Patient Turmoil: Trusting the Health Care System

Those that live with a chronic disease are often credited with surviving through symptoms, side effects of medications, and other health issues that come along with their illness. However, people rarely think of the stress that comes along with gaining the healthcare necessary to treat their disease and live a relatively normal life.

Many systems interact in a patient's treatment - the health care team who helps determine the best way to manage a disease, the pharmacy to fill prescriptions, and the insurance who will supposedly make all of this affordable. Even if a patient stays with the same businesses, this can get incredibly complicated if anything changes within these businesses or in the person's life.

In the past two weeks, I intimately learned the danger of systems that do not share information and may not always communicate enough to truly benefit the patient. Although I thought everything remained the same, several small changes almost necessitated hospitalization and brought forth the prospect of surgery.

Two weeks ago, I told Walgreens to refill my prescription for Ustekinumab as I always do prior to my injections (completed once every eight weeks). This started the beginning of my realization over the stress that comes from needing to trust that everyone in your team will do what's right. First, the pharmacy sent my prescription to the wrong pharmacy, but a phone call two days later fixed that. With my normal time-frame, this would not have been a problem. Three days passed; normally it takes two or less to fill my prescription through their specialty pharmacy. My husband and I spent over an hour on the phone on a Saturday to determine what was happening with my prescription.

By the end of our phone calls, we had no idea who had been paying for my medication for the last 9 months. The nurse on call at my new clinic said they could only help if my symptoms worsened to the point of needing hospitalization.

One week after I started the process, I had five days left to receive my prescription on time. I started again calling the pharmacy to determine why my prescription was rejected and asking the physician who wrote the script to talk with the insurance. At that point, we learned the insurance company required another prior authorization, although never told me I would need another so soon. We figured it could not take long since the insurance approved it at the beginning of the year. However, I learned the clinic was working with an insurance I told them to take off file in January. 

Throughout the rest of the week, my husband and I spent many hours on the phone trying to figure out what blocked me from receiving the treatment that has been the only medication to ever bring me into remission. From the clinic using my maiden name, to the pharmacy using my wrong insurance, to the insurance company saying they would pay for $1500 and leave the other $21,000 for me to pay, I thought my only option would be going to the hospital and potentially needing surgery depending on how bad my disease would become in the process.

Through all of this, I could tell certain people in each system were tired of my micromanagement. However, seeing all the mistakes made by each establishment, I no longer trusted that anyone knew what I needed or how to help me get what I needed. Every time I learned of a new mistake, my stress levels skyrocketed because I needed to contact the other systems to make sure they were not impacted by that mistake.

Thankfully, I found one person in each business who became my trusted advocate. I would only speak to that person and they kept me updated on their progress and dealt with my situation personally. They understood my distrust of the system and left messages while I attended class so I knew my situation was being handled appropriately. Without these people, I cannot imagine how my symptoms would have continued to progress and where I would even be today.

This situation exceptionally highlighted to me the trust that the health care system imposes on patients. Without a way to truly connect clinic, pharmacy, and insurance, and without a way for the patient to easily check on updates, the patient is at the mercy of people who are not personally connected to their case and may make small mistakes that have immeasurable consequences. Unfortunately, I see none of this changing until someone in power needs to deal with a situation similar to this, or until healthy people become cognizant of the constant struggles of those of us living with a chronic disease.

Until then, I implore those in any part of health care to have patience. Try to understand the constant worry and stress we have in trying to treat our disease. If we make a mistake or forget to tell you something, please remember that we have to work with everyone in our team which can include many places we need to update with insurance, medication, or personal changes. Beyond all of that, we are trying to lead normal lives while managing a chronic disease which probably causes daily strife that we must overcome. After a fight with one of my past physicians, he told me something I will never forget - he must try to remember that when he sees me, it's a normal workday for him; when I see him, I may be experiencing one of my worst days due to sickness. You may be stressed during your workday, but imagine needed to live with this every day and needing to interact with this health care system while trying to stay healthy.

Healthcare System: The Added Woes to Patients

After 13 years of dealing with a chronic illnesses, what surprises me most is that I'm still surprised at how the healthcare system manages (or doesn't manage) patients. With a year of medical school stuffed into my brain and a summer filled with strange, new symptoms, I find myself marveling over how our society deals with someone with a chronic disease.

First off, I have so much respect for people who enter healthcare for the right reasons and truly devote themselves to helping others. If you are one of those people, please know you have my deepest gratitude; you make more of a difference than you can possibly know.

For those whose job is purely a job, I only ask for more patience and perhaps a touch of empathy. For some employees, dealing with patients is an 8-5 weekday job with vacation and holidays. 

I don't receive a break from my disease. It is with me 24/7 regardless of my plans or vacations. My illness does not slow down when I have an exam coming up nor does it clock out when I travel. When I call, even if my issues deal more with quality of life, I really do need help. I am not trying to make your day harder. When I become frustrated on the phone, do not think that I enjoy the conversation any more than you do.

We say that our system tries to focus more on the needs of the patient, but this entirely depends on the clinic and individual healthcare professional. I know people may scoff and wonder what the big deal is. However, when trying to stretch every dollar and having an insurance that will only cover one specialist appointment each year, that one appointment means more than you can imagine. If you use your one appointment on a physician who has different beliefs on symptoms a patient should deal with, then that's it. No do-overs and you have another year of very uncomfortable and painful symptoms until you can try out another physician and hope that this year will not also be a waste.

As a patient, I find how different physicians code appointments for billing fascinating. I know doctors who bill for everything regardless of what the insurance will cover. Other physicians learn what insurances will cover and if it is something small, will not write down a small portion of the exam in order to save their patients some money. When I keep calling about symptoms and seeing if I can put off an appointment, I'm not trying to make your life difficult. I don't have endless income to afford several appointments and tests. Treating me as though I'm looking for free healthcare only makes me feel guilty about being sick.

