A Comprehensive Naturopathic Guide for Complete Digestive Wellness

Category Archives: IBS

20130626-080451.jpgA New Diet…. Begun just over four weeks ago, is really helping! I am inspired by my friend, and fellow Crohnie, Katy Haldiman, RN, MS, The Paleo Nurse, and my consultants, Jordon Reasoner, and Steve Wright of SCD Lifestyle, to try a simplified diet to help my recent recurrence of Crohn’s from spreading.

Crohn’s is not easily deterred. I was so lucky to have seven years of clinical remission. It was only in the last year, that my disease spread. My last seven years have been filled with hope and health, and it is easy to fall into despair when the doctors tell you that your disease has gone from nonexistent to “severe.”

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Rather than saying “Woe is me,” and spending time feeling sad and useless (I did a lot of that, believe me), I decided to take action, and try to live the words of the Dalai Lama:

“Scientists say that a healthy mind is a major factor for a healthy body,” His Holiness said. “If you’re serious about your health, think and take most concern for your peace of mind. That’s very, very important.”

That said, I am on my way to health, for sure—no time to sit on my cushion meditating (I do that daily for a few minutes still); rather, I need to stay focused and take care of my body: better food, sleep, stress relief, education, awareness, team building, satisfying work, making money enough to live on, giving back to my community and the world…working for peace, justice, and environmental sustainability. According to His Holiness the XIV Dalai Lama, peace of mind is essential for health—words to live by.

This new diet, very much like The Paleo, is giving me strength and vitality. It is not for everyone—and I always tell people you must proceed with a doctor’s knowledge, for Crohn’s and UC can be serious, even fatal, if not managed correctly. I have worked really hard to form a collaborative team—my own book’s co-author, Jessica Black, ND, is my stalwart supporter and her book, The Anti-Inflammation Diet and Recipe Book has just come it in a second edition and has sold almost 100,000 copies! Jessie is an amazing health practitioner.

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I have eliminated ALL grains and dairy from my diet—woohoo! What a difference. I found this great site, and I can use almond meal flour (also coconut flour), and I eat fruits and veggies, nuts and animal protein pretty much non-stop. I had an adjustment for the first week, as I really missed my oatmeal in the morning, but as you can see from the photo, my morning meal is wonderful and tasty, too.

I hope this post inspires people to look at their own diets, and proceed with caution (this diet is not recommended if you have flare-up symptoms of Crohn’s or ulcerative colitis). I began this diet with no symptoms, and after the first week, I started to feel like I had more energy, and my stress levels are kept low by walking 4 miles a day and sleeping 8 hours per night.

I’ll post some more photos of my wonderful meals… Summer is the best time to do this diet: only organic fruits and veggies and meat must be antibiotic-free, grass-fed…that whole thing! I buy all local meat, eggs, fruits and veggies… And I plan on putting up and preserving a lot of them this summer so I can continue summer’s bounty from my freezer (and canning room) during the cold Vermont winter!

I also have a nice little garden growing…. Kale, and more kale! Plus, tomatoes, green beans, lettuce, spinach, onions, asparagus, etc. growing your own food is another way to reduce stress and get physically fit—gardening is good for upper body strength!

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I have been taking probiotic powder for many years. The new research on gut bacteria recently, and hype around probiotics, makes it imperative for consumers — and those of us with IBS or IBD, — to know why and how we should take the supplements.

Here is an excellent article by Michael Pollen from the NYTimes. (Photo above by Hannah Whitaker for the New York Times. And styled by Emily Mullin.)

I am a big proponent of getting vitamins and minerals from diet, and vitamin D from the sun, but sometimes we may be compromised (like missing the most important segment of small bowel, the terminal ileum, as in my/Dede’s case), and need to supplement. Probiotics are found everywhere in our diet — fermented food is a great source — wheat, coffee, bananas, onions, garlic, honey, and of course, yogurt and kefir.

The grocery stores and markets are rife with disclaimers of “Probiotics! Added to Everything!” So, what do we do? How do we know what is best?

I asked my co-author, Jessica Black, ND, to come up with a simple description I can pass along to our followers and readers…. Here is what she wrote, and I hope it is helpful:

Probiotics are essential to proper GI function. Probiotics help maintain a healthy barrier between what we ingest and what gets through to our blood stream. Probiotics play a large regulatory role in the GI lining immune system, which sets the stage for the immune system balance throughout the rest of the body.

