'Roid Rage

Nearly every Crohn's or Ulcerative Colitis patient has, at some point, been prescribed steroid medication. And nearly every Crohn's or UC patient will tell you, it's the necessary evil.

This class of medications, known as anti-inflammatories, cortico-steroids, or just steroids, is commonly prescribed to help calm down inflamed intestines. Crohn's and UC's most common symptom is inflammation of the lining of the intestines, and it can cause severe pain, cramping, bleeding, and can also indicate infection. The steroid medications work very quickly to reduce this inflammation, thus reducing the pain, bleeding, and discomfort. The most common steroid medications used for Crohn's and Colitis are Prednisone, Methylprednisolone, and Prednisolone. They all come in various brand names and strengths, but typically produce the same results.

When I was first diagnosed with Crohn's in 2002, I was prescribed 80mg per day of Prednisone. 80mg is a LOT of steroid power. Within one day, I was feeling better, was able to eat regular foods, and had regained some of the long-lost confidence I had in myself.

After about a week of being on 80mg of Prednisone, I started to notice I was putting on weight, which, at the time was a good thing. I had lost over 20 pounds too suddenly before the diagnosis, and needed to gain some of it back. I also noticed my face getting fuller, which at first, I thought was because of the weight gain.

I was wrong.

Prednisone and other steroids come with a myriad of side-effects. "Chipmunk cheeks" is a very common side-effect, and over time, seriously makes you appear to have a mouth full of food. How or why this happens, I do not know (and I'm too lazy to Google it at the moment). But it happens to so many users of Prednisone, that it's almost become an inside joke - thus the silly picture above.

In addition to puffy cheeks, steroids come with a seemingly endless list of other side effects. The longer you take the steroids, the more side effects you'll likely experience. In fact, long-term use of steroid medication is highly discouraged by most doctors, because after awhile, the risks of the drug outweigh the benefits.

Since I seem to love making lists (see my previous posts), here is a list of the most common side effects of steroid medications:

• Aggression / irritability / anxiety
• Water retention
• Fast, slow, or irregular heartbeat/pulse
• Headaches
• Pounding in the ears
• Swollen fingers, hands, legs, and feet
• Breathing difficulty
• Blurry vision
• Dry mouth
• Heartburn / indigestion
• Increased hunger/appetite and thirst
• Insomnia
• Increased blood pressure
• Nervousness
• Inability to concentrate
• Loss of sexual ability
• Delayed healing of wounds
• Swollen cheeks or neck
• Worsening acne
• Thinning hair
• Dry scalp
• Irregular menstrual cycle (in females)
• Food intolerance (dairy, gluten, etc.)
• Yeast infections and/or thrush
• Uncontrollable shaking or tremors

Long-term steroid use can cause:

• Osteoporosis or loss in bone density
• Depression
• Chronic bronchial problems, shortness of breath
• Spinal pain and vertebral compression fractures
• Thinning of skin
• Hyperhydrosis (sweating too much)
• Muscle wasting (decreased muscle mass)
• Hyperglycemia and glucose intolerance (with symptoms similar to diabetes)
• Hallucinations
• Violent behavior
• Hypothyroidism
• Congestive heart failure
• Stomach ulcers 
• Pancreatitis

(Please note: THESE LISTS ARE NOT ALL-INCLUSIVE. Report your possible side-effects to your doctor, or directly to the FDA in the United States, or to your local drug regulation body.) 

Because the side-effects can be serious and life-threatening (and annoying), most doctors will eventually prescribe a different type of long-term medication to help control Crohn's Disease or Colitis. There are several different classes of medications for Crohns and Colitis, some of which I will cover in future posts.

As if this nightmare of steroid side-effects isn't horrifying enough, suddenly stopping your intake of steroid medications can also have serious effects. It's almost always prescribed that patients slowly "wean" off of steroids, to avoid having the same, or worse side effects listed above. This weaning process can last for weeks or months, depending on your dose and condition.

As I said before, steroids do work very well for most Crohnies and UC sufferers. They work quickly and effectively, and it's often a huge relief just to feel better. But I highly recommend getting off of them before you develop a seething love/hate relationship with them, like I have!

