Friendship and IBD

“Friendship is the hardest thing in the world to explain. It’s not something you learn in school. But if you haven’t learned the meaning of friendship, you really haven’t learned anything.” – Muhammad Ali

I started with this beautiful friendship quote because I’m going to talk about Friendship in this article. Friendship is a very unique relationship. Friends are not related to us by blood, even though they won’t have any expectation in the relationship they are always with us to support, to help, and to find purpose and meaning in our life. For me, they’re one of my major pillars in my life. The emotional bond between my friends and I helped me to recover back my strength, especially during pre and post-surgery. In this article, I would like to share how my friends helped me to build back my strength during my early days of being diagnosed with Crohn’s.

My friends have been good listeners. Whenever I have problems, the first group of people that I look for are my friends, not even my family, because my friends are willing spend their time to listen to my problems and my feelings. They’re fully present when I start to talk. There are no distraction such as phones, people, or work, and they give their 100% focus to what I’m saying. I was in campus during the time I was officially diagnosed with Crohn’s. I was depressed, and they were the ones l looked for to talk to and to share of my health condition with. Once I uttered everything I wanted to say, they kept silent for a moment and then they started to give their suggestions. The point is, they listened and digested my problem before giving their best solution. I think this is the best part of friendship because they didn’t jump to conclusions. Instead, they listened to me first.

They cheer me up with great humor. My friends do understand laughter is one of best medicines to keep me healthy. My friends, unlike myself, are funny and their sense of humor always bring me happiness. In our conversations, there are always some funny jokes that make me laugh. Even when I’m in a bad mood, they are able to make me laugh and refresh my mood and cheer me up. In fact, friends with a good sense of humor can make our world feel good. Whenever I spend time with them, I never have a thought of pains, depression, or that I have Crohn’s.

Another great quality of my friends is that they care about my daily activities. This is an important quality that my friends show toward me that I really appreciate in them. Caring friends take a lot of dedication and love to keep the relationship always warm. My friends often call me to ensure I’m doing fine. They accompany me for my endoscopy appointment every year. They take extra caution on my food intake whenever we go out to eat. There are many more things that they do for me. And, most importantly, they also like to use positive words to keep encouraging me. They’re say encouraging words such as “you can do it Sara”, “you must be strong” to motivate me so that I can keep moving on in my life. Their words give me more confidence and strength whenever I need it. Their words lead my thoughts and emotions to positive ways.

Friends provides a place for us to share and to discuss our feelings. In fact, friends are the best emotional medicine for people like us to overcome from depression and lift us up and encourage us to take a leap of faith to change our life into something better.

Digestive Disease Week: Efforts to Understand Disease and Improve Management of Inflammatory Bowel Disease

DDW is one of those experiences I don’t think I will ever forget. Whenever I used to think about how researchers are out there studying Crohn’s Disease, it always felt detached. Like they are faceless people in labs hundreds of miles away. That changed with DDW. I could see the men and women working enthusiastically towards the betterment of my life. I could see their faces, I could hear their excitement, and suddenly research wasn’t this abstract idea any more. Research is now Ashwin Ananthakrishnan, Pabitra Sahu, and the countless other researchers who spend their time and resources in pursuit of a better life for people with IBD.

I could probably write about each and every IBD session at DDW, but I have chosen to focus on the session titled Efforts to Understand Disease and Improve Management of Inflammatory Bowel Disease. This was one of the first sessions I attended at DDW, and it covered a wide variety of topics. Within this session, two presentations stood out: Higher Resource Utilization and Economic Burden Associated With Fatigue in Inflammatory Bowel Disease and Randomized Clinical Trial: Exclusive Enteral Nutrition Versus SOC for Acute Severe Ulcerative Colitis.

Higher Resource Utilization and Economic Burden Associated With Fatigue in Inflammatory Bowel Disease

Fatigue can be one of the most debilitating parts of having IBD. Most of us have had days where everything we have planned becomes derailed because our bodies are exhausted. There is this idea that fatigue is a normal part of life for people with chronic diseases. Like it is expected, and therefore it isn’t worth addressing. I certainly know that fatigue gets put on the backburner at most GI offices. I’m not even sure if in my 5 years as an IBD patient that I have ever had a discussion about fatigue with my doctor.

I think that most IBD patients would agree that fatigue has not only a large impact on their disease, but on their life in general. This disconnect between how providers and patients view the importance of fatigue is challenged by the research presented by Dr. Ashwin Ananthakrishnan. He discusses the findings from his study focused on determining the economic burden of fatigue in IBD patients. Before we get into his findings, it is important to set the stage. The study presented was a Retrospective Nested Case Controlled Study.

  • Retrospective - looks at the past.

  • Nested - The case control was taken from a specified group of people

  • Case Controlled - IBD patients with fatigue were matched with IBD patients without fatigue.

The study looked at patients with both CD and UC who were newly diagnosed (<12 months). There were 21321(!) patients in the fatigue and non fatigue groups. Outcomes compared include rate of:

  • IBD surgery

  • Hospitalization

  • ED visits

  • Outpatient Visits

  • Total, medical, and pharmacy costs

The researchers looked at the above outcomes from all causes and from IBD specific causes. That is just to say that they wanted to determine if the hospitalizations, ED visits, and outpatient visits were because of the patient's IBD or some other outside factor.

So what did they find?

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That is a significant difference in every. Single. Outcome. IBD patients with fatigue are more likely to be hospitalized, visit the emergency department, and have outpatient visits than those without fatigue. What did that mean for the costs? The researchers also found that IBD patients with fatigue had higher direct costs than those without fatigue. This was true in both mild and moderate/severe disease, showing that even in patients with mild disease fatigue increases healthcare costs.

This is huge. A lot of the time, in America at least, healthcare is focused on cost-benefit analysis. That is to say: if the insurance company spends the money, is the benefit great enough to justify that expense. This study shows that leaving fatigue untreated in IBD patients results in significantly greater expense, which in turn means that there is a huge benefit in making sure that fatigue is treated in IBD.


Overall, the study presented here reinforces the importance of treating fatigue in IBD patients. Fatigue appears to be a source of economic burden that warrants an increased attention and interventions. For IBD patients, hopefully this means that our providers have increased awareness of how fatigue impacts our day to day lives. Now that there is an understanding that fatigue is a problem, the logical next step in my mind is for research to determine how best to address fatigue in IBD. For now, frequent naps and an unholy amount of coffee will have to do.

Randomized Clinical Trial: Exclusive Enteral Nutrition Versus SOC for Acute Severe Ulcerative Colitis

The next study from this session I wanted to hone in on discussed exclusive enteral nutrition (EEN) in severe ulcerative colitis. EEN is when patients are fed enteral formula either by mouth or through a feeding tube for a period of time. It has been shown to promote mucosal healing, correct dysbiosis, modulate the immune system, and improve nutritional status. Currently, the best research for its use is in the pediatric Crohn’s Disease population, where it is considered a first line therapy. I am a huge proponent of the need for more research in EEN, which is why this study is so exciting.

The goal of this study presented by Dr. Pabitra Sahu was to evaluate + EEN vs standard of care for acute severe ulcerative colitis. Both groups received steroids treatment, so the main difference between groups was diet: EEN vs a normal diet in the standard of care group. EEN consists of peptamen, which is a semi elemental (partially broken down, easier to digest) formula. The study evaluated 62 patients, 32 in the EEN group and 30 in the standard of care group. The authors primarily wanted to know if EEN had a significant effect on corticosteroid failure, with a few secondary outcomes including measuring markers of inflammation and fecal microbiome analysis.

As far as the primary result, this study found that there was no significant difference between the EEN group and standard of care group when comparing the rate of steroid failure. This doesn’t take into account that 5 patients in the EEN group were found to be intolerant to EEN, and thus had to stop therapy early. When the authors compared the EEN group without these patients to the standard of care group, a significant difference in steroid failure rate was observed.

As far as secondary outcomes, there are a few worth mentioning. The EEN group had a significantly shorter duration of hospitalization when compared with the standard of care group. The EEN group also had greater reduction in CRP (measure of total inflammation) from day 1 to day 5 than the standard of care group. 

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Analysis of the fecal microbiome showed that there was a significant difference in the distribution of four bacterial genera. One bacteria, Erysipelotrichaceae (who thought that name was a good idea?), was increased in EEN. Erysipelotrichaceae has been linked with increased inflammation and disease activity in pediatric IBD, so it appears to be beneficial that the EEN group had an increased number of this genus. 

To conclude, this study showed that there is a possible benefit to a short course of EEN alongside steroid treatment to improve steroid response rate, decrease duration of hospitalization, decrease inflammation, and modify the microbiome. While this study might not be strong enough to warrant using EEN for each and every severe UC patient, it at least provides another option to discuss with motivated patients looking to improve their chances responding to therapy. I know that if I were to be hospitalized I would want to do everything possible to increase my chances!

A Letter to My Crohn's Disease

You know that I like to write.

Today you have your honor again.

I want to confess to you that you can happen to me, but you do not define me.

When my mind is clouded by logical thoughts, I like to express to you in irregular lines the emotions that overwhelm me.

You taste complacency complacently and wrongly, but the only reason I write to you is because it works therapeutically in me.

Addressing you as if you exist while I am struggling to annihilate you is redemptive.

Immediately after I feel invulnerable.

Today I have set you up in the steepest corner of my mind and I observe you.

You changed me a lot.

You forced me to live in the arms of uncertainty.

