Thursday, October 30, 2014

IBD Springboard: Moving from Pediatric to Adult Care Review



Photo from the Springboard flyer.


I had the privilege this summer to present at the first IBD Springboard: Moving from Pediatric to Adult Care co-sponsored by Pediatric IBD Center at UPMC Children’s Hospital of Pittsburgh, the Visceral Inflammation & Pain (VIP) Center, and the Adult IBD Center at UPMC Presbyterian. This event focused on young adults who experience major transitional growth during their late teen years. Issues can be even more involved for those with IBD (Inflammatory Bowel Disease: Crohn’s disease and ulcerative colitis) transitioning from high school to college lifestyle. Flare ups are often difficult and need special food attention during and after an episode. IBD individuals and families sometimes don’t think enough about nutrition when the IBD is in remission. The pressure to fit in with friends and peers can be overwhelming when the young adult is transitioning into independence and they often want to feel normal by trying to “fit in”. Some of the top challenges of pediatric care transfer to adult care were discussed. Not only does an IBD individual now have classes to juggle and new responsibilities, but they also have to be keenly aware of how to communicate with their professors about IBD, self-management, adherence to treatment program and medication (Mom isn’t there anymore to wake you up and make sure you have your meds refilled), and more. I can’t say enough how much being a part of this great event meant to me.

I have to say a special thank you to Joy Jenko Merusi, Director, Digestive Health Programs, Division of Gastroenterology, Hepatology and Nutrition of University of Pittsburgh who made this event possible.

This post isn’t meant to diagnosis or treat IBD. Please seek out specialized medical care. If seeking further information for the services that this event discussed, please visit http://www.dept-med.pitt.edu/gi/ibd.html.
  
IBD Springboard: Moving from Pediatric to Adult Care Key Note Speakers
 
  Taking Control, David Keljo, MD PhD – Pediatric Gastroenterologist/Director, CHP IBD Center. AMAZING!! Dr. David Keljo thoroughly explained IBD pediatric transfer and considerations.
  Accommodations & Services: What Can I Request?, Noreen Mazzocca, MSEd – Disability Specialist, University of Pittsburgh. Extended flare ups and missed classes can be navigated through if proper protocols are taken prior to the semester. I learned from this speaker and especially from the young college panelists that it is paramount to contact the Disability department before entering college. Again, I can’t stress the importance that you are not disabled with IBD, BUT you are your number one and need to pre-plan with the best possible resources available if a flare up happens.
  Sleep & IBD: Secrets to College Survival, Eva Szigethy, MD, PhD – Psychiatrist & Founder/Director, VIP Center.  Here I learned about the great resources that VIP center offers. Dr. Szigethy broke down why IBD need sleep….and good quality sleep at that.
  Creating a New Eating Norm for Living in the Dorm, A very catchy title that Leslie Bonci, MPH, RD, CSSD, LDN, Director of Sports Nutrition, UPMC provided. Thank you Leslie for the valuable information you passed along! I was thrilled to be able to fill in and present at the event. 


**Plus a Young Adult Discussion Panel: I thought this was a very valuable component. A panel of six college students (Pitt, Slippery Rock, Butler Community College, Thiel, and Duquesne) with IBD provided a Q&A session. I was hanging on to every word they said in describing their experiences. They used their own real life experiences to help teens learn how to speak up and also navigate life in college. Some of the major points they spoke about were:

  • Don’t be afraid or wait to speak up. Contact the colleges’ Disability Specialist before college starts and fill out all the proper paperwork even if you don’t think you need it.

  • Talk to each teacher privately after a class or during their office hours and let them know. This is very important in that you’re not trying to play catch up if a flare up happened in the midst of midterms. This is where to the importance of a dialogue with the Disability Specialist was highlighted by all the students.

  • Don’t wait till you’re sick to go to the doctor. Go when you are starting to get sick…NOT after you are very sick.


MAJOR Nutritional CONCERN WITH IBD
  Inadequate intake due to pain after eating
  Increased nutrient requirements/losses
  Poor intestinal absorption due to surgery
  Chronic Diarrhea (not fun if you’re close quarters with roommates)
  Drug-Nutrient Interactions
  Food Phobias (e.g. total elimination of essential food groups)
  Increased nutrient requirements


WHY IS THIS AN ISSUE?
So why is college a concern? Keeping it simple, college is a very transitional period in time for any freshman. When you add in a gastrointestinal considerations, balance is essential in studies, social life, nutrition, medications, sleep, professional development, etc.
  • The majority of college freshmen will experience some change in body in the first year at school
  • On average- a 5 pound weight gain- NOT the “freshman 15” that is often stated
  • Calcium and iron intakes tend to be low
  • Most frequent complaints:
    • Fatigue
    • Colds
    • Headaches
    • Digestive issues


WHY DOES THIS HAPPEN?
There are several differences in eating behavior between high school and college such as:
  • Different schedule- may vary day to day
  • Greater food availability- cafeteria style vs. what is at home
  • Different times of the day to eat
  • Experimenting with new eating patterns such as vegan, vegetarian
  • More late night snacking, but more likely to be higher calorie items
  • Less availability of fruits/veggies due to limited refrigerator space and what the cafeteria stocks
  • Composition of meals can range from salads to cereal
  • No one is telling what to or not to eat!
  • Alcohol
  • Activity may decrease if you don’t participate in a sport in college and you did in high school
  • In some cases, activity increases dramatically in sports participation due to the coach’s demands

KNOW YOUR GENERAL MEDICAL INFO!
A new student and family may want to know where the health center is located, what services are available, and how much they cost. It may even be helpful to establish a relationship with the school’s medical staff and having your hometown doctor or pediatric doctor release the medical records to the health center. Why would you want to do this? Well, the medical staff would be prepared if you do suffer a flare up. This is where I would recommend to gather the below bullet points before heading off to college. 

MEDICAL FILE CARD
       Year of diagnosis
       Segments of GI tract involved
       Past medications
       Current medications (type/amount/timing)
       Past surgeries
       Recent colonoscopy/EGD/CT/MRI results
       Current insurance information


WHAT TO DO ABOUT IT for IBD?
  • DO establish some kind of eating routine that you can live with
  • You may not get to the dining hall for breakfast daily, but you could still have breakfast by having a piece of fruit and yogurt, or a bowl of cereal, or a packet of instant oatmeal in your room
  • Do be careful about what you keep around for evening snacks
    • Snack size bags of microwaveable popcorn
    • Instant oatmeal
    • Soup
    • Yogurt
    • Packets of flavored tuna
    • Nuts, cereal and dried fruit for trail mix
  • Do be smart about the ALCOHOL. Alcohol is a trigger for an IBD flare up. Trust me, don’t be afraid to say no to your friends/peers. Remember, everyone’s friend is the person who volunteers to be the designated driver.
  • If you are tired all the time, the caffeine is only going to do so much. SLEEP is essential. Really, I can’t stress enough how important sleep is for maintaining health in IBD
  • Make sure you are eating enough and often enough to provide your body with energy

CONCLUSION
In college, slow down. Make eating a priority and not an afterthought. Seek out the resources available at college if there needs be accommodations for possible flare ups. Contact the health center prior to the semester and establish a relationship with the dinning management and the college registered dietitian if there is one on staff (potential tour of the dining facilities could be a good bet).

Other resources to note:

Crohn’s and Colitis Foundation of America: http://www.ccfa.org

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: http://www.naspghan.org

Thank you!
Edie


P.S- Your dog pic of the day. Special visit of Kenya the Super dog.