What astounds me most during this time, is that physicians still exist who believe they have the right to tell patients to just deal with symptoms. After my fortune of dealing with several amazing healthcare professionals, I cannot stand a doctor who thinks they know more about my disease, my life, and how those two interact. I lived with this illness and my symptoms for much longer than any professional has learned about the disease in general, with much less time to learn about my particular illness.

In this past year, I learned that much more reform is necessary for patients to truly receive the care that we deserve as human beings. We are not cases from a textbook. We are not idiotic people who know nothing about our disease. We are more than a job.

The Power of One Doctor

As I make my way through medical school, I naturally look back to my own experiences. Due to recent health circumstances, I realize the immense impact of a single physician on a person's outlook on the medical profession and on their health.

In my own experience, three types of physicians exist. The ones who help you thrive, the ones you forget about, and the ones who make you worry every time you come into contact with the medical community.

My first GI doctor was the first. She challenged me to take control of my disease and to advocate for myself. During the two weeks following my diagnosis, she called me over her lunch break as the "poop patrol" to ask about my bowel movements (color, consistency, etc.), my symptoms, and what I ate. She then asked me to piece together as to how my lifestyle could affect my symptoms. Although I was 10, she forced me to quickly mature and to learn to listen to my body. Every appointment, she told me the same thing, and I will always remember it.

Although she was the one with the medical degree, she could never understand my personal disease. She told me she could only help me as much as I helped her to know what was going on in my body. No test or person could tell me what I was feeling or about the state of my health.

Every appointment she asked about my thoughts about my disease. She asked about my symptoms and what I wanted done. It didn't matter what the tests showed; she said they were a piece of the puzzle, but no where near as important as how I felt.

This physician taught me to trust in myself and my body. She taught me to understand what my body told me and how to figure out what triggered symptoms and how to try to avoid those triggers.

For several years, I had a doctor who was the last of the three described types. When I came to him, I was experiencing the most intense symptoms of my life. After going through clinical studies and finally having 25 centimeters of my intestines removed, we thought I was in the clear for awhile.

However, within a few months, symptoms reappeared in full force. My physician never thought much of my worries. It was only through determined insistence that he would alter medications. When one medicine gave me full-body, medicinally-induced psoriasis, his only response was that he hoped I could handle it and gave me a prescription for anti-itch cream.

I took it upon myself to fix my disease. My physician was no longer a team player, so I educated myself as best I could. I attended conferences, spoke with doctors from around the country, and ended up learning about many different alternative medicines. I saved myself with the help of many other medical professionals, but not with that doctor's help.

About a year later, symptoms picked up and I spoke about my worries every appointment (I was on a clinical study and had monthly appointments/injections). After nine months of begging for something to be done, my physician finally said he would do something. At that point, however, any trust we had was gone. During those nine months, he told me my symptoms weren't that bad and he thought I could live with them. He thought that maybe they were in my head and several times suggested a consult with pain management because he thought my body was trained to always think I was in pain. With him as my physician, I constantly doubted myself and my body. I would leave for my drive back to school crying because I didn't know if my doctor was a jerk or if I had a psychological problem.

I switched to a new physician at the clinic who looked at my records and couldn't believe how long this had been going on. Two tests later, and we found a treatment. Those nine months didn't have to occur and none of it was in my head, but it continues to affect my healthcare.

Now, when I feel ill, the first thing I tell my fiance when he says I should call my doctor is my worry that the doctor won't believe me. I don't want the physician to think I make up stories for attention. All of the work my first physician put into me to trust my body and my symptoms was washed away by one physician who couldn't be bothered to take the time to really listen to me. Rather than talk to the physician when I'm sick, I take it upon myself to try to lessen my symptoms because I don't believe a GI will help me.

I hope patients don't allow one physician to compromise their health. We need to advocate for ourselves and I learned my lesson about getting a new physician as soon as the relationship turns sour.

For future physicians, I hope you learn the humility of realizing the patient knows more about their disease than you ever could. I hope you take the time to really listen to your patients and to help them thrive.

The relationship between a patient and physician is so critical to a patient's entire well-being. I hope that future changes in the culture of medical care allows for patient experiences to matter and to inform the doctor just as much, if not more, than the actual tests.

Learning to Say No: How I manage medical school with an autoimmune disease

Let's be honest. Most people accepted to medical school are over-achievers. Not only academically inclined, they tend to be over-involved in volunteer work, leadership positions and often have TA'ed for a pre-med course or two. Pre-med students are the first to volunteer and the last to leave.

Once I found my footing in college, I became that student. I worked 15 hours a week, volunteered 10+ hours a week, worked on independent projects and carved a name for myself among the faculty. Naively, I thought medical school would be the same. Through strict lifestyle choices, I would continue to excel in every aspect while still enjoying life.

When classes began in August, I thought for sure I would be enjoying a full plate of activities by mid-September. However, tragedy struck my family at the end of August and I needed to deal with the grief of losing my brother.

As the semester continued, I kept wondering where my time went. If I was going to continue to be active in extra-curriculars, I needed to find the time to participate. After each block of exams, I told myself I would find the time in the next block. However, each exam brought on a mini-flare and I would take time afterwards to relax and bring my body back to a healthy state.

Professors and physicians continuously tell me they hope I can overcome the challenge of having a chronic disease during medical school. I didn't understand that until recently. Although I want to be heavily involved in other activities other than academics, I need realistic expectations about what my body will allow me to do. The most important part of being a doctor is learning the information that will allow me to help my patients. My experience with Crohn's disease already taught me more than any person can about interactions with patients. Right now, I need to focus on staying healthy, and doing the best I can academically.

