Postpartum Anxiety & IBD

By: Dr. Fasika Teferra

Did you know that women with IBD are at a higher risk of developing new-onset mental health disorders in the perinatal period? [1] Not every pregnancy, birth, and postpartum experience is all happy and bright. One of the most neglected topics that should take the spotlight during pregnancy follow-up is postpartum depression and anxiety.

There is a whole spectrum of mental illness and mental health, and that holds true for postpartum depression and anxiety. I do not attribute my late recognition of postpartum anxiety to a lack of knowledge because I am a medical doctor, but rather, it is due to ignorance. I didn’t think that having some of the symptoms I had was that big of a deal. I was told as a first-time mom, I would worry about everything, but I didn’t stop and think to what extent that was normal. Thankfully, I had a very subtle experience and found some things I could do to catch myself when I am worrying too much. Meditation and breathing techniques had been quite successful.

Although I was able to finally recognize it, it was already months after my delivery. As a first time mom, I read through all the blogs I could find and all the youtube videos I could discover. They taught me about how to pack my hospital bags, what kinds of cloths to wear and things to bring for your baby to list a few. But there were none that I came across that prepared me for what would happen after we leave the hospital and start our lives with our newest family member. It never even crossed my mind to watch out for something like this or even discuss it with my husband. It just isn’t being talked about enough yet.

There are so many mothers who struggled with this behind closed doors and some who have passed away because of this. I want to do my part by raising awareness to this critical issue of motherhood. There is still more that needs to be done. It is not shameful to be experiencing it, and it is certainly okay to ask for help!

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1.     Vigod SN, Kurdyak P, Brown HK, Nguyen GC, Targownik L, Seow C, Benchimol EI. A5 FIRST-ONSET PSYCHIATRIC DISORDERS IN PREGNANT AND POST-PARTUM WOMEN WITH INFLAMMATORY BOWEL DISEASE IN ONTARIO, CANADA: A POPULATION-BASED STUDY. Journal of the Canadian Association of Gastroenterology. 2018 Feb;1(suppl_2):7-8.

My Journey as an International Student

By: Maalvika Bhuvansunder

Living on your own in a new and beautiful country sounds like one of the best things that could happen. For individuals with a lifelong debilitating illness like IBD, it can be extremely scary to live alone. The independence could come at a cost as there is a lot that could go wrong, but there is also so much that can go right!

My journey began with a lot of uncertainty, all these questions: Should I even be doing this? Would I survive without my parents there? What do I do if I have a flare? How would I manage cooking when in flare, and so many more. I had never even slept over at a friend's place since the diagnosis, as my home was my haven, let alone move to a completely different country! This was when my parents stepped in and explained to me, this was my dream to go to the UK and to pursue it no matter what. To make things easier, my dad travelled with me to the UK and helped me settle in. 

One of my biggest fears going in was, how would I make friends with this condition, would I even have the energy to make new friends? I decided to keep my fears aside and to be candid about my condition. It was not worth it for me to make friends who would not understand my situation, and I’d rather not have such friends. Being candid truly paid off in the best way possible! The friends I made there were understanding of my condition and acknowledged that with this condition, there are certain limits. They always found a Crohn's friendly alternative for us to do and never made me feel inferior. I remember having one of the worst flares I had experienced there and being worried about how was I going to tackle this. Let me tell you all that it was the moment after the flare that gave me the confidence that I GOT THIS! I survived a flare alone for the first time, and although it seems weird that something like this made me so happy, that’s what I was: happy. My friends who were in the UK constantly checked up on me and so did my new ones. It gave a sense of relief that although, to a large extent, I have to deal with this alone, I had people who I could turn to at such times.

Just when I thought I got this and I can handle everything, the biggest crisis we all faced hit, the PANDEMIC. I had plans to go back home, but the flights were suspended. I was in shortage of medicines and every supermarket was in shortage of food. I genuinely did not know how I was going to survive this. Calling home and crying about it my mom gave me the best advice, either I can cry at this situation or see how to manage the crisis. I contacted all the nearest clinics and found to my relief that the one closest to me was open. The first thing I did was meet the doctor and stock up on the meds. As for the food, well, Mom to the rescue. Within a day, she couriered all necessary items and made sure I had enough stock to last me for months. Another thing that helped me get through this was my friend. She was studying in another city in the UK, and we decided the best thing to do was to be together during this time. Together, we made sure to make the best of the situation and be each other's support at that time. She was a lifesaver! I do not think I could have survived the pandemic on my own.

IBD had taken a lot away from me, but I am glad I took this step despite all the fear and apprehension. Living in a new country turned out to be the best decision of my life. I got to pursue what I had always wanted to and learned a lot about myself. This experience was needed for me to have the confidence that I can manage things on my own.

There are a few simple steps one can take to make sure our journey in a new country goes smoothly. In collaboration with one of the fellows, we are coming up with a handbook containing useful information for anyone deciding to move to a different place for their studies. Hopefully, you all have the same amazing experience I did!

Friendship and IBD: Know when to not give advice

By Varada Srivastava from India

Photo by Helena Lopes from Pexels.

Hanging out with friends, attending parties, going to school are all things kids with Crohn's disease lose out on. You’re hospitalized or too sick to get out of bed many times, especially during the beginning stages of diagnosis. Not to mention the mental health issues that come with dealing with a chronic illness from a young age - anxiety, depression, PTSD associated with hospitalization are all too common. It can be very difficult to maintain friendships when you’re trying to survive daily life. How people react to your chronic illness is one of the pivotal points of friendship. I couldn't help but notice a pattern between the friendships I’ve maintained over the years. The common factor between them has been my friends’ ability to listen and not give unsolicited advice when I am talking about my disease. This is a quality I personally look for, however I have heard from many of my other friends who have a chronic illness that this is something they appreciate as well.

As someone who has been living with this illness for more than 6 years now, I have received my fair share of undesired advice from family, friends and random strangers. It is something that really aggravates me. Getting advice when you're trying to rant is pretty annoying in general but when you add IBD - something that is a very personal and a sensitive topic - the reaction you get can be explosive. Living with a chronic illness is tricky, most of us have figured out what works for us whether it's medicine or food after a long and painful journey. And as young adults, most of that journey is still left. One of the main reasons why some of us have such a negative reaction towards this is because it comes across as insensitive and like a privileged view on something very complicated.

This however, doesn’t mean that you don't look out for your friends with IBD. One of the foundations of a good friendship is caring for and helping out your friends. If you are a loved one of someone who suffers from a chronic illness, ironically, this is the advice I would give you:

1

Ask your friend whether this is something they are comfortable talking about. Never push them to talk about their diagnosis, medicines or journey.

2

Don't take it personally if this is something they would like to keep private. Many of us have gone through very difficult diagnosis journeys and talking about them can bring back a lot of trauma.

3

Research about the condition. Try to understand where your friend is coming from and what they struggle with on a daily basis.

4

Try not to give unsolicited advice, but do intervene if you notice them doing something that may not be in their best interest.

Having a good support system is extremely important for someone with a chronic illness. Friends give us a safe space to express and explore our emotions. Friends are, in reality, the best emotional medicine for people like us to overcome sadness and motivate us to take a leap of faith to transform our lives for the better.

To Anyone Who’s Been Called a “Difficult Patient”

By: Carina Diaz

My experience with getting a diagnosis and how it still affects me today.

This summer will be my ten year anniversary of having Crohn’s Disease, and throughout the years, I’ve been told the same phrase over and over again by many doctors: “You’re a difficult patient.” 

Hearing this since the age of 18 has been hard on my mental health. I’ve internalized those words and blamed myself for the state of my body. I thought that my symptoms being out of control was because I ate something that I should’ve have (I can’t resist pasta or cheese), I was thinking too negatively, or maybe it was just karma for something I did wrong. But none of that is true.

This is for anyone who has also been told that they’re a hard case, a real head scratcher if you will, as my ostomy nurse tells me. I’m going to tell you the words I wish someone would’ve told me: It’s not your fault. You did nothing to deserve this. You aren’t being punished (although it can definitely feels that way at times). 

