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My Student Has Crohn's - What do I have to know?

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Posted 10/31/2007 3:50 PM (GMT 0)
Hey Crohn's Disease Forum,

I'm a high school teacher, and this year one of my students has Crohn's Disease. I don't really know much about this condition. The girl is smart, but misses a lot of class. I teach a morning class, and I've noticed that occasionally she'll miss my class and I'll see see that she's come to school later on in the day. It confuses me to see her sitting over with her friends after being too ill to come in to school in the morning.

I guess I just came on this forum to find out, from its collective experience, what I should know about having a student in my class with bad Crohn's. For example, is there anything you wish someone could have told your teachers back in high school, to make coping with your illness that much easier? I realize school is hard when your sick for a couple days, and must be nearly impossible when that sickness is constant. I really just want to understand.

Thanks,
Concerned teacher.
Posted 10/31/2007 3:57 PM (GMT 0)
there are some great brochures for teachers and administrator on the CCFA website to help you understand what your student is experiencing.

It is completely normal for a Crohn's patient to feel very ill in the morning or anytime of the day and for that to change within hours. Or vice versa, to feel completely fine and then wham.... be very ill.

The educational brochures from CCFA should be quite helpful for you.

Cudos to you for the taking the time to try to understand your students needs, so many don't!
Posted 10/31/2007 3:59 PM (GMT 0)
Hi, I'd like to say that I think it's wonderful you're coming here to learn about Crohn's. You're right, it is really hard to go through high school being sick, and being constantly sick with a fairly embarrassing condition.

I know for me, and a lot of others with Crohn's, the morning is the hardest time of the day. Throughout the night, your stomach is digesting your dinner, and you're not active to help with that digestion, so you wake up feeling ill, having cramps, sometimes being nauseous. A lot of the medications that we have to take also make us nauseous. For example, when I started Imuran, I took it at night to try and help combat some of the nauseous feeling, but even so, most mornings, I would wake up, and not want to get out of bed because of how badly I felt. That could be a huge factor in why your student isn't showing up until partway through the day.

I really wish that I could have told my teachers that the reason I wasn't doing assignments was due to the fact that after school, I was so wiped out and didn't want to do anything other than come home and sleep. It wasn't a disrespect to them, and I wanted to do my work, but I physically wasn't able to stay awake long enough to do it.
Posted 10/31/2007 4:01 PM (GMT 0)
The mornings are typically the most active time of the day with crohns, also you know what they say, "don't judge a book by it's cover"...she may not look sick as many if not most of us don't but that doesn't mean she's not having troubles functioning especially in the mornings....also being in high school I'm assuming she's mensterating and during that time of the month can exacerbate CD symptoms (possibly a pattern of when she's absent and not just late for class).

For me it was hard enough getting this DD in my early 20's I couldn't imagine what it must be like for children and teens when all they want to focus on is school, friends and having fun...with crohns she can't even experiance the "do what I want" feelings because this crappy disease is so limiting, not only does it affect us phycically but mentally/emotionally as well and the younger the CDer the harder it must be. Anxiety and depression often go hand in hand with this disease so if you notice any changes regarding this I hope you are able to discuss it with her, being so young she might not even realize if she gets depressed.

Also with having CD the urges to "go" are typically very frequent and fast. A typical crohnie often has to run to the bathroom as soon as the urges hit, many of us have had "accidents" even at home, let alone out in public. This is often what brings on anxiety, the worry of not making it to the toilet in time and soiling ourselves is very depressing and aggrivating. It's truly an ugly disease.

Sorry for the run on sentences teach!! LOL


:)
Posted 10/31/2007 4:15 PM (GMT 0)
CT....I want to thank you so very much that you are interested enough in your students to try and understand this disease.  My daughter was diagnosised when she was 12.  Her high school years were very hard on her.  Because of the nature of the disease she was/is very secretive about it.  Not many people knew.  I would inform the nurse and school counselor but she didn't want too many others to know.  Of course her teachers would know sooner then later that she was ill.  One thing she had to live with was that rumors were spread that she had an eating disorder because she got very thin.  That was hard for her to deal with. 

