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Crohn's Disease Forum » Parents of Kids with IBD » Getting ready for upper and lower scope


03-11-2017, 07:59 AM   #1
Ladybug12
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Getting ready for upper and lower scope

Good morning all. My daughter is having this procedure done on Tuesday. Any tips you all can share in regards to the cleansing process would be appreciated. I would like to thank you all in advance for your response as well as responses to my previous post.
03-11-2017, 01:18 PM   #2
pdx
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Here is a link to a thread with lots of tips:

http://www.crohnsforum.com/showthread.php?t=75284

I hope it goes well.
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Daughter E (15) dx with Crohn's 12/18/14 at age 12

Current treatment:

Remicade started 12/24/14 (currently on 9 mg/kg every 6 weeks)
Oral methotrexate restarted 12/2/16 (15 mg weekly)
vitamin D, folic acid, multivitamin, Prozac

Past Treatment
90% EN via NG tube 2/9/15 - 4/2/15
50% EN via NG tube 4/3/15 - 4/18/15
Supplemental EN via NG tube 5/7/15-6/19/15
Budesonide 3/3/15-6/30/15
Oral methotrexate 3/13/15 - 5/14/16 (15 mg weekly)
Topical clobetasol for Remicade-induced psoriasis
03-13-2017, 07:45 PM   #3
Ladybug12
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Here is a link to a thread with lots of tips:

http://www.crohnsforum.com/showthread.php?t=75284

I hope it goes well.
Thank you for sharing this link with me.
03-14-2017, 11:20 AM   #4
pdx
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Hope the scopes are going well. Let us know what the doctors find out.
03-14-2017, 11:46 AM   #5
Ladybug12
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Hope the scopes are going well. Let us know what the doctors find out.
We are currently waiting. She was given some medicine to calm down. She laughed her behind off. 😂😂😂
03-14-2017, 12:02 PM   #6
my little penguin
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Silly juice or aka versed
Some kids don't like it after they wake up
Since they don't remember much if what happened
Good luck
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DS - -Crohn's -Stelara
03-14-2017, 12:15 PM   #7
Ladybug12
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Silly juice or aka versed
Some kids don't like it after they wake up
Since they don't remember much if what happened
Good luck
I just spoke with the GI Doctor. There is a lot of inflammation. He suggested upping the dose of mtx and getting her to drink high calorie shakes 4 times a day. I'm not taking this very well. I don't want to cry in front of my boys. I just feel so loss right now.
03-14-2017, 12:30 PM   #8
Maya142
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My daughter also did supplemental EN (formula). She was unable to drink enough formula so ended up needing a tube. But some kids are very successful with drinking formula. Keeping the formula cold and using a straw helps.

Usually EEN is used to induce remission, and supplemental EN is used for supplemental nutrition and to help the kiddo grow and gain. There's also some evidence it helps kids stay in remission.

Remind me, is she also on Remicade? Or just MTX?
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Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
03-15-2017, 08:24 AM   #9
Ladybug12
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My daughter also did supplemental EN (formula). She was unable to drink enough formula so ended up needing a tube. But some kids are very successful with drinking formula. Keeping the formula cold and using a straw helps.

Usually EEN is used to induce remission, and supplemental EN is used for supplemental nutrition and to help the kiddo grow and gain. There's also some evidence it helps kids stay in remission.

Remind me, is she also on Remicade? Or just MTX?
I asked about the overnight feedings and the other drinks that you guys mentioned on this sight. He think it is best to get her to drink the Ensure drinks 4 times a day. She is back to 86lbs since doing the overnight prep. Her previous weight before symptoms was 94lbs. Her hair has fallen and thin out, I think that is due to the infusions. Right now I am just trying to figure out a way to help her physically and emotionally.
03-15-2017, 09:54 AM   #10
Maya142
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The good part is that Ensure is the most palatable of the drinks. It just depends on if she tolerates it or if she needs a more broken down formula.

Since you are trying Ensure, I would get a couple of flavors for her to try. Your GI's office may even have samples. Make sure they're cold, and have her drink with a straw.

I will tag some other parents whose kids have been able to drink their formula.

my little penguin
crohnsinct
03-15-2017, 11:57 AM   #11
crohnsinct
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When did she start Methotrexate? That could be the cause of the hair falling out (gets better with time) although the loosing weight and not absorbing nutrition would be high on my suspect list.