Probiotics restore proper gut ecology – the proper balance of all important microorganisms lining the GI tract.

I also excerpted the section in our book on probiotics, and feel free to send an email to request a PDF of the full article (dede@livingwithcrohnsandcolitisbook.com).

Last, but not least, my brand is called UltraFlora “Synergy” probiotics made by Metagenics (I buy from the naturopath, but here is link: http://www.metadocs.com/products/detail.asp?pid=86

It is a 50-50 blend of Lactobacillus acidophilus and Bifidobacterium lactis, a highly viable and pure strain, also dairy-free and gluten-free. It has 15 billion live organisms, and needs to be refrigerated in order to retain its efficacy.

Good luck! Questions or comments welcome, of course.


Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis)

By Drew Nystrom L.Ac., CMT

Our first-ever “guest post” on Dede’s blog! Drew and I “met” through Dede and Jessica Black, ND’s Facebook page, and Dede invited him to educate our readers and followers about the benefits of accupuncture. WTG, Drew! This is like a new book we should publish! A very thorough examination of signs and symptoms of Crohn’s and ulcerative colitis, along with specific treatment plans for acupuncture. Since Dede (seriously) is a wimp when it comes to needles (also, working on this using Ayurvedic treatment to help with this possible symptomatic “sensitivity” on the skin, which is very likely bowel, related, since the skin and the bowel ARE related!~)…Please welcome Drew, and share this, and come visit him if you live in the Southern California region—like our friends at the CrohnsJourneyFoundation.

This happy woman is like Dede, who hates needles, but has monthly acupuncture treatment—it really helps alleviate symptoms and detoxify the overworked liver, etc. when you have an auto-immune disease

This happy woman is like Dede, who hates needles, but has monthly acupuncture treatment—it really helps alleviate symptoms and detoxify the overworked liver, etc. when you have an auto-immune disease

Inflammatory Bowel Disease is a heading/umbrella that has other diseases underneath it. You may have heard of Crohns Disease, Ulcerative Colitis and Irritable Bowel Disease. You may know someone who’s been diagnosed with one of these or you may have had one of these unfortunate afflictions. In any case these can be serious debilitating conditions that sometimes require extreme care for severe cases but all require long term care. In this article I will discuss the differences and similarities between the three.

Crohn’s Disease: A chronic inflammatory condition of the intestinal tract was first described by Dr. Burrill B. Crohn in 1932, along with Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer. Mostly affects the end of the small intestine called the “Ileum” and the beginning of the colon/large intestine “Cecum” but can affect the entire length of the GI tract. Crohn’s disease can affect the entire thickness of the bowel wall leaving “skip lesions;” whereas, Ulcerative Colitis only affects the superficial layer of the large intestine.

Ulcerative Colitis: A chronic inflammatory disease that affects only the Large Intestine (aka: colon). The lining of the colon becomes inflamed, and ulcerations occur which bleed and produce pus.The inflammation and the ulceration lead to spasms, cramping/pain and frequent bowel movements.

Like Crohn’s Disease Ulcerative Colitis is an autoimmune disorder where your body attacks itself.

 

Crohn’s Disease

Symptoms related to inflammation of the GI tract:

• Persistent Diarrhea

• Rectal bleeding

• Urgent need to move bowels

• Abdominal cramps and pain

• Sensation of incomplete evacuation

• Constipation (can lead to bowel obstruction)

More severe symptoms:

• Fissures in the lining of the anus (tears)

• Fistulas (tunnel from one loop of intestine to another or connects the intestine to the: bladder, vagina or skin)

Ulcerative Colitis

Symptoms related to inflammation of the Colon:

• Bowel movements become looser and more urgent

• Persistent diarrhea accompanied by abdominal pain and blood in the stool

• Stool is generally bloody

• Crampy abdominal pain

General symptoms that may also be associated with IBD:

• Fever

• Loss of appetite

• Weight Loss

• Fatigue

• Night sweats

• Loss of normal menstrual cycle

Types of Crohn’s Disease:

Ileocolitis: The most common form of Crohn’s, ileocolitis affects the end of the small intestine (the ileum) and the large intestine (the colon). Symptoms include diarrhea and cramping or pain in the right lower part or middle of the abdomen. This type is often accompanied by significant weight loss.

Ileitis: This type affects only the ileum. Symptoms are the same as ileocolitis. In severe cases, complications may include fistulas or inflammatory abscess in right lower quadrant of abdomen.

