Wednesday, November 6, 2013

The Brain-Gut Axis...Part 2

I found this page today while doing a little browsing “Five Hot Topics in Inflammatory Bowel Disease Research”. If you take a look at number 4, it says “The Brain-Gut Axis”. This is the same thing as the Mind-Gut Connection I talked about in an earlier post. While I was very happy to see that this is one of the “hot topics” in IBD research, I was a bit surprised. I can’t tell you how many GI doctors, nurses, other medical professionals I have contacted to tell them about the importance of looking at the psychological effects of IBD as well as the importance of preparing patients psychologically for surgery. I’ve told them about the services I offer, in terms of counseling, speaking and support groups. While some of these doctors understand the importance of the psychological component to these illnesses, it seems that most of them either don’t understand, don’t believe in it, or don’t want to take the time out of their busy schedules to learn about how psychological help may benefit their clients.

I believe there is truth to this “Brain-Gut Axis” and I think it needs to be taken more seriously in the medical community and that it needs to be mentioned to patients. Referrals need to be offered if needed. After all, how would patients, especially new patients, have any idea how much their psychological state could affect their disease course or management. I guess my question is, how can we make this a regular part of IBD treatment? Any ideas would be welcomed.

Monday, October 28, 2013

Get Motivated! 10 Tips That Will Help You Reach Your Goals

At times, having a chronic illness can make it hard to stay motivated to reach goals. Some days you may not feel well enough. Other days you may think “what’s the point if I’m always going to be sick?”. Below are 10 tips to help you stay motivated to reach your goals.

1. Start with one goal: Often times it’s hard to get motivated because there’s just too much going on. When there are a million things going on in your life and five different things you want to achieve, it’s very hard to remain focused. Write down your goals and then prioritize. Choose one goal to work on and focus only on that goal. You will achieve your goal quicker and it will be easier to stay focused and motivated if you work on one goal at a time.

2. Start small: Once you have chosen the one goal you are going to focus on, write down baby steps you can take to get there…and I’m mean BABY steps. Start very small. It will be easier to continue to be motivated if you start small and are able to see your successes.

3. Recognize small successes: Each time you complete a small step toward your larger goal, recognize it and be proud of yourself! Recognizing that you are completing the steps necessary can be very motivating because you will see that you are getting there!

4. Set a timeframe for completing your goal: Think about what an appropriate, realistic timeframe would be for completing your goal and mark it on a calendar in red. Look at that day on your calendar regularly as a reminder and as a motivator.

5. Find inspiration: Whether it is from someone you know who is already doing what you are working toward, reading information online, reading blogs, books or magazines, finding inspiration to reach your goal can do a lot to give you a boost of motivation.

6. Remind yourself of your goal: Make a poster with a short sentence describing your goal or simply write it on a piece of paper in big letters and tape it up where you will see it every day; on your mirror, on your refrigerator, on your desk at work…you get the idea. It’s hard to ignore it when it’s in your face every day.

7. Tell people about your goal: Whether it’s just one person or a whole bunch of people, telling people about your goal will make you feel accountable, which in turn will help to motivate you to succeed.

8. Get support: If you have a friend or family member working toward the same goal as you, talk to them about doing it together. Having a buddy makes accomplishing a goal easier. You can rely on each other during the times you are each feeling less motivated and you can celebrate together when you have reached small milestones. If you don’t have a personal friend or family member working toward the same goal, look online for any support groups that may be out there.

9. Create a routine: Make accomplishing your goal a part of your daily or weekly routine. For example, if getting in shape is the goal you are struggling with, dedicate yourself to exercising on specific days of the week at the same time on each of those days. While it may be a struggle at first, once you get into a routine it will be easier to stay motivated.

10. Replace negative thinking with positive thinking: Instead of thinking “I will never be able to do this”, think “I can do this and I will do it!” Make an effort to recognize your negative thinking patterns and make a real effort to turn those around. Negative self-talk will make it ten times more difficult to stay motivated and reach your goals.

Wednesday, September 18, 2013

The Five Stages of Grief for Chronic Illness or Chronic Pain

I’m sure some of you have heard of the five stages of grief developed by Elizabeth Kübler-Ross. Kübler-Ross developed these stages to explain the process individuals go through who are near death. But did you know that these five stages can be used to explain the process people go through when diagnosed with a chronic illness or chronic pain? Below, I will explain how these stages relate to those of us with chronic illness or chronic pain. Along with the “depression” stage, I have added anxiety because I think this is common in most of us who experience a chronic illness or chronic pain. As you read these, think about which stage you may currently be in. Remember, these stages are not linear. You can jump back and forth between stages depending on where you are at in your diagnosis.