When did she start Remicade? How much is he increasing her methotrexate?

Is she having symptoms right after infusions or does she get some relief right after and then the Remi just wears off? Sorry I searched your post history and can't find what led you to this point and just trying to get an idea of why just the increase in mtx if she had considerable inflammation.

As for the formula, is he asking for 4 servings a day to try to help induce remission or just gain weight? If just gain weight, there are lots of recipes on the Boost and Ensure sites for smoothies and such that help make the shakes more palatable.

I know your doc asked for Ensure but Ensure and Boost are pretty interchangeable so I would also try the Boost shakes. One of the brands makes a dark chocolate and one makes a coffee flavored shake. My girls were direct opposites of each other. One liked Boost chocolate and Vanilla Ensure and vice versa for the other. They did Exclusive Enteral Nutrition to induce remission while we waited for the maintenance meds to take over.
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Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
Remicade
Methotrexate (12.5mg wkly - oral)
Vit d 2000IU
Multi vitamin plus iron
Calcium
Folic Acid
Previously used - Prednisone, Prevacid, Enteral Nutrition

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohns
Methotrexate (15mg weekly oral)
Enteral Nutrition
Entocort
IBD-AID Diet
Vit d 1000IU
Calcium
Folic Acid
Previously used: Mtx injections
03-15-2017, 11:58 AM   #12
crohnsinct
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Oh yeah and in addition to the cold and straw recommendations it also helps to serve in a cup, thermos etc with a lid so you can't smell the shake since smell is so closely tied to taste.
03-15-2017, 12:07 PM   #13
Ladybug12
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Oh yeah and in addition to the cold and straw recommendations it also helps to serve in a cup, thermos etc with a lid so you can't smell the shake since smell is so closely tied to taste.
Thanks for tip. Smell is a big issue for now when it comes to trying new things.
03-15-2017, 12:21 PM   #14
Ladybug12
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[QUOTE=crohnsinct;970204]When did she start Methotrexate? That could be the cause of the hair falling out (gets better with time) although the loosing weight and not absorbing nutrition would be high on my suspect list.

When did she start Remicade? How much is he increasing her methotrexate?

Is she having symptoms right after infusions or does she get some relief right after and then the Remi just wears off? Sorry I searched your post history and can't find what led you to this point and just trying to get an idea of why just the increase in mtx if she had considerable inflammation.

As for the formula, is he asking for 4 servings a day to try to help induce remission or just gain weight? If just gain weight, there are lots of recipes on the Boost and Ensure sites for smoothies and such that help make the shakes more palatable.

I know your doc asked for Ensure but Ensure and Boost are pretty interchangeable so I would also try the Boost shakes. One of the brands makes a dark chocolate and one makes a coffee flavored shake. My girls were direct opposites of each other. One liked Boost chocolate and Vanilla Ensure and vice versa for the other. They did Exclusive Enteral Nutrition to induce remission while we waited for the maintenance meds to take over.[/QUOTE
Hello. My daughter was diagnosed at 14 with crohns May 2016. She was given steroids medication to help with the inflammation. 6mp was the second medication given. She had a bad reaction to this medication. She had her first infusion treatment in June 2016. She responded quickly to this medication. Recently, after getting the infusion she was complaining of pain. The pain was athe it's worst before and during her cycle. Her infusions are now every 6 weeks. Mtx was added at 0.4ml once a week. Her Crp levels when last check was 1.95. I was told to give her the ensure drinks 4 times a day to help with weight gain and get the inflammation under control.
03-15-2017, 12:26 PM   #15
my little penguin
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How many mg/kg of remicade is she getting ?
You can go up to 10 mg/kg every 4 weeks
And 25 mg of mtx

Mtx is not that strong and if they found a lot on inflammation
Not sure why the tiny bump in mtx
Verses increasing remicade
Since mtx is just in the side lines to keep antibodies at bay
03-15-2017, 01:42 PM   #16
crohnsinct
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MLP is thinking along the same lines as I.

It is important to figure out how soon after infusion her symptoms are occurring. If right away then it is more likely that she has lost response to Remicade. In that case no amount of playing with mtx is going to help and a switch of biologic is probably more indicated.

If it takes a bit then the dosage level of Remicade might not be high enough and she might be metabolizing the med more quickly. What dose is she on? My older daughter was on 12 mg/kg every 5 weeks when inflammation was at its worst. Inflammation also contributes to burning through the med quickly so it is pretty much standard to be at higher doses when starting and backing down later.