What was your steroid use like? Feel free to share in the comments! By the way, comments can now be left anonymously! Just choose "Anonymous" from the drop-down box next to 'Comment As.' As always, remember to share this blog with anyone you think might be interested!

OM NOM NOM (Foods post, part 2)

As I sit here enjoying my mother's frosted sugar cookies, I'm reminded of how lucky I am to be able to be sitting here... eating my mother's frosted sugar cookies. To most people, eating simple foods is just second nature. It's a part of life. Hungry? Grab whatever's available. It's not so easy for a Crohnie to just grab-and-go, unfortunately. We have to analyze, consider the risks, and bargain with ourselves over every single bite we take.

As promised, I am posting a list of foods that I, personally, can enjoy with my Crohn's, usually without any problems. (For part 1 of this topic, click HERE) But, I want to make it clear that every Crohn's/UC patient is different - what one of us can eat could send another of us to the hospital. So, this list is purely from my own perspective, and maybe it will help other Crohnies discover some things to try.

YAY FOODS!:

• Pasta - regular pasta is best for me. The whole-grain type gives me far too many problems. Anything from spaghetti to macaroni to bow-ties. YUM! I have to make sure it's fully cooked and soft (al dente is too hard to digest), and I really love it with just some butter and cheese, or even Alfredo sauce. Red meat sauces are iffy... I try to avoid any meat in them, unless it's meat I've added myself. Plus, the abundance of the tomato acids in the red sauces tends to produce severe acid reflux, so I can only have small amounts of red sauces. I recently started mixing red and white sauces, and it's delicious! 
• Filled pastas, such as ravioli, tortellini, or stuffed shells - If they're filled with mostly cheese, I'm good to go! The ones that are filled with sausage or other meats tend to cause some discomfort, but I still allow myself to enjoy it from time to time. That's the "bargaining" part of our diet... you know it might make you slightly ill, but the indulging might be worth it!
• Seafood - I really love all sorts of fish, shellfish, and even the occasional clam strips. There are a few things I have to remember with these delights: watch for bones!! These can cause harm to anyone, not just Crohnies! And if it's cooked with too much butter or grease, I'm going to be in some major discomfort. Again, I do bargain with myself on seafood, because I LOVE IT. 
• Cooked Veggies - Raw veggies typically send me to the floor in the fetal position within a few minutes after eating them. I now avoid them completely. But COOKED veggies are much easier on the digestive system, and I can enjoy quite a few of them. Some of my favorites are green beans, beets, mushrooms, artichokes, squash (such as acorn squash or spaghetti squash), zucchini, summer squash (the yellow kind that looks like zucchini), and cooked/steamed cauliflower.
• Potatoes - I didn't include this in the "veggies" above, because I think it deserves to be in it's own category. I LOVE potatoes. It doesn't matter how they're prepared. Mashed, baked, sliced, diced, chips, fries, tater tots, boiled... I'll eat them! I garnish my baked potatoes with cheese, butter, or sour cream (or all of the above, if I'm feeling adventurous). I like fries and tots dipped in ketchup, ranch dressing, or even mayonnaise. I loved oven-baked diced potatoes, as long as the spices used aren't too hot or whole. Heck, I will even peel a small potato and eat it like an apple, on occasion! They're so delicious, and they're filling, so for me, it serves as a meal in itself.
• Bread - I choose non-enriched white bread for my diet. Not considered "healthy" by most standards, but whole-grain bread and enriched breads make me very sick. The bakeries at most grocery stores sell Italian or French breads that are perfect for me. They freeze nicely too, so I can stock up. I enjoy making toast, with various items on top: butter/margarine, jam (NOT preserves!), peanut butter, and sometimes even mayonnaise. Don't judge.
• Condiments - I can enjoy small amounts of many types of accessory foods: real butter or margarine (vegetable spreads); smooth peanut butter, including almond and cashew butter - as long as there are no chunks of nuts; jams and jellies without whole pieces of fruit (no preserves or marmalade); salad dressings of all sorts; mayonnaise (I prefer the type made from olive oil rather than eggs); ketchup; A-1 steak sauce; barbecue/BBQ sauce; Alfredo sauce; marinara sauce without meat; sour cream and sour cream-based dips; wine sauces; Hollandaise sauce; maple syrup; yellow (non-spicy) mustard; cream cheese spread. I'm sure there are others that I can't think of off the top of my head at the moment, and I'll revise the post as I think of them.