In this stage, the world becomes meaningless and overwhelming. Life makes no sense. We are in a state of shock and denial. We wonder how our life is going to change and how we are going to live with those changes. Denial and shock help us to cope and make survival possible.

This stage can be dangerous for people with chronic illness/pain because at this stage if they are in denial about their illness or pain, they may not take the necessary steps to get themselves the treatment they need.

Example: “It’s not a big deal, it will go away”


Anger is a necessary stage of the healing process. Be willing to feel your anger, even though it may seem endless. The more you truly feel it, the more it will begin to dissipate and the more you will heal. There are many other emotions under the anger and you will get to them in time, but anger is the emotion we are most used to managing. Your anger has no limits and it may extend not only to your friends, doctors, your family, yourself and your loved ones.

Example: “This isn’t fair! I didn’t do anything to deserve this!”


This is the stage where we want more than anything for life to be what it once was. We become entrenched in “if only” or “what if” statements. Guilt is often bargaining’s companion. The “if only’s” cause us to find fault in ourselves and what we “think” we could have done differently. We may even bargain with the pain or illness because we would do anything not to feel it anymore.

Example: “Please just don’t let this ruin my life”.

Depression (and/or Anxiety)

After bargaining, our attention moves squarely into the present. Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever. It is important to understand that this depression is not a sign of mental illness. It is the appropriate response to a loss. We withdraw from life, left in a fog of intense sadness, wondering, perhaps, if there is any point in going on. Depression after a loss is too often seen as unnatural: a state to be fixed, something to snap out of. Being diagnosed with a chronic illness or experiencing chronic pain is a loss – a loss of the life you once had. Depression is one of the many necessary steps along the way toward healing.

Having a chronic illness or chronic pain also may bring up feelings of anxiety; anxiety about what the future holds, anxiety about not being able to live up to expectations now that this illness or pain is present, anxiety about social situations, anxiety about medical bills, etc.

Example: “I’m going to be in pain forever so why even bother”.


Acceptance is often confused with the notion of being “all right” or “OK” with what has happened. This is not the case. Many people don’t ever feel OK or all right about having to live with pain or an illness for the rest of their lives. This stage is about accepting the reality of your situation and recognizing that this new reality is the permanent reality. We will never like this reality or make it OK, but eventually we accept it. We learn to live life with it. It is the new norm with which we must learn to live. We must make adaptations and alterations to our lives. We must find new things that bring us joy.

Example: “I’m not going to let this define me. I will learn to deal with this the best I can”.

Tuesday, August 27, 2013

10 Ways to Manage Stress with a Chronic Illness

1. Relaxation techniques – Relaxation techniques are very helpful for relaxing your mind and body. The simplest relaxation technique is deep breathing. To do this, sit in a chair or on a couch with your feet planted on the floor. Close your eyes if you would like. Begin by taking a deep breath to the count of 3 or 4, inhaling through your nose. Pause for a second and then exhale through your mouth to the count of four. While you are breathing in and out, focus on your breath and on counting. Repeat this until you feel relaxed.

2. Evaluate your priorities – We tend to have a lot going on in our lives with work, school, relationships, kids, etc. A lot of the time, our health tends to take a backseat to these other priorities. When you have a chronic illness, it is really important to make your health a top priority. Sometimes it takes evaluating the priorities in your life and figuring out how you can rearrange things, where you can ask for help, and what you can hold off on in order to make sure you are taking care of your health.

3. Participate in at least two enjoyable activities per week – It’s really easy to start feeling depressed and anxious when you have a chronic illness. To help avoid this it is important to do things you enjoy. Make it a goal to do two things you enjoy per week. That can be anything, ranging from reading a good book to taking a walk on the beach.

4. Make lists – Make a list of the things you absolutely have to do on a certain day and a list of the things you would like to do but don’t necessarily have to do. Focus on doing the things you have to do. If there is time and you have the energy, then you can start on the list of things you would like to do.

5. Enjoy the days when you feel good – Whether there are many of these days or they are far and few between, enjoy the days when you feel good and be grateful for them. It’s really easy to focus on the negative things about having a chronic illness. Instead of doing that, focus on what you can do when you feel good.

6. Be proactive with your medical treatment – Make sure you stay on top of doctor appointments and medications. That way you won’t fall behind, which will only make you more stressed out. Plan appointments far ahead of time so that you make sure to get a day and time that is convenient for you. Order prescriptions early so you aren’t rushing to the pharmacy the day you run out of medication. Make sure to report new symptoms to your doctor as soon as possible so that something can be done about it. You see where I am going with this…

7. Find social support – Whether it be with family or friends, or a support group for people with chronic illness, having support is extremely important for managing stress.

