The Life Insurance Questionnaire

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So tonight I had to answer some medical questions over the phone to some poor sap probably not making much more than minimum wage. From the way she read the questions, I could tell she was relatively knew at this. The questionnaire was for a new life insurance policy my wife and I are applying for. I had to answer questions about doctors, medical history and diagnoses.  I knew this was going to get interesting when the first question was about medication.

Luckily, this is coming now and not at the time a few months ago when my pill intake was over 40 pills a day.

So I rattled off my list:  Imuran, 100 mg.  Prednisone, 10 mg.  Flagyl, 250 mg three times a day.  Prevacid, 30 mg.

She then asked me the diagnosis that the medicine is treating.

"Crohn's," I replied.

"When were you diagnosed with Crohn's disease?"

"In 2000."

"What symptoms did you have to prompt that diagnosis?"

"I had some pain," I replied.

"Just pain?  Anything else?"

I paused.  I wasn't sure just how much information I was to give.  How detailed should I be?  Did I need to tell her about mucous poops?  Or the times the toilet bowel looked like something from one of those Saw movies?  I decided to go easy on her.  "And frequent elimination," I added.

"Frequent elimination?"  She was quiet for a moment, as if looking for something on a computer screen.  "Did you say elimination?"

"Yeah."  It was silent on the other end.  I could hear the keys tapping.  She was trying to find the box to check off on the form, undoubtedly.

I decided to help her out.  "I shit a lot," I explained.

"Oh," she said with surprise.  I heard some keys tapping and imagined with a slight chuckle a box on a computer screen somewhere in a dark room with the phrase "shits a lot" suddenly checked off.

Then she asked about diagnostic tests.  Oh, boy.  Where to start?  I listed off colonoscopies.  One in 2010.  2008.  And every two years before that.  Sigmoidoscopy in 2012.  Endoscopy in 2012. Exploratory surgery in 2012.  A CT scan in 2012 for a suspected fistula.  That was negative, I quickly added.  Three CT scans in 2010.  Stress test in 2010.  Another one in 2012.

"What were the stress tests for?" she asked.

"Costochondritis," I replied.

She paused, looking for a list on her screen.  "Can you spell that?"

I did and then explained that it is inflammation of the cartilage in the rib cage.  Back in May of 2010, I experienced severe chest pain and was brought to the hospital in an ambulance (I didn't mention that part.)   The CT scans revealed nothing abnormal.  And it was decided that the inflammation was probably related to the general inflammation I had as a result of Crohn's.  Nothing wrong with my heart, I assured her.

"What was the stress test for in 2012 then?" she asked.

"Oh, that.  I was experiencing pain and palpitations."

"Costo...whatever it was?"

"No.  It was the result of the large dose of prednisone that I was on at the time.  And the stress, most likely, during a particularly bad flare up."

"How often do you experience flare-ups?"  she asked.

I paused and thought about it. And the truth was, I really wasn't sure. The worst flare up I had was a year ago. I missed a couple of weeks of work as the Crohn's moved to my lower colon. That was when they had to go in and look at the inflammation and ulceration in the lower colon. I haven't had a severe flare since, but I have been on numerous medications since then, including a whole regimen Chinese herbs and ointments that I have since stopped.

I rarely get flares in the summer.  Probably because I am off from school.

I flare up in the Fall, usually. The Spring. The severity varies. Sometimes food can be a trigger, of course, but I didn't want to go into that whole history.

"About once a year," I said.

After answering some more questions about doctors and family history, the interview ended.  Now some stranger who I will never, ever meet knows a hell of a lot about me.  More than most people, actually.  And all of that data about tests, doctors, medicine and symptoms are now part of another large database.  My personal experience will soon be categorized and quantified; my weight, height and medication transformed into numbers that will be added to spreadsheets and risk assessments.  Everything I am will be reduced to a formula and that formula will determine how much I will have to spend on life insurance so that my family can be secure in case something happens to me in the near future.  Or if medical bills need to be paid.

How much risk is a Crohn's patient worth?  That is what someone, somewhere sitting in a cubicle staring at those numbers will determine.

Generally, I am pretty healthy.  Except for the Crohn's, of course.  But that doesn't matter to a number cruncher.  Life insurance companies are in the business to make money, plain and simple.  My experience---rattled off through a phone interview and a physical examination next week---will be reduced to a single number that represents my worth to someone who really has never met me.

But they have met Crohn's.

And to them, that is all that matters.