As much as I hate to admit it, I need to say no to many more things than I can say yes to. Thankfully, I found my way into working with the CCFA on projects and another student excited to start a young adult support group. This way, I can be involved with helping others, while still finding the support I need to overcome my disease.

In a disease that is so dependent on low stress levels, I've learned to truly plan my time and understand my capabilities. Although I'm not as involved as many of my classmates outside of school activities, I have as much on my plate as my body can handle. And I'm okay with that.

Once, I thought I would be spending these four years taking Madison by storm. Now, I'm excited to continue to learn about the human body and how to make it well, along with continuing to fight for my own health. I will survive and I will become the best physician I possibly can.

Status: Lab Rat

I have learned many disturbing things about our medical system as a lab rat.

Currently, I'm on my second clinical study; when no other options exist, clinical trials can feel like a godsend, especially if the medication works.

No one tells you what it's like to be on a study when you need more help than purely receiving the drug. After finishing my undergraduate career, I will move to another state. Months ago, I asked the nurse on the clinical study about switching to a closer clinic. Her original response was that it wasn't possible. Thankfully, my boyfriend said that you can usually transition and I pushed. Finally, she gave me a website and told me I needed to look up whether the clinical study was offered near my medical school. I was flabbergasted. As a health care professional, was it not her job to help me? I called a nurse I trust, and she helped me locate other sites.

The clinical study nurse then checked into that site and told me I was unable to participate in a clinical study there. She said I could continue going to the same clinic I've attended - four hours away from my medical school. For monthly visits in which I would need to miss class, this option seemed unacceptable. She said I could call the insurance company and see if they would cover this experimental drug - I have now been talking with the insurance company for over an hour, and still have no answer.

To many people, this situation may seem reasonable. The nurse has done her job and now it's time to do my part. I don't know how to fully explain how difficult this situation is. After 10 years of never achieving remission, I have now been on a drug for over 2 years that, for the most part, keeps me out of the ER and reasonably healthy. However, that doesn't matter to the clinical study. I understand that data collection is important for the scientific process, but that doesn't make my life any easier. At what point are patients treated as people who deserve health just as much as anyone else? The coordinator has treated me as an expendable lab rat that has completed her time.

Even if I can convince the insurance company to help pay for this drug, I have no idea what dosage I'm on, or even how often I receive this drug. And although I will have to go off the clinical study, they will not release any of my personal information to me to help the transition. I will need to start from scratch with 2 possible dosages and 2 possible time frames. They will put me on the low dosage to start, but who knows if that will work. The danger of going off-label is that some people start a flare-up, become sick, and then potentially the drug stops working.

This system holds no compassion for patients. When I've spoken with people who work on the study and insurance companies and mention the importance of staying on a medication and dose that works for me, they don't even apologize. Their response is, "Oh well, we can't do anything for you."

I don't feel as though my health is important to these people - I know it's not them in particular; they're just doing their job. We have a broken system that doesn't help the people who truly need it.

As a lab rat, I've learned that science, over health and all else, is most important.

Humans of Mayo Clinic

My school has started a "Humans of..." and it's been really cool to learn about what people are thinking and how those experiences affect their lives.

For anyone that knows me, they know that I love talking to strangers and learning about their lives, ambitions, etc. My favorite place to talk to people is Mayo Clinic because you never know where the people are going to be from and usually they have very powerful stories. I usually try to share those stories, but it doesn't always happen. I think it's important for people to realize just how strong we can truly be.

A couple months ago I saw a woman in the waiting room - she was painfully thin and had an IV line placed in her arm for easy access. I sat next to her and asked why she came to Mayo. She said that she came to live. Back home, she was told that she had two months left to live. They had taken out so much of her intestines that they couldn't remove anymore. She weighed less than 100 pounds and the medicine wasn't working. For the last few months she had been taking nutrients intravenously because she could no longer eat. Mayo was her last hope, but it had to work - back home she had a daughter that was counting on her and she was going to keep fighting until she was strong enough to be everything that her daughter needed her to be.

Talking to this woman was inspirational. While she was telling me that she didn't know how much longer to live, I saw a fierce desire to not only survive, but to come out stronger. She wanted health not only for her, but for her family. No matter what the cost was for her, she would do whatever it took to make life easier for her daughter.

This last week I sat behind a family. They started talking about his colonoscopy that was happening the next day and how that would affect what happened next. I excused myself for eavesdropping and asked if he was possibly going to be diagnosed with IBD. Turns out - he actually was diagnosed with Colitis 20 years ago without a flare-up until last year. Then things got real bad really quickly and he had his colon removed. He was having chronic pouchitis and they were looking at possibly doing a permanent ostomy. We talked for a bit and I told them about the Great Bowel Movement and then about camp when the wife said her niece has Crohn's disease. They seemed really excited to be able to talk to others about IBD so I'm not sure if it's something they really talk about.

During this talk, his family was the most inspiring. Throughout my eavesdropping the wife and boy seemed to be very supportive of the man. They didn't make the visit into a huge deal, but were letting him lean on them as much as possible. So often, we focus on how difficult the disease can be on the patient and lose sight of how it can affect the family dynamics. Many times, patients' families are the unsung heroes. Them and friends. I don't know what I would do without my friends who sit with me and distract me when I'm having a hard day.

I'll try to share the stories of others more often - I don't always have time to chat with people, but I like to.

My wish

Hey everyone - it's been a hectic time so I haven't had time to post lately. I originally started the blog to give advice to others, but lately it has become my place to vent about my feelings about IBD. I've gotten a lot of e-mails from people saying that they feel the same way, so I want everyone to know I really appreciate that you read this and care enough to reach out to me.