8. Exercise – Do what you can when it comes to exercise. Swimming, yoga, or even taking a short walk can do a lot for stress management. If you are having a difficult time thinking of exercises you can do, talk to your doctor and brainstorm together.

9. Make time for yourself – With everything going on in our daily lives, it is important to schedule in some “me” time. Even if it’s only a short amount of time per day.

10. Try not to put so much focus on the things that are out of your control – We only have control over so much. We do not have control over the fact that we have a chronic illness. But we do have control over what we are going to do about it. We can choose to let it affect us negatively every day, or we can choose to learn to make alterations and accept it. We can choose whether or not we are going to be on top of our medical treatment so we can get our illness under control as much as possible. We can choose to focus on the negative things about our illness, or we can choose to try and find a positive. We can let our illness become who we are or we can choose to let it be something we have.

Monday, August 19, 2013

Why Don't Medical Professionals Know What a J-Pouch Is?

It’s amazing to me how many medical professionals have absolutely no clue what a J-pouch is. I can’t tell you how many times I’ve had a doctor or nurse ask me to see my pouch. Really?!? I don’t know why it surprises me anymore but it still does. I don’t know what it’s going to take to educate these people. Shouldn’t they know?

A few days ago I had a pouch endoscopy because of the prolapse of my intestine into my pouch that happened a couple weeks ago. Because my surgeon was out of town while it happened (story of my life) he was unable to take a look while I was at the hospital so he wanted to take a peek to see if he could see anything that may have caused the prolapse. I went to the GI LAB at the hospital to have this procedure done. Did you happen to notice that I capitalized GI LAB? While I was there, I once again had a nurse ask if she could see my pouch…at a GI lab!! This amazed me. I again had to explain that it is an internal pouch and you can’t see it. Luckily, shortly after she asked me that question she gave me a hefty dose of Versed which saved her from a slap in the face, just for asking that question. Just kidding, but really, it kind of annoyed me. Anyway, the good news is that my surgeon said my pouch looked normal and that he couldn’t see anything that would have caused the prolapse. I guess now it’s just a wait and see game. If it happens again, we’ll deal with it then.

All of these experiences with these doctors and nurses make me wonder how or if we can educate the medical world about J-pouches so we aren’t constantly being asked about it. Any ideas?

Wednesday, July 3, 2013

Accepting Your Chronic Illness


1. The act of enduring without protest or reaction.
2. The act of recognizing as true.

One of the hardest things to do when you have a chronic illness is to accept your situation. It is something that usually takes time and a lot of hard work to achieve. Why is it so hard to accept having a chronic illness? There are many reasons. Having a chronic illness may mean a complete change in lifestyle. It may mean taking several medications daily. It may mean the inability to do things you once enjoyed. Having a chronic illness may mean not knowing when you are going to feel good and when you are going to feel bad. There are a lot of unanswered questions that come along with having a chronic illness: “Why me?”, “What did I do to deserve this?”, “What is in store for my future?”.

When I talk about acceptance with my clients, I don’t mean that it is okay that you have a chronic illness. What I mean by “acceptance” is recognizing that your situation is long-lasting and making alterations in your life that will enable you to live the happiest, fullest life possible. You can’t avoid your illness but you can learn to live with it without struggling. It also means the ability not to let your illness define who you are. Your illness is something you have, it is not who you are.

So, how do you begin the process of accepting your chronic illness? Step one is acknowledging the fact that you may never get the answers to all of your questions. You may never find out why this happened to you or if there was something you could have done to prevent it. Sometimes it just is. Asking why can leave you feeling helpless. Step two is making alterations in your life. For example, if exercise is something you really enjoyed before you got diagnosed and you are now unable to exercise to the extent you could before, think of ways in which you are still able to exercise. Maybe yoga would be a better option, or if running is too strenuous now, take long walks instead. The third step of moving toward acceptance is to find meaning in your situation. You may never find the answer to why this happened to you. Instead of focusing on that aspect of your illness or on the negative parts of your illness, find a sense of meaning in your situation. Maybe that means leading a support group for others who have the same diagnosis as you do, or volunteering at a hospital, or maybe you have decided that you want to become a doctor because of your experiences. Whatever that meaning is for you, it is important to find something positive to focus on. Lastly, make it a goal to participate in at least one enjoyable activity per week. Having a chronic illness can be life changing. In order to avoid depression and in order to learn to live with your illness, it is important to continue to do activities you enjoy. Maintaining a sense of normalcy in as many areas as you can while making alterations in those areas that are necessary will help you to feel more in control of your life.