An Open Letter to the Illinois General Assembly RE: Medical Marijuana

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Dear Representatives to the Illinois General Assembly:

My name is Bruce Janu.  I am 44 years old, married to a wonderful woman and the father of two young boys, ages 8 and 6.  I teach high school history in suburban Chicago.

I don't use drugs of the illicit kind.  My drugs are completely legal but potentially very dangerous.

You see, I have Crohn's disease, which is an autoimmune disease that attacks my digestive system, causing bleeding ulcerations in various sections of my colon.  It is a painful and sometimes debilitating condition.  Last year, I missed a couple of weeks of work as a result of my condition.  In addition, I have had numerous procedures and have experimented with a multitude of drugs.

Currently, I am taking 10 mg of prednisone daily.  I have been on prednisone everyday for over a year now.  My dose has been as high as 40 mg a day.  Prednisone is a steroid that not only lowers the body's ability to fight infection, continued use causes bone loss, cardiovascular problems and cataracts.

In addition, I am taking 750 mg of Flagyl each day.  Flagyl is an antibiotic that has some anti-inflammatory properties.  It also can cause numbness and tingling in extremities and increases the risk of seizures.

And, last, but not least, I am taking 1000 mg of Imuran a day.  This is a drug used to inhibit organ rejection in transplant patients and is also used to treat autoimmune diseases, such as Crohn's.  It is a severe immune system inhibitor.  Use of Imuran increases my chances of getting lymphoma and leukemia.  In addition, fungal infections and a certain type of fatal white-blood cell cancer known as T-Cell Lymphoma is more prevalent for Crohn's patients being treated with this drug. 

Pain is a constant reality in my life.  I am so used to it, I imagine my tolerance has grown very high over the years.  But, even so, I have heavy duty pain-killers at the ready.  Just in case.

I am not sure that medical marijuana would do anything for me.   That option, however, should be available when discussing treatment with my doctor.  More and more studies are showing that marijuana can be an effective treatment for people with Crohn's disease.

So much political rhetoric these days involves paying lip service to such amorphous terms as "freedom" and "liberty."  Where is the freedom--where is the liberty---for a person suffering from a debilitating disease when he or she cannot seek all medical options?  Should someone suffering from cancer be denied a basic treatment---a natural alternative to pharmaceuticals--simply because of a political agenda?

If my doctor were to recommend medical marijuana for my Crohn's, would it be moral and ethical to deny such treatment due to some outdated notions about cannabis?  After all, it would be highly regulated and the chance of it turning into a "gateway" to harder, illicit drugs is pure fantasy.  I am more likely to become addicted to the Vicodin in my cabinet than any amount of medical marijuana prescribed to me by a qualified doctor.

It is time to truly enter the 21st century.  Opening the door to medical marijuana will also promote more research into cures for diseases such as mine.  It will allow an alternative avenue to those seeking relief from symptoms without having to fear the side effects of the numerous, but far more dangerous, pharmaceutical options.

In this veto session of the General Assembly of Illinois, I urge you to vote yes on HB 30.  It is the right thing to do.  It is the ethical thing to do.

Thank you.

Sincerely,

Bruce Janu
Battling Crohn's since 2000

Fistula, In-Grown Hair or Staph?

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This is the sore a couple of days after draining;
it is about the size of a dime.

As I mentioned earlier, I took Imuran for two weeks and then stopped due to some pain that had returned in my right side. Blood tests turned out okay, yet the pain was still there.

And then the sore appeared.  It was relatively small, located just underneath my navel.  I hadn't seen it before due to two things:  1) it was located right at my waistline and covered most of the time under the band of my undies and 2) the flab of my gut covered it.

I didn't think anything of it.  Probably an ingrown hair or something, I told myself.  By the time I noticed it, the pain was rather high, however, and it resembled a volcano that was about to blow.  So I did what any person would do in such a situation:  I drained it and cleaned it with alcohol and went on with my life.

When talking with my I doctor, I mentioned the sore and she became concerned.  Although I assured her that it was nothing but a topical skin infection, she said that it could also be a fistula.  These noxious ailments are often mistaken for ingrown hairs or boils.  They are small, but painful infections that tunnel through the walls of the colon, through soft tissue until they reach the outside.  Fistulas can happen anywhere and for someone like me, any such external infection located on the abdomen is cause for worry.

