Digestive Health Newsletter

Managing IBD During the Holidays: Tips to a Stress-Free Holiday Season

Betty White, MN, ARNP

Volume 23, 
November 01, 2010

by Betty White MN, ARNP

Betty White Betty has been a nurse for over 17 years and has spent almost 13 years in gastroenterology. She currently manages the Infusion and Research Center at Digestive Health Specialists, where there are close to 200 patients on biologic therapy for inflammatory bowel disease. She has been appointed as a member of Crohn’s and Colitis Foundation of America’s (CCFA) National Nursing Advisory Board and the Medical Education Committee of the Northwest Chapter.



Table of Contents



Introduction

Most of us experience some form of stress during the holidays. If you have inflammatory bowel disease (IBD), holiday stress can increase symptoms such as diarrhea or abdominal pain, causing you to miss out on family gatherings, travel, and the joy of the holiday season. This newsletter will focus on suggestions to help you get through the holiday season feeling healthy and happy.

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How can I manage the extra shopping?

Plan your trips by making a shopping list ahead of time and checking that the stores you’ll be visiting have public restrooms. If you’ll be spending the day at the mall, don’t forget to bring along your medication, so you don’t miss a dose. You may find it helpful to shop with a family member or friend who can hold your place in a line if you need to rest or use the bathroom. Or, try asking others to shop for you. If you make a detailed list with price ranges and information about where to find a particular item, someone else can easily make the actual purchase, allowing you to avoid the stores all together. Shopping online may also be an alternative.

Next year, be proactive and try shopping for holiday gifts throughout the year. In January, make a list of the family and friends to whom you would like to give gifts and the sorts of things they need or enjoy. Then, each month make it your goal to purchase one item on your list. That way, when December rolls around you will have already purchased gifts for at least 11 people, making holiday shopping less stressful on your body and your wallet.

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What should I think about before making airline reservations?

Consider asking for an aisle seat near a bathroom. Pack a carry-on bag with water and food you can tolerate, as well as extra undergarments, cleansing wipes, ostomy supplies (if required), and a plastic bag for soiled clothing.

Make sure all medication is clearly labeled in its original container and that you have a two or three day supply in your carry-on bag, just in case your luggage is lost or misplaced. If you use injectable medication that needs refrigeration, ask the airline if they can store it for you during your flight, as typical ice packs stay frozen only for several hours and may not be permitted in carry-on bags depending on current security measures.

If you are traveling overseas, take care to avoid travelers’ diarrhea and consider asking your physician about having a prescription for antibiotics on hand. Regardless of what medication you pack, it’s always a good idea to have a note from your doctor that lists each prescription and its purpose. Depending on your destination, you may also require one or more vaccines, but keep in mind that some cannot be given to patients taking medications like azathioprine, 6-mercaptopurine (6-MP), or biologic therapy. The International Association for Medical Assistance to Travelers can help you locate clinics around the world, so that you know where to go in an emergency, and the “IBD and Your Lifestyle” newsletter provides more tips about traveling with IBD, as does the Crohn’s and Colitis Foundation of America (CCFA) Web site.

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How can I keep up with all of my social obligations?

Learn to say “no” by giving yourself permission to pick and choose what you do during the holiday season. Figure out how many events you can handle in a week without feeling stressed and exhausted, and then try to prioritize which to attend and which to graciously decline. Keep in mind that it doesn’t have to be all or nothing -- in some instances you may feel up to making a brief appearance at a party, but not staying for the entire evening.

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How can I stick to my diet at holiday parties?

If you are invited to a dinner or open house, try offering to bring a dish. That way you can be sure there will be food that you can safely eat. You can explain that you are following a particular diet or simply say that you’d like to share a favorite recipe. When it comes to cocktail parties, it might be best to eat before you leave your house, so you won’t be tempted to eat something that might not agree with you just because you’re hungry. Regardless of the occasion, it is always safest to pass on a dish if you are not sure about its ingredients.

When it comes to alcohol, there is no proof wine, beer, or other liquor will make your IBD symptoms worse. However, alcohol can interact with antibiotics, pain medications, and some anti-inflammatory medications, so always be sure to check with your pharmacist before drinking alcohol if you are taking any over-the-counter or prescription drugs.

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Are there particular foods that I should avoid during the holidays?

When it comes to specific foods, there is no single answer that works for everyone with IBD. However, you may find that avoiding greasy, rich foods and high-fiber foods will help with gas, diarrhea and bloating. Many patients also find that avoiding dairy foods and choosing foods that are low in gluten improves symptoms. For example, try this easy recipe for gluten-free peanut butter cookies. I usually suggest eating a healthy amount of lean meats, fruits, vegetables, and grains, as tolerated. You may find that keeping a food diary may help you identify what foods you tolerate well and what foods you should avoid.

