Saturday, August 31, 2013

Weekend Links: ChemoCentryx Drug Crohn Failure, Chronic Bowel Disease Increases in UAE, Vedolizumab Remission

ChemoCentryx SHIELD-1 for Verniron Fails
     The drug company ChemoCentryx that their drug verciron (chemokine receptor CCR9) really didn't help patients with Crohn's disease. The clinical endpoint is was whether or not patients has a decrease of at least 100 points in their CDAI score after 4 months. 608 patients were enrolled in the study (which is not only timely but very costly). Vercirnon was suppose to launch in 2016. Vercirnon was an oral drug and had lower costs associated with it since it wasn't a biologic which are much more expensive according to this article.

Bowel Disease Increasing In UAE
     It appears that doctors in the UAE are seeing a rise in the amount of inflammatory bowel disease. Dr. Nathwani has said he has seen a 10%-15% increase since 2007. Dr. Nathwani sees about 3 or 4 new patients every week with IBD every week. Dr. Kataa says that white people who are young are a higher risk of getting it. Perhaps one theory which I might believe to be true is the clean hypothesis which basically states that autoimmune diseases are on the rise because we might be in fact too clean which explains why developed countries have seen an increase in autoimmune diseases while undeveloped countries with more parasites have fewer cases of autoimmune disease. The pigworm drug trials will shed more light onto this.

Vedolizumab Helps Remission for Ulcerative Colitis
According to this study from the New England Journal of Medicine. The medicine actually had better results for patients with ulceartive colitis than Crohn's disease. In patients with ulcerative colitis 42% were in clinical remission after one year according to this article. The remission rate for Crohn's patients was only 15%. This is a very low remission rate for Crohn's. What would be interesting to see if the 15% of Crohn's patients had anything in common.

Sunday, August 25, 2013

First Solid Bowel Movement in Over 7 Months! Humira is Working!

So today something pretty wonderful happened. Not only did I get 10 hours of sleep (I felt quite amazing today as a result), but I had my first solid bowel movement around 4 P.M. (I only had to go once today as well)! I was so happy since I haven’t had one since January 6 of this year! Although, it is good, I hope this continues into the near distant future. I have notice for the past week my bowel movements looked a little more solid. I have noticed I have gained weight and now weight about 152 lbs which is pretty good (I was about 142 a few months ago).

One theory might be that the c difficile I had previously is now out of my system my colon has actually been healing for the past week months. Also my dosage of Humira has increased (it actually more than double since for a few weeks I was injecting it incorrectly as some of the liquid was leaking because I wasn’t holding the injection in long enough). Hopefully this is the start of more things to come!!

Friday, August 23, 2013

Diclyomine Helping Crohn's! Near 100%

So about a week or so my GI prescribed diclyomine which seems to have helped. I noticed less cramping and pain after I started taking it. The only thing I have noticed is that is my nose seems to have dried up and I have no moisture. My bowel movements have decreased as well. Part of the reason could be increasing the Humira and my colon now having some rest after my c difficle episode. Right now I am suppose to be taking 2 diclyomine pills a day but about two days ago I wanted to see if I could get by with one. When I first started taking it I noticed that I was a tad dizzy but this went away. My GI told me to immediately stop the drug if I get constipated. The only other side effect is blurred vision which I haven't notice yet

On another note I took a road trip to Dallas last weekend and felt quite amazing. I really do think stress has some impact on Crohn's health. I feel pretty good this week but when I was able to sleep for 9 to 10 hours, relax, and not have anything to worry about I felt good.

I am pretty satisfied with were I am in my condition. The Mayo Clinic called me to see how I was doing (I e-mailed them when I wasn't sure about what treatment course to take) and the doctor I saw suggested 6-MP however one draw back to this is monthly blood testing. He agreed that me taking diclyomine was a good idea. I somewhat agree with my GI's approach since it is more conservative. I would honestly say right now I am probably at 90% (10% due to diarrhea). Perhaps my colon is finally healing and my body is getting back to normal. It is quite amazing earlier this year I felt on the verge of death and had to get 3 liters of fluids pumped into me and now I am quite almost back to normal.

Wednesday, August 14, 2013

Mid-Week Links Part II: Probotics Don't Help Crohn's, Fecal Transplant Cures 97% of C Diff, Pill Camera Approved For Crohn's

Probiotics Doesn't Help Flares For Crohn's
     This study showed that taking probiotics doesn't help Crohn's patients. 47% of the people who took probiotics had relapsed while 53% of the patients in the placebo group relapsed. Really there was no statistical difference between the two groups.

 Fecal Transplant at Mayo: 97% Effective in C Difficile
    This study out of the Arizona Mayo Clinic (they have branches all over the United States) showed that 97% of patients who received a fecal transplant got rid of their c difficile. A majority of patients noticed an improvement in 3 days. The study was only done on 31 patients however this is another data point showing fecal transplants are effective! Hopefully, we can see in the future if fecal transplants can help things like ulcerative colitis, Crohn's, Parkinson's disease, multiple sclerosis, autism, obesity, and maybe even depression.