So she ordered a CT scan^* and I was convinced that I now had a fistula.  I looked up fistulas on the internet. I compared pictures of fistulas to the sore on my abdomen.  Self-diagnosis is something we crohnies always do--and almost always assume the worst.  It's not that we are negative about our ailment, just realistic and prone to being prepared for the worst.

I had my CT scan on Friday evening and by Sunday I had the results.  My doctor phoned me to explain that it was not a fistula, but that I did have moderate swelling in my lower colon. Other than that, everything looked okay.  Nothing on the CT scan could explain the sore.

The sore was troubling to her, however.  Imuran is an immunosuppressant and could leave the body open to various infections.  This is the reason why I had to go through additional tuberculosis testing before starting the drug.  Among other things, immunosuppressants have the tendency to awaken latent tuberculosis in the body.

This is the sore today.

I saw my general practitioner today in order to get a look at the sore.  It's still there, but very much smaller.  He too was concerned that, after draining and applying alcohol, it was still red and swollen.  So, he gave me an antibiotic particular to skin infections.  And he told me that if it comes to a head, not to drain it.  I need to come back in so that he can take a culture and determine what type of infection it is.  Staph, he said, is something that has been coming back with a vengeance.

My GI wants to continue with the Imuran.  I am up for that, but have to wait until this sore is gone.  I have a week on this new antibiotic and then we will go from there.  What is strange, however, and most likely the reason for such caution, is that I have been on Flagyl for the last 9 months.

Flagyl is an antibiotic.

So, whatever it was that gave me that little, yet painful pustule, was strong enough to evade the Flagyl.

This new antibiotic is called Keflex.  Amazingly, it is not one that I have every had before.

Let's see if it works.

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^* You know you're a crohnie when a skin infection requires a CT scan

Another Medicine Come and Gone...for Now.

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Crohn's is a particularly stubborn disease.  In all of my years of having it, not much has worked to curb its symptoms.

For the last few months, I have been feeling pretty good.  And that is because of a regimen of Flagyl and Prednisone.  Plus, the summer is usually a good time for me.  Relatively stress-free, summer is the best medicine for my Crohn's.

When I start school again in the Fall, I usually experience some flare-up.  That is to be expected.  This year, however, was pretty good.

Until I started the Imuran.

Let's back up a bit, as it has been awhile since I posted.

Back in December and January, I experienced a new round of flares as my Crohn's moved to my lower digestive tract.  Not only was it excruciatingly painful, but also debilitating.  I had to take off work.  I had to spend my time sitting in a warm bathtub several times a day.

I experimented with herbs and acupuncture.  I gave up dairy.  Nothing seemed to help----except the Flagyl and Prednisone.

Flagyl is a powerful antibiotic taken three times a day.  And prednisone is a steroid.  Both of these drugs work, but are not good to be taken in the long-term.  Flagyl can cause nerve damage and prednisone---well, it may help relieve Crohn's but it does a number on bones, joints, muscle tissues and can cause cataracts.

I began to feel instantly better.  My GI recommend me to see a specialist at the University of Chicago.  So I made an appointment.  But I couldn't get in for at least 4 months and finally saw him in August.  After a long review of my history and charts, he told me that I needed to be on something stronger.  And, like my GI, recommended that I begin Imuran.

Imuran is a TNF blocker.  Crohn's is an autoimmune disease in which it is believed that the body's immune system attacks healthy tissue in the digestive system.  Imuran inhibits a particular protein called Tumor Necrosis Factor, thus decreasing the body's inflammatory response to Crohn's (it is also used for rheumatoid arthritis).

There has been a lot of success with Imuran and Crohn's; but there are some potentially dangerous side-effects to such drugs as well.  Believe me, I have read the list and it scared the hell out of me.  But, as the University of Chicago specialist told me, "Statistically, prednisone is more dangerous.  We know what prednisone is doing to your body right now and you cannot be on it for the long term."

So, two weeks ago, I started a daily regimen of Imuran.  50 mg.

I was still feeling good.  In fact, I started going to the bathroom less.  And, for the first time in years, felt constipated once.  Hhhmmm.  I forgot what that was like.

But then the pain came back.  In my right side.  Not excruciating, but subtle.  It came and went.  Some days it was in my lower abdomen, just right of my belly button.  Today, the pain is stronger and is now on my side, about halfway up my abdomen.  And I have some pain once again in my lower digestive tract.  Not much, in fact, barely there but enough for me to notice.

So, needless to say, my doctor told me to stop the Imuran for now.  She believes that I am probably having a reaction to that drug.  I went to the hospital yesterday for a blood test.  The blood test will tell how my body is processing the Imuran and if I should continue.

