Kyle's story

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Our son Kyle was diagnosed with Crohn's in February of 2008, just 2 weeks prior to his 9th birthday. He was anemic at the time, and had been having issues for much longer than my wife and I knew prior to hospitalizing him. We look back now at pictures and memories of the 6-9 months leading to his diagnosis and simply feel ill at what we didn't notice at the time. He suffered much longer than any 8 year old should. Needless to say, we now have poo patrol and poo control in our household!

He was treated with Prednisone, 2 units of blood, and put on Pentasa which he has been taking since his diagnosis. He also takes omeprazole/prilosec and miralax on a daily basis.

Other than that, he has been quite problem free up until about 5 weeks ago. He started noticing a bit of diarrhea and sometimes blood along with it. We contacted his doctor (new doc since we moved about a year ago) and he was put on Prednisone again, and his pentasa dosage was also upped since he had actually grown quite a bit in the past 9 months. Over the course of a few weeks we started seeing improvement, but then things stagnated a bit and he actually started having some nausea and vomiting. We were just getting ready to take him back up North to visit friends and family, so we scheduled an appointment and got him looked at. His Prednisone (which was in the weaning stage) was re-upped, and an antibiotic was added due to suspicion of c-diff infection. He was feeling ok, so we left for our 10 day trip.

He was doing ok until about halfway into the trip, when he started going downhill, and fast. He had almost constant nausea and was not eating much. He was making many, and long, bathroom trips with poos ranging from a 1 (on a scale of 1-5 with 5 being bad) to a 3-4. By the last two days of the trip, he basically was able to do nothing other than sit around and feel sick. I knew he was getting dehydrated, and tried to get as much clear fluids in him as possible, but apparently it was not enough.

We got back to FL on Tuesday night, and he ended up bedridden on Wednesday unable to keep anything down. We had called the Doc several times and gotten several different meds to try for the nausea, but nothing worked.

My wife took him to see the Doc (who is over 90 minutes away) yesterday, prepared with bags packed for a hospital stay. He had to be taken into the doctor's office in a wheelchair at this point since he was so weak. They gave him IV fluids and some anti-nausea meds, and had some discussions about changing his meds. In this case, the plan was to start Humira to try to get him into remission. The Doctor wanted to do a colonoscopy and endoscopy on him, and we decided to just get him admitted to Arnold Palmer Children's Hospital in Orlando and do the procedures today. He threw up almost immediately after being admitted, and was then forced to complete the "prep" for the procedures. That made him extra miserable, causing extreme nausea, very serious abdominal pain, and some vomiting.

On top of that, his IV "blew out" his vein, and filled up his arm with fluid. He has deep veins, and they roll, so getting IVs in him is difficult and painful. The poor guy is having a bad go of it...

His colonoscopy today was not good. His entire large intestine is seriously inflamed and ulcerated. The Doctor did not even get into his small intestine as he didnt want to cause any further problems. His upper scope looked good, so that was some "good news" if there is such a thing. They treated him with hydrocortisone and are planning a Remicade infusion tomorrow. They need to get the inflammation down and get him able to eat, drink, and function before he can come home to recover.

We are overwhelmed by the situation right now, as we had gotten so complacent about his disease over the past 3 years, as he had almost no issues. This was a serious wake-up call, and it is not close to being over yet. We are just hoping that he responds to treatment and that more drastic options don't need to be considered yet. We just want him to have a "normal" life, whatever that means...

We have four children, one with a certain autoimmune disorder (6 year old son with type I diabetes diagnosed at Age 4), one with asthma (12 year old daughter and twin of Kyle), and another (14 year old daughter) who has shown high ANA and other markers in testing, but has come up with a diagnosis so far of Fibromyalgia (originally suspected RA). We are still working on learning more about her, and currently gathering medical records to try to find the right doctors to see if she can be helped. Her bloodwork points to Celiac or possibly Lupus, but we will need help to figure it out.

All of these things showed up in our children in a period of less than three years. We moved. Far away. Of course we moved to the gulf coast of Florida, and just found out the hard way that my wife is horribly allergic to Fire Ant stings. When it rains it pours!!

