Challenges as a Crohn's Warrior in Malaysia

In Malaysia, Crohn’s disease is also known as “Western Disease” or “Rich People Disease.” The reason behind this is mainly because Crohn’s is a rare disease in Asia,  particularly in Malaysia, as compared to Western countries. Many in Malaysia have never heard of this disease. Therefore, they are not aware of the Crohn’s and colitis patients’ struggles with their pain, medical procedures and psychological issues. 

At the beginning stage, I had no one to guide me. I had no idea on how to handle my newly diagnosed disease. With no medical background, no one in the family or friends with similar conditions, I struggled to cope with this disease and my normal life. Can you imagine the struggles I faced as a first year university student with my condition? I was  alone and I didn’t even understand what was going on and my normal was no longer a  normal. The internet was my only resource for information other than my doctor. By reading  everything I could find in the internet, I slowly started to understand this disease. Back then,  there wasn’t even a support group for Crohn’s in Malaysia as the disease is relatively unknown to Malaysians. In fact, I didn’t even known about any other Crohn’s patients until I  met one almost a year later after my diagnosis. My gastro doctors encouraged me and other patients to start a group so we could create a support system to each other. Now,  newly diagnosed Crohn’s patients or caregivers in Malaysia have access to few channels  that they could use to discuss, ask, guide and support each other going through this painful disease. 

Living with chronic disease, I had to adjust and adopt to new diet and lifestyle.  Changes in diet were mostly trial and error in the beginning. I had to monitor my  consumption and take note of any changes. Why did I have to monitor those changes? It is simply because I wanted to avoid flare ups that were caused by certain food that I consume.  For me, I found that my Crohn’s is mostly under control when I avoid foods that contain eggs. So I have to ensure my daily food consumption is egg free. If I didn’t, I’d have to visit toilet frequently the whole day. Precaution is needed for Crohn’s patients because flare ups can happen in any situations, therefore any heads up is a good one to have. 

Apart from my diet, I had made some massive changes to my daily activities too. Since I’m an Ostomate, I have to ensure that I don’t partake often in hardcore sports in order to avoid stoma prolapse. 

The understanding and acceptance of IBD in society is still a challenge for me. Most of them, as  I mentioned above, do not know about Crohn’s disease. I remember one of my friends asking me “Sara, is your disease infectious?”. At that time, I just laughed and say “No, it  doesn’t”. The lack of awareness, although understandable, is a huge disappointment when  someone I confided in is not taking any initiative to understand it.

Stress is another thing that I started to consciously manage. What is the connection  between Crohn’s and stress? Well, stress generally affects a person emotionally and mentally as it damages a person’s emotional equilibrium. But it also affects the person’s health. Even a person without chronic disease can feel their health being affected by high stress levels. So, anyone with chronic health issues, such as IBD patients, have higher  chances of having a relapse and flare when they are stressed. It is imperative that I  recognize my stress inducers, my stress level, my tolerance level and ways to reduce stress  so that I do not have chronic flare ups. Although it is impossible to live stress free all the time, I  believe that I should try to manage stressful situations to the best of my abilities.

Navigating relationship with Crohn’s is complicated and challenging. Crohn’s has created ups and downs in my relationships with my family, friends and loved ones. In the beginning it was really hard to explain to them my condition. They did not understand the condition or why and how I got this disease in the first place at all. It took a while for my  family to accept my condition and now they are slowly getting used to it. They are a great  support for me at the moment, and my heartfelt thanks. 

Dealing with Crohn’s is tough enough and unfortunately, Crohn’s is not something  that we can ignore or that it will disappear one day. Every single day is a challenge for me because I go through physical and psychological pain. I have to survive, improve my quality of life and live my life as normal as possible; I hope more people will become aware of  Crohn’s disease, of patients’ struggles, and accept their conditions. Be kind even if you don’t see someone’s struggle, their pain or their decreasing health.

Planning with Crohn's

Stay with me for this one – I promise it won’t be as boring as it sounds! If you immediately switch off when you hear the world ‘plan’, or indeed ‘regime’ or ‘strategy’, you’re not the only one! There are, however, benefits to planning when you live with a chronic condition like Crohn’s Disease – and more importantly, if your plans become routines, then they’re more likely to become second nature, and you’ll find yourself doing those tasks subconsciously. Here, I will share some of my planning tips, which you may just find helpful. It’s all about finding what works for you so that you can manage to fit in all of the things you want to do, despite your health condition(s).

Smartphone apps

There are tons of smartphone apps available to help you keep lists, plan activities and so on! I keep it fairly simple, making use of macOS/iOS Calendar, Reminders and Notes (or the same apps on other operating devices). The calendar function is ideal for noting down all of your appointments. This helps for looking to the future, but also looking back at when and where different events occurred. The reminders app is an absolute lifeline for me. I have separate folders for different activities (e.g. university, health, work, voluntary commitments and so on). I add in activities, and a date/time (or location) reminder. This definitely helps me to keep track of everything that I need to do. If I didn’t, I would definitely forget! From a health tracking perspective, this is ideal as a reminder for booking in my next vitamin B12 injection which takes place every three months, as well as for when I need to ring up my doctor to arrange routine blood tests, when I need to self-inject my treatment, and when I need to order my repeat prescription. You may think that you’ll remember everything, but when you are busy with ‘life’, on top of ‘brain fog’ which many of us can relate to, it’s easy to forget. I know I have done that in the past, particularly when it came to self-injecting my treatment. I would remember that I need it on Tuesday for example, which would be the two-week dose period. However, I would have a busy day at college, would forget when I came home, and then in bed at night, I would suddenly remember, and think ‘I’ll have it tomorrow’. But then tomorrow became the weekend, and before I knew it, it may be a whole week later and I still hadn’t given myself my injection. I knew that was no good, but I just needed to do something about it – which I did!

Finally, Notes are brilliant! Again, I have different folders for a whole variety of different items. ‘Health’ is one of those. I use notes for keeping track of how I have been feeling, as well as for noting down points to discuss with my healthcare teams. I also use notes to keep track of discussions held with healthcare professionals, either face-to-face or over the phone. It’s just another good way to have information at your fingertips to help with your care, while the discussions are still ‘fresh’ in your head. 

Scheduling in rest days

We all know what it’s like to live with a condition like Crohn’s – we have so much robbed away from us. As a result, when you are feeling on the better side, you will naturally try to fit in everything that you can. I know that I have been there! Though sometimes, it really doesn’t pay off. That’s why I try to give myself time and space to just ‘do nothing’ – because I know that’s what my body needs. In pre-pandemic times, I would avoid booking in too many back-to-back travels, so that I always had some time to recover. In the current climate, I do my best to block off certain days where I’ll have meetings, keeping overs ‘free’ to do work at my own pace, and also take it easy. It’s all about being in control, as much as possible, so that you give your body (and importantly, your mind) the time and space to breathe.

Leaving the house with everything that you need

Phone. Wallet/purse. Keys. Mask! The list goes on – but it’s really important to have everything that you need to hand. As well as the usual items that most of us require these days, I also have supplies in my backpack and car for every eventuality. This includes painkilling tablets and gel, anti-spasmodic tablets to help with cramps, laxative tablets if I notice a blockage, anti-diarrhoeal tablets if the opposite happens, lactase enzyme to help me digest products containing lactose and the RADAR key to access locked accessible toilets. This list can go on and will depend on personal circumstances. I always find it best to have everything stored in one bag, so you can ‘grab and go’. It may feel excessive, but you will thank yourself later on when you’re not caught short.

Knowing your triggers and avoiding them

Although everyone is different, we all have some kind of trigger which can worsen how we feel. For me, I know that stress is a key trigger for worsening symptoms. That’s why I try to minimise stress as much as is practically possible – although that is much easier said than done! That’s why you’ll generally see me planning to do work well in advance of deadlines, for example, and seemingly ‘being on top’ of everything. In reality, it’s much harder to do, and I do find myself rushing for deadlines still – but at least I have minimised that as much as is practically possible. I am also my own worst enemy. As a perfectionist, I place huge amounts of pressure on myself to succeed and to do everything to the very best of my abilities. While it’s a good quality to have, it isn’t when it impacts on your health. So, it’s really important to be kind to yourself, and to re-evaluate your workload if you find yourself totally swamped and feeling ill. Nothing is worth more than your health.

Do you have any other planning tips which help you to live with your condition whilst getting through life? Let us know in the comments and on social media! 

What to Expect When a Loved One Gets Diagnosed with IBD

Navigating an IBD diagnosis is not easy. It can be messy and emotional and very tiring. The person diagnosed with IBD will be feeling many emotions, probably all at once. But it’s not just hard on the diagnosed individual; it can be very hard on their loved ones as well. It can be difficult to figure out what to expect and what to say and how to act when you find out someone was diagnosed with Crohn’s disease or ulcerative colitis. Hopefully this article will provide some insight into what to expect when that diagnosis happens. 

The first few hours and days after your loved one gets diagnosed with IBD can be very confusing. You are processing their diagnosis, while trying to be there for them as well. While everyone processes it differently, there are likely some common reactions you can expect. Here are a few things to keep in mind:

• Be prepared to simply be there for them. Whether they want to talk about it or not; whether they want you to accompany them to appointments or infusions; whether they want someone to sit with them while they are sick. And even if they don’t want any of that, make sure that they just know that you will be there if/when they do. Be there for them when they are ready to talk to you. Tell them you are there if they need anything and be ready to back it up with your actions. There is nothing worse than empty words. 

• Be prepared for them to become experts on their own bodies. They will become very familiar with their symptoms and will likely know when something is not right. Learn to trust that. If they tell you they think something is wrong, don’t try to argue with it. 

• Be willing to learn with them. For me, I read up a lot on my diagnosis. I read others’ stories, I read articles, I read medical journals. And I wanted my friends and family to understand some of what I was learning. So, be willing to read the articles they send you. Educate yourself on their disease. Don’t be afraid to be educated. 

• Be ready for the hard days. The days when their medication isn’t working. The days when their Prednisone is making them miserable. The days when they are in the hospital. Not every day will be hard, but some will be. So be prepared when they come. Remind your loved one that it won’t last forever. 

• Also be ready for the good days! The days when they find out they’re in remission. The day when they try a food they haven’t been able to eat in a while and it goes well. The days when they feel like themselves. Just as the bad days come and go, the good days will come, too. 

• Be ready for the doctors’ appointment. Especially when your loved one is first diagnosed and they are working to get control of the disease, there will be a lot of doctors’ visits. There will be ER visits and hospital stays. There might be infusions they have to go to on a regular basis. They may or may not want you to come. Be ready to support them either way. With COVID, they may have wanted you to come and you may not be able to. If that’s the case, try to get creative with ways to make them feel like you’re there. FaceTime them, call them, text them. Do something to make them not feel so alone. 

• Ultimately, be ready for a journey. It isn’t always easy and there will be really hard days. But your loved one is now part of a community that is welcoming and ready to help when they want. There will be people that they can relate to and that can understand them in ways that someone without IBD can’t understand. Encourage them to reach out to people they see on social media. Encourage them to ask questions and not be afraid to speak up. The IBD community is a great one and people are always willing to help! 

Navigating a loved one’s IBD diagnosis can be a daunting thing. It is a lot to process and there is a lot of unknown. But by just being supportive and being attentive to your loved one, things will probably go a lot better than you expect them to. 

Judging Symptoms with Crohn’s

Sometimes, it feels like all gastro symptoms are inflammaotry bowel disease (IBD)-related… especially being symptomatic with IBD for so long. However, it’s not always case – which can cause a great of confusion, as well as making life just that bit more complicated!

As well as Crohn’s disease, I also have gastroesophageal reflux disease (GERD), irritable bowel syndrome with constipation (IBS-C), an internal rectal prolapse and lactose intolerance. I was diagnosed with Crohn’s disease in 2008, after several years of experience gastro-related symptoms. So, at that point, I assumed that everything I had experienced was the result of Crohn’s. What I failed to realise, and what wasn’t explained very well at the time, was that I also had GERD. I was suddenly prescribed all of this medication, without being properly informed of the purpose of each different medication.

