Disability & IBD: A summary and thoughts on “Measuring Disability in IBD: The IBD Disability Index”

by Lexi Hanson (Missouri, U.S.A.)

A brown wall with a white spray-painted ‘disabled’ symbol.

In his article “Measuring Disability in IBD: The IBD Disability Index,” Colombel discusses how IBD is viewed in literature and society. He mentions that IBD has received limited attention due to two main reasons. First, IBD has been considered less disabling compared to other chronic diseases, like multiple sclerosis, leading to underestimation of its impact. Second, there has been confusion in the literature about the true definition of "disability" in relation to IBD, with many definitions that do not align with the World Health Organization's (WHO) standard. 

Disability, according to the WHO, refers to the objective problems patients face across various health domains, which is distinct from subjective quality of life. Challenges specific to IBD, such as access to toilets and dietary restrictions, affect disability, and Colombel argues, should still be measured using the same WHO definition applied to all diseases. 

To address this gap, the IBD disability index was developed through a comprehensive process, including a systematic literature review, patient interviews, an expert survey, and a cross-sectional study across multiple continents. The final index incorporates a range of factors such as sleep, energy, body image, pain, and environmental influences (e.g., access to healthcare). It aims to provide a standardized measure of disability in IBD patients. 

The IBD disability index is currently being validated and is expected to help in clinical trials and research. Some questions in the index include sleep, body image, and pain. Once validated, Colombel believes it could influence patient care by raising awareness about disability in IBD and guiding healthcare interventions. It could also help identify predictors of disability and support the development of strategies to prevent disease progression and long-term disability. 

In clinical practice, while the index may not be used daily, it could inform clinicians to ask patients about issues that affect their disability, improving patient care and satisfaction. Measuring disability in IBD will ultimately lead to better understanding and management of the disease, enhancing both clinical outcomes and quality of life for patients.

My thoughts:

This is so fascinating to me, as someone with IBD. The comparison of how disabled someone is based on how impacted they are by their circumstances – and if they can make it through the cut-throat application process to be considered “truly” disabled by the government – seems to lead to isolation of people with chronic conditions like IBD.

When we’re quick to make comparisons or “rank” disability, we alienate others who may not experience disability exactly as we do, but who still may understand our lifestyle or lived experience more so than able-bodied individuals.

I also think there's a unique aspect of being in "remission" with IBD that others don’t always understand, which makes it complex. Sometimes, my IBD impacts me more than it might seem to others, but because the effects aren’t always visible, it’s a concept that can be difficult for people to fully understand.

Having an "index" to show how IBD affects people's lives could really help shine a light on the struggles many face. It could be a way to put into words the challenges that aren’t always visible, making it easier for others to understand just how much this condition impacts daily life – especially in contexts like healthcare appointments, where patients sometimes feel their experiences are not being heard or validated by providers.

Encouraging healthcare providers to use a client-centered, holistic approach when listening to us can lead to a healthier relationship with the healthcare field, and additions like training and feedback surveys could also help in this aspect. In the meantime, we can start by sharing our IBD experiences (through blogs, videos, campaigns, or social media), to help others understand the real-life impacts of IBD, in hope that spreading awareness and knowledge provides some insight into what we go through!

Citation: Colombel JF. Measuring Disability in IBD: The IBD Disability Index. Gastroenterol Hepatol (NY). 2013 May; 9(5): 300-2. https://pmc.ncbi.nlm.nih.gov/articles/PMC3740806/

(Image from Unsplash)

Battling an invisible illness while everyone else plays “doctor”

by Beamlak Alebel (Addis Ababa, Ethiopia)

A person with medium tone skin and chin-length black hair stands behind a clear bubble. Their hands are pressed against the glass, as if they want to get out.

Exams are already stressful, but for those of us dealing with invisible illnesses, they can feel like an impossible battle. The pressure to perform, sleepless nights, and depression don't just affect our mind - they also affect our whole body too: and while we struggle through the pain, others think they have all the "expert" answers:

My Brother wonders, "maybe it is some unknown disease science hasn't discovered yet."

My Parents think, "it must be setan (evil spirit), we should take her to holy water."

Society assumes, "it's probably caused by her poor lifestyle or malnutrition."

Meanwhile, I am just trying to survive this exam while everyone else plays doctor.