Gastroduodenal Crohn’s disease: This type affects the stomach and the beginning of the small intestine (the duodenum). Symptoms include loss of appetite, weight loss, nausea, and vomiting.

Jejunoileitis: This type is characterized by patchy areas of inflammation in the upper half of the small intestine (the jejunum). Symptoms include mild to intense abdominal pain and cramps following meals, as well as diarrhea. In severe cases or after prolonged periods, fistulas may form.

Crohn’s (granulomatous) colitis: This type affects the colon only. Symptoms include diarrhea, rectal bleeding, and disease around the anus (abscess, fistulas, ulcers). Skin lesions and joint pains are more common in this form of Crohn’s than in others.

Types of Ulcerative Colitis:

Ulcerative Proctitis: For approximately 30% of all patients with ulcerative colitis, the illness begins as ulcerative proctitis. In this form of the disease, bowel inflammation is limited to the rectum. Because of its limited extent (usually less than the six inches of the rectum), ulcerative proctitis tends to be a milder form of ulcerative colitis. It is associated with fewer complications and offers a better outlook than more widespread disease.

Proctosigmoiditis: Colitis affecting the rectum and the sigmoid colon, the lower segment of colon located right above the rectum. Symptoms include bloody diarrhea, cramps, and a constant feeling of the need to pass stool, known as tenesmus. Moderate pain on the lower left side of the abdomen may occur in active disease.

Left-sided Colitis: Continuous inflammation that begins at the rectum and extends as far as a bend in the colon near the spleen called the splenic flexure. Symptoms include loss of appetite, weight loss, diarrhea, severe pain on the left side of the abdomen, and bleeding.

Pan-ulcerative (total) Colitis: Affects the entire colon. Symptoms include diarrhea, severe abdominal pain, cramps, and extensive weight loss. Potentially serious complications include massive bleeding and acute dilation of the colon (toxic megacolon), which may lead to an opening in the bowel wall. Serious complications may require surgery.

Causes and who’s affected:

As many as 700,000 Americans may be affected by Crohn’s Disease and Ulcerative Colitis. It is equally common in men and women and while it can affect a person at any age there is a higher risk during the years from 18-35. The cause of IBD is not fully understood but there is a connection between diet and stress; as well as hereditary, genetics and/or environmental factors that play a role in the development of IBD. Studies have shown a greater risk of 5-20% increase in someone acquiring this disease if a “first-degree” relative (parent, child, sibling) has it and an even greater chance if both parents have an IBD. Crohn’s is most common among people with Eastern European backgrounds and it is increasing in number for African Americans. Ulcerative Colitis is more common among Europeans with a Jewish background heritage.

The environment that you put yourself in plays an important role as well. The occurrence is higher in “developed” countries than in “underdeveloped countries, higher in urban areas rather than rural, and in northern versus southern climates.

Treatment with Chinese Medicine:

acupuncture-lakewood-ca-269x300Due to the differential diagnosis that is applied in Chinese Medicine there are different “patterns” that exist when dealing with a disease. This is a similar idea to the different types of Crohn’s Disease and Ulcerative Colitis described above. However, with Chinese Medicine, the patterns are based off of the symptoms the patient is currently experiencing as well as their history, their facial color, body odor, general demeanor, abdominal diagnostic, pulse diagnostic and tongue diagnostic. All of this information is compiled which leads to one of many “diagnostic patterns” to which the according acupuncture points, herbal formula, diet and lifestyle is prescribed. Chinese Medicine is a powerful therapy that can help treat severe cases and help keep mild cases and patients who are in remission stay in remission.

Before we discuss the differential diagnosis, there are a few terms that need to be explained. First one is the “Organ” system. In Chinese Medicine each organ is attributed to specific functions that don’t necessarily match a scientific viewpoint. For example the “Spleen” and “Stomach” are considered to be in charge of the digestive functions and water metabolism in Chinese Medicine. The “Spleen” actually handles some of the function of the “Western” spleen, pancreas and small intestine. The “Liver” has to do with the free flow of qi, which is easily obstructed by stress, emotions, diet and lifestyle. The “Kidney” can be attributed to water metabolism, as well as genetics and our “reserves.” The term “burning the candle at both ends” is a great way to describe how stress and lifestyle can damage the Kidneys. The “Heart” has to do with our emotions and deals with blood. When the digestive system isn’t absorbing food properly we cannot produce the nutrients and blood needed to support these organs. “Heat” refers to inflammation and “Dampness” refers to water metabolism malfunction. Both of these can manifest in numerous ways, as you will see below.

