As I deal with Crohns, they like to do a colonoscopy every year given the greatly increased chance of cancer. So in March I had my yearly colonoscopy with the EGD this time and here is a summary of the results.
(I had to ask a couple of times to get a hard copy of the pathology report with notes, but I do prefer to see the data like this.)
There were a total of 35 biopsies taken with 20 repeat biopsies from the same site sent out for mast cell testing. The reason there were repeated samples taken is that he wanted to send a set out to the Mayo clinic lab for the mast cell counts and to act as a cross check for the local lab, the local lab was not setup for mast cell testing.
Here are the locations - the number of biopsies and the (mast cell counts)
Cecum - 3 (7,12)
Ascending colon - 4 (16,16,15)
Hepatic Flexure - 1 (12)
Descending Colon - 4 (17,14,12)
Transverse Colon - 5
Splenic Flexure - 2
Duodenum - 2 (15)
Gastric - 3 (15,14,14)
Esophageal - 3 (7,9)
Sigmoid Colon - 4 (9,9,12)
Rectum Biopsy - 2
Terminal Illium - 2, (15, 14)
Overall the mast cell counts average about 14 (range 7 - 17) which while considered "normal" it is elevated they seem to be more or less the same through the GI tract. So it is above the accepted normal range, but not high enough for a Dx
The pathologist did not individually list all of the collagen membrane thicknesses but made a note in the report that the higher numbers were noted in the ascending and transverse colon and that the average is at 7um, which shows improvement over the last set which was closer to 12 microns. There was no signs of polyps and the crypt disturbances were limited to the terminal illium.
Overall it is a good report in that there is no signs of cancer, the collagen band thicknesses have reduced and there is little signs of active Crohns in the terminal ilium or colon. The one interesting note is the somewhat increased mast cell counts and a good question is does this increase mean anything? It's higher than the baseline, but not high enough for a Dx.
Besides the colonsocpy results, I did struggle these past weeks with a pretty good flare up, I'm sure it's due to a mix of physical stresses from the colonoscopy and simple emotional stress. One thing that has occurred is a flare up of lower back, hip and knee joint pain combined with uveitis.
Due to these symptoms, my GI doc did run a blood test to see how the levels of the active component of Imuran were in my blood and they were found to be well below the therapeutic range. Typically my levels of Thioprine (the active component of Imuran) are at about 430ng/ul and they had fallen to 216ng/ul. The low end that's considered effective is 330ng/ul. To remedy this I have increased my Imuran daily dosage 25% and will have the levels checked again in July.
As part of these symptoms, especially the lower back pain in the sacrum, hip pain coupled with the eye pain, my doctor had a genetic test done for the gene HLA-B27 which is a possible indicator of Ankylosing Spondylitis (AS) and it did come back positive. Although you should note that having this gene does not mean you have AS, but those with AS have this gene 90% of the time. To look into this further I have an appt with a rheumatologist on the 21st of June.
I did find out though that it is somewhat common to have AS with various IBDs and it has been postulated that AS in and of itself may be a cause of chronic D.
So thats the health summary in a nutshell...overall I'm doing fairly well and this most recent flare has more or less settled down, now it's time to figure out what up if anything with AS
Well it's time to get ready and do my favorite kind of cooking ...BBQ....
Edit...and added data...my vitamin D levels are at 31 while taking 5000 units a day for the last year.
