Crohns Disease My Uni Assignment

 

Crohn’s disease according to PubMed Health (2011) is a type of bowel disease that affects parts of the intestinal tract which can occur anywhere along the gastric tract(GI) from the mouth to the rectum, the disease usually starts in the lower part of the intestine. The inflammation can penetrate deep into the linings of the targeted organs. Where it can cause significant pain, increase bowl movements in diarrhoea form.  Crohn’s medical term is known as inflammatory bowel disease (IBD) another condition or symptom is Ulcerative colitis. The cause Crohn’s disease is thus far unknown in the medical field, and is potentially connected with the immune response that cannot distinguish between the normal function of the body’s tissue or the external substances. This term for is called an autoimmune system where by the immune system is becomes overactive leading to chronic inflammation. On the other hand UK Stats (2002) states no proven causes of Crohn’s Disease so far exist apart form the body’s immune system reacts to a bacterium or virus causing inflammation. Other common symptoms are anaemia, abdominal, rectal bleeding, weight loss and fever.

Who is at risk and at what time scale, according to National Association for Colitis (NACC) they state currently 250,000 people are affected with Crohn’s and Ulcerative Colitis. Whereas, the World Health Organisation believe that approximately 60,000 people in the UK are affected. This disease can develop in children and can have an effect on growth. Majority of people are usually diagnosed in their 20s and 30s from this pointers indicate this age group is at most risk. Race of the person, usually whites have the highest risk of the disease it can affect all other ethnic people. There is a higher risk if you have a close family member, such as a sibling of parent with as much as 1 in 5 chance of developing the condition Thirty times the risk if you have a brother or sister and sixty seven times if you have a twin. Smoking is one of the risks of developing Crohn’s disease and smoking can lead to other diseases. The area where you live can have an impact on Crohn’s disease such as industrialized or urban areas due to potential environmental factors or a diet in high in fat or refined foods. People in northern climates also have a greater risk of the disease, due being more industrialized area.  Gomez, J , (2001) also states epidemiology as study: investigation  of health related issues and disease and their distribution shows up in genetics, in certain circumstances relates a particular race of people for instance there is a distinct link of Crohn’s to the Jewish race in particular the Ashkenazi Jews with a risk of up to thirty per cent. I may not matter if the person lived ib New York, Paris of London due to the genetics it has and impact only this particular group of people. These people tend to have limited amount of lactase this is an enzyme for the digestion of milk, although logic says to avoid milk products for this group this cessation in itself has no significant effect. Israel has some of the largest portions of Crohn’s sufferers, due partly to the genes, however, can also be due to the fact Israel is also and industrially developing country.  Although, diet of western, Indian Mediterranean or or French is associated with Crohn’s, there indicators such as sugar, approximately 150 per cent more people in Birmingham have a high intake as well as 120 per cent of people living in Tel-Aviv. Although the author suggests it is uncertain if sugars if a likely cause of Crones or not, it however does trigger a physiological effect of taking more sugar. Fruit and veg intake statically is less for Crohn’s sufferers; approximately twenty – five per cent of people have less than a portion. This according to the author hardly has an impact on the UK recommended guidelines of five portions a day. Filler foods such as bread, pasta, biscuits, cakes and potatoes are the main diet. Whole families may even have the same intake of food, in which case there may even be more than one Crohn’s sufferer or ulcerative coliste suffer in that family group. Milk, one the products researched to access if there is a link with the disease an American group a section of them stayed in remission without symptoms that had not been allowed dairy products compared tto those that were allowed. Studies in the last five years suggest that a contaminate in the milk called mycobacterium parutuberculosis is a prime cause of Crohn’s, however stopping the intake of the author contradicts himself stating for many patients has no effect on the symptoms p14.  Food intolerance tests indicate wheat and dairy as the one with the most impact. The study was conducted over a seven day period with the food disguised as black current drink of lentil soup and delivered direct into the patient’s stomach.  Due to high oestrogen levels it was found that like smoking the pill was associated with potentially damaging tiny blood vessels in colon this posed a increased risk of Crohn’s particularly in the colon area rather than the ileum. P16. According to Anderson RA( 2001), level of the following are depleted such as zinc vitamin B12 and folic acid and potentially made need injection to supplement these low levels.

