Table of Contents

Forword xxi

Introduction 1

About This Book 1

Conventions Used in This Book 2

What You’re Not to Read 2

Foolish Assumptions 2

How This Book is Organized 3

Part I: The Who, What, and Why of Crohn’s and Colitis 3

Part II: Getting Medical Help 3

Part III: Healing and Dealing with the Disease 4

Part IV: Living and Coping with Crohn’s and Colitis 4

Part V: Considering Special Populations with Crohn’s and Colitis 5

Part VI: The Part of Tens 5

Icons Used in this Book 5

Where to Go from Here 6

Part I: The Who, What, and Why of Crohn’s and Colitis 7

Chapter 1: Crohn’s and Colitis One Step at a Time 9

Knowing Crohn’s and Colitis 9

Getting the Treatment You Need 10

Recognizing That You’re Not Powerless 11

Living a Full Life with the Disease 12

Special Advice for Pregnant Women and Kids 12

Chapter 2: Defining Crohn’s and Colitis 13

What Crohn’s and Colitis Are 13

Looking at the big picture: Inflammatory bowel disease 13

Zeroing in on Crohn’s and colitis 14

The Signs and Symptoms 19

Blood in stool 21

Diarrhea 22

Abdominal pain 23

Urgency 23

Tenesmus 23

Other symptoms 23

Other Parts of the Body Involved in Crohn’s and Colitis 25

Bones and joints 25

Skin 27

Liver and gallbladder 28

Kidneys and bladder 29

Eyes 30

Complications of Crohn’s and Colitis 30

Intestinal complications 31

Nutritional complications 34

The cancer connection 38

Chapter 3: How the Digestive System Works 41

Tracking the Journey of Food inside the Gastrointestinal Tract 42

The oral cavity (or mouth) 42

The stomach 44

The small intestine 45

The large intestine 45

The anus 46

Getting Help from the Liver, Pancreas, and Gallbladder 46

Liver 46

Pancreas 47

Gallbladder 47

Understanding How Inflammation Affects the Digestive Process 48

Gastritis: Inflammation of the stomach 48

Enteritis: Inflammation of the small intestine 49

Colitis: Inflammation of the large intestine 50

Proctitis: Inflammation of the rectum 51

Chapter 4: Who Gets Crohn’s and Colitis and Why 53

Who Gets Crohn’s and Colitis 53

The Role of the Immune System in Crohn’s and Colitis 54

An immune system primer 54

When your gut’s immune system goes awry 58

Environmental Factors 58

Food 58

Air 60

Hygiene 60

Other environmental factors 61

Genes Gone Bad: The Role of Genetics 63

How genes work 63

The role of family history 64

Key genes for Crohn’s and colitis 65

Getting a genetic test 66

Part II: Getting Medical Help 67

Chapter 5: Assembling Your Healthcare Team 69

Finding the Right Doctor for You 69

Why you need a specialist 70

How to choose among the specialists in your area 70

Your first visit 71

Rounding Up Other Key Players 73

Your primary-care physician 73

Nurses 73

Physician assistants 75

Registered dietitians 75

Psychiatrists 76

Surgeons 76

Friends and family 76

Chapter 6: Getting a Diagnosis 77

Preparing for Your First Visit 77

Charting your signs and symptoms 78

Assembling your medical records 81

Talking to Your Doctor 82

Getting over the embarrassment 82

Communicating your symptoms 83

Being realistic about your expectations 83

Knowing What to Expect during a Physical Exam 84

General physical exam 84

Focused physical exam 84

Rectal exam 85

Being Poked and Prodded for Medical Tests 85

Blood tests 85

