I Have a Problem

By: Sang Hyub Kim, DPM Candidate c/o 2018, New York College of Podiatric Medicine

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I was diagnosed with ulcerative colitis in 2009. For the past five years, I have literally taken tons of immunosuppressant medications, ranging from corticosteroids (prednisone), to chemotherapeutics (6-Mercaptopurine) in an effort to suppress the inflammation in my colon. Currently, I inject adalimumab (Humira^®) into my thigh every two weeks, hoping for a remission.

Ulcerative colitis (UC) is an autoimmune disease that triggers inflammation in the large intestine, causing ulcers and open sores. In severe cases, scar tissues may form and the infected colon must be surgically removed and replaced via a colostomy. During a colostomy, a surgeon creates a stoma, a hole that connects an organ to the outside environment, in the healthy section of the colon to bypass the rectum and anus. As a result, a patient who undergoes a colostomy must wear an ostomy pouching system to collect intestinal waste.

UC is a chronic illness. Unlike other conditions affecting the gastrointestinal (GI) system, like the stomach flu virus or diarrhea, UC persists forever and cannot simply be cured with an anti-diarrheal medication (e.g. loperamide) or a healthy diet. It is a physiological problem and must be medically monitored and properly controlled with prescribed medications and physician’s visits.

Along with Crohn’s disease, ulcerative colitis is classified as an Irritable Bowel Disease (IBD). Crohn’s disease manifests the same signs and symptoms as UC, but it affects the entire GI tract, from the mouth to the anus. IBD is sometimes called an “invisible illness,” for a patient can appear physically normal and even be happy, but is using the bathroom more than ten times a day, often discharging mucous and bloody diarrhea behind closed doors.

Personally, I have found UC to be socially debilitating as a result of its flare-ups and inflammation. It is hard for me to simply enjoy a beautiful day or to take a stroll in the park without worrying about where the bathroom is. Especially in public places, such as subways or the mall, with no access to a bathroom, I find it difficult to control my bowel movements and many times defecate in my pants. Moreover, the numerous side effects of the drugs I am taking, ranging from nausea to insomnia can sometimes drain my life, causing lethargy, apathy, and hopelessness.

Unlike HIV or cancer, there is a relatively small amount of government funding and support for IBD. Moreover, there is no conclusive scientific research on the relationship between a diet and IBD. Current research states that IBD can be triggered by both genetics and environmental factors such as stress, sleep, diet, infection, or unknown causes. However, physicians and scientists still cannot pinpoint to one source or cure for IBD. There are still a great deal of studies to be done on its cause, treatment, and remission.

Despite the lack of clear answers, I am still optimistic about the future of patients dealing with IBD. Although there is no permanent solution now for IBD, there has been significant progress and development in treatment of IBD in recent years. Living in the United States in this particular generation, I am privileged to administer adalimumab. There are additional medications, such as intravenous infliximab (Remicade^®) and oral mesalamine (Pentasa^®) to experiment with in the future. Through writing about IBD and speaking directly to IBD patients in various support groups, I hope to continue to raise social awareness. With persistent education and fundraisers, future generations of IBD patients can hopefully have an easier time coping medically, mentally, and socially.

[pubmed_related keyword1=”ulcerative” keyword2=”colitis” keyword3=”mesalamine”]