Over time, and with the right treatment, I became more informed, and I was able to get my Crohn’s disease under control, to the point where I was deemed to be in clinical remission. This was concluded by considering blood tests for inflammation (CRP and ESR), colonoscopy and gastroscopy results, small bowel MRI scan results and faecal calprotectin results, each of them done at different frequencies over different periods of time. This happened gradually over a few years, and in the process, I learned more and more about my body. However, I began to struggle with more gastro-related symptoms, which I initially thought were a Crohn’s flare, but soon realised were not exactly the same as before my Crohn’s diagnosis. I felt bloated and constipated, I had abdominal pain, and I was passing mucus. It became clear that I most likely had IBS-C. The problem I found with IBS was that there was no quick and easy fix for it – not that there has been a quick and easy fix for Crohn’s disease, but at least I was able to take some treatment which helped control the inflammation. With IBS, I felt very much in the dark. Recommendations were an anti-spasmodic to relieve cramping, laxatives to ease constipation, and avoiding foods which seemed to make me ‘worse’. I watched what I ate very closely, and soon identified certain green vegetables as a trigger, as well as milk products, which I tried to reduce. 

Little did I know, but the milk products weren’t just a trigger for worsening my IBS symptoms, but I was also lactose intolerant. I was diagnosed in 2015 – some seven years after my Crohn’s diagnosis. This only happened after one doctor felt there was something else going on and decided to test for lactose intolerance and Helicobacter Pylori infection – and thank goodness they did! I’ve managed to cut most forms of lactose completely out of my diet since, and when I can’t, I have found a lactase enzyme supplement I can take immediately before eating or drinking something containing lactose, to help me avoid those unpleasant symptoms.

I thought that was going to be it when it came to gastro problems. Then, something else came along! Originally blamed on my IBS-C, I noticed I was struggling more with constipation, despite eating a balanced and healthy diet, and doing everything else ‘right’. A couple of healthcare professionals didn’t really acknowledge my perspective, and just said I need to take laxatives permanently – something which I do take, but often feels like a ‘quick fix’ or ‘cover the wound with a plaster’, without understanding the underlying reason for these changes. Many blame IBD, plus IBS for constipation, without necessarily looking further. It sometimes feels as though assumptions are an easier option in the medical world, but not for those of us living with these symptoms. Moreover, I had observed changes beyond those I had learned to notice by living with IBD and IBS-C. 

Cutting a very long story short, I ended up going for a proctogram which revealed I had an internal rectal prolapse – which is basically when your rectum folds in on itself. It wasn’t the most dignifying procedure – much like most gastro-linked investigations. Dignity often goes straight out of the window! However, this finding did explain the sharp shooting pains I had been having in my rectum, as well as the mucus I had been passing, the ‘fresh’ blood I had noticed, and why it sometimes felt as though there was a physical obstruction – because there was. The verdict was ‘there’s not much we can do’ – something I think we’re all too used to hearing. There are surgical options, but they come with risks and they more or less said they would not be considering that option for somebody of my age. So, I was sent away with pelvic floor exercises, and the notion that ‘I just have to live with it’ – which I do. At least I received an answer for the symptoms I had been experiencing, even if I don’t have an answer as to ‘why’ I have a rectal prolapse. My current hypothesis is that it is something to do with hypermobility, which has consistently been overlooked – but that’s a whole different story!

All of these different symptoms, and the conditions subsequently diagnosed, have taught me so much. I have learned to really listen to what my body is telling me – which is not easy but does improve with time. I’m not always right, but my judgement certainly seems to be stronger now, after all of these years with IBD, IBS-C, GERD, a prolapse and lactose intolerance. I am much better at distinguishing as to ‘what’ is causing ‘what’ – although it’s impossible to always be ‘right’! You just tune into what you are feeling, almost like detective work. You place pieces of the puzzle together to help you build the picture of what you think is happening. Your previous experiences and your observations guide you, alongside being proactive in terms of knowing clinical indicators, recognising new triggers, stressors or symptoms, and then being proactive in seeking the right input from the right healthcare professionals. It comes more naturally after years of having to take things into your own hands to get answers. For example, I now know that the abdominal pain and cramping that I frequently experience is when I am perhaps a little constipated as a result of IBS-C and my internal rectal prolapse; so I adjust certain parts of my diet and take additional laxatives when I begin to notice patterns changing, early on. Likewise, the ‘whale’ noises and ‘washing machine sensation’ immediately indicate that I’ve consumed something containing lactose without realising – like the time I ate a gorgeous cheesy pizza, and then realised I hadn’t taken my lactase enzyme… I suffered for the next few hours! 

These conditions, in one sense, sensitise us to be more receptive to how our bodies work. I don’t think I would have been as knowledgeable or as ‘switched on’ as I am if I hadn’t been diagnosed with them – and I wish more people recognised this, particularly certain healthcare professionals. I often have grievances with professionals who rely solely on certain clinical indicators for disease remission. For example, those who just use CRP as an indicator as to whether you are in remission or not. This has happened to me in the past when I was evidently in the middle of an IBD flare, but at that point in time, I was not confident at self-managing my health. As it turned out, my faecal calprotectin was off the scale, and so some additional treatment helped me out immensely. What did I learn? Nobody knows my body better than myself. Healthcare professionals can help me the most when they listen to what I am saying, acknowledge my expertise, and then work with me to identify what is really happening, and then plan with me as to what to do to help manage symptoms so that I can get on with my life, and most importantly, have a good quality of life. So, when anybody questions what you are thinking or feeling, remind them of this point, and hopefully, they will change their approach so that it is supportive, rather than a hindrance.

Emotions and IBD

There are a lot of emotions that come with the diagnosis of any chronic illness, or even any major life change. But laying on the operating table, under the haze and fading twilight of the anesthesia medication exiting my veins, I felt nothing. The echoing silence of the room was heavy all around me. I expected to feel an overflowing stream of emotions flow over me, but instead the most striking sensation of my diagnosis was emptiness. It could have been the drugs dulling my system and my perception of the world. Yet, over time, I’ve started to think that the cause of the void-like feeling around my diagnosis was something incredibly real, and not artificial. The feeling of change is oftentimes so big that it feels like nothing. 

In that hospital room, so much had changed with a simple test. The scale of the moment was beyond comprehension. My parents and I communicated without words, because anything that could have been said would have failed. All the periods, letters, and adjectives in the world would never be enough to frame that point in time. So, somehow and instead, I just knew that I had ulcerative colitis without being told. Shock, and the whole experience, was such a surreal feeling. To know that something has snapped, or broken, or ended, but to be unable to directly confront that realization is off-putting. It was easier to not speak the change aloud, because to speak it into the world would make it extra real. 

In the weeks after my diagnosis, it was as if a light switch had been switched back on. All of the fear, grief, and anger I had missed earlier suddenly now surrounded me. The trauma of illness is such a widespread and varied experience, but it can be difficult to describe and discuss. It’s isolating to feel different, and to feel like you’ve lost a piece of yourself. Health is something that most people take for granted or don’t think about. So when it’s taken away from you, its absence becomes the dominant part of your everyday life. The shift in my lifestyle to one focused on health had a significant impact on my mental health. I was in an environment, my freshman year of college, where everyone seems to be testing the limits of their independence. Thus, to feel completely dependent on my unstable day-to-day health felt unfair and tragic. 

It’s a challenge to have the energy to battle painful, and draining symptoms on a daily basis. I learned that adjusting to my illness, and all of the treatment that comes with it, was a major part of my healing journey. On top of that, I realized that acknowledging the emotions I was experiencing was an important part of accepting my illness. It’s normal and natural to be angry, to grieve, and even to be nostalgic for your life prior to diagnosis. In fact, for me, it was the first step towards opening up and connecting with others in the chronic illness community. My experiences, feelings, and my relationship towards my health has been full of highs and lows. Most of all, I’ve learned that the negative and positive emotions I’ve encountered from dealing with illness are all valid. They’ve helped me grow, learn, and evolve as an individual. Every journey is different, and that is perfectly okay.

Studying with Crohn's

By Simon Stones

I feel as though I’ve been studying for most of my life – well, there is some truth in that! After 22 years in education, it is safe to say that I am well and truly ready for the formality of it all to end… though I know I’ll never stop learning in life!

There’s no right or wrong way to go through education, especially once you reach the end of your compulsory education. Add into the mix one or more chronic conditions like inflammatory bowel disease, and things can feel a little more complicated– especially when deciding on what you want to do, and the way in which you want to do it. Moreover, what works for one person won’t necessarily work for another – which is it’s so important to do what’s right for you. 

I went straight from compulsory education to University, where I completed a four-year Bachelor’s degree in Biomedical Sciences, before going straight to a three-year PhD in healthcare. Some may say it’s sensible to get all of your education done at once. Some may say I was lucky to be able to progress through the ranks one after another. Some may also say I must be slightly bonkers. In all honestly, it’s a good mix of the three, especially the last one!

My thirst for learning really began during childhood, while living with juvenile idiopathic arthritis. As a result of my restricted mobility at the time, I struggled to participate in sport. It is here when I channeled my energy into my academic learning – my body wasn’t much use, but I had a brain and I wanted to use it. Living with a chronic condition throughout my childhood had, in one sense, conditioned me to be inquisitive and desperate to learn. Although I missed quite a lot of time at school through being at the hospital and being unwell, I never gave in. I would always be working – it could be reading, completing workbook exercises, or writing. Every appointment, every infusion, every day sat in bed unable to move. In one sense, it gave me a purpose at a time in life when a lot of things didn’t seem to be going my well.

When I was diagnosed with Crohn’s disease at the age of 14, I was just about to embark on the final two years of secondary school here in the UK, where I would complete my first set of important exams, known as GCSEs. At the time, I wanted to become a science teacher, and so I knew it was essential for me to do well in my exams. Everyone kept telling me that I would pass, but being the perfectionist I am, I didn’t want to just ‘pass’ – I wanted to ‘the best’. Others often assumed that because of my health problems, getting a ‘pass’ would be ‘amazing’. This was often well intended but came across as a little patronising. I asked myself why should I achieve less than what I am capable of, just because of my health? It was this mindset which pushed me through. Don’t get me wrong – the stress of the exams in their own right, plus the stress I placed myself under, wasn’t helpful towards my health, and a regular pattern around exams would be a flare-up of symptoms. The same went for my A-Levels, the qualifications required for most University courses.

Over time, I tried my best to develop strategies to help to me manage my stress, while making sure everything was in place to help me achieve my potential without being at a disadvantage from my health conditions. It is often easier said than done, but planning has been fundamental to me limiting the stress I’ve found myself under while studying. In practice, this meant keeping on top of work, writing up notes as soon as possible, and looking ahead at what needed to be done by when. I also made sure that my school and college were fully aware of my health conditions, and that I had access to all the support I needed. This included extra time and the option of rest breaks in exams if needed, as well as being in a room away from the main exam hall that was near to an accessible toilet. Nowadays, with increasing use of technology, I would hope it is easier for students to keep in closer contact with their teachers/tutors, as well as be able to access different pieces of work electronically. This was starting to happen when I was at college between 2010 and 2012, but a lot has changed since then!

“It always seems impossible until it’s done.”

I started University in September 2012, originally studying Biology with a view to becoming a science teacher. I had toyed with the idea of studying Medicine, but I came to the decision that it wasn’t for me at the time. Sometimes I wish I had pursued the Medicine route, but I’ve certainly no regrets. After one year of Biology, I decided to focus my degree on Biomedical Sciences. It was during this period that I began my patient advocacy journey and found my love for research. Inevitably, the first few years of my degree involved quite a lot of work in the labs, which I thoroughly enjoyed and found fascinating. However, on a number of occasions, I did have some issues. While experiencing flares with both my Crohn’s disease and arthritis, in addition to experiencing quite severe cramps and pain while also in remission, I found it challenging to be on my feet constantly while performing tests in the lab. I always had a lab chair nearby, but it wasn’t always practical to be sat down. There were many times when I would be wishing for time to pass quickly so I could get my work done and sit down to get some relief. These experiences helped me to decide that being in the lab 24/7 in the future wouldn’t be for me, despite my love for science and research. Thankfully during my third year, I spent a year on secondment with a pharmaceutical agency, where I was able to use my knowledge and love of science in a way to inform medical communications and the drug development process. Like most things in life, you learn along the journey… coming across the things you least expected doing that you learn to love the most.

While I loved my time at university, I certainly wouldn’t want to repeat the undergraduate degree process! While it was worthwhile and an incredible experience, it was demanding. Thankfully, I graduated in 2016 with a first-class degree.

I then found myself at another crossroad. Do I take a graduate job and leave studying behind, or do I go on to do a PhD? Most people tend to undertake a Master’s degree before a PhD… but I guess I’m not most people. I came across a three-year funded PhD place in healthcare, focussed on supporting children with long-term conditions. I felt as though it was screaming out to me, ‘please apply!’ I decided that I would only apply for this PhD, and if I didn’t get it, then I’d look for a graduate job. I genuinely didn’t believe I would do, but with some luck, I received that wonderful call on Thursday 9th June 2016 – the afternoon after delivering a talk at the European Rheumatology Congress in London. I couldn’t believe my luck!

