A&E or not?

[Charlotte.]

Hello everyone,

I have been in a chronically active Chrohn’s-Arthritis state for the past year, diagnosed in September 2014 when immediate therapy with Remicade was started. After only a partial relief of symptoms, I was just put on Humira a week ago and my Arthritis has already improved whereas my Crohn’s symptoms became even worse. I cannot eat anything for a few weeks now due to massive terminal ileum pain, so my doctor put me on Modulen but now the nausea becomes unbearable, I cannot even drink much (but probably enough not to dehydrate, I have no diarrhea by the way). A few weeks ago, when the Arthritis became even worse and I could barely walk due to articular effusions and pain, I started having rectal pain and burning as well, so the inflammation seems to have spread from the ileum to the rectum my doctor thinks.
Since I now experience extreme nausea for two days I cannot even sip the recommended amount of Modulen drinks, maybe only one instead of six of them. Zofran only helps for a short while. I’m a bit afraid my body cannot recover with that less nutrients and calories but I don’t want to be admitted for TPN or something.:shifty-t:
Do you think I’d rather go to A&E? What would you do?

Thank you

Charlotte

 

[UnXmas]

A&E only treat emergencies, they will help you if you are dehydrated, or malnourished to the point that it is immediately serious - and it sounds like it could be getting to that point. They can also give you strong painkillers or anti-nausea medication. They will check that your symptoms are not an indication of a dangerous complication.

But A&E is not the best place to go for long term treatment advice, and while they will try and diagnose anything immediately serious, they won't perform thorough testing for any purpose other than ruling out emergencies. So you'll need to see specialists - your gastro doctor - to understand all that is wrong and work out a treatment plan. But if you're very worried or show signs of dehydration, or the pain is unbearable, go to A&E.

Is your worry that going to A&E will result in an admission? Or is it the TPN that worries you? Both are possibilities, but TPN is a last resort, and there are other ways to get you hydrated and give you more nutrition. How quickly can you get appointments with your doctors? It sound like your need for better treatment is becoming quite urgent.

 

[Charlotte.]

Thank you UnXmas. It's probably the fact that I could be admitted and they would not do anything apart from treating symptoms that might go away by themselves through Humira? I was hoping that things improve but I am concerned they get worse and then it is even harder for Humira to show any effect on my Crohn's maybe.
I probably should see my gastro as soon as possible to treat the symptoms until my condition improves but I'm already on Zofran which does not seem to work enough.
As I am not malnourished or something it should be okay to do some tea fast for a few days until I can see my gastroenterologist, I think.

 

[Jennifer]

Definitely call your GI and see if there's anything else they can do for you. If you have a lot of inflammation then adding steroids on top of the Humira may help as it can take many months for Humira to start working for some people. Do you have a fever or even a low grade one? If you're not able to keep anything down, if the pain gets too bad and/or you have a fever then go to the hospital. Some fluids and extra meds will help some for now and they can do blood work and an imaging test to see what's going on. They don't do MRIs usually but can do a CT scan of your lower abdomen and send the results of your tests to your GI.

Usually if you're wondering if you should go then you probably should. Keep us posted.

 

[Axelfl3333]

Agree with everybody above,if in doubt go to the doctors.good luck

 

[24601]

If you can get the nausea under control - and there are many anti-nausea meds to try, one may work better than the others - then you might be able to drink a therapeutic amount of Modulen, which could be useful while you give Humira time to see if it will work for you.

If you can only drink one Modulen a day then it sounds like you are at risk of dehydration so I would go to A&E even if just for fluids and they can check you out to see if there is anything requiring urgent intervention.

Good luck! Let us know how you go!

 

[Charlotte.]

Saw my doctor today and he believes it could just be gastroenteritis, also called the stomach flu because there have already been three other patients with similar symptoms this week.:yrolleyes: I was infused some fluids with omeprazole and some more zofran in it. Well, maybe he is right and this massive nausea without d is a kind of virus but as I experience my “typical“ Crohn’s pains in the lower right more intense than usual as well, and I also have more mucus than normal, a virus would not be what I would expect. Even though we only know for sure that the terminal ileum is inflamed, I experience mild nausea very often in a more active state of Crohn’s.
What do you think, can a virus mimic Crohn’s-like symptoms?:sign0085:
As I get ill very rarely, the last cold was about 5 years ago my immune system seems to be relatively strong and I don’t know anyone having the stomach flu right now. I have to see my gastroenterologist again next week for my second humira shots, maybe until then I myself can figure out if it was just the flu.

 

[24601]

I think there are a number of things that can cause Crohn's like symptoms but you can really only know by testing. For example stool samples to check for an enteric infection and bloods and fecal calprotectin and imaging to check on your Crohn's inflammation.

Anything else is just guesswork - including your doctor's opinion that it could be gastroenteritis because there have been other patients with similar symptoms. I mean he's right that it could be but the more important question is not what could it be, but what is it? Did they not run any tests? Without knowing what you are actually dealing with right now it's hard to say what your best course of action is except for the usual - stay hydrated, try to drink the Modulen, go to A&E if you have a fever, severe pain, and so on.

I hope your GI can give you some answers! Good luck! :ghug: