Canterbury Crohn’s & Colitis Support Group Inc.
P O Box 2568
Christchurch
Patron: Prof. Philip Bagshaw Medical Advisor: Dr Richard Gearry
Christchurch School of Medicine Christchurch Hospital and School of Medicine
President: Claire Secretary/Treasurer: Katrina
16 November 2008
General meeting: Tuesday 2 December
Time: 7:30pm
Venue: Papanui Methodist Church, corner of Harewood Road and Chapel Street, Papanui, Christchurch
Guest Speaker: Dr Richard Gearry (gastroenterologist)
Dear members,
We will be having a general meeting very shortly. As mentioned above, Dr Richard Gearry will be our guest speaker. The title of his talk is “What happens when you don’t have enough small bowel left – intestinal failure in IBD”.
We were hoping to be able to reproduce an article from the Woman’s Day magazine that was featured recently but at the time of printing we hadn’t received permission to include it. The article featured actor Anna Julienne (Maia from Shortland Street) who spoke about her recent diagnosis of Crohn’s disease. Oh well, hopefully in our next newsletter we’ll be able to put it in.
Mountain Motion –
Approaching 30
You may remember two guest speakers we had at a meeting a while ago, Vaughn and Jamie, two men who were going to climb 30 New Zealand mountains (Vaughn of course has colitis). They keep us regularly updated; here is their latest email –
G'day guys,
Well what a winter aye. Nelson had the most snow we've seen in a long long time.
In between snowboard instructing at Rainbow, some alpine instruction at Mt
Robert and taking school kids tramping, biking and swinging them from ropes at
Rotoiti Lodge I certainly got my fill! Jamie also managed some trips to the
Snowy Mountains of NSW in between beavering away at Mountain Equipment so he
kept his legs moving over winter too.
Mountain Motions missions went in to hibernation over winter
but we still got the word out there by getting a great selection of photos up on
our website and presenting 3 slideshows in Nelson. Altitude Outdoor hosted the
first Approaching 30 presentation and it went really well. Next stop was the
Nelson section of the NZ Alpine Club and finally for the Staff at Rainbow Ski
field. People were impressed with the quality images and some great stories from
our adventurous summer. Jamie is still working very hard editing our
video footage and updating trip reports and blogs. But the big news is my
current state of well being. My Colitis is good at the moment and the dairy/
wheat free and low carb diet along with herbal and vitamin supplementation and a
very active winter saw me maintain my fitness and improve my health from
summer.
So things were looking great for getting into the mountains in November and
knocking a few more off as well as presenting a few more slide shows on route.
But 2 weeks ago I went and had a spill off my mountain bike. I prefer the
downhill variety of stunts and jumps and every now and then things can go
awry. In this case I misjudged the direction off a large drop landed off track
and got thrown over the handle bars. I landed back first on a rock and fractured
3 vertebrae and my thumb. It was a very bumpy ride to Nelson hospital in a back/
neck splint and a few days on the strong painkillers. Fortunately I was wearing
my back protector and the vertebrae, although badly compressed, are stable so I
did not require surgery or transfer to Burwood. I was able to mobilise after 3
days in hospital and then got sent home to get horizontal. The prognosis is good
for no long term complications but I am out of action for at least 3 months and
then will require extensive rehab. So the mountain missions this summer are
going to be put on hold. Jamie will still look to make a trip south and climb
some peaks, but I will be happy to just get back on my feet and into some gentle
tramping and biking by Christmas.
Once again thank you all for your incredible support last summer. We couldn't of
had as many great trips and motions on mountains without your input and energy.
Hopefully we'll continue our relationship and together we can complete the
Approaching 30 project and spread the word about the NZ Crohn’s and Colitis
Support Group and self propelled, leave-no-trace mountaineering!
Regards
Vaughn
(Jamie)
www.mountainmotion.co.nz
PREGNANCY AND IBD
IBD is a disease that often affects young people and so it is not surprising that many IBD patients (women and men) have concerns about fertility and pregnancy.
A survey of women in the UK with IBD found that women’s main concerns were that the stress of pregnancy and motherhood may cause their IBD to flare up or worsen in pregnancy or the months afterwards and that they may have difficulty caring for their baby because they were ill. In addition, both men and women with IBD are concerned that their children may inherit the condition.
Top ten questions raised by patients attending the IBD clinic will be covered in this article.
1. What is the risk of my baby inheriting IBD?
Genetics play a role in IBD, but that role is complex and incompletely understood. Children of a parent with IBD are at increased risk of developing the disease: for most affected people this risk is less than 10%. In general, the risk is lower if the parent has UC and higher if the parent has Crohn’s Disease, but not more than 10% in most families. In Jewish families and those with other affected relatives, the risk may be higher and if both parents have IBD: the risk of a child being affected is about 35%. For most people with IBD therefore, the likelihood of having a child who will never develop IBD is greater than 90%. It is also important to remember that children of mothers who smoke in pregnancy are more likely to develop IBD.
2. Is my fertility likely to be affected by my IBD?
It is important to remember that infertility is not uncommon in the general population, affecting about 8% of couples. For the majority of people with IBD, there is not any increased risk of being infertile compared to the general population. There is a small amount of evidence that women with Crohn’s Disease may be less fertile when their CD is active, but that this is not a permanent effect. There is also a suggestion that people with UC who have undergone pouch surgery may have some difficulties with conception. Otherwise the news is good and most people with IBD can expect a normal chance of conceiving.