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What is the best strategy for managing stress?

Even when you have the best intentions, it can be hard to avoid stress during the holidays. And although stress does not cause IBD, it can certainly make it worse. Different methods of managing stress work for different people. You may find that exercise is a good outlet. Sometimes taking a long walk can work wonders. Or maybe it’s helpful for you to put up your feet for a few minutes and listen to your favorite music. Sometimes, managing stress can be as simple as remembering to breathe. Try to focus on breathing in serenity and breathing out stress. That’s a technique you can use no matter where you are, whether it’s waiting in a long line at the grocery store or waiting for your in-laws annual visit.

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Conclusion

However you celebrate the holidays, when you have a chronic disease it’s best to plan ahead, keep to your routines, and know your limits. Remember that life isn’t perfect, and that goes for the holidays too. It probably won’t be possible for you to throw the perfect party, accept every invitation, or buy the perfect gift for each person on your list. But if you keep a sense of humor and focus on what you can do, you might just find that you have a new outlook on the season.

Happy Holidays!

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Flourless Peanut Butter Cookies

Ingredients

2 cups peanut butter

2 cups sugar

2 eggs

Instructions

Preheat oven to 350o. Combine sugar and eggs until well mixed. Add peanut butter. Refrigerate for 30 minutes or until firm. Place teaspoons full of dough on cookie sheet. Using a fork dipped in sugar, press cross marks into the top of the cookie. Bake for 12 minutes and let cool before transferring to plate.

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Important Safety Information about AZASAN

WARNING: Chronic immunosuppression with this purine antimetabolite increases risk of neoplasia in humans. Physicians using this drug should be very familiar with this risk as well as with the mutagenic potential to both men and women and with possible hematologic toxicities. See WARNINGS section in complete Prescribing Information.

AZASAN® (azathioprine tablets) 75/100 mg is indicated as an adjunct for the prevention of rejection in renal homotransplantations, and also for the management of active rheumatoid arthritis to reduce signs and symptoms.The most commonly reported side effects associated with AZASAN therapy are leukopenia and/or thrombocytopenia, secondary infections, neoplasia, nausea, vomiting, diarrhea, fever, myalgias, skin rashes, and hepatotoxicity. AZASAN therapy should be given cautiously when used concomitantly with allopurinol, ACE inhibitors, and other agents affecting myelopoiesis. AZASAN is contraindicated in pregnant and lactating women and in patients who have shown hypersensitivity to this product.

Consult with your physician to see if this product is right for you.

Complete Prescribing Information for AZASAN, including BOXED WARNINGpdf

Important Safety Information about METOZOLV® ODT

WARNING: TARDIVE DYSKINESIA

See full prescribing information for complete boxed warning.

Treatment with metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with the duration of treatment and the total cumulative dose.

Metoclopramide therapy should be discontinued in patients who develop signs or symptoms of tardive dyskinesia. There is no known treatment for tardive dyskinesia. In some patients, symptoms may lessen or resolve after metoclopramide treatment is stopped.

Treatment with metoclopramide for longer than 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia.

METOZOLV® ODT (metoclopramide HCl) is indicated as short-term (4 to 12 weeks) therapy for adults with symptomatic, documented gastroesophageal reflux disease (GERD) who fail to respond to conventional therapy and for the relief of symptoms associated with acute and recurrent diabetic gastroparesis (diabetic gastric stasis) in adults. Therapy should not exceed 12 weeks in duration. Take on an empty stomach up to four times daily, at least 30 minutes before eating and at bedtime.

METOZOLV ODT is contraindicated in patients with intestinal obstruction, hemorrhage, or perforation; pheochromocytoma; known sensitivity or intolerance to metoclopramide; epilepsy; or are receiving concomitant medications with extrapyramidal reactions.

Extrapyramidal symptoms (EPS), manifested primarily as acute dystonic reactions, occur in approximately 1 in 500 patients treated with the usual adult dosages of 30 to 40 mg/day of metoclopramide. These usually are seen during the first 24 to 48 hours of treatment with metoclopramide, occur more frequently in pediatric patients and adult patients less than 30 years of age and are even more frequent at higher doses.

Drug-induced Parkinsonism can occur during metoclopramide therapy, more commonly within the first 6 months after beginning treatment, but also after longer periods. Patients with a history of Parkinson’s disease should be given metoclopramide cautiously, if at all, since such patients can experience exacerbation of Parkinsonian symptoms when taking metoclopramide.

There have been rare reports of an uncommon but potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) associated with metoclopramide. Clinical manifestations of NMS include hyperthermia, muscle rigidity, altered consciousness, and evidence of autonomic instability. The management of NMS should include immediate discontinuation of metoclopramide and other drugs not essential to concurrent therapy.