Fast forward nearly four years, and I am near the very end of my PhD – writing up my PhD thesis on a topic that is so close to my heart – supporting young people with juvenile idiopathic arthritis and their families to manage their health and wellbeing. It’s like a dream. The PhD study experience has been a very different one to everything before. Unlike school, college and an undergraduate Bachelor’s to a degree, a PhD doesn’t feel like ‘studying’. It certainly feels more like a working job, but one where you’re wandering around in the dark. It’s also quite an isolating and lonely journey, though I have been blessed with wonderful supervisors, supportive colleagues, and great friends and family.

As I’m writing up my 80,000 to 100,000-word PhD thesis (yes, I know, it’s going to be a book!), I’ve been doing an awful lot of reflecting, thinking about what worked well, what didn’t work well, and what I would do differently if I was to repeat the PhD again, or do another PhD… which I can guarantee is not going to happen! During this thought process, I feel blessed to have been given the opportunities that I have received over the years, but I also acknowledge that the majority of those achievements have been down to guts and perseverance – and I should be proud of that. 

Sadly, it has also highlighted many of the cracks where people with chronic conditions fall through along the academic journey – and how attitudes and practices need to change so that others aren’t discriminated against by an ableist culture which doesn’t recognise and support people of all backgrounds to achieve their goals. We can do this by speaking up, highlighting our needs, and making sure others support us in doing what is needed. Never feel as though you are making a nuisance of yourself, or that you are demanding unachievable things – and if you are made to feel like this, don’t give up, seek support, and fight for what you are entitled to.

What have you experienced as an IBD patient because of the pandemic?

Photo by Bruno Cervera from Pexels

Today the Crohn’s and Colitis Young Adult Fellows joined together to share what they’ve experienced as an IBD patient during this global pandemic. So we asked our fellows how they have been affected by the pandemic as IBD patients and this is what they want to tell you!

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“Thankfully, I’ve not had too many problems during the pandemic. My IBD is relatively well controlled at the moment, but I still fall in the group of people in England who are strongly recommended to stay at home, because I am immunosuppressed. Therefore, I haven’t taken any chances. I was able to get my medications delivered to the house, and I now have weekly food deliveries too - though trying to get a slot is harder than you think! My regular follow-up appointments at the hospital have been cancelled until further notice, but I am doing okay at the moment so there’s no need for their input. I have the IBD helpline and email address should I need them - but hopefully not! The only other problem I’ve had is arranging for my three-monthly vitamin B12 injection, which I’ve had for around 10 years due to malabsorption. My surgery has deemed this ‘non-essential’, and are only injecting those with consistently low levels. Clearly, I don’t fall in that category, because I’ve been on regular treatment for so long. They have suggested oral supplements which I would need to buy myself, but the problem of malabsorption - so the supplements are unlikely to be of any benefit.”

Simon Stones

“Though I am not on any immunosuppressive medication, I have felt heightened awareness of the fact that I have an autoimmune disease and an overactive immune system in general. When I realized how serious the pandemic was, my anxiety spiked not only because of the reality that was to come but regarding how many people dismissed the repercussions of proper, careful social distancing or #stayinghome. I was lucky that I was able to communicate with my GI provider and get refills of medications I use during flares and on a regular basis without having a last-minute visit. I only leave my house for essential needs such as groceries (once per week max), prescriptions or to get out of the house to exercise so I can regroup physically and mentally.”

Rachael Whittemore

“As someone who is immunosuppressed, I have been experiencing heightened anxiety because of the pandemic. I have been fortunate to work from home and have the privilege of having family nearby that can transport my groceries to me, but that being said, I still feel the fear and frustration upon seeing the news every day and knowing that there are many people who are not taking this as seriously as I feel they should. I began isolating before the quarantine was in full swing, because of my compromised immune system, and have only been in public to go to the pharmacy drive-in (while wearing a mask of course!). I am trying to channel my anxiety into healthy outlets, such as my art, to avoid prompting a stress-induced flare. All I feel that I can do at this time is stay at home.”

Lucy Laube

“As someone with IBD who’s living in a developing country, the major challenges stem from the lack of robust health infrastructure. Thankfully, I’m not in a flare and neither am I on any medication. However, I do have an ileostomy which requires constant maintenance. I have been facing difficulties in acquiring bags and other components of my ostomy. Luckily, I was able to procure a small amount of these components before the lockdown, but at an inflated rate. I’m also having difficulties procuring basic things like cotton and micropore tape. This keeps me in a constant state of anxiety. I am constantly checking apps to see if I can get the essentials at reasonable rates. Additionally, there is no easy access to any form of basic healthcare in case of an emergency, and that makes me nervous.”

Nikhil Jayswal

“To already live in a body and in a life that inherently holds so much unknown and vulnerability when it comes to my health, and to have that sense of uncertainty that constantly exists within myself now amplified throughout the world, to have that unknown intensified to this extent, has brought even more challenges and emotions to the surface. It feels like the unpredictability that comes with living life with a chronic illness has multiplied tenfold. I am immunosuppressed, and the only time I have gone anywhere except for my house or my backyard was to get blood work taken to check on my levels. While every precaution was taken in doing so, and it is a privilege to have such access, it was still an anxiety-ridden experience. I am incredibly grateful that I am not currently flaring and that I have the ability to be in contact with my GI provider through telehealth services, but I think it’s important for people to realize that IBD doesn’t just “stop” or “slow down” during a pandemic.”

Rachel Straining

“As someone who is immmunocompromised due to the medications I am on, I am always cautious of when I go out and am in large groups of people. With the pandemic, this caution has increased tenfold. I am fortunate enough to be staying with my parents right now. They go grocery shopping so that I do not have to go to the stores. I limit the number of places I have to go. When I do go out, I wear masks and gloves. I come home and immediately put my clothes in the washer and take a shower. I sanitize everything that I buy. When I’ve had to go for my infusions, I have to go through multiple check points to ensure I do not have the virus. All of my doctor appointments have been virtual. Although my health is not perfect right now, I am thankful to not be flaring like I was at this point last year, as I was in the ER every couple weeks. While the rest of the world seems to want to jump into reopening, I get anxious thinking about the ramifications of opening too soon. I cannot control how anyone else responds to this and who follows quarantine and who does not. But I can continue to do my part and stay at home.”

Samantha Rzany

“When you live with a chronic illness, you’re often forced to make compromises for your health. You have to take on a second job as the captain of your health. Since the pandemic began, navigating the healthcare system has become more difficult and uncertain. Chaos is a part of any illness that remits and flares, but when chaos is the defining state of the global world, it can cause undue stress. Personally, I’ve had to postpone doctor’s appointments, and alter my treatment plan to cope with our new reality. It’s been difficult to choose not to participate in activities I enjoy doing, like socializing with friends, but I know that I have to make sacrifices to protect my health and the lives of others. While I cannot eliminate all risk, I am trying to minimize my stress and focus on what I can control. I am taking precautions, such as wearing a mask, and going out for only essential needs. The entire experience of the past few months has brought health to the forefront of the public’s attention. I am hopeful that it will improve the public discourse on chronic illness, and lead to more resources in the health sphere. After all, public health is a collaborative effort, and not an individualistic one.”

Grady Stewart

As someone who is immunocomproised, I carry around the stress of potential sickness anxiety with me. Before the pandemic, I have always been transparent with people in my life about my need for them to stay clear of me if they are not feeling well . This advocacy that I was working on getting good at is now amplified x3. My remicade appointments have carried on, first I couldn’t bring anyone now I am allowed to and it’s back to normal. I feel isolated and lonely but thankful for my roommates who keep me company and my cousin who drives me to the grocery store. For me, it has been a major trigger to have the topic of conversation constantly be of health and healthcare. My hope is that this will bring a new normal. That together we can collectively make workplaces schools etc more accessible for all and that there is now a general awareness and understanding for the immunocompromised community.

Amy Weider

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Reflections on Being Diagnosed with a Chronic Illness as a Child

By Leah Clark

When I was twelve years old, I was diagnosed with Crohn’s disease. From personal experience, I believe that being diagnosed at a young age can be seen as a blessing and a curse. Of course I am partially biased; I don’t want to go through my life wishing that I had been diagnosed at a later age. There is literally nothing that can be done to change that. With that, let’s start with the bad news about being young and diagnosed with a chronic illness. At the time, I didn’t fully understand what what was going on half the time. I remember feeling healthy, and then all of a sudden, I was feeling awful all the time. I would could home from school exhausted; I barely ate anything because everything made my stomach hurt. It wasn’t like a normal cold with the sniffles and running nose. That I could recognize, but these new painful experiences were different, and I didn’t know what was going on until I finally went to the doctor.

Reflecting now, I realize what else was going on, apart from getting Crohn’s disease. Part of my childhood was taken away from me, and that’s a pretty big statement. A part of my childhood was not lived because I was too sick to live it. While other kids my age were able to go to pizza parties and stay up late at sleepovers, I literally was too exhausted to keep up. Along with Crohn’s, I was also diagnosed with Celiac disease, so I can’t eat gluten anymore. Not only was I that sick pale girl with bathroom problems, I also couldn’t eat half of the diet a normal child eats. No chicken nuggets and pizza rolls. I had to bring my own snacks when it was someone’s birthday at school. This was also a time before the gluten free diet fads exploded the industry, so there were not many options for me that didn’t include basic foods. You never realize how integral food is in American culture until you can’t eat it anymore.

“A part of my childhood was not lived because I was too sick to live it.”

Aside from missing out on those experiences, I also missed out on social and developmental aspects. For example, in my middle school, there were a lot of tall, athletic girls and boys that participated in volleyball, basketball, tennis, track, cross country, so on and so on throughout the year. Sure, middle school sports aren’t really that much in terms of importance, but at that age, sports signified a time to spend two hours with your friends outside of the classroom. I wanted to be part of that. I didn’t want to miss out on what my friends talked about, who they were talking to, all the hot gossip. You know, typical middle school things. However, I was not good at sports, like, at all. While all my other friends were growing up, getting taller and having fun actually being good at sports, I was not. I was malnourished for so long that I skipped that part of purperty. In fact, I’m still the same height that I was in 8th grade, 5’2. Maybe this is why I don’t like participating in sports even to this day. I feel like I don’t “fit in” in the activity, and I sometimes still get angry that I can’t be better at them.

Anyways, the point I’m trying to make is not that I was bad at sports when I was younger, or that I couldn’t eat birthday cake with everyone. The point I’m trying to make is that I was deprived of childhood experiences that I would consider vital in growing up. Some days, I wish that I had a different childhood; I wish I wasn’t diagnosed when I was so young. It brought not only sadness into my life, but a lot of anger, for a long time. I was forced to grow up faster than my classmates. Heck, I understood how healthcare worked at the age of 14. But, it’s frustrating to be a child and not understand why bad things are happening to you for no reason. For awhile, I felt like I was being punished for something. Why do bad things happen to a good people? Am I a bad person? It took so long for me to realize that sometimes, life sucks, and sometimes good people get sick.

The picture on the left is my 6th grade school photo. My face was thin. I hated smiling. I felt like a ghost being trapped in a body I didn’t recognize. The picture on the right was taken this summer, almost ten years after the other. It’s safe to say I don’t feel that way anymore.

That being said, being diagnosed at a young age was also a blessing in disguise because I was an impressionable pre-teen and able to adapt to my new lifestyle of having a chronic illness in the same way I adapted to other major changes in my life (puperty, middle school, etc). I thought of it as, “Well, I guess this is a thing now,” and I just accepted it as my new life. It wasn’t until later when I would look back on my life that I realized I had experienced some pretty tough things. Of course, I didn’t love it at the time. Who would love having to explain to all your classmates why your face looks like an inflated balloon from prednisone? Or why you have to skip school to go to the doctor’s office for infusions every few weeks? I was lucky enough to go into remission fairly quickly after diagnosis, and (most) classmates did not even discuss my disease with me because it wasn’t affecting my day to day life. I have spent almost half of my entire life living with Crohn’s disease. I know tricks to help with flares. I’ve had years of experience in learning what foods affect my body. Yes, it has been a learning process, but as I grow older, I will be gaining more and more knowledge on how to handle my disease. I learn more about myself and what kind of person I want to be everyday. These experiences, though rough, have shaped me into the person I am today.

