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Crohn’s Disease

What Is It?

Crohn's disease is a long-term (chronic) condition in which inflammation causes injury to the intestines. It typically begins in young adulthood, most often between ages 15 and 40.

No one knows for sure what triggers the initial intestinal inflammation at the start of Crohn's disease. Many experts think that a virus or a bacterial infection might start the process by activating the immune system and that the body's immune system stays active and creates inflammation in the intestine even after the infection goes away. Family members may share genes that make Crohn's disease more likely to develop if the right trigger occurs. Ten percent to 25% of people who have Crohn's disease have at least one relative with Crohn's disease or a similar disease called ulcerative colitis. Crohnύs disease is more common in people of Jewish heritage, relative to non-Jews.

Once Crohn's disease begins, it can cause lifelong symptoms that come and go. The inside lining and deeper layers of the intestine wall become inflamed. The lining of the intestine becomes irritated and can thicken or wear away in spots. This creates ulcers, cracks, and fissures. Inflammation can allow an abscess (a pocket of pus) to develop.

A unique complication of Crohn's disease is called a “fistula”. A fistula is an abnormal connection between organs in the digestive tract, usually a connection between one piece of the intestine and another. A fistula can be created after inflammation becomes severe. To understand how a fistula is created, consider the way the intestine attempts to heal. Between attacks of inflammation, the intestine recoats itself with a new lining. When the inflammation has been severe, the intestine can lose its ability to distinguish the inside of one piece of intestine from the outside of another piece. As a result, it can mistakenly build a lining along the edges of an ulcer that has worn through the whole wall of the intestine, forming a fistula.

The section of the small intestine called the ileum (in the right lower abdomen) is especially prone to damage from Crohn's disease. However, ulcers and inflammation can occur in all areas of the digestive tract, from the mouth all the way to the rectum. A few other parts of the body, such as the eyes and joints, also can be affected in people with Crohn's disease.


Some people with Crohn's disease have only occasional cramps, or diarrhea that is so mild they do not seek medical attention. However, most people who have Crohn's disease experience long stretches of time with no symptoms interrupted by bursts of symptoms, called an exacerbation, when inflammation returns. During an exacerbation, or during the initial appearance of Crohn's disease, you might experience the following symptoms:


It may require months for your doctor to diagnose Crohn's disease with certainty. Your doctor will look for evidence of intestinal inflammation and try to distinguish it from other causes of intestinal problems, such as infection or ulcerative colitis, a related disease that also causes intestinal inflammation. If you have Crohn's disease, your symptoms and the results of various tests will fit a pattern over time that is best explained by this condition.

Tests that can indicate inflammation and show evidence of Crohn's disease include:

Expected Duration

Crohn's disease is a lifelong condition, but it is not continuously active. Following a flare-up, symptoms can stay with you for weeks or months. Often these flare-ups are separated by months or years of good health without any symptoms.


There is no way to prevent Crohn's disease, but you can keep the condition from taking a heavy toll on your body by maintaining a well-balanced, nutritious diet. By storing up vitamins and nutrients between episodes or flare-ups, you can decrease complications from poor nutrition, such as weight loss or anemia. Your doctor will monitor your blood for complications of poor nutrient absorption.

Crohn's disease can cause a higher risk of colon cancer, particularly if it affects a large portion of the colon or rectum. It is important to have your colon checked regularly for early signs of cancer or for changes that can precede a new cancer. If you have had Crohn's disease affecting the colon or rectum for eight years or more, it is time for you to start getting regular testing to look for cancer. One good strategy is to have a colonoscopy exam every one to two years once you start regular testing.


Medications are very effective at improving the symptoms of Crohn's disease. Most of the drugs work by preventing inflammation in the intestines.

The medication commonly used first is a group of anti-inflammatory drugs called aminosalicylates. They are chemically related to aspirin and suppress inflammation in the intestine and joints. They are given either by mouth (pills) or by rectum, as an enema. Some drugs in this group include sulfasalazine (Azulfidine), mesalamine (Asacol, Pentasa, Canasa, Rowasa), and olsalazine (Dipentum).

Certain antibiotic drugs, particularly metronidazole (Flagyl) and ciprofloxacin (Cipro), help by decreasing the bacterial growth in irritated areas of the bowel. They may have a side benefit of decreasing inflammation, too. If you still have diarrhea, but there is no infection, antidiarrheal medications, such as loperamide (Lomotil) may be helpful.