I used to always look for a reason for why I was going through this. Maybe by having an explanation, I would feel better about my situation. I wanted something to blame. I wanted to be able to direct my anger towards something more tangible. I was craving to have some level of peace or stability. Getting diagnosed felt like my world was ending.

I was having abnormal symptoms for just a few months. I had to go to the bathroom frequently and having a bowel movement was very painful. I would try to avoid food as much as possible, because food meant having to poop and pooping meant pain. When my mom confronted me about skipping dinner and learned about what I was going through, she took me to my primary care doctor, which led to getting a referral for a gastroenterologist. I thought I would be told what was wrong with me, given medicine to treat it, and that everything would fine once again. That had always been my experience with doctors. I had always gotten answers and something to help. I didn’t know that there were things that doctors couldn’t fix or at the very least, have answers for. Getting a diagnosis meant I could no longer ignore how my body was feeling.

I didn’t know what was realistic for me to want out of life anymore. Would I be able to travel, have kids, or even live on my own? My doctor didn’t seem to take my age into account when he told me the results of my colonoscopy and endoscopy. I was finishing high school and getting ready to begin college. I was overwhelmed with the possibility of not being able to keep up with my peers, of not being normal. 

Hearing this since the age of 18 has been hard on my mental health. I’ve internalized those words and blamed myself for the state of my body.

The language that doctors use, whether or not it’s intentional, often puts the blame on the patient. “I don’t know what to do with you.” “You’ve failed this medication.” “I’m referring you to someone else. I can’t help you.” This has been so harmful to my mental health. It made me think I had done this to myself. At the end of every day, my mind would race through all the possible factors: I wasn’t managing my stress levels, I ate something that I shouldn’t have, I didn’t check the ingredients in what I ate thoroughly enough, I wasn’t taking the right supplements, or I needed to try another diet. For years, I picked apart my thoughts and actions. I dealt with a lot of toxic positivity from family. As well meaning as it may have been, it just fed into blaming myself. 

If you can relate to my experience or have been through it yourself, I hope you’ve been able to find comfort and support in community. It’s what organizations like CCYAN are here for. You’re not alone, you’re not to blame, and there are people out there who understand what you’re going through. I hope that knowing you aren’t alone brings you a bit of comfort. 

A Post-Colonoscopy Reflection

By Mara Shapiro from the United States

Featured photo by Scott Webb from Pexels.

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Colonoscopies and endoscopies or “scopes” as I like to refer to them, quickly become a part of our lives as inflammatory bowel disease (IBD) patients. Everyone and their doctors’ are different, but most of us will get scoped every year or two for the rest of our lives. For pediatric and young adult patients with IBD, that can be a daunting realization. Even though they aren’t a major surgical procedure, the prep is torture, and it is still a day or two we need to spend away from school or work at the hospital and then recovering. It’s a lot. Scopes can become a huge source of stress and anxiety, they certainly are for me.

I just got my yearly scopes and it was definitely an experience I won’t forget. Between chugging Suprep at 4 am, wearing a diaper for the drive to the hospital, and then going into an adrenal crisis at home following anesthesia, this was an experience for the books. Like with other recent parts of my chronic illness journey, I’ve been trying to be more mindful of all these difficult experiences and what I can learn about myself and about life as a result. Here are some of my reflections from my latest scopes and from where my Crohn’s disease is at in general. I hope these reflections can spark some new insights for you as well.

I am stronger than I think.

For me, chronic illness is a constant reminder that I can do hard things. I can do hard things that previously terrified me. Not only can I do these hard things, but I can excel and come out the other end a stronger and more confident person. I try to go into big appointments, procedures (big or small), and flare-ups with the mindset that I am stronger than I think and know that I have what it takes to make it through. This is how I try to be positive and optimistic. I’m not perfect! I oftentimes struggle with negative self-talk and we are all entitled to feel bad for ourselves on occasion, but the difference is knowing deep down that YOU CAN DO THIS and returning to a similar positive mantra especially when things are tough. I went into these scopes with the mantra that “I am stronger than I think” and “I can do hard things” and I survived and I’m proud of myself for getting through them with such a positive mindset.

It’s all about the mindset.

Over the past year, I have really focused a lot of my energy on my mindset and the narratives I am telling myself about what’s going on around me. I have found that being in control of my mindset, and how I feel and view what’s happening, has allowed me to create a much healthier relationship with my chronic illness(es). For example, I went into these procedures with the mindset that: This is going to be hard, I’m going to hate it, but I can do it because I can do hard things. I need to do this for my present and future health. This mindset that I am suffering for a few days for information that will help my doctors and I better control my IBD was very humbling for me and gave me that extra motivation to chug that last gulp of Suprep.

I know my body best.

In addition to having Crohn’s I also have Addison’s disease, a form of adrenal insufficiency where my adrenal glands don’t produce any cortisol (our body's natural stress hormone needed for most of our bodily function). Since January 2022 I have been on a cortisol pump which allows me to get a 24/7 continuous subcutaneously infusion of cortisol in a way that closely mimics the circadian rhythm pattern of a healthy person’s cortisol cycle. This treatment has been life-saving and given me my life back in remarkable ways that are hard to express. Having surgery or anytime my body is under intense periods of physical stress can be dangerous because my body does not naturally increase cortisol production in response to stress the same way a healthy person does. I need to manually try to guess how much extra cortisol I need and also increase my dose for a few days or longer. This was my first time going under anesthesia since having Addison’s disease. Long story short, the anesthesia team did not follow the protocol my endocrinologist wrote out and I ended up going into an adrenal crisis within an hour or two of returning home after the procedure. I am very thankful for my intuition and my dad’s help - we were able to quickly increase my cortisol pump rate and within a few hours, I stabilized. Thankful is the only way to describe how I feel, as this situation could have easily ended differently. Especially after this incident, I always know that I know my body best.

Remission is not a cure.

Thankful is also how I feel that my scopes showed no signs of active disease. Stelara is continuing to work wonders for my Crohn’s disease. However, even though I am in “endoscopic remission”, I am still not symptom-free and there’s a common misconception that being in remission means you’re cured and good as new. I hope in time I will become one of those patients who forget they have IBD, but for now, even though my ileal ulcers have begun to heal, I still have just as many bad days as good ones.

I have Crohn’s but it doesn’t have me.

This one is a bit cheesy but throughout the course of these procedures, I realized that I am in control of my disease. By in control, I mean that I have the power to decide how much my disease impacts my life regardless of how much power and control it tries to take from me. Even on the days when I’m in a lot of pain and not sure how I’ll be able to get more than a few feet from the bathroom, I am still in control of how I let that affect me. My disease is not my entire identity nor my self-worth, it is just a part of me. I have Crohn’s and it’s a huge part of who I am and how I interact with the world, but it is not my entire world. There’s a lot of strength to be found in being able to reclaim some of the power and control that this disease has previously had over me.

My Journey with Exercise and IBD

By: Isabela Hernandez

Exercise can be a sensitive topic for people with IBD. For me, diagnosed with ulcerative colitis early on in my childhood, I never consistently played a sport growing up due to flares and frequent hospital visits. Little did I know that this inexperience would shape my relationship for years to come. People subconsciously implement exercise as a basic part of their everyday life throughout childhood. Because of this, as adults, they’ve developed a sense of comfortability with the idea of exercise. But for those with IBD, Saturday soccer games or just a run around the block is not a top priority. Getting into remission is always the goal and once it happens, the need to exercise is one of the many things that follows. This often leads to frustration on what to do and how to feel comfortable in the gym or at home trying to better your physical health. I never realized how dysfunctional my relationship with exercise was until I got to college.

College was the first time I began to exercise consistently without quitting. I was not forced to deal with severe sickness or constant hospitalizations, which led me to explore my ability to exercise. Gradually, I was able to learn exactly what I enjoyed doing to get my heart rate up. The journey of finding a relationship with exercise is an individual process. It is different for everyone and takes time. Personally, my life changed when I discovered strength training.