Something isn't right. Not sure what, maybe it is just that my wife and I are a bad gene combination! Anyway, I have been perusing the forum and gathering much information, so just thought I would "dump" a bit. Thanks to everyone for their openness and understanding in here. Reading some of this stuff is scary, but it is also reassuring...

Steve
 
Hi Steve and :welcome:

My oh my, you guys have been through the wringer! I'm so sorry to hear about about Kyle...:( and your other children.

Have you come across the Parent's Forum yet? If not, pop by and have a good browse.

I have to dash out right now, late Saturday morning here!, but I wanted to welcome you first and just let you know that you are alone. Oh man, I have had those exact same feelings when looking at photos of my kids, bloody awful.

I will pop back later and talk more. Welcome aboard!

Thinking of you guys, :hug:
Dusty. xxx
 
Oh wow Steve...your poor family!
I'm so sorry your son has been diagnosed, but I am glad for you that you have found Arnold Palmer Hospital...they are terrific ! We have been there a few times for different reasons. Have you met Dr. Bornstein? He's a pediatric GI there, and from what I know of him, he's terrific !

I sure hope that Remicade does the trick for Kyle ! If not then maybe Humira could be an option as well before any surgery is considered ? There are some great success stories here from parents who's kids are doing very well on Humira.
My daughter started Cimzia in May, but she just turned 18 this year so she is "of age" as it is not yet approved for children. It still makes me nervous though because she is barely of age, but it seems to be doing wonders for her so far.

Is it a possibility that your oldest can be seen and diagnosed at AP as well? Or Kyle's twin sister ? Are they sure they don't have CD as well, or has it even been suspected at this point?

I'm just amazed at your story and feel so bad for you all!
As our Dusty told you already, please check out the Parents forum as well...there are so many amazing and supportive parents here !
:ghug::ghug::ghug:
hang in there dad !
~T~
 
Hi again Steve,

I hope Remicade does the trick for Kyle, poor love. I guess it's Crohns Colitis that they say he has? If he has such problems with his veins are they looking at him going to Humira at any point?

We have a Remicade Club and Humira Club here that you may like to like at, plus there are parents on the forum that have children on these medications as well.

There are many extraintestinal manifestations of Crohns including joint pain, pain, headaches, eye issues, rashes and others. What are the symptoms your 14 year old daughter has that led to the diagnosis of Fibromyalgia?

Any questions you may have about any of your children please don't hesitate to ask. Only two rules! Nothing is too much information and there is no such thing as a dumb question. :ybiggrin:

Good luck Steve and I hope you get answers soon for your kiddos!

Dusty. :hug:
 
First, thanks for your support and encouraging words. Things are looking up at the moment, but we have a long road in front of us at the moment.

At the Doctor's office on Thursday, the plan was to start Kyle on Humira. They wanted to do the colonoscopy and endoscopy, but were talking about waiting until next week to do those. My wife (I was not there, at home/work and taking care of the other three) discussed it with Kyle and they decided they wanted to get everything over with since he was basically already "cleaned out" anyway, so he was admitted to the hospital.

He has improved greatly since yesterday at this point, primarily due to being re-hydrated we think. His nausea is gone, and although he still has some abdominal pain, he is feeling much better. He is up and about a bit, and he has even smiled and laughed a few times, so that is a big step forward. They did the Remicade infusion this morning. I am not 100% clear on why they decided on the Remicade vs Humira in the hospital. He got thru the infusion fine, and is doing well right now other than being tired. The plan is still to put him on Humira so that we can treat him at home. With a 6 year old diabetic, we are certainly comfortable with needles and all of the fun stuff that comes with that. It looks like the Humira is very simple if you get the pens anyway. With his vein issues, we would certainly prefer to avoid the IVs if we can.