Just have patience with her, and if possible give her more time on assignments.  Michelle never missed school unless it was necessary and always did her work even if sometimes it was late. 

Posted 10/31/2007 4:18 PM (GMT 0)

Thank you for caring enough about your student to try to dig up more information. The following link takes you to the Crohn's and Colitis Foundation's web page.

If you scroll down under the "Brochures" heading, you will see a brochure you can download that is specifically meant for teachers and other school personnel.

http://www.ccfa.org/info/brochures/?LMI=3.4

Crohn's is a very serious and life-threatening disease. Most patients must take medicine every day of their lives and cope not only with the painful and depleting effects of Crohn's itself, but also with the toxic side effects of the medications. In fact, some of the most common drugs used to treat Crohn's are in the family of chemotherapy medicines.

What is really insidious about this disease is that Crohn's patients often don't look sick. They can be fine, or nearly fine, one minute and  on their way to the hospital in the next. Even when they look fine, they could really be in pain or exhausted.

Posted 10/31/2007 4:21 PM (GMT 0)

Well hello teacher!  Thanks for caring enough to find us.  i wish my niece (who is suspected of having Crohns) had a teacher like you.  Her teacher did not understand that sometimes running to the bathroom in 5 minutes was not an option and she had an accident at a young age.  Very traumatizing.

I also recommend a visit to ccfa.com for further info.  however, some basics thoughts:

Mornings do tend to be worse.  I often go to work later than "normal"

I do not look sick even when I am curling up like a ball from the pain.

CD can cause nausea, diarhea, constipation, bleeding, severe cramping, nutritional deficits-all of which can come or go anytime

Having Cd often means dietary restrictions and the wrong foods can exacerbate symptoms

Each person with CD is very different in care and symptoms

Sprinting to the bathroom--even if it means knocking people over is not uncommon

CD has some non digestive issues that some people get-eye issues, muscular, joint issues, skin manifestations so your student may have problems beyond just the "stomach cramping" that she would not want teen peers seeing.

Feel free to come to us with any questions....we may be miserable sometimes, but we generally have a great sense of support and humor here.  If you are comfortable offering us to her...recommend this site to your student

Posted 10/31/2007 4:23 PM (GMT 0)
Concerned Teacher,

I just wanted to say that your students are very lucky to have you as a teacher! You obviously care a great deal about your students if you have taken the time to seek out information that will help you understand one of the children in your class. I am sure the folks here will give you great insight.

Thanks for being a concerned teacher!
Posted 10/31/2007 4:42 PM (GMT 0)
I know everyone has already said it, but it really is great that you care so much about your student. In high school I would always try and downplay my disease because I didn't want to worry teachers/ get treated differently/ be the 'sick kid'. And that caused me a lot of trouble. Crohn's is so difficult to deal with, just on a day-to-day basis. Yeah, flairs (periods of intense inflammation) are miserable, but the regular day can be just as bad. Morning problems are very common among Crohnies, I have them myself. I'm in college, and I have to have very special circumstances for this reason. I don't have any classes before noon, and I don't have many classes at all. It's going to take me longer to graduate, but it's gotta be like that.

What people don't understand is that when I come to my classes, I'm fine. When I'm well enough to come in, I'm okay. And very often when I'm not, I pretend to be, or take pain killing drugs and fake it, because it's darned depressing to be sick all the time, and I really just need time with friends, or I think I'd explode (and be even more depressed than I am.)
High school was very hard for me because I'd miss a lot of classes from sickness. Crohn's is triggered and exacerbated by stress, so when I had a lot of work to catch up with, I'd get sicker and miss more school. It was this terrible, terrible cycle, and I'd end up with so much work left undone I would be too overwhelmed to even start it. I just lay in bed, feeling self-piteous and self-hating at the same time. And then I'd come in to school and the one thing that kept me sane was the couple minutes I could see my friends, and not my teachers, who had no idea what I was going through because I had downplayed it from the start, and just thought I was making excuses. I had a reputation in high school that was completely undeserved, and it tore me apart knowing teachers thought I was a 'slacker' when really I was just a sad, sick little girl who wasn't well equiped to handle her condition.