And then we'll go from there.

If I can't take Imuran, I am not sure what is next.  Humira?  That is a TNF blocker as well, but is made differently (Imuran is made with mouse DNA and Humira is made with human DNA).    Will that make a difference?  Don't know.

But so far, the scorecard isn't too good for the drugs that I have taken:

If only we could bottle and sell summer.  Then I think I would be cured.

More to come.

My Flagyl Experiment (with updates below)

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I have been taking Flagyl now for a couple of months straight.  Plus, 10 mg of Prednisone.  Feeling pretty good, I must say.  However, occasionally, I miss that cold beer or nice glass of wine.  There's warnings all over the Flagyl literature:  "Do not take with alcohol."  Apparently, the Flagyl interacts with the alcohol to create the same substance in your body that is sometimes used to treat severe alcoholism.  That is, it makes you violently ill when it comes into contact with alcohol.  Projectile vomiting may be the result of this concoction.

According to the literature:

Drinking even a small amount of alcohol (ethanol) while taking Flagyl can make a person very sick. Flagyl and alcohol together cause severe nausea and vomiting, flushing, fast heartbeat (tachycardia), and shortness of breath. The reaction has been described as being similar to the effects of Antabuse, a drug that treats alcoholism by causing patients to become very sick when they drink.

Now, I don't want to be violently ill, so I have avoided alcohol completely.  No beer.  No wine. Nothing.

However, I have been reading lately that the "no alcohol" thing may not be true.  At least in most people.  Several studies have been done and found no correlation between alcohol and Flagyl.

Recent clinical studies have failed to demonstrate a significant interaction between metronidazole and alcohol. Despite the lack of a demonstrated interaction, your healthcare provider and pharmacist will probably still warn you to avoid alcohol while taking this medicine.

So I have decided to try an experiment.  And it goes something like this:

1.  Glass
2.  Cold can of Guinness
3.  Pour Guinness into glass
4.  Drink
5.  Wait to get sick

Simple experiment.  And it could go either way.  Plus, my wife isn't here tonight to tell me that this isn't a good idea. I'll keep you posted.  Until then, here's to science!

UPDATE #1 (11 pm)

It's been about an hour.  I've been nursing the Guinness.  When I took the first sip, I had my doubts.  The last thing I wanted to do was to ruin my favorite beer forever.  I had a bad experience with tequila back in college and it took several years to get over that.  However, after about 12 ounces consumed---nothing.  No nausea.  No head aches.  No projectile vomiting.    

UPDATE #2 (12 am)

All 15 ounces of Guinness consumed about 50 minutes ago.   No reaction.  Just a little tired.  Going to bed. 

$746 in Herbs and All I Got Was This Bloody Colon

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A week after finishing up the Flagyl¹, my colon took a turn for the worse.  I started going more and then, about a week later, pain and blood.  Lots of blood.  In fact, it was like a Quentin Tarantino film in the toilet bowl.  Reservoir Bowels.

It wasn't a pretty sight.

So I called up my gastroenterologist and she put me back on the Flagyl.  Three days later, the blood stopped and the pain subsided.

Since then, I have grown very skeptical of Chinese medicine.  For a while, I was convinced that the reason I was feeling better was due to the herbs.  After all, I have consumed over 3000 herbal tablets since February and spent nearly $750.  Now I am not so sure.

At my last appointment, Dr. X told me that this usually happens. When you go off of western medicine, he explained, symptoms usually come back for a short period of time.  However, it felt like I was getting another infection.  The external Crohn's was obviously making a comeback and, much like "Hail to the Chief" announces the president's arrival, the blood and pain were a clear signal as to what was around the corner.  And it wasn't Obama.  I didn't want a repeat of the episode that landed me in surgery at the beginning of the year.

So, I am back on Flagyl and wondering what to do next.

I decided to do a little experiment.  Through muscle testing, I have been diagnosed by Dr. X of having reactions to dairy.  As a result, I have not had any dairy in my diet for almost four months.  I had muscle reactions to both milk and cheese products.  I explained the whole process in a previous post.

As part of my experiment, I brought to my appointment some mozzarella cheese, pesto and olive oil.  I cut the cheese into a rectangle and told Dr. X that it was tofu. I put it in my mouth and he pushed on my leg.  No reaction.  The problem here is that I had a reaction several weeks earlier to the same product.  The only difference is this time Dr. X didn't know the true identity of the food.

