Weigh loss & dizziness

[Catherine]

I actually saw Sarah have dizzy spell while standing today, she has been having them for a couple of weeks:ybatty::ybatty:

She now agrees that she has losted 2 kg since Christmas. Her BMi 18.4 and weight 55 kgs (121lbs) she is also looking very pale.

She is sleeping into 1pm and staying up half the night. She doesn't want to keep a food diary.

I think the weight issue is due not eating:ybatty::ybatty:

Is it possible to have a Crohn's flair with no GI symptoms?

How do make a young adult understand that this weight loss can not continue?

 

[Patricia56]

Yes it is possible to flare with few if any obvious GI symptoms. Eventually there will be symptoms but the first obvious sign could be something like a full obstruction or abscess.

The weight loss could be a GI symptom. The dizziness could be from many things but if it is Crohn's related then it is probably due to blood loss causing anemia. You can have blood loss that isn't obvious in the stool.

If she's cooperative I'd say some labs would be a reasonable thing to do at this point. Might help clarify things.

I will say, as the mother of 2 teens, that staying up and sleeping in are typical behaviors here at our house and I understand it is typical for most teens. Their brain goes through a shift where that pattern is normal for them for a couple of years.

The not eating is not normal or typical unless you think she's got an eating disorder issue. If she won't eat because it gives her pain or nausea then I would think that is a definite sign that something isn't right.

 

[DustyKat]

^^^^ +1.

Sarah is an early to bed early to rise type person (takes after me!) but Matt’s natural sleep pattern when uni is out is very late nights and very long lie ins the next day.

I would also look into Vit D, Magnesium and Zinc levels and aim to at the high end of normal.

Dusty. xxx

 

[Catherine]

She had bloods done yesterday, full bloods, iron, b12, folate and d. I had her in tears tonight because told her should have been asking to have them done not doing the usual why do I have them done today. As she knew she has symptoms eg dizziness and weight loss.

For Sarah, dizziness is associated with low body weight. She says the dizziness this time started with the hot weather. We had a week of 41c+ days. She has Orthostatic hypotension dx by neuro, heart condition excluded.

She never had visual blood loss as a symptom but had concurrent IDA and ACD at dx.

She is eating but not enough. Breakfast on 1pm, 3 piece of toast with jam. Lunch, 4pm sandwich and evening meal 7pm, meat and 3 veg.

This is a person who has always need 3 meals and 3 snacks to maintain her weigh. Without swimming she is just not hungry.

 

[DustyKat]

I wonder if dehydration is also playing into it too?

When does she start back with studies?

Do you think being back in a routine will help?

Is a visit to a dietitian worthwhile?

Matt’s last vist to the GP has resulted in a referral to a dietitian and I am curious to see what comes of it. My only concern is that given where we live I doubt there will be a lot of IBD experience but hey ho. The GP told me he referred him because given the life long nature of the condition he feels that Matt needs to understand the role of diet, his relationship with it and how he can maximise outcomes through his diet.

Dusty. xxx

 

[crohnsinct]

Oh man Catherine! I feel your pain. O has gone through fainting and dizziness off and on over the past few months. We are watching her like a hawk as far as eating and hydration go. She also got the all clear from cardio. Neuro is up next.

I wonder if Sarah (like a lot of other high school swimmers who suddenly stop) might not be subconsciously a little worried about putting on weight so she cut back the intake but cut it to far. Of course with this chronic illness you have to also wonder about inflammation etc.

Sorry no answers just :ghug:

 

[crohnsinct]

Sorry Catherine but I was obsessing over your daughter today while at a 5 hour track meet (of which my daughter ran a total of 4 minutes! why does she pick all the horrible spectator sports).

So back to Sarah...2 kg translates to about 1 pound (using the 2.2 conversion our clinic tells me to use). So 1 pound I wouldn't sound the alarms here but it definitely could be water and dehydration...you just wouldn't believe how much water weighs! Take dieters for example...the first few days quite a few pounds drop off easily and it is all water. Given the heat you guys are having I would believe dehydration and that could lead to the dizziness/fainting feelings. Then add the death of the dog...sadness...lack of appetite...maybe it is a combo of things?