Haha, I hope that insight helped some. I guess there's a lot I wish I could have told my teachers, in hindsight. Crohn's sucks, always. It hurts physically, and in all other ways. It's hard to understand it's impact as an outsider, but I really do appreciate your attempts.

You should tell her about these forums, we're a good, supportive community to be a part of.
Posted 10/31/2007 5:20 PM (GMT 0)
Hi Teacher! Im so glad you came here.  There is a lot I wish everyone knew about crohns disease.  For me one of the big issues in high school was all the strict rules.  I was not diagnosed w/ crohns but at that time was told I had IBS (irritable bowel syndrome) which has a lot of the same symptoms.  Here are some of the issues I faced:

1.) Food and Drink. I could not eat in the morning or I would get instant diarrhea or vomit.  If I didn't eat at all I would get very very dizzy and naseaus.  I needed to get to school, get through maybe half of my first class, and then snack a little... maybe some crackers.  I also couldnt eat at home and then drive because I might have to use the bathroom.  The key was to get to school, eat, poop, then go to classes, and maybe poop some more.  But as you know, there is usually a no eating rule in school.  I also was always very dehydrated and wished I could have gum or water to deal with the dry mouth.  Also not allowed.  I broke all three of those rules and because I was a nice, smart, kid, most of the teachers just looked the other way.  I told most of them about my medical issues, in the process of being diagnosed, and they were good about it.  Also, if I snacked throughout the day my stomach was a lot better than if I just ate lunch. 

2.) Bathroom access.  We were expected to use the bathroom in the 2 minutes between classes.  Not always enough time, and crowded with peers that didnt' want to hear or smell what I needed to do.  Also, during classes all the bathrooms were locked (to keep out skippers) except the ones downstairs on the other side of school.  I would also need to ask permission, sign out, get a pass, get to the locked bathroom, sign in, etc.  All with a bathroom montior outside to prevent smoking.  Once I was honest with my teachers, a few let me go without a pass, and let me take their key off their desk to the upstairs bathroom so I could be in private, and not have to run as far.  This also made me a lot less nervous because I wouldn't have to interupt the whole class w/ my hand up just to go to the bathroom, sometimes for the third time that class.

3.) Gym class.  I was an athlete in high school.  I could run 5 miles every afternoon.  But I COULD NOT work out in the mornings due to my naseau and lack of food.  In my high school gym was a requirement.  If you missed a class you had to make it up.  Problem for me, I also sang so I had choir instead of study hall and after school I had my sports practices.  I had no time to make it up and the gym teacher wouldnt let me do extra miles in sports to credit gym class.  Also, if you missed gym you weren't supposed to be allowed to partake in the after school sports.  I also had an ovarian cyst at this time that we thought caused my issues.  My doctor wrote a not that I could be sick in the morning and not in the afternoon and to let me go to practice/games.  When I found out I was going to fail gym for missing too many classes I was nuts.  I wouldnt be "held back" a year despite the fact I had super grades.  I went to my principal and he said not to worry about it, he would take care of it.  I ended up w/ a C in gym and moved on to the next year.  Thanks principal.

4.) Field trips.  I had to go to the bathroom after eating so eating on a field trip was always scary.  School busses were also bad because they have no bathrooms and the whole school would have to wait if I needed to stop.  I think a better plan would be to allow a kid w/ crohns to travel w/ their parent or one of the chaperones in a seperate car.  That way if they need to leave or stop at any point they can. 

5.) Assemblys.  Any time I was in a large group I got really bad anxiety if I wasn't on the aisle seat.  I felt like I wouldn't be able to sneak out if I needed to go to the bathroom.  Make sure your student has access to an aisle seat whenever in groups.

6.) The nurses station.  Generally, the nurse was great.  However, they sometimes forget that throwing up and diarrhea are normal for us.  Any time I would throw up, she would want to send me home.  Sometimes throwing up made me feel better and all I needed was some mouth wash and to go back to class. 