I was able to adapt to my new lifestyle of having a chronic illness in the same way I adapted to other changes in my life. I thought of it as, “Well, I guess this is a thing now,” and I accepted it as my new life.

The one thing about being diagnosed at a young age that outshines all the rest is the fact that I have met so many wonderful people with the same disease as me. I was diagnosed in the summer of 2009, and that same summer was the year my parents sent me to a summer camp for kids with inflammatory bowel diseases. I was a camper there every year from then on for six years and was fortunate enough to be a counselor for four years after. It was such a joy to meet kids my age that knew exactly what I was dealing with. We were able to share stories, give eachother advice on how to handle our illnesses, and just spend a week being a “normal” camper. I am happy to have been diagnosed at a young age, because I was able to meet other kids that were diagnosed at a young age, too. It’s a special bond. I have made lasting friendships with mnay people, and it has been an amazing journey. I understand not everyone diagnosed at a young age was able to meet people their age with their illness. IBD can be a very isolating disease, but the thing I find to be one of the best things about my illness is the community established from it. A good support system can honestly be the difference in someone’s life that changes how they look at their disease. I know for me, just the fact of knowing there were other kids like me, helped me so much with my when I was younger.

If I could give just one piece of advice to someone with IBD, it would be to establish a support system. If you haven’t met anyone that has IBD, I encourage you to seek them out. Whether that be a club on your college campus, a support group in your town, or even online, meeting other people will similiar experiences with you can be se rewarding. I was fortunate enough to establish these relationships at such a young age, and for that, I am grateful to have been diagnosed with my chronic illness as a child.

New Year's Resolutions from a Fellow Crohnie

By Erin Ard

Living a life with inflammatory bowel disease is in one word, unpredictable. For Crohn's disease, you pretty much do what you can to control the inflammation in your body by controlling your food intake and working with your gastroenterologist on what treatment methods to use. Not to mention, dealing with any other additional complications or side effects. I was diagnosed with Crohn's disease 10 years ago now and I've learned a lot about strength, resiliency, and the imperfection of the human body. Since my diagnosis, I've learned a lot about my body and my disease including how to accept all of its flaws. But because reality tells me I will deal with this disease for the rest of my life, my journey with Crohn’s is not over yet so there is still so much more to learn.

My journey with Crohn's started back in high school and honestly, I had no idea what would be in store for me. When I was finally sent to see a specialist, we would drive over an hour to my gastroenterology appointments. I started out taking mercaptopurine to suppress my immune system but quickly advanced to Remicade as a long-term treatment. On Remicade, I finally felt like myself again – at least a version of myself with additional manifestations of my Crohn's. The joint pain and short-lived fevers still persist, even today. It has been 8 years since I started on Remicade and a lot has happened over those years. I finished high school, moved away from home, and started college at the University of Wisconsin - Madison. Since starting college I've learned a lot more about myself as an individual and how Crohn's affects my life as a whole. In fact, it has changed since I was diagnosed and achieved remission the first time around.

I moved through the years mostly symptom-free. With only the rare stomach ache, but still able to maintain your daily routines. I knew precisely how my daily life would change if my disease was active. I valued the time I had thinking I could eat what I wanted without repercussion or go on a long run without my joint pain forcing me to limp the remaining distance. When your Crohn's is in remission, you have the freedom to eat delicious - maybe not so Crohn's-compliant - foods. You may even plan travel trips into your year with minimized anxiety of having an episode. I had the freedom to do all of these things! Since 2019 started, I tackled my vision board ideas by cooking more from scratch, trying out healthy recipes in my Insta Pot, and booking my first flight on a plane! Followed by several more flights to exciting new locations I hadn’t dreamed of experiencing because of the travel-anxiety instilled by my Crohn’s. For a woman in her early 20s with Crohn’s disease, I was crushing it! Then a few reality checks later, the unpredictability of IBD set in and I learned an important lesson. That no matter how far into remission you've gotten, odds are you might flare-up again in the future.

Photo by Evie Shaffer from Pexels

This sad truth is where I found myself recently. For the last few months, I've felt pretty off. I was getting more frequent belly pains, indigestion, irregular bowel movements, and my joints were starting to bother me more. I had originally attributed all of my symptoms to not eating well, which was a naïve thing to believe.. In retrospect, I had been struggling to stay in remission for the past couple of years. With the way that Remicade infusions worked over my 8 week time period, I would started getting symptoms again around week 7. That last week was a familiar struggle which included neglecting some of my responsibilities at school. I would end up skipping a class here or calling into work there - each pretty understandable given the circumstances but I still regretted having to do. About a year ago I went in for another colonoscopy (my third so far) because of these recurring symptoms and because my last one was towards the beginning of my diagnosis. The results didn't come back perfect, of course. They found some inflammation in my distal colon and the opening to my small intestine, which would explain my irregularity, stomach pain, and indigestion. I was told my gastroenterologist would be in touch to discuss what my next steps would be. After that visit, everything concerning my disease went on hold for awhile. In other words, life happened. My obligations for school and work started to take over my free time. Being the Crohnie I am, my limited will power from the fatigue would have me put the small tasks off until the following day. Meaning my health was put on a back-burner because they would always be put off until the “next day.” I was still receiving infusions every 8 weeks and conquering through my days, so I didn’t jeopardize my self-efficacy. I felt able to accomplish whatever I set my mind on. Eventually I started to wonder what my prognosis would turn into if I continued living this way. So I finally scheduled that appointment, this time with the gastroenterologist that performed my last colonoscopy.

Since I've started this fellowship with #CCYAN - the Crohn's and Colitis Young Adults Network, I've read so much about other people's experience and learned the expansive symptomology of inflammatory bowel disease in other bodies. Since the start of the year I realized how crucial it is to maintain your disease to prevent complications or necessary surgery in the future. Heading into the new year, my new outlook will be focused on achieving remission and maintaining a healthy body, any way I can. Let me share with you what my Crohn’s-related New Year’s resolutions are for 2020..

Learn to accept the unpredictable.

The first resolution I’d like to explore more is in how I think. Because Crohn’s can be so unpredictable, accepting this as a fact of the disease may help uncontrollable events feel less traumatizing. When you can learn to seek solutions or simply see the positive rather drowning in the self pity, loathing, disgust or whatever you might feel, you will feel a bit more at ease. It takes so much energy worrying about what "could" happen in the future. Like what "might" happen if you venture away from the privacy of your home and go to the movies today. Or "if" you might have the urge to go on an airplane while the bathroom is busy. Or "if" you don't make it to the toilet on time. Events like these are bound to happen and throw you for a loop if you aren't prepared. I should clarify that learning to how to accept and not worry about the future doesn't necessarily mean you shouldn't prepare for anything and everything. Because the first thing we all learn with IBD is that preparation is key to surviving any traumatic bathroom incident!

To take initiative when it comes to my well-being and body's health.

The second resolution involves how take action when Crohn’s is clearly affecting my body. My bad habits of binge-eating sugary treats or ordering high-fat take-out when I’m not feeling well starts to become routine when I don’t take responsibility for some of the fall out. I’d like to learn how to better take initiative to prevent consequences or make the most of my recovery. This means staying in close contact with my gastroenterologist about any trouble I’m having, not eating foods I know will quarantine me in the bathroom the next day, and keeping track of my symptoms, as tedious as that might be.

Recently I received not-so-great news from my gastroenterologist and it felt like my world was collapsing. After I took a calprotectin test which showed an adequate amount of inflammation, she told me that my Crohn's was flaring up again. It took me a bit to realize that what I was experiencing was actually long-lived. I had started getting symptoms months prior and it took me too long to get back on track. Something simple that could have helped me notice something sooner would have been a food log, which unfortunately, I don't have a lot of experience in carrying out. However, I do see their value and hope that this next year I can explore this path and hone in on what my exact food triggers are and how my body changes throughout the year. If you are now interested in doing the same, see this article on How to Use a Food Diary to Help Manage Crohn’s Symptoms and Flares from Everyday Health. I might not go as far as weighing my food, but at least I will get an idea of what food leads to which symptom.

My disease will change as much as I do.

This is one thing I needed to accept my disease started to flare up again. I was caught up in the idea that I had achieved remission and that everything would stay relatively constant. I just couldn’t see myself going through what I had in high school again, when my Crohn’s had surfaced. Since then it’s been a constant flow and I tried to push any thought that the disease would hold me back aside - which was an advantage for the time-being. However, this also kept me from growing because I just shut everything out. I wasn’t able to harness the power of vulnerability in having an illness to accept myself as I am and love my body.

After spending the last 8+ years in remission, with only some minor episodes, finding out my disease was flaring up again came as a shock to me. I've noticed that I'm the type of person who is apprehensive around big life changes. I like how things are going, I am comfortable with how everything is, and if I have to suffer through it a little, I am fine with that. However, this kind of mindset wouldn't suffice anymore and I've been realizing that more and more every day. My doctor and I have been working hard to put my disease back into remission. I'm trying some new medication out and taking everything new in day by day. IBD is so specific to every person, so how it presents itself or progresses is going to look different in all of us. And as all of us grow into young adults and beyond, our disease will change over time as well. For the better, or not so much.

My body will do some weird things, just learn to go with it.

You would think having to deal with gut pain would be enough, but there are so many other things that can factor in! The most common list of symptoms for Crohn's disease include abdominal pain, diarrhea, and fatigue. But the lesser known, indirectly related symptoms should also include weird noises, smells, urgency and accidents. Your gut will make loud gas-y noises while it’s quiet in the office. You will have to take frequent, unexpected breaks when the urgency gets the better of you. And the unfortunate reality is that sometimes, you won't make it to the bathroom in time.

The most healing part of my being more vulnerable this past year, was accepting these symptoms as they were instead of trying to control them. Because when I’d try to control them, I would get gut upset, constipation, or even more uncomfortable. I eventually started to tell people that yes, I have had accidents in the past and brushed this confession off like it was normal. Humor always goes a long way in these situations. Because of the healing I’ve already had, I want to pursue this resolution in 2020 as well to see my body’s flaws in a new light.

My hope is that you will find some inspiration to create your own list of resolutions for yourself. Whether they are similar to mine or completely different! Join me in making a resolution list for yourself this year and we can both actively improve our life with IBD together!

Doing the imPOSSIBLE while living with IBD

By Andi Nowakowski

Limitations and sacrifice are an unfortunate aspect of living with a chronic condition, which is why I was very excited when, this summer, I was able to take part in an activity I’ve been wanting to do for a long time; I donated blood.

It may not sound like much, but between the numerous immunosuppressants I take on a daily basis, my Crohn’s disease diagnosis and all the issues that are in tandem with IBD, I didn’t know if this was a donation I would ever be able to make. Even so, when the company I was interning with over the summer announced it was hosting a blood drive, I decided to do some research and was surprised to find that I would likely be able to contribute!

Whew! This experience was a rewarding mix of anxiety and exhilaration. The day of the blood drive arrived, and I was asked to fill out a survey that included questions about my age, weight, specific medication use, surgeries, etc. They checked my vitals and iron levels and deduced that I was a good candidate to donate. The only thing left to do was sit down and give over some of my life-saving bodily fluids-- an accomplishment I have been dreaming about for years. 

The nurse warned me to look away as she was about to place the needle, advice that, as a professional patient, I flippantly dismissed. Being an IBD patient, I am used to being poked and prodded with needles. Let me tell ya, that needle was MUCH larger than I anticipated. A word to the wise, if you have a fear of needles, you may want to keep your eyes averted at all costs should you decide to donate. In the end, it took about 15 minutes. They took a pint of blood while I sat in a reclining chair and enjoyed a well-earned snack. I was shocked at the amount of blood they drained out of me. Turns out, the average person has about 10-12 pints of blood in circulation but only needs about 8 to function normally. Honestly, though, I was really proud of myself for taking on this challenge and pushing my own limits.

Donating blood is a thankless, but worthwhile task. The person who will ultimately end up receiving your blood will never know who you are, but it is a life-saving and meaningful endeavor. For many, donating blood is a routine measure and most people probably don’t think twice about it, but for me, it was a way of giving back a little bit of good to the world. It was my way of saying, “Screw you Crohn’s.” It was my silent triumph against IBD and the limitations that come with it. The goal of this article is not to persuade you to go out and donate blood. I will say that it was physically challenging for me to do so. That being said, I do hope to inspire you to push yourself and seek out the endless possibilities that this world has to offer. Be patient with yourself and your condition, but don’t let IBD stop you from pursuing your dreams. Allow your experiences to strengthen your resolve and keep challenging yourself to experience all that you can. 