I look you straight in the eyes, I confront you.

Today I am strong, because of you I have experienced one by one all my fears.

You are so close to me that I can smell you.

You know I had a hard time accepting you.

I spent so much time struggling to keep you away from me.

I invested in denial, I place between us the right distance and the right pretense.

I denied you countless times even though I recognized you from your look in the mirror.

I was overwhelmed from within.

Υou soaked my eyes, you occupied my body.

You mortgaged my life for no reason.

You trapped me with a loan of hope between before and now and ignored the aftermath.

You crumpled my wings.

I woke up confused, I think confused, I write confused.

Time flies.

I find that everything and everyone goes without asking me.

I know you will think I am strong, I went through a thousand waves to be here.

Every second, I define myself, I realize my existence.

I was angry, I refused, I accepted, I fight.

And because the most important thing in difficult times is to always find a reason to smile, I smiled and touched the scar.

The one that is always there to remind me that I was once received, the one that I found the strength and healed.

What is the strongest proof that although I was received, I fought with all my strength and I succeeded.

What I carry in my body as a precious medal of strength.

The one that will always motivate me with a smile to exorcise my fears and start for the new victory.

Full of stubbornness.

I endure and I do well.

I fight because that's all I learned and I win.

I win and in every victory I stand up.

I have learned to fall and get up.

Every time I reach an end I smile timidly and carve out a new beginning.

There are experiences that are experienced completely alone.

Experiences full of lost days and awkward moments.

A little more and you know I will rise stronger.

Digestive Disease Week: Diagnosing and Managing Pediatric IBD in the 21st Century

I am grateful to have had the opportunity to attend Digestive Disease Week (DDW) 2021. Learning about diagnosing and managing pediatric IBD in the 21st century allowed me to reflect on my own experiences as a pediatric patient through a different perspective. Two presentations stood out to me in this session.

To begin with, the first presentation that stood out to me,“Therapeutic Drug Monitoring with Newer Biologics”, was led by Dr. Lissy de Ridder who highlighted ustekinumab, vedolizumab and infliximab treatments. Dr. Ridder emphasized “treating-to-target” pediatric patients because of the lack of treatment options for this patient population. 

Dr. Ridder explained what Anti-TNF therapeutic drug monitoring (TDM) has taught us about secondary loss of response: 

  1. A secondary loss of response that is immunogenic is categorized by a decrease of the drug and an increase of antibodies in the patient. 

  2. A secondary loss of response that is pharmacokinetic is categorized as a decrease of the drug and no antibodies in the patient. 

  3. A secondary loss of response that is pharmacodynamic is categorized as a sufficient level of drug and no antibodies in the patient but the patient does not respond to the drug. 

The course of action for these different types of secondary loss of response according to Dr. Ridder: 

  1. A patient who has an immunogenic secondary loss of response to a drug will have the drug exchanged for a new drug in the same class and an immunomodulator will be added to the treatment plan.

  2. A patient who experiences a pharmacokinetic secondary loss of response to a drug will have the dose of the drug increased and/or decrease the intervals that the drug is received. 

  3. A patient who experiences a pharmacodynamic secondary loss of response requires that the drug be exchanged for a drug of a different class or surgery. 

Additionally, Dr. Ridder and her team conducted a study analyzing trough levels of young pediatric patients using infliximab and found that 75% of these patients were underdosed at the beginning of their treatment. As a result, these patients also did not have the recommended trough level and therefore responded less to infliximab. These results reveal that young pediatric patients responded less to infliximab because of underdosing.

Because of Dr. Ridder and her team’s study, the Medical Management of Pediatric Crohn’s Disease ECCO-ESPGHAN Guideline has changed to:

“In patients on anti-TNF agents, early proactive therapeutic drug monitoring [TDM] followed by dose optimisation is recommended. LoE:2 Agreement: 87.5” 

Other highlights of Dr. Ridder’s presentation were:

  • Vedolizumab is more successful in UC patients compared to CD patients and is used after failure to anti-TNF in patients 

  • Vedolizumab should not be used in patients with acute severe colitis 

  • Ustekinumab should be used for CD patients who experience failure to anti-TNF and also patients who have severe psoriasis 

The second presentation that stood out to me, “Results of the First Pilot Randomized Controlled Trial of Faecal Microbiota Transplant for Pediatric Ulcerative Colitis” was led by Dr. Nikhil Pai who highlighted patient interest in FMT and the barriers to FMT.

Dr. Nikhil Pai stressed that this trial was a result of a “significant patient and parent interest and emerging FMT data”. The study compared patients who received FMT treatments vs. patients who received placebo treatments for six weeks. The patients involved in this study were “UC patients between the ages of four to seventeen, had active disease, no CDI and no significant change in Rx in four weeks”. 

The study highlights:

  1. Fecal calprotectin significantly decreased in FMT recipients compared to placebo group

  2. FMT is beneficial six months after initial treatment 

  3. Future studies of FMT should consider at-home treatment or oral encapsulated therapies due to the lack of feasibility of the study 

  4. Supports FMT for pediatric UC patients 

  5. Need for more FMT research 

Overall, I am excited to see future studies about new treatments for pediatric patients with IBD and how these treatments will transition into adulthood. 

Navigating Relationships with IBD

As someone chronically ill, feelings of guilt, FOMO, and loneliness can be all too familiar. The severity and unpredictability of IBD can take a toll on the relationships you have with others, including romantic interests, friendships, family members, and coworkers. When i was diagnosed with Crohn’s Disease at the young age of twenty one, i quickly became frustrated that my poor health was holding me back from participating in classic twenty something year old activities. My unpredictable and debilitating symptoms made it difficult to leave my house, to follow through with plans, and to eat and drink at restaurants and bars. At the beginning of my journey with Crohn’s Disease, I was overwhelmed with feelings of loneliness and guilt when I had to miss out on my college friends' activities. I kept my symptoms and diagnosis to myself, not really allowing any of my friends to understand how to include and support me. 

Sharing your IBD diagnosis with your partner, friends, and family is a terrifying and overwhelming experience. Naturally, we strive to hide our vulnerability, but I hope to deliver advice through my own personal experience to help nurture your relationships and ensure you receive the support you deserve. 

My best advice is to share your IBD diagnosis with the people you surround yourself with. We cannot control how others react to our diagnosis, but we can control what we share with them. I often tried to hide my illness from others, and then became frustrated when disagreements arose over my frequent cancellations from flares as well as feelings of loneliness from no one understanding what I am going through. It’s important to allow those close to you to know what you are dealing with. Remember, someone that loves and cares about you will not be scared by your diagnosis, they will want to support you and be there for you in times of need. The first thing you need to do is allow them the chance to show up and support you. Be honest about how your disease affects you, whether that be generalized as last minute cancelations or going in-depth about the symptoms you experience. 

Remember your self worth. You may have inflammatory bowel disease but IBD does NOT define you. You have amazing, unique and loving qualities that make you amazing with or without IBD. Whenever I have trouble separating myself from my IBD diagnosis, I write down 5 things that I love about myself, whether that be my passion for helping others, my love for animals, or anything else that makes me, me! 

Ask for help. Be honest about your needs as someone with IBD, especially when flaring or on colonoscopy, infusion, injection and surgery days. Your friend or partner might not know how to best help you. Try to be honest and communicate your needs and wants to your partner, friends, and family to be best supported.

Create boundaries. Every person with IBD has different needs. Be honest about what you like and don’t like. Create boundaries with friends and family, especially about unsolicited advice or anything that may bother you. Has everyone heard the ‘you should try ___ (sub: yoga, veganism, meditation, etc.) and you will be cured’? My advice to create boundaries without offending a loved one is to express your appreciation and thanks but highlight how every person with IBD is different and that advice like this negatively affects you. Again, put yourself first. If someones advice or actions are bothering you, speak up and share that with them. Most of the time, people are only trying to help and this will help guide them to most effectively support you. 

As someone dating with IBD, the psychological aspect that can join a chronic illness, along with physically feeling sick, can create obstacles in relationships. Communicating with honesty will allow all parties to a relationship to feel loved, wanted, and respected. I truly hope these tips will help you navigate and make the most out of your relationships.

Meal Replacements and Oral Nutrition Supplements

Sometimes eating sucks. When my body hurts, I'm tired, and my gut is bloated, the last thing I usually want to do is add fuel to the fire by eating a meal. This is an unfortunate situation to be in because eating is one of those things we kind of have to do to survive. Luckily, there is a way to meet our needs without really eating. Enter the oral nutrition supplement. Calorie dense nutrition shakes designed to give you all the vitamins and minerals you need for livin’ in as little volume as possible. You can down one of these bad boys in under a minute and not have to worry about figuring out how you might fit an entire meal in your distended abdomen.

There are a lot of different nutrition supplements on the market, and it can be difficult to try to figure out which to buy. There are so many factors to consider, it can almost be overwhelming. In this article, I have tackled a few of the more common factors people consider when looking for supplements. Hopefully I have been able to provide some clarification on the differences between some of the common choices for meal replacement shakes.

Calories

The amount of calories I look for in one of these supplements depends on why I am using it in the first place. Am I trying to replace a meal? Then I would probably reach for something with a higher amount of calories. I usually try for at least 250 calories per shake, but closer to 500 calories is probably better. If I am using the shake to replace a snack, maybe 200-300 calories would be more desirable. 