Below are examples of some different patterns that could be “diagnosed” as Crohn’s Disease or Ulcerative Colitis and what the treatment principle should be.

• Spleen Qi Deficiency: Intermittent dull abdominal pain that is alleviated with pressure, abdominal distention, early satiety, nausea, loose stools or diarrhea, loss of appetite, waxy pale or sallow complexion, fatigue, weakness, shortness of breath with exertion, spontaneous sweating, dizziness, and light headedness. Might have mild bleeding of dark, purplish blood, or less commonly, red blood preceding or following a bowel movement; or black, tarry, sticky, unformed stools; or occult blood in the stool discovered upon routine testing. There may be other signs of bleeding, such as heavy menstrual periods or easy bruising.

  • Tongue: pale and swollen, with tooth marks (or pale and thin with significant blood deficiency).
  • Pulse: Thready and weak or moderate.
  • Treatment Principle: Strengthen Spleen, supplement and elevate qi. Nourish Blood and stop bleeding.

• Liver Qi invading the Spleen: Recurrent Diarrhea which may be urgent and preceded by cramping abdominal pain. The pain is relieved following defecation. The diarrhea may alternate with constipation. Symptoms become worse with stress and tension or eating. There is a possibility of mucus and blood in the stool. Other signs and symptoms include abdominal distention, poor appetite, nausea, heartburn, indigestion, borborygmus, flatulence and belching, which relieve abdominal discomfort, hypochondriac discomfort, ache and tightness generally worse on the right side, irritability, depression, moodiness, shoulder and neck tension, temporal or tension headaches, cold fingers and toes, premenstrual syndrome and breast tenderness.

  • Tongue: normal or darkish body, or pale, or with slightly red edges: greasy coat especially over the root (depending on the degree of heat, deficiency and Dampness.
  • Pulse: Wiry
  • Treatment Principle: Harmonize the Liver and Spleen, regulate Liver qi, Support and strengthen Spleen, Alleviate spasm and pain, and stop diarrhea.

• Blood Stagnation: Chronic Diarrhea with a feeling of incomplete evacuation or tenesmus. The stools may be purple or black, sticky or tarry. The diarrhea may alternate with constipation.Fixed and localized, sharp or stabbing abdominal pain (usually in the lower left quadrant) which is worse with pressure. Dark complexion, dark rings around the eyes and purple nails. Spider naevi or vascular abnormalities over the abdomen, face and legs (particularly the inner knee and ankle).

  • Tongue: purple or with brown or purple stasis spots; sublingual veins dark and distended
  • Pulse: wiry, choppy or thready.
  • Treatment Principle: Transform and eliminate stagnant Blood from the Intestines.

• Damp Heat dysenteric disorder: Frequent, foul smelling, explosive diarrhea with blood, mucus and pus: the mixture of mucus and blood will vary depending on the balance of Heat and Damp.Burning anus, tenesmus, colicky abdominal pain, abdominal distention, scanty concentrated urine, red complexion, red eyes, dry mouth, and thirst (maybe with little desire to drink). In the early stages there may be fever and chills, headache and a floating pulse.

  • Tongue: greasy yellow coat; with more Heat a red tongue body and a dry coat; with more Dampness, a thick greasy tongue coat
  • Pulse: slippery and rapid.
  • Treatment Principle: Clear Damp Heat from the Intestines and Regulate Qi and Blood, stop pain.

• Spleen and Kidney Yang Deficiency: Chronic and relentless diarrhea which is thin, watery and mucoid, and may contain pus and blood. In severe cases there may be incontinence of stools and rectal prolapse. The diarrhea is worse from exposure to cold and cold foods. Mild tenesmus or a dragging sensation in the lower abdomen, not relieved by diarrhea. Mild persistent abdominal pain, which is better with warmth and pressure. Loss of appetite, listlessness, fatigue exhaustion, depression. A waxy pale or sallow complexion, cold extremities, cold intolerance, weakness and soreness of the lower back and legs.

  • Tongue: Pale and swollen with a thin white coat.
  • Pulse: deep, thready, weak and slow.
  • Treatment Principle: Warm and Strengthen the Spleen and Kidney Yang. Disperse Cold, transform Dampness. Astringe diarrhea and elevate qi.