Aren't I good at shoving your head firmly back in the sand?

 

[Catherine]

Dusty, will try and get her to hydrated more, maybe it a slow recovery from the hot weather.

We did the dietian thing prior to dx due to her inability to keep weight above 55kg as a 14 year old. She need to follow the principals.

Studies start on the 3rd March Routine should help.

Crohnsinct, Sarah weight peaked at 62kg, due to exercise and pred, she did cut her food intake at that point. I think her ideal weight while not swimming is around 58-60kg.

I love it if was a pound weigh loss, the conversion go the other way, 2kg equals 4.4 pounds.

 

[DustyKat]

So back to Sarah...2 kg translates to about 1 pound (using the 2.2 conversion our clinic tells me to use).

4.4 (2.2 pound per kilo) as Catherine said cic. You need to lay off the booze hun.

Ahahahahaha

 

[poppets mum]

Just wanted to let ya know my kid has had low weight issues for over a year. No Crohns dx but due to pain when eating she has a hard time. In summer she did black out and GI ordered ekg.(normal) we now see a dietician who has set specific goals for her, such as putting 1 to 2 lbs on in 4 weeks by adding extra calories to food she is already eating. Eg 1 tbs of peanut butter to toast or Granola to yoghurt basically just putting in extra calories without too much extra food. So far we are finding this to be quite helpful.

 

[Catherine]

We did find dietician helpful and had a specific eating plan to increase calories and increase dietary intake of iron.

Dietician looked at the food diary, advice low ferritin wasn't due to dietary intake. The dietician has been grouped together in her eyes with the medical professional who dx her with ibs and stress.

We also had a normal ekg and ultrasound of heart due to fainting while exercising

 

[crohnsinct]

How did you know I was drinking?! And would you believe I was a statistics major in college....got my masters too!

O.K. 4 pounds does sound like more of a concern but new theory and I am cold stone sober....could the weight be muscle loss due to the stopping of exercise? IDK when she stopped and if a young girl could lose muscle that fast but maybe????? How are her clothes fitting?

I also believe hydration is key. These girls just don't drink enough. WATER!

 

[DustyKat]

And would you believe I was a statistics major in college....got my masters too!

No way! That is classic! :roflanim:

 

[SupportiveMom]

I think you might be onto something with the dehydration & muscle-fat issue being less active, imo. I have certain things that trigger me being more diligent or strict on my girl because it is a sign of negative things to come. It sounds like Sarah is showing signs that you know shouldn't be ignored.

Summertime & off of school is difficult because of the lack of schedule. I had a heck of a time during the summer. Sounds like you are on the right track to get some answers with the blood work. I know from my own teenage years I barely ever took my mother's advice. I am hoping my girl listens more than I did. Food diaries & bowel movement trackers are all on me. It is already frustrating. I hope she gets more on board before graduating to adult care.

 

[Catherine]

Was told to asking whether she has eaten. She said her weight is this fine. So my response was if her weight is this fine, she not lose anyone weight.

I think we have an agreement.

New question, I know dose aza by blood levels is better than weight per kg. But I believe the maximum dose by kg is 2.5, she is now taking 2.73 per kg. I know it used at higher rates for other conditions.

 

[crohnsinct]

Wow! You are good! Got an 18 year old to agree! We should send you to the Middle East to broker some peace talks!

Sounds like maybe Miss Sarah should learn about dosing by weight, see she is a little over and go ahead and take charge and call the GI's office and ask if she needs to cut back due to loss of weight.... sneaky way of getting weight loss info to the GI! Hey a mother has to use all the weapons in their arsenal! Peace time or not!

 

[Catherine]

Had phone consult with GI today.

Bloods look good.

Hemoglobin is 11.1
White cells 3.8

Will being testing faecal calprotectin due to weight loss, just awaiting referral form in, the mail.

No problem with the med dose due to weightloss as at the bottom end of the target range.

Sarah needs to monitor her weight but fortnightly weight checks often enough.

 

[Patricia56]

I don't know the normal range for your lab but a hemoglobin of 11 would be 2 points below the normal level here.

And her RBC (red blood count) would be helpful to know.