It is also pretty usual for Crohn's to make the girls cycle worse.

FWIW - mtx was pretty ineffective with getting my daughters' inflammation under control but it is worth a shot.

There are studies that show that supplemental enteral nutrition is helpful at maintaining remission but not so much at inducing remission. Most studies have shown that exclusive enteral nutrition is needed to induce remission. When my older daughter was dx'd she was on Remicade for 4 months and never got to remission. We added exclusive to get her to remission and then handed Remicade a healed bowel and it was able to take over from there.

The whole process is a ebb and flow kinds thing and you just have to stay flexible and not get too attached to any one therapy.
03-15-2017, 03:32 PM   #17
Ladybug12
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Join Date: Jul 2016
How many mg/kg of remicade is she getting ?
You can go up to 10 mg/kg every 4 weeks
And 25 mg of mtx

Mtx is not that strong and if they found a lot on inflammation
Not sure why the tiny bump in mtx
Verses increasing remicade
Since mtx is just in the side lines to keep antibodies at bay
The Remicade dosage is 5mg. I just spoke with the doctor and he is now prescribing prednisone again for the inflammation.
03-15-2017, 03:33 PM   #18
Ladybug12
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MLP is thinking along the same lines as I.

It is important to figure out how soon after infusion her symptoms are occurring. If right away then it is more likely that she has lost response to Remicade. In that case no amount of playing with mtx is going to help and a switch of biologic is probably more indicated.

If it takes a bit then the dosage level of Remicade might not be high enough and she might be metabolizing the med more quickly. What dose is she on? My older daughter was on 12 mg/kg every 5 weeks when inflammation was at its worst. Inflammation also contributes to burning through the med quickly so it is pretty much standard to be at higher doses when starting and backing down later.

It is also pretty usual for Crohn's to make the girls cycle worse.

FWIW - mtx was pretty ineffective with getting my daughters' inflammation under control but it is worth a shot.

There are studies that show that supplemental enteral nutrition is helpful at maintaining remission but not so much at inducing remission. Most studies have shown that exclusive enteral nutrition is needed to induce remission. When my older daughter was dx'd she was on Remicade for 4 months and never got to remission. We added exclusive to get her to remission and then handed Remicade a healed bowel and it was able to take over from there.

The whole process is a ebb and flow kinds thing and you just have to stay flexible and not get too attached to any one therapy.
Kate Farms is what he is now recommending since she is experiencing pain after the nutritional drinks.
03-15-2017, 05:02 PM   #19
Maya142
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Have you considered a second opinion? I ask because increasing the MTX and not the Remicade seems odd to me. Also, supplemental EN will certainly help her gain and grow, but it won't induce remission. I guess now that he's adding Prednisone, it makes more sense.

But I have never even heard of Kate Farms - kids are usually put on Ensure/Pediasure/Boost if they can tolerate polymeric formulas. If they need semi-elemental formulas, it's usually Pediasure Peptide or Peptamen Jr. If they need an even more broken down formula - an elemental formula - then Elecare or Neocate Jr are used.

Have they done her Remicade levels?

Where are you located? The best pediatric GI departments are at Boston Children's, Cincinnati Children's and CHOP. A second set of eyes can REALLY help.
03-15-2017, 05:40 PM   #20
Ladybug12
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Have you considered a second opinion? I ask because increasing the MTX and not the Remicade seems odd to me. Also, supplemental EN will certainly help her gain and grow, but it won't induce remission. I guess now that he's adding Prednisone, it makes more sense.

But I have never even heard of Kate Farms - kids are usually put on Ensure/Pediasure/Boost if they can tolerate polymeric formulas. If they need semi-elemental formulas, it's usually Pediasure Peptide or Peptamen Jr. If they need an even more broken down formula - an elemental formula - then Elecare or Neocate Jr are used.

Have they done her Remicade levels?

Where are you located? The best pediatric GI departments are at Boston Children's, Cincinnati Children's and CHOP. A second set of eyes can REALLY help.
I am located in Dallas,TX. She is being seen at Children's Dallas. It has been difficult finding a "good" doctor. Most GI doctors on the list didn't answer calls or had a long waiting list. The last time her levels were checked they were at 8.7
03-15-2017, 05:46 PM   #21
Maya142
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Some of those hospitals will do a record review - so you don't actually have to travel. I think BCH and Cincinnati Children's do that - not sure about CHOP.