I really wanted to write about something happier - that I'm finally out of my rut and enjoying the life of a Crohnie again. As involved as I'm getting in the IBD community (through the council and MN Chapter), I feel like the past me would be super excited about everything I'm doing and happy that I have Crohn's because of all of these opportunities.

Lately, however, it's been so much more difficult. St. Olaf is always questioning, "What do you want to do with your life?" I've always replied that I want to be a doctor in a small town and just live a quiet life. I've realized that I've been lying to myself.

My dreams are to travel the world. I want to go to third world countries and hand out medical supplies. I want to see the wonders of the world. I want to swim in all of the oceans and seas (except for the really cold ones... maybe them as well). These are what I dream about all the time, and St. Olaf says these dreams are possible.

My Crohn's tells me otherwise.

My Crohn's says that I'm going to have pain after I eat, that I'm going to be tired all the time, and that I'm going to spend a good portion of my day in the bathroom. I know I should be grateful; I don't go to the emergency room as often and I don't absolutely need surgery. Doctors are always saying that people with IBD are not going to feel as well as they did before, even when they are in "remission."

I'm supposed to be okay that my disease doesn't allow me to travel? I'm supposed to be okay that I have to drive to Mayo every other week so I can help this big pharmaceutical company get their medication out on the market? Which they'll charge probably more than $10,000 an injection. I want to know why having a disease means that I have to accept these limitations as though it's a part of life.

I absolutely love camp and my Crohnies, but it is so so hard to know that I will probably never be able to fulfill my dreams because it just isn't practical, that I will have to always live near enough to a large clinic that will have all of the latest drugs for me to be on. I know there are tons of people that have it worse than me, but seeing my friends doing a semester abroad or doing research in another country is so hard. Several of the chemistry professors told me that they would be more than happy to give me letters of recommendation for any program that I want to apply to, but I had to tell them that I can't because of my Crohn's.
I know someday this will all work out, but it's so hard being at this point in my life.



Mentality

I'm really trying to write one post a week, but we'll see how this goes!

One thing that has been really difficult for me lately is trying to figure out what kind of mentality I'm supposed to have regarding Crohn's disease. My "growing up" with this disease revolved around a doctor who believed I should feel as though I didn't have a disease. She always wanted me to call her if I was sick for more than a few days and had ruled out a cold or the flu. Then, we would switch around doses and hope that that was enough to make me feel better. My first couple years, I was constantly fiddling around with medication because my doctor believed that a remission meant I could go weeks without a single symptom.

Over time, I've realized that I may never become symptom-free. I'm so tired of constantly switching medications and trying out new things. However, I now wonder at what point I'm supposed to become satisfied. I realize that most Crohnies live with an almost everyday, symptomatic disease, but how many symptoms are too much?

Unfortunately, I still want to be completely healthy. I want to wake up and not be nauseous, or have formed stool when I poop. I don't know if I'm supposed to accept the fact that I'm going to always have pain and run the risk of accidents occurring, or if I'm supposed to fight to feel better. We're all hoping that this diet tips me into the realm of feeling better all the time, but it's hard to imagine what that's like after ten years of constant pain and diarrhea.

I know I can take pain and I can deal with all of the symptoms, but I really don't want to. It seems like there may be no other choice, but that doesn't seem like any real way to live.

All I can say is that I hope this diet works, and I hope that I stop craving ice cream.

What to do when medicine fails

Hey everyone! January flew by. J-term has ended and I am currently relaxing at home, about ready to fill out a facilitator training application so I can run an official CCFA support group. Crazy stuff.

I've definitely learned that one needs time for relaxation. Lately I've been so worried about getting everything done for the NCCL (national council of collegiate leaders) and the support group on campus and school work, that I haven't taken a lot of time for myself.

My Crohn's has seen the need to show itself again. I find myself running to the bathroom and lying awake at night because the pain makes it difficult to fall asleep. I felt so well after starting this clinical trial - I don't understand why all my syptoms are coming back. After calling Mayo because I was running a temperature, they talked about the possibility of hospitalizing me. I don't about other organic chemistry students, but I don't have the time to sit around in the hospital trying to get better.

So what do I do?

I've never understood why medications don't work for me that work for countless other people. Maybe I have a really strange form of IBD. I can eat raw vegetables, but cooked ones won't be digested. It's as though my body feels the need to be unique.

The only thing it seems like I can do now is rely on natural treatments and diet. I had given up on the no grain, no dairy, no sugar, no fruit diet because I felt so depressed eating on it, but it seems like that's my best shot. For Lent, it looks like that will be my devotion - trying to get healthy again.

Sometimes I wonder what it would be like to  have a normal digestive tract. Food would be fantastic, but I would probably weigh 50 pounds more. I would be able to sleep more, but I would probably get less done because I'd be sleeping.

I never was a believer in holistic type things or diets - they always seemed like a bit of hogwash. Maybe in a month or two from now I will actually reach remission, and I will be able to tell everyone that diet is what put my severe Crohn's in remission - not the fancy medicines that my brilliant doctor said would make me feel better.

Winter Blues

I don't know about everyone else, but I definitely get hit with the winter blues. Between the cold, the lack of sunlight, or the lack of really being able to do anything, I always get a sense of futility during the winter. It's almost like a mini-flare. I can't go outside to play, I can't run around, and I really don't want to go places (although now it's because -35 is just too cold to go for a walk in).

Right now I've especially been getting hit with the blues. Because it's so cold, my intestines feel like they're cramping up when I go outside. As well, I'm really hating my diet - I'm not a rabbit, so why would I constantly want to be eating leafy things? However, when I eat something that's not on my diet, my stomach grumbles at me. This morning I had grapes for breakfast, which earned me some quality time in the first floor bathroom in the library.

As great the opportunities have been through my disease, I definitely am feeling the hopelessness that sometimes comes along with chronic diseases. With the clinical trial, I was hoping that I would finally feel good, but I'm tired all the time, even after eight hours of sleep.