I’m sure many with IBD can understand what it is like to feel the relentlessness of feeling physically weak. I never once felt strong, and especially while flaring, the physical weakness I sometimes experienced was debilitating. I was hesitant at first to enter the gym, since I had no idea what I was doing. I was numb at the thought of embarrassing myself trying to exercise. This is a common fear that many have and it’s something that an individual must push through. In living with a chronic condition, there will always be times when we feel weak, but it is our responsibility to power through and uncover moments within exercising that make us stronger. As time progressed, my level of comfort in the gym grew, and my idea of what strength was began to shift. Not only was I physically feeling stronger than I ever had in my life, but more so, I mentally grew stronger. I really do believe that working on my physical health catapulted me on a journey to finding strength everywhere, not just in the gym. However, not every journey is perfect.

The more time I spent strength training, the more I began to get frustrated trying to build muscle. An uncommonly known fact about IBD for some is that individuals with UC or Crohn’s typically have a harder time putting on muscle. Sarcopenia is the reduction of muscle mass/strength and it exists in roughly 52% of Crohn’s patients and 37% of UC patients. [1] This is still an ongoing and evolving area of research, but it explains why for some IBD patients, it is extremely difficult to put on muscle. Many things drive sarcopenia in IBD patients, including chronic inflammation, vitamin D deficiency, adiposity, malabsorption and the dysregulation of the muscle microbiome axis. [1] Protein intake/absorption is usually reduced in IBD patients, so it is typically recommended that higher protein intake could serve as a solid attempt to prevent muscle loss. [1] This could result in a lot of frustration for IBD patients, and it needs to be recognized that it is not you; it is the IBD.

The science behind this phenomenon is very complicated and ever evolving. The reason I highlight this fact is that if you are like me and are on your journey with exercise, the frustrating roadblocks you are experiencing specific to exercise are not uncommon. Keep going and find what makes you feel good physically. For me personally, it was strength training, and my roadblock was the struggle to build muscle. Nevertheless, I will continue to do what makes me feel good while trusting the process and recognizing that IBD will always affect every area of my life. Whether we realize it or not, our IBD will always be there and try to prevent us from progressing in certain areas that we didn’t even realize it would affect. We must accept this and move on without letting it stop us. It is extremely important to talk to your doctor about the role of exercise in your life and what your body is capable of doing in the moment, taking into consideration disease activity. I hope that every person with IBD finds their own form of exercise that makes them feel happy, at peace, and above all, strong!

References:

1.         Dhaliwal A, Quinlan JI, Overthrow K, et al. Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview. Nutrients. 2021;13(2):656. doi:10.3390/nu13020656

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 This article is sponsored by Trellus

Trellus envisions a world where every person with a chronic condition has hope and thrives. Their mission is to elevate the quality and delivery of expert-driven personalized care for people with chronic conditions by fostering resilience, cultivating learning, and connecting all partners in care.

Pregnancy & IBD: My Experience

By: Dr. Fasika Teferra

Pregnancy is a gift from above. I believe when a child is born, so is the mother. I am a completely different person now than I was a year ago. There is no one specific time, but the whole pregnancy and childbirth experience changed me to the core. The journey was not perfect; I had so many lows, as I had highs. Although it is difficult, I wouldn’t change a thing, and here is why.

I had always wanted to have a baby at an early age. I was never taught what it means to be a mother nor what a child expects of you; they don’t teach that in med schools. It was fair to say that I never got the proper guidance from anywhere, but I believe it is like that for most moms. We don’t know what we are getting into until we are actually in it.

The first time I felt this was when I was in labor. The word I could use to explain that moment is stuck. I felt stuck because I couldn’t do anything to make the pain go away. It reminded me of the awful pain I had around the time I was first diagnosed with Crohn’s Disease. I couldn’t take any medicine to make it stop (there were no epidurals in Ethiopia when I gave birth). I was not in control, which is something I was accustomed to. All the labor related videos I watched and the breathing technics by doulas didn’t help because I was in over my head. Labor sucked.

But my pregnancy journey was amazing. I loved seeing my belly grow, feeling my baby kicks, assembling his crib and getting him cute outfits. Although the fear of relapsing still lingered at the back of my mind, it was easy to set it aside and enjoy the process.

I am well aware that I was able to stay in remission throughout my pregnancy and that could have contributed to me having a medicine free throughout my pregnancy. I experimented with a lot of diet and meditation just to make sure I stay in remission. As each person’s journey with IBD is different, I encourage you to work with your doctor to find out when it is best to have a baby. I hope that for anyone reading this article that may want to be a mother someday but is scared, I am here to tell you that you shouldn’t be. Pregnancy and delivery, whether you have IBD or not, is a rollercoaster ride, but one that is worth it in the end.

Grief with IBD: Remember to Turn on the Light

By: Maalvika Bhuvansunder

Grief is a term generally associated with the loss of a loved one. In this scenario, the loved one is me. Grief for me was losing the person I used to be before my Crohn’s. I was always a happy and vibrant kid who would just never stop talking, never one to make plans beforehand, and was very flexible. I used to take life easy and would never overthink any scenario. I became a completely different person, to be precise, the exact opposite of who I was before. I’m always overthinking, moody, and can not function without a plan. It felt that instead of being a part of my life, Crohn's became my life. Activities that used to bring me happiness like dancing and reading, were no longer of interest to me. I used to love going out with family and friends, but the thought of going out scared me. I felt the safest inside my house, having minimum interaction with the outside world. This “safety”, however, did not bring me any happiness. I was constantly miserable even when I was not in a flare. My mood started reflecting on my behavior with others. I was constantly snapping at my family and getting angry for no reason. I became this person that I could not recognize. I remember distancing myself from my friends and internally blaming them for the distance.  

After a struggle of three years, I reached a short-term remission in 2019. The timing could not have been any better, as I was relocating to Manchester to pursue my Master's. For my Master's thesis, I was researching grief and suicide bereavement. That is when I had my eureka moment! The themes that emerged from the research were isolation, anger, guilt, and loss of interest in activities that once used to bring them happiness. During this research I realized these were the exact emotions I had felt. Upon self-reflection, it made sense that, in a way, what I experienced was a type of grief. Grieving the girl that used to get happy at the smallest of things, the one who used to take life as a beautiful journey, and the girl who never used to get angry. I was using unhealthy coping strategies to make up for the grief I felt from losing the person I was before.  Along with grieving the past me, I was grieving the future. All these questions of will I be able to work, find someone who accepts my condition, and a lot of other things. I remembered one of my research participants expressing how much she lost in the present day by worrying about her past and future; it was completely futile. This type of grief is something I am sure many individuals with a life-long illness might feel but would not have realized what it meant.

““Happiness can be found, even in the darkest of times, if one only remembers to turn on the light.””

— Albus Dumbledore, 'Harry Potter And The Prisoner Of Azkaban'

At that particular moment, this quote from Harry Potter resonated with me: “Happiness can be found, even in the darkest of times, if one only remembers to turn on the light.” I was so focused on hating my situation that I forgot to switch on the light in my life, to appreciate those that stuck by me. Crohn's may have played a part in this internalized grief of mine, but it was me that refused to see the good things. Yes, I am no longer the girl I used to be; however, Crohn's made me a much more resilient and empathetic individual. It instilled in me the sense of being nonjudgemental and understanding others struggles. I started to appreciate my body for working its best to survive despite the condition. I was grateful for my family and friends that stuck by me despite my infuriating behavior. It was an eye-opening moment for me.

I made a promise to myself to start doing the things that once bought me happiness, no matter how small they are. We cannot change the past, nor can we predict the future. Why waste away our present amidst this?! It is very natural to grieve the things we lost due to our illness and what we think we might miss out in the future. At such times, I stand in my balcony and remember to switch on the lights in my present life and find happiness in the smallest moments. When we have an illness that takes a huge toll on our body, we must make sure that on the days we do feel okay to make the most of it.

Energy Management with a Chronic Illness

By Varada Srivastava from India.

