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.

http://voices.yahoo.com/the-psychological-epidemic-patients-gastrointestinal-12196127.html?cat=5

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
•Bloating
•Cramping
•Diarrhea or constipation

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

•Rectal bleeding
•Fever
•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.

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.

Proving Everyone Wrong...Including Myself

Having a chronic illness comes with a lot of stigmas…you’re weak, you’re fragile, you can’t…

I was diagnosed with rheumatoid arthritis when I was 18 months old. Although I played several sports when I was young, for a long time I had the mindset of “I can’t”, especially when it involved being physical. That mindset stayed with me as I grew older and while I have always loved working out at the gym, I would stay away from things I thought I couldn’t do, like running or certain leg exercises that would hurt my arthritic knee.

After I was diagnosed with ulcerative colitis, and especially after my four surgeries, I started noticing that other people thought that I “couldn’t” as well. I started to see that they had this impression of me that because of everything I had gone through I was fragile. I know of course that this mindset of theirs wasn’t intentional and it wasn’t meant to make me feel bad but it did. I have never seen myself as a weak person and I didn’t want others to think of me that way. I noticed comments people would make including that I could sit out while the others did something physical, or asking me what I actually did when I worked out and then being surprised at the answer because for some reason they didn’t think I actually worked out when I went to the gym.

Lately all of this has been bugging me more and more so I’ve decided to do something about it, not only to prove others wrong, but to prove to myself that I can do it. So, last weekend I did my first 5k mud run and let me tell you, it was a blast! Sure, my arthritic knee hurt while I was training for it. I was one of the slowest on our team. But I did every obstacle, ran/walked the whole thing, and I finished. I know for some people a 5k is simple. But for me it was a challenge. When I told some people I was doing a mud run, I know they were surprised and didn’t think I’d be able to do it. But I proved them wrong. And I’m not stopping there. I’m signed up for another 5k in three weeks and I’m determined to finish it even if it means walking most of it. And I’m not naïve. I know I probably shouldn’t be doing these runs because it’s not good for my knee (and I know my rheumatologist would have a fit if he knew what I was doing) but I’m determined at least to finish the 5k that’s coming up. After that, maybe I’ll think of something else to do to challenge myself and to keep proving to myself and others that I can. There are so many things I’d like to do that I never thought I could before: Rock climbing, biking, long hikes…Who knows what it will be but I know now that as long as I take care of myself and listen to my body, my possibilities are endless.

The Big 3-0

Tomorrow’s my birthday…the big 3-0 and I can’t help being depressed about it. I know it probably sounds silly to most of you because 30 is still young, but it’s just one of those feelings I can’t help. All of my friends and family pretty much think I’m being ridiculous. I’ve been told “Just be happy you’re alive”, “It’s just a number”, “At least you still look young”, blah, blah, but here’s the thing…I hardly ever get angry or pity myself about what I have been through with my IBD and my four surgeries. I’ve tried to make the best of it and think I’ve done a pretty good job at it. Sure while I was going through my surgeries, particularly surgeries number 1 and 2, there were times I felt depressed and thought that what I was going through was completely unfair. But other than that I think I’ve been pretty good. During the literally hundreds of blood tests, I never complained. When I had to go back to the hospital after my takedown, have two blood transfusions and spend 4 days in ICU because I was severely anemic, I didn’t complain. When I had to have my fourth surgery because my J-pouch twisted, I took it in stride. So the reason I’m so unhappy about turning 30 is because I feel like ulcerative colitis stole almost 3 years of my life. During those 3 years I had thought I was going to build my career and have a baby. Now because of UC, I’m farther behind in my career than I had wanted to be and I don’t even know if I’m going to be able to ever have kids. I realize that life doesn’t always happen the way we plan it. But aren’t I allowed to be angry for at least a couple days? So to everyone who has had to listen to me complain about turning 30, it’s not because of the number, it’s because I feel like a few years of my life have been stolen and I’m just a little bit pissed off about it. I’ll be fine by the weekend :-)

8 Ways to Combat Stress During the Holidays

With the holidays around the corner, times might be starting to get a little stressful. There’s last minute gift shopping, menu planning, travel plans, etc. We all know that stress can make symptoms of IBD worse, so I wanted to give you a few ways to try and alleviate some stress this holiday season.