 

The alimentary tract ( also know as the gastro intestinal tract G.I tract) according to livinston is under the control of the brain its messenger being the autonomic nervous system, it  starts from the mouth to the anus. The mouth being the entry point of food, with the teeth and jaw working to masticate the food the tongue with its sensors signalling the brain as to the enjoyment or not of the food, the salivary glands help to moisten the and lubricate the mouthfuls of food which then make its way down the oesophagus via a muscle movement like wave called peristalsis (also is in motion throughout the whole of the alimentary tract)  into the stomach p6 Silva also has an added function as it contains ptyalin a starch digesting enzyme. It is suggested that each mouth full of food is chewed 32 time to as this benefits digestion. The stomachs muscle relax ready for the food due in, and its glands start to output digestive juices, like hydrochloric acid and pepsin. Just past the stomach the duodenum receives chyme the process food for the stomach and bile from the ducts to neutralize e acidic contents as they start their journey into the small intestines which comprise of the duodenum, jejunum and ileum this organ according to liviston is the most affected by Crohn’s P8. This then connects to the caecum and connects to the large intestine. The pancreatic juices including the bile juices help break down to obtain vitamin E,K,A,and D I the function of the illume is absorbed most of the nutrients from the cyme into the blood stream. The ileum ends at junction of the ileocaecal valve and the connect to the large intestine for final exit.

 

Crohn’s dieses can show itself in a number of ways some of the signs and symptoms are in th abdomen particularly in the lower right hand corner near the appendix area due to pain and swelling of inflamed tissue such as the peritoneum a membrane covering the intestines. Borborygmi is a term used for excessive air passage in the intestine working harder in order to keep things moving. Since everything may have a different taste there could be a loss of appetite which may lead to Anorexia. The compounding effects of nausea, anorexia and diarrhoea may be due to lack of trace elements and vitamins not being in the diet. nausea generllay has a knock of effect form the stomach and duodenum when the illeum passes undigested food in the intestines and the this irritates the colon p23. On occasions lumps may also be felt in the abdomen this according to Gomez, J (2001)could be due to coils of intestine being bridged by inflammation  this would generally not be a serious problem. Inflammation goes hand in hand with a raised temperature.  Diaherra meaning frequent loose stools, sometime due to the severity there is pain, pus, mucus or even blood discharge. Under nutrient has potently a combition of these three conditions, eating very little to do the loss of appetite, the abdomen unable to absorb nutrient, fats, proteins , vitamins carbo hydrates and minerals. the author also state if the function of the illumis impaired no matter how well your intake of food is the ileum will not be able to transfer these nutrients into the blood stream. Stunted growth for people who had developed Crohn’s at a young age.

 

For the purpose of this assignment based on a female Mrs C  whose signs and symptoms are fictitious and therefore, within the context of Data Protection 1998, no prior permission is required. This law provides protection for the individual whose data is used or stored. No sensitive data of a personal nature as to sexual orientation, religion, criminal record and political beliefs the clients mental and physical condition should be kept without permission. The personal information will be regulated and covered for written and electronic form (i.e. Internet, intranet and email) the client would have had the right to request what information is held about them. Teesside School of Health and Social Care (as a student of this institution disclosure is to protect both the student and the organization) together with Department of Health protocols would otherwise have to be followed in respect of data obtained and used. Otherwise one would have to have a signed consent from the client for the information to be used in this assignment. Practice professional code of conduct followed and data must be used in a confidential and sensitive manner regarding information about its clients.