I'm not one to bemoan my disease, so I'm trying to think of a way out of these winter blues. There's a support group meeting coming up this thursday, so I'm thinking quality time with the Crohnies will be beneficial. This year I've realized that I've been immersing myself more within the IBD community - between the support group, national council, and just spending more time with the Crohnies on campus.

I think that is a good way to stay away from those sad feelings. Don't try to pretend the disease doesn't exist, but embrace it, and see all of the good aspects that come from it. Although I have to admit, that's not always the easiest thing to do. Some of the Crohnies on campus see the psychologist at school regularly. I've heard that over 90% of people with IBD are depressed - maybe we should all make a committment to finding someone we can talk to about our problems. They're too difficult to live with on your own. Just the other day I had my first accident of the school year. Right afterwards, I texted my Crohnies and we bashed IBD and made poop jokes and then ended up reminiscing about great times at camp. I know I wouldn't be able to do this without them.

I guess that would be my advice right now - talk it out. It's totally cliche, but the burden becomes easier to bear when you share it.

Being an Advocate

What a busy January! I'm finally back into the swing of things after the council trip to Philadelphia. So far, being on the National Youth Leadership Council - or whatever it's now or will be called - has been a great experience. All two weeks of it. I'm learning a lot about what's going on in IBD in the other parts of the U.S., especially with research. Hopefully in the next few years we'll be treated more specifically on the pathways that are being blocked by the mutant genes we have. The Children's Hospital of Philadelphia is also going to be looking into what is the "perfect" bacterial state of a healthy gut, and hopefully determine what kind of diet would help a Crohnie reach the same levels of bacteria.

Although it's scary thinking that I'll be working with entirely new branches of CCFA, it's really exciting. If all works well, I'll be able to work with Crohnies from the University of Minnesota to reach an even wider audience than St. Olaf and the Northfield community.

The rate of IBD is increasing - probably a mix of better diagnosis and whatever environmental cause. However, people still aren't understanding our disease. One of the leaders of the council explained how her professor wouldn't allow her to take a test later even though she had spent the night in the hospital. Things will only get better if we go out and educate people about our disease. I know poop isn't the most glamorous thing, but we all do it. If you don't spread the word, how can you expect others to understand what your needs are?

For more advice/information on living with IBD in college, you can like Campus Connection on facebook, or go to the National Youth Leadership Council webpage on CCFA. If you type those in google search bar, it should pop up. In the next year we'll be revamping the webpage to have more information and better access to all the links/templates provided on the CCFA webpage. Also, we'll hopefully have programs that will help you spread the word about IBD on your campus. The next couple years should bring about a new understanding of this disease, and I'm very excited that we all get to be a part of this.

New Year's Resolutions

This year, I decided that my health would be top priority when picking out a New Year's Resolution.

When I went home, there was many Christmas cookies and family parties filled with forbidden foods. It was incredibly difficult, but I stayed away from foods I shouldn't eat during my families' Christmas parties; however, I cheated a lot at home by eating most of our Christmas cookies. I realized that it was a lot easier to stick to my diet when I was being held accountable by other people. I'm not always going to be around people, so my first New Year's resolution is to stick to the diet! I will allow myself to eat one piece of my dove dark chocolate (what girl can honestly give up chocolate??) now and again, but that is going to be the extent of my cheating. As great as some of the no-no foods taste, I've realized that I enjoy being healthy so much more.

My second resolution is a bit more ambiguous. I just want to live a healthier lifestyle. I'm going to go to the gym, do yoga, sleep more... and feel good about myself! This is going to be the year that I finally achieve remission status; I can feel it.

I want to challenge other people out there - not just Crohnies - to really evaluate your health. I'm not going to go all health nut on you because I always hated when people did that to me, but there's so many bad things in the food we eat today, and we put all that junk into our bodies. You don't have to have such a strict diet, but anything processed is bound to be really hard on your system. Instead of popping a tums or something to stop diarrhea, figure out what food is causing you problems, and stop eating it.

Eating healthy can be easy, even at college. Yesterday I e-mailed the guy in charge of our kitchen and told him what's going on. He had me meet with the head chefs and I now have all their numbers and text them what I want to eat a half hour before I go to eat. Today I got sauteed spinach and fish. It was so delicious. I won't be using it all the time, but it's nice to have variety. Plus, they said they have shrimp; I know which girl will be asking for that every week (haha).

To end this post, I want everyone to think about one thing they can change about their lifestyle (eating, exercise, etc.) that would make a positive impact on their life, and go for it!

Following the Diet

After receiving e-mails about the diet, I figured I should share what I'm doing and how it's been working for me.

I knew that completely cutting out processed foods and carbs was going to be extremely difficult. I don't eat poorly, but I was never a super healthy eater. I did some research about diets and found out that sugar can actually mess with our brains the exact same way as drugs do. If you take it out cold turkey, you will most likely have withdrawal symptoms and crave it so much that you have to eat sugar again. I decided to start the diet slowly.

I always (unless there weren't any good options) took a dessert after lunch and supper. First off, I cut that out. At first, I really wanted a peanut butter cookie or a piece of chocolate cake, but after a week, I decided to have one, and I didn't even want one. I no longer think about taking a dessert because I just don't want it anymore.

Then, I realized that I ate a lot of bread. When I didn't know what I wanted, I would make a sandwich. Instead of doing that, I would make a quesadilla. It still has grain, but not as much. Once I stopped craving sandwiches, I started making sure I took a salad, piece of meat, and possibly fruit (which isn't on the diet, but I wanted to get into eating healthy).

