Strange symptoms lead to double diagnosis

Steven Bowman Jr. is a football fanatic. So the early fall of 2005 was like many before, with Steven playing his heart out with a Chesapeake parks and recreation league team. But something was different this season: Steven began losing weight and complaining of "tummy troubles."

Over the next several months, the 10-year-old went from 81 pounds to around 60 pounds. Though he had occasional episodes of vomiting, diarrhea and fatigue, he always quickly felt better, and tests ordered by his pediatrician didn't shed any light at first on his symptoms.

His mom, Selece Bowman, was concerned, but she thought his weight loss might be because of increased activity during that time.

Later that school year, Selece mentioned Steven's strange symptoms during a visit to Dr. Angela Hogan, his asthma specialist at CHKD. Dr. Hogan knew Steven well enough to realize something wasn't right. So she recommended that Steven see a gastrointestinal specialist right away. "She made the referral that day with Dr. Willis at CHKD," Selece said.

That's when pediatric gastroenterologist Lauren Willis entered Steven's life. She arranged for a complete battery of tests, including blood work, X-rays of his small intestines, an endoscopy to view the inside of the upper part of his digestive tract and finally a colonoscopy of his large intestines with a biopsy of tissue from his colon. Her conclusion was Crohn's disease.

Dr. Willis explained to the Bowmans that Steven was suffering from the chronic bowel condition that causes inflammation of the digestive tract – usually the small intestines – that may recur at various times over a lifetime. There are many theories about what causes Crohn's disease. Recent research has shown that some patients clearly have genetic factors playing a role. Environmental factors and intestinal bacteria also contribute to the complex equation.

"It is a very insidious disease," Dr. Willis explained. "It comes on slowly and can be hard to detect at first. Often it can take several years to get to a diagnosis."

While Crohn's disease may come on at any age, the age group most often affected is between 15 and 35 years. There are about 50,000 people in the U.S. with Crohn's disease, according to Dr. Willis, "and it seems to be on the increase."

The Bowmans were grateful to know the cause of Steven's discomfort and weight loss because it meant they could help him get on the right track with nutrition and alleviate his suffering.

"I was really worried because I was dropping weight," Steven said. "But I knew Dr. Willis would figure it out and help me get better."

And that's exactly what happened.

A multi-pronged treatment plan was built around a healthy diet to ensure adequate nutrition and weight gain and medications to help control bowel inflammation and assist the boy's immune system.

"Steven has done very well," Dr. Willis said. "Once we get the disease under control, we expect long periods of remission. But we have to keep a watchful eye, because there is no way to predict when a remission may occur or when other symptoms will return. Otherwise, there's no reason for Steven not to grow up normally, be able to participate in activities like other children and go off to college some day."

As Steven's spirits soared, so did his weight, along with his strength and stamina. But he and his family were about to make another unexpected revelation with a different connection to CHKD. During a routine blood test, Dr. Willis discovered that Steven had an unusually high level of sugar in his blood,

The new diagnosis was type 1 diabetes, a second chronic autoimmune disease.

"There isn't a strong connection between Crohn's disease and diabetes," Dr. Willis said, "but we know that auto-immune diseases can coexist."

So Steven started down yet another path of education and care, this time from CHKD's diabetes specialists.

"By the time I learned about the diabetes, I wasn't afraid," Steven said. "I knew they'd take care of me this time too." During a brief period of hospitalization, Steven received intensive education on how to control his diabetes.

Today at nearly 12 years old, he weighs a healthy 98 pounds and is looking forward to the coming football season. At Hickory Middle School, he especially likes math and playing clarinet in the band. This summer's plans include a week-long mission with his church youth group to help feed the homeless at a Washington, D.C., shelter.

His frequent visits to his CHKD doctors are usually close to home at the CHKD Health Center at Greenbrier, where his mother is often able to schedule appointments that coincide for both Steven and his brother, Stanford, 6, who sees a speech therapist.

"Steven is very comfortable with the asthma, Crohn's and diabetes," his mom said. "He's the master of his own medications and CHKD has been there for him – and for all my family – the whole way. Otherwise, I couldn't imagine dealing with these challenges."

Drs. Hogan and Willis practice at CHKD with Children's Specialty Group PLLC.