1. Make lists – Before you go shopping, try and figure out what it is that you want to buy the people you have left. Write down their names and the gift you are planning on buying so you know exactly who you have left to buy for and where you need to go. If you’re not sure yet what to buy, at least write down their name so you don’t need to think about it later. If you are cooking the holiday dinner, write out separate lists for what dishes you are planning to make and ingredients you need to get. While you are cooking, cross off each dish after you complete it so you know what you have left to do. If you are traveling, make lists for what you have left to do to plan your trip, things you need to pack, etc. Being organized will reduce your stress level tremendously.
2. Have you been invited to a ton of holiday parties? Are you wondering how you are going to attend them all? Don’t worry about attending everything! Prioritize the parties you really want to attend and tell the others you are sorry you can’t make it. Everyone knows this is a busy time of year so they will most likely understand if you can’t come this year.
3. Take time out for yourself – In order to reduce stress during the holidays, take some time out for yourself, even if it’s only for a few minutes per day. Read a book you enjoy, take a yoga class, watch your favorite TV show…whatever it is that helps you to relax.
4. Make a financial budget and stick to it – Most people tend to over spend during the holidays which then can create more stress once you get the credit card bill. Come up with a reasonable budget for yourself to spend on gifts, decorations, food, etc. and then stick as close to it as you can.
5. Delegate – If you need help shopping for presents, cooking, decorating, or cleaning, ask for help! You don’t need to do everything yourself!
6. Keep your regular routine – During this time of year, things are so hectic that it’s hard to get everything in. In order to reduce stress on yourself and your family, try to stick to your regular routine as much as possible, at least during the week. Have regular meal times, stick to your regular work-out schedule, and go to bed at the same time you usually do.
7. Make sure to keep your doctor’s appointments and take your medications at your regular times – Sometimes when we are so busy, it is easy to cancel doctor’s appointments and forget medications but doing so may exacerbate symptoms.
8. Enjoy the time you have off from work and enjoy the time you are spending with your family.

Giving Thanks

Since it’s that time of year I thought I should write about thankfulness. When you have a chronic illness, sometimes it’s hard to see past the negatives and really take a look at what there is in your life to be thankful for. For me, when I was really sick with ulcerative colitis, it was hard for me to think of anything to be thankful for. I just couldn’t understand why this was happening to me and I began to look at life through a negative lens. I was so sick, I had to put my life on hold to have major surgeries, I had to wear an ostomy bag, I was in terrible pain, I had complications from the surgeries…nothing seemed to be going right. Now that I am healthy again, I look back on my whole experience and realize that I had, and still have, a whole lot to be thankful for. I have an amazing husband, family, and friends who were there for me throughout everything and I have fantastic doctors who gave me my life back.

Although my experience was a rough one, I remember during one of my many hospital visits I was staying on the cancer floor. Every day I could hear the patient across from me coughing and vomiting because of the chemotherapy. This went on pretty much nonstop. I remember thinking that as bad as my experience was it could be worse and that there were people who had it much harder than I did. It put things in perspective.

Having a chronic illness can be an eye-opening experience if you let it. It can make you more empathetic to others who have an illness. It can teach you to appreciate what you have, even the little things, like going outside for a walk, eating a good meal, or spending a night out with friends. It can help you to realize that you are strong and can deal with anything. It helps you to focus on the things in your life that really matter. So, I urge you to try and think about the things in your life that you are grateful for, despite your chronic illness and despite how hard it can be sometimes.

PTSD After J-Pouch Surgery

I have come across so many people, clients and others, who have experienced PTSD after the J-pouch surgeries that I felt it was time to finally write about it. This is not intended to scare anyone who may be facing these surgeries. I think that in these circumstances it is best to be prepared from all angles about what may or may not happen before, during and after these surgeries. Being prepared is the best defense because then you can deal with it before it becomes a problem.

When people think about PTSD, the first thing that usually pops into their heads is that it is something that war veteran’s experience. But really take a look at what PTSD stands for: Post-Traumatic Stress Disorder. So it can happen after experiencing any kind of traumatic event…and from my own experiences and from those of the many people I’ve talked to who have had these surgeries, they can definitely be traumatic, especially if you’re not well prepared. Unfortunately, PTSD, depression, anxiety, and all the other crazy emotions that a lot of people feel during and after these surgeries is not something that any doctors to my knowledge talk about…at all. They only talk about the medical side of it, which I get because they’re medical doctors, but at least a mention of the potential emotions that one might experience would be helpful!

