Shit Watch 2013 is Over

Tweet

So Shit Watch 2013 has finally ended. After several days of Miralax and Proctofoam, my lower colon opened up just enough to....you know, let loose.

Normal Colon

Why has this been happening? My doctor thinks I probably have a colon stricture. This is a narrowing of the colon---for me, the lower colon. This was the area last year that gave me a tremendous amount of difficultly that had resulted in my switch over to Imuran. As I have mentioned before, Crohn's can manifest itself in any part of the digestive system---from the mouth to the anus, internal and external. Until last year, my Crohn's was intent on hanging out in my upper colon, near the connection to the the small intestine. Apparently not happy with just that neighborhood, my Crohn's bought some real estate in my lower colon--in the anorectal area. The lesions and inflammation there sent me to the hospital and required a new approach to treatment.

Colon with Stricture

It's that area once again that has been causing some problems as of late. Evacuating the bowels (this is the technical term for "taking a shit") has become difficult, due to increased inflammation. However, I have not had the pain that I had last year and this could be due to a stricture.

What causes a stricture? Could be a variety of things--from simple inflammation to a hernia, fissure, twisting of the colon or a tumor. Stress can make it worse. The only thing that can be done to find out the cause is to---you guessed it, shove a camera into the neighborhood and look around.

So I am heading to the hospital again on April 8th for a "flexible sigmoidoscopy." Fun.

Depending on the cause of the stricture, the solution can be relatively easy. According to my doctor, it could be just "ballooning" the area to open it up a bit or simply removing an obstruction that might be present. Biopsies will also be taken on the inflamed tissue as well.

And pictures. Hopefully, plenty of pictures.

The Life Insurance Questionnaire

Tweet

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.

My Talking Colon

Tweet

My colon talks sometimes.

As anyone with Crohn's can tell you, a colon sometimes makes a lot of noise. It gurgles. It burps.  It sloshes. Sometimes it is soft. Sometimes it is loud and angry, causing spasms that resonate throughout the abdomen.

And usually it just doesn't care what you are doing or where you are.  Sometimes it wants to announce to the world that it is there. Such an attention seeker is a colon.

The other day I was at a meeting after work. A couple of dozen people were sitting around a table. We were discussing various issues and events facing the people in our line of work. My colon decided it wanted in on the discussion.

First it gurgled; a guttural sound that rises from deep within the bowels and tingles the skin. Everybody with Crohn's knows that sensation.

And when that happens, we tend to shift in our seats to try and mask the sound, hoping others did not hear the noise. Sometimes we cough lightly to cover up the noise. But none of that actually works; we know that, but do it anyway.

My colon decided that day that it was not going to be silenced.  It gurgled some more. It bubbled loudly. It was like that drunk relative at a family reunion still living in his parent's basement, wanting to prove to everybody that he's made something of his life.

People were beginning to notice my colon. They glanced my way. Eyebrows were raised.

I stopped trying to hide it and was instantly reminded of William S. Burroughs.

In his very bizarre novel, Naked Lunch, Burroughs writes about a man with a talking asshole:

Did I ever tell you about the man who taught his asshole to talk? His whole abdomen would move up and down, you dig, farting out the words. It was unlike anything I ever heard. This ass talk had sort of a gut frequency. It hit you right down there like you gotta go. You know when the old colon gives you the elbow and it feels sorta cold inside, and you know all you have to do is turn loose? Well this talking hit you right down there, a bubbly, thick stagnant sound, a sound you could smell. 

For the first time in my life, Burroughs actually made sense. My colon was talking. Like the asshole in Burroughs' story, my colon was giving me "the elbow" and trying to get recognized.

It wasn't too long before the guy sitting next to me turned and said, "Is that your stomach?"

I laughed. Everyone just assumes that when such a noise emanates from a body, it must be the stomach announcing that it is hungry. Which is funny because it is not quite the same sound as a hunger rumble.  And everyone knows it.

"No," I replied.  I actually wanted to say:  No, that's shit rushing through my innards.  But I didn't.

"It's my colon," I said in an exaggerated whisper.

"Oh," he replied, a little surprised and perhaps a tad bit embarrassed.   He looked back down to his computer.

"It talks sometimes," I added.

For the rest of the meeting, as we discussed the various issues facing people in my line of work, my colon occasionally added its own two cents. A gurgle here. A slurp there.

