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CROHN’S DISEASE

4 brief case
histories

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Case 1 M56/63 fv 1981
REASON FOR VISIT
• He wanted to immigrate to Australia
to be with his sons but feared that he
would not manage the travel
actually, he could not manage the hour’s train
journey to London

• His diarrhoea was so urgent and


frequent that he was becoming fearful
even of going shopping.
2
HISTORY OF COMPLAINT
• He had suffered with bloody diarrhoea
with mucus for 6 years without real
remission; it had started one Christmas.
First visit in August with an ambiguous
diagnosis of Ulcerative Colitis but by the
time of his second visit in October, a
diagnosis of Crohn’s Disease was at last
confirmed.
• Prednisolone “calmed it down”; he had
received no other treatment.
3
PAST HISTORY M63

At age 28 had suffered a


peri–anal rectal abscess.
From age 24 until age 35, he
suffered from “malignant
malaria”.

4
OUTCOME
• Between his first and second visits he
had taken a course of antibiotics which
improved his symptoms greatly.
• He continued to improve rapidly
following dietary changes and
concurrent herbal medicine. He had
regained his confidence about going
out.
• Within 6 months he wrote to say that he
was shortly on his way to Australia.
5
Case 2 F36
REASON FOR VISIT

• Wakes always with


pain and diarrhoea,
and also within 20 to
60 minutes after
meals.
6
HISTORY OF COMPLAINT
• Diarrhoea for a few months @ age
17 then remission while at college.
• Diagnosed with Crohn’s Disease
age 23 @ St Mark’s hospital.
• Colon and Ileum removed.
Only Rx at FV: prednisolone15mg for 2 months
except for depo–provera for contraception.

7
PAST HISTORY
NOT breast–fed. Inconsolable baby.
By 15 anorexic. Aspirin overdose @
16.
Benign Parotid tumour removed age
31 but also Radiotherapy

8
FAMILY
3rd of 3 maternal of 2 paternal
M “strapping”
F alcohol & tobacco in xs. Died of
stomach cancer following chronic peptic
ulceration.

His siblings mild arthritis and mild


Crohn’s
her own siblings “fine” apart from sister
with mild diarrhoea.
Found family relationships difficult, especially 9
with father.
OUTCOME
• Improvement “dramatic”. NO PAIN.
• Two months later events provoked
relapse Pregnancy and termination.
• Remission established with return to
herbal medicine & dietary discretion.
Also gave her
aromatherapy.
• Relapse a year later treated quickly and
successfully.
10
Case 3 F31
REASON FOR VISIT
• She wished to reduce her dependence
on pharmaceutical drugs and wished
to come off Azathioprine together.
• Although stable on Rx, prone to occasional
crises that would last 6 weeks & resistant to
medical stabilisation

(Azathioprine 50mg, Prednisolone 5mg, Asacol, Pentasalazine,


Fe–Sulphate, Ascorbic acid, B12 injection)
11
PAST HISTORY
• Not breast fed (SMA) very ill neonate
“reacted to cow’s milk”
• bowels normal till age 18; chronic sacro-
iliitis resulting in numbness distributed
at that level
• 16 Diagnosed Diabetes (ID)
• 18 blood pr Diagnosed with Crohn’s
• 21 married “stolid healthy man”
• 2 pregnancies, both to term: 1 of each:
both well 12
FAMILY
• Elder of 2 girls by 13 months
Mother robust, “difficult”,
confrontational
mgm healthy till late onset
diabetes
mgf “stubborn”
• F farrier alcoholic
pgm “bitter”, hysterectomy; died 82
pgf MI stroke, sudden death aged
70
• sister mild asthmatic with 2 children 13
PROGRESS
• 2001 initial reaction to herbal
medicine: headaches, digestive upset, 2
hypos, after adjustments*, she
improved
• within 6 weeks both her consultant
physicians declared themselves pleased
on the basis of blood tests and clinical
assessment. No hypos and was able
progressively to lower dose of insulin.
• bowels very settled. 14
PROGRESS 2
• Succeeded in coming off
Azathioprine on May 13th 2002 with
full cooperation of her consultants
and waited until 20th August of that
year to confirm in a fulsome letter
her good state of health.

15
PROGRESS 3
• March 2005 Relapse following
family discord.
• Appendicectomy following Crohns
stricture.
• swift return to health which she
ascribes to post–surgical herbal
medicine.
16
Case 4 M24
REASON FOR VISIT
• wanted to reduce griping pain
(especially at ileostomy site) and to
retard Stricture / Granuloma formation
for which he was awaiting surgery.
Frequent blockage by stricture.

• Also troubled by recent painful, scaling


& peeling spots on back.

17
HISTORY OF COMPLAINT
• Crohn’s diagnosed @ 13yo when his
weight dropped to 3 stone 10lbs
treated with predsol enemas, Methasalazine,
Azathioprine (no benefit), Metronidazole (aggravated
condition), Prednisolone 60mg; Fed with elemental by
naso–gastric tube.

• colon & terminal ileum surgically


removed @18

• Symptom free until 23: granuloma:


stricture in distal jejeunum / tracking 18
fistula VERY PAINFUL
PAST HISTORY
• Elder of 2 (several miscarriages
between his birth and that of his sister)
Born 8lbs, 2 ozs, 15½”, very hairy with
eczema;
breastfed 6 months; no colic; good
sleeper,
prone to sore throats, later developed
asthma;
chubby till 6 when given MMR vaccine
when he
became very slight
19


GENERAL HEALTH
• Seasonal rhinitis June & July
Adult height 5’6’’
musculo-skeletal: “worried that he
might break”.

• Very hirsute in androgenic distribution


but also petite.
• Psychologically: fastidious, a dreamer
but forward planner, cautious; “finds
relationships difficult”: but he thinks this
was the case before illness. 20
FAMILY
• Mother 48 “seems OK”, never sees doctor;
smoker; “sulks”: 2nd of 4 amongst whom:
depressives and sociopaths

• mat. gm died 2003 Ovarian Cancer; smoker


mgf policeman, estranged, possibly died
of CCF

• Father 52 fiery; volcanic rages; patient


terrified of him as a child; disordered
pigmentation, urticaria
pat. gm lives with family; “sulks”
pgf violent; aunt with OCD

• sister “seems OK”.


21
• he is unsure of the source of his mixed
OUTCOME
• Feels better in self. Only one blockage
since taking herbal medicine, which he
put down to an unripe banana.

• Spots went away very soon.

• After planned surgery to remove


Granuloma resumed herbal medicine
because his digestive tract felt ‘tight’,
his breathing also tight with wheeze +
hay fever and return of the spots.
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