On the fibromyalgia, we had a lot of blood testing and other things done, and met with both an ortho and a rheumatologist. This was spurred by constant complaints and issues related to joint pain in our daughter. She was pretty active, doing martial arts 2-3 days per week, and often swimming 5+ days per week training for competition. I don't remember all of the details right now, but she was missing certain things that are typical of RA. They did a "sensitivity" test on her with a pressure device with a spring gauge asking her to say "when" the pain got too much on various pressure points on her body. The doctor confirmed that her sensitivity was high, and I guess the standard thing now is if they can't find another good explanation for someone with her symptoms, they say it is fibromyalgia. Of course she is 14, emotional, sometimes depressed and hormonal, etc so they also recommended psychiatric help as well. While that may not be a bad idea, we are certain that it isnt that simple...

Since then, we moved to FL and we got all of her medical records sent to us so that we could "shop" for doctors. My wife spent a lot of time with her test results, etc. The number of errors and inconsistencies we have found in our family records is AMAZING, and downright scary. We also found with her records that there were a large number of things in her blood tests that were well into the "abnormal" range that were never even communicated to us. My wife has done a lot of research on those items and combinations which is what has led her to considering Celiac's and/or Lupus as a possibility for her.

We are planning to follow up on that once we get thru the immediate issues. It has just been hard to even figure out where to start with it. What kind of Doctor do we even go to? It is all unclear.

What IS clear, is that we have learned that we need to self manage our health care. We also have to constantly take a look at the big picture and try to put pieces of the puzzle together. The doctors don't often seem to do that, and even many of the good ones are somewhat myopic in their approach to assessing symptoms and cause/effect.
 
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Good to hear Kyle is feeling better Steve. What a relief for you all! I hope things continue to go well...:). I'm sure you won't encounter any problems with administering the Humira at home, I bet you give a needle with your eyes closed! :lol:

I agree with you that things aren't that simple with your daughter. Do you mind if I ask what the abnormal blood results are?

Dusty. xxx
 
Wow Steve, you guys have been hit pretty hard!! I agree with you, it does seem odd that they'd use Remi once and then change to Humira. I don't believe I've ever seen that mentioned on here. Was Kyle only on Pentasa for the last 3 years? Most seem to have a stronger maintenance med in addition to Pentasa/Asacol. I hope he's well on his way to remission now and you all are closing in on the answers for all your kids. Good luck!
 
Yes, he was Pentasa only since diagnosis other than the Prilosec.

On the daughter's blood:

Nov 2009 - test in preparation for ortho appointment
ANA was 320 - speckled pattern
Rheumatoid factor negative

MPV was 7.2 for normal range of 7.4-10.4

Overall blood results classified as "abnormal"

01/2010 - in preparation for rheumatologist appointment
WBC - 9.6 (normal 4.6-9.4)
RBC 5.17 (normal 4.1-5.1)

Metabolic panel
Albumin 5.2 (normal 3.4-5.0)
Calcium 11.2 (normal 8.6-11.0)
Total Protein 8.1 (normal 5.9-7.9)
ALT (SGPT) 26 (normal 30-65)

Urinalysis -
Urine Leukocyte - Trace (A)


There was also note of "restless" sleep during the interview

Her trigger point testing confirmed sensitivity
They called for additional labwork for ANA, celiac, and HLA B27 and possibly a sleep study.

HLA B27 ANTIGEN - not detected
SM antibody and SM/RNP Antibody were both normal
Scleroderma antibody normal
Sjogrens antibody normal
Anti-Thyroid peroxidase AB normal
Thyroglobulin normal
Free T4 normal
TSH normal
Gliadin Antibody
Gliadin IGA normal
Gliadin IGG abnormal = 18 (normal less than 11)
TTG normal
Immunoglobulins normal

Completed sleep study which was showed no sleep disordered breathing but more "arousals" then normal

April 2010 followup indicated that most recent labs were not consistent with "inflammatory disorder" and that most likely was "amplified pain syndrome" possibly exacerbated by depression.

How's that!!! :)
 
A quick update on Kyle:

After the remicade infusion and lots of fluids he started feeling remarkably better. The Doctor Ok'd him on Sunday morning to eat "normal" food. You should have seen the look on his face, since all he wanted for days was a piece of French Toast!