• Yin Deficiency with Residual Damp Heat : Chronic diarrhea with small quantities of sticky mucus and blood. Frequent urge to defecate but often in vain. Mild lower abdominal pain, tenesmus, loss of appetite, nausea, dry mouth and lips, thirst worse at night, afternoon or tidal fever that’s worse at night. Heat in the palms and soles, nightsweats, flushing , emaciation, weight loss.

  • Tongue: red or scarlet and dry, with a greasy or peeled coat.
  • Pulse: thready and rapid.
  • Treatment Principle: Nourish and supplement yin and clear residual Damp Heat. Nourish and regulate Blood and stop dysentery.

• Heart and Kidney Yin Deficiency: Recurrent mouth ulcers, which appear in clusters and tend to aggregate on the tongue or tongue tip. The ulcers are painful and hot, with a narrow, slightly swollen, mildly red margin. They frequently recur and persist for up to several weeks before resolving. Often of many years duration, the ulcers tend to be provoked or aggravated when the patient is stressed, anxious or upset. Nervous, anxious individual, insomnia, vivid dreaming, panic attacks, palpitations, forgetfulness, dizziness, tinnitus, lumbar ache, sensation of heat in the palms and soles, dry mouth and throat, night sweats.

  • Tongue: red with little or no coat, redder at the tip.
  • Pulse: Thready and rapid.
  • Treatment Principles: Nourish Heart and Kidney yin. Clear Heat, calm the (spiritual) Shen.

Forms of treatment include acupuncture, herbal formulas (which can be taken internal or external), Massage/tuina, dietary therapy, exercise and lifestyle consultation. When we utilize and multiple forms of therapy results are seen at a rapid rate.

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*Disclaimer: The information offered in this paper is not intended to diagnose but rather to inform the public about IBD and give a brief look at how Chinese Medicine looks at and treats IBD.
References:
http://www.ccfa.org /
• Will Maclean and Jane Lyttleton, (2003), Clinical Handbook of Internal Medicine “The
Treatment Of Disease with Traditional Chinese Medicine” Volume 2 Spleen and Stomach, University of Western Sydney


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One of our readers wrote recently, saying her arthritis pain was really hard to deal with . . . Here is Dede’s answer, and hopefully some tips for others who also suffer from the related symptoms of arthritis.

Arthritis pain? Oh, I have it, too!

Arthritis is such a drag. but remember: We are all in this together . . .

Here’s what you can try:

    Daily morning yoga with Rodney Yee DVD called “AM/PM Yoga”
    Take Omega 3 fish oil capsules 2 “softgel” caps up to 2-3 daily with food (use best brand, highest quality—Dede uses Metagenics “OmegaGenics/EPA-DHA 720”)
    Take a lavender bath with candles nightly before bed and use Epsom Salts in the water
    Eat the healthiest diet: no sugar, caffeine (if you must, water down coffee and green tea okay), dairy or red meat
    Make an appointment with a physical therapist (insurance usually covers this!)
    Go to see an experienced acupuncturist (Chinese medicines best) and have 3-4 treatments in 2 months to see it it helps (make sure it is someone trustworthy with good recommendations)
    Get a massage monthly to help cleanse and detoxify
    Every time before your bath or shower use a dry Loofa sponge and brush your skin all over briskly to accentuate healthy cellular growth
    Get 8-9 hours of sleep nightly
    Use a castor oil pack to lay on sore joints—you can buy castor oil at a health food store, and Dede soaks a wool rag with it, to make a compress, then put SaranWrap over that, followed by a small towel, followed by a heating pad—ahhhh! The pain miraculously fades away, and you are forced to sit still and can read a book. Or, even better, you can meditate while you heal.
    Walk 3-4 miles every day to clear your mind and keep your joints fluid and muscles strong to support the bones
    Ride a bike for cross training — great for quad strength, and it is easier on arthritic knees…

Monday is the “Living With Crohn’s & Colitis Bicycle Challenge”!!! Get out there and start pedaling—post photos of you on a bike on our Facebook wall, and “Thnk Pos!”


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Most research on digestion, and the associated bowel diseases that are unfortunately on the rise in the world, starts with food and chewing. They talk about the act of chewing (mastication), and how the food is broken down with saliva, and goes down the esophagus, where it then enters the stomach and is further broken down (peptides and stomach acid)—then the slowly digesting food enters the small intestine.