On the first appointment at the salon with Mrs C I watched her walk towards me to assess the confidence in the walk and whether the was any part emphasise. I stood up smiled and shook her hand professionally. I ask Mrs c to take a seat and proceeded to take a detailed consultation in which all the medical history, including lifestyle. From the consultation It was evident my client stress levels and physiological impact was quite high due the length of time Mrs C has had Crohn’s disease particularly when she has had to give up a full time job this carries added pressure on finances, together with funding the appropriate diet. As stated earlier Mrs C was diagnose 3 years ago with this condition and currently works part-time as a secretary. Mrs C’c Gp has prescribed anti-Inflammatories to help reduce inflammation such as Amino salicylates these help in reducing flare-up of Corticosteroids are used for very short periods of time as they can have serious side effects according to Bupa UK. (2011). My client also suffers from bloated feeling and wind the disease has had a tremendous impact on the social life as the client fears going out for long periods in case of bowel activity, pain and flatulence, holidays are also out of the question as flare-up can happen any time. Therefore, I have proposed to initially treat my client with a 1hour long full body massage as this should have a positive effect on the blood and immune system in particular as well as according to Micozzi, M S, et al, (2008 p,139 -145) have an impact on stress levels and comfort by seventy one per cent, and pain management by sixty seven per cent. Also states that recover from fatigued muscle would be speeded up. The treatment should also promote healthier sleep as suggested according to the research I would aim to provide the massage towards the end of the day giving gentle repetitive stroke to help induce hypnotic state of the central nervous system. According to Snyder, R. (2006 p,286) massage helps loosen of soft fibrous adhesions,  help in reducing pain due to fact massage stimulates large diameter nerves. However, the report also shows massage does not always produce relaxation, a factor that may suggest this from the research is that there could be arousal stimulating effect. The author then goes on to say, other studies show that massage has an improvement on psychoneuroimmunological effects on the mind and body in production of antibodies this would benefit my client in that it go towards helping target the inflammatory problems in the bowel.  The main precaution I would ensure is that the massage is not too deep or stimulating for the client, with the emphasis being to relax. On completion of the treatment I spent another fifteen minutes going through what suggestion I put forward to help gain the most out of this treatment according to Weil, D A (2009) massage therapy has a positive impact on lymph movement and is clinically used in lymphedema patients. Massage improves blood flow therefore helping clear waste like lactic acid and other toxins. There is a feel-good factor with massage as serotonin and endorphins are increased.  The physical stimulation of massage has an impact on the gate control mechanism as pain stimuli are pacified.

 

Dunne, J. (2001) in relation energy pathways Meridians lines is pathways through the body along which subtle energy’s or human life force travel. These channels are connected to particular organs in the body. It is believed that when these pathways become restricted or blocked that give rise to malfunction there are a number of techniques that can be used to unblock or rebalance these energies. In targeting acupressure points along the governor vessel and bladder meridian as working these two channels helps re balance the other meridians.

 

After care for my client is a very important aspect of getting prolonged benefits out of this and future therapeutic treatments Change4Life  (2011) 5 a day fruit and Veg  as per government guidelines and the NHS, with an increase in fibre intake, together with chewing each mouthful a minimum of thirty two times to help promote digestion and absorption. Improve on water intake to 3 glasses a day for 3 days then 4 glasses a day for 4 days and slow increase to minimum of 6 glasses a day. Take up gentle relaxing walk in parks or forests as walk4life (2011) Together with a diary of each day how my client slept, bowel movements, dietary information and water intake.

This would give a good indication as to how the overall holistic treatment has benefitted my client. According to National Institute of Clinical excellence (NICE) have made a recommendation for manual therapy to be done up to 9 sessions over a 12 week period. I would therefore be inclined to follow this protocol for the best outcome to suggest at least 9 sessions. Prefer to carry on with the same massage technique as it would other be more appropriate to ascertain how treatments progression for the health of the client.  I would to assess massage pressure on each subsequent visit systematically within clients tolerance level increase pressure a little portion at a time.