As one of our founders, the late Cory Lane, used to say, “live each day like an adventure.”

Andi

Life Hacks for IBD

By Leah Clark

It seems like these days there are life hacks for everything. Want to remove stems from strawberries? Poke a hole through the bottom with a straw. Color your keys with nail polish so it’s easier to identify them. You even can start harvesting plants using old paper tower rolls. The point is, there are all of these different “hacks” used in the everyday life, but are there some for those with IBD? We’ve compiled a list of five of the most useful and best life hacks for patients with IBD.

Use online services for errands when low energy or mobility struggles arise from IBD

The internet can be a wonderful place, and that is especially true for online shopping and services. Sometimes, those with IBD have problems running errands or leaving the house to pick things up. It can take up so much energy to do something as necessary as grocery shopping for people with IBD because of how much work it takes. For this, a nice hack is to order things online and have them shipped to your home directly, taking out the work and expended energy of having to do it yourself. Many grocery stores now have services that offer delivery of food and other items the same day you order. Ordering things online from department stores, too, saves time and effort. Many times, stores online offer more options than seen in stores, too!

Mobile apps are available to track symptoms, record food diaries, and more

One of the best life hacks for people with IBD is right at their very finger tips. There are so many apps available for mobile devices that can make managing their disease much easier. If diet is a concern for your disease, try using an app that records your own food and keeps track of nutrient breakdowns if you’re trying to focus on certain areas of your diet (such as maintaining high vitamin levels or increase calorie content). This also keeps a record so you can look back and see what might have affected your body if your symptoms worsen, as you can check for patterns. An all around good IBD app is called Cara Care, and it helps you track all of your IBD symptoms, such as bathroom frequency and sleep. It even allows you to create your own custom areas to cater to your unique IBD experience.

Monthly subscription boxes can eliminate the stress of always remembering necessary products

Much like the first life hack mentioned, it can be a struggle to spend time and energy to go shopping for things you need in your life. Not only that, living with IBD can be mentally draining, and it can be difficult to keep track of everything if your brain is exhausted. Luckily, there has been a great trend of companies offering monthly subscriptions where they ship products straight to your door that can make living with IBD a lot easier. Companies such as Blue Apron and Hello Fresh offer meal prep that is delivered straight to your door, eliminated the struggle of having to plan meals during busy times of your life. Other services such as Dollar Shave Club and even Walmart cater to provide hygiene products that don’t break the bank.

Keep an emergency IBD kit with you whenever you travel

Not so much a hack as it is just a smart idea, but a good idea is to always travel with essentials that can help whenever an IBD problem arises. This can include wet wipes for the bathroom, an extra roll of toilet paper, more underwear, an extra set of prescription medications or laxatives, a heating pad, or anything else that can ease symptoms when they occur. Accidents can happen, and it is especially hard to deal with them when you are far from the comfort of your own home. With the emergency kit, if anything unexpected happens, it will be easier to handle.

Sign up with your university’s center for disabilities services to get accommodations

Maybe a lesser known service that universities offer is their center for students with disabilities. Each university has a different name for it and how they provide accommodations, but they are here to help. With this service, students can sign up with their documented disease and receive accommodations they need related to their disease. In terms of those with IBD, these accommodations can range from requesting a dorm room nearest to a bathroom to receiving extra time on quizzes and exams for bathroom breaks. It’s important to set up an appointment with the service to ensure enough time allocated before such accommodations need to be implemented (such as extra test time). Also, if you ever need to take leave from school due to your disease, the center for disabilities will work with you until you’re able to return to class.

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What are some “life hacks” that you use for your IBD? Comment below and share with the rest of us so we can make living life with IBD a little bit easier!

Explaining IBD to Those Without It

By Leah Clark

Imagine your abdomen is a blender. Now, someone shoves 10,000 little knives into that blender. Crohn’s disease is pressing the on button.

I have been living with Crohn’s disease now for about ten years, and this analogy is the best I have conjured when describing my pain to those that have never felt it. To my closest friends, I feel very comfortable discussing my health and my symptoms. When I’m having a bad IBD day, they know about it. Whether it’s from the expressions on my face, my absence from the group, or strictly from me telling them, they know. Describing my disease to others that don’t know more, or/and have never heard of Crohn’s disease is another story.

It’s more than just a stomach ache, or it’s more than an overall “not feeling well.” When I talk about being tired, I’m talking about my entire body aching with every step I take. I’m talking about how even the thought of getting out of bed brings me to exhaustion because I don’t want to exert energy. Fatigue is only one part of it. When I talk about pain, I’m talking about truly stabbing pain, like a pitch fork plunged into your body and every time you move, the pitchfork twists a little deeper and a little wider into your gut. I’m talking about a boulder the size of a microwave being pressed into your intestines, with each step you take another rock being added on top. I don’t even want to get into the toll my mental health takes because of my disease; I’ll leave that for another discussion.

“Imagine your stomach is a blender. Someone shoves 10,000 little knives into that blender. Crohn’s disease is pressing the on button.

”

I’ve had many years of experience in processing and handling the pain associated with my disease. I’ve also had many years of explaining to people the reason why I am in pain and exactly how I am affected by my Crohn’s disease. Sometimes I enjoy talking about my disease; I see it as a way to communicate and educate others on the disease so maybe next time they meet someone with it, they can have more sympathy towards them and a better understanding. Other times, I find it a chore. Going on and on, again and again, explaining the same story I’ve been telling others for the past ten years. I always start with the same script:

1. I have Crohn’s disease. Have you ever heard of it/do you know what it is?

2. It’s an inflammatory bowel disease. Do you know what that means?

3. Basically, my intestines attack themselves and I need medicine to feel better, otherwise bad things can happen to my digestive tract.

Depending on how interested the person is, I go into more or less detail, explaining more than just “attacking my intestines.” The average person does not have a gastroenterology medical background, so I keep it light and leave out the details of my bowel movements. When I decide to go off script, it’s usually from two different reasons. It’s either because I am not feeling well and I need to express my pain someone (hence, where all of the previous analogies I’ve given come into play), or when someone is just not getting it.

Generally, people are pretty understanding when I explain my illness, but sometimes you get those wackos that feel the need to put their opinion about your illness down your throat. People have tried giving me new diet tips or foods to eat to “cure” my disease. Suggestions of “just workout more, try yoga” as if yoga is the magical cure to any problem I have. People have expressed how fortunate I should be that “at least it’s not cancer” or a different illness. One thing never to say to someone with a chronic illness is, “Well, at least you don’t have [insert any other disease].” It doesn’t make us feel better, it honestly makes us feel worse because it invalidates our own pain and suffering from the very illness we have to live with for the rest of our lives. I would never wish my disease onto another person, but when it comes to times like this, I sometimes wish they could just experience for a day what it’s like during a flare. Then they’ll see if yoga is really the best thing for me.

“One thing never to say to someone with a chronic illness is, “Well, at least you don’t have [insert any other disease].” It doesn’t make us feel better, it honestly makes us feel worse because it invalidates our own pain and suffering.”

I’m not trying to bring the mood down and paint a bad picture of what living with Crohn’s disease is like. For me, it’s not always pain and suffering. There are things I’m happy about and things in my life that wouldn’t exist without it. Bonds I’ve created with other people with IBD, self assurance and confidence in myself to overcome obstacles and challenges I face everyday, and awareness of my health are just some of these examples. My disease has shaped me into the person I am today, and although it sometimes feels like knives poking out of my gut, on the days it doesn’t, I’m happy that my IBD has given me a platform and a place in a community with compassionate people going through the same things I am.

A Five Step Plan to Prepare for the Stress of School

By Erin Ard

August has always been my favorite month of the year. The word itself feels warm and seems so full of light. Summer is winding down, many of us have been able to do things we never have time for during the school year. We've been able to spend loads of time with friends or family, gone on vacation to somewhere new and exciting, explored some new DIY projects, or tackled a task from our ever stagnant To-Do list. We might even be exhausted from all the fun and relaxing times we've had that the thought of summer ending, is naturally bittersweet. August is our last month to ourselves. When August 31st comes around, classes are just around the corner. Now, I don’t mean to scare or worry you that you are running out of time. You still have plenty of time to relax and prepare. (But tick tock..)

This September will mark my own re-entrance to school after taking a year off. In May of last year, I graduated with my Bachelors and will be going back as a re-entry student to study DIETETICS! I am so excited you guys, you don't even know! Even though it's only been 15 months since I was in college, I feel like the mom who rediscovers herself and goes back to school after x number of years devoted to others. But this is MY time to shine! My heart is so full of excitement and intrigue for the new topics I'll be learning about and the career path I am headed towards. I have had 15 months to decompress from all those days spent studying, non-stop, on end and will be reattending with renewed energy and outlook. Because I know how stressful college life can be and the added stress of taking care of a chronic illness, I want to share some of my own insight on how to prepare for another school year.

After having a few rough semesters and thinking about this new year, I decided to do some research on how to prepare yourself mentally, emotionally, and physically. Many of the tips I found were in reference to another stressful life event, but they still hold potential for alleviating the stress experienced in school. Stress is stress, right? And when you have an inflammatory disease, a part of keeping your disease in check is taking the right precautions around stress management. So whether you are ready to get a move on or still trying to deny the fact that summer is ending, here is a five step plan to get you started.

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Step 1

Use this last month of summer to really get to know yourself, on every level.

Try to understand how you deal with stress by thinking about your past. Think back to a time when you were dealing with a lot of stress, maybe even in the midst of a flare-up, and ask yourself: How do I tend to perceive about the situation? Do I react to the stress or work through it? Are my thought tendencies self-deprecating or more self-righteous and determined? How did I feel physically, emotionally, and mentally? What was I missing? What could I have done differently?

Try this writing exercise! Like you would write a story, write down what was happening during a time you were being pushed to your limits. Bullet-point every obstacle and bold everything you tried to overcome the situation, even the failed attempts. Then, like how a writer outlines a story-line, write out how you would resolve the story. Include who and what from your life you would need and when you would use them. Keep this as a guide or for inspiration!

Step 2

Plan ahead, for EVERYTHING and keep yourself accountable.

It can be helpful to set up a plan for yourself ahead of time. Whatever makes yourself more productive, make a promise to DO THOSE THINGS! Get tasks done early when you are feeling well and full of energy, so you can rest when you are not. Prioritize what is most important in your life. Stick to a routine or try new things. Think about how much you need to do to be successful and what kind of effort that will take. Then start to build up your plan around these thoughts. Being accountable for yourself and the work you must accomplish ahead of time will save you in the long run.

Try this writing exercise! Make a promise to yourself for the new school year. Write down a few things you want to strive for, big or small. Then display it somewhere you will see every now and then as a nice reminder. This will keep you centered and focused on what you want to achieve and how you will do it. Here are some examples: "I promise to make good decisions for my health and well-being. I promise to make my bed each morning. I promise to do what I can, when I can, and not judge myself when I cannot."

Step 3

Be the responsible person you and your body deserve!

Make responsible decisions when it comes to food choices, workload, and managing stress. A part of developing a successful plan is sticking to it! If you know about your own unhealthy habits that can impact your ability to manage stress, then take steps to reroute them. Start with replacing bad habits with positive ones.

Step 4

Have a de-stress plan when life starts to get tough.

By having something set in motion ahead of time, you can comfort yourself knowing you've prepared for this! So whip out your de-stress kit and get to it! Here are some ideas to get you started:

• If you feel yourself getting anxious, stop for a moment. Practice deep breathing and positive inward thoughts or commit some time to a guided meditation. You may feel more calm and refreshed afterwards.

• Set up a routine to decompress after a long week (take a warm bath with a glass of wine, settle in with your favorite book with a cup of delicious tea, or just take a nap - but use this last one sparingly)

• If you struggle with eating healthy, staying away from trigger foods, or staying on a grocery budget then try your hand at food prep. Taking your Sunday afternoon just for this task can be relaxing in itself and can yield some great benefits. Say goodbye to wondering what your next meal will be and ordering too much take-out!

• Write a letter to yourself to read when the going gets tough. I did this in the depths of a my lowest moment and it allowed me to pull myself out of an emotional rut to refocus on happiness and success.

Step 5

Pick yourself up when you fall.