The silent struggle of invisible illness

Living with IBD means battling symptoms that others can't see. It is a constant storm - worsening digestive system, gut motility issues, poor sleep, and one of the biggest triggers, stress. 

Exam deadlines and academic pressure can make symptoms flare up. But instead of understanding the real impact of stress on chronic illness, people jump to conclusions. They blame supernatural forces, poor diet, or anything except the real medical condition.

Why awareness really matters 

The truth is, many people don't understand invisible illness until they (or someone close to them) are directly affected. This lack of awareness leads to stigma, misdiagnosis, and people suffering in silence. We need more conversations about IBD not just in medical communities, but also in everyday life.

Invisible illnesses like IBD can be incredibly tough. Friends and family should understand that IBD is a serious, life-threatening condition, and many factors outside our control can trigger painful flare-ups. Other people's misconceptions about IBD just add to our stress as patients...so if stress is a known trigger, we need to address these misunderstandings! 

This is why it is important to raise awareness, have discussions, and help others recognize the impact that IBD has on us. 

Because we know invisible illnesses exist, so why do we keep doubting those who live with them?

Instead of playing doctor, maybe it is time we start listening.

(Image from iStock, credit: nadia_bormotova)

Social Media’s Influence on Gut Health

By Isabela Hernandez (Florida, USA)

We must be very cautious on what social media tries to sell when promoting these gut healing products.

I can’t be the only one who was succumbed to the influence of “gut tik tok” or Instagram posts claiming that a magic powder from Amazon will cure your gut. I see these posts, still knowing that I need to be trusting professionals over influencers, and a small part of me wonders Is this the cure I’ve been looking for? On days I’m writhing in pain or annoyed about my medications, I truly do think about buying into an influencer's recommendations on how to heal your gut and buy the millions of supplements they promote. Maybe I won’t ever have to take medication again! BUT, we must be very cautious on what social media tries to sell when promoting these gut healing products.

“I see these posts, still knowing that I need to be trusting professionals over influencers, and a small part of me wonders Is this the cure I’ve been looking for?”

On days I’m writhing in pain or annoyed about my medications, I truly do think about buying into an influencer's recommendations on how to heal your gut and buy the millions of supplements they promote.

It’s always disheartening for me to see people who have managed to “cure” their gut with products I’ve never heard of and wonder, is it even true? Most of the time, it is not. But it’s hard for us, those who have suffered with these diseases for a while and will continue to do so, to see these videos and not feel a flicker of hope that maybe our cure lies in the next new gut supplement. I’m not saying all the information on social media related to gut health is bad, some of it is very informational! There are many trained professionals out there who make incredible content based on diseases of the gut. We just need to learn, as a community for people with GI issues, to follow professionals who we trust to give us well-informed advice. It’s important to use social media as a means of getting trustworthy information, not gaining false hope by influencers with promotional content that lacks real evidence. This is definitely something I need to work on as well but I trust we will all be able to find a healthy balance when it comes to social media.

“ It’s important to use social media as a means of getting trustworthy information, not gaining false hope by influencers with promotional content that lacks real evidence. ”

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This article is sponsored by Trellus

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

Obtaining Higher Levels of Degrees as an IBD Patient

By Isabela Hernandez (Florida, U.S.A.)

Many people go on to get their master’s, go to law school, medical school, or any form of higher degree past an undergraduate education. I am currently in the midst of applying to medical school. Recently, I have been filled with an anxiety about the future of when I do start this career path. This anxiety is not centered around whether I am capable of handling the pressures of medical school, but rather, if my ulcerative colitis is.

My goal is to go to medical school; it always has been. I know that I can handle it and have the potential to succeed. But, what scares me, is if my body can handle the lifestyle of a medical student. I have often heard from current medical students that it is a constant study, class, study, exam, and repeat lifestyle, leaving little time for self-care. It is so difficult when mentally you know you can do something, but you never know what you can expect from your IBD. It is so frustrating sometimes when you're in this battle of uncertainty with your disease, truly feeling like the future is uncontrollable. I am writing this not to give any sort of advice, only to express how I feel about a path I have chosen for myself and if anyone else can relate to my concerns.