3. Might my fertility be affected by my IBD treatment?
Men who take sulphasalazine (Salazophyrine) experience a reversible reduction in their sperm count while taking the drug (this does not meant it can be used as a reliable male contraceptive!) There is no convincing evidence that any of the other drugs used to treat IBD have any effect on fertility. It is vitally important that men or women who are taking methotrexate, or have taken it within the last three to 12 months, do not try to conceive, as this drug is extremely harmful to the unborn baby. Before trying for a baby, it is important to be as fit as possible and folic acid supplements are very strongly recommended for women with IBD who are thinking of starting a family.
4. Will I have a healthy baby?
Probably. Again, it is important to remember that miscarriage is common and that a small percentage of babies born to any healthy woman have a problem (termed congenital abnormality) In women with IBD, there is a slightly increased risk of miscarriage and of having a smaller than average baby that is born prematurely. These risks seem to be mainly in women with Crohn’s disease and are associated with the IBD being active in pregnancy. Flare-up of IBD in pregnancy is associated with an increased risk of miscarriage and of having a premature or small baby. There has been some recent debate about whether women with UC may have a slightly increased risk of having a baby with a congenital abnormality, but there is no evidence that women with IBD are more likely to experience stillbirth or problems with their newly born babies.
5. Are there likely to be complications of pregnancy?
Complications of pregnancy such as high blood pressure and diabetes are no more common in people with IBD than in other women of the same age. Pregnancy and labour are usually uncomplicated and the majority of women experience a normal, uncomplicated delivery. Caesarean section is very rarely advised for reasons to do with IBD.
6. Will my IBD flare up get worse during pregnancy?
The course of IBD has been shown to be unchanged during pregnancy and the three months afterwards. The chance of having a relapse of IBD is the same as in any other year. If relapse does occur, it is most usual in the first three months. The pattern of disease is unchanged by pregnancy. It is advisable to try to conceive while the disease is quiet, and if that is the case, most women will remain in remission through the pregnancy. If conception occurs when the disease is active, there is a significant chance it may remain active throughout the pregnancy, not the best thing for mother or baby. Recently, there has been some interesting evidence to suggest that after having a baby, women with IBD and especially UC may experience less than the expected number of flares of their disease, so possibly pregnancy has a positive effect on the disease process.
7. If my IBD does flare up, what will happen?
We know it is bad for the unborn baby if a mother has active IBD in pregnancy. So it is important to investigate and treat symptoms of active IBD in someone who is pregnant. Sigmoidoscopy and colonoscopy have been shown to be safe in pregnancy, but doctors will only advise these if really necessary and try to avoid X-rays unless they are urgently needed in someone who is seriously ill. If IBD is active in pregnancy, it is important to treat it because there is good evidence that the risk of the mother suffering active disease is more dangerous to the unborn child than most of the treatments that are used.
8. Is it safe to continue to take mediation during pregnancy?
No woman wants to take medication during pregnancy. It is however, important to remember that the evidence from studies shows that the slightly increased risk of having a premature baby is due to the IBD being active during pregnancy and not to any effect of medication. The most important thing is to be as well as possible during your pregnancy. If possible, before planning a pregnancy, you should discuss your medication with your Gastroenterologist to make a plan before conception rather than suddenly stop all medication when you conceive. In this way you should be able to weigh up benefits and risks of stopping or continuing medication. Nutrition is important in pregnancy and some women with Crohn’s Disease who have difficulty gaining weight may need nutritional supplements, which are safe. 5-ASA drugs, including sulphasalazine are safe. Most Gastroenterologists advise continuing these medications before and after conception and taking folic acid supplements. It is safe to take these drugs by mouth or to use suppositories or enemas. Steroids (prednisolone) used to treat relapses are also safe, if it is required because you are unwell. The use of other drugs in pregnancy is more controversial, but it is always important to remember there is a balance between the use of the medication and the aim of keeping well. For some IBD patients, who have been unwell in the past and are well and stable on azathioprine or 6-mercaptopurine, it may be reasonable to continue these treatments during pregnancy after full discussion. Despite a theoretical concern about these drugs, there are many patients who have experience pregnancy while taking them and very little evidence of any problems.
9. Will I be able to look after my baby?
It is most unlikely that your health status in terms of your IBD will have changed after pregnancy compared to before it. Looking after a baby is tiring and demanding for anyone and may provide extra challenges for someone with IBD. This is something to think about carefully before embarking on your pregnancy, but for most people with IBD the answer is yes you will be able to look after your baby as well as any other parent.
10. Will I be able to breastfeed?
Again, you probably will if that is what you want to do. Breastfeeding is extremely beneficial for your baby and may reduce the risk of their developing IBD. It is definitely safe to breastfeed whilst taking 5-ASA drugs (Asacol, Pentasa, etc), sulphasalazine and prednisolone. There is no evidence of harm for breastfeeding while taking azathioprine, 6-mercaptopurine and infliximab but it is unsafe to breastfeed while taking many other drugs used to treat IBD and its best to have a full discussion about this with your gastroenterologist before the baby is born.
(Auckland CCSG October 2008)
2008-2009 MEMBERSHIP
SUBSCRIPTION
As of the AGM the 2008 – 2009 subscription was due. A number of members have already paid but if you haven’t already please return the slip below with your payment, or alternatively pay at our next meeting. We are still trialling internet banking but please please please remember to put your name as a reference or else we have no way of tracking payments.
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If you have any questions please do not hesitate to email me, our email address is - info@crohnsandcolitis.org.nz
It would be wonderful to see as many of you as possible at our meeting J
Kind regards
Katrina
Katrina
CCSG
Secretary/treasurer
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