Featured photo by Pixabay.

Finding a way to manage time with a chronic illness is a complicated process. It can be frustrating to figure out the new normal when you are originally diagnosed. For people with chronic illness it can be very difficult to figure out what is physically and emotionally possible for us to do that day. There are a few theories that have come to help us cope with this.

Moreover it’s very important for people who don’t have a chronic illness to understand it.

Christine Miserando is a lupus advocate who is known for coming up with the spoon theory. According to her, the difference between being sick and being healthy is having to make choices or to consciously think about things the rest of the world doesn’t. The healthy have the luxury to live life without having to make constant choices which is something most people take for granted. People with chronic illness are given a certain amount of spoons whereas healthy people have an unlimited supply. In her story, she gave her friend 12 spoons to get through the day. Each spoon represents the amount of energy we have for a certain task. For people with chronic illness, each task is also divided into smaller tasks.

For example: wearing clothes in the morning requires a series of decisions in which we have to keep our illness in the front of our mind. If you are getting blood drawn that day, you need to make sure to not wear long sleeves; if you feel the onset of body ache, you need to wear warmer clothes. These micro calculations take up the majority of our mental space. Do I take my medicine before or after lunch? Should I just wear a summer dress to relieve the pressure on my stomach? Are my hands too sore to handle buttons? I can't do many tasks if I take pain medicine. These are only a few of the many questions we tackle everyday. Each task requires a game plan. This constant mental gymnastics is incredibly tiring.

Emmeline Olsen wrote another article for IBD New Today which focused on the pitfalls of following the spoon theory. The spoon theory is based on the loss people with chronic illness face. But according to Emmeline, having a chronic illness piles stuff onto our original to do list. She gave the analogy of a filled bucket, healthy people can fill their bucket as much or as little as they want. Having a chronic illness is like filling the bucket with stones, each time you do a task which is exclusive to people with chronic illness, a stone is added to the bucket. Having a flare is compared to having a bucket filled to the rim. The worse the disease gets, the heavier the bucket is, the more chance it has of overflowing.

Having read both these theories, I think I tend to follow a mixture of both. Right now, I'm in remission, I am able to carry a heavier bucket. Doing daily tasks is comparatively easier and the stones in my bucket are less. However during a flare when I don't have enough energy to get out of bed the thought of lugging a bucket around seems exhausting. The amount of tasks seems overwhelming. That's when I like to follow the spoon theory. It helps in breaking down everyday tasks into smaller, more manageable activities.

Dealing with a chronic illness is very subjective, while some things work for one person they might not work for others. The goal is to find what works best for you, mostly through trial and error. And while going through this process it is very important to remember to be kind and patient with yourself.

Keeping Up with Your Care

By: Isabela Hernandez

Having a chronic condition isn’t easy. It’s something that needs constant upkeep, monitoring, and attentiveness. For me, a sometimes lazy 22-year-old college student, keeping up with my care is at times the last thing I want to do. I’ve neglected to refill my prescriptions, get my labs done, and reschedule my appointments. It is not something I am trying to recommend to anyone, but the difficultly of taking care of yourself is sometimes just plain irritating and difficult.

The way I’ve justified this behavior is: if I am going to have my ulcerative colitis forever, then I can take care of this later.

It creates this toxic cycle of neglect that can lead to dangerous outcomes. Once I let this neglect and annoyance take over, it’s difficult to pull myself out of it. Sometimes my wakeup call is even a mini flare. This would happen to me because I would view my disease as this burden that I could never escape. Something that only I had to constantly maintain day in and day out, and no one else. With this mentality, there was no way I was going to stay on top of my care. I would ignore things and push appointments off as much as possible. However, after my neglect facilitated the progression of an intense flare, I realized I needed to incorporate my disease into my life in a positive way.

What helped me the most was just treating my ulcerative colitis as a class that I needed to do assignments for and keep up with.

I started to schedule things into my day and treat it as task, rather than a pestering duty that if I didn’t do it, my health would suffer. Sometimes I would even write things into my planner so I could visually see that at this hour I absolutely needed to take my medication and at that hour I needed to call my physician for follow up labs. These were small changes that helped me stay as present as possible while trying to take care of my Ulcerative Colitis. It is something easier said than done but it is okay if you sometimes feel like taking care of yourself is too much and it is too hard. It’s because it is. It’s hard, its draining, and sometimes laziness takes over.

IBD patients are fundamentally built in a way that our health is the one thing always consuming our thoughts, and at some points this mentality overwhelms the mind.

And it is ok, too, at times get angry at our disease and wonder what life would be like without it, but this does no one any good. If you’re anything like me, finding ways to schedule health tasks into your day rather than just “getting around to it” really changed how I take care of myself. It relieved stressors that would follow if I didn’t do certain things for my care and allowed me to just do the task and move on. Just remember that even on days when we don’t feel like taking care of ourselves, we are still doing the best that we can do. 

This article is sponsored by Trellus

Trellus envisions a world where every person with a chronic condition has hope and thrives. Their mission is to elevate the quality and delivery of expert-driven personalized care for people with chronic conditions by fostering resilience, cultivating learning, and connecting all partners in care.

The Impact Patient Advocacy has had on my Life

By Varada Srivastava from India.

“Patient advocacy has helped me feel a part of a community as well as cope with my illness.”

Patient advocacy is something I was first introduced to thanks to the blog of Natalie Hayden. She's a former news anchor and author of the blog, “Lights Camera Crohn’s”. A person who suffers from chronic illness has to constantly face challenges since the time of diagnosis, which is excruciating, to say the least. Overcoming challenges faced throughout our journey, from diagnosis to daily life, is something many of us experience. In fact, it seems like I would break down every time I read her blogs. I spent the entire day reading her blog and crying.

Many people don't realize the severe impact that chronic illness occupies in the lives of patients. How much chronic illness impacts our daily lives. Fighting an invisible illness is often isolating and heartbreaking. I discovered Natalie Hayden’s blog probably 5 years after my diagnosis and that was the first time I did not feel alone with my disease. I acknowledged the importance of patient advocacy when I realized that if I had this support when I was diagnosed, perhaps I would not have felt so lost until coming to terms with my illness.

India faces a lot of misdiagnoses because of health illiteracy, lack of medical facilities, and expensive medications. The feedback IBD patients may get is also typically insensitive.

Having a system of people who help you and encourage you during difficult times is crucial. It's easy to feel alone when you're struggling on the sidelines. And when people don't reach out, it can be difficult to stay optimistic. When it comes to Crohn's disease, it is often referred to as debilitating. And that it is. However, I’d also argue that what's really debilitating is constantly worrying about the unexpected.

It is common for Crohn's disease and ulcerative colitis patients to have what is known as "psychophysical vulnerability." 1 Stress, emotional distress, and inadequate coping skills can all have a negative impact on how the disease progresses and decreases quality of life. 1 There are always two types of reactions you receive from people. Friends who support us and people who give unwanted advice.

For several years following an initial diagnosis, the number of procedures and medications can be overwhelming. Determining trigger foods and finding medications that work, are also among the significant challenges. Having a network of individuals who have gone through the same process is helpful to a great extent. It has been an invaluable experience for me to connect with young adults from around the world who face similar challenges.

Patient advocacy has helped me feel a part of a community as well as cope with my illness. If you can find a friend who understands, even if you've never met in person, you can gain comfort. It may be something you didn't know you needed it until it was offered to you. I have accepted that rather than being afraid to reveal my disease, it is more helpful to be vocal about it and get advice on how to cope with it.

As a result of this, starting a support group at my university and applying for the Crohn’s and Colitis Young Adult Network fellowship has been two of the most rewarding personal experiences in my life. Being able to help others with things I have struggled with, is an incredible opportunity for me. I'm very grateful to patient advocates for this reason. The awareness of autoimmune disorders is constantly growing all over the world and I feel blessed to be a part of it.

Featured photo by Polina Kovaleva on Pexels.

Resource: (1) Bonaz BL, Bernstein CN. Brain-gut interactions in inflammatory bowel disease. Gastroenterology. 2013; 144(1):36-49.