He ate and drank, without any pain or other issues. They released him from the hospital on Sunday afternoon and he is home now and doing very well. We are having to manage his food intake and watch his fluids to make sure he doesnt over or under-do anything. He is feeling extremely well, and has had 2-3 BMs already with no blood or D at all. The doctor was sort of flabbergasted that he was looking and feeling so good so quickly after what he looked like on the inside. As are we.

We had a lot of people in our expanded circle of friends thinking positive thoughts and praying for him. While we are certainly not deluding ourselves into thinking everything is fine and he is completely out of the woods, I will say that given the outlook we had on Friday/Saturday, it is nothing short of a miracle how well he is doing today.

He has been eating small meals pretty regularly no nausea and only a tiny bit of discomfort that he says he thinks was "gas" last night before bed.

Hopefully the trend will continue. And we can stop this :ybatty: for a while...

Thanks to everyone here for their support and for the information!

BTW, we had our GI doc look at the older daughter's bloodwork, etc last year, and he said it didnt "look" like Crohn's to him FWIW...
 
Great news Steve! I have seen people here say they have fab results with Remicade like your son has, feeling fantastic very quickly.

Yeah, your daughters bloods don't shout Crohns but I would still wouldn't rule it out completely. Maybe keep a diary and see if you pick something up that way, whether it is Crohns related or not? Have a look at the diary inclusions we have listed here.

Dusty. xxx
 
I am so happy to hear this news Steve ! :)

May it keep on for a very, very long time, and hopefully give your entire family a much needed breather!

thanks for sharing and updating the great news.
~T~
 
Hi Stimpee. While I am brand new here and looking for advice and reading all around me I am flabbergasted at what you have been through but so relieved for you when I read you last post. I am in no position to advise right now but you can be sure I have my fingers crossed for all of you and hope things look up now for a long time. Best of luck.
 
BTW, Kyle's has been seeing Dr. Mehta, but Dr. Bornstein was his doc in the hospital and my wife and Kyle thought he was awesome!
 
Good news Steve! Just curious, if the Remi does turn out to work that well for Kyle, any chance they'll keep him on that instead of switching?
 
Ok, so it has been a while since posting. I got involved in another thread about the potential impact of stomach flu, and figured I should update this page.

Kyle was doing very well in July after his Remicade treatment, and got a second treatment of Remicade and it appeared that we were well under control. We then switched over to Humira, primarily for convenience of being able to administer at home. While this seemed like a good idea at the time, I guess we should have left well enough alone! During the first 2-4 weeks of the switch, he started showing some light signs of flare. Not major, but a bit of bleeding, etc. We kept with it, and they kept his prednisone up for a while, and things were doing well. Other than the shots being a quite painful (Kyle said that on a scale of 1 to 10, they were a 23!), things appeared to be going well. I had some massive employment issues in July-Sept, and even lost my health insurance for a brief period twice. Talk about stress...

We then started to wean him off the prednisone 4-5 weeks ago.

Kyle got the stomach flu after it went thru the rest of the family about two weeks ago. He has beed on Humira for about 10-12 weeks and we were just weaning him off the prednisone - he was down to 5mg every other day.

Well, either the stomach flu, or the prednisone weaning, or both sent him into a flare. He went downhill quickly over a week, but after bumping the prednisone back up seemed to be getting better. Then the past 2-3 days went downhill again. He was admitted to the hospital yesterday afternoon to try to get an idea what is going on.

The got an IV in him last night after 4 sticks (he has deep veins, and they roll, so that is always a nightmare for all but the most skillful phlebotomists) and got some fluids and IV prednisone in him. Then he got the wonderful "clean out" meds for his procedures. He ended up succumbing to the nausea last night and threw up once, but otherwise made it thru the night, but with little sleep.

He had the procedures this morning, and came through all of that ok. Talking to the Doc afterwards, it appears that the last bits of his large intestine are a bit worse than last time, but his esophagus is a bit better. He confirmed our suspicions from the past few weeks, that the Humira was/is simply not working for him. He set him up immediately for another Remicade infusion. Partially because it was not working, but perhaps more importantly that the Dr. feels it will give much more flexibility in dosage, frequency, etc. Both in times of need, as well as if we get him under control (can spread out treatments and drop dosage easily).