Pill Camera Approved For Crohn's
     The FDA cleared the PillCamera SB 3 for Crohn's disease and anemia. I believe the SB stands for small bowel. What is interesting is that 75% of Crohn's patients have lesions in their small bowel. What is even more interesting is that after 3 months of using the camera 62% of patients changed treatment and 40% of patients changed medication. Basically you just take the pill camera with a glass of water and it takes pictures of your small bowel and sends them to your doctor (you wear a small belt and recorder). More than 2 million people have already taken the PillCamera which is interesting. The risks are pretty minor. The risk of retention is less than 3% for Crohn's patients.

Mid-Week Links: Heat and Crohn's Flares, $1.5 Million Crohn's Research, MicroBiome in Crohn's, and Implantable Device For Crohn's

Heat Waves and Crohn's Flares 
     This article from the August issue of The American Journal of Gastroenterology shows that a heat wave increased IBD flares by about 5%. This is interesting because I live in both a hot and humid state. What would be interesting is it there was a worldwide study looking at patients from various countries all over the world and looking to see if warmer temperatures in general caused flares. I know someone who is dating a guy who has Crohn's for a long period of time and his metric is every 4th of July he knows he will feel bad. Maybe there is some truth to this study.

Kenneth Rainin Foundation Awards $1.5 million For IBD Research
    The Kenneth Rainin Foundation which is a non-profit created by Kenneth Ranin who was an entrepreneur founded an instrument company and created a foundation to support the arts, sciences, and health research. The foundation actually established an IBD center at UCSF. Ranin has a daughter (Jennifer) that was diagnosed with ulcerative colitis (she also has a Ph.D). The $1.5 million will be used to invest in research that can help understand causes and cures for inflammatory bowel disease (IBD).

Distinct Microbiome in Crohn's Intestinal Mucosa
      Researchers examined Crohn's patients who were undergoing surgery for either Crohn's or for reasons other than inflammatory bowel disease. What is interesting is that patients with diseased Crohn's tissues had more than several hundreds times the amount of bacteria compared to patients with normal tissue. What this really would say is that there are different subtypes of Crohn's disease. Hopefully this research will result in more targeted therapies in the future.

Implantable Biologic For Crohn's Disease?
     A California company called SetPoint Medical has developed a very small device that can be implanted and somehow mediate the immune system to reduce inflammation for people with both rheumatoid arthritis and Crohn's disease. Below is a picture


Saturday, August 10, 2013

Reaching a Crohn's Plateau: Humira Every Week Still Having Diarrhea

So today (August 1, 2013) I went to see my gastroenterologist who was following up increasing my dosage of Humira. My health has been decent however not the same I was when I originally started taking Humira. I am still having diarrhea about 4-5 times per day. My pain level is decent. Most of the day I go without pain.

My GI said the goals for managing Crohn’s are making sure patients are eating well, not tired, no fever, and decent energy levels. My parents were not aware of this and they were thinking I would go without diarrhea. I mean it is sad in a way for now I will continue to have diarrhea. However, I know that as medicines progress could really improve not only my quality of life but the over 1.4 million people with inflammatory bowel disease (IBD). One good thing is that today if you have Crohn’s or ulcerative colitis you have more options. If you had Crohn’s or ulcerative colitis in the 1980’s or even early 1990’s you really only had a the option of Asacol or Prednisone. Now there are biologics, 6-MP, methotrexate, Asacol, Prednisone, and surgery. The surgery that can be done now is much minimal with surgeons taking out less of the colon and intestines and less scaring which is positive.

My doctor told me in the next year or so interlukin’s could be the next big thing for IBD. I believe STELARA is one of these since it targets interleukin- 12 and interlukin-13 which targets inflammation for Crohn’s. I covered STELARA here and the results from a trial.

The plan my GI laid out was to do a C-reactive protein test and to consider giving me anti-diarrhea/anti spasm medicines. Recently, I have been having IBS like symptoms. The idea is that this should do some good. I e-mailed the doctor I saw at Mayo and to get his thoughts and he suggested to a c-reactive protein test, in addition to a CBC (complete blood count), and c difficile test (since I did have c diff for so long). However, his recommendation would be to include 6-MP or methotrexate with the Humira to give it a boost. My GI today said that white males who are young have an increased risk of developing lymphoma (however the increased risk is on a percentage basis). I did some research and the risk was about .1% which is about 1 in 1000 (however it is still there).

I have been thinking about what I eat and last Sunday I ate a brownie sundae with ice cream and some Mexican food for dinner and really felt it. I think food has a role, however I think some people might overstate its impact. With this said my internist recommended a nutritionist who I have thought about seeing. The most I could lose is actually eating a well rounded diet. It would be nice if I could figure out if I have trigger foods. In general I think chocolate might make me worse and anything greasy. However, I still have pain if I have chicken noodle soup so. 