We get the basic science of food and sustenance. I am interested in what happens INSIDE the small and large intestines, and why, for some of us, the microbial balance is disrupted resulting in bowel disease—which, in some cases like Crohn’s can be incurable and a lifelong struggle.

The small intestine is in fact smaller (in diameter) than the large intestine. It is where vital absorption of nutrients for the body’s health occurs. I think of it this way— to use a road biking analogy—if your tires are inflated, and the road is smooth, the inner tube is fresh and new, your feet are on the pedals and the movement spins the wheel with a steady and productive ease, then your digestive tract functions as it should. All antigens, are dealt with swiftly, and promptly, with the T-helper cells, and white blood cells, doing their job like a little army of white-suited patrols, following behind you like a bicycle sag-support wagon. The road is flat—no bumps, or traffic jams, or debris!

An antigen is any substance that causes your immune system to produce antibodies against it. An antigen may be a foreign substance from the environment such as chemicals, bacteria, viruses, or pollen. An antigen may also be formed within the body, as with bacterial toxins or tissue cells.

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I won’t bore you with the details… But I did get into an argument the other day with my friend, Geoff. He tends to be a “know it all,” but then again, I pretend to be one, too! I said, “the digestive tract is longer than a football field!” To which he replied, “You’re wrong, and that’s crazy!” Together we looked on Google and found that the length of the digestive tract is about 20-30 feet, which is the WIDTH of a basketball court!!

Duly chastised, I began to ponder the sports field/court analogy, and the physical image/link to gut disease…. We, especially Americans, “get” the length of a court or a football field — soccer, maybe not so much! The physical representation, or image, of the digestive tract spread out in one long line across a basketball court makes me smile and cringe at the same time. I love basketball, don’t get me wrong! My daughter played D3 ball, and I am a big Carolina fan, but last night I was watching the Duke-Maryland game (Blue Devils lost!), and my mind occasionally saw a black line across the court. . . .

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Now that we know the length of the digestive tract, let me add by saying the small intestine is much longer, and more vital to our nutritional health. There is an excellent research site and description of the process from a bio-chemical perspective here.

Below, is a description of the process of digestion, and note that in Celiac disease, the villi is damaged and does not function as it should. For those of us who most likely have what Dr. Kalish refers to as sub-clinical gluten intolerance, or Leaky Gut (damage to mucosal lining), it is imperative to strengthen our immune system which can become compromised: lifestyle changes, supplements, and Eastern medicine are all great ways to help us balance and strengthen our immune systems. For us Crohnnies, the actual wall of the small intestine is damaged, for uc-ers, the large intestine is inflamed and irritated, but can be removed to alleviate symptoms.

The small intestine is a long and narrow tube about 6 to 7 meters (20 to 23 feet) long. Food completes its chemical decomposition in which a compound is split into other compounds by reacting with water in the small intestine with the help of the liver, pancreas, and intestinal glands who pour their secretions into it. In the small intestine, there are an enormous number of tiny projections called villi, which absorb the end products of digestion. Villi and folds in the walls of the small intestine cover the lining and greatly increases the surface for absorption, which contributes to the length of the small intestine. The human small intestine has a surface area about ten times greater than the skin surface.

The large intestine is wider in diameter but shorter than the small intestine. It is only about 1.5 meters (5 feet) long. There is no decomposition of food in the large intestine. Bacteria in the large intestine break down any quantity of proteins that have not been completely digested. The large intestine is mostly used to store feces or waste, which consists of 10 to 50 percent of bacteria, undigested cellulose of plant cell walls, minerals, and water. This is then eliminated through the anus. (Physics Factbook)

The circular bicycle wheel image, for me, is much more compatible with my idea of the function of the small bowel. The large snakelike image of the width of the basketball court helps to justify the length in my mind, but the real process—that of digestion—is vital to our health, and it is our job to keep the tires smooth and running.

Happy spring everyone! Get out your bicycles, and tune them up! April 1st marks the beginning if the “Living With Crohn’s & Colitis Bicycle Challenge”…. Please post your progress here, and on our Facebook and Twitter pages—if you can’t ride, try walking every day!

Last, but not least, if you want to support me in my Half Marathon for the Crohn’s & Colitis Foundation (www.ccfa.org) this summer, please check out my fundraising page. I am excited to run with Team New England, and you can read why, here….

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A new year’s tip from LWCC—start planning a small vegetable garden for spring! Just ’cause we (or someone we love) has Crohn’s or uc, doesn’t mean we can’t enjoy food and the delicate taste sensation of fresh herbs!