He slept most of the afternoon, but appears to be feeling considerably better so far. Hoping he gets some more rest this evening, and wakes up tomorrow with a similar "amazing" recovery like he had last time in the hospital after his first Remicade infusion.

Dexky, sorry for the lack of response to your July post, but I guess now that it is 11/11/11, we have a good answer to that one!!

As a side note based on the conversations above a while ago, we had also put somewhat of a "hold" on making progress on our daughter's condition due to my employment and health insurance situation (how sad is that?). However I started a new job a few weeks ago with a big company with amazing health insurance coverage, so we got her in last week to the rheumatologist. No firm thoughts yet, but while my wife was in the hospital with Kyle this morning and he was getting his "oscopy's" done, I was with our daughter while she was getting a 2 hour MRI with contract to try to see if anything physical is going on. She is also going to have an appointment with the GI's at Arnold Palmer in the coming weeks at the rheumatologist's recommendation to check for Celiac. We got to discuss that with the docs today, and they are going to "pre-order" some labs and everything for her appointment, so hopefully we will get that sorted out soon.

Kind of weird when the 7 year old with diabetes is the "easy one"!!! :D
 
I hope there's no problems with him going back to Remi and it continues to work well for him Steve. Best of luck for both your kids!!
 
Hey Steve,

I hope all going well with Kyle and the Remi works as well as last time. Wee hours of the morning for you there and I hope that Kyle is getting some good sound sleep.

As to the insurance...oh my goodness!...I really feel for you guys having the added stress of dealing with that. As if you don't have enough on your plate already!

Good luck mate and let us know how Kyle and your daughter get on.

Dusty. xxx
 
Thanks again for the support. I generally have somewhat "conservative" views on politics, but I can tell you that once you lose your health insurance when you have kids with the kind of issues we have, it makes you understand how incredibly screwed up our "system" is here in the US. Reform? NOT!!!

Kyle went to sleep at 11, and is he still sleeping (after 8 here). Hopefully that is a good thing.
 
I haven't been on here for a bit, but figured I would give an update.

We have been struggling with Kyle still for the past few months. We weaned him off the prednisone around Christmas time, and things haven't been so great since then. He was on 5mg of prednisone to maintain, and they have upped his Remicade treatments in January and Feb to 10mg (I think), which is apparently a high dose. While he is mostly blood free, his frequency and urgency are still so high that he is still missing massive amounts of school, and he suffers from stomach pain and nausea at a very high frequency.

His last Remicade treatment was on 2/28, which was also his 13th birthday. He still felt like crap immediately after his treatment, and we discussed with the Doctor what else we can do. The recommendations were either Entocort, or Methotrexate. His Mom and I decided to give the Entocort a shot since we were reluctant to put him on anything more "nasty".

He has been on the Entocort for just shy of 2 weeks, and the only improvement is that he is not having any blood anymore. However his quality of life has not improved at all, and he has not been to school since before his Birthday.

We have reluctantly decided to try the Methotrexate. It will be about 10 days before he can get that started. The Doc prescribed more prednisone starting at 60mg for 3 days and then ramping down quickly, but Kyle said he would rather suffer through another few weeks than go back on the high dose Prednisone.

And on the bright side, his sister Emily just had an Endoscopy and Colonoscopy last Thursday. She showed some signs of inflammation in her colon, but nothing too severe. We are waiting for the biopsy results to come back on her...

Guess I will bop over to the Methotrexate forum to read a bit over there.

Steve
 
Hi Steve,

I'm so sorry that Kyle is still having a rough time of it.

Has anyone mentioned the idea of trying enteral nutrition to you? It has about the same remission rate as prednisone in the pediatric population without all the side effects. If you're not familiar with it, I'd research it a bit.

Have you tried any major dietary changes such as removing dairy and gluten?

I can imagine you're feeling overwhelmed, especially with all the health issues your kids are having. I have a lot of respect for you moving far away, I think I would have done the same thing.

