A case of Crohn’s Disease

By Kenneth N. Woliner, M.D.
Posted: Thursday, June 10th, 2010

“How’d you find, me again?”

“The ER doctor said that if I didn’t see you, I’d have to see him again.”

“Don’t mind him,” Elizabeth said pointing at her husband. “Jeffery’s still out of sorts since the last time we went to the hospital;4th time in the last 12 months. He even needed a blood transfusion!”

“It was awful! After being in the bathroom with crampy, bloody bowels for 3 hours, Lizzy said I looked as pale as a sheet. So at 3 a.m. – we were back at Cleveland Clinic’s Emergency Room.”

“That must have been horrible.” Empathy is easy when you have shared experiences. “I have Irritable Bowel Syndrome. Thankfully, I haven’t been to the hospital for that in over 10 years.”

Jeffery’s eyes lit up. “That’s like Crohn’s! So you know what it’s like to speed off the highway to find a toilet. How did you get better?” “I did what you’re doing right now. I went to a Functional Medicine physician who actually listened to me. I spend 80+ minutes with all new patients (and yes, we have 2 bathrooms in the office – no waiting).”

I continued gathering my history. “So what have you tried so far?” “Everything. Anything. Asacol. Imuran. Steroids (Prednisone), of course. I was doing okay on Remicade for awhile until …” Elizabeth jumped in, “Until you got an infection that put you in the ICU for 6 days!” Shaking her head at me, “Jeffery almost died!”

“That drug can cause life-threatening infections. That is why they have the strongest “Black Box” warning on the label.” “It’s a shame it is so toxic. I didn’t mind that the hospital charged $15,000 dollars because my insurance knocked it down to only five grand. Still, with a $2,000 deductible and 20% co-pays …” “It cost $10,000 a year!” Elizabeth managed the family finances. “At that price, they should find a way to make it safer!”

I moved on, “Did they ever check for food allergies?” “Yep. The allergist did a skin test and said I didn’t have any.” I interrupted, “Not exactly. The Rosacea I clearly see on your face tells me that food allergies definitely are at play here. This handout explains why food allergy tests need to be done correctly, to be useful.”

I finished my history and started my physical exam. “Why are you looking in my ears?” Pointing at his belly, “My problem’s down here.”

“Your ears are full of wax! Excess ear wax production happens when you are deficient of essential fatty acids like fish oil and primrose oil. And that is also a cause of Crohn’s disease!”

I looked Jeffery over from head to toe (literally) and when I finished I said, “I’m glad you brought in some of your old labs to this first visit. That way we can start on page two as opposed to page one. Your treatment starts today.” “You aren’t going to make me eat rabbit food are you?” “Don’t worry. This is going to be easier than you think. First, I need a few tests you’ve never had before: an accurate look at food allergy; vitamin deficiencies, and a Comprehensive Stool Analysis to see how well you digest and absorb your food. I look for good bacteria (such as Acidophilus) as well as bad bugs we need to get rid of.

“Though I have a list for you of foods that are ‘safe’ to eat, most patients love having ‘medical foods’, protein shakes that have extra anti-inflammatory nutrients in them. They taste good, actually, and I still drink at least one shake a day.

“You’re so malnourished that you’ll need some ‘pharmaceuticalgrade’ vitamins. We actually inject vitamins when people are really bad off. How about we start with a simple B-12 shot today?”

Within the first month, Jeffery’s episodes decreased to less than twice a week, none being so bad that brought him to the hospital. He was only allergic to 4 foods, but one of them, Milk, he was drinking every day. With the other targeted, but non-toxic therapies I prescribed, we were able to space out visits to once every six months. At his most recent visit, Jeffery asked, “So how did that ER doctor know to send me to you?”

I couldn’t violate patient confidentiality by telling Jeffery that I also treat that ER doc for Crohn’s, so all I could do was shrug my shoulders and say, “He’s in the know.”