Since it is completely different from undergrad, I am not completely sure if the tactics I acquired there will even apply in medical school. I know that I will need to find ways to mitigate my stress and my disease at school, in order to achieve balance and reduce flares. But this is always easier said than done. I am still a while away from actually getting into school and starting, but I want to address this fear by recognizing that “you don’t know until you know.” This is a phrase my sister always says to me when I start overthinking about the future and scenarios that might negatively affect my progress. One never knows how things are going to turn out until they actually happen, and for the most part, the anxiety leading up to an event is always worse than the actual moment that it happens. I hope by writing this, I encourage not only myself, but others to pursue any career choice they know deep down they would succeed in. Don’t let your IBD scare you away from a bright future, like mine has been trying to. Rather, focus on the facts that you know now, address them, and work your way into the future. The future is always unknown, so we might as well try for the best future we can.

This article is sponsored by Trellus

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

Working Full Time with IBD

By Carina Diaz (Texas, U.S.A.)

All I remember wanting when I was really sick was to have my own apartment and a full time job like my friends. I’ve been working a 9 to 5 job for almost three years now and have fully experienced the pros and cons. What I didn’t realize until I started was that managing my IBD is a job within itself. Balancing the two can be very exhausting.

The accessibility that remote work provides has really changed the game.

Deciding to disclose that you have IBD to your employer is a difficult and personal choice. I have been very lucky that at my current and previous jobs, I’ve felt comfortable talking about my illness. Not only that, but COVID-19 has made the world embrace remote work, and as someone who deals with fatigue regularly, this has helped me a ton. I don’t have the energy to get up every day, make breakfast, shower, and commute to work. The accessibility that remote work provides has really changed the game.

It can be tricky in an interview to gauge work culture, but I’ve found that it’s very important to ask as many questions as possible on it. Below is a list of some examples:

1. How would you describe the work environment?

2. What is your management style?

3. Which company value do you more relate to and why?

4. What are the qualities of the top performing employees?

5. What does work/life balance look like at your company?

These questions can help give a clearer picture on what the company is expecting from their employees. Do they micromanage? Or do they just care that you get the job done? Do they work more than 40 hours a week? Are the top performers workaholics? What are the benefits and perks of working there? The answers will reveal a lot.

It can be tricky in an interview to gauge work culture, but I’ve found that it’s very important to ask as many questions as possible on it.

Another perk of my current role is having unlimited PTO. If I feel like I need a day off to rest, I’m able to do so. It’s not just a nice vacation perk. Organizations like Chronically Capable are great resources to find jobs that have flexibility. It helps to start your job search with a list of “must have” qualities that you’re not willing to compromise on. Tiktok has also been a really good resource on building a resume, interview tips, and how to plan a job search.

A “must have” on my list is being open about having IBD in the interview process to gauge how it’ll be received. I mention having monthly doctor appointments, but that this wouldn’t get in the way of finishing tasks. Most companies I’ve interviewed with have said that’s no problem, and I’ve been very lucky in that regard, but not every organization will be that way. 

There are laws in place to prohibit discrimination, but unfortunately not every employer is willing to be flexible and offer appropriate accommodations. I feel very lucky to have positive experiences when joining the work force so there are good employers out there! For me, being open about my illness is a way of advocating for myself and ensuring that my needs are met.

Embracing the term "Disability"

By Natasha Kacharia (U.S.A.)

Last year, I was applying for an internship. I do not remember what internship but that is not the point. This internship, like most, had a voluntary self-identification of disability section that goes on to list what a disability may include: blindness, deafness, cancer, etc. However, this list was different because it included gastrointestinal disorders.

I know. I know. The lists of disabilities are usually prefaced with the phrase: disabilities may include but are not limited too. Yet, the fact that this internship specifically bulleted my condition put an unexplainable smile on my face.

You see, the voluntary self-identification of disability section always stressed me out. I never knew what box to check: yes, no, or I do not wish to disclose.

Screensot from the Voluntary Self-Identification of Disability form

The fortunate or unfortunate reality of living with a chronic illness is that people do not see the constant stomach cramps, the hemorrhaging of blood, the fatigue, the insomnia, the arthritis, or the nausea, and they definitely do not see the psychological effects of the disease. No, when people look at me, they see a healthy, possibly a little unfit, college student.

Thus, when the disability section inevitably comes on the application, I always wonder what box to check: yes, no, or I do not wish to disclose.