Shit rushing through my innards.

My colon talks sometimes.  And I could tell, on this occasion, it was really enjoying itself.

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

Tweet

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.


-------------

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?

Tweet

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

Tweet

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.

My Introduction to Traditional Chinese Medicine

Tweet

If you were to meet my Traditional Chinese Medicine doctor on the street, you would never think he was a doctor of Chinese medicine.  First of all, he's not Chinese.  That, of course, doesn't matter.  But it's kind of like walking into a Mexican restaurant and everybody who works there has blond hair and blue eyes.  The food may be good, but are you getting the "real" thing?

My doctor is passionate about Chinese medicine, that's for sure.   He's been practicing it for 40 or so years.  He is an older gentleman, with dark hair and a dark mustache.  He looks like Mario from Nintendo, only older and taller.   And he's not a cartoon.

We'll call him Dr. X.  That sounds mysterious.  And it fits for Chinese medicine.

Chinese medicine is mysterious, especially for someone in the West, raised on Western concepts of medicine.  The Chinese have an entirely different way of approaching medicine.  It's about balance and harmony.  They throw terms around like "Hot" and "Cold" and apply it to your condition.  Heat is bad and certain foods, like coffee for example, put heat in the colon.  Tea, on the other hand, is "cold" and that is soothing to the colon.  It's all about balance.  The ying and yang.

Dr. X and I talked for awhile at my first appointment.  Tried acupuncture for the first time.  And he prescribed a bunch of pills for me.  All herbs designed to provide balance to my system and remove that "heat" from my colon.  Here is what I am taking:

• Honeysuckle-12 tablets a day.
• Agrimony--12 tablets a day.
• DHT-INT--12 tablets a day. This is a blend of peach seed, Job's Tears seed, Baikal Skullcap root, Patrinia, immature bitter orange fruit
• RBX--15 tablets a day.  Pulsatilla root, Lithospermum root, Sophora fruit, Sanguisorba root, Corydalis rhizome, Rhubarb rhizome, Red Peony root, Licorice root

This  is divided into 3 doses, taken before or after meals.  The hardest thing about taking these 17 pills at once is the amount of water than needs to be consumed.  Yesterday, after taking pills in the morning, I started on my way to work.  My ride to work is about 40 minutes and halfway there I realized something:  I had to pee.  Bad.  Luckily, McDonald's was nearby and off I went.

The problem with stopping at McDonald's in the morning is the smell of coffee.  The one thing that I look forward to every morning is my coffee.  In fact, just last week, we bought a new coffee maker.  And McDonald's smelled of coffee that morning.  But I haven't had any coffee since meeting Dr. X last week.  He gave me a list of food to avoid:  coffee, alcohol, seeds, nuts, chocolate, spicy foods, raw fruits and vegetables.  Not only are these things difficult to digest---and we want to lessen the distress on my colon--they also contribute to the "heat" that  damages my colon, according to Traditional Chinese Medicine.

So, I no longer have my coffee.  Once my condition is under control, and Dr. X thinks that the probability of me experiencing relief from Traditional Chinese Medicine is very good, then I may be able to re-introduce some of these foods later.  But, for the time being, I am missing my coffee.

And my wine, that is for sure.

Are things working?  I don't know.  My colon has calmed down a bit.  I go maybe two times a day and it's relatively normal.  My lower colon, both interior and exterior, is still very inflamed.  Talk about a pain in the ass.  Haven't noticed much change there, nor did I expect to experience much change this quickly.  Patience is the key, as Dr. X told me.  But I am impatient.  Like most people, I want things to get better now.  That's the way we work in the West and Western medicine caters to this desire.

Dr. X told me that he has a patient who has Crohn's and was going 17+ times a day before he started this treatment.  I've never been that bad.  When I first was diagnosed with Crohn's, the most I ever went was 14 times in one day.  This other patient now goes only once a day and he is no longer taking any drugs.  My colleague at work who gave me Dr. X's contact information told me that his good family friend has Crohn's and it has been controlled with the help of Dr. X.  So I am hopeful.

But skeptical as well.  Much of what what we have done--from the herbs to the acupuncture-- seems a little alien to me.  And that would fully be realized at my next appointment.  Let's just say that Dr. X blew my mind.

And it involves milk.

More on that later.....