The following were recorded as results for the first treatment the client from the dairy that was kept, fruit and vegetable intake had increased to approx. 3 portions a day. This is on target towards the government minimum for the client. From this client bowel movement were at the same frequency and still watery.  Sleep patterns for the first few day were improved due to the effect of the relaxing treatment of the massage. However, the subsequent patterns were erratic on further questioning with regards exercise and meditation this had not as yet been schedule by the client. This would be good area for the client to concentrate on, after the second treatment. The life style change has had an impact on the client in terms of scheduling appropriate foods to eat as well as balancing what her on partner prefers to eat. The peak of stress was mid-week at work this is believed to have an additional impact on sleep patterns for the following days as suggested in the following article Insomnia ( 2011) results indicates that a lack of control over stressor in life will have an impact on sleep. Chronic sleep debt as per The Lancet (2011) in particular done on 11 men with only 4 hours sleep each night for 6 nights, has a harmful effect on carbohydrate metabolism and functions of the endocrine system, therefore age related chronic disorders may trigger at an earlier stage in one life. So it is imperative for this client to get a minimum of 6-8 hours’ sleep for long term health. Loss of

 

Gomez, J , 2001. Living with Crohn’s Disease. 2nd ed. London: Sheldon Press.

 

Anderson, R. A. (2001) Clinician’s Guide to Holistic Medicine McGraw-Hill Professional Book Group, Blacklick, OH, USA

 

Crohn’s disease – PubMed Health. 2011. Crohn’s disease – PubMed Health. [ONLINE] Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001295/. [Accessed 30 March 2011]

British Colostomy Associated | British Colostomy Associated. 2011. British Colostomy Associated | British Colostomy Associated. [ONLINE] Available at: http://www.bcass.org.uk/hello-world/. [Accessed 30 March 2011].

 

Crohn’s disease – information, symptoms and treatments | Bupa UK. 2011. Crohn’s disease – information, symptoms and treatments | Bupa UK. [ONLINE] Available at: http://www.bupa.co.uk/individuals/health-information/directory/c/crohns-disease. [Accessed 30 March 2011]

 

Micozzi, M S, et al, 2008. Complementary and Integrative Medicince in Pain Management. 1st ed. U.S.A: Book-Mart Press

Crohn’s Disease – Inflammatory Bowel Disease | Bupa UK. 2011. Crohn’s Disease – Inflammatory Bowel Disease | Bupa UK. [ONLINE] Available at:http://www.bupa.co.uk/individuals/health-information/directory/c/crohns-disease#textBlock198967. [Accessed 08 May 2011]

Snyder, R, 2006. Complementary/Alternative Therapies in Nursing. 5th ed. New York: Springer Publishing Company

Weil, D A, 2009. Integrative Oncology. 1st ed. Cary, NC, USA: Oxford University Press .

 

 

D H (2011) [ONLINE] Available

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122238.pdf. [Accessed 08 May 2011].

 

DH(2011)http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4088835.pdf

Easy ways to get your 5 fruit and veg a day | Change4Life . 2011. Easy ways to get your 5 fruit and veg a day | Change4Life . [ONLINE] Available at:http://www.nhs.uk/change4life/Pages/adult-5-a-day.aspx. [Accessed 08 May 2011]

 

Walk4Life. 2011. Walk4Life. [ONLINE] Available at: http://www.walk4life.info/. [Accessed 08 May 2011]

Dunne, J, 2001. Nutrition Almanac. 1st ed. Blacklick, OH, USA : McGraw-Hill Professional Publishing .

Role of Stress, Arousal, and Coping Skills in Primary Insomnia . 2011. Role of Stress, Arousal, and Coping Skills in Primary Insomnia . [ONLINE] Available at: http://www.psychosomaticmedicine.org/content/65/2/259.short. [Accessed 09 May 2011].

Impact of sleep debt on metabolic and endocrine function : The Lancet. 2011. Impact of sleep debt on metabolic and endocrine function : The Lancet. [ONLINE] Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01376-8/fulltext. [Accessed 09 May 2011]

 

Inge Dougans, 1992. The Art of Reflexology: A New Approach Using the Chinese Meridian Theory (Health workbooks). Edition. Element Books

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