I farm in my yard here in Florida and not a day goes by that I don't get stung by fire ants. Luckily I don't have horrible reactions like your wife. However, I get great joy out of taking a shovel full of one mound of ants, sprinkling a line of the ants over to another mound, dumping the rest of the shovel full on the new mound, and doing the same thing back. Each mound thinks the other invaded and they go to war. Good times. :)

We're here for you bud. Let us know what we can do for you.
 
Hi Steve. Such a rough time you all seem to be going through. Bless Kyle's heart having to put up with so much and I hope things really brighten up for him VERY soon. Cant help more than giving words of support but hope that knowing we are all here for you will at least be some comfort. Take care.
 
Hi Steve,

I'm so sorry that Kyle is still having a rough time of it.

Has anyone mentioned the idea of trying enteral nutrition to you? It has about the same remission rate as prednisone in the pediatric population without all the side effects. If you're not familiar with it, I'd research it a bit.

Have you tried any major dietary changes such as removing dairy and gluten?

I can imagine you're feeling overwhelmed, especially with all the health issues your kids are having. I have a lot of respect for you moving far away, I think I would have done the same thing.

I farm in my yard here in Florida and not a day goes by that I don't get stung by fire ants. Luckily I don't have horrible reactions like your wife. However, I get great joy out of taking a shovel full of one mound of ants, sprinkling a line of the ants over to another mound, dumping the rest of the shovel full on the new mound, and doing the same thing back. Each mound thinks the other invaded and they go to war. Good times. :)

We're here for you bud. Let us know what we can do for you.

Started researching enteral nutrition today, and my wife is going to speak with Kyle's GI about it. We are still waiting for the call on when we can try the Methotrexate just to try to get things under control. He only feels well enough to "function" for 2-3 hours per day at this point. He is eating and staying hydrated, but he is totally fatigued and either has nausea or is in pain for a lot of the day. We tried going dairy free for about 2 weeks and noticed no change, and it was killing Kyle since he LOVES cheese. And we were fanatic about it too, even avoiding anything that could even remotely have milk or dairy products of any sort in it. We haven't tried completely gluten free, but he shows no signs of celiac in any of the tests.

On some other notes, my wife has been getting stung occasionally by the ants, and I guess she has built up some immunity or something, as she has been able to handle the reactions when it happens.

Another interesting twist, is that our older daughter Emily just got a confirmed diagnosis from Kyle's GI the other day. Based on the biopsies from her colonoscopy, she was dianosed with lymphocytic and/or collagenous colitis. Although it is somewhat rare at her age, she is also a "special" case due to the involvement of her joints. We havent had a chance to speak with the Doc yet about it in detail regarding treatment, etc. However we are becoming at least remotely hopeful that perhaps we can start treating her. We also have a call into her rheumatologist since in the process of researching her condition we see many references to EDS - Ehlers Danlos Syndrome. When reading about people's experiences with that, it sounds like a cookbook match to what we have been going thru with her for 3+ years now. It will be interesting to see where that goes...

I have been joking with my wife that we obviously should have vetted each other a bit better before getting married and having four kids! :D

Of course we are now preparing to subject our one remotely healthy child, Kyle's twin sister, to extensive testing to figure out what is waiting to come out and surprise us on the autoimmune menu for her. We are three for four so far on kids with autoimmune disorders. Kind of depressing! We must have done some really bad stuff in our past lives...

Thanks to everyone for the continued input and support.

Steve
 
Hi Steve,

A few things:

1. Have you had Kyle's vitamin B12 levels tested? People with Crohn's Disease are commonly deficient and one symptom is fatigue.

2. Good deal on the enteral nutrition. I'm curious what your GI says.

3. I have Lymphocytic Colitis. The whole age thing some doctors have going is a load of crap. There's a load of people of all ages being diagnosed with it. The "old ladies" demographic is dated. Oh, and plenty of us get joint inflammation. My worst is in my chest and it's called costochondritis. I'm sorry to hear your daughter has it. It sucks. :( We have a support club for Microscopic Colitis if you're interested.
 
