1. Patient: Carla Pennypacker Diagnosis: Chrons Disease

2. Chrons Disease

3. Symptoms of Chrons Symptoms: Carla has experienced Abdominal pains Abdominal pains Diarrhea Diarrhea Weight loss Weight loss Poor appetite Fever Night sweats Rectal pains Cramps in abdomen and sides Severe inflammation Inflammation in the colon Bloody Diarrhea Diarrhea Anal fistulae Peri-Rectal abscesses Inflammation in small intestine Tiredness Sluggish/ Tired

4. Body Systems Affected Digestive System: The small intestine is inflamed therefore affecting the digestive system Excretory System: The Large intestine is inflamed therefore affecting the Excretory system Circulatory System: The blood iron level lowers because of Chrons which can result in Anemia which affects the Circulatory system

5. Tests Tests requested: Test results: CBC CBC: RBC – 4.0 Colonoscopy WBC: 15,000 Shows severe inflammation in colon inflammation in colon Blood Iron Level Hematocrit: 30% Upper GI Series Shows narrowing and inflammation inflammation

6. Treatment Treatments: Patients with rare or mild symptoms don’t need any medications at all. There is no cure for Chrons but remissions help heal the swollen and infected systems.

7. Our suggestion We think that the best option for your treatment is to take Infliximab which is a new generation of medicine that controls the TNF (Tumor Necrosis Factor) which is a chemical in the body that causes inflammation so the inflammation is controlled.

8. Infliximab Side Affect: Allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue Chest pain Fever or chills, usually related to the infusion Muscle or joint pain Red, scaly patches or raised bumps on the skin Allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue Chest pain Fever or chills, usually related to the infusion Muscle or joint pain Red, scaly patches or raised bumps on the skin Signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine Swollen lymph nodes in the neck, underarm, or groin areas Unexplained weight loss Unusual bleeding or bruising Unusually weak or tired Yellowing of the eyes or skin Signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine Swollen lymph nodes in the neck, underarm, or groin areas Unexplained weight loss Unusual bleeding or bruising Unusually weak or tired Yellowing of the eyes or skin You should report to your doctor as soon as possible if you experience any of these side effects.

9. You should tell your doctor if you have any of the following Tuberculosis (TB) or have been near someone who has TB. Your doctor will check you for TB with a skin test. If you have latent (inactive) TB, you will begin TB treatment before you start REMICADE®. Lived in a region where certain fungal infections like histoplasmosis or coccidioidomycosis are common. Infections that keep coming back, have diabetes or an immune system problem. Any type of cancer or a risk factor for developing cancer, for example, chronic obstructive pulmonary disease (COPD) or had phototherapy for psoriasis. Heart failure or any heart condition. Many people with heart failure should not take REMICADE®. Hepatitis B virus (HBV) infection or think you may be a carrier of HBV. Nervous system disorders (like multiple sclerosis or Guillain-Barré syndrome).

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