Dr. Gad Friedman
  • Welcome
    • About me
  • Endoscopy
    • Gastroscopy >
      • Tips for a better gastroscopy
      • Preparation form
      • Frequently asked questions
    • Colonoscopy >
      • Tips for a better colonoscopy
      • Preparation form
      • Frequently asked questions
      • After the colonoscopy
    • Sigmoidoscopy >
      • Preparation form
    • Video Capsule Endoscopy >
      • Preparation form
  • Digestion
  • Common symptoms
    • Bloating
    • Burping
    • Flatulence
    • Heartburn
    • Mucous in stool
    • Stomach Rumbling
  • Straight talk
    • Celiac disease
    • Colon cancer screening
    • Diverticulosis
    • Hemorrhoids
    • Inflammatory bowel disease >
      • What to talk about
      • How to choose your treatment
      • Is my treatment working?
    • Irritable bowel syndrome
  • Diets
  • How To
Noto, Sicily

Your doctor is one of the most important paths to good health

But you need to know what to talk about

Often patients go to their doctor but they do not have a clear understanding of what is important to talk about.
This section is about arming you with the discussion topics that are important if you have inflammatory bowel disease.


Your symptoms:

You should be able to tell your doctor if you have the following symptoms, how often you have them and what triggers them to start or get worse and what makes them better. 
For example: "I am having diarrhea 5 times a day, usually after meals that are fatty. Loperamide decreases it."

The following are important symptoms to mention:
  1. abdominal pain or cramps
  2. bowel movement changes (diarrhea or constipation)
  3. bloating and abdominal distension 
  4. nausea and/or vomiting
  5. weight loss
  6. poor appetite
  7. fever
  8. passage of blood
  9. skin or joint changes
  10. fatigue or poor exercise tolerance
  11. any disease around your anus

Remember that feeling OK is not good enough. We want you to feel well so you need to tell your doctor all the important symptoms.

Your medications:

It is important to always come with a list of all the medications you take including ones over the counter. You should understand why you are taking these medications and be familiar with possible side effects. 
If you have been previously treated for IBD, try to keep a record of what medications you tried in the past. It helps a lot if you can recall when and for how long you took them and why you stopped e.g. allergy, side effect, ineffective.


How will your doctor monitor you?

Symptoms unfortunately do not always tell the whole story and may not help in predicting early a relapse. This is why your doctor may need to do some tests to understand the level and extent of your disease.
These are initial tests that should be considered:
  1. complete blood count (CBC). This checks if your hemoglobin to see if you are anemic.
  2. Electrolytes (sodium, potassium, calcium, magnesium). These can be abnormal from diarrhea or malabsorption.
  3. Urea and creatinine. These tests for kidney function and sign of dehydration.
  4. Liver profile. Helps to rule out any underlying liver disease that can be associated with IBD or may alter with medication selection. 
  5. Ferritin and vitamin B12 level to assess for deficiencies
  6. C-reactive protein (CRP). This is a marker of inflammation.
  7. a stool test called fecal calprotectin. This is a marker for intestinal inflammation

For more in depth assessment other tests such as radiology imaging (CT or MR enterography) and a colonoscopy may be ordered.
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Although not necessary at first visit, I will often order some tests early as I may need these results available later before certain medications or treatments can be prescribed.
  • Thiopurine methyltransferase (TPMT). This is ordered before starting azathioprine to know if the patient metabolises the drug normally
  • Tuberculosis exposure tests. Either a PPD and/or a quantiferon blood test. This will be needed prior to starting any biologic medications.
  • Hepatitis B and HIV serology. The immune suppressing drugs can reactivate a chronic Hepatitis B or HIV infection.
  • Celiac disease serology. I have had cases where the patient has both IBD and celiac disease so I find it worthwhile to know early.

Tell us as much as you can

You may not feel comfortable on a first visit but these are also crucial to mention since they are important in your well being.
  1. sexual difficulties from poor sexual drive or vaginal pain. This information can change treatment or investigation choices.
  2. work or school problems. We need to know how the disease is affecting your life so we can help you.
  3. Family planning. Treatment plans will need to be discussed with you and your partner if you are planning to have a baby in the following 6-12 months.

Be honest about smoking

We all know smoking is not good for us for many reasons but you may not appreciate that smoking has clearly been shown to worsen Crohn's disease and is a factor in more difficult to treat disease.
So tell us and we can try to help you.
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Vaccines

Although strong evidence is not yet available, I believe vaccination is important especially as many of our patients will be on immune suppressing agents. 
I will typically consider vaccination for:
  • Hepatitis A and B
  • Pneumonia (Prevnar and Pneumovax)
  • Influenza (recommended yearly)
  • Varicella if there is no history of chicken pox  (varicella serology can be performed)
  • Shingles (Shingrix)
  • HPV vaccine
Of course, we should first make sure that childhood vaccinations are up to date.
www.ourdigestivehealth.com
www.GadFriedman.com
  • Welcome
    • About me
  • Endoscopy
    • Gastroscopy >
      • Tips for a better gastroscopy
      • Preparation form
      • Frequently asked questions
    • Colonoscopy >
      • Tips for a better colonoscopy
      • Preparation form
      • Frequently asked questions
      • After the colonoscopy
    • Sigmoidoscopy >
      • Preparation form
    • Video Capsule Endoscopy >
      • Preparation form
  • Digestion
  • Common symptoms
    • Bloating
    • Burping
    • Flatulence
    • Heartburn
    • Mucous in stool
    • Stomach Rumbling
  • Straight talk
    • Celiac disease
    • Colon cancer screening
    • Diverticulosis
    • Hemorrhoids
    • Inflammatory bowel disease >
      • What to talk about
      • How to choose your treatment
      • Is my treatment working?
    • Irritable bowel syndrome
  • Diets
  • How To