The biggest criticisms of muscle testing is that there is no scientific proof that it works.  Although most doctors are well-intentioned, some argue that the "reaction" to certain foods is merely the doctor doing something different in order to get that reaction.  Every food item that was dairy based was found to create a reaction in my body.  Except the cheese that he thought was tofu.  But I don't think he did anything different.  But, at the same time, I am not sure why my leg gave out one time and not the other.

I don't know what to think at this point.  Even the pesto didn't create a reaction, and that has cheese in it as well.

So is the Chinese medicine all a waste?  Or, perhaps since I have purged myself of dairy, my body no longer registers a little cheese as a threat?

I had to cancel my appointments for the last two weeks and haven't been on herbs for over a week and a half.  Since stopping the herbs, I have not noticed any difference  The only thing I am on at this moment is Flagyl, which I take three times a day.

Logic tells me it has been the Flagyl all along.

I will see my gastroenterologist in two weeks and she wants to start me on a more aggressive treatment:  a TNF inhibitor, such as Humira or Imuran.  I haven't decided if I am going to go back to my Chinese traditional medicine doctor or not.   And I am not sure I want to go the route of a TNF inhibitor.

Everything is up in the air.

I am feeling pretty good now.  I guess that is what counts.

Maybe I should try the wormwood² next.

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¹ Flagyl is a powerful antibiotic.  It is one of the oldest drugs to treat Crohn's and has been pretty effective in treating fistulas and anal/rectal Crohn's.  Although it was developed to treat stubborn bacteria, like c. difficile, it was discovered to have anti-inflammatory properties.  Some people stay on Flagyl for months or years.

² Wormwood is the bitter herb found in absinthe.  Some traditional doctors are using it in place of TNF inhibitors.  A couple of recent studies suggest it as an effective treatment for Crohn's.  Of course, none of these studies have been conducted in the United States, most likely because there is no money in using an herb to treat a disease such as Crohn's. After all, the TNF inhibitor market is a $13 billion a year industry.

The Ying and the Yang: Western v. Eastern Medicine

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Today, I finished my month-long supply of Flagyl.  This is an antibiotic used mostly to treat intestinal or vaginal infections.  Since I don't have a vagina, the drug was used to treat my colon.  But not for a bacterial infection, however.

My surgeon prescribed it for me when I was having issues with external inflammation and pain.  Here's the thing about Western doctors:  they don't like not-knowing why things happen the way they do.  I asked him why I was getting an antibiotic to treat inflammation.

"We have found that Flagyl helps with anal Crohn's inflammation," he said.  I think he was expecting it to end there.  Obviously, he doesn't know me very well.  I like to know why.

"Why is that?"  I asked.

He paused a moment, thinking of what to say.  "We don't know," he finally replied.  Western doctors don't like not knowing and I think they feel a little bit inadequate when forced to make that admission.  They feel like they should know.  After all, they spent a great deal of money becoming doctors and we expect them to have all the answers.  In the West, we spend a great deal of time trying to determine the causes of ailments.  And since there is no determined cause for Crohn's, a lot of it is trial and error.  And that doesn't sit well with most doctors.

Now, contrast this with my Traditional Chinese Medicine doctor.    A couple of months ago, Dr. X began prescribing for me various herbs to treat my Crohn's.  One of the herbs is honeysuckle.   Honeysuckle has been used in traditional medicine for thousands of years.  It is a natural anti-inflammatory.  I asked Dr. X what it was about honeysuckle and Crohn's.

His response:  "I don't know."   Okay.  Not too different from my Western doctor.  But he didn't stop there.

"And, to be honest with you Bruce, I don't care.  All I know is that it works."

I was a little surprised by his candor.  "These herbs have been used for thousands of years.  I don't know why they work. And it really doesn't matter, does it?"

"I guess not," I replied timidly.

Dr. Zhengang Guo

Dr. X studied herbs under Zhengang Guo, who grew up in China and learned herbal medicine from his father.  After studying Western medicine and oncology, he came to the United States in 1981.  A few years later, he began teaching a class in Traditional Chinese Medicine at the University of Illinois, the first class of its kind in the city.  One of his students:  my very own Dr. X.  

"I'm not an herbologist," he continued. "I am not even sure of all of the herbs in the various formulas I prescribe.  I'd have to look at the labels." 

Okay, this was a little bit too much candor for my taste.  It was one thing not to know why things happen the way they do, but to revel in it went against every academic fiber in my being.