• Fruits - Probably the most difficult part of my diet is trying to integrate fruits. They hate my guts! I can eat bananas, pears, and small oranges without any problems. That's about it. However, I haven't given up on trying all kinds of fruits! They are all so tasty and delicious, so sometimes I'll "test" them out to see how my body responds. Unfortunately, it's usually a very negative response, and I wind up in bed or on the toilet all day long. *sad face*
• Processed Foods - Fortunately for me, I live in America, where the processed food industry output is abundant and inexpensive. Also, highly controversial. Processed foods typically involve the use of many chemicals not meant for human consumption. BUT... my body seems to be OK with this. In fact, my guts seem to prefer a factory-made, preservative-loaded chocolate cupcake over a homemade one. I've given up on trying to understand it, and I just roll with it. I still eat these kinds of foods in moderation, but sometimes, it's all I can stomach. Especially instant oatmeal. YUM! Or Little Debbie Zebra Cakes. OMG. YUM. Oreo Cookies? TO DIE FOR. Doritos? A must-have. Kraft Macaroni & Cheese? My life support. Banquet oven-ready Pot Pies for 89 cents? I'll eat them daily! Ramen noodles = my go-to meal. It is not without guilt that I enjoy these foods, but they truly are my comfort foods - they do not cause my Crohn's to act up whatsoever... probably because my body can't figure out what to do with all those chemicals!
• Fast Foods - I strongly dislike fast-food, but let's be honest: sometimes, you just need to grab something quick and you don't have any other options. McDonalds is a place I have a love-hate relationship with. I love their breakfast foods, namely the breakfast burrito. It's cheap, simple, and easy on my stomach. It does have small amounts of sausage and peppers in it, but they're so overly cooked and processed that my body doesn't seem to notice. Their lunch and dinner offerings are a HUGE hurdle for me. Their burgers are made with overly-processed meat, so I CAN digest them, but they are so greasy, I wind up feeling terrible for hours afterward. Their whole-piece chicken products (like the grilled chicken sandwiches) are delicious, and I usually do OK with them, as long as there are no veggies on the burger. Big NO to the fried foods, except for their French fries - I can nosh a small handful of those without any problems. 
• Rather than go through each and every fast-food restaurant menu listing, I'll just say that I try to avoid fast food as much as possible. Subway's offerings have been my best bet thus far, but even their "fresh" ingredients tend to make me ill. I'm better off making a PB&J sandwich to go before I leave the house for the day, to eat when I'm hungry.
• Soups - Soups are usually pretty good to me, as long as I choose ones that don't have difficult ingredients. I stay away from soups with lots of peppers or celery, but I certainly enjoy the potatoes, carrots, and barley. Clam chowder is one of my favorites, along with cheesy potato soup, and good ol' classic chicken noodle soup. 
• Dairy - this has been an ongoing roller-coaster for me. Depending on my current medication regimen, I can either enjoy all the dairy I want, or I can't have a drop of it. When i'm on steroid medication for my Crohn's, I become so intolerant of dairy, that it literally comes right back up and out my mouth. But, when I'm not on that type of medication, I can indulge in all things dairy and it's wonderful! I do TRY to indulge in moderation, but lets face it - ice cream, cheese, milk, yogurt - it's all so delicious! I tend to go a little overboard at times, thus making myself sick. But I believe that could happen to anyone who over-indulges in any kind of food. 

I hope my list above will offer some insight into the diet of a Crohnie. Again, this list is NOT going to be the same for every Crohnie. Some patients find that dairy, gluten, or preservatives are their worst enemies. Some can only eat liquid forms of everything. And some even resort to eating ONE type of food every day for the rest of their lives, to avoid getting sick. 

I recommend Crohn's and UC sufferers warriors learn by process of elimination what foods work best for you. And then, in a year or two, try again. I have discovered that I can eat some foods now that I couldn't eat previously. I believe our bodies and our symptoms are ever-changing, and it is to our benefit to change with them. 

A great source for elimination diet tips and how-to's can be found at  http://www.precisionnutrition.com/elimination-diet.

What are some of your go-to foods? What about your big no-no foods? Comment below!