Some nutrition supplements come as a powder that you can mix with water or another liquid. The benefit of these supplements is that you can add as much powder as you want and customize the amount of calories to the situation. Products like Modulen IBD, Huel, Garden of Life Raw Organic Meal Shake, and Super Fuel all come as mixable powders. Garden of Life is one of the lowest calorie options I have seen, coming in at 120 calories per serving. 

Most ready to drink supplements also have higher calorie options available. Ensure and Boost both make higher calorie versions of their regular nutrition shakes. You can usually tell a higher calorie shake because it will have the word “plus” in the name, i.e. Ensure Plus or Boost Plus. The big downside of these higher calorie versions is that a lot of the extra calories come in the form of sugar.


Fat

Fat is a tricky one. Often demonized, fat plays an important role as a source of energy, absorption of certain fat soluble vitamins, and managing inflammation. Certain fats are even essential, which means that we must get them from our diet. The type of fat in nutrition supplements matters. In most supplements, the fat content will be from vegetable oils. Animal fats are unusual or minimally used due to their tendency to be solid at room temperature.

Certain fats in vegetable oil, such as the Omega 6 fatty acids, are sometimes mis-labeled as pro-inflammatory. While these fats can be used by the body to create inflammatory molecules, research has shown that omega-6 fats are associated with lower or unchanged markers of inflammation. If you are somebody who is concerned about these fats, choose a supplement higher in monounsaturated fats such as Orgain or Huel. Looking for the words “high oleic” in the ingredients list is a good way to know that the oil used is high in monounsaturated fats. One supplement, Super Fuel, actually lets you add the fat to your shake yourself, so you can choose the exact type of fat you want!

Carbohydrates

There are a lot of considerations when looking at the carbohydrates in nutrition supplements. Some of the important things in my opinion are the sugar content, presence of artificial sweeteners, presence of maltodextrin, and fiber.

Sugar is an interesting one. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) says in their guidelines that there is insufficient evidence to recommend any specific change of intake of complex carbohydrates or refined carbohydrates or refined sugars and fructose. Therefore, any reason to limit sugar would have to be based on the known effects of high sugar consumption on heart health, gut health, weight gain, and other markers of health. Many of these supplements are high in added sugars, so it might be prudent to look for some of the lower sugar options such as Super Fuel, Huel, Orgain, or Garden of Life.

Some supplements contain ingredients that might be harmful in IBD patients. Specifically, maltodextrin and artificial sweeteners. Some of the low sugar supplements, such as Premier Protein, use artificial sweeteners like sucralose to replace sugar as a source of sweetness. Most supplements found in stores, including Ensure, Boost, and store brands such as Equate contain maltodextrin as a source of carbohydrates. In the IOIBD guidelines, the researchers note that it may be prudent to limit intake of both maltodextrin and artificial sweeteners. The authors also note, however, that the evidence for maltodextrin is theoretical and mostly based on animal models. Nutritional therapies that involve consuming nutrition supplements with maltodextrin have been found to be effective in IBD, so the jury is still out on maltodextrin.

Fiber is also a hot topic in IBD. Many foods considered healthy contain fiber, but many IBD patients who are flaring consider fiber to be something that aggravates their disease. Many of these supplements contain very small amounts of fiber, usually between 1-2 grams per serving. Some supplements, such as Huel, Kate Farms, and Super Fuel contain a higher amount of fiber. The general consensus from what I have researched appears to be that if you tolerate fiber, more is better. Like many other factors in IBD, fiber seems to be something to consider on an individual basis. Of note, Walmart’s brand Equate was the only supplement I looked at that had 0 grams of fiber per serving.

One thing to note is that some supplements include blends of fruits, vegetables, and other plant compounds. Orgain, Garden of Life, and Kate Farms all include these special blends, likely to try to mimic the benefits of eating whole foods. Other supplements, such as Huel and Super Fuel are made primarily from whole foods.

Protein

The protein needs of an IBD patient are increased during a flare. Protein is needed to help repair damaged tissue and maintain muscle mass, among many other functions. I think it is important to make sure that the nutrition supplement you choose has the protein your body needs to function optimally.

Most supplements have enough protein to meet your body's needs. A little trick I use is to try to shoot for 20% of calories from protein. You might need to whip up your phone calculator in the store, but the math isn’t too hard. First you would take the grams of protein and multiply it by 4, because there are 4 calories in every gram of protein. Then, all you need to do is divide the number of calories of protein by the total calories and multiply by 100 to get the percent!

Meal Replacements and Oral Nutrition Supplements

Let's do an example with Orgain’s Nutritional Shake:


Looking at the bottom, we see Orgain has 16 grams of protein per serving.
Step one would be to multiply 16g by 4 to get the number of calories, which would be 64 calories of protein.

Step two, would be to divide the number of protein calories by the number of calories in a serving, which can be seen at the top of the nutrition facts label.

We would do 64 calories divided by 250 calories and get 0.256.

The final step, to get a percentage, would be to multiply by 100 to make that number a percentage. So, .256 multiplied by 100 is 25.6%. 

25.6% is more than 20%, so Orgain would pass my little test!

Some of the higher protein supplements out there are Huel, Ensure Enlive, and Premier Protein, and Garden of Life. It is important to note that if you aren’t in a flare, your protein needs are likely no higher than the rest of the population. 


Carrageenan

Carrageenan is an emulsifier used to help the ingredients in shakes mix smoothly. It has also been shown to cause a variety of negative effects in animal models, such as increased blood in stool, increased inflammatory markers, and lesions in the bowel. For these reasons, and some small scale human research, IOIBD also states that it may be prudent to reduce intake of processed foods that contain carrageenan in both UC and Crohn’s Disease. Most of the supplements found in stores, such as Ensure, Boost, and store brands such as Equate use carrageenan in their nutrition supplements. If carrageenan is something you wish to avoid, you can usually locate it at the bottom of the ingredients list. You can see it is the last ingredient in Ensure Plus.

To Conclude

I wish I could add more detail, but I don’t want to break your scroll wheel. The most important thing to do when looking for an oral nutrition supplement is to take a look at the nutrition facts label and make sure you are comfortable with the nutrition content and ingredients in your shake. I usually try to look for higher protein and fiber, and lower added sugars while avoiding sucralose, maltodextrin, and carrageenan. Oh and the shake has to taste good too. Could you imagine not wanting to eat anything and reaching for a shake that didn’t even taste good? Neither could I. Considering all that, I usually go for Orgain nutritional shakes. They fit my goals as far as cost, taste, and nutritional content are concerned. 

Another option is to try to make your own shake in a blender. It can be pretty easy to toss some oats, a banana, and a few scoops of peanut butter together and have a tasty, nutritionally dense smoothie to sip on. You even save some money that way too! At the end of the day, store bought shakes or homemade, oral nutrition supplements can be a great way to give your body the fuel it needs to function when you don’t feel like making or eating a meal.

The Day I Got Vaccinated for COVID-19

I have completed the vaccination with both doses of the COVID-19 vaccine.

The day I had the appointment for the first dose of the vaccine, I woke up early and got ready as if I was going to a great event.

As an immunosuppressed individual, the last year was full of restrictions and prohibitions.

The organization of vaccination in Greece is exemplary for the data of the country.

When I arrived at the vaccination center, I said my name at the entrance and they led me to the place where the vaccination would take place.

After I was vaccinated, I stayed at the vaccination center for about 30 minutes and then left for home.

For the next few hours, all I felt was a slight discomfort at the injection site.

The days passed quickly and the day of the second dose came.

I woke up early again, got ready and went to the vaccination center.

 This time when I finished the vaccination and while I was waiting for the necessary time to pass after, they informed me that after the second dose I might have a few more side effects.

And indeed it was true, as for the next 24 hours or so I had chills, low-grade fever and fatigue.

These symptoms, however, did not make me regret my decision to get vaccinated.

My vaccination was completed with joy and emotion. I did it not only for myself, but for the whole society.

Vaccines have brought us all in front of a mirror, it is almost a historical fact. We are all witnesses and companions of a scientific miracle.

However, there are people who have learned to talk only about individual rights with complete disregard for the collective, who think that the "I" can survive without the "we". These people are actually few, but they manage to channel fear through misinformation and fake news to a large part of the population.

I did it not only for myself, but also for those around me, and for those who died because they were not lucky enough to have a vaccine when they became infected with the virus.

When a Patient Becomes a Caregiver

As an IBD patient, all my life I only knew to seek care from the outside world. I was always getting fostered and protected by my family and loved ones, allowing me take the shelter of being a patient. I never once had a thought that one day I would also be placed in that situation of taking the role as a caretaker. The universe always has a different plan for me. It tells me to expect the unexpected when everything seems settled and going smoothly in order to make my life more adventurous.

Year 2021 started on a positive note, then the severe flare I suffered through last year slowly showed some mercy upon me and started to settle down. I was at the verge of reaching back to the stage of normalcy. But things didn’t go as I had hoped. There was a lot of upheaval and overwhelming situations waiting for me, even before I could breathe a sigh of relief. One such instance was being infected by the corona virus and living the quarantine life (an experience I have penned down in my other article). Another one which I am sharing with you all now: The situation in which I had to assume the role of a caregiver and take upon the responsibility of my family.