"Look, you didn't come to me to find out why Crohn's happens. I have no idea," he said.  "You came to me to feel better.  And that's what Traditional Chinese Medicine focuses on:  not the cause, but but the symptoms.  I know what works.  Why it works?"  He then shrugged his shoulders.  "It really doesn't matter."

So there it is:  the ying and the yang.   The Western doctors forever searching for a cause; the Eastern doctors using the time-honored technique of "whatever works."

Still, I have one less pill in my system now.  Soon, I'll be done with the prednisone as well.  By next week the only medicine coursing through my veins will be Dr. X's herbs (plus the probiotics and vitamins I am taking). 

And then we will truly see if "whatever works" really has some truth to it. 

My Sh*t Don't Stink: The Biology of a Bowel Movement

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Yesterday, my wife and I had a date night.  Actually, it was a "date afternoon."  We saw a movie---the first one in a long time and went out to dinner to the Lucky Monk.  I can't remember the last time we had seen a movie, probably last November when we went out for Cheryl's birthday.  This felt good to get out, especially since I have been feeling better.  I ordered BBQ salmon but had to forgo the micro brew due to my taking of Flagyl.  We talked about the movie, the menu selection at the Lucky Monk and, of course, my colon. 

"Your poops sure don't stink as much," my wife told me.

You know you're a Crohn's patient when the topic of dinner conversation turns to bowel movements.  At a restaurant, no less.

And so we spent some time discussing the odoriferous particularities of my daily habits.

As I mentioned before, unless you have small kids, we adults--for the most part--go through life pretending that we don't have rectums.  We don't talk about it unless it is giving us trouble.  And most people find such talk at dinner to be inappropriate, at best (I sure hope the two guys sitting next to us, stuffing their faces with large burgers, didn't mind).

The fact is, our "daily habits" can tell us a lot about our overall health.   And odor is a big part of it.

The main ingredient in a good, healthy shit is water, actually.  Undigested food comes next, mostly fiber and seed.  The rest of it is living and dead bacteria and the bile and other fluids that helped breakdown that food in the process.  The breaking down of the materials produces a little methane gas. ¹   That is the main source of the odor, plus the levels of bacteria in your colon.  Food choice can cause the levels of methane and bacteria to fluctuate, thus affecting the overall odor.  A healthy bowel movement does not stink as much as an "unhealthy movement."

According to a Patrick Donovan, a naturpath in Seattle,  "You're passing methane and bacterial, degraded foodstuffs, so there's always going to be an odor. But it shouldn't be a very strong, pungent odor." ²

And let me say: my movements the last couple of months have been horrendous in the odor department.  Usually, people tend to not notice as much their own particular odors; we're so used to it, I guess, that our brains no longer even recognize the extent to which we have stunk up the room.   But even I have noticed some of them.  From the second floor, no less.

Now that's some stinky feces.

Of course, that was when I had in infection.  Still, even before the infection, my Crohn's infused colon produced some mighty strong stink bombs.

But not as much anymore.

The question, yet again, is why?  It is well known that those people who consume milk tend to have stinkier poops.  In order to digest the lactose in milk, your body produces a protein called lactase. In fact, as we grow older we produce less lactase and therefore have a more difficult time digesting lactose.  Even if we are not "lactose intolerant,"  the more milk we drink, especially as we get older, tends to produce more mucous and foul-smelling movements.  Most of the world becomes lactose intolerant by the age of ten due to the ceasing of the body's ability to produce lactase, except those in the United States and of northern European extraction where milk products are a large part of the diet.  Over 90% of people in China cannot drink milk in adulthood. ³
 
I have given up milk completely, so this could be one of the reasons for the lessening of odor.

Bacteria is also an important component of digestive health. In fact, you can not survive without the billions of bacteria living in your gut.  Some of that bacteria is bad.  In fact, you have billions of e. coli bacteria throughout your system.  However, the good bacteria keeps that bad in check.  It's like an epic war of bacteria going on in your stomach and intestines.  When the bad bacteria wins some of those battles, so to speak, the odor level of the poop and gas goes up.

I have been taking some probiotics to help keep that balance.  Each day I take L. acidophilus (the good stuff in yogurt) and Align, a proprietary beneficial bacteria called bifidobacterium infantis created in a lab by Proctor and Gamble.  My GI doctor recommended this a couple of years ago.  So, I take it.  However, it is a little expensive for a 30 day supply.  L. acidophilus can be found at any drugstore.