Throughout this time, I'd stopped drinking milk for every meal. I made sure I drank a glass of water in line for the drinks and then got a second; this is based on other diet articles I read. Water helps clear out our intestines. I stopped putting cheese on my quesadillas and salads and no longer took cottage cheese.

Now, when I crave potato chips or something salty and unhealthy, I eat almonds. I've been doing this long enough that I actually crave almonds over chips. I make sure I eat a small salad with every meal.

I've made myself the goal that by the new year, I will be 100% on this diet. It will have taken me about a month to make the transition, but I don't mind that it took a long time. Having the goal has allowed me to eat a cookie when I want one without feeling guilty, but I'm also working on only eating these foods. It's not difficult, and I feel so much healthier.

 

I will keep you all updated on how the diet is going and whether I feel better. I never believed a diet would work, but we'll see!

 

Merry Christmas!

A Cure/Cause of IBD?

Finals are finally done! Which means I have time to write another post. Today, I had the fantastic opportunity to talk with Dr. Steven Gundry from California. He's done some really amazing research, and I'm hoping to summarize his explanation of his theories about the cause of IBD.

Dr. Gundry first was a transplant surgeon, and apparently one of the best. He first began with the joke about how most people stop an elevator from closing with their hands, but surgeons stop it with their heads, because it's the least important part of their body. Joking aside, he took me throughout the timeline of his research. Dr. Gundry and his partner would do heart transplants, and several times it happened that the patients would develop coronary heart disease. They attributed it to the fact that those patients did not have healthy hearts before the transplant, so the same occurred with the new heart. However, the same thing began to happen when they did heart transplants on otherwise healthy kids.

Down the road, Dr. Gundry met a man who cleared his arteries in six months, with diet and supplements alone. This is a crucial part of his journey. He told me that you cannot see anything unless you go in with your eyes open, and without preconceived notions. Many researchers tend to already have theories about what should work, and that's what they end up seeing. Dr. Gundry saw that this man was clearly better, so for a year he tested this diet on himself and other humans. He thought that it worked, but wasn't sure how.

Dr. Gundry began to suggest this diet to his heart patients. His patients had amazing results. What couldn't be completely helped through medication was gone with this diet. Patients with other diseases said that they were even feeling no symptoms from the diet, which made sense because it was anti-inflammatory. People's arthritis was no longer bothering them, and Crohn's patients, who could never get rid of some symptoms no matter what treatment they tried, were symptom free.

At this point, Dr. Gundry looked at what exactly the diet was doing, whether it had more to do with what patients were eating, or what they weren't. What he realized, was that all the foods he had taken out of their diets included the protein lectin. This is a protein similar to gluten, but he has found that it plays a bigger role in autoimmune diseases. When on a gluten free diet, people tend to eat foods that are made from rice or corn, but corn contains 40 proteins that are very similar to gluten, so that explains why a gluten free diet may help, but it usually doesn't completely take away the symptoms of the disease. Lectin is contained within the seeds of certain plants and the genes of American cows (which is why people shouldn't eat cheese or drink milk from the United States).

This is how he explained how lectin is the problem. Plants are smart, a lot smarter than we give them credit. They can make matter from sunlight, which we have not been able to do yet. However, animals are their predators. In order to keep from being eaten, plants will put proteins (which act as poisons) within their seeds (or babies), in order to keep reproducing. Most animals, once they become sick from eating this plant, will stop eating it. He says that humans are pretty dumb; we think that we can overcome these poisons and take tums or immodium instead of not eating the foods that sicken us.

Lectin is contained in plants that were not originally eaten by our ancestors (if you are from European descent, possibly others as well), such as corn, potatoes, and seeds of fruits. At the beginning of human life (about 30 million or billion years ago), we only ate plants with two leaves. Although they also contain a poison, we had a long time to adapt and be able to digest them. Up until we were introduced to different foods (roughly 10,000 years ago), there is no evidence of arthritis in the skeletal remains of humans. As well, before that time period, most humans averaged to be over 6 feet tall. After then, humans shrunk to an average of about 4 feet, 10 inches (roughly 8,000 years ago). It took only 2,000 years to feel the damaging effect of eating poisons their bodies weren't used to. As he said, 10,000 years is merely a blink of time compared to the 30 (million/billion) years that we've had to evolve to be able to eat green, leafy vegetables.

The Kitavan society from the South Pacific eats no grains, and its only starch is from the taro root. They live well into their 90's with no modern medical care; they have no strokes, heart disease, or many other diseases of the modern world. And they smoke.

Italians refused to eat tomatoes until about 300 years ago because they believed the seeds to be poisoned. Irish people refused to eat potatoes until they had a famine 150 years ago because they believed them to be poisonous.

People with autoimmune diseases have a hyper-sensitive immune system. Dr. Gundry explained that when our immune system sees these toxins in our body, they attack more heavily than they do in a normal person's body.

Dr. Gundry also said that most people with IBD can relate the start of their symptoms to a certain event in their life, one that is usually related to stress or taking antibiotics. This is because our body relies heavily on the bacteria within our gut. There's about 5 pounds of bacteria in our gut, but they contain more genetic information than the rest of our cells combined. If these are messed up, such as by antibiotics or stress, it can start the onset of IBD if we are genetically predisposed to it.

 

I know this post isn't super well organized, but I'm still processing all of this as well. I was never a big believer in diets; throughout my 10 years I've been on tons of different diets, and none (except for liquid) have made me feel any better. However, I've been trying this diet (cheating a little bit now and again) for about 2-3 weeks now, and I had my first day of no loose bowel movements in months, if not over a year. I've gone through years of no remission, but I'm finally hopeful.

 

If you're interested in the diet here's what you can't eat:

Fruits

Corn

Grains

Dairy products from the U.S.

Sugar

 

What you can eat:

Nuts

Green, leafy vegetables

Meats (preferably organic)

French cheese or milk

Sheep and goat milk/cheese

 

If you have questions, feel free to message me!