My father, who is now 66 years of age, was a very healthy and a disciplined person all through his life. Suddenly, one night he returned back home limping and thudded on the sofa. This was something very unusual for me and my mom, who just stood watching him numb. He was yelling with pain and anxiety. I stood clueless because I had never come across such a situation. Every time it used to be me who used to shout, scream and yell with pain and frustration making my parents anxious and stressed out. My mom had recently taken her first dose of vaccination; she was feeling very weak and was unable to come to my dad’s rescue.  I was so confused as to what to do, whom to contact, and what action to take. I didn’t even know what first aid to apply to make him comfortable and relieve him from the pain. Finally, I just gave him some painkillers which helped him sleep. One night passed, and in the morning, he woke fresh and was back to normal. But it didn’t last long. After a month, the same thing repeated. I was so confused that I never attempted to assess the root cause. Later, the pain started to show up more frequently which completely restricted his movement.

This was when I was forced to take up end to end responsibilities of the house, for which I was completely not prepared.  Not being able to understand which doctor or specialist to consult, I felt overwhelmed, burdened, and even trapped as the current pandemic and imposition of lock down made the situation even worse. I felt unprepared and unable to manage the responsibilities and feelings that came with it all. I felt pressured by other family members to provide care, despite having little or no strength nor bandwidth to do so. I could only oversee my near future dealing with a crisis of financial worries, difficult decisions, uncertain future and unexpected and unwanted lifestyle changes. Fear, hopelessness, guilt, confusion, doubt, anger and helplessness all took a toll on my physical and mental health. 

As I am someone who wishes to see the good in every experience, I consider this a learning experience. It made me stronger and prepared me to face the worst. Here is what I learned from the past few months, which I do not wish any other fellow IBD mates to struggle with. They say, every person has a unique story, and every story has the power to touch the lives of the readers, their family members, loved ones, friends, coworkers, and the greater community. That’s why I felt it was important to share my story and let the readers understand the do’s and don’ts under these circumstances:

3. Know what you can’t do and never try to do it all alone.

First, we must know what we cannot do and most importantly, we must never try to do it all alone. It’s always better to reach out to others whom we think can do it for us. In my case, with too much pride, I wanted to manage it all alone. I felt that as a daughter, it was my responsibility to take care of the family without burdening anyone else. This was really painful and stressful. We need to set realistic limits on what we can do. For instance, if you are in a flare and if the other person is too heavy for you to lift, you may be able to help them roll over in bed, but should never try to lift them all alone or catch them when they fall. We may end up pressurizing our intestine and create more severe or worse damage for ourselves. There are ways we can safely help a person sit up or walk but we have to learn to do it without hurting ourselves.

2. Learn to ask for help.

Allowing others to help can take some of the pressure off and give us time to take care of ourselves. Often family and friends want to help but may not know how or what we need. We need to talk to our loved ones, so there is a clear understanding on what we are able to do and what external support we are seeking. My stubbornness had never allowed me to let my own siblings know what was happening at home. Everytime they called up i used to say everything was fine. But if I had expressed my concerns, things would have been much easier for me to handle.

Talking to others who are going through the same experiences canreassure us that we are not alone. Human connections can help us stay strong, let people know what we need, and what motivation they can offer. We cannot and should not try to be responsible for all.

3. Practice Patience and Exercise Compassion

During these times, the relationship with other family members can be tenuous and difficult. At times I wondered “why me?” as caretaking was a stressful set up, involving great sickness, making it is easy for tempers to flare and patience to run thin. So, patience is the most important virtue one should develop. As IBD patients, we can understand this well- we understand that the person who is suffering in pain is not always in complete control of their actions and, with that in mind, we can give the situation extra time to calm down and respond with ease if there are some heated moments.

It is obvious that these situations can easily create frustration within all the members at home. Frustration, however, leads to a strained and fractured relationship, which is not right for the home setting. My dad used to hesitate to express his sufferings completely. Instead of allowing frustration to take hold, we should seek to exercise compassion. Compassion for yourself and others allows people to soften their hearts toward another person and get to a place of honest communication.

Such incidents can also lead to work-related issues like missed days, low productivity, and work interruptions. The stress of managing responsibilities on top of worrying about keeping our job can be overwhelming. Dealing with these issues is important and the best way is to keep at least our reporting manager informed of what is happening and how we are dealing with it.

It’s ok to feel angry, helpless, frustrated, hopeless and show resentment. It is normal - these are our feelings and we should learn to accept them. There is nothing wrong with feeling that way. No matter what we do, we will very likely come to a point where we feel that we have failed in some or the other way. But we have done the best we can. At times we may even feel that we could have handled the situation better or done something a better way. At these times, it’s important not to blame ourselves. We should find a way to forgive ourselves and move on.

Mental health matters a lot. We need to Meditate, take breaks, choose a quiet area, close our eyes for 5 minutes, listen to our inner self, breathe while we visualize being in a serene place with birds and waterfalls. Listen to soothing music and get as much rest as we can. By using positive affirmations we can also help to ease out stress.

After all, it is utmost important to take our medicines on time, manage our doctor appointments, get done our regular checkups and follow ups as per the schedule, eat and sleep well without being drowned with exhaustion by managing these responsibilities.

As a concluding statement, I would wish to bring light on the importance of treating our caregivers with love and dignity. We often tend to take for granted our parents who are our primary caregivers throughout our IBD journey. If you are the one being cared for, encourage your caregiver to share with you and with others the difficulties he or she is facing. It will take only one friendly gesture to make a significant difference in that caregiver’s life. Encourage them to find that friend in whom he or she can confide..Help them find one friend whom he or she can ask for help and support as “Troubles shared are troubles halved”.

Traveling with IBD: Tips On Navigating an Airport

Whether we’re celebrating an accomplishment, going on a vacation, or in my case, visiting a city before a big move, traveling is a rewarding and often necessary aspect of our lives. A topic that is not widely discussed is traveling while living with a chronic illness(es). We have to be more mindful about certain aspects of traveling that other abled-bodied people never have to consider. This was my first time traveling post diagnosis, which was extremely anxiety producing and almost dissuading in a sense. Why do I have to take extra precautions? I quickly learned that this form of self-destructive thinking was only preventing me from being present. 

I recently traveled to the beautiful city of Pittsburgh, Pennsylvania to take a tour of campus before I start my masters program, as well as getting a feel for the city overall. Throughout my trip, I made sure to record a few helpful tips, tricks, and pieces of travel and airport related advice that would make the overall experience less stressful for my fellow members in the IBD community. 

Traveling is a privilege that chronically ill people deserve to be afforded. Exclusionary language and barriers paired with a lack of resources and information can make the idea of traveling quite daunting, but these tips should make the reality of travelling more palatable. With the tail end of the pandemic emerging, we all deserve the opportunity to travel as comfortably and healthily as possible!

traveling with IBD

Tip #1: Store your medication in your carry on 

It’s important for us to have access to all of our medication at all times. I found it very helpful to store all of my medications in my carry on bag, in a small pocket that is easily accessible. This way it is easy to keep track and organize all your medicine so you can stay on schedule. 

Tip #2: Get a collapsible water bottle

As IBD patients, we know that we are at higher risk of dehydration, so we need to have full access to water. But wait, you can’t bring water into an airport, right? There’s a loophole! I bought a collapsible water bottle before my flight and I stored it in my carry on. It’s small, super convenient, and you can fill it up once you leave security. After your water bottle is filled, you are then able to take it on the plane. 

Tip #3: Check the airport map to find all bathroom locations

We all know the feeling of needing emergency access to a restroom, and this feeling is no different in an airport, if anything it's exacerbated. I found it extremely helpful to locate all the bathrooms before I arrived at the airport so I knew which ones were closest to my terminal. Many airports have detailed maps scattered around, and the Apple maps app also gives you a detailed layout as well! 

Tip #4: Stress management is key

Traveling can be very stressful on our bodies. In my case. Stress and anxiety are triggers for my symptoms, so finding healthy ways to mitigate that stress is super important. We all have our own unique ways of reducing stress, but I found that packing headphones and listening to music helps tremendously. Chewing gum is another simple and useful stress reducing tip! 

Tip #5: Be sure to get an AirBnb or hotel close to restaurants that cater to your dietary restrictions 

Trying new restaurants, eateries, and bars is an integral part of the traveling experience, but it can be rather difficult for those of us with IBD since we have many dietary restrictions. My tip is to research restaurants, super markets, or local grocery stores in advance. This helped me so much during my trip; preplanning can make all the difference. We don’t deserve to be robbed of the full experience, so researching options beforehand can increase overall satisfaction. 

While there are so many other tips that I could provide, these five were the most pertinent. Utilize these tips to ensure happy and safe traveling! 

This article is sponsored by Connecting to Cure.

Connecting to Cure Crohn’s and Colitis is a grassroots, volunteer organization that brings together the IBD community with a focus on caregivers and families. Connecting to Cure Crohn’s & Colitis provides community and support for those coping with these chronic illnesses, while raising awareness and funds for research as well.

Digestive Disease Week: Epidemiology & Natural History of IBD

DDW 2021: Epidemiology & Natural History of IBD

         The Digestive Disease Week virtual conference kickstarted on Friday, May 21, 2021, with 5 societies (AASLD, AGA, ASGE, DDW, SSAT) taking part and over 15 different tracks. In the Inflammatory Bowel Diseases track, I joined the Epidemiology & Natural History of IBD session. Dr. Sunanda V. Kane, from Mayo Clinic, Rochester MN, opened the session, with the aim to understand how Inflammatory Bowel Diseases (IBD) are distributed through race, ethnicity and gender in the United States. The session hosted six speakers, covering the following sessions:

Session #1: Dr. Edward Lee Barnes – RACIAL AND ETHNIC DISTRIBUTION OF INFLAMMATORY BOWEL DISEASE IN THE UNITED STATES

This study used PCORnet (National Clinical Research Network) data as well as US Census data (2015).