Update and question (for David or others):

Kyle's Crohn's continues to improve (it appears anyway). We currently have him on Remicade, Methotrexate, Pentasa, Entocort along with supplements of B12, Folic Acid, Iron, Melatonin to help him sleep. Wow, that's a list.

We had a flu go thru the family in May. Kyle got very sick and missed a bunch of school. We thought he had asthma since he was having so much difficulty breathing and was coughing a lot. Ultimately he ended up being diagnosed with pneumonia and was put back on relatively high dose of Prednisone briefly when it appeared to be asthma. He broke two ribs from coughing. He missed a total of nearly 50 days of school this past school year.

Fast forward. Even with less frequent remicade treatments, his Crohn's symptoms appear to be under control. However he still looks like he is on Prednisone. His face is very round and red, his neck and chin are very thick, he is still holding on a lot of extra weight, and has been very lethargic and fatigued. Another big issue is that we noticed significant stretch marks appearing on the inside of his thighs, lower back, back of his arms, etc. We spoke with his GI about the stretch marks and the round face and they said that should not be caused by the Entocort.

We are very concerned about the stretch marks since he now no longer wants to go to the beach, swim, etc. Two weeks ago, he was driving his racing go-kart (the only good thing he seems to have left), and someone spun in front of him, in avoiding them he ended up going sideways into a crash barrier and broke another rib. Even though he had a Dexascan a few months ago we are very concerned about his bone density. We were doing some research this morning on it and trying to figure out how to treat and reduce them. In doing so, we are finding many references to Cushings and relation between it and Entocort (although it is rare).

In addition to being concerned about how to deal with and treat all of this, we are also questioning our choice of Doctor at this point. For someone to be completely oblivious and unconcerned about these relatively obvious and visible symptoms, is unacceptable to us. With all of the issues with our kids, it certainly seems like these Doctors all have massive tunnel vision down their one known path, and can't pull back and look at the big picture. And they are the "experts"?

Does anyone have any insight or recommendations? In particular, does anyone have any recommendations for a top notch GI for a 13 year old boy? Preferably in Florida, but frankly we are willing to travel just about anywhere to get the proper treatment.

Kyle has a remicade treatment tomorrow, so I plan to try to discuss some of this with his Doc or nurses then, just hoping I can keep my cool, as I am pretty p*ssed at the moment....

Thanks,
Steve
 
Hi Steve,

I'm not well educated about the relation between entocort and Cushings, hopefully someone else is. You may want to create a thread about it in our entocort forum in addition to this thread. What I do know know comes from this article which stated something along the lines of,
Budesonide (Entocort) doesn't appear to suppress the adrenal gland much, especially compared to conventional corticosteroids but kids may be more likely to have their adrenal gland suppressed than adults.

I wonder if the entocort is even necessary at this point with all those other meds. I mean good grief, it seems like they're pumping him full of every treatment at once. Except of course for the ones that don't have many if any side effects such as enteral nutrition and LDN. :(

As for a second opinion, I'd ask the members in the Parent's of Kids with IBD forum. I know many of them have found fantastic doctors.

If you're worried about his bone density, I would also request they test his vitamin D (especially with that pneumonia), calcium, and magnesium levels if they haven't already. Then read up on this thread about vitamin K2 to see if it's something that is worthwhile pursuing.

I haven't been much help, I realize :( I wish there was more I could offer. I can't imagine your pain :(
 
Steve,

I decided to pull out the book I referenced above and copy what is says about Entocort safety. How long has he been on the entocort and at what dosage?

From the book:

"Among the myriad adverse affect attributed to the corticosteroids, particular attention has been devoted to their ability to accelerate loss of bone density in patients with IBD. A small comparative study of bone markers also suggest that short term budesonide therapy does not impair osteoblast activity. However, early observational data suggested that Budesonide was not associated with better bone preservation than low dose prednisone. A more recent and large randomized controlled trial found that budesonide 9mg daily to induce less loss of bone mineral density than prednisone 40mg daily over 2 years in corticosteroid naive patients with Crohn's disease. No such difference was seen among patients with corticosteroid exposure.