And let's not forget the herbs Dr. X, my doctor of Traditional Chinese Medicine, has given me.  What these have done...I have no idea.

The only thing my family has noticed, apparently, is that my shits are less stinky.

And less stinky is a good thing.


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1.  This is the main reason why farts can be lit on fire.  There was a guy I knew in college who relished every opportunity to turn his ass into a flamethrower with a Bic lighter.  On one trip to Madison, Wisconsin, for a theater festival I was involved in, he spent the night shooting flames out his butt and consequently lit his underwear on fire.
2.  Martiga Lohn, "The Bowel Truth." http://findarticles.com/p/articles/mi_m0NAH/is_3_29/ai_54189553/ Accessed March 11, 2012.
3.   "Got Lactase?" Understanding Evolution. University of California Museum of Paleontology. August 2007 http://evolution.berkeley.edu/evolibrary/news/070401_lactose
Accessed March 11, 2012

Is it the Herbs? Or what?

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So, here it is: 5:30 in the morning. I have just finished my breakfast and am waiting.

Waiting to go.

You see, I haven't gone in well over a day.  That's right.  For the first time in...well, as long as I can remember, I haven't had to go.  And if you're having problems reading between the lines here, I haven't made a doodie in approximately 40 hours.  This hasn't happened since before the Crohn's came along.

I have a pattern in the morning.  Of late, I usually went about twice before going to work. So yesterday, I hung around as long as I could so that I could take care of business here---after all, I have the bidet and the bathrooms at work are...well, let's just say they haven't been updated since the building was built in 1968.  And they don't have bidets.

I feel good for a change, actually.  Better than I have been in several months.  So why is this happening?  That is what I am having a problem wrapping my head around.

I am still taking the Chinese herbs.  41 herbal pills a day.

I am on 15 mg of prednisone.

9 mg of Flagyl.

Two types of probiotics:  acidiphillus and Align.

I have given up milk and dairy products.

I receive acupuncture a couple of times a week.

Is it any one of these things or a combination of them all?

I have been on prednisone on and off (and at larger doses) over the course of the last year.  And this hasn't really happened on the prednisone.  So, I don't think it is that.  Plus, I am on the lower end of the dose.  I started off at 40 mg.

Antibiotics such as Flagyl usually mess up the intestines and make the bowels move even more.  So, I don't think it is that.   However, my surgeon prescribed the Flagyl not for an infection but for inflammation.  He said that Flagyl reduces inflammation in the colon for some Crohn's patients.  But they don't know why.  Could this be the reason?

The acupuncture....I still don't get this.  But who knows?

The only other options:  the herbs, the dairy-free diet and the probiotics.

I have been taking the probiotics for a week, after going on the Flagyl.  This is the first time I have ever taken two.  Why?   I thought two different strains of beneficial bacteria is better than one.

So that leaves the dairy-free diet and the herbs.

It's been a couple of weeks now without dairy.  I have started using Earth Balance Natural Buttery Spread in place of butter (and I love butter.  I could eat butter as is.), almond milk instead of regular milk and have checked the labels on products to make sure there is no milk or casein in the ingredients.  I even removed the cheese from the pizza I ate at my brother-in-law's house the other day.  That was hard. 

But I have given up milk before---maybe not this strict, but there was a time when I didn't have milk products.  And I never had results like this.

So it looks like the herbs may be what is making me feel better.

About five years ago, I controlled my Crohn's symptoms through the use of a high-fiber diet.  I ate about a cup of bran every morning.  For someone with Crohn's, the bran bulks up the stools and makes movements less frequent.  However, according to my gastroenterologist, the Crohn's was still there---and getting worse, actually.  The bran was just covering that up.  The last thing I want is to go into another colonoscopy only to be told that things have gotten worse.  I may be feeling better, but the colon doesn't lie.

My fear is that this is what the herbs may be doing.   But then again, isn't that what all drugs do?  Since the cause of Crohn's is not known, the various drugs used to treat Crohn's merely cover up the symptoms by reducing some of the inflammation.  But the root of the Crohn's is still there.  Somewhere.

The jury is still out on this one.  In the meantime, I continue to wait.

And I will continue taking the herbs.


***Update***

Nature called a little after 6 am today.

Crohn's, Pus and Nurse Ratched

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I have two young boys, so the potty talk in my house is pretty excessive.  As it is in most households with young kids, I assume (and hope).  However, as we get older, potty talk gives way to polite conversation in which certain things are never discussed.