Through this study, we learnt that:

  1. Adult and pediatric patients with Crohn’s Disease (CD) or Ulcerative Colitis (UC) are more likely to be White and non-Hispanic.

  2. Both adult and pediatric populations of Black/African American and Hispanic ethnicity are less likely to have a diagnosis of CD or UC as compared to White patients.

  3. Comparing adult to pediatric populations, across race, shows that IBD diagnoses is rising among non-White populations, while staying more or less constant for White populations.

  4. For drawing further inferences, it is important to conduct more research on health equity patterns among IBD patients, with an improved understanding of the demographics and epidemiology of these varied IBD patients.

Session #2: Dr. Fernando Velayos – PREDNISONE, BUT NOT BIOLOGICS OR IMMUNOMODULATORS ARE ASSOCIATED WITH SEVERE COVID-19 OUTCOMES: A COMMUNITY BASED STUDY

IBD management includes a series of immune-system-altering medications. In the context of COVID-19, this study sought to find out whether certain management techniques/medications put IBD patients at a greater risk for developing severe COVID-19 outcomes.

This study suggested:

  1. The use of oral prednisone prior to SARS-CoV-2 diagnoses, is associated with hospitalization, ICU admission, and death. Thus, during the pandemic, doctors are advised to minimize outpatient steroid use where possible.

  2. Immunomodulators and biologics are not associated with severe COVID-19 outcomes.

  3. IBD is not an independent risk factor for severe COVID-19 outcomes.

Session #3: Dr. Mehwish Ahmed – CROHN’S DISEASE, ANXIETY AND DEPRESSION, AND BASELINE C-REACTIVE PROTEIN LEVEL PREDICT RISK FOR INCIDENT IRRITABLE BOWEL SYNDROME-LIKE SYMPTOMS IN QUIESCENT INFLAMMATORY BOWEL DISEASE

Approximately 41% of patients with inactive IBD report having IBS-like symptoms, leading to a lower quality of life. This study aimed to identify risk factors associated with IBD-like symptoms in patients with inactive IBD.

The study suggested:

  1. Those with moderate to heavy alcohol use, comorbid anxiety or depression, use of psychotropic medications, increased C-reactive protein and the presence of rheumatologic intestinal manifestations are at higher risk for developing IBS-like symptoms.

  2. Crohn’s disease, comorbid anxiety or depression, and increased CRP levels are independent risk factors.

Confirmatory data is required for further analysis.

Session #4: Dr. Mohamed Tausif Siddiqui – PREVALENCE AND OUTCOMES OF ALCOHOL USE DISORDERS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Alcohol has always been a potential trigger for IBD. However, more than half of the total number of patients with CD or UC, who identify as current drinkers, are moderate or heavy drinkers. This study sought to find out whether Alcohol Use Disorder (AUD) is associated with in-hospital mortality, keeping age, gender and ethnic trends in mind.

This study observed:

  1. Irrespective of CD or UC, IBD in general, is affected by AUD, causing in-hospital mortality.

  2. The risk factors associated with AUD are: (1) Age bracket [51-65], (2) Gender [Male], Race [Caucasian].

Session #5: Dr. Poonam Beniwal-Patel – RACIAL AND GENDER DISPARITIES EXIST IN INFLUENZA VACCINATION RATES AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Patients with IBD are observed to have overall lower vaccination rates than the general population and are associated with an increased risk of infection, especially vaccine-preventable diseases (VPD). This study determined if disparities in race or ethnicity exist within immunization rates of patients with IBD.

The findings were:

  1. Black patients had significantly lower rates than white patients for influenza vaccinations.

  2. Female patients had significantly higher rates than their male counterparts for influenza vaccinations.

Future studies can assess the causes for these disparities, and advise on strategies to combat vaccine hesitancy. In the context of COVID-19, this research will be especially important for IBD patients.

Session #6: Dr. Chung Sang Tse – LOW HEALTH CONFIDENCE IS ASSOCIATED WITH SIGNIFICANTLY MORE HOSPITAL-BASED, ACUTE HEALTHCARE UTILIZATION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A NATIONAL SAMPLE OF OVER 18,000 ADULTS

Patient engagement and activation with regards to their health is a growing concern for positive engagement with healthy lifestyle choices and lessened emergency department (ED) visits and hospitalizations. Health Confidence is a proxy measure for this and is influenced by a multitude of factors, including personal beliefs, socioeconomic status, health literacy and disease specific knowledge.

This study showed that

  1. The health confidence of patients who had an ED visit or hospitalization were lower than those without an ED visit or hospitalization.

  2. A health confidence score of 7 (range 0-11 on Likert scale) appeared to be an inflection point for ED visits and hospitalizations, and thus for score less than 7, they should be considered at increased risk for the same.

  3. Health confidence was not different between UC or CD patients.

  4. “Interventions that increase health confidence may reduce high-cost, acute healthcare utilization.”

Digestive Disease Week: Role of Diet, Lifestyle, and Environment in IBD

I thoroughly enjoyed attending Digestive Disease Week’s session on Role of Diet, Lifestyle, and Environment in Inflammatory Bowel Disease. Let's start from the beginning and understand why studies surrounding diet, lifestyle, and environment are so important in understanding IBD. 

IBD affects nearly 3 million Americans and over 200,000 Canadians. IBD is an immune-mediated disease that occurs due to certain, unknown environmental exposures in those with underlying genetic predispositions. Research on environmental exposures is needed to discover what environmental factors may contribute to an individual receiving an IBD diagnosis. This research will not only create an overall improved understanding of IBD, but also contribute to reducing the onset of IBD as well as cures for IBD. 

Ultra-Processed Foods and Risk of Crohn’s Disease and Ulcerative Colitis 

Two speakers in this session I found extremely interesting, the first being Dr. Chun-Han Lo. Dr. Lo reviewed his study on ultra-processed foods and risk of Crohn’s Disease and ulcerative colitis. The Western diet is thought to increase the risk of IBD through changes in the gut microbiome which can trigger immune function when compared to the Mediterranean diet. 

Foods were separated into four categories from least to most processed:

  1. Unprocessed 

  2. Processed culinary ingredients 

  3. Processed foods

  4. Ultra-processed food products

Dr Lo explains that right now, it is widely known that higher consumption of ultra processed food products is associated with all-cause mortality, cardiovascular disease, metabolic syndrome, obesity, and cancer. Agents and thickeners, that are often added to ultra-processed food products, were also examined. The study aimed to examine the associations between ultra-processed food products and the risk of incident of Crohn’s Disease and ulcerative colitis. 

The results indicated that higher consumption of ultra processed food products, specifically ultra processed grain foods and fat and sauces, was associated with an increased risk of Crohn’s Disease. Additionally, emulsifiers and thickener containing foods increased the risk of Crohn’s Disease. No subgroups had an association with risk of ulcerative colitis. This differentiates the impact food may have on Crohn’s Disease versus ulcerative colitis, furthering complexifying IBD. Further studies are needed on the effect of ultra processed food products in patients with established IBD may be warranted.  

Although you may not be surprised by the results, studies like these are so important to allow room for more niche research and continue to allow researchers and doctors to understand the WHY behind IBD. As a Crohn’s Disease patient with many food intolerances, I am excited to see research surrounding diet and quality of food. There is little research backing the quality of food, and many suggest following a specific diet such as low FOD-map, gluten free, dairy free, among many others. It’s extremely exciting to see additional research surrounding foods, specifically processed versus unprocessed foods. My hopes are that this study can contribute to encouraging people to eat better quality foods and, in turn, reduce Crohn’s Disease diagnoses. Further, my mind jumps to future research covering whether reducing ultra processed food products after an IBD diagnosis could help treatment and management of disease. 

Development of a Composite Environmental Score to Predict Age of Onset and Outcomes in IBD

Dr. Nidah Shabbir Khakoo spoke on the development of a composite environmental score to predict age of onset and outcomes in IBD. Specifically, Dr. Khakoo focuses on the fact that many environmental exposures associated with IBD are increasingly seen with Westernization. The study aimed to explore the relationship between individual environmental exposures and the age of onset of IBD. This study is extremely important in order to come to the understanding of what can cause a person to be diagnosed with IBD earlier in life, rather than later. 

As someone with IBD, I have frequently wondered what environmental exposures in my life have caused my IBD to have an earlier onset? Why did I receive my IBD diagnosis in my early twenties compared to others that are diagnosed in their fifties? These studies are crucial to understand potential causes for earlier disease onset and overall understanding of IBD. 

This study was administered on adult patients previously diagnosed with IBD. An environmental survey that queried age-dependent and lifetime exposures to various environmental factors were given among the participants to identify the environmental exposures each subject has had throughout their lifetime while looking at the age of their diagnosis. It is important to note that this study had a large number of hispanics, an underrepresented group in IBD research. The study looked at the age of disease onset, specifically comparing hispanics vs non-hispanics and Crohn’s disease vs ulcerative colitis patients. 