My Ileostomy Story

By Carina Diaz

In May of 2021, I went to the ER for what felt like the millionth time. I had been struggling with cysts and abscesses forming in my vagina for the past three years and this time was no different. Or so I thought.

I had already been to the ER earlier that week and was seen by a male doctor who, in hindsight, wanted to quickly drain the cyst and get it over with to move on to the next patient. I told him that I wanted a CT scan, but he said it wasn’t necessary. For my second ER trip of the week, I was seen by a female doctor. I made a comment about this being my eighteenth time having to do this in the last three years and with a look of concern on her face, she said, “That’s not normal. Let’s do a CT scan.” To which I said, “Brilliant idea.”

The part that I hate most about going to the emergency room is having to wait. And wait. A nurse takes your vitals. Then you have to wait. Someone comes to get your insurance information. More waiting. You tell the doctor what’s wrong. Even more waiting. The doctor comes back with a nurse. They do what they need to do. And you wait some more for either discharge paper work or to be admitted. 

After getting a scan, it was decided that I would need incision and drainage surgery. But guess what? My gynecologist only does surgery at one hospital and it wasn’t the one I was currently at. So I had the joy of, you guessed it, waiting for an ambulance to come to transport me to another location. Watching the night sky through the back windows wouldn’t have been so bad if I wasn’t strapped to an uncomfortable bed made of plastic.  

This was the second time I’ve had to get incision and drainage surgery, so it wasn’t a new experience to me. What was new was being presented the choice of potentially having to get ileostomy surgery. It would give my colon a break and let the fistula heal (a surprise that was discovered during the surgery). 

To be honest, getting an ostomy bag was the worst-case scenario in my head as someone with Crohn’s Disease. It sounded scary and uncomfortable. What clothes could I wear? Would people see it? Would I smell? Am I going to wake up in pain after the surgery? When the hell will I be allowed to eat?! I don’t want a poop bag strapped to me. All of these thoughts were floating in my head while three doctors stood in front of me explaining the process. The good thing was that it would be temporary. 

I let a doctor use a robot to cut me open and pull a bit of my intestine out. I didn’t wake up in pain, but I was scared to look at my body. The rest of the week was a blur of learning how to empty it, clean it, and how to live with this new change.

At the time of writing this, I’ve had an ostomy bag for ten months. While it has greatly improved my quality of life and lowered the severity of my symptoms, it has definitely been challenging. I have three different skin conditions, so my torso really hates having something taped to it. I have yet to find a bag that doesn’t irritate my skin. During my second month after surgery, I kept getting blowouts at night and barely got any sleep. It was painful and itchy. My ostomy nurse likes to describe me as “a real head scratcher.” 

Having IBD makes me think a lot about the duality of life. I’m grateful that this surgery was an option for me because it has helped in many ways, but I still have to make sacrifices. I still have to deal with discomfort, and I’ve had to relearn my body yet again. That cycle will continue when I eventually (hopefully) get reversal surgery at some point.

Some people have positive experiences with ostomies and say that it has given them their life back. If that’s not the case for you and you’re also struggling with having an ostomy, try to remind yourself that you’re doing your best. Take it one day at a time and cry when you feel the tears forming. I recommend watching your favorite show if you’ve had a hard time changing your bag. Those stomas can be so unpredictable.  

Constructing a Visual Language in the Chronic Illness Community

By Ibrahim Z. Konaté from the United States and France.

Featured photo by JULIO NERY from Pexels

Learning at the age of 23 that I have a life-long disease was incredibly destabilizing. Once my care team developed a treatment plan that allowed me to regain some normalcy, I felt that I was still struggling to find my footing in this new reality.

The power of receiving my diagnosis lay in finally having the vocabulary to explain to others what I was experiencing, but I was still left without the tools to process this journey for myself.

I turned to my care team and was introduced to resilience, coping, acceptance, and many other important post-diagnosis concepts. Though I was able to receive guidance on these tools and worked to incorporate them into my life, I felt like I was missing something. As these words started piling up, it became harder for me to grasp their meaning.

The more I read about these words, the greater the chasm between myself and these concepts grew. I was meant to apply these ideas to my life but felt incapable of seeing them as anything beyond research frameworks.

I needed a way to animate these notions to see how I could fit them into my daily life. As a visually-oriented person, my first reaction was to see what imagery was already associated with these terms. When I put these words into Google Images, I was confronted with drawings of flowers growing through cracks in the sidewalk and stock photos of mountain hikes. Though these images got the basic point across, I was seeking something that could translate these ideas from words on a page to relatable human experiences and emotions.

For inspiration, I took a trip to the Brooklyn Museum and saw an exhibit entitled The Slipstream: Reflection, Resilience, and Resistance in the Art of Our Time. This collection showcases the work of intergenerational, BIPOC artists to “hold space for individuals to find their feelings of fear, grief, vulnerability, anger, isolation, and despair—as well as joy, determination, and love—reflected in art.” Though this exhibit was curated in response to the global pandemic and social events of 2020, I recognized my own struggles in the featured artwork. My favorite part of the exhibit was a room dedicated to centering pleasure to cope with and overcome conflict.

This is black text written on a white wall. At the top of the image is the word “Pleasure.” Below this image is a paragraph of text that reads: “In tumultuous times, experiences of joy, humor, leisure, and rest can hold radical possibilities for transformation. These artists capture moments of everyday pleasure, be they located in family, friendship, and community, in life’s daily rituals, or in creativity and the act of art-making itself.”

I started to wonder - if I could place any piece of art in this room to represent my experience as a Crohn’s Disease patient, what would I choose?

I spent the next week searching through digital archives to find an image that not only would embody my journey thus far but would also remind me of how developing resilience would help me keep moving forward. Finally, I found the perfect image, bought a poster of it, and hung it up on my wall. Now, the first thing that I see when I get up in the morning is a picture taken by Malian photographer, Malick Sidibé, entitled Nuit de Noël.

This photograph was taken in the early 1960s after the liberation of most West African countries from colonial rule. I think about the insecurity that was experienced by many people, including my parents, during this time of transition. When I see this picture, I remember how my family taught me that even in uncertainty one can still smile, dance, and hope that the future brings better days.

A square picture frame with black borders hangs on a white wall. The image in the frame is a black and white photograph showing a man and a woman dressed in light clothing dancing at night in a courtyard. Below the framed image are 5 sunflowers.

Words are important, but sometimes they are not enough. To conceptualize the abstract notions of resilience and acceptance, I needed to find imagery that could help me envision these concepts in my life. My belief is that there is something incredibly universal that can be found in our subjective experiences. I want us to create a new visual language to describe our journeys in this community. My hope is that we can replace the stock photos we find when we search for images related to resilience with artwork or even our own pictures. So I ask, what images describe your story?

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This article is sponsored by IBDStrong.

IBD Strong is a volunteer grassroots organization that provides a community of hope, connection, inspiration and empowerment to children, teens and families living with Inflammatory Bowel Disease. They believe that every individual diagnosed with IBD deserves hope and opportunities to thrive. IBD Strong’s mission is to inspire and empower individuals living with IBD to not let the disease define them.

Taking the Road Less Traveled

By Mara Shapiro from the U.S.

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;

Then took the other, as just as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that the passing there

Had worn them really about the same,

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

- Robert Frost

This Robert Frost poem has been long imprinted in my heart. It was one of my mom’s favorite poems. My mom passed away from aggressive breast cancer when I was 8 years old. Ever since, this poem has felt like a connection between my mom and me. For years I have turned to this poem when I have longed to feel her close. However, this poem has also become a roadmap for me in many ways, a guide for finding my way through life’s adversity (of which there has been plenty).

“Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.”

This famous excerpt from the poem hits home the most and is the part most up for interpretation by readers. Two roads diverged in a wood… and I took the one less traveled by… and that has made all the difference. In the context of my life with chronic illness, the two roads here are being healthy and being ill. As one with a chronic illness, we are on the road less traveled. I interpret this last line to mean that my chronic illness journey has impacted me so strongly, led to so much personal growth, made me the person I am today and that it has made all the difference. It is often through the journey and experiences that are less appealing and less traveled that we find out the most about ourselves. Adversity and our response to it are our biggest teachers. That has certainly been the case for me.

