction.aspx

One thing to ask to look into
Reflux that doesn't seem controlled can be vcd
Glad you like the new Gi


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## Maree.

Will add it to my list of things to ask about.

Liam's strongest symptom is moderate to severe pain behind his breathbone. 
Moderate can be triggered by eating, severe always by exercise.

When it's severe he complains of pain in throat and sometimes of liquid from his stomach coming up into his mouth.  Last week we had an episode where he also talked about difficulty breathing.  Severe bouts also seem to trigger headaches and dizzyness.

The GI expressed concern that because his bouts of severe pain, are always exercise triggered that it might be angina.  He suggested we stop all exercise, which we're very reluctant to do with our sporty little boy who adores his football.


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## Dexky

Maybe he could do a cardio stress test just to be sure.  You here about kids dying playing sports because of undiagnosed heart conditions!  Sorry, don't mean to sound scary but you just never know!


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## Catherine

We had the heart tests for the problem Dexky mentioned due to faint while exercising.  

Also have his blood pressure checked out.


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## Niks

I really hope he doesn't have to give up sport!  Hopefully you will find a cause for all his discomfort and reflux.

Thinking of you guys xxx  :ghug:


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## Dexky

So he was cleared for sports by the tests?


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## Catherine

Sarah was cleared for sport after ultrasound of her heart and 11 led ECG

She was dx with Orthostatic hypotension due low body weight.

As Dexky said you need to get this checked out, neuro had Sarah tested with a ECG straight after the appointment even although he was sure it was orthostatic hypotension.  The ultrasound had already been performed.


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## araceli

I am sorry he is not feeling good. Hopefully his new GI finds whats wrong soon. Best wishes and Hugs.


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## Maree.

Last football fixture of the year tonight, and his dad has told him he can play.  
It's a five aside round robin event and I think they'll be short games.

Currently 37C/99F and 50% humidity, my weather app is currently saying feels like 44C/111F.

Its forecast to get to 42C/108F but as it warms up the humidity is burning off which should help.

Will definitely be keeping a real close eye on him.


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## Maree.

To answer questions, the idea he shouldn't play sport was raised by GI at last medical appointment, and my husband said no, not at this stage, I think because the heart issue idea seemed like a very left field idea to him and so far no test results to support that idea.  

Liam has not yet had any non IBD related testing order by new GI, I believe we'll be seeing him later in the week to discuss, the next set of tests he wants to run.


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## Dexky

Holy Moly, In that heat even being a spectator sounds dangerous!  I'm sure hydration is high on everyone's radar but still!  I assume it's getting on up in the afternoon/evening there so I hope it goes well!!  Go Liam!


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## Maree.

Two hours to football.  We have lots of drinks including rehydration fluid

Temp dropping 36C/97F now but humidity rising 60%
Weather report now claiming feels like 48C/118F and it really does.

Hoping temp will drop a bit further but forecast overnight minimum is 32C/90F so it's not going to cool down very much.

First time two times we had to take Liam to hospital with abdominal pain we're both days hotter than this when they had 2pm tryouts or games.


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## DustyKat

Good grief! I won't whinge again about standing on the sideline in the snow flurries!


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## Maree.

We seem to have got through tonight's games with no ill effects, which is a huge relief.  Glad we let him play.  It was a internal club tournament and at the end they had presentations.

Liam won Player of the Season for his U12 development squad (selected from top players from 13 schools), which is really impressive because he hasn't been at all well this year and because he's the youngest kid on the squad, Liam was born on the cutoff date, one day younger and he'd be still playing U10's.  All the other kids on his team and that they play against are much bigger & stronger.


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## Niks

Bless him! So glad it went well! What a star  

Well done Liam!! :congratualtions:


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## CarolinAlaska

I'm glad it went well and that he had no ill effects.  That alone should be a negative stress test!  !  Congratulations on the high recognition.  You can be proud of him for sure!


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## Tesscorm

Wow, what a GREAT accomplishment!  He must have been so happy!! 

:medal1:


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## ChampsMom

Maree. said:


> Liam won Player of the Season for his U12 development squad (selected from top players from 13 schools), which is really impressive because he hasn't been at all well this year and because he's the youngest kid on the squad, Liam was born on the cutoff date, one day younger and he'd be still playing U10's.  All the other kids on his team and that they play against are much bigger & stronger.


Woo hoo!! Way to go Liam!!!


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## DustyKat

Wow, what a fab update Maree! :dusty::dusty::dusty: 

Mega congrats to Liam for his award! Well done! :award2:


:mademyday: 

Dusty. xxx


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## Jmrogers4

Congratulations Liam!  Must have made him feel fantastic, he should be very proud.


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## jmckinley

Congrats Liam!!


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## my little penguin

WAY TO GO!!!! :dusty:


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