Earlier Ulcerative Colitis Onset: 

  • US Born 

  • C-section Delivery

  • Fewer bathrooms 

  • Decreased housing density 

  • Ex-smokers

  • No farm contact 

Earlier Crohn’s Disease Onset:

  • US Born

  • Water source - plastics 

  • Fewer bathrooms 

  • Decreased housing density 

  • Smokers 

Dr. Khakoo shares that the environmental score presented explains a greater amount of the variation in the age of UC onset than Crohn’s Disease onset. Additionally, weighted and not-weighted scores did not predict disease location, presence of extraintestinal manifestations, likelihood of surgery or hospitalization, or number of biologics needed. Certain environmental exposures, such as bottle feeding, showed opposing effects in ethnic groups with IBD, leading to assume that cultural and socioeconomic factors may influence disease onset. 

These results give a baseline that other research needs to build off of. It is becoming increasingly evident that ethnicity differentiates environmental factors contributing to IBD and more research is needed to understand these differences. I’m looking forward to hearing of future studies regarding this subject and am hopeful more nuances regarding environmental exposures and the timing of IBD onset will be discovered.

It was great to hear from multiple experts about diet and environmental factors relating to IBD. I think that the data so far shows that there is a lot of work to do to understand what environmental factors contribute to IBD. I am looking forward to seeing future studies dive more in-depth to discover the causes of IBD. I am incredibly grateful to have heard from Dr. Chun-Han Lo and Dr. Nidah Shabbir Khakoo, and am confident these studies will have a large influence on future research on Inflammatory Bowel Disease. 

World IBD Day: What's Something You Wish People Knew About Living With IBD As a Young Adult?

world ibd day

"What’s something you wish people knew about living with IBD as a young adult?"

Savannah:

As a young adult with IBD, I wish others knew how hard it is to balance nurturing our health while also taking part in classic twenty something year old activities. Not only do we have to focus on our health everyday but we are also navigating the world, discovering who we are and what we want to be. IBD doesn’t define us and our goals, but it sure does impact us on a daily basis and creates significant barriers. 

Andre:

Having IBD as a young adult robs you of fully experiencing your youth. Most of us are diagnosed between the ages of 18-26. These are formative years that will influence the rest of our lives, but we are not afforded the opportunity to experience the same highs as our healthy peers. This does produce a high level of perseverance, but the isolation and FOMO will always be present. 

David Gardinier: 

I wish people knew how much energy is at a premium for us. I feel like with IBD, I have a set amount of energy each day. If I use all that energy up during the day in my internship, I don't have any left for the rest of the day. This is especially true when I go out and play ultimate frisbee. I wish everyone else knew that I am not just being lazy halfway through the game, but that I actually get tired twice as fast as everyone else even though I am doing the same amount of work. It can be frustrating knowing that my disease will hold me back from performing the same as other people the same age I am. The more people that know how much fatigue impacts young adults with IBD, the more empathy will exist surrounding this disease in our population.

Jennifer:

Tackling a chronic illness as a young adult is overwhelming, to say the least. To fight a disease that can neve be cured, while simultaneously trying to figure out who you are and what you want to do with your life -- well, that’s hard enough as it is. I hope people can be compassionate towards young adults with IBD, realizing that we are battling a fight they may not always see.

Sara:

Many people have the wrong conception about young adults who live with IBD. They think having IBD is karma, especially for those from Asian countries because their life is filled immensely with strong cultural and religious beliefs. This thought that IBD is caused by Karma is unacceptable and should not be entertained. Living with IBD is not karma; in fact IBD patients are warriors. Young adults with IBD are brave and super strong people. In today's world, they face so many challenges in their daily life, such as family, relationships, finances, and social pressure. But still they never give up in overcoming those challenges and prove their life is beautiful.

Nathalie:

I wish people knew that living with IBD as a young adult does not make me too weak to handle things. Sometimes people keep things from me to protect me or because they think I’m going through too much to hear about someone else’s life. I believe these intentions are honestly kind, but it’s okay to ask for my support. My normal is different from a lot of other people’s normal and that's okay. I don’t feel like I’m going through too much and I don’t feel weak, my IBD isn’t tragic, it is just a part of my life. 

Kumudini:

I just wish that people knew it's normal for any human being to use washroom the number of times one wishes. Moreover, nobody is voluntarily willing or would like to time pass there. Its absolutely normal to miss appointments and give us the space of silence. We did not invite this disease by unhealthy eating habits. We never would like to refuse any yummy food, it's just that we love our intestine so much and we do not want to dump it with something which doesn't suit it.


Vasiliki:

Getting diagnosed with a chronic illness such as IBD is always a difficult condition. It is even more difficult when you receive this diagnosis at a young age. You suddenly find yourself dealing with issues that have to do with your health; you try to find ways to improve your health and balance the daily life of a young person with the life of a chronic patient. This is not always a straight line, sometimes you encounter obstacles and difficulties, but with will and effort you overcome them and move forward. The most important thing for me in this whole journey is to find allies who can support you and help you effectively. Αnd of course in no case do not give up your dreams. Τhe difficult days will come and go, but life is in front of you even if sometimes it is cloudy. Remember that you are more than your illness! 

Disability Makes Me Feel Colorful

When I was first diagnosed with Crohn’s disease, I remember hating myself. For so long, I was so angry at the world. I was angry because I couldn’t run anymore. I was angry because I was in pain. I was angry because I felt like I wasn’t capable of anything. 

The stigma of disability is often composed of beliefs that people with disabilities are too sick to do anything, are not capable, and weak. 

Years later I realized the only reason I hated myself and hated my disability was because society made me believe that having a disability was the worst thing that could have ever happened to me. 

People would frequently tell me things like I should reconsider what I wanted to do with my life because of how my illness would impact me. I have been told that it was surprising I could even do what I have done in my life. I have been told that I would be in pain forever.

I have had doctors not believe in me. I have been blamed for my illness. I have been shamed for my weight, for not eating enough, for not trying hard enough, for being too tired, for eating too much “fast food” and an endless stream of hateful and hurtful words.

Sometimes even members of my own family would shame me and suggest I caused my own illness. I think that hurt the most. 

But they could not have been any more wrong. 

Living with a disability allowed me to see my black and white world in color for the very first time. 

My disability gave me inspiration for my future career. It allowed me to realize what my true passions and dreams were. It allowed me to appreciate the smallest, tiniest things that no non-disabled person would ever be able to notice. It opened up the door for new hobbies. It empowered me to focus on my mental health. More than anything, it gave me a second chance at life. 

I live for myself now.

I started painting which is weird because I used to only be able to draw little doodles on the bottom of my notebooks. 

I do yoga when before I would over-exercise and tire out my body. 

I found out about Trader Joe’s vegan chocolate chip oatmeal cookies with coconut (only after the very serious hunt to find snacks that were IBD friendly for me).

The air tastes better. Songs are not even songs anymore; they are seven different melodies and sounds happening at the same time and I can appreciate every bit of it. Every time I take a step without pain, it makes me feel like I am walking on clouds. The sun feels warmer.

I feel colorful. 

Personally, my disability was the best thing that could have ever happened to me. It is difficult. It is painful. It is exhausting. 

But it does not make me weaker than anybody else, less capable than anybody else, and I do the same things anybody else does, and I do it while I’m sick too. 



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This article is sponsored by Lyfebulb.

Lyfebulb is a patient empowerment platform, which centers around improving the lives of those impacted by chronic disease.

Tribute to Khichdi - A South Asian IBD Comfort Food

Note: While Khichdi is regarded by many as a nutritious, can-do-no-harm food, and has existed in ancient ayurvedic literature (ancient Indian medicinal journals) as a food that cleanses and heals the digestive system, the food is not a one-stop solution to IBD, and there is always the chance that it does not suit everyone’s bodies. My views are not medically backed, as I am not a nutritionist, dietician or doctor; I talk about my journey of IBD with a food that has become dear to my heart (and tract).

Khichdi has a soft spot in the hearts of many South Asian people, not limited to just the IBD folks. It’s appeal to such a diverse diaspora over a varied amount of time is amazing but not surprising, due to its flexibility in becoming anything it’s fans desire. In India, a country with many inequalities, khichdi is a dish that can both dress up fancily as a wholesome comfort food for some, and strip down to a humble meal that provides a day of nutrition for others, becoming a unique thread that ties the polar opposite lifestyles of the rich and poor of India. It simultaneously also acts as a thread connecting the ill and healthy, with Ayurveda texts prescribing it as a staple meal as part of a larger lifestyle free from illness and pain, but is also a very popular meal outside of Ayurveda. It has its place in popular literature1, journals of travellers2, was chosen to be the main showcased food for World Food India 20173, has a dedicated restaurant to capture its varieties4, and is used widely as holy offerings in Hindu temples5. The meal has countless variations in all the states across the country, retaining its quality of being a trusty comfort food at its core, a pretty big feat considering all the various ways the states of India differ so widely.

When I first started showing symptoms of Ulcerative Colitis, among my many concerns, one big one was how my diet was going to be constricted to only khichdi. For a lot of the South Asian community, this restriction to their diet as they were diagnosed/even now when they show symptoms, is very relatable. I had observed a few years of my brother’s diet with UC before I started showing symptoms myself, and I cringed at how disciplined he was expected to be in eating bland khichdi, oftentimes for multiple meals, for days, weeks, even months at a time. My first few years of having UC, I followed the same path for the first couple of years, following treatment only in the Ayurvedic realm, which required many bland bowls of the rice meal. It’s safe to say I was sick (not the IBD way) and tired of it. It wasn’t until I was out on my own, in rural India for the first time, that I realized my need and dependence on the food I had come to rely on so much after learning to listen to my body. During my first few weeks of being in a remote village managing my flare ups, I was uncomfortable on many levels, and yet my memories shine with gratitude for the few times I was able to successfully find and/or be invited for a warm and simple meal of khichdi. It had effectively found a place in my heart as the one and only food that I could rely on, even in the remotest of places. 