For me, this poem has allowed me to see the meaning and value my chronic illness, my journey on the road less traveled, has had on my life. That is not to say that there have been countless times where I wished I was on the road more traveled, the journey of a healthy person, but through acceptance and perspective, this poem helped me see that I am grateful for the path I am on (even though it was forced and not a choice I made because the path looked like it needed more wear, to use the words of Robert Frost).

The general theme of this poem implies having a choice in which road one gets to chose. In many situations in life that is the case. However, I never viewed this poem within that scope because the roads in my life have been characterized by frequent dead ends, U-turns, K-turns, and certainly a few lonesome, unpaved, rugged roads. While the interpretation of this poem falls naturally onto those who have faced some difficult choices in their life and had to later grapple if they had taken the right path, mine differs slightly and takes into account such forced early life adversity that a lot of us with chronic illness can relate to.

I want to thank Robert Frost for helping me see that while the path of being ill is not the path I would have chosen, it has certainly made all the difference in shaping who I am and who I was meant to become.

The poem has been popularly interpreted to mean a lot of different things about the power (or lack thereof) of choice and how to retrospectively make meaning out of said choices. However, I have always had a different interpretation of this poem, as did my mom. We think of the roads, not as choices where we had full agency but rather roads that life put us on anyway and most importantly, the CHOICE we all have in making the most out of whatever road we end up on. Losing a parent as a child certainly puts you on the road less traveled. Being diagnosed and living with multiple chronic medical conditions, especially through childhood, adolescence, and young adulthood also puts you on the road less traveled. Where I look to Frost and think of choice is in the last line, “And that has made all the difference.” I have been on the road less traveled my whole life, and it has made all the difference. I would not be ME without my journey on the road less traveled. Despite the suffering, the grief, the pain of this road we’re on together as people with chronic illness, I would not change the person it has made me.

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I’m curious to know your thoughts and interpretations of “The Road Not Taken” by Robert Frost. Post a comment here or reach out to me on Instagram @m.shappy, I’d love to hear from you!

Featured Photo by Mohan Reddy on Pexels.

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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.

IBD & Travel: Ethopia

By: Fasika Teferra, M.D.

As a healthcare provider and Crohn’s Disease patient, I can tell you that living with IBD in Ethiopia is not easy. Most medications are not so readily available and doctors don’t speak English as their primary language. I hope through this piece of article give you a glimpse of how it is like for an IBD patient in Ethiopia and some tips if you wish to travel to our amazing country that is well known for its 13 months of sunshine!

North Ethiopia | © Ian Swithinbank / Flickr

Most low- and middle-income countries do not have access to quality and affordable medicine and health care. This information is widely known. However, patients and doctors still try to close the gap of this scarce resource and healthcare disparity as much as they can. As an IBD patient, I have had to rely on just oral medications. Other types of medicine are not available yet for IBD in Ethiopia. Managing my Crohn’s through adjunct therapy such as diet and stress control has proven effective for me, personally. When I have to schedule my endoscopy/colonoscopy, I would have to take a few days off work, as bowel preparation takes up to three days. Although medicine and other supportive treatments are not available here, patients still are able to manage their diseases with what they have, and IBD patients also can come to Ethopia and go as they please.

As an IBD patient, I have had to rely on just oral medications. Other types of medicine are not available yet for IBD in Ethiopia.

As an IBD advocate, one thing I have noticed among the diaspora community is fear of travel to other countries. Although it is scary to travel to a new place where you don’t know how the health system works or know a place to turn to, if God forbid, you need to go to the emergency care, I am here to tell you that it is not as bad as it seems. From my personal experience, IBD patients have a better travel experience when they bring a medical summary from their primary doctor to Ethiopia. Should you need an emergency care, just by reading that paper, a GP or gastroenterologist is able to understand your condition. In addition, bringing your own medicine is always a good idea as it is not readily available. If I were to recommend one resource that has helped so many it would be IBD Passport. It has a global database of a lot of GIs, their centre and ways to contact them even before you depart. I know for a fact that I would travel much more comfortably if I knew where to go to if I needed anything.

From my personal experience, IBD patients have a better travel experience when they bring a medical summary from their primary doctor to Ethiopia. Should you need an emergency care, just by reading that paper, a GP or gastroenterologist is able to understand your condition.

Even though it is widely known most of the advance IBD treatments are not available everywhere, that should not be a reason to travel and explore new places. I am sure there are many tools out there that can give some perspective on your destination’s healthcare system but it is always a good idea to research ahead of travel. IBD should not hold you back from adventures!

The Unknown with IBD: My Journey of THE DIAGNOSIS

By: Maalvika Bhuvansunder

Crohn's, is a term I am familiar with now, to the extent it feels that I am synonymous with it. In medical terms, Crohn's is defined as an inflammation in the gastrointestinal tract, which manifests in symptoms such as abdominal pain, unexpected weight loss, and many more (Baumgart & Sandborn, 2012). However, all I could understand was that I am in for a journey filled with lots of pain.

It was in 2016, that my health started to get worse. I lost a lot of weight, was not able to eat properly, and was moody all the time. My family and I initially thought that maybe it was the flu or food poisoning. However, my health never seemed to improve. Deciding to go to the doctor, I had made up my mind to expect the worst. To my pleasant surprise, I was diagnosed with anaemia. I say pleasant because my mind had made up that I had cancer, and in comparison to cancer, anaemia was a piece of cake. Despite getting treated for anaemia, my health remained the same, with no improvement whatsoever. Later, I was diagnosed with amebiasis (Pritt & Clark, 2008). I was relieved thinking finally, I have a proper diagnosis. Things seemed to improve for a while; however, it started to get worse. At the suggestion of my GP, we met a gastroenterologist. Now, before this, I was completely unaware of such a discipline in medicine, so my family and I went in completely blank, not knowing what to expect.

“All I could understand was that I am in for a journey filled with lots of pain. ”

The first thing my gastro told me, based on my previous reports, was there seemed to be some sort of inflammation in my abdominal area. I was told to get a colonoscopy done, only after which the doctor could confirm a diagnosis.

On the way home, I started to research the entire colonoscopy procedure. I was stressed out reading the process and was hoping to find a way out of undergoing the procedure. Thinking back to it, I am not sure what I dreaded more, the prep process of having to drink that awful colon cleanse, or the actual colonoscopy itself. Had I known before what colonoscopy was, I might have been less skeptical about it. The day of the colonoscopy went pretty smoothly, and I was drowsy for most of the day. We were not told anything that day and had to return a few days later for the official diagnosis. We again went in completely blank, not knowing what to expect. That is when I got THE diagnosis, CROHN’S. Now, I had never heard such a term and neither had my parents. The doctor’s explanation regarding my treatment plan just sounded gibberish to me. The one thing that I could not take my mind off was, this condition does not have a cure; it will be with me for the duration of my entire life.

We always hear how an early diagnosis can solve half the problems; however, with any gastro-intestinal condition, the dilemma is that the symptoms are very similar, and getting an early diagnosis may not always be possible. From personal experience though, I feel with IBD it doesn't really matter when we get the diagnosis as it is not a curable illness.

“ This condition does not have a cure; it will be with me for the duration of my entire life. ”

The scariest part about IBD for me was the unknown. Not knowing when a symptom will hit you, how severe it will be, not knowing if you can make it to plans and outings, and not knowing if it's an IBD flare or the flu, always having to be afraid, fearing the unpredictable. I had never met anyone else with my condition, and I did not have anyone to ask questions about this. I was unable to comprehend why I got this and was really unsure about how I will get through it. Accepting this condition took me a long time. I realised something through this process, the importance of support. If we have the right kind of support and care team, slowly but steadily we will see improvements. Above all, we will be able to accept our condition, and it makes the predicament of the unknown a little less scary.