The bottom line is there are too many hard and fast rules in a school setting.  It is necessary to manage mass chaos.  But, when you know you have a sick student, bend the rules.  Allow them what they need to feel better.  This is a lot easier when the student is open about his/her disease and other students know why that student has "special privileges."  However, if you see your student sipping a bottle of water, you can always just pretend you didn't see.

Thanks and let us know how things go!!

Posted 10/31/2007 5:25 PM (GMT 0)
i think you sholud let her have it easier than the other kids. teachers are supposed to be fair, i know, but do you think she feels life was fair making her sick all the tiem? other kids in high school go to school, do their homework, hang out with their friends,etc. the problems they hvae are things such as problems with parents, bad grades, boyfriend problems. this girl obviously has more to deal with. it was so scary in high school, knowing i was going to be sick for the rest of my life! and being sick all the time. and getting bad grades when i knew i could do better, but i was too sick and exhausted and sad and scared to do anything when i got home but lie around miserbale.

i am so glad i am out of high school. i dont know if i could do it again. i cant believe i even graduated at all. and i dont even have BAD cd!
Posted 10/31/2007 5:46 PM (GMT 0)

I think telling her you know what Crohn's is and if she needs to talk you are available, will mean a lot. She can't talk to very many people about it and having someone to care enough to research the disease means a lot. My mom gives me a hard time about not feeling well and she won't research and understand what I go through, and that hurts, even with me being a grown woman!

I work full time and went back to school in 2002 to get my Bachelor's degree. I did an adult program that was accelerated and the most stressful thing I've ever done. By the end of three years I thought I was dying. I had blood in the stool, cramping, extreme fatigue, joint pain every day and diarrhea constantly. I was finally diagnosed right as I finished school so started my treatment when my stress was gone, so things have gone well.

Something I wish I would have known about years ago was baby wipes! I have used them for a few years and they are a necessity for me now. I keep a baggy full in my purse always. So maybe slip her a travel size one and say hey, I heard these help!

Posted 10/31/2007 5:50 PM (GMT 0)
peachpitt- I respectfully disagree. Yes she should allow her the necessary accomodations but don't grade her differently w/ lower standards just because she has crohns. If the student says Ive been sick and need an extension fine. But the reason a lot of people don't disclose that they have crohns is because they do not want special treatment. I am sorry that you had such a hard time in high school. However, there are a lot of people with chronic illness that are able to keep up with their workloads and when they receive a good grade they want to know they earned it, not that their teacher felt bad for them. I agree that accomodations make a person whole. More time on tests to make up for time in the bathroom, more time to study if they have been sick, over looking the number of classes missed do to the disease, fine. But when it comes to grading, the standard should be the same.
Posted 10/31/2007 6:09 PM (GMT 0)
I agree with Fitzy. If she's missing mornings out of sickness and dragging herself in to sit with her friends then clearly she wants some sort of normalcy. Treating her completely different might not be doing her a favor!
That said, high school was not the most friendly place. Teachers seemed to feel they had to give assignments, busy work, every night, and your grade was dependent on doing them. I always understood the content of the classes and learned everything quickly, but it was the busy work that brought me down. It was like in high school, actually learning came second to jumping through dumb little hoops. Which is fine if that's all you have to worry about, maybe it's a game, but when you force yourself through school all day and come home ready to collapse, having three or four hours of meaningless drills and five paragraph essays ahead of you really sucks. And when this meaningless work piles up, it sucks that much more.
So yeah, you shouldn't just be like "disease = free pass" with her, that's not cool, but it's also not fair to hold her to the same level as the rest of the class necessarily. I don't know what to say, use your judgement, I guess.
Posted 10/31/2007 6:32 PM (GMT 0)
It is funny that I saw this post today because I was just thinking to myself last night -  how would I have handled this disease if I were still in high school.  I didn't get Crohn's until my first year of college and you have a bit more freedom then but I have a son in 9th grade and I was thinking how do you go to the bathroom in the 3 miutes they give you to get from class to class?  Luckily my son doesn't have Crohn's so it isn't a concern for him. 