If you fail, a normal part of life, then you will need to brush yourself off and try again. Don't blame yourself, don't blame your shortcomings on your Crohn's or Colitis, and don't project your failures onto the universe. These tendencies will only allow you to harbor negative feelings about yourself or your past. Practice accepting things as they are and moving on with a more determined attitude. Find out where you might have went wrong and correct any bad behaviors that may have caused you to fail. Are your Netflix binge habits infringing on your study time? I know mine have before. Learning is all about finding what works for you and readjusting. This includes finding what works well in your own study habits. Try out some new ones if the old ones get stale.

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Whatever your plan ends up being, make sure that it is true to YOU! Incorporate everything you know can work and don't waste your time on what doesn't. I promise to

What strategies help YOU manage stress?

Cooking with Crohn's - Gluten Free Strawberry Shortcake

With the summer heat, comes the summer treats! Watch this video of CCYAN Fellow, Leah, makes a delicious gluten free strawberry shortcake following the two recipes down below. It's important to stick to your own dietary needs to feel free to accommodate the recipe to your liking!

Recipe for Shortcake

• 1 1/2 cups gluten free all purpose flour

• 2 3/4 teaspoons baking powder

• 1/4 teaspoon salt

• 2 tablespoons sugar

• 3/4 cup heavy or whipping cream

• 1 large egg

Instructions

• Preheat the oven to 450°F. Line a baking sheet with parchment paper and set it aside.

• Mix the flour, baking powder, salt, and sugar together in a large bowl.

• In a separate bowl, beat together the cream and egg. Pour the wet ingredients into the dry ingredients and mix to form a cohesive dough.

• Scoop the dough in 1 1/2-ounce balls onto the baking sheet; use the palm of your hand to gently flatten each to about 2" to 2 1/2" diameter.

• Brush the tops of the shortcakes with cream, and sprinkle with coarse white sparkling sugar.

• Bake the shortcakes for 10 to 12 minutes, until they're risen and baked all the way through; break one open to make sure.

• Remove the shortcakes from the oven, split, and top with berries and whipped cream. Store, well-wrapped, at room temperature for several days; freeze for longer storage.

https://www.kingarthurflour.com/recipes/easy-gluten-free-shortcakes-recipe

Recipe for Whipped Topping

• 1 cup (8 fluid ounces) heavy whipping cream, chilled

• 1/2 cup (58 g) confectioners’ sugar

• 8 ounces cream cheese, at room temperature

• 1 teaspoon pure vanilla extract

• 1/8 teaspoon kosher salt

Instructions

• Transfer 2 tablespoons of the cream to a small bowl and set it aside. In the bowl of a stand mixer fitted with the whisk attachment or a large bowl with a handheld mixer.

• Place the remaining cream and beat on medium-high speed until soft peaks form.

• Add the confectioners’ sugar, and continue to beat until stiff, glossy peaks form.

• Transfer the whipped cream to a separate, large bowl and place in the refrigerator to chill.

• In the same bowl, place the cream cheese, vanilla, salt and reserved 2 tablespoons cream.

• With the whisk attachment, whip the cream cheese mixture on medium-high speed until light and fluffy.

• Remove the whipped cream from the refrigerator and add half of the whipped cream mixture to the cream cheese mixture, and whisk to combine.

• Add the remaining whipped cream, and fold it into the filling carefully until combined.

https://glutenfreeonashoestring.com/gluten-free-fruit-pizza/

What to Know When You Care About Someone With Crohn’s Disease

By Erin Ard

Chronic illness can be easy to ignore if you aren't the one living with it, but when you start to see how it affects a person you care for, it can strike a cord in you too.

When you meet someone with a chronic illness, it's natural to be curious about their life. You may even feel compelled to a) make their day easier, b) ease their pain, c) see their worth, or d) just help them feel comfortable. And if you want to lift the weight of living with a disease, choose all of the above.

Having IBD myself, it is THE. MOST. AMAZING. feeling in the world having someone who wants to know more and take care of you. So I must commend you for making it as far as reading this post.. You are ONE of FEW who would stick around someone with such a debilitating disease!

This topic has been on my mind for a while now. And when I started writing, I noticed how challenging it was to explain how this disease can affect someone. Experience with IBD is so diverse and can change so fast! For instance, in this moment I would say, "You really don't need to worry about me!" Because in reality, my own Crohn's has been in remission for years with only a few minor complications and I've made big strides in accepting my disease. I can go without thinking about my Crohn’s most days, but that doesn't mean these feelings of security have always existed and won't change in the future. Maybe your person is in the same boat, still it is invaluable to know what could happen. Whether you are a friend, family member, or lover, I want to help you understand the fundamental struggles, how it can affect someone (mainly by using myself as an example), and what you can do.

The first thing to know is that every person with the disease is unique and handles it differently. Some people want to be taken care of, while others may hide their struggles from you; so it's kind of up to you to know your person - I'm sorry I don't have all the answers! Thought, I can promise that anyone with a chronic health issue does not want to be characterized by their disease nor feel like a burden. It poses a challenge to balance helping them feel better and making the disease a big deal. If they choose to let you into that part of your life, that's great! It is too easy to discredit the harm it can impose. My first piece of advice is to have an open mind. Even though you won't be able to fully understand how it affects their body, mind, and lifestyle after reading this; you can keep learning.

 Before I jump into the nitty gritty of it all, we should go back to basics. Whether you just met someone with IBD, have know about the disease for years, or have it yourself it can be helpful to know how the disease works. With Inflammatory bowel disease (IBD), our immune systems get a little confused and end up attacking the healthy tissues causing inflammation along our digestive tract. IBD is a blanket term for the two most common forms: Crohn's disease and Ulcerative colitis. There are many commonalities between individuals who live with IBD. The most common symptoms are abdominal pain, fatigue, fever, and the infamous diarrhea. IBD can be classified from mild to severe depending on symptoms, e.g. frequency of diarrhea, abdominal pain, fever, weight loss, anemia, bowel obstruction, and more! IBD itself does not limit your life expectancy, however, it can lead to some life-threatening complications. And symptoms can be kept under control with medication, thankfully, allowing people to live normal lives whilst their disease is in remission.

The day-by-day symptoms and risk for complication in combination can be very draining for someone, both physically and mentally. Not only are these symptoms tiresome in their own right, but can bring about mixed feelings - fear of flare-up recurrence or inability to find a bathroom, worry over not knowing what you can or can't eat, embarrassment of symptoms, and maybe denial of the pervasive hold it can take on your life. Even though my disease is in remission, it takes constant maintenance to feel in control of my body's health.

Much of my knowledge comes from learning about my own Crohn's symptoms and how it has impacted my day-to-day life. So I will try to describe what to look out for when caring for your person and their IBD.

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It's a daily struggle.

IBD is a hidden illness, making it hard to understand what kind of struggles we endure because they can't be seen. If your loved one says they don't feel okay but look fine, trust them. They know their bodies better than anyone. I know for myself, every once in awhile I have shooting abdominal pains, discomfort from something I've eaten, unreliable energy levels due to fatigue, joint pain, sensitivity to temperature, and recurrent symptoms close to my Remicade infusions. Usually on bad days, I take it easy on food I prepare for myself and the activities I do.

Tip: Have patience and learn to enjoy a few more Netflix movie marathon nights than usual.

It's a love and hate relationship with food.

With Crohn's we have our own food triggers, which can be devastating to our digestive systems and send us running to the bathroom. Unfortunately for us, there is NO SINGLE ALL CURING DIET PLAN that can help us. We really just have to figure it out on our own since triggers differ from person to person. I get a lot of questions like, "Can you eat this?" "Or what can you eat?" and the answer isn't very simple. I can eat just about anything I want most days, but if I'm feeling off or it's getting close to my next infusion appointment - I take it easy on the hard to digest foods. I try to eat as healthy and balanced as I can while still getting the same sense of satisfactory indulgence as anyone else. For instance, I would love to eat an entire pan of brownies (and have gotten close a few times) but this would lead to me feeling like sh** the next day; as it would with anyone I feel. If you switch this desire I hold for brownies during a flare-up, it gets a bit more complicated and pretty much impossible. During a flare-up, however, my indulgences subside and I only crave foods that will sustain me without bringing about more harm.

Tip: Expect a mix of eating habits, since our health can change pretty fast. If they are on a strict diet plan, say gluten-free for someone with Celiac or gluten intolerance, get to know what they can and can't eat! It will be a whole lot easier for them if you have a good understanding and they can stop answering the "What can you eat?" question, at least coming from you :). A lot of people also take supplements to make up for the nutrients lost in their diet or from not being able to absorb an efficient amount through the gut. The biggest thing to understand, like with me, is that there are foods we just can’t eat AND there are foods, though you wouldn’t think so, we are still able to indulge in!

Flare-ups are hard to overcome.

When the disease is active, you'll see all of the main physical symptoms taking root. A flare-up can last several days to a few years and can limit our ability to perform daily activities; sometimes even landing people in the hospital. During my own flare-ups, my limitations were somewhat subtle. I was still able to attend school and join sports, but my performance level was not where it could have been (this became clear once I achieved remission). After school I would too often fall onto the couch, exhausted from the day. I didn't have a solid bowel movement for months. I would give up and have emotional break downs in the bathroom. I became afraid of food because my body couldn't digest it properly anymore. I missed a lot of school, plans with friends, and family get-togethers. What I did attend, I would be withdrawn, wanting to lay down or be at home. Flare-ups are very socially isolating and can force us to miss out on a lot of what makes life fun :(

Tip: Be your own person and don't feel like you need to spend every occasion we miss out on with us, because we don't want you to miss out either! If your person is not feeling 100% and tries to dip out on plans, be heartfelt and ask, "Are you sure? What is making you not want to go?" Reassure us that not every day will be a bad one. Sometimes we have to stick it out to reach the good moments. In time, when we are healthy again, we will be able to push through what limits us. And help us see the value of little things, even if it's just an evening of Cards Against Humanity  or binging The Office.

We have some tricky immune systems.

Many of us take medication to suppress our immune systems to fight inflammation. Some people may get sick more or less often, depending on their medication. When I first started Remicade, it was rare to find me sick with the common cold. However, since my dosage was increased I seem to get sick more often and have a harder time fighting the sickness off. *Insert disappointed emoji *

Tip: Help us take precautions when going out - use hand sanitizer, disinfect grocery carts, and mind your sneezes. Especially during cold and flu season! Maybe consider bringing over a box of tissues and some chicken noodle soup when these efforts fail :)

Everyone has their own self-esteem issues and insecurities.

IBD makes us feel a loss of control over our bodies (quite literally sometimes) and can indirectly cause visible changes (e.g. weight fluctuations, inflammation of the skin or eyes, mouth sores, etc.). Complications with IBD may involve j-pouch construction surgery - a major cosmetic change with added stress over maintenance and potential leakage - or bowel resections and scarring. This can also extend to social interactions, like when we have to explain why we can't eat certain foods, obsess over the details with travel plans, or being conscious of our frequent bathroom visits.

Tip: Depending on the person, procedures causing cosmetic changes may not sit very well. All that we ask is you be open and accepting of every scar or medical device. Each one tells a story of our struggles and what we had to face to find strength again.

IBD has it's own added mental health challenges.

People with IBD are at higher risk of having anxiety or depression. It is all too easy to get down on yourself when you deal with constant set-backs. With IBD, a lot of the symptoms happen behind closed doors.. Usually bathroom doors. Or in the scope of mental health, you can envision the mental wall that keeps others from seeing your thoughts, feelings, and worries.

Tip: I implore you to keep an open mind. We might need a little extra encouragement when it comes to self-worth, seeing the positive, and enjoying life when our IBD gets in the way.

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Being available and accepting of what we deal with can make such a difference to us. Like I said before, IBD can be socially isolating and I hope this post has helped you to understand why that is. I also want to say that people with Crohn’s or Ulcerative Colitis are the strongest, most ambitious people I know. They deal with keeping their health in check while juggling school, work, friends and family, their goals, AND everything else!

Your person may or may not deal with what I've laid out. Honestly, there is way more that could be discussed on "taking care of someone with Crohn’s" than what I know. Getting to know your person with their Crohn’s lifestyle will have a learning curve. It’s going to take some time and a considerable amount of observational skills to become an expert and if you aren't sure, ask! Just know that you can't do everything for us. You can't take all the pain away or make us healthy. What you can do is keep an open and accepting mind around our abilities. Be patient with our limitations. Help us feel comfortable and emotionally supported when we miss out. And get to know our many qualities in addition to being fighters. To go even further, I respect someone willing to challenge me when I hesitate on getting out of my comfort zone.