 

[Catherine]

Patricia, she hemoglobin is what they like to call low normal, the range is (11.5-16.5). She has mild anemia. Yes her GI would like it higher, but it is at level that ok.

Yes I would like it higher.

In the last year hemoglobin has been in 11.0 -12.5 range much better than the 9.0 to 11 range of the year before.

Still waiting to see the results, as they have not arrive in the mail yet.

 

[CarolinAlaska]

Catherine, when Jaedyn's nutritional status is not good, she gets dizzy easily. Does Sarah supplement her diet at all? Lately we've found success with Carnation Instant Breakfast - tolerating well and drinking without a fight ! She agreed with her counselor today to 2 meals, 3 snacks and 2 carnations/day as a goal... I think she could gain on this. She's gained from 88 lbs post tonsillectomy to 90 lbs in a month, but was up to 91 last week... I think this week she got a little lax on her supplementation, but she was eating fairly well... Overall, I think she is feeling good.

 

[Catherine]

Got the test results today.

RCC 3.45 x1012/L (3.8-5.8)

Lymphocytes 0.8 (1.0-4.0)

Comment: The total leucocyte count is at the low end of normal. There is mild anaemia.

Vitamin D 100 nmol/L (>50)

Vitamin B12 340 pmol/L (150-700)

Folate 1740 nmol/L (>630)

 

[Catherine]

I don't think having anemia is acceptable.

Vitamin D seems low for February and taking 500mcg

Vitamin b12 should be higher.

Folate is higher than i like as she has rising folate and falling b12.

 

[DustyKat]

Will the doc be happy to tackle those issues?

 

[Catherine]

Doctor has request a faecal calprotectin to rule out weightloss is due to Crohn's.

I just tell the GI what doing in the way I supplements

Not going to change vitamin d supplement until the current bottle run out but will then purchase caltrate with more d.

Will try and get her to take b12, b multi and iron supplements daily instead of twice a week.

GI has asked that a symptom diary be keep (currently not doing).

Anaemia maybe a side effect of the medication due to the high dose.

 

[DustyKat]

Sounds like you have it well in hand Catherine! :thumleft:

Dusty.

 

[Catherine]

Sarah fainted while out today. This is her first faint since just after dx.

Faecal calprotectin was done Wednesday, should have the results in 10 days.

It been hot today 30c and humidity very high.

 

[Sascot]

Hope it turns out to be the heat. We are still waiting for calprotectin results - 4 weeks and counting!

 

[DustyKat]

I hope she is okay and its nothing serious.

Good luck with the FC results Catherine and Sascot. :goodluck:

Dusty. xxx

 

[crohnsinct]

Oh man! Is she well hydrated? Quite a few girls are fainting around here these days.

 

[Catherine]

This time she fainted without feeling dizziness.

She had being lying down as she felt hot, and she had feeling wanting to throw up. Boyfriend was sending messages on her phone and her tried to chase him and fainted. It seems like the faint was caused by getting up to quickly.

She seems fine. My husband is driving her work now, she taken a extra shift with 40 mins notice.

 

[fayee]

I have dizzy spells when my iron is running low. When I was first diagnosed with Crohn's my Haemoglobin count was at 86 (saying if it was 76 or lower I'd need a blood transfusion). I started taking iron (Platinum's EasyIron, Iron - 18 mg, Folic Acid 800 mcg, Vit B 12 (methlcobalamin) 1000 mcg, Vit. C (ascorbic acid) 50 mg, Vit B^ (pyrodoxine hydrochloride) 25 mg) once a day. This did not increase my haemoglobin count (but rather maintained it at 86).

I generally can tell when I'm going to faint but the other day I was caught off guard and ended up hitting my head and ending up in ER. The Doctor told me to double up my iron. Maybe something you can look into? But I'd suggest speaking to a DR because I know overuse of Iron can cause vomiting (which I've experienced) and even depression(?)

Also maybe a liquid iron supplement? I have taken one before (forget the name but its in a tall white and red box, beet and apple?). Liquid is supposed to absorb better than pill forms, BUT I'm unsure if that's the case for persons with IBD.

Good luck to you both!