References:

Baumgart, D., & Sandborn, W. (2012). Crohn's disease. The Lancet, 380(9853), 1590-1605. https://doi.org/10.1016/s0140-6736(12)60026-9 

Pritt, B., & Clark, C. (2008). Amebiasis. Mayo Clinic Proceedings, 83(10), 1154-1160. https://doi.org/10.4065/83.10.1154

Body Neutrality > Body Positivity

Body Neutrality > Body Positivity

By: Carina Diaz

My body has been through many shapes and sizes since the diagnosis of my Crohn’s disease in 2012. The combination of medications and inflammation has altered my weight, the shape of my face (thanks Prednisone), and effected my ability to exercise. After many years of weight fluctuations, I now see three people within myself: the person I picture in my mind, the one I see in the mirror, and the one I see in photos. 

Halfway through 2017, I came back home from a four month internship in Florida in very bad shape. I had lost a lot of weight, had little appetite, was under constant fatigue, and went to the bathroom almost 20 times a day. I didn’t deal with many IBD symptoms in college outside of bloating and cramps, so this was new territory for me. I was bed bound for several years and shrunk down to skin and bone. I avoided my reflection every time I went to the bathroom. I felt like a shell of a person. My body felt like an itchy, uncomfortable sweater that I couldn’t take off. 

“I still have days where I’m mad at my body, but being able to take a step back and shift my thoughts away from the frustration has brought back some peace.”

As my health slowly began to improve and my mind became more clear, I noticed how often my thoughts centered around the way I looked. I felt detached from my body and even more so after getting ileostomy surgery in May of 2021. I’ve had to relearn my body over and over again because of the constant changes IBD has put it through. It’s very easy to feel disconnected from your body when you have IBD. I’ve often felt that my body and I are two different entities at war with each other, and neither side wants to wave the white flag. 

There’s so much content online about self-love and loving your body. “Start the day by looking in the mirror and say three things you like about yourself out loud.” “Love the skin you’re in.” “You’re beautiful just the way you are.” I’ve found that it’s not possible to feel good about yourself everyday. Our bodies change, even for people without health conditions. We’re constantly shown images of what we should aspire to look like and the products to buy to help us attain it. 

A concept that has helped me reframe my thoughts around body image is body neutrality. It encourages you to accept your body for what it is and puts more emphasis on what you’re capable of instead of what you look like. To me, this means to meet my body in the day I’m in. For example, on days when I have low energy, I’m going to take care of myself by working from my bed, ordering takeout, having snacks and water within reach, and not worrying about the state of my apartment. I’m not going to expect myself to cook, clean, and run errands on a day that I’m not feeling well.

I know that this might not be a helpful concept to everyone, but it is a practice that has helped my mental health and self image. I still have days where I’m mad at my body, but being able to take a step back and shift my thoughts away from the frustration has brought back some peace. Instead of viewing IBD as a punishment from my body, I’m trying to remind myself that my body is going through this with me. Neither of us are to blame; it’s just our reality. We’re both doing the best we can.

RV Camping with Crohn’s: How I Reconnected With Nature After My Diagnosis

This article was written by Mara Shapiro from the U.S.

Featured photo by Nubia Navarro (nubikini) from Pexels.

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“Look deeper into nature, and then you will understand everything better.”

— Albert Einstein

I’ve always found nature to be healing, and where I’ve felt the most relaxed. Previous to my Crohn’s diagnosis I was a competitive rock climber and would frequently travel to some of the best outdoor rock climbing destinations in the United States with my climbing team. It wasn’t just the act of rock climbing or spending time with some of my closest friends, it was truly the beauty, peace, and serenity of nature that made me the happiest. I found a lot of my bliss in the mountains throughout my teenage years whether it was through rock climbing, snowboarding, or hiking. 

A childhood dream of mine has been to own an RV so I could camp and enjoy nature with ease and virtually anywhere. This dream became a much more realistic goal when I was diagnosed with Crohn’s disease in July 2020. I was diagnosed at the Mayo Clinic in Rochester, Minnesota and I live in Southern California. Due to the COVID-19 pandemic, it was safer for my dad and me to drive the two and half-day nearly 2000 mile trip rather than fly (we also got to bring my best friend and Corgi companion, Morty, on this road trip). I was pretty sick at the time and relied on diapers and lots of Imodium to get through that road trip, which we did a total of twice round trip that summer. 

Every time we passed an RV or travel trailer of any kind I would point it out. We must have passed hundreds of them on the 2000 mile stretch of interstate. I would daydream about the day I would have my own RV and be able to just pull over and use my own private toilet whenever I needed it. Sitting in my Subaru Crosstrek wearing a diaper, you bet I was dreaming about all those RVers and how lucky they were to have their own toilet within arms reach. No more accidents, no more sketchy truck stop bathrooms… Of course, I dreamed of other parts of RV life too, and those daydreams helped me pass the time, a time that was full of such fear and unknown. 

Fast forward to October 2021, I have graduated college, I have an amazing full-time remote job, and I am ready to start the process of finding and buying my own RV. After months of research, I decided on a Forest River R-Pod 190. It was a perfect size, weight, and floorplan for Morty (my 2.5-year-old Corgi and travel companion) and me. In small travel trailers like mine, the bathrooms are usually very small and called a “wet bath'' where the toilet and shower are in the same space and when you shower the entire bathroom gets wet. I was lucky enough to find a floorplan with a “dry bath”, where the toilet is fully separate from the shower! For the amount of time I spend on the toilet, I knew I needed a dry bath! Add this to the list of things that “normal” people with “normal” colons don’t think about…

At the end of November 2021, I picked up my R-Pod and camped in it for the first time! The past few months have been full of a lot of trial and error, endless learning, and many moments of frustration. I have also felt so empowered by my newfound confidence and independence. I have had so many new experiences and explored beautiful new places with Morty. I have fulfilled my childhood dream and created a new hobby and source of joy that has added so much to my life. IBD and chronic illness can take a lot from us, and can often make us feel out of control. For me, finding an accessible way to camp with my RV is one way that I have taken some of that control back.

Advice for Camping (or getting back into any hobby) with IBD

Take it slow!

I’ve learned (mostly by trying to do too much too quickly) that the best way to partake in strenuous activities is to do it slowly and at your own pace. It’s easy to look around at others and match their pace, but especially when it comes to setting up a campsite there is no rush and it’s not a race. So if I need to take a break and have a snack or drink or lay down on the bed in between setting up or taking down camp then I do! Find your pace and stick to it.

Ask for help!

Asking for help can be hard, but sometimes it’s so needed! Especially with camping, 9 times out of 10 your fellow campers are super friendly and always willing to lend a hand! As a solo female camper, I am hesitant to ask for help unless I really need it, but I have learned that there are usually kind people within an earshot who are there for you. Asking for help from friends and family to help you enjoy your hobbies is also key. Especially when flaring, I’ve been able to have my dad come to assist me with some of the strenuous camping tasks so that I could still enjoy some relaxing time in nature.

Acceptance is key!

Acceptance is a spectrum and some days and in some phases of life, acceptance comes easier than others. I have really channeled my inner acceptance narrative when I go out camping. I try my best to accept things as they are and as they come and not get too frustrated when something unexpected happens or I end up being more symptomatic than I had hoped. I could be feeling sick at home so I might as well be feeling sick in my camper in nature! “It is what it is, and I’m camping,” I say with a (forced) smile when the stress starts to build. Find your acceptance and get back to your beloved hobbies!

Whether it is camping or another outdoor adventure or trying a recipe you haven’t made since your diagnosis or trying something totally new that you’ve always wanted to try, I want to encourage you all to take that leap of faith, argue with that voice in your head that’s been holding you back, and go for it!

This article is sponsored by Lyfebulb.

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

Biosimilars and My Experience with Them

Information in this article is for educational purposes only. This article reflects personal experiences and is not meant to diagnose or treat any disease or illness. This article is not sponsored and you should consult with your medical professional about any information related to your medications.