Other more powerful anti-inflammatory drugs may be helpful, but they can also suppress your immune system so that you have an increased risk of infections. For this reason, they are not often used on a long-term basis. These drugs include prednisone (Deltasone, Prednisolone, Orasone) and methylprednisolone (Medrol, Solu-Medrol), budesonide (Entocort), azathioprine (Imuran), 6-mercaptopurine (Purinethol), cyclosporine (Neoral, Sandimmune), and methotrexate (Rheumatrex, Folex).

A new drug, infliximab (Remicade) has been used in recent years for severe Crohn's disease, particularly when a fistula has formed that does not respond to other treatments. This medication blocks the effect of a chemical called "tumor necrosis factor" that may be responsible for causing inflammation in the intestine.

Surgery is another possible treatment. In general, surgery to remove a section of the bowel is recommended only if a person has bowel obstruction, persistent symptoms despite medical therapy, or a non-healing fistula. Up to 50 percent of people who have Crohn's disease will end up having at least one operation during the course of their disease.

When To Call A Professional

New or changing symptoms often mean that additional treatment is needed to keep Crohn's disease under control. For this reason, people who have Crohn's disease should be in frequent contact with a doctor. One serious complication, bowel obstruction, causes vomiting or severe abdominal pain and requires emergency treatment. This occurs when the inside of the intestine becomes narrowed so that the digestive contents cannot pass through. Other symptoms that require a doctor's immediate attention are fever (which could indicate infection), heavy bleeding from the rectum, or black paste-like stools (this is how blood looks after traveling a long distance through the intestine).


Crohn's disease can affect people very differently. Many people have only mild symptoms and do not require continuous treatment with medication. Others require multiple medications and develop complications. Crohn's disease improves with treatment and is not a fatal illness, but it cannot be cured. Crohn's requires people to pay special attention to their health needs and to seek frequent medical care, but it does not prevent most people from having normal jobs and productive family lives. As is the case for any chronic illness, it can be helpful for a newly diagnosed person to seek advice from a support group of other people with the disease.

What is Diabetes?

It is important for everyone at risk of type 2 diabetes to understand the causes of the disorder because it is by treating the causes early - and effectively - that we can prevent or minimize the severity of the complications associated with this disease.

Below you will find answers to some of the questions frequently asked by people learning about diabetes. We hope this information helps you better understand what diabetes is.

What is diabetes?

Diabetes mellitus (diabetes) is a condition characterized by high levels of blood glucose (the simple sugar that "fuels" the cells of the human body). Diabetes develops when the body can't produce or effectively use a hormone called insulin that helps to remove excess glucose from the blood.

The most common type of diabetes is type 2 diabetes, which is caused by the body's failure to make enough insulin or to be able to use it properly. The second most common type of diabetes is type 1 diabetes, which happens when the body can no longer make this vital hormone.

Type 1 Diabetes

Type 1 diabetes develops when the body can no longer make insulin, the hormone that helps to remove excess glucose (the simple sugar that "fuels" the cells of the human body) from the blood. People with type 1 diabetes must be treated with injections of supplemental insulin. Type 1 diabetes accounts for 10-15% of all diabetes and occurs most frequently in children and adolescents.

Type 2 Diabetes

Type 2 diabetes, which occurs mainly in adults, is much more common than type 1 diabetes and accounts for roughly 85-95% of all cases diagnosed. Patients with type 2 cannot produce or effectively use a hormone called insulin that helps to remove excess glucose from the blood. Type 2 diabetes has different causes and can develop and go undetected for years in people at risk. Decades can pass before it begins to show any signs, which is why type 2 diabetes is usually detected first in the middle-aged or elderly, long after damage to the body has already started.

It’s worth noting that diabetes and obesity are conditions that commonly come hand-in-hand. Consider seeking diagnosis and treatment at IES Medical Group if you would like to undergo a procedure to assist in weight loss.

The World Health Organization (WHO) estimates that 135 million people worldwide are affected by type 2 diabetes, and it is probable that even more will have developed this condition by the year 2025 -- from 200 to 300 million1.

What are the symptoms of diabetes?