Depression associated with metoclopramide use has occurred in patients with and without a history of depression. For those patients with a prior history of depression, metoclopramide should only be given if the expected benefits outweigh the potential risks.

In one study in hypertensive patients, intravenously administered metoclopramide was shown to release catecholamines; hence, caution should be exercised when metoclopramide is used in patients with hypertension. Any rapid rise in blood pressure associated with METOZOLV ODT use should result in immediate cessation of metoclopramide use in those patients.

Since metoclopramide produces a transient increase in plasma aldosterone, patients with cirrhosis or congestive heart failure may be at risk of developing fluid retention and volume overload. If these side effects occur at any time in any patients during metoclopramide therapy, the drug should be discontinued.

Adverse reactions, especially those involving the nervous system, may occur after stopping the use of METOZOLV ODT.

In clinical studies, the most frequently reported adverse events (≥2% occurrence) were headache, nausea, fatigue, somnolence, and vomiting.

Complete Prescribing Information for METOZOLV ODT, including BOXED WARNING pdf

Important Safety Information about OSMOPREP

WARNINGS

There have been rare, but serious reports of acute phosphate nephropathy in patients who received oral sodium phosphate products for colon cleansing prior to colonoscopy. Some cases have resulted in permanent impairment of renal function and some patients required long–term dialysis. While some cases have occurred in patients without identifiable risk factors, patients at increased risk of acute phosphate nephropathy may include those with increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, or baseline kidney disease, and those using medicines that affect renal perfusion or function (such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], and possibly nonsteroidal anti–inflammatory drugs [NSAIDs]).

It is important to use the dose and dosing regimen as recommended (PM/AM split dose).

OSMOPREP® (sodium phosphate monobasic monohydrate, USP, and sodium phosphate dibasic anhydrous, USP) Tablets are indicated for cleansing of the colon as a preparation for colonoscopy in adults 18 years of age or older. Considerable caution should be advised before OSMOPREP is used in patients with severe renal insufficiency, congestive heart failure, ascites, unstable angina, gastric retention, ileus, severe chronic constipation, bowel perforation, toxic megacolon, gastric bypass or stapling surgery, or hypomotility syndrome. Use with caution in patients with impaired renal function, patients with a history of seizures or at higher risk of seizure, patients with higher risk of cardiac arrhythmias, known or suspected electrolyte disturbances (such as dehydration), or people taking drugs that affect electrolyte levels. Patients with electrolyte abnormalities such as hypernatremia, hyperphosphatemia, hypokalemia, or hypocalcemia should have their electrolytes corrected before treatment with OSMOPREP.

OSMOPREP is contraindicated in patients with a known allergy or hypersensitivity to sodium phosphate salts or any of its ingredients, and in patients with biopsy–proven acute phosphate nephropathy. In clinical trials, the most commonly reported adverse reactions (reporting frequency >3%) were abdominal bloating, nausea, abdominal pain, and vomiting. It is recommended that patients receiving OSMOPREP be advised to adequately hydrate before, during, and after the use of OsmoPrep.

For complete Prescribing Information for OSMOPREP including BOXED WARNING.pdf

Important Safety Information about VISICOL

WARNINGS

There have been rare, but serious reports of acute phosphate nephropathy in patients who received oral sodium phosphate products for colon cleansing prior to colonoscopy. Some cases have resulted in permanent impairment of renal function and some patients required long-term dialysis. While some cases have occurred in patients without identifiable risk factors, patients at increased risk of acute phosphate nephropathy may include those with increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, or baseline kidney disease, and those using medicines that affect renal perfusion or function (such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], and possibly nonsteroidal anti-inflammatory drugs [NSAIDs]).

It is important to use the dose and dosing regimen as recommended (PM/AM split dose).

VISICOL® (sodium phosphate monobasic monohydrate, USP, and sodium phosphate dibasic anhydrous, USP) Tablets are indicated for cleansing of the colon as a preparation for colonoscopy in adults 18 years of age or older. VISICOL is not to be used in patients with congestive heart failure, ascites, unstable angina pectoris, gastric retention, ileus or acute obstruction or pseudo-obstruction, severe chronic constipation, bowel perforation, acute colitis, toxic megacolon, or hypomotility syndrome. Use with caution in patients with impaired renal function, pre-existing electrolyte disturbances, or people taking drugs that affect electrolyte levels. VISICOL is contraindicated in patients with a known allergy or hypersensitivity to sodium phosphate salts or any of its ingredients. In clinical trials, the most commonly observed (≥1%) adverse reactions occurring with use of VISICOL were generally transient and self-limited and included nausea, vomiting, abdominal bloating, abdominal pain, dizziness and headache.

Consult with your physician to see if this product is right for you.

Complete Prescribing Information for VISICOL, including BOXED WARNING pdf

The information contained on this page is intended for US patients, healthcare professionals, and pharmacists only.

WB 10/05

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