Stool tests 87

Scans 87

Endoscopy 88

Identifying Other Diseases That Mimic Crohn’s and Colitis 89

Chapter 7: Taking Medications for Crohn’s and Colitis 93

Steroids 94

Types of steroids 94

How steroids work 95

When steroids are used 96

Side effects of steroids 97

Aminosalicylates 98

Types of aminosalicylates 98

How aminosalicylates work 99

When aminosalicylates are used 100

Side effects of aminosalicylates 100

Immunomodulatory 101

Types of immunomodulators 101

How immunomodulators work 102

When immunomodulators are used 102

Side effects of immunomodulators 103

Biologics 104

Types of biologics 104

How biologics work 105

When biologics are used 105

Side effects of biologics 106

Antibiotics 109

Types of antibiotics 109

How antibiotics work 109

When antibiotics are used 109

Side effects of antibiotics 110

Other Medications 111

Antidiarrheals 111

Bile salt binders 112

Analgesics 112

Iron 113

Calcium and vitamin D 113

Vitamin B12 114

Chapter 8: Considering Surgery 117

When You May Need Surgery 117

For Crohn’s disease 117

For ulcerative colitis 118

Types of Surgery 119

Resectioning the small intestine 119

Removing a stricture 121

Treating fistulas 122

Draining abscesses 123

Resecting the colon 124

Pouch surgery 126

Complications from Surgery 128

Short-term complications 128

Long-term complications 131

Ostomy: What It Is and How to Deal with It 133

Types of ostomy 133

When you may need ostomy 134

How to care for your stoma 135

Your ostomy pouch 135

Ostomy complications 138

Part III: Healing and Dealing with the Disease 141

Chapter 9: Paying Attention to What You Eat 143

Considering the Impact of Nutrition 143

The impact on your immune system 144

The impact on wound healing 145

Identifying the Nutrients You Need 145

Macronutrients 145

Micronutrients 150

Fiber or No Fiber? That is the Question 154

Types of fiber 155

Why fiber matters 155

Fiber’s role in Crohn’s and colitis 156

Considering Specialized Diets for Crohn’s and Colitis 157

Liquid diets 157

Low-residue diets 158

Lactose-free diets 160

Elemental diets 161

Nutritional Support: When You Can’t Go It Alone 161

Enteral feeding: Feeding through a tube 161

Total parenteral nutrition: Feeding directly into your veins 162

Nutrition supplements: Boosting your diet 163

Chapter 10: Preventing Health Problems 165

Getting Vaccinated 165

Why vaccination matters 166

Which vaccines you need 166

Caring for Your Skin: It’s Not Just Cosmetic 170

Identifying the skin complications you may face 170

Recognizing and reducing your risk of skin cancer 171

Caring for your skin “down there”: Perianal skin care 172

Boning Up on Bone Health 173

Opening up about osteopenia and osteoporosis 174

Seeing what Crohn’s and colitis can do to your bones 175

Managing bone loss 176

Screening for Cancers 178

Colon cancer 178

Cervical cancer 180

Chapter 11: Alternative and Complementary Therapies 181

Let’s Get Physical: Exercise 182

Recognizing the health benefits of exercise 182

Looking at how exercise can help with Crohn’s and colitis 183

Gathering some useful exercise tips 184

Working Over-Thyme: Herbal Therapy 185

Healing with herbs 185

Identifying beneficial herbs for Crohn’s and colitis — and knowing which herbs to avoid 186