Uncertainties of a Clinical Trial

Tomorrow is my week 6 appointment for the Ustekinumab clinical trial.
I had a great week about fours weeks ago in which I had only 2-3 bowel movements a day, and very little pain, but I'm back to 5ish a day and difficulties sleeping because of the pain. I get tired so easily and I don't like eating because it just causes more pain.

Sometimes it is so frustrating to be on a clinical trial. I have no idea if I even got the medication. However, there was that one week of being quite a bit closer to a remission state, so I want to have hope that I got the medicine and that it could possibly work for me. As well, because I've been back to where I started, if not a little worse, I know for sure I will get the drug this next time, so I will hopefully be able to tell if it's going to do anything for me.
This whole not knowing thing just gets to me. If I actually got the placebo, but I had that one really great week, why did it only last one week? And what could I do to get that back, because it wouldn't have been from the medication. But if I did get it, why did I only feel good for that one week? Why are my symptoms worsening on it?
Being on a clinical trial, well, I don't really have much hope left to ever reach a remission status. If this doesn't work... then what do I do? I go on another clinical trial and go through all of this uncertainty again?
Mrs. Buntrock told me about her no-carb, no-sugar diet. While it sounds like it's really worked for her, I'm 19 years old. I would be restricting myself from eating pretty much everything. I love pizza and ice cream, I really don't want to stop eating it for the rest of my life.
There's a lot of times where I wonder if I will ever reach a remission status. Since I was 10, I have had 2-3 months where I had few enough symptoms to be considered in remission. Is that what I have to look forward to the rest of my life? While I love learning about different medications and the theories of the cause of IBD, I would much rather learn about it from a book and not as a patient. At least I'll have plenty of personal experience when I'm a gastroenterologist.
All these questions, but no answers. I just hope that all the data they get from me brings us a little bit closer to understanding IBD.

Being a Crohnie College Student

*Disclaimer* I may be rambling because I'm not feeling the greatest.

Today I woke up feeling absolutely awful. I have a headache, cramps, diarrhea, and the overall spaciness I sometimes get when not feeling well. It really put my last post into perspective for me; it's a lot easier to be thankful about a disease when you aren't feeling super sick from it. On the note of being thankful, I thought about making a post about being a college student when you feel like crap (poop jokes!).

We all know how much it sucks to be sick. All you want to do is lie in bed, drinking 7-up and watching movies or sleeping. There isn't anything that can get you out of bed. Except for having organic chemistry, a biology test, and a test that 30% is participation. There's not really the I-can-miss-class-because-I-have-Crohn's situation going on here.

I know a lot of people that take advantage of anytime they are "sick" to miss class. People with diseases especially have an excuse because they can't help it. Frankly, I don't live by that rule. If I'm not down and out on the bathroom floor, I will make it to class. My professors know that on a bad day I won't be participating, but they know that I will not be using my disease as an excuse. I've found that you will be respected a lot more when they see that you are making an effort to be places even when most people would have called it quits. IBD has made me so much stronger, that I know I can make it to class even when I feel like a bus has run me over.

I'm trying to think about what my overall message for this post would be. It isn't that you should go to class every time that you feel awful, because sometimes that just isn't possible. I guess it's that we are a strong people. We know what it's like to be in such immense pain and have accidents and not be able to eat the things we want. I think it's important to not say that you are going to skip something because it's okay since you have a disease. You have to fight and do everything that you can, because otherwise you'll be stuck in your bed everyday, and that doesn't sound like fun.

One thing I've found helpful, is keeping in contact with my professors and my support advisor about my disease. They know when I'm not feeling well, and they work with me to make sure I'm still doing everything to get the best education possible.

You can do everything any non-digestively challenged person can, you just have to fight a bit more.

Thankful for Crohn's

I know it's been pretty much forever since I've last posted, but with finals coming up I am so incredibly busy.

With Thanksgiving come (and gone), I felt it time to really think about how thankful I am to have Crohn's disease. It's not that IBD is rainbows and unicorns, but I've spent so much time in the recent past being angry about my never-ending flares to really remember why I love having this disease.

Because of my Crohn's, I've been able to enjoy life more.

Since the start of my clinical trial, my CDAI (Crohn's disease activity index) has reduced dramatically, not to a remission, but I have quite a bit less pain. The other day, I had one formed bowel movement and almost no pain. It was such a glorious day, and I fully enjoyed it.

That day made me realize that, without my Crohn's, I would not have been able to appreciate feeling healthy and well. I will never take a day that I am able to get out of bed and do everything I want for granted. I think that's pretty darn cool. Each day that I wake up in little-to-no pain, I feel fantastic.

Even when I'm feeling fairly ill, I enjoy everything I do more, because I know I'm going to pay for it later. Eating a greasy pizza, or popcorn is absolutely amazing, because it has to be, or it wouldn't be worth putting myself through the after-pain.

I realize it sounds silly to be thankful for pain and accidents, but they help put life into perspective. Today, I was so thankful to not have to rush to go to the bathroom. I casually waited until it was a convenient time, and then walked over. Best bathroom time in a long time. Most people just go to the bathroom, and that's it. I'm so happy I have the chance to be grateful about making it on time.

For all those people who feel sorry for us with a chronic disease, I feel sorry that you probably don't have the chance to appreciate some of the simplest things in life.
Crohn's disease is an awesome disease :)

 

 

Accepting Your Disease

Accepting the fact that you have a chronic disease is a hard pill to swallow, especially when that pill causes unendurable pain and sadness. Although I was diagnosed almost 10 years ago with Crohn's disease, I still find myself getting very angry or depressed, especially during times of flares.