Prescribed 33 Antibiotics Over 10 Year Period Cause of Crohn's?

So I thought I would publish the list of prescriptions I have been prescribed over the past 10 years. Walgreens actually provided this information to me. An interesting study would be to examine the prescriptions people with ulcerative colitis or Crohn's. Since I was prescribed antibiotics 33 times over the course of 10 years I wonder if there is any connection between antibiotics and contracting Crohn's. Also since I was 16 years old I worked out pretty hard. At the beginning I was doing much. However, once I went to college (between 2005-2009) I increased it and remember on some Saturday nights at the gym burning over 700 calories which probably had an effect on my immune system.

December 14, 2011-Asacol HD 800 MG
November 30, 2011-Prednisone 10 MG
November 8, 2011-Hyoscyamine .125 MG
*Was hospitalized day before Thanksgiving 2011
November 23, 2011-Diphenoxylate/Atropine
November 23, 2011-Metronidazole 500 MG
November 23, 2011-Ciprofloxacin 500 MG
October 24, 2011-Levofloxacin 500 MG
October 14, 2011-Prednisone 4 MG Pak
October 7, 2011-Nabumetone 500 MG (foot had some pain in it)
October 4, 2011-Clarithromycin 500 MG
October 3, 2011-Amox-Clav 875 MG
*Around this time developed bronchitis and around same time began to have diarrhea, had a lot of pain in abdomen (would wear ice packs on stomach to help) and lost 25 lbs
May 24, 2011 (diagnosed with IBS) Hyoscyamine .125 MG

Zylet (for eye issue I had)
August 10, 2010-Amox-Clav 875 MG

March 19, 2009-Cephalexin 500 MG
February 17, 2009-Cephalexin 500 MG
January 11, 2009-Cephalexin 500 MG
January 2, 2009-Amoxicillin 500 MG

November 11, 2008-Azithromycin 250 MG
October 2, 2008-Cephalexin 500 MG
September 18, 2008-Prednisone 20 MG
July 18, 2008-Cephalexin 500 MG
May 21, 2008-Cephalexin 500 MG
March 8, 2008-Cephalexin 500 MG

December 21, 2008-Cephalexin 500 MG
November 11, 2007-Doxycycline 100 MG
October 5, 2007 Doxycycline 100 MG
July 26, 2007-Cefadroxil
July 11, 2006-Amoxicillin 500 MG

December 18, 2006-Amoxicillin 500MG
September 25, 2006-Cefprozil 500 MG
September 25, 2006-Prednisone 20 MG
April 19, 2006-Cefprozil 500 MG
April 19, 2006- Prednisone 20 MG
April 13, 2006-Amnesteem 40 MG

December 19, 2005-Claravis 40 MG
November 23, 2005-Claravis 40 MG
August 17, 2005-Methylprednisolone 4MG Dospak
August 17, 2005- Amoxicillin 500 MG
June 22, 2005-Zithromax 250 MG
January 25, 2005-Biaxin XL 500 MG

September 24, 2004-Advair Diskus
September 4, 2004-Zithromax 250 MG
August 07, 2004-Prevacid 30 MG

September 10, 2003-Biaxin XL 500MG

November 18, 2002-Adoxa 100MG
November 13, 2002-Biaxin XL 500 MG
October 08, 2002- Ampicillin 500 MG
September 26, 2002-Cefzil 250 MG
September 4, 2002-Biaxin XL 500 MG
February 11, 2002-Biaxin XL 500 MG
May 24, 2002-Biaxin XL 500 MG

Tuesday, August 6, 2013

Dicyclomine and Crohn's: Now Taking

So my GI called me last night around 7 P.M. to tell me the results of my blood test. Primarily he was looking at my C reactive protein (CRP) which measures inflammation in the blood. My CRP was only .8 which is pretty low (which is a good thing). My GI prescribed me dicyclomine which is to actually help people with IBS (I actually had IBS right before Crohn’s). However, since my colon and stomach have been in a spasm mode it makes sense to prescribe this. I took the medicine last night and the on the bottle of the drug it says not to use heavy machinery after taking the drug. The drug was only 64 cents which is quite a deal. I was a little dizzy last night (which is a usual side effect). Today I felt a little light headed however felt virtually no pain. As I write this as of 7 P.M. I have only gone to the bathroom twice today which is better than the 4-5 times per day I have been going which is pretty good. The past few days I have had to go after lunch. Even after I ate I really didn’t feel much pain afterward. The only side effect is I did feel a little lightheaded today at work however I remember when I first took Asacol I was sweating for at least a week at night.

The plan my GI laid out was to call him in about a week to see how I was doing. I really do appreciate a doctor that calls me personally and gives me lab results instead of having a nurse do it. Hopefully this drug will do the trick. I have gradually since May (after the fecal transplant) been getting back to normal. The goal is to stop the diarrhea and feel well.