Mornings are more difficult for most crohnies but eventually you figure out a routine that works for you.  I work and still have to be to work everyday by 8:00 so I have built extra time into my morning routine to allow for setbacks. 

I would say the thing that your student needs the most is the freedom to leave class to use the restroom without permission and no questions asked.  And if you think it is being abused then you would need to have a chat with the student.

In my 16 years of having this disease my take has always been that I am in control, not my crohn's I have not allowed it to run my life.  The easier you make it for this student the less she is in control and unfortunately that will not help them in the long run.  She i not always going to have  adifferent set of rules than everyone else in life.

So cut her some slack but not so much that she doesn't have to work for her grades.

MB

Posted 10/31/2007 8:30 PM (GMT 0)
Teacher you are wonderful to care enough to find out what you can do to help this student. I was diagnosed my senior year in high school and missed SO MANY days of school! I had a few teachers who were always on my case about missing school or missing my assignments and all I was trying to do was just survive!

Yes, mornings can be the "worst" part of the day for people with Crohn's. It was and still is for me. So, it's normal for her to show up later in the day and NO, it doesn't mean she's not sick. She can be sick and not "look" sick.

As a fellow teacher (now unable to work due to crohn's) I would tell you to go easy on her in the way of not giving her a hard time for absences or missed work. Yes, she gets the grade she earns, no passes for missed work, but if she's struggling with a recently diagnosed illness, she's got more to worry about than some missing assignments. I don't know what your teaching style is, but you know there are those teachers who think that the whole world revolves around their single class. This girl won't be able to make that happen for you, so just be understanding. AND... let her go to the bathroom without even asking. Take her aside and tell her that any time she needs to go, she can just get up and leave. I remember being in high school and a teacher did that for me! God bless that woman. Having to go #2 in the high school bathrooms was bad enough, but worrying that I'd have to ask in front of everyone to leave, OR worrying about not making it there in time.... was enough to make me want to stay home every day. She will be grateful for your compassion.
Posted 10/31/2007 10:47 PM (GMT 0)
Hi Your student is lucky that you have interest in it's condition.I have a child with IBS and it has not been easy at times some nights were painful and it is harder to concentrate when in pain. Crohn's can be a painful tiring condition which effects anywhere from mouth to anus. Some of us have had complications of abcess and fistula's. B-12 is usually low and some nutrients don't always get into our system. Children need most support and understanding because stress can cause pain and symptoms. Being allowed to stay after school or more time for asignments help. As people have mentioned meds can cause side effects which can be hard to deal with. They also need private bathroom time because being in a public situation causes them stress and they try not to go to the bathroom when they should be going without the other students around no one needs a bunch of people around when you are in pain and trying to get something out of you think of being in the delivery room with a bunch of people present not a very good situation to be in .Most of all being patient and understanding will make your student less stressed and worried. Only your student knows what is going on inside it's body. lol gail
Posted 10/31/2007 11:27 PM (GMT 0)
Its so awesome to see a teacher concerned about one of your students as much as you are. I am 21 with crohns and have to kids. It is a very horrible disease, and the most active part of the day for me is the mornings. It will make you very fatigued and there are a lot of days the only time I can get out of the bed is if I need to use the bathroom. It is also very painful and very difficult to live with. I'm young and I can relate to how it feels to have this condition. Its very hard to understand why it happened or understand why things go the way they do. First of all he/she needs all the support from friends, family, and teachers like you that they can get. I suffer from severe depression now, and sometimes I feel like slapping myself to snap out of it. I can only imagine how bad it must be to have to go to school being so sick. I lost my job when I first got diagnosed for taking to much time while I was in the hospital and haven't been able to work since. It's very important that your student knows not to lose faith. Talk with her and encourage her to keep her head up, because there are many brighter days ahead. Good luck and I appreciate the fact that you are so caring for your students.
Posted 11/1/2007 6:04 PM (GMT 0)
im not saying you should be like "disease girl.....A++" im saying you should just remember that when grade. like, mabye not for homework, but for like the overall grade. grades dont mean much really, like someone said, its about jumping through hoops. its hard to jump when your in a lot of pain, that's all im saying. when your guts are bleeding its hard to walk, let alone jump.
Posted 11/2/2007 12:43 AM (GMT 0)
Kudos to you, concerned teacher for reaching out and caring. I am a special education administrator and former school psychologist. I also have Crohn's. All of the suggestions and descriptions above are excellent. In addition, by law, if students have certain medical conditions that negatively impact them educationally, they may qualify for an accommodation plan under Section 504 of the Individuals with Disabilities Act. This is not necessarily special treatment but could include things like extended time, ability use the restroom when needed, shortened day, etc.just to "level the playing field". Check with your school psychologist or check the student's record to see if she might have a 504 plan-otherwise you can talk with her about whether she thinks one would be helpful and you can make a referral for one.
Posted 11/2/2007 1:45 AM (GMT 0)
Concerned Teacher,
Please understand that Crohn's is a very individualized disease. But a mild equivalent would be like the worse case of flu you ever had and experiencing that every day for years, just occasinally, or at certain times of the day. There could be times that it is hard for her to walk and etc. due to the extra-intestinal effects of Crohn's in addition to the situations that were stated above.
Navy
Posted 11/2/2007 3:21 AM (GMT 0)
Dear Concerned Teacher,