I've always tried to see the positive side of IBD; my best friends were met through Camp Oasis or other IBD conferences, I've discovered my passion for the medicinal field, and I've become a stronger person because I have needed to deal with a terrible chronic illness since I was a child. However, that doesn't mean I'm always super ecstatic that I have this disease that's attacking my digestive system.

The most difficult times for me have been when I haven't been able to eat what I want, or had to completely sit out of something because I couldn't push myself any farther. Today, with health care such a hot topic, I worry about being able to fulfill my dreams because I will need to find a way to pay for expensive healthcare, and the rising cost of medical bills. I see other people not needing to worry about what they do to their bodies, and I wish that I could have just a few less worries in my life.

Every once in awhile I hit this roadblock, in which I see my entire future before my eyes, painful day after painful day. I'll never be able to eat without worrying about whether or not I've just given myself some extra hours of pain. I see a life in which I will be worried about passing on my Crohn's to my children; in which case I would feel so incredibly guilty for causing them the same pain and suffering I go through on a daily basis.
There are so many points in my life where I have cried and cried, thinking that life cannot possibly be fair. Why was I chosen for this disease? What did I do to deserve this?

Recently, I have learned that realized that things happen for a reason. I may not like the fact that I can't always do the things I want, but I pray and ask God for the patience to understand that life is not meant to always go the way I want. I've also definitely learned to slow life down. I do not need to get the best grade on every test, be the fastest, be in the most activities.

All I need to be... is me.

Crohn's disease, although it does not define me, is such an integral part of my being. I am who I am because I have had tribulations. I think the way I do because I know what it's like to be picked on because  my medications have made me fat or slow. I know what it's like to feel all alone. Crohn's disease has made me empathetic to those who suffer and it makes me so happy to be able to help other people. Although I still have many hurdles on my road to acceptance, I know that I am okay with who I am, and that has brought me closer to my goal.

Telling Your Significant Other

During our IBD talk at Camp Oasis, the teenage girls were asked to talk about how and when they would tell their significant other about their disease. I thought this was a really interesting topic as some people are super open, and others don't tell many people. This can be a delicate subject, and it's up to you when you tell him/her about your IBD.

If your SO didn't know before you started dating, how do you start up the conversation about IBD? "I'm really enjoying this salad. By the way, it may give me uncontrollable diarrhea." Not exactly an easy topic to broach.

The perfect time to break the news is different for each relationship. If you start out strong, it may be easier to get it out in the open right away (probably not during a meal). Honestly, if your SO can't handle the fact that you have a digestive disease and thinks it's gross, he/she is so not worth your time. Telling your SO early on means that you can slowly bring up other topics about it - food, bathroom issues, doctor appointments, etc.

However, if you don't feel comfortable telling your SO right away about your IBD, that's fine too. It may be better to tell them before things get too serious - some people are jerks and it's easier to get hurt if you're deep into the relationship. As well, it may be difficult to explain why you have to run to the bathroom several times or have to cancel on several dates. Complete honesty is best to keep relationships healthy.

I've found it to be so much easier when my guy knows about my Crohn's. They understand why I can't eat certain foods and know that I'm not being a party pooper when I say I don't feel like going out. Plus, many people will be truly curious about the disease and want to know more. As great as Crohnies are, sometimes it's nice to talk to someone without IBD just to get out your frustrations.

Telling someone that you have IBD can be a truly terrifying ordeal, but so rewarding as well. Most people will be on your side and so eager to help you fight your battles. Don't be too scared - they care more than you think.

Troubles and Titterings of a Trial

I was originally going to add this to my post on my first infusion, but I figured not everyone would want to read my personal experience. These are my worries about going on a clinical trial and how I assayed those fears.

I was definitely a clinical trial hater. Why would I want to put something in my body that isn't even FDA approved? Who knew if I was going to get some awful side effect? I thought I was going to be treated as a number and a lab rat to the pharmaceutical companies.

Here is a list of my fears, and how I got past them:

1. I'm just a number to the company funding this project, how do I know it's in my best interest?

-This was the point where I knew I had to trust my doctor. He gave me his honest opinion that this was my best option, I did my own research, and it seems like this may actually work.-

2. If this isn't FDA approved, how do I know this won't give me really awful side effects?

-I was totally freaked out by the thought of getting cancer from this medicine. My doctor explained the process of clinical trials. First, they go through Phase 1 in which they inject the drug into humans and see whether or not they actually stay in the blood and will do what they are meant to do. If it actually works, it goes to Phase 2. There, they test for side effects. They see if anything awful crops up. Although I wondered about long-term side effects, what research has shown us so far, is that side effects in medicine are not very different in 20 years than they are in the first 5. Finally, if they pass these two phases, they make it to Phase 3. Here is where they see if the drug actually helps the patients. The patients fill out paperwork and possibly a journal which gives a CDAI (Crohn's disease Activity Index). A certain dosage is decided, either one dose or something else determined by the company, and administered to the patients. Depending on the time frame in which the drug is again administered, a new CDAI is taken to see if the quality of life is actually improving. They are testing to see if the drug can bring a patient to remission. A part of Phase 3 which only occurs if patients' CDAI is lowered is an extended Phase 3 which sees if the drug can keep a patient in remission. If the drug isn't quite FDA approved, but the company decides to keep it in study, the drug enters a Phase 4 which could last up to 4 years or longer.

Basically - a drug has to be very safe in order ot enter Phase 3.-

3. It doesn't really fit in my schedule, can that be changed?

-Unfortunately (Actually... fortunately), clinical trials are very strictly monitered by the FDA. They have to be extremely regimented or people can go to jail. You have to either make it work, or the clinical trial isn't your option. You have to decide if it's right for you.-

 

If you have any other questions or doubts about going on a clinical trial - send an e-mail or post a comment and I will help you the best I can!