Crohn's 360: Talking to Your Doctor About Crohn's Disease 

Dr. Howard Siegel, Gastroenterologist: I am Dr. Howard Siegel and I am a Gastroenterologist here in Southern Jersey. I have been in practice in this area for 21 years. I trained in gastroenterology in Philadelphia at Thomas Jefferson University and then Temple University.

Dr. Siegel to Patient: What kind of work do you do?

Patient: Nurse. 

Dr. Siegel: Do you drink alcohol?

Patient:  No.

Dr. Siegel:  And most importantly, do you smoke?

Patient: Never.

Dr. Siegel: Good because I don’t like my Crohn’s patients to smoke. It has been shown that smoking will not only be harmful for your Crohn’s, it can actually make you less likely to respond to any medications that we use.

Screen Copy: Talking To Your Doctor About Crohn’s Disease

Dr. Siegel: In general what we need is a close communication between the patient and the doctor, or the patient and the doctor representative which could be one of my nurses.

Screen Copy: TIP: Open Communication is Key

The first thing we want to do is to take a complete history [of the patient]. We want to learn about what the patient’s symptoms are  and when they developed. We want to take a family history, we want to learn if there is anyone in the family who has had Inflammatory Bowel Disease such as Crohn’s Disease.  

Screen Copy: TIP: Prepare to Discuss Any Family History of IBD    

Dr. Siegel to patient:  Now refresh my memory,  anybody else in the family have Crohn’s?

Patient: I have a cousin with ulcerative colitis who just had surgery and a colostomy. He is sick with that. And I have a cousin on my Dad’s side with Crohn’s. He is colostomy, ileostomy; they just cannot get him under control. 

Dr. Siegel: This particular patient, Pat, I have known for a very long time and she is very much in control of her disease. She keeps close monitoring of when her flares are. We are then going to perform a physical examination. We are going to look for  any areas of tenderness or swelling  that might indicate inflammation below the surface.

Screen Copy: TIP: Keep a Journal to Track Your Condition

Dr. Siegel to Patient: Did he tell you if the Crohn’s Disease involved you colon or your small intestine?

Screen Copy: TIP: Know the Specific Areas Affected by Your Crohn’s

Patient: Basically it was the small intestine.

Dr. Siegel: Ok.

Dr. Siegel: We are going to look at the skin for any signs of inflammation. In rare cases the inflammation within the bowel can be so severe that the bowel actually leaks out of the bowel and  can make its pathway all the way to the skin, at which point we can see leakage of intestinal contents come to the skin – and that is called a Fistula. Once we have taken a history and we have examined the patient we are going to take some blood studies. Anemia is often a hallmark of Crohn’s Disease. We are going to check nutritional parameters to see if  the patient is malnourished. Perhaps because of the bowel inflammation they have not been able to absorb their nutrients well. There are some blood studies that are elevated in people with  inflammation that we’re going to check them for. We are then going to want to actually look at the bowel. Depending on where the symptoms are – if the symptoms are obviously coming from the colon because we see blood in the stool or diarrhea.

Screen Copy: Fistual: Intestinal content leakage to the skin

Patient: In 1982 I had 6,7,8 bloody stools a day. I did not know what it was but I feared it was colon cancer, so I waited a while to go to the doctor.

Dr. Siegel: We are eventually going to look inside the colon and that is done with a colonoscope which is a long, flexible camera that we can actually pass into the patient’s bowel and look at the colon.  That is certainly very helpful when the disease involves the colon, and  less so when the disease involves the small intestine.

Screen Copy: Colonoscope: a thin, flexible tube with a camera used to perform a colonoscopy.

Dr. Siegel to Patient: I just want to double check on your last colonoscopy which was in July of 2011. The colon looked very good which is not surprising. Most of your disease has been confined to just in the small intestine which you know is not uncommon for Crohn’s Disease. I am going to examine you and order your follow-up laboratory studies.

Screen Copy: Tip: Keep records of dates and results of colonoscopy

Dr. Siegel:  We do schedule relatively frequent visits when the patient is very active and when the patient becomes less active it is our pleasure to see them less. These patients want to get back to their lives. They do not want to spend their lives always in the hospital or in the doctors office or getting testing, but when they are sick we need to see them frequently. We often hook them up with other support services. There are foundations of patients with Crohn’s Disease that they can speak with and other support groups. All of these services are available and we encourage our patients just to use them.