I would put your name on a waiting list of a doctor you do want to see and then call about cancellations. Sometimes they can put you on a cancellation list and other times you need to call every few days to ask if there's been a cancellation. We have done that. It's a pain, but it works.

I just noticed that your daughter has been on Remicade since June 2016 - and is flaring again? Has she ever been in remission? It sounds like she might need a dose increase and possibly, if that doesn't work, a different biologic.
03-15-2017, 06:30 PM   #22
Ladybug12
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Some of those hospitals will do a record review - so you don't actually have to travel. I think BCH and Cincinnati Children's do that - not sure about CHOP.



I would put your name on a waiting list of a doctor you do want to see and then call about cancellations. Sometimes they can put you on a cancellation list and other times you need to call every few days to ask if there's been a cancellation. We have done that. It's a pain, but it works.

I just noticed that your daughter has been on Remicade since June 2016 - and is flaring again? Has she ever been in remission? It sounds like she might need a dose increase and possibly, if that doesn't work, a different biologic.
Hi Maya,

The last time her crp levels showed no inflammation was in June and July. I just got a response back from the nurse stating that the last time her levels for remicade were checked in November. They were at 5.53. The Mtx was recently added a little over a month ago. Prior to the procedure she had some complaints due to being on her cycle. Previously, she had an MRI that showed improvement from the previous but showed inflammation. This is why MTX was added. During the prep with the dulcolax pills I felt like I was doing harm with all the cramping and pain she was going through the first day of the prep. I feel lost at the moment. Thank you and thanks to everyone for taking the time out to respond to the questions I've posted here.
03-15-2017, 06:32 PM   #23
crohnsinct
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When were the levels taken? Was she in remission? 8.7 is a solid level so I would understand the GI not increasing the Remicade but only if it is a recent level.

5mg/kg is the lowest dose. Many kids on here are up around 10 mg/kg when inflamed and many stay that high or just a tad lower during remission.

FWIW -- my daughter was at 10mg and was doing great. Doc slowly lowered dose down to 5mg and whammo FLARE!
03-15-2017, 06:38 PM   #24
my little penguin
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Crohnsinct
Probably meant
That a level of 5.53 is much lower
than a normAl level of
8.7

Right crohnsinct
03-15-2017, 06:43 PM   #25
Maya142
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5.53 is on the lower side. MTX can sometimes increase Remicade trough levels, but increasing the dose is quicker and more effective. They can go all the way to 10 mg/kg every 4 weeks (and sometimes even go higher).

I hope your kiddo feels better soon. The prep process is miserable for all kids, but necessary for the info scopes give. I hate giving my kiddo Dulcolax too - it's awful!
03-15-2017, 06:48 PM   #26
Ladybug12
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When were the levels taken? Was she in remission? 8.7 is a solid level so I would understand the GI not increasing the Remicade but only if it is a recent level.

5mg/kg is the lowest dose. Many kids on here are up around 10 mg/kg when inflamed and many stay that high or just a tad lower during remission.

FWIW -- my daughter was at 10mg and was doing great. Doc slowly lowered dose down to 5mg and whammo FLARE!
In looking at the paperwork, she has always been on 5mg. He has never increased the dosage. She was receiving her treatments every 8 weeks. This was changed when I noticed she was hurting a couple of weeks before her infusions. This was always close to when her cycle was due. He then changed the treatments to every 6 weeks.
03-15-2017, 07:24 PM   #27
Maya142
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If she's getting 5 mg/kg and her levels are only 5.53, then you definitely have room to increase the dose and even the frequency.

However, if they're 8.7, then probably increasing the dose won't help a whole lot. You said both things, so not sure which you meant was the most recent level?

For what it's worth, my daughter is flaring too and we found that her symptoms get a LOT worse during her period while she is flaring. When she isn't flaring, she's usually fine during her period.
03-15-2017, 07:46 PM   #28
crohnsinct
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OK The posts were flying fast and I posted before the one that said the last level was 5.53. I was responding to the Remicade dose of 5.

So YES 5.53 is a low trough level. Most studies state acceptable is 5-10 and most favor closer to 10. My daughter was just tested and her level was 5.6 and guess what...she is flaring.

Also, the fact that your daughter gets some relief right after infusions but gets worse as time goes on would indicate that her dose just isn't high enough.
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