Expert Q&A

Search our library of questions and answers below, or submit your own question to our panel of experts.

Questions Answered By Expert

Expert Image

Karlee Ausk, MD

associate director of the Swedish IBD Center

Q: My 17yo daughter was diagnosed with Crohn's 11 months ago. Currently being treated with Humira (since July). The last 3 1/2 months she has had several bouts with throat swollen glands. They are visibly swollen on the outside and painful to touch and painful inside. ENT thinks it is related to Crohns.GI specialist said he never heard of that. Overtime, the antibiotics do "work" but then 2 to 3 weeks later the swollen glands return.

A: I am sorry to hear that your daughter is having problems with swollen glands. Is her Crohn’s is under control? I have seen some children develop swollen glands on Humira and some of the considerations are: check Humira levels and if it is too high, consider titrating the dose. Discuss with your doctor if she should be seen by ENT and whether she needs an immunology evaluation. hide answer

Q: My 22 yr old son is a college student and takes Entyvio infusions for Crohns. I’m concerned and not finding thorough answers to whether or not he should be vaccinated for Covid. And if so, which vaccine is recommended. What are others doing in similar situation?

A: He should be vaccinated for COVID. Back in April 2021, the International Organization of IBD (which is a panel of international experts) said that we should vaccinate IBD patients with whatever vaccine we can first gain access to. All the 3 vaccines available in the US (Pfizer, Moderna and Johnson and Johnson) are fine in IBD patients. They all will need boosters as well. Of note, the response to the vaccine will be decreased by being on Entyvio, but this still confers your son a level of protection he would otherwise not have without the vaccine. hide answer

Q: I am getting ready to have another colonoscopy. I know that the split prep is typical. However, I am not willing to wake up in the middle of the night. I have two young children and the idea of being up more than I need to in the middle of the night is enough to make me cancel my colonoscopy (since I have no way to catch up on rest). I know that there are alternate schedules since I have done them in the past. What are some prep schedules that would not require me to be up at night?

A: Studies have shown that the split prep is more effective and providers a cleaner colon. The challenge is that almost any prep will have you waking up at night due to starting at 5pm and the colon getting moving early evening and likely throughout the evening. I think if you have concerns about your prep and timing, work with your ordering provider to see if you can arrange alternative schedule. Ie last colonoscopy of the day and doing alternative prep that still work meet requirements for NPO status. hide answer

Q: To get a UC flare under control, my doctor prescribed me prednisone, in a stronger and longer dosage than I've taken before. I was on 40 mg for 3 weeks, and through the tapering process am now at 30 mg. Two weeks ago at the 35 dose level, I started feeling funky -- very foggy and lightheaded, like I could not focus on anything. I still am experiencing this, with a bit of head pressure. Is this normal and due to the steroids? Is there anything I can do to mitigate these side effects?

A: Prednisone/steroids can make some people feel different/off. However if you are having any specific localizing symptoms like a headache or pressure I would recommend evaluation with a medical provider to do an examination and exclude other causes to your symptoms. It is challenging as there is really no way to mitigate the effects of steroids other than decreasing the dose or not taking them. Another consideration could be using a more gut selective steroid like budesonide-MMX (Uceris) or budesonide (Entocort) hide answer

Q: Hi, I'm 13 years old and was diagnosed recently with Ulcerative Colitis. When I flare, my hands get super dry, scaly, bloody, and painful. It only happens when my stomach is bad. Is this related to the illness?

A: It is challenging to answer this based on what you are describing as rashes are best visualized. However that being said skin manifestations of inflammatory bowel disease are common. When this happens I would recommend you send photo to your GI provider who might consider a dermatology referral for further evaluation. hide answer

NEXT