Finally, remember to take care of yourself too. Not only can the symptoms be draining on the person with Crohn’s, but seeing your loved one endure such bodily torment could drain you as well. Take time to rest, focus on the good, and keep fighting for your person!

What advice would you give to your loved ones?

An Invisible Illness is Still an Illness

By Erin Dunne

Images from the "Suffering the Silence" web campaign that allowed people to publicly share their experience with chronic illness.

When I was younger, one summer my family was visiting my grandparent's lake house in Indiana. The water was low enough my cousins and I were able to walk out to the anchored raft off the edge of the deck without much swimming or with a life vest. On the way back to the deck I felt a sharp pain in my right foot and felt a piercing sensation with every step I took. My grandmother sat me on the deck to find I had stepped on a large shard of a broken bottle and it was lodged in the center of my foot. I remember bawling from the pain as she attempted to take the shard from my foot but after it was out, I only had a small bruise and a scar. The discomfort I felt in this moment was easily seen by my family members because of my expressions and they could physically see what was causing the pain- but it isn't always this easy with an invisible illness. For many people, without physically seeing the direct source of the pain, it is hard to believe that there is any pain at all. Not seeing the discomfort of an individual doesn't mean that they are not sick. It is not seen by the naked eye, so it is easy to assume that a person is healthy or "normal" when in reality, a person could be having a really bad flare day but "they look fine." Something can be seriously wrong inside of you that only you can feel.

“Just because you cannot see the pain another person is dealing with doesn't make it any less real.”

An Invisible Illness is a chronic condition that is not visible to an onlooker. Examples of invisible illnesses include: Digestive disorders, heart conditions, diabetes, lyme disease, mental illness, etc. The symptoms that are often associated with these illnesses can hinder ones ability to enjoy life and be involved in everyday activities they love- which can be very frustrating. Adjustments are often made to meet the needs of their new, often lower, energy levels and limited ability to move. While medication and treatment plans can help greatly with the physical symptoms, the mental game that can occur due to encounters with others, insecurities, and fighting one's own thoughts can contribute to the pain an individual is already in.

There are times where one may be interacting with others and it seems as though they are witnessing insensitive encounters and whispers from those around them. Comments are often made as to why they are often absent to class, work, and social events. Even comments on ones mood- why they are short tempered, withdrawn, or why they lay around so often (maybe even being referred to as lazy). "Laziness" to an invisible illness sufferer can be just as important as any medication or treatment they are taking to help their symptoms because it is helping their body recover from the havoc that is wreaking within. When explaining how they are feeling to others, it is common to be countered with the comment "but you look so good." Further fueling the idea that capability is based on the way a person looks. All of these small contributions can lead the individual with the illness to question themselves and often look down on their recovery. There have been times I have felt bad for having to cancel plans for being sick- I feel as though I let others down, or I have gotten mad at myself for not being well enough to go about daily activities. There are times I compare myself to others that are in good health and think of when I was able to do similar things but I become upset with the fact that I am unable to do those things currently. While it is easy to automatically go to these negative places, they truly don't help with recovery so what is the point? Focusing on so and so's good health won't make my symptoms any better so why am I wasting my energy on being jealous? It is best to focus on yourself and your needs in the current moment.

These illnesses can only be experienced and felt by the individual that has them- we can try to describe our discomfort to others but it is hardly ever satisfactory. Each day can look different for various people because each person has different degrees of productivity that is possible for them. For me, on a good day I am refreshed from a good nights sleep, am able to eat at every meal and even snack in between, get some form of exercise, and have concentration throughout the day that allows me to get tasks like errands and homework done. Other days I may only be able to do a fraction of these things and witness extreme brain fog that makes concentration close to impossible. There are times where I have multiple productive days in a row or I have low energy days that I often become frustrated with. One of the biggest lessons that I have learned through the years is to give myself grace on the days that I may not be able to get done what I had originally planned.

As I have mentioned before, I am a big advocate of listening to our bodies- it knows much quicker then us if it has been overworked and needs to recover. Giving yourself grace and being kind to your body is key with any invisible illness because we too cannot see what is physically causing us pain. Sometimes we do not even know of what event or substance caused the discomfort but we experience it. If you had things planned for the day and you wake up and don't feel as though you can complete everything, that is OKAY! Do what you think you can handle and be easy on yourself. Move as much as you can throughout the day, be gentle on your gut and nourish your body with foods that you know work best for you, and do something that makes you happy! You know yourself and your healing abilities better than anyone else so you must do what you can to honor your body in times where it may need more attention. It's okay if others do not completely understand or are able to empathize to the degree you wish they could, but it is important that they are as understanding and supportive as they can be. Although it may feel like it at times, there are others in similar situations that understand the isolation that comes with invisible illnesses. It is important to acknowledge that you are never alone in your journey, even in moments where it seems as though you are.

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People could say to those without invisible illnesses that they are lucky they don't have to deal with a disorder. And while I would never wish an illness on anybody, I don't necessarily agree that I am less lucky I have to live with an invisible illness. Are there some days I wish I had never been diagnosed with Crohn's Disease? Absolutely- but those are typically the days that I have become so fixed on the negative that I forget to acknowledge the positives that have come out of my diagnosis. There is always room for growth and I believe that having Crohn's has allowed me to grow remarkably into a person that empathizes for others, I wish to care for and help others because I understand the pain and loneliness that can be felt amidst illness, and I have been able to be a part of a wonderful IBD community. On a more personal level, I have found a love for cooking as I have had to alter my diet to fit my bodies needs, I am more in tune with my body and mind, I understand how to handle low energy/ mentally challenging days, and I give myself grace more than ever before. Yes there are times where it is very hard to handle the insecurity that others don't understand and may judge because they may think I am lying about my pain, but I know myself more than anyone and if I feel the pain, I know it is real- I don't need to validate that to anyone else.

There are many highs and lows of having an invisible illness but I think it is very important to try to find as many highs as possible to make the lows not seem as bad, but also to learn how to handle the low moments better. Life is happening for us, not to us and looking at these illnesses as opportunities for growth can help our perspective towards them remain as positive as possible.

Stay Lovely,

Erin D.

Supporting our Mental Health: Moving past or accepting your negative unconscious thoughts

By Erin Ard

Happy #MentalHealthAwareness month! AND #CeliacAwareness month! And hey, if you're into it.. #InternationalMasturbation month too!

The month of May is known for quite a few awareness and observance campaigns. Interestingly enough, the main topic I want to address in this post loosely relates to each of these. #NUTS! In mental health, this can refer to your negative unconscious thoughts. For Celiac disease, these can be a great source of protein on a gluten-free diet. And well.. you get it.. But I mainly want to address mental health when you are living with #IBD.

There is evidence that #depression and #anxiety are more common in individuals with IBD compared to the general population. Which makes absolute sense when you think about what we deal with on a daily basis and during a flare. Mental health really becomes a topic of discussion when you put the stress of school into the mix.

I can remember an incredibly stressful time during my semesters as an undergrad. I was juggling 5 paper deadlines within the same week with exams looming in the weeks to follow. I ended up having to sacrifice my social life, sleep, and taking time to care for my body. Not having any time to properly focus on my health added to the stress. It felt like I was failing at life because I didn't have time for myself or my friends and family. Fortunately I made it through this time despite needing to make these sacrifices, but after it was all over I made my health a priority.

During these times, it's easy to fall into bad thinking habits. Our negative thinking habits are hard to shake. A lot of times we don't notice them. These gloomy, self-deprecating thoughts can feel so natural to our personalities or our every day thought processes, but they don't need to be. Thankfully, you can retrain your brain to respond differently when these thoughts pop up and here is one strategy how. Say it with me!

"Awwww NUTS!"

This is a common saying for me that is usually followed by a lot of giggling.. But this word found a whole new meaning when I learned about the concept of NUTs as it pertains to mental health and #mindfulness. When I discovered this lesson, I thought it was so enlightening that I had to share it with all of you!

If you have ever felt held back by your own thoughts, tendencies, or fears. This is for you.

NUTs appear in our unconscious and tend to affect how we think and act throughout the day. They can impact how we view ourselves and our ability to face adverse situations.

These are incredibly personal and can look different to each person. As individuals with IBD, we probably share a few common negative thoughts. It may sound like, "I can't live my life how I want because of this disease." " I won't get through another flare up." "I will never live normally again." or "I hold my friends or partner back."

The gist of the practice is to name these thoughts and evaluate them. Here are my top five negative thoughts (some of which, you might have too) and what happened when I brought them to the front of my consciousness..

1. "I am going nowhere."

2. "My anxiety keeps me from achieving my goals, meeting new people, and finding love."

3. "I am unable to connect with others."

4. "No one is interested in what I have to say, so I won't say anything."

5. "I won't be successful because of my Crohn's."

Saying mine out loud was oddly therapeutic, almost satisfying. Even now, when I read them over the more silly they seem. When I formed that first NUT, the rest poured out in a rush. More and more came to the forefront because so many of these had been piling up over the years. Rather than acknowledging them, I would shove them aside. I tried to ignore them - like if I forgot about them, they wouldn't be true. I ended up delaying my chance for peace of mind.

If I had given them some thought as they arose, I would have realized how much unnecessary power they had. They secretly dominated my mind for several years. How I acted in social situations, dealt with difficult circumstances, coped with certain physical limitations, or processed the aftermath of some high emotional states. It was easy to find myself down a rabbit hole in my unconscious surrounded by debilitating negativity. Because of this exercise, I'll be able to find a way out now.

I can't say that I've completely moved past these negative thoughts, however. Honestly, some of them still give me a pang of discomfort because they were so deeply rooted in my unconscious mind. You might find that some of your NUTs hold a bit of truth to them, but that is still okay. Even if you do find one to be true, can you accept that?

I highly recommend trying this out for yourself! What thoughts could be holding you back or keeping you from seeing your potential? Name the first things to come to your mind and ask yourself, are these true? Do they have to be true? How do they make me feel? And then ask yourself, what would my life look like if I no longer had these thoughts? Be sure to open yourself up to whatever happens in this exercise.

With love,

Erin

A special thank you to the Mindful Leadership Program and Elisha Goldstein for teaching this concept to help others.

Stress, Its Effects on IBD, and How to Handle It

By Erin Dunne

We all have had moments where it feels like everything is happening all at once. Whether that be good or bad, it can be extremely overwhelming. With school and work, it may be projects piling up, exams, or a packed schedule. In our social lives, we may have weddings, plans with friends, and family events that happen within a short time frame. We may think of stress as a superficial, short term feeling that goes away once the chaos has subsided, but that is not always the case. The effects of stress can stay within the body for hours and sometimes days after the stressor has vanished. The intensity of the body's response depends on the individual and how they handle the stressor- either focusing on their emotions, avoiding the situation, or nourishing themselves and acknowledging the issue. It is essential to understand the different types of stress, how each variety can affect the body, and how to handle yourself when faced with such situations. Knowing what to do is not only beneficial for your overall health, but it makes you feel powerful and amazed at the control you can have over the situation!

What is stress and what does it do to the body?

Stress is the body's response to any situation that poses demands, constraints, or opportunity (Riehl, 2019). There are two main types of stress that people face: Acute and Chronic. Acute is short-term and is most common. An example would be daily occurrences such as a project deadline, or being stuck in traffic. Chronic stress is prolonged and can contribute more harm to the body if experienced too often. An example would be involvement in a toxic relationship. When the body detects a threat, the brain activates the sympathetic nervous system which stimulates a response typically known as the "fight or flight response." The sudden release of hormones, primarily adrenaline and cortisol, prepares the body to take action. When the rush of hormones is constant, this can cause a lot of wear and tear on your body. Once the alert phase is activated, the goal of the body is to return to its natural, parasympathetic state with regulated hormone levels.

When in "fight or flight" mode, the body focuses all of its energy into systems that are necessary and shuts off others that are not being used. One that becomes restrained is the digestive system. While there is no direct correlation between stress and IBD, more research has been conducted to investigate the influence of stress triggering symptoms. Ongoing stress can often go unnoticed, but it continues to impact the function of certain systems of the body. Stress is hard on the digestive system, as it affects which nutrients your intestines absorb, and how quickly food is moved. A recent study has found that IBD symptoms may increase because the sympathetic nervous system acts on the lining of the colon and may worsen current inflammation. Evidence has also led scientists to believe that stress hormones may help harmful bacteria reside in the intestines (Norton, 2010).

What causes stress?