Editors note - It is common practice to urge patients on maintenance budesonide to take calcium 500mg plus vitamin D two per day and to follow bone density measurements. Also be aware that grapefruit juice alters the metabolism of budesonide and other medications.

The low systemic bioavailability of budesonide infers reduced capacity to suppress the hypothalmic-pituitary adrenal axis. When compared to placebo, oral budesonide was associated with transient but measurable suppression of adrenal function in a pooled safety analysis of maintenance trials for Crohn's disease. However, systematic literature reviews have demonstrated that both oral and rectal budesonide induce significantly less adrenal suppression, respectively than oral or rectal corticosteroids. Adrenal suppression with budesonide appears to be dose related but negligible at does less than 9mg daily. Still, corticosteroid supplementation should be considered for patients on full dose budesonide who require emergency surgery.

It is noteworthy that children may be more prone to adrenal suppression than adults. However, many of the key induction and maintenance trials have been conducted in pediatric populations with ostensibly good tolerability and safety. These trials have used robust induction doses of 12mg daily despite lower average body weight of pediatric cohorts. Short term exposure to inhaled budesonide has been associated with growth retardation, but it is not clear whether oral budesonide has a similar effect. From this cumulative experience, oral budesonide dos appear relatively safe for use in children as an alternative to conventional corticosteroids but more data are needed."
 
HI Steve. I wish I could be more helpful as you must be so frustrated and at your wits end. If something tells you to change doctor then do it. Definitely get a second opinion as David says anyway. I really hope someone on here can send you in the right direction. I know for sure we will try. Best of luck
 
Thanks for the support. I will try to get a post together for some of the other subforums shortly.

He is on 9mg of Budesonide/Entocort currently. He has been on it since roughly the end of February. We struggled with a combination of Remicade and 40+mg of Prednisone on and off from last August thru the end of the year. Every time we would try to wean off the prednisone he would regress.

The Remicade in my opinion isn't "working" in that it is not really providing significant relief. I think it keeps him from bleeding, but that is about the extent of it. He needed the Prednisone to control diarrhea, urgency, and stomach pain/nausea. We stopped that in January and symptoms started coming back. We were given the option of Entocort or Methotrexate. We discussed LDN and even provided the studies, etc to him. He was interested, but did not feel there was enough data yet.

We tried the Entocort and after 3-4 weeks with no real relief we decided to go with the Methotrexate. We didnt want to do it, but frankly Kyle made the choice himself. He just wanted to feel better.

It has certainly done the trick, as other than the flu and pneumonia, he has been feeling pretty good for 4+ months now. But frankly he LOOKS like he is still on prednisone, and the stretch marks on his body have raised a new level of concern.

I think we are going to go see a doctor in Sarasota that is a DO and also listed as "alternative medicine". She is on the "list" of docs that prescribe LDN, so I frankly think we have little or nothing to lose to pay a visit.

We will discuss the Entocort and the side effects with his GI tomorrow, and we also have an appointment with a dermatologist for him next week to see if we can treat the stretch marks before they become "permanent"...
 
By the way, just a quick response to some of the information David posted. One thing I have learned, is that if there is a teeny tiny chance of something, and it happens to be really unusual and rare, then it is probably the situation with us. Seems like we keep dealing with issues that aren't "supposed" to happen with our family!

Just have to keep telling myself that it could be worse, and for many people it is!!

Maybe I can take comfort in the fact that Kyle's doctor said recently that he was one of his "most challenging" cases. Great...
 
Hi to you and your family,
Your story really touched my heart and I would love to pray for you and your family. I have crohn's and also fibromyalgia with myosis of the muscles too. They put me on effexor xl for that and it has helped me so much. I had headaches and pain so bad I wouldn't even go anywhere for awhile there.
I am on a low carb diet (SCD) and on probiotic multi enzyme formula for the crohn's and it is helping alot too. I rarely have problems since I began the probiotic multi enzyme formula. I take them with every meal. I hope they find out soon what your daughter has, they are all too young to go through all this. Try to put it in God's hands as worrying will make you sick as well. I will pray for a great outcome and hope for the very best for you and your family! Teresa:rosette1:
 
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