Unless you suffer from Crohn's, that is.

Modesty is not something that we embrace (hence this blog).  People who have Crohn's can discuss all sorts of things that most people could never imagine uttering.   Although everyone poops (as the title of that children's book tells us), most adults walk around like they don't.  Not us Crohners.  After all, there is not much sacred anymore when you have to lie face down on a table that tips forward to the point that all you can see are the specks on the tile floor, your body positioned like an A-frame house.  In this position, the doctor can then spread your butt cheeks and get a good look at your backside, like a giant peering into the attic window.  Probably not too different from stirrups at the gyno, I imagine.  "Should I close the blinds?" a nurse asked me at my last appointment.

"Naw.  I like the natural light," I replied.  If someone wanted to look in, be my guest; it sure wasn't a pretty sight.

When one has Crohn's, they become intimately knowledgeable about their digestive system.  We understand a thing or two about mucous membranes.  We can detect subtle changes in consistency and odor.  We can talk about the problems we may have with our ileum.  Or detect the smallest traces of blood in a swirling bowl of seemingly primordial goo.

Pus isn't a big deal for us.

Last week, I came down with a fever.  It was at the most inopportune time, however.  My sister, brother-in-law and nephews were over.  I started feeling chills.  My temperature was around 100º.  The chills got worse and I had a hard time controlling the shaking.  My first thought:  the flu.  After taking some Advil, I was feeling better.  But then my temperature shot up to 101.5º.  That night I was shaking so bad, I almost hyperventilated.

Over the course of the next 48 hours, my temperature fluctuated between 94º and 101.6º.  I saw my general practitioner the next day and he was pretty astute.  He did a flu swab---nothing like a long Q-tip shoved up your nose.  "This is going to make your eyes water," said the nurse.

And it did.  Gushers.

But it wasn't the flu. "Didn't think so," said my doctor.  "I think it's bacterial.  You usually don't see those fluctuations in temperature with a virus."

So he put me on a Z-Pak.  All I thought was that this was not related at all to my Crohn's and was still pretty sure I had some type of virus.  But, I took the antibiotic anyway. 

A day later, the pus came.  Lots of pus. 

Since the Crohn's moved lower and is now both internal and external, I have been dealing with discharge and pain "down there" on a daily basis.  It was actually getting better over the last couple of weeks.

Or so I thought.

The pus was pretty excessive.   And the pain increased.  The antibiotic was drawing the infection out--probably something that I have been fighting for awhile, but since the area was so inflamed it wasn't noticed when I was in the office last. 

But, there it was, dripping from my butt.  There wasn't much I could do to control it it, except to keep it as clean as possible.  Use gauze if necessary.  Frequent trips to the bathroom.

Thank God for the bidet.  That has been a life-saver.

So, here I am, several days later and the infection no longer hurts.  There is hardly any pus drainage anymore.  The inflammation is better.  Thanks, Z-Pak.

What happens next?  I may go on another round of a different antibiotic just to make sure it is cleared up.  My fear is that the problem may be a fistula or an abscess.  But my surgeon doesn't think so.  He hadn't seen any evidence a couple of weeks ago.  He actually prescribed Flagyl for me at that time, but not for an infection but for inflammation. "For some people," he said, "Flagyl helps with anorectal Crohn's.  We don't know why, it just does."

That's the thing about Crohn's: much of it is a mystery.

But, like the good patient I am, I didn't take the Flagyl.  I didn't want to take an antibiotic for 30 days if not needed.  Plus, I started taking the Chinese herbs a couple of days later so I didn't feel like it was necessary.

After telling that to my surgeon's nurse the other day, she went Nurse Ratched on my ass and basically blamed the infection on my failure to follow directions.  After a minute or two of condescending lecture, I began to wonder two things:  1) did this nurse ever play Nurse Ratched in some community theater production of One Flew Over the Cuckoo's Nest and 2) maybe I should start taking the Flagyl next week.

"You should probably start taking the Flagyl next week," she said.  She can also read minds apparently.

So, I will begin that treatment in a couple of days.  But I am still unsure if I want to go 30 days on an antibiotic.

Seems a bit excessive, especially for someone with colon issues.  Antibiotics kill the good bacteria with the bad, so this could make my colon worse---all to make my rectum better. 

Oh, the decisions we have to make: do I protect the butt or the flora in my colon?  I don't particularly like the pus, that is for sure.

And you probably don't want to read about pus again, I imagine. 

So.....hello, Flagyl.