Biologics are drugs derived from natural resources and manufactured by various biotechnology methods. They can benefit patients with rheumatologic diseases, inflammatory bowel disease, malignant conditions, etc., by halting disease progression, alleviating symptoms, and improving quality of life. Biologics are one of the top-selling drugs worldwide. Still, the high cost of this drug is a major drawback, so it remains unaffordable and inaccessible to many patients. 1

Biosimilars are non-innovator or copy products of the original biologic drug. More notably, they are cheaper. The development of biosimilars allows for broader and necessary access to these medicines because of their lower cost and hence greater affordability. This improves cost-efficacy ratios and access to these drugs. India is one of the leading manufacturers of similar biologics. 1

Exemptia is a biosimilar of Adalimumab which often goes by the original brand name - Humira. Exemptia is a TNF inhibitor and anti-inflammatory drug manufactured and promoted by Zydus Cadila, in India. The dosage depends on the severity of the case.

I was prescribed Exemptia in 2016 when I was 16 years old. My first year with Crohn’s I was put on multiple medications, but none of them seemed to work for more than one month. Finally, after a year I was put on steroids (Budesonide). These came with their own set of issues but were able to manage symptoms for a while. Soon my body stopped responding to the steroids as well. The doctors and nurses had been extremely supportive and helpful but I was getting exhausted by the frequency of my hospitalization. I had missed 3 years of high school already and was wondering whether my life would ever go back to normal. The next step was either surgery or biologics. After a long discussion with the doctors and extensive pros and cons lists, my parents and I decided to give biologics a chance. That was the best decision we made, I was lucky enough to experience remission thanks to this medication.

Exemptia was relatively new at that time, having been released only a few years prior. Before starting the medicine, it was made sure all my vaccinations were up to date. CT scans & blood tests were done to eliminate the possibility of having any viruses or infectious diseases like TB. The first dose was 80 milligrams, and this was followed by 40 milligrams every two weeks. I have been on this medication on and off for six years. While hospitalizations were frequent during the first few years of starting this medicine, they have significantly reduced now. One of the biggest benefits I saw from this medication was that it brought normalcy back into my life.

I am now an undergraduate student and it's very important for me to stay on top of college deadlines, my biosimilar helps me achieve that. The administration of the injection is relatively easy as well since it's a subcutaneous injection or an injection under the skin. My recommendation would be to get a friend or family member to help because it does hurt while the medicine is entering the body. However, I have been lucky enough to not experience any side effects right after the administration of the injection like fatigue or soreness. Like any other medicine, there is a downside to this too, including recurrent infections and problematic storage conditions of the injection. The injection should always be kept at a temperature between 2-8 Centigrade (35-46 degrees Fahrenheit), which is rather challenging to do while traveling or living away from home. However, overall my experience with this medicine has been very positive despite its drawbacks.

Resource

1. Meher BR, Balan S, Mohanty RR, Jena M, Das S. Biosimilars in India; current status and future perspectives. Journal of Pharmacy & BioAllied Sciences. 2019; 11(1): 12-15.

This article was written by Varada Srivastava from India.

Photo by Damir Mijailovic from Pexels.

Learning to Center Myself in my IBD Journey

By Ibrahim Z. Konaté from the United States and France.

Featured photo by Africa Studio/"Shutterstock.com

Disclaimer: Nothing said in this article is medical advice. Seek professional advice from your care team before making any changes to your nutrition plan.

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Food was my gateway back into my culture.

As a first-generation American, the narrative about my identity has usually been out of my control, and like so many others in my situation, I decided to focus my young adulthood on unpacking this conflict and reconnecting to my roots.

Growing up between France and Virginia, I knew Mali only through stories, pictures, and most importantly, food. When I left home for graduate school, I made sure to ask my mom to teach me all of the family recipes.

The comfort provided by these meals was essential in my life, especially leading up to my diagnosis of Crohn’s Disease while in isolation from my support system in 2020.

The initial relief I felt from receiving my diagnosis after years of experiencing symptoms was immediately followed by shock at the absence of global cuisine in IBD medical and advocacy materials. I started worrying - could it be that my culture and my identity as an IBD patient were incompatible?

There seemed to be no room for me in the IBD community because fundamental components of myself were either excluded from the conversation or labeled as dangerous. This feeling was amplified through many virtual cooking events that I attended and with most IBD-specific recipes that I found online.

It seemed as though a lot of IBD advocacy spaces were focusing on a specific lived experience and I wanted to make sure that everyone had space to center themselves within their own disease journey.

In recent years, the incidence of Crohn’s Disease and ulcerative colitis has been increasing across all demographics in the United States, with a markedly high increase for BIPOC patients. With the increasing diversity in the IBD community, it is imperative that we continue to build a space where everyone can be accepted, no matter who they are.

As a newly diagnosed Crohn’s Disease patient, I was able to meet with a nutritionist at my local IBD Center. I came out of this appointment with a lot of information about the Mediterranean and low FODMAP diets, and a list of recipes that were all inspired by western European cuisine. I decided to take the advice of my nutritionist to incorporate this Mediterranean diet into my life, but first, I wanted to break it down into its components and see if I could build up a regimen that looked more like myself.

Separating this culinary concept from its name and origin allowed me to deconstruct and generalize it into high fruit, vegetable, fish, olive oil, and whole-grain intake. Once I had these parts, I found myself able to create the dishes that my mom had taught me before I left home. There were of course minor substitutions, but the essence of the recipes and the culture that they represent were still present.

I started challenging myself to see if I could make my new dietary accommodations fit into my culture and hoped that this revolution in myself would allow others to steer their experiences in managing their condition.

This February, for Black History Month, I walked around my home of Harlem in New York City to explore food from across the African Diaspora that may fit into the deconstructed diet guidelines provided to me by my nutritionist.

Here are three dishes from local restaurants that align with the guidance from my care team or can be slightly altered to avoid trigger foods.

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Gumbo - American South - Miss Mamie’s Spoonbread Too

Gumbo is a thick okra-based stew that is native to the American South. It is the official plate of the state of Louisiana and has Creole and Cajun varieties. Creole gumbo tends to have seafood, dark roux, and filé powder from the sassafras plant. Cajun gumbo typically incorporates chicken, but variations will be found for both of these recipes in different households. There is often the presence of onions, bell peppers, and celery in this stew, but any of these can be omitted or substituted if they risk triggering a flare-up.

Mafé - West Africa - Teranga

Mafé is a sauce made with peanut butter and tomato sauce. It is usually served over rice or couscous with meat. At Teranga, they prepared it with chicken but this can be served with a vegetarian or vegan substitute.

Jollof rice is also native to West Africa (my mom says that it's absolutely native to Senegal but every country seems to have its own variation and claim to the recipe!). It gets its bright red appearance from tomato paste and spices. I grew up eating jollof rice almost exclusively with fish, but it pairs well with other meats and vegan options as well. The trademark flavor can still be obtained by excluding any spices or peppers that may aggravate a flare-up.

Plantains - Africa, Caribbean, Latin America - Homemade, bought from a local market

Plantains are a fruit related to the banana that exists all over the African Diaspora. It is an incredibly versatile dish that can be a snack or an entire meal. I grew up eating them fried in oil but there are other recipes that prepare them by roasting or even with an air fryer.

This experience has taught me the importance of representation. That being a person with IBD and honoring my origins are two experiences that can coexist. In fact, prioritizing my customs allowed me to have better control over my relationship with my diagnosis.

I encourage you all to think about what traditions make you who you are today. If you do not see yourself celebrated in the diversity that is our IBD community, center yourself and find others who will support you and cheer alongside you as you make this a space where we can all be our authentic selves together.

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This article is sponsored by IBD Strong. IBD Strong is a volunteer grassroots organization that provides a community of hope, connection, inspiration and empowerment to children, teens and families living with Inflammatory Bowel Disease. They believe that every individual diagnosed with IBD deserves hope and opportunities to thrive. IBD Strong’s mission is to inspire and empower individuals living with IBD to not let the disease define them.