Homeopathy 187

Getting help from homeopathy? 188

Homeopathy and Crohn’s and colitis 189

Traditional Chinese Medicine 189

Understanding traditional Chinese medicine 190

Controlling Crohn’s and colitis with traditional Chinese medicine 190

Mind-Body Intervention 191

Aromatherapy 191

Hypnotherapy 192

Yoga and meditation 192

Music therapy 192

Support groups 192

T’ai chi 193

Worm Therapy 193

Putting worms to work for your health 193

Seeing how worms can help Crohn’s and colitis 194

Part IV: Living and Coping with Crohn’s and Colitis 195

Chapter 12: Living with Crohn’s and Colitis 197

Dealing with Your Diagnosis 197

Stage 1: Denial 198

Stage 2: Anger 199

Stage 3: Bargaining 201

Stage 4: Depression 201

Stage 5: Acceptance 202

People Who Need People . . .: Keeping Your Relationships Going Strong 202

So, what’s new with you? Telling people about your diagnosis 203

Come here often? Dating with Crohn’s and colitis 205

Like a horse and carriage: Keeping your marriage strong 206

Caring for a Loved One with Crohn’s or Colitis 207

Finding little things that help a lot 207

Helping during a flare 208

Helping after surgery 208

Getting the help you need for yourself 209

Chapter 13: Avoiding Triggers 211

Smoking: Why You Need to Quit 211

Drugs: Just Say No? 214

Non-steroidal anti-inflammatory drugs 214

Antibiotics 215

Stressing Out 215

Food, Glorious Food 217

Artificial sweeteners 217

High-fat foods 218

High-fiber foods 218

Caffeine 219

Dairy products 220

Alcohol 221

Mr. Sandman, Bring Me a Dream 222

What sleep does for your immune system 222

The effect of sleep on Crohn’s and colitis 222

How to get a good night’s sleep 223

Chapter 14: Working and Traveling with Crohn’s and Colitis 225

Working with Crohn’s and Colitis 225

Working your job hunt around your disease 226

Telling your employer and co-workers about your condition (or keeping it to yourself) 226

Starting your day off right 228

Planning your commute 228

Packing an emergency kit 228

Speed bumps ahead: Coping with job-related challenges 229

Taking advantage of the Family and Medical Leave Act 230

On the Road Again: Traveling with Crohn’s and Colitis 232

Assembling a vacation survival guide 232

Getting immunized before you travel abroad 233

Packing for your trip 233

Avoiding travelers’ diarrhea 235

Finding a bathroom . . . fast! 236

Part V: Considering Special Populations with Crohn’s and Colitis 195

Chapter 15: Kids with Crohn’s and Colitis 239

Identifying How Crohn’s and Colitis are Different in Kids Than They are in Adults 240

Gender 240

Symptoms 240

Effect on growth and development 241

Getting a Diagnosis 243

Managing Crohn’s and Colitis in Kids 244

Monitoring medications 244

Paying attention to nutrition 248

Vaccinating your child 249

Growing Up with Crohn’s and Colitis 250

Preschool: C is for Crohn’s and colitis 251

Surviving school 251

Turning 18: Adulthood begins (at least in theory) 252

Going off to college 253

Chapter 16: Having Sex and Getting Pregnant with Crohn’s and Colitis 255

Sex and Fertility 255

Sexual activity 256

Contraception 257

Your menstrual cycle 259

Fertility 259

Pregnancy 260

Pregnancy planning 261

While you’re pregnant 262

The big day and beyond 266

Part VI: The Part of Tens 269

Chapter 17: Ten Myths about Inflammatory Bowel Disease 271

Diet is the Cure 271

Kids Get It from Their Parents 272

It’s Caused by Stress 272

You Can’t Get Pregnant if You Have It 273

Surgery Is Required 273

If You Have It, You’re Guaranteed to Get Cancer 274

You’re Responsible for Your Flares 275

Surgery Cures It 275

You Can Stop Taking Your Medications if You Feel Better 276

You Have to Stop Taking Your Medications during Pregnancy 277

Chapter 18: Ten Reliable Resources 279

The Crohn’s and Colitis Foundation of America 279

The United Ostomy Associations of America 280

You and IBD 281

MyIBD.org 281

WebMD 282

Mayo Clinic 282

The Culinary Couple’s Creative Colitis Cookbook 283

The International Association for Medical Assistance to Travelers 284

KidsHealth 284

IBD U 285

Glossary 287

Index 297

About the Author

Tauseef Ali, MD, is an expert in the field of inflammatory bowel disease. Currently, he serves as a faculty member in the Section of Digestive Diseases and Nutrition at the University of Oklahoma College of Medicine. He is also the director of the OU Physicians Inflammatory Bowel Disease Center. Dr. Ali has served as an academic editor-in-chief of the World Journal of Gastroenterology.