Below are my recipes for a flare-up version a and normal version I like to enjoy as my go-to comfort food:

Plain Khichdi (Flare-Up Version)

Ingredients:

1 cup rice (any, preferably broken)

¾ cup lentils (yellow mung split)

7-8 cups water

1-2 Tbsp ghee (clarified butter)

½ tsp turmeric

Salt to taste

Steps:

  1. Wash rice and lentils in a bowl, and add to a pot on a stove.

  2. Add salt and turmeric and bring to a boil.

  3. Cover and put in on a medium-high heat. It will take 15-20 minutes to cook. It’s best to keep stirring occasionally and checking to get a porridge-like consistency.

  4. When cooked, pour into a bowl and add ghee on top. Enjoy!

 

Khichdi with Vegetables (Normal Version)

Prepare Khichdi same as above.

For the Vegetables:

Ingredients:

2 inches bottlegourd, peeled and diced

1 carrot, peeled and diced

1 green bell pepper, diced

1 tomato, medium sized, diced

1 onion, medium sized, diced

1-2 Tbsp ghee

¼ tsp garam masala

¼ tsp paprika

Salt to taste

 

Steps:

  1. While khichdi cooks, heat up a frypan with ghee.

  2. Add the onion. When the onion turns translucent, add the tomato.

  3. Add salt so the tomato mushes up quicker.

  4. Add the carrot and cover the pan. Keep stirring occasionally. If needed, add water to fasten the cooking.

  5. When the carrot is soft, add the bottlegourd. Cover the pan and let it cook, checking from time to time.

  6. After the bottlegourd is cooked as well, add the bell pepper.

  7. Depending on how mushy you like you bell pepper, add your spices (garam masala and paprika) and remove from heat. Keep the pan covered for some time.

  8. Plate on top of the bowl of khichdi. You can add more ghee on top as per your liking. Enjoy!

  9. Khichdi is generally paired with plain yogurt in India, as well as pickles and papadum (crispy lentil chip).


1 https://www.moralstories.org/birbals-khichririce/

2 https://www.thebetterindia.com/119823/khichdi-history-brand-india-food/

3 https://seachef.com/khichdi-gets-ultimate-boost-to-be-promoted-as-brand-india-food/

4 https://khichditgf.com/

5 https://metrosaga.com/indian-temples-and-their-prasadams/



What is a Healthy Diet?

Back when I was in college, I had a professor who hated the word “healthy”. She argued that the word had no real definition. At first, I am not sure if I agreed with her. Surely it was safe to say that something like spinach was a healthy food, right? It has fiber, loads of vitamins and minerals, and is low in calories - perfect health food! As time went on, and I thought about it more and more, I discovered she was right. There really is no one definition for the word healthy, because it applies differently to each of us.

Every person has their own goals as far as their health. For a bodybuilder, gaining muscle might be considered healthy. For a sprinter, something healthy might improve their times on the track. For others, healthy is eating in a way that will help extend their life. You can see that it isn’t as simple as slapping the label “healthy” on a food and calling it a day. 

One of my favorite examples is birthdays. It doesn’t take a nutrition expert to know that birthday cake doesn’t improve physical health, but what about mental health? The goal on birthdays has never been to help you sculpt that hot summer body, but rather to celebrate with friends and family. It is a time to feel joy that we have made it another year on this Earth. If taking the birthday cake away harms that goal, well then the only conclusion I come to is that birthday cake is health food. Don’t tell anybody at the hospital I work at I just wrote that.

What about for people with IBD? What does a “healthy” diet look like for us? Having an interest in nutrition as well as IBD, I wrestle with this question a lot. I know that for the general population, foods like broccoli and brussel sprouts have been shown to reduce cancer risk, among other benefits. Therefore, they would generally be considered “health food”. But for somebody in an IBD flare, you might be better off roasting a package of nails at 350 in the oven for dinner. All that roughage is just going to result in pain and irritation as it passes through the inflamed intestine. For an individual with IBD who is in a flare, broccoli and brussel sprouts might be the furthest thing from healthy food they can eat.

That is why I think it is so important that we all understand the temporary and individual nature of the word healthy. It is not set in stone, what is healthy for you to eat today might not be healthy for you tomorrow. You should never be ashamed because you are not eating what the average person would call a “healthy” diet with this disease. That isn’t to say that you shouldn’t pay attention to diet at all. Your definition of a healthy diet will depend on your goals, which will most likely be very different from the friends, family, and coworkers you interact with on a day to day basis. Don’t compare apples to oranges. Take the time to define your health goals, and then determine what foods will help you reach those goals. Find your healthy diet.

Preparing for your GI Appointment

When your health is on the line and you have unlimited questions about your IBD flare, the anticipation to speak to your Gastroenterologist can be overwhelming. My heightened anxiety before and during my GI appointments would cause my mind to go blank the minute I sat down with my doctor. Negative or serious news can cause forgetfulness and wandering thoughts after the appointment, leading to me questioning the advice I was given. Throw the current coronavirus pandemic into the mix and things become even more complicated. Here in Canada, majority of medical appointments are now conducted over the phone contributing to a loss of connection and personable service. Medical appointments can be emotional rollercoasters, especially when receiving potentially life changing news about your illness and treatment plan. Below are four tips that will allow you to be best prepared for your medical appointments and will help minimize the stress, emotions, and feelings of frustration that may accompany the crucial medical appointments with your IBD specialist.   

Tip #1: Write down your questions 

Writing down all the questions and concerns you have before your appointment will ensure you remember to bring these topics up. Create a note in your phone or notebook ahead of your appointment and write down any questions, concerns, or notable symptoms you are having that you’d like to discuss with your doctor. Organize these questions and concerns in categories to easily hit all the topics in a simple and efficient way. Some great category suggestions: symptoms, medications, surgery, diet, accommodations, or any that work for you! Make sure you pull out your notes during your appointment and refer to each one, checking them off as you go. This will result in leaving your appointment feeling satisfied that you shared all your concerns with your GI and feel confident in your treatment plan. 

Tip #2: Bring a notebook with you 

Waiting for a medical appointment and then forgetting what the specialist said is the absolute worst feeling. Bring a notebook with you and write down any important suggestions, advice, medications, or risks your specialist speaks about. Anxiety and nerves can be high during an appointment leading to forgetfulness. If you write down quick notes about the conversation, you will be able to more easily remember the conversation afterwards and feel a sense of peace with the appointment. Not only will you have a better understanding of your treatment plan but your doctor will respect and sense the seriousness you are taking to fight your Crohn’s Disease or Ulcerative Colitis flare. 

Tip #3: Audio record the appointment 

Audio recording the conversation provides a simple and easy way to playback the conversation when you forget or want a refresher of the treatment plan your doctor provided you. This way you can easily save all your recordings to look back on in the future. Remember to ask your doctor for permission before recording! You can easily record the conversation with a recording app on your phone. 

Tip #4: Bring a friend or family member with you 

Attending a doctor appointment alone can be nerve racking and anxiety-inducing. My biggest tip is to bring a parent, a close friend or family member with you and bring them up to date on the reasons for your appointment and the questions and concerns you have. Another great idea is to give them a copy of your questions and concerns so they can speak up and ask if you forget to bring something up. Additionally, it’s always great to have someone advocating for you and your symptoms if your doctor quickly dismisses a concern you have. 

A big concern as a young adult attending a doctor appointment with a parent is that your doctor may speak directly to your parent rather than speaking directly to you. If this happens, remind your doctor that you have brought your parents with you only as support and you are responsible for your own health. Also, you can confide in your parents and remind them to ask the doctor to speak directly to you, the patient. If you find your guest is taking over the conversation, remind them that you’d like them there only as emotional support and stay quiet except when specifically needed. Outlining these expectations with your guest prior to the appointment will allow for a smoother and more successful appointment to take place. 

Whether you are currently diagnosed, in a flare or just having a check-in with your GI, these tips will allow you to maintain control and get the most out of your in-person or virtual appointment. Remember, the healthcare professional is here to help YOU. Do not feel guilty for asking numerous questions, being in-depth, writing things down, and prolonging the appointment due to concerns. 

Good luck! 

Why Malaysians Don't Talk About Their IBD

Malaysia is a beautiful and a welcoming country in Southeast-Asia. We are known for our multi-ethnic and multi-religious population living together in harmony. However, sometimes it is harder to talk about chronic illnesses as the culture and the society refrains you from talkin about negative occurrences. Illnesses are considered negative, and therefore, people with illnesses are regarded cautiously to a certain extent and they are advised to not discuss or talk about it in public. Awareness of IBD is very low among Malaysians. Many do not even know of its existence, let alone understand it. IBD patients often do not discuss their illness with anyone due to fear of not getting social acceptance, fear of rejection, and fear of losing opportunities that they deserve.

The geographical position plays an important role in social acceptance. People living in urban areas have more access to information and they often see display of information in many places. But that is not the case for those living in rural areas where information is scarce and few and far between. When IBD patients do try to talk about their illness, oftentimes, these geographical differences make it harder. Although it is easier to discuss your health issues in public for urban people, they often will choose not to do it again if the reaction was not good. As illnesses are considered negative, talking about them only brings more fear and unwanted attention. The society will think that either the patient is trying to get fame out of it, or they are imprinting fear of something that is not common. This “hiding illness” attitude causes more misunderstanding and more likely causes the patients to develop low self-esteem associated with their IBD.