Diabetes type 2 is symptomatic only when blood glucose levels are above normal. Common symptoms of high blood sugar in diabetes include being very thirsty, frequent urination, weight loss, lethargy, blurred vision, and recurrent infections. On the other hand, many people do not have any symptoms at all and therefore early detection is very important. The main sign of diabetes is too much glucose in your blood, something your doctor can detect.

What causes type 2 diabetes?

Sedentary lifestyle, obesity, smoking, high cholesterol levels, high blood pressure, and age accelerate the development of the disease in susceptible individuals. The factors that determine whether an individual develops type 2 diabetes or not are mainly genetic (i.e., in the family).

What is Insulin?

The primary "tool" used by the body to keep blood sugar levels under control is a hormone called Insulin. Insulin is made by special cells (called beta cells) found in the pancreas. When a person who does not have diabetes eats something, the body releases insulin to the pancreas as part of the process that converts food into fuel. Insulin helps cells in various organs to take in the glucose (sugar) that they need as fuel and also helps remove high levels of glucose from the bloodstream. In this way, post mealtime glucose spikes (high blood sugar levels after meals) are turned into normal blood sugar levels. Someone who cannot make insulin or one who cannot make proper, effective use of the insulin produced, ends up "starving" the cells of insulin and leaving blood sugar levels higher than they should be.

The Challenges to the Caregiver When Dealing With End-Stage Dementia

End stage dementia is the last of the three stages of dementia. The challenges of this stage are dramatically different for the earlier stages. Many family caregivers are exhausted and often burned out from providing care at home when they get to this level of care.

The caregiving skills needed are dramatically different than the previous stages. At this stage of the disease, the former personality or the person that once was is no longer there. The mental capacities have remarkably deteriorated. The majority of brain cells in all areas of the brain have disintegrated. The death of these brain cells has a profound negative effect on the body and its organs.

Most problems in the early stages of the disease were mental, especially in terms of memory. Now, at end-stage dementia, it will be the physical decline that will take most of the caregivers' time. Negative and disruptive behaviors will decrease or be eliminated. At this stage, the body and mind are deteriorating and starting to fail. The individual affected by dementia can no longer control many bodily functions and requires total care.

The mental and emotional characteristics that were once the focus on care will now take a back seat. The challenges of providing physical care are now the priority. By this time, many family members decide placement outside the home is necessary. Some family members feel that they want to continue to provide the care at home. Studies show that there is a better quality of care provided in the home setting. While it is possible to provide home care for someone at this late stage of dementia, it is really important that family caregivers understand that they will need added support. This support may come from family members, home health providers, and palliative and hospice care services.

More on caregivers and the challenges of dealing with end-stage dementia at home Late-stage dementia symptoms and problems can be a real challenge for caregivers. Arming yourself with knowledge about what to expect during any of the dementia stages will bring you some comfort and help you provide better care. Individuals at this stage become startled easily by noises or even a person entering the room. Take time to introduce yourself every time you approach them and let them know who you are.

Maintaining weight is difficult at this stage. Swallowing difficulties may arise and there is an increase in the possibility of aspiration pneumonia. It is a good time to have a swallowing and feeding evaluation preformed to become educated on feeding techniques to decrease the potential for this to occur. This is a time when getting them to eat anything for the calories are important. Often time, sweet things such as custards, puddings, and ice cream are good choices.

There are new behaviors that may appear, such as holding onto something and not letting go of it. Unless this object will cause them harm, do not try and remove it. They lose the ability to control movements and may even develop habits of patting something repeatedly.

Many individuals develop a sensitivity to touch and may respond when touched by moaning or crying out loud. The response is an exaggerated response that they no longer have control over.

Skin care at his stage is very important, as there is a decrease in nutrition, fluid intake, and activity. At the end-stage of dementia, the individual is mostly confined to bed, so complications such as infections, pneumonia, and pressure sores can occur. Support services such as non-medical home health care and palliative and hospice services are needed at this time. Many questions if hospice will hasten death. It does not. Hospice will allow you to provide the best quality of care and make them as comfortable as possible. These services support the caregivers as they come to the end of their caregiving journey.

The challenges of providing care to those with end-stage dementia at home are possible to overcome. It is also important for a family caregiver to realize that they are not a failure if a placement is necessary. The most important thing is that the individual with dementia receives the best care. It is difficult for many family caregivers to change from their full-time caregiving role to that of an advocate. Many caregivers fail to realize advocating for quality care is just as important as being able to provide the care.

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