The same questions always run through my head: Does my condition qualify as a disability? Am I disabled?

Do you understand my indecisiveness now? When people think disability, I am not the person they imagine.

However, with a singular phrase – gastrointestinal disorders – the internship made me feel seen. Finally, I was free from my indecisiveness and the weights of my secret. For a singular moment, my invisible illness did not feel so invisible anymore.

Yet, I still had trouble identifying as disabled. Was I only disabled when I was in a flare, or can I always check the disability box? Do employers only ask for disability disclosure to engage in affirmative action for individuals with disabilities? If so, then do I have the right to check the disabled box, as having an invisible illness, I have not been actively discriminated on due to it. Meeting other people within the chronic illness community simply made me more confused; some readily embraced the term disability, while others sheered away from the term chronically ill. I met people whose illnesses were far more severe than mine and did not self-identify the term disabled, so what gave me the right? Was I being overdramatic? The fact that the people surrounded me did not recognize my struggles did not give me the space to embrace my own struggles.

But I am done. I am done with self-doubt. I may have an invisible illness, but I am done being invisible. I am ready to dance in the open, so for my next application, I am going to check yes. Yes, I have a disability.

Featured photo by Tara Winstead from Pexels.

Imposter Syndrome Being Healthy

By Isabela Hernandez (Florida, U.S.A.)

I was diagnosed with IBD when I was three, specifically with ulcerative colitis. When I look back at my life, there is not a time where I do not remember constantly living and dealing with my chronic illness. When I think about my childhood, the first thing I think of is being sick. Living with illness means we deal with an extra set of emotions and priorities that a lot of the world does not have to. Medicines, appointments, refills, procedures, and pain immediately flood my brain the minute I wake up in the morning. It is something we all deal with and try to integrate as best we can into our daily life.

Medicines, appointments, refills, procedures, and pain immediately flood my brain the minute I wake up in the morning.

As I grew up, in a strange and twisted way, I started to feel comfort being sick. Hospitals felt like home. Walking into doctor’s office felt more normal to me than walking into school. Over time, I felt this intense solace within being sick and for some reason, started to feel uncomfortable being healthy. Being sick was MY normal, so what was being healthy? Around the time I was 11 or 12, I was put on an experimental treatment that allowed me to stay in “remission” until I was 19. I put remission in quotes because it does not mean the disease is done and over. We still deal with medications, appointment, mild procedures, and mild symptoms. In these seven years where my disease had toned down, every day I woke up with this feeling that being somewhat healthy was wrong. I knew how to be sick. I was good at it. But, I had no idea how to deal with anything being in remission. I had a serious case of imposter syndrome these years and felt this extreme anxiety that in any moment, I was going to go back into my comfort zone of flaring, something I had endured for so long that it felt normal.

It is not fair that we spend so much more time in sickness than in health, that now sickness is our normal.

Not a lot of people mention that although flaring IS the worst part of having IBD, being in remission doesn’t mean life is instantly easy. It comes with a whole new set of fears and anxieties about how to go back to “normal” life. What is normal life for us when in remission? It is very confusing and something I still try to figure out on the daily. It is not fair that we spend so much more time in sickness than in health, that now sickness is our normal. It is our life. But what I have come to realize is that my sickness is NOT who I am. It has definitely shaped many parts of my personality and how I have become who I am now, but it is not the biggest and most defining part of who I am. I used to think that my IBD was who I am and that is it. It is definitely not, and we are just the people that our sickness has shaped us to be. I know that every day is a struggle, in remission or in a flare. I recognize that and actively try to remind myself that even though I feel comfort being sick, it is NOT normal. It just makes us all stronger.

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 This article is sponsored by Trellus

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

Friendship and IBD: Know when to not give advice

By Varada Srivastava (India)

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

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

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

1

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

2

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

3

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

4

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

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

Photo by Helena Lopes from Pexels.

IBD in College – Put it on your Resume!

By Isabela Hernandez (Florida, U.S.A.)

“It was a burden that I hated and equated as the worst part of myself. From the ages of 3 to 19, I treated it as this deep dark secret that I told no one about.”