I know you've had plenty of praise for your concern, but I have to commend your level of dedication as well. It is so refreshing as a parent to see a teacher taking the time to notice, and then inquire via this website for information, and on your own time. I can tell that your the kind of teacher that is always observing your students to see if they are doing well, well adjusted and enjoying your class. 

I don't have much more advice that several others here haven't already offered. Perhaps offer some individual help to make up for missed class time. I know that's a tall order, but I think you'll feel very good about donating your time in such an important way.

Posted 11/2/2007 3:36 AM (GMT 0)
Hello CT and Welcome. Like everyone else, I think it's great that you're making the effort to learn about Crohn's and how you might be able to help this young lady.

I have on occasion gotten into some trouble for talking about what is expected of us in terms of "reasonable accomodations" as required under the ADA in terms of working. Since I've been sick since I was a child, I can apply the same sort of "rules" to school as well. There is such a thing as cutting someone too much slack. Yes, she is sick and often the mornings are the worst for us. It certainly is for me, but that does not excuse unexplained abscences.

Have you discussed this with her and her parent(s)? Has she made any attempt to keep up with any schoolwork and/or projects that you require from the rest of the class? There were plenty of times that I was too sick to get to school or to work later on, but I always made an effort to keep my work up to date and to do extra projects that I'd work out with individual teachers. Having an illness does not require that we get a free pass on requirements, including addressing the problems we are having with our teachers, counselors or bosses. It is important to understand that we might be unable to make a specific deadline due to illness, but not to be completely excused from our responsibilities.
Posted 11/2/2007 4:27 AM (GMT 0)
Hi, I think it's great that you want to learn more for the sake of your student.

As many here said, mornings can be hard for us. For me it's worse the earlier I have to get up, that and after I eat. I was lucky enough to not get this until I was 19. But as of now I can not work. I tell everyone I know that I'm sorry but I just can't always be depended on when it comes to being somewhere at a certain time. The pain and diarrhea attacks can hit me at any moment, and can last anywhere from a few minutes, to several hours. To a few days! So that can be why you see her doing okay later in the day. Once my attacks are over, I'm tired, but okay too.

I won't say give her some slack as for as grades go. But I would say so on the attendance part. Maybe make it so that she can make up the work. But showing that you care will make a world of difference too.
Posted 11/2/2007 4:46 AM (GMT 0)
This is the best Place right here to learn about Crohn's. This is one of the worse disease anyone can get. I had a good friend die this year from this disease, she had Crohn's for a long time. I took it really hard because i have Crohn's myself.
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