So what does this PTSD look like? Mostly, it’s the anxiety and fear of getting sick again and having to go through anything remotely similar to what has already been experienced. I wouldn’t say that I’ve had full on PTSD after my surgeries, but I definitely experience some parts of it. The fear of getting sick again, having to go back to the hospital again or going through another surgery can be terrifying sometimes. Also, being away from my doctors can be really scary. I recently got back from an almost 2 week trip to Europe. The anxiety and fear of something going wrong while I was away and not being able to see my doctors was so overwhelming that I almost didn’t want to go. Another symptom of PTSD after these surgeries is flashbacks. A lot of people that I’ve talked to say that sometimes out of the blue they will have flashbacks of a certain time while in the hospital or during recovery and that it brings back all the emotions they were feeling at the time. Sometimes, just thinking back on everything you have gone through can be emotionally draining. For most people, the period of time from when they were sick enough to need the surgeries until after the takedown is kind of like a “do or die” situation. Nothing else matters during that time other than getting through it and getting healthy again. So for a lot of people, dealing with emotions at that time is just not an option. They just need to be focused on getting through it. So after the takedown, when things are finally starting to get a little bit back to normal, these emotions can come on like a flood…uncontrollable and overwhelming.

So for those of you who have experienced PTSD or are experiencing it after your surgeries know that you are not alone and that this is completely normal. The best thing to do is to find someone to talk to about all the feelings you are experiencing. That way you can find a way to cope with your feelings, accept what has happened, and live your life again. For those of you who may be facing these surgeries, please don’t let this scare you. It is better to be prepared going into the surgeries so that you are better equipped to deal with these emotions if they arise. Even after all the things I’ve dealt with during and after my surgeries, I would still recommend the J-pouch surgeries to anyone. They were life-saving and they have only made me stronger.

Rollercoaster of Emotions

Last Friday I had my annual flex sigmoidoscopy to take a look at my J-pouch. After a whole year of doing fantastic and feeling great I went into this appointment a little nervous but very confident. So after two hours of waiting (no fault of my doctor’s but still very annoying) my nerves kept building. Throughout the exam everything was looking great, until the very end when my doctor found a small piece toward the top of the pouch that was a little inflamed with a small ulcer. One ulcer. Upon seeing that my mind started racing and I started freaking out inside but remained calm so my doctor wouldn’t think I was a crazy person. After he took a biopsy and I got my pants back on, I asked him “what could it be?”, “is it Crohn’s?”, “when will the results be back?” After giving me a smile and trying to calm me down a bit he told me that he didn’t know what it was, it could possibly be Crohn’s but he didn’t think so and not to worry (REALLY?!), and that the biopsy results should be back within a week or two.


So since Friday morning I’ve been able to think of nothing else. I’m trying to remain positive, but having that camera up my butt again and seeing an ulcer again has really played mind games with me. It’s brought back that whole flood of emotions that I felt when I was sick with UC and while I was going through my surgeries. The thing I’ve realized is that those emotions and these experiences will never go away. Even if the results come back and it’s not Crohn’s , this is something I’m going to have to go through every year when I have that exam. The nerves beforehand and the praying to God that nothing shows up during the exam. So it makes me think. For those of us who have had J-pouch surgery as a “cure” for UC, is it really a cure? Possibly it is a cure for the actual physical ulcerative colitis (although not always for those who find out after that they really had Crohn’s all along, or the small percentage who have complications after the surgeries). But emotionally, having these surgeries is definitely not a complete cure. It is something that will always be with us. Those emotions, those memories, that fear. I’m not saying I wouldn’t have had the surgeries. Not that I had a choice, but if I had, I still would choose to have them and I would still recommend them to anyone. They saved my life and gave me a better quality of life. For that I’m definitely grateful. I guess I’ve just realized that for most people it doesn’t end once the surgeries are over. It’s a process. Which is why I think it is so important to take care of yourself both physically and psychologically, during the illness as well as after. I think it’s also the reason I’m so passionate about counseling people with IBD…because I GET IT. And you can’t get all the emotions and fears unless you’ve been through it. So for now, I’m going to do some of the things I tell my clients to do…try and remain positive, deal with my emotions, and since I’m feeling good, enjoy life…and pray that the ulcer is nothing.

Cosmopolitan Magazine

Recently I had the pleasure of sharing my story with one of the editors at Cosmopolitan Magazine. Here is the link to the story:


http://www.cosmopolitan.com/advice/health/jennifer-kaplan-ulcerative-colitis-story?click=cos_latest