I used to think that confident people were born confident, brave people born brave, and happy people born happy. An immature thought, but I believed characteristics like these were just naturally inherent. I convinced myself that I was just born to be sick with my IBD. It was a burden that I hated and equated as the worst part of myself. From the ages of 3 to 19, I treated it as this deep dark secret that I told no one about. For some reason, it was virtually impossible for me to tell friends about my UC and how it affected me. I kept everything to myself and never shared when I was feeling physically sick, or even worse, mentally drained. Luckily, I have a great family, an unrelenting support system that even when I didn’t want them to be, they were there for me. However, when someone with IBD goes to college, either newly diagnosed or a long-time patient, their assumptive world shatters. You’ve moved miles away from home with the most annoying friend you could ever think of, your IBD. At least that’s what I thought when I got to school. How am I going to deal with it? Am I going to tell people? Will they think I’m weird? What do I eat? What if I must go to the bathroom in class?

The questions were looming over me the minute I got to school. My fear overwhelmed me; it convinced me to believe that I would never find a way to integrate my UC into my new college life. I was fighting this mental battle against myself, and simultaneously seeking to get involved in any sort of organization at my school to feel more comfortable there. My university happens to be heavily research focused, and I was interested in the healthcare field. I decided to push myself out of my comfort zone and join a lab that focused on the one thing I knew the most about, IBD. It was there, in that moment that I felt empowered by my disease for the first time. I chose to openly use my IBD as a qualification, as an asset rather than a detriment. As time went on, I started to get more involved in other organizations that focused on IBD, such as this fellowship, that views one’s IBD as a contributing factor rather than a limiting one. I took a part of myself that I once hated and allowed it to become a distinctly unique piece of me. The transformative growth I underwent from concealing my IBD to using it to make me stand out was an unparalleled feeling.

“I am continuously seeking out ways in which I can intertwine IBD with my life, my work, and my interests.”

My biggest recommendation for anyone in college with IBD is to put IBD on your resume! Not literally, but in your own rhetorical way. Have it be your secret superpower that allows and pushes you to get involved in opportunities that reside in a world you so deeply understand. Work with nonprofits for IBD, get involved in research, or join a support group. Apply for scholarships for students with IBD. If you don’t happen to find any opportunities for students with IBD, start some! Start a support group or start a club exclusively for college students living with IBD. Find absolutely anything that connects you to your disease, because the minute you do this, you start to not only view your disease, but your potential, in a different light. If we as IBD patients are going to live with this forever, we might as well use it in a way that gives us the upper hand. Live a life with activities that are filled with opportunities that let you be proud to be someone with a chronic condition. Four years ago, I would have never been able to muster up the confidence to talk about my disease in the way I do. Today, the version of me that exists cannot stop talking about it. I am continuously seeking out ways in which I can intertwine IBD with my life, my work, and my interests. Every day, reaffirming that my IBD is the part of myself I am most proud of. Don’t let IBD hold you back from finding opportunities that make you feel fulfilled in a way you might’ve never known existed; use it to your advantage. It is a piece, that once embraced, can be advantageously employed in a surprisingly positive way.

"But You Don't Look Sick" - A Photo Journal

By Vasiliki-Rafaela Vakouftsi from Greece.

“But you don’t look sick”. How many times I have heard this? Maybe I don’t look sick to you but I am sick and my daily life is far from what you may think. 

I tried to captures in pictures my daily routine as a chronic patient and I’m going to share them with you. 

First of all, let me tell you some things about me. My name is Vasiliki-Rafaela, I’m a musician and I have Crohn’s Disease, Adrenal Insufficiency, Psoriasis and Psoriatic Arthritis. I have written a book about my journey with Crohn’s and a book about my life with Adrenal Insufficiency. Also, I really like traveling and I really miss it with the pandemic. 

Now let’s start with the hospital visits…

...the hospital stays and therapies…

...the hospital stays and therapies…

...take the pills, medicines and supplements…

...and maybe today is the day of the week for the injection for Crohn’s…

...or maybe I need the emergency shot for Adrenal Insufficiency…

And now it’s time for a walk.. Don’t forget to carry the pills with me...

...and of course my medical ID…

Back at home again.. Really exhausted...Let’s check the e-mails and read a book before going to sleep

That’s a little idea of how my daily life is. But, you’re right. So before saying “You don’t look sick” think of what is behind the image and what you cannot see…