I am sitting here in my kitchen at home in Vermont, after a lovely two weeks of vacation spent with my family. As I was drinking my morning tea, I looked up and saw this:

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So, what does this photograph mean? Right now, it symbolizes rebirth. I started the amaryllis before the holidays from a bulb…and now it is in peak bloom—hope; new life, new meaning…. But lest I wax too poetic here, I should note that a really determined chipmunk (probably the same invader of my garden last summer) is destroying my bird feeder as I write this! As I watch the greedy scavenger—the rodent—I think of the Hindu god, Shiva Nataraja, The Lord of the Dance:

The two most common forms of Shiva’s dance are the Lasya (the gentle form of dance), associated with the creation of the world, and the Tandava (the violent and dangerous dance), associated with the destruction of weary worldviews – weary perspectives and lifestyles. In essence, the Lasya and the Tandava are just two aspects of Shiva’s nature; for he destroys in order to create, tearing down to build again.

~

Since I found out I was in the midst of a severe flare up just six weeks ago, I have been plagued with fear that I will need surgery, have to take Prednisone again, and live again in the cycle of disease. Prednisone, especially, is a drug I hope I never have to take again—though I never got the symptoms of the round face, the bloating, etc,, I got the inner turmoil kind of symptoms: the frenetic feeling of gears winding up inside your body….not a good state to live in. Yes, those are the fears that lock us inside of ourselves when we are sick.

Well, not to dwell on that is easier said than done!

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Here is a photo of my iPhone from when I was in Mexico last week…. As I lay in my hotel room bed for a whole day of fever and drifted in and out of consciousness, I put all the Spanish words for my disease in my “Favorites” in Spanish Dictionary, for fear I would have to explain to the hotel manager in case he had to call an ambulance to take me to the hospital (Merida was probably closest, but the hospital in Tulùm looked like a place for the bedraggled tourists to come to get treated for sunburns!). I was convincing myself that the flu I caught traveling was really a worsening of my flare up into a bowel obstruction.

My irrational fears were perhaps due to exhaustion and loneliness (my family went off to the beach ;(…. But I gradually realized that my fears were making me sicker! I always had trouble traveling when I lived with active Crohn’s-coltis for twelve years. We would pack our kids into the car, tents, camping gear, etc., and travel someplace like Okrakoke Island off the Carolina’s…..I remember that trip fifteen years ago, and being sick as a dog in bed for days, horribly bloated, and despairing the entire time…. I will never go back to that dark period of disease (though I hope to visit Okrakoke again someday in a normal state!), for it was a frame of mind that did nothing but foster the negativity around my life.

So, fast forward to hotel room in Tulùm. The cheerful towels our maid, Gabriella, created in animal sculptures, made me feel worse—their sweet little eyes stared out at me across the bed, and I felt they were mocking me — fever, perhaps?! After five hours of lying in bed and drinking nothing but water, and learning Spanish words about diseases of the bowel, I was ready for a change… I got up, showered, went out with my family for dinner, and my son helped me order a plate of the blandest food we could order at the restaurant, el Capitan.

Perfecto! I felt revived—chicken and vegetables will do that for me, along with a light cranberry juice (pure, no additives), mixed with mineral water. I thought the fact that I wasn’t moving my bowels was because there was a growing obstruction, when in fact it was due to the fact I hadn’t eaten much solid food in the last two days. It is amazing how illness, especially fever, will make us regress. We all want to be back in our mother’s bed with someone rubbing our forehead! My husband, who is not the most hovering-docile sort, was the practical one who said, “You haven’t eaten much at all!”

Well, that is my wisdom for the day…. Or is it wisdom? It seems more like common sense—keep the food journal going, and when you travel especially don’t forget it, or when you are faced with a new situation, like going off to college, or camp, or starting a new job…. It is essential for those of us who live with disease to be able to ask for help, but also to realize that our self pity might be making us sicker.

~

It is with that thought, and positive energy, that I want all of us to have in our Crohn’s & Colitis community as we move into the new year. “Think Positive,” was told to me by a doctor when I cried in my hospital bed, a few weeks before my bowel resection when I was overtaken by fear of the unknown and shaken by the heavy dose of steroids they had me on. A medical student, Dr. Osei Bonsu, DO, (currently an Internist in Galax, VA), was his name—and he held my hand and gave it a squeeze.