Remember, having a chronic illness does not have to be solely a negative experience. Along with the negative feelings and experiences derived from triumphant feelings and strength that come with overcoming obstacles. With each success comes the confidence that you're able to live a full, rewarding life and maybe even a more meaningful life than if you hadn't been diagnosed with your illness.

Wednesday, June 26, 2013

The Psychological Epidemic in Patients with Gastrointestinal Diseases: Help is Needed for Patients Suffering from Suicidal Thoughts, Depression, Stress and Anxiety

I don't know how many of you have read about the suicide of Aaron Swartz. While their may have been many factors that lead to his decision to take his life, many of the articles written about him mentioned the fact that he had ulcerative colitis and that this may have contributed to his depression. After I read some of these articles I couldn't stop thinking about it. I decided to put my thoughts into words. Below is the link to an article I wrote about the psychological problems many people with gastrointestinal problems face. While suicide is a drastic measure, it is not unheard of.

If you cannot open the link directly, please copy and paste it into your browser.

Monday, June 24, 2013

Irritable Bowel Syndrome and Inflammatory Bowel Disease: What's the Difference and Which One Do I Have?

Many people get confused between the terms Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), and understandably so. Many of the symptoms of these diseases are similar and, in fact, may people who have IBD are first diagnosed with IBS before receiving the correct diagnosis. So, what are the differences?

Main Differences between IBS and IBD

The biggest difference between IBS and IBD is that IBS is a syndrome, not a disease. IBS does not lead to colon cancer and it does not cause bleeding. IBD, on the other hand, is a disease, can lead to colon cancer and bleeding is one of the main symptoms.

IBD includes a group of diseases in the gastrointestinal tract. The two main diseases are Crohn's disease and ulcerative colitis. Crohn's disease can affect the entire gastrointestinal tract, from the mouth all the way down to the anus. Ulcerative colitis is limited to the rectum and large intestine (colon).

Symptom Differences between IBS and IBD

General symptoms of IBS include:

•Abdominal pain
•Diarrhea or constipation

For people with IBD, all of the above symptoms apply in addition to:

•Rectal bleeding
•Weight loss
•Inflammation/ulcers of the gastrointestinal tract seen during colonoscopy and/or endoscopy

Treatment Differences

The difference in the treatment of IBS and IBD is that with IBS, the focus of the treatment is on the symptoms. Anti-diarrhea medication is given if diarrhea is the main symptom. Diet change may be necessary if offending foods are causing the problem. Changes in stressful activities may be required if stress is a culprit.

When the diagnosis is IBD, treatment focuses on controlling the inflammation that is causing the symptoms. Anti-inflammatory medications or immunosuppressant medications are often used. In severe cases, surgery may be needed.

Which One Do I Have?

To confirm your diagnosis, it is extremely important to visit your doctor. Your doctor will take note of your symptoms and perform certain tests and/or procedures in order to make the correct diagnosis. Keep a journal of your symptoms and bring it to your doctor to make sure you aren't leaving anything out. If you think certain foods are causing a problem, keep a food journal of the offending food and the symptoms created by eating that food and bring that along as well.

Friday, June 21, 2013

J-Pouch Surgery and Getting Pregnant

When I was told there was an 80-85% chance I wouldn't be able to conceive on my own after the J-pouch surgeries, I was devastated. I cried for three days. My husband and I had only been married for six months and we both wanted children. I couldn’t believe this was happening to me and questioned what I had done to deserve this.

It took me the three days of crying to come to terms with the fact that I didn’t have any other choice. I was so sick that it was either I had these surgeries or I died. I had to realize that whatever was in store for me I could handle. Whether or not I could conceive on my own or through in vitro fertilization, I was going to have a child. The most important thing was to get healthy first.

I think that for most women facing this surgery, the idea that they may not be able to have children without help is one of the most difficult parts. Also, the decision of whether or not to try to get pregnant with the ostomy before the final take down surgery is a big one as well.

It is important to go into this situation as informed as you can. Know your options. Talk to other women who have tried getting pregnant after the surgeries and find out what their experience was. Talk to your partner about what you will do if you are not able to get pregnant on your own so you are prepared. As scary as the statistics are, it doesn’t mean it’s not possible. Our bodies are made to bounce back. It is important to remain positive and remain hopeful.

Just to prove that it is possible, here is a picture of my beautiful 16 week old baby boy.