This reaction is initiated by the presence of stressors, anything that triggers a physical response. The causes of stress differ for each individual- we all have our unique threshold and perceive situations differently. For example, if there is a presentation that requires the student to talk in front of their class, one person may not mind public speaking and are not worried about presenting, while another student may dread public speaking and feels exceptionally anxious. Of course, not all stress is bad- an example of good stress would be the feelings you may experience before an athletic event. Some common stressors include school, work, busy schedule, traveling, finances, lack of sleep, and poor diet.

How to handle stress:

Generally, there are two types of coping styles; Problem-Focused and Emotion-Focused. People who are Problem-Focused approach the issue head-on, whereas people who are Emotion-Focused tend to lean into distractions and avoid the issue. It is critical to recognize what coping style you tend to resort to naturally so you are more prepared when faced with a future problem. You are also able to understand yourself better! Regardless of your natural response to a stressful situation, it is also essential to know how to take a break amid chaos. Taking a break allows yourself to calm down and assist your body back to its normal state.

Stress reduction techniques can help you find peace and maintain perspective when consumed by pressure. It is vital to find something that appeals most to you- what works for one person may not work for another. Trying out a few different techniques can help you see what works best for you and can quickly become your go-to reaction to stressful situations. Some great things to incorporate into your stress managing tool-kit include: incorporating physical activity, talking and spending time with friends, reading, and baking. Even taking the time to focus on your breathing when you find yourself becoming overwhelmed can help manage the intensity of the stress response. Finding an activity that stimulates rest, clears your head, and makes you happy is one of the most beneficial things you can do for your overall well-being!

How I learned to calm my mind with movement:

Through the years, as I have become more aware of listening to my body and provide for its needs, I have learned the importance of handling stress better. I recognize now that when I experience significant amounts of pressure in a short amount of time, not only do I feel exhausted but I also suffer from an increase in symptoms. If I am under stress for a more extended amount of time, I have prolonged symptoms and discomfort. I have developed habits of practicing yoga, going on walks, and meditation- all things that allow me to slow down my mind and put life on pause. However, I do not only do these things when I'm stressed. They bring me such joy and contentment; I make time each day to do at least one (sometimes all) of these activities!

One of the best things about yoga is that it can be done almost anywhere. I love taking advantage of the beautiful weather and fresh air!

Typically, I start my morning with at least a ten minute meditation which helps me set my intentions for the day. While I have tried to sit in silence and meditate, my attention span is not that disciplined yet, so I use guided meditations from Headspace. If you're interested in practicing meditation, I would recommend downloading an app or finding videos on YouTube- both great resources! Another thing I do quite often is take what I like to call "Mindful Walks." I put on a podcast or playlist and take a long walk, making sure to be present and aware of my surroundings.

My favorite way to relieve stress is through my yoga practice. When I was younger, my older sister and I used to take classes together, and I have been intrigued ever since. Through the years I have leaned into my yoga practice to help quiet my mind and work on connecting my body and brain. At first, I was intimidated by the idea of flowing on my own. I thought it had to be in complete silence or to mellow music, and surrounded by aromatherapy. I soon realized that the purpose of yoga practice was to embrace my own intentions and make the most out of my time. I don't put pressure on myself to have a perfect session because I'm learning and am allowing my body to move the way it wants. Most of my sessions include aromatherapy, the twinkle lights in my dorm, and one of my favorite playlists. Even if it is only taking five minutes to flow, I notice an extreme shift in my mood after a session- I feel renewed.

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In the past, I would isolate myself and push through the pressure until I would eventually crack and break down. In the moment, I may not feel like moving or pausing but I have to remind myself of how I feel afterwards and the temporary rest I am giving to my body. After I am active, I not only feel more relaxed but I feel happier and come out with a better mindset- more motivated, present focused and ready to take on the next challenge.

Stay Lovely,

Erin

IBD Diets: Gluten Free for Crohn's and Colitis

By Leah Clark

Because of the popularity of Hollywood fad diets, the term 'gluten-free' has become more and more popular over the past decade. While not necessarily intending to do so, this trend actually brought great change to individuals suffering from celiac disease, non-celiac gluten sensitivity, and inflammatory bowel diseases. With new food products coming to market and more menu items coming to restaurants, it has provided a new way for people that cannot eat gluten to experience food. As someone that was diagnosed with both celiac disease and #Crohn's disease ten years ago, I can confidently say I know my way around a nutrition label. That being said, not everyone that is on a gluten free diet, or that is planning on starting one, knows what to do. When discussing your treatment plans for your IBD with your doctor, discussing diet changes should not be forgotten. So, is going gluten free right for you?

Bacon, eggs, potatoes...who says living a gluten free lifestyle means giving up your favorite breakfast foods!

What is gluten?

With all these terms of gluten free, gluten sensitive, wheat-free, gluten-friendly, and more, it can be confusing to know what it all means! Isn't flour gluten, or is it any grain? To start with the basics of a gluten free diet, one has to know what to look for. Gluten is the proteins found in wheat, rye, and barley. So when on a gluten free diet, wheat, rye, and barely are the foods to avoid.

How to read labels

Okay, so know that I know what to avoid, what are the necessary steps to ensure that I don't eat the wrong foods? Check labels on everything. Even if you think something may be gluten free, it never hurts to read the nutrition labels. Certain foods don't have labels, such as fruits and vegetables; however, these foods do not consist of any other ingredients other than what they are called-apples, carrots, oranges, etc. Foods that are made with other ingredients, such as cereal, pasta, and crackers, are foods that need to be checked. Luckily, most companies are good about food labeling, so boxes will often say "Gluten Free" or "Contains: milk, soy, and wheat."

However, sometimes there are tricky labels that you need to look out for. For example, the cereal Rice Krispies is not #glutenfree. The ingredients include rice, sugar, salt, malt flavor, and vitamins and minerals. The key word here is malt. Although the other ingredients are okay, the malt flavor is not. Malt is a tricky word because it is not wheat, rye, or barely; however, malt is a derivative from barley. Therefore, Rice Krispies are not gluten free. Words like malt extract, malt flavoring, barley malt, wheat-germ, and non-gluten free oats, are words to look out for.

What foods can I eat?

A good rule of thumb is to stick to foods that are labeled gluten free, or are"natural" foods. By natural, I mean foods that are not made with large amounts of ingredients. A good starting gluten free grocery

list could include:

• Fruit-apples, bananas, kiwi, oranges, grapes, strawberries, raspberries, blueberries, plums

• Vegetables-carrots, corn, green beans, lettuce, spinach, broccoli, radishes, celery, zucchini

• Milk-can be almond, dairy, soy, cashew

• Protein-lean meats, chicken, eggs

• Dairy products-cheese, gluten free yogurt, butter, cottage cheese

• Grains-white or brown rice, gluten free oatmeal, gluten free breads and pastas

Gluten free pizza? Yes please! Restaurants have gotten better at properly preparing gluten free dishes, including delicious pizza, to make it easier for people to enjoying going out to eat.

Gluten free diet can not only be good for your gut, but also for other parts of your body because of how healthy a gluten free diet can be. Many of the foods listed are healthy in their nature, like lean meats, fruits, and vegetables. However, just because something says "gluten free," does not mean it is part of a healthy diet. Sure, chocolate is gluten free, but if all you ate was chocolate, would that be the best way to go on a gluten free diet? Probably not.

But I thought gluten free foods always tasted bad?

A common misconception about gluten free food is that it tastes gross. While yes, there are some bad gluten free food products out there, this is no different than there being bad gluten food. It all depends on your preferences and experimenting with different brands. Making home-made gluten free brownies is not as simple as using a Pillsbury box recipe of 'normal' brownies (although, there are some Pillsbury gluten free baking products that taste great). The point is to try new brands and baking techniques that work for you. I've spent the last ten years of my life finding my favorite brands of pastas, crackers, and bread, and I can honestly tell you, it wasn't I traveled to an entirely different country and tried their gluten free bread that I found my favorite. Gluten free food can taste just as good, if not better, than the food you're used to! It just takes some time and preparation.

How do I know if gluten free is right for me?

Honestly, it all depends on what you and your doctor think is best for you. I had to go gluten free because I was diagnosed with a disease that literally required me to. Yet, I know several people with Crohn's or colitis that have gluten free diets that do not also have celiac disease. In short, if eating certain foods make you feel bad, do not eat those foods! There are other foods I avoid even though they are gluten free, such as popcorn and caffeinated sodas, because I know they upset me. It truly depends on each person and if it is going to help with your treatment for IBD.

Crohn's in College: The importance of understanding flare-ups and your disease

By Erin Ard

I've been living with #CrohnsDisease for 11 years, but even with years of experiences, mishaps, and triumphs, I feel I'm still learning how it affects me. One of the biggest realizations happened recently when I was in college. Around my junior year I had hit a wall. It was becoming increasingly harder to navigate my studies and my energy level was draining rapidly. I had been taking classes year round for three straight years, taking classes in the summer and having heavy, difficult course loads to accommodate my second major and research. Unbeknownst to me, I was actually neglecting my health.

I started consistent Remicade treatments in high school and the difference it made was 100 fold. I went from an underweight, fatigued freshmen to a strong, motivated sophomore. The change was so positively significant that I thought all of my worries about Crohn's were behind me. I could eat good food again! And play competitively in sports! And I carried this mindset into college. I thought my struggle was over and could focus all my energy on school.. And I carried this mindset into college. Turns out I was wrong.

After a few painful semesters I started to realize what was happening. I was starting to get burnt out, I was sleep deprived and running on fumes. I was struggling with my motivation and my anxiety was building. Though seemingly dormant, my Crohn's disease was still affecting my mind and body.

I had ignored all of the signs up until this point. The fatigue and anxiety I felt in classrooms. The random little fevers during an important lecture that distracted me. The joint pain that slowed my walk to class or hindered my ability to exercise. The gut discomfort during an exam that forced me to finish quickly to get the hell out of there. And finally the gut-wrenching pains that made it impossible to walk. Everything added up, but it took me three years in college to see.

Starting my senior year I sought accommodations from our Disability Center on campus, which alleviated most of the worries set in place by my Crohn's. However, I was left wondering.. Why did it take me so long to figure out Crohn's still had a big impact on my daily life?

Essentially, it came down to my personality and one big misconception. During the initial stages, Crohn's had such an emotional impact that I've always tried to shut it out. In shutting it out, I failed to seek out information from outside resources and tried to figure it out on my own. In doing so, this lead to one big misconception around the focal point of Crohn's disease - flare ups.

I never generally understood what they are, their causes, how to help remedy them, and everything else. See, before I went on Remicade I was in a constant state of flaring up. I was unable to get it under control long enough to have a normal bowel movement. Which meant I wasn't able to eat much and I didn't have a lot of energy. I lived off of my mom's homemade chicken noodle soup and mashed potatoes because they were the only meals gentle enough to my gut. Here is what I have learned since then.

Flare-ups are periods of time when the disease becomes active and symptoms reappear. They consist of prolonged symptoms like gut pain from inflammation, diarrhea, blood in the stool, fatigue, and/or weight-loss. How long the symptoms last and the severity of them is different from person to person. Some medication, like Remicade/Renflexis/Infliximab, is specifically used to control symptoms enough to enter remission (i.e. an absence of symptoms or inactive disease), which means no flare-ups! Medication may be combined with other meds or diet restructuring to help keep symptoms under control. Over time, however, the same treatment regimen may not have the same affect. So adjustments in type of medication, dosage or frequency, or further diet modifications may be needed. Here, this whole time, I had thought of my disease as in remission, inactive, and needing no more thought. When in reality, it's going to be an every day effort.

See this article from Very Well Health to learn more about flare-ups and different ways to define remission.

My personal tip is to pay attention to what your body tells you. Focus on whether certain symptoms are still present - do you have gut pain? Diarrhea? Painful bowl movements? Other non-gut related symptoms? Pay attention to how long these symptoms persist and take notes. This might mean your Crohn's or Colitis is still active and it's important to tell your health team. If one thing just isn't doing the trick, there might be additional options to help you reach your potential in healthy living. And if you haven't already, seek out information about the disability center on your campus!

I've recently started to pay more attention to my body's responses. What used to be my response to the question, "What can you eat?" has changed from, "Oh, I can eat anything!" to, "Well.. I'm still trying to figure that out." In all honesty, I AM still figuring it out. Though certain foods don't affect me like they did before medication, they still influence how I feel. And it is my responsibility to make sure I take care of myself by eating the right foods and not the wrong ones.

Be attentive. Always seek a better understanding. Don't be afraid to ask questions or ask for help. And most importantly, take care of yourself!