~

Now, back to planing my vegetable garden for spring planting….just a few months away.

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“What goes around comes around . . .” may actually be an old proverb meaning “the status eventually returns to its original value after completing some sort of cycle”. . . . Or, “a person’s actions, whether good or bad, will often have consequences for that person.”

I am thinking about that old saying a lot lately, due to the news that I have a severe recurrence of Crohn’s disease. Crohn’s can be found anywhere in the intestinal tract, from the mouth to the anus, but it usually presents in the terminal ileum, as it did in my case. Since I no longer have the 20 centimeters of terminal ileum (or the ileo secel valve that links it to the large colon), I now have the spread of the disease on the other side of my sutchers…. 20 more centimeters of small bowel are severely inflamed. For the record, that is a total of almost 2 feet, 20cm being around 8 inches. Here is a good definition:

The small intestine (or small bowel) is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. The primary function of the small intestine is the absorption of nutrients and minerals found in food. The average length of the small intestine in an adult human male is 6.9 m (22 feet 6 inches), and in the adult female 7.1 m (23 feet 4 inches). It can vary greatly, from as short as 4.6 m (15 feet) to as long as 9.8 m (32 feet).[3][4] It is approximately 2.5–3 cm in diameter. The small intestine is divided into three structural parts: Duodenum, Jejunum, and Ileum.

The small intestine is where most chemical digestion takes place. Protein, lipids (fats) and carbohydrates are broken down and a process called diffusion takes place where nutrients are absorbed into the blood vessels through the wall of the small intestine (the terminal ileum is where the B-12 and bile salts are specifically absorbed). There are all sorts of mucosa and wrinkly tissue down there—hence the language from my latest colonoscopy had terms like “serpentine” to describe the tracks of inflammation they found). There is a lot going on in the bowel—the second brain—including the delicate villi, which is Latin for shaggy hair (I love these descriptions!).

Do you have Crohn’s or uc?
If so, we have even more in common! Interestingly, I keep my book off my Facebook personal page—not to hide my disease, but to not “promote” my book, for fear people will think I am only selling a medical memoir written with a naturopathic doctor to make money (not!!).

Maybe I should become brave like Mike McCready, and be even more open….in this teeny tiny post, I will explain that I have lived with this sucky disease since I was in college, and was only diagnosed when I was forty.

When I turned 50, I lost a significant portion of both large and small bowel, and I have enjoyed a great quality of life ever since my surgery—pain-free! What a joy to have my life back!!! I take nothing for granted, and I wake up each and every day feeling blessed and lucky (I’m Irish), and I do not like to listen to self-absorbed people talk on and on about, you know….. Anyway, as I was sayin’ …. My book is ranked number 11 on Amazon in disease, and consistently No. 1, 2, or 3, in Kindle’s Gastroenterology ranking. Many people actually write to me and say thanks—the greatest gift in the world! I want to say “thank you” to my readers, my friends, and all of the community—anyone who has struggled with disease, or losing a loved one—we are all connected!

What does Karma mean?
A Sanskrit word, and one from Hindu-Buddhist religious traditions, it means that “the total effect of a person’s actions and conduct during the successive phases of his existence, regarded as determining his next incarnation.” I don’t know about you, Dear Reader, but I am ready for this cycle of disease to be over!

From the Dalai Lama
Take into account that great love and great achievements involve great risk.
When you lose, don’t lose the lesson.
Follow the three R’s:
– Respect for self,
– Respect for others and
– Responsibility for all your actions.
Remember that not getting what you want is sometimes a wonderful stroke of luck.
Learn the rules so you know how to break them properly.
Don’t let a little dispute injure a great relationship.
When you realize you’ve made a mistake, take immediate steps to correct it.
Spend some time alone every day.
Open your arms to change, but don’t let go of your values.
Remember that silence is sometimes the best answer.
Live a good, honorable life. Then when you get older and
think back, you’ll be able to enjoy it a second time.
A loving atmosphere in your home is the foundation for your life.
In disagreements with loved ones, deal only with the current situation. Don’t bring up the past.
Share your knowledge. It is a way to achieve immortality.
Be gentle with the earth.
Once a year, go someplace you’ve never been before.
Remember that the best relationship is one in which your love for each other exceeds your need for each other.
Judge your success by what you had to give up in order to get it.
If you want others to be happy, practice compassion.
If you want to be happy, practice compassion.

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