Malaysians do not talk about their IBD to others due to the fear of rejection. The IBD patients fear that their family, friends, or colleagues will distance themselves if they know about their illness. The patients’ family might feel uncomfortable in discussing or even acknowledging the illness as they tend not to talk about sickness generally. Talking to colleagues is simply averted for the same reasons too. The fear of social rejection is very strong among IBD patients as their very own body is against them and this trauma alone could lead IBD patients to not open-up to others.

Fear of losing opportunity is another reason for IBD patients for not discussing their health issue with anyone, especially to a potential employer. They fear that they might not be able to get a job because of their chronic illness. Potential employers will hesitate to employ a person with illness which may cause them to take leave at unexpected times.. Many Malaysians do not disclose their sickness because they are worried to lose the opportunity that they deserve, therefore, they are not willing to disclose their sickness with their future employers during job interviews.

IBD patients in Malaysia fear not getting acknowledged socially, rejections of loved ones and of lost opportunities. It causes them not to talk about their IBD very casually to anyone. It is a very real health issue that needs to be talked about. Support groups are the first step Malaysian IBD patients have taken to make this disease more known and to assist each other’s. More and more people, especially the younger generations, are getting this disease in Malaysia now compared to a decade ago. Therefore, an accepting society is needed. I hope more people are open to understanding and accepting our differences. We might not have the best health condition but we are real and we exist!

Invisibile Disabilities

When we hear the word disability, our mind goes to a wheelchair, mobility problems, deformities and everything else obvious.

But is disability always visible?

The answer is no. Disability is not always visible.

Society's prejudice and stereotypes about disability want the individual to show obvious signs of disability. Inadequate information, distorted perception and misinformation perpetuate these stereotypes. People with chronic diseases, such as some autoimmune diseases, but also other diseases, often have nothing in their appearance that openly displays their disability.However, people with these diseases experience a form of disability, vital functions of their body are affected and their lifestyle is shaped accordingly. The professional status of the individual and / or his socialization and integration into society can also be affected. They depend on expensive treatments, they need several hospitalizations, surgeries, etc.And as if that were not enough, they have to fight a battle as "invisible" in a society full of prejudices and stereotypes, a society that discriminates against their disability.

I do not think there is anyone who does not want to be healthy; everyday life is hard in a society that daily degrades your dignity. Almost every day you have to prove yourself, and explain again and again..because you have an invisible disability. And to be treated in the worst way, because you do not fit the mold they have as a given.

Is the state responsible for this situation? Of course state has a great responsibility.It is the state that has the obligation to educate and sensitize the citizens about the various forms of disability, to cultivate mutual respect. It is the state that has the obligation to ensure the conditions for the integration of people with disabilities in society, to give people with disabilities equal opportunities for education and work, insurance and care. And above all, the state is the one that, in the difficult economic and social conditions in which we live, has a DEBT to protect people with disabilities and to defend their rights.

People with disabilities do not ask for sadness and pity, they ask for equal treatment.

But let's start with something basic: Let us not judge others by their appearance. We never know what battle they are fighting and what is hidden behind their appearance and their smile.

Calling in Sick and IBD

Hustle culture - committing your life to your job and career - has become normalized and even expected in young adults. After graduating university, many find their self worth linked to their career, earning promotions, competing with coworkers, and impressing your boss. As a twenty something year old with Inflammatory Bowel Disease, the struggle to balance work with your health is never ending. 

Those with a chronic illness understand not to take life for granted and that each day can be as unpredictable as the next, but we often forget this and get caught up in prioritizing a career over our own health and wellbeing. Calling in sick to work is inevitable, everyone has to do it at some point in their lives, whether it’s for a mental health day, the flu, or a flare-up. Yet, there are so many negative stigmas around missing work and around prioritizing your body. 

The feelings of guilt that come with calling in sick to nurture your body, whether you see your body deteriorating, know a flare is coming, or if a flare comes out of the blue, can be overwhelming. The stigma associated with hustle culture and calling in sick can feel disheartening. I have always had a hard time taking a sick day, and I always felt like I was letting my boss and coworkers down and that I wasn’t worthy of employment. Intense feelings of frustration and annoyance invaded my mind when debating whether to call in sick and these intrusive thoughts caused my body more stressors on top of being physically ill. I often remind myself that prioritizing my body is my number one job. Without my health, I wouldn’t have a job and I wouldn’t be able to participate in all the amazing experiences life has to offer. 

A helpful comparison to calling in sick is the safety instructions reviewed when boarding a flight, right before take off. The flight attendant always reviews the emergency instructions, stating that if the plane were to lose oxygen, you are always to put on your own oxygen mask before helping someone else. Putting yourself first will enable you to not only succeed at your job, but also to succeed in other aspects of life. If you were to ignore your body’s signals that you need rest, you will become more sick and risk the most important thing, your health. 

You are not weak, undeserving, or less important than your colleagues and friends because you need to call in sick more often than the average person. You are strong, resilient, and brave. We battle a viciously unpredictable disease that many do not understand. Do not let your worth be measured by whether you call in sick. I challenge you to listen to your body and honour what your body is saying, you never know how far you will fly until you respect and love yourself and with that includes respecting your body’s limits. 

Recently, I took two sick days at work due to a small flare up and my boss and coworkers were overly supportive. Although feelings of guilt surfaced when I was making this decision, the second I returned to work, everyone showed how much they cared about my wellbeing.

If you are experiencing toxicity in the workplace, contact the Human Resources department. If your company does not have a HR department, set up a meeting with your boss or manager. If you continue to be pressured to not take sick days, to put your job before your health, this may be time to look for another job and boss that cares about you and allows you to put your health first. 

On this note, being able to call in sick has undeniable privilege. Many people across the world are unable to call in sick without suffering financially or being penalized at work. Openly having these hard conversations during the hiring process or with your HR department will contribute to breaking the stigma and providing accommodations for those that are chronically ill. It’s important to speak with your boss or HR representatives regarding sick leave, paid sick days, and working from home options. Speak up to your government representatives and express the need for a handful of mandatory paid sick days across your province or state.

The Power of Music

I still remember the first time I listened to the song Where’d You Go by Fort Minor. It was June of 2016, and I had just recently been diagnosed with Crohn’s disease and finished my last semester of high school. It had been a semester of overcoming pain and fatigue to drag the shell of my body across the high school finish line. With those less than stellar circumstances, I was overcome with emotion hearing the lyrics describe in words exactly how I was feeling: 

She said "Some days I feel like sh**,

Some days I wanna quit, and just be normal for a bit,"

 I cried then, and I still tear up occasionally listening to the song and thinking back on that period of my life. That is the power of music, the ability of the songwriter to share their feelings in a way that connects with another human. It grants the comfort of knowing that others have experienced the same things you are experiencing now. That can be powerful for those of us with IBD, because it can be so easy to feel isolated and alone in our struggles. 

Today, I want to take you through some songs I feel reflect the IBD experience for me. I encourage you to listen through the links as you read.

One song I keep going back to is Times Like These by Eden Project. The first verse starts out with what a lot of us feel sometimes:

It's been a long, long time

We've come a long, long way

No, I can't see the finish line, scared half to death, but that's okay

It's been a long, long night

After a long, long day

My body's aching, but I know somehow, my feet will find a way

I don’t know about y’all, but I can think of at least a dozen times I felt like this with my IBD. It can be so hard to try to imagine the finish line when the reality of your disease forces you to acknowledge the present instead of looking toward the future. And that is scary. When day and night you are exhausted just putting in the bare minimum effort, you can forget to look at the big picture. I don’t even have to tell you how much I relate to the body aching line. But the great part about this song is that it doesn’t end there. Near the end, the artist sings:

These are the times we will hold

In the silence, when I've given all of me

And it's alright that it's over

And I found fight, like a soldier coming home

In the silence, but I have never felt so free

The future's so bright, this is our time

And I'll live it how I dream

It is beautiful how the artist not only changes the lyrics to reflect the hope, but if you listen, the entire mood of the song changes as well. The tempo speeds up, the instruments are cheery, and there is a joy in the tone of the singer. I know when I had flares in the past, it didn’t feel like a time in my life worth remembering. But I do look back on those times in my life now and see how they shaped my future. I see how I was supported and loved by family and friends, and how it gave me a feeling of gratitude for every new day on Earth. Some days you won’t be able to see the finish line, but eventually you’ll look to the future and it will be so bright.

Another song I feel encapsulates the IBD experience is Mountain at My Gates by Foals. It starts out with this verse:

I see a mountain at my gates

I see it more and more each day

What I give, it takes away

Whether I go or when I stay

Doesn’t that just sound like the IBD experience? We have this mountain of IBD in front of us, and sometimes it feels like it takes away everything from our lives. The beautiful thing about this song is it is about overcoming that mountain. The second to last verse goes like this:

Oh, when I come to climb

Show me the mountain so far behind

Yeah, it's farther away

Its shadow gets smaller day after day

Sometimes our disease can just feel impossible to overcome. But one day we will come to climb, and we will have realized we have conquered that mountain. We will look back, and see all that we have accomplished. Whether it is overcoming a flare, graduating college, or just taking a shower this morning, we all have mountains ahead of us that are made more difficult to climb by our disease. That just makes the view that much better once we reach the top.

Please leave a comment with any song you felt has been an integral part of your IBD journey, I would love to give it a listen.