Diary of a Crohn's Flare: The Rules

Playing by “the Rules” doesn’t work anymore.

During my years of remission, dealing with my Crohn’s was something like playing a game.  I learned that certain foods and activities caused problems while other things seemed to not affect me much.  I’ve developed the rules after years of observing how I felt after eating and doing different things made me feel.  As long as I played by the rules, I could count on not feeling too bad.

For example, popcorn caused problems.  Occasionally I would eat popcorn knowing that it might cause pain or even blockage but I could make that decision before hand and pay the consequences if they came to pass.

If I planned to run, then I would fast for several hours before my planned run to reduce the chances of suffering severe diarrhea and cramping.

However, with my recent flare the rules I’ve developed don’t work anymore and I’m finding that deeply unsettling.  Now, I’m working on establishing the rules for my Crohn’s Flare.  So far the rules seem to be that consuming anything can cause problems – pain, bloating, sense of fullness, etc.  Although my stool remain loose, my frequency of bowel movements and quantity of each has decline substantially (although this probably has as much to do with decreased eating) and I worry about keeping my digestive system going.

For perhaps the first time in my life, I'm finding it really hard to eat.  Although my body feels hungry and weak from hunger, the sensation of fullness and the thought of how much pain the eating causes makes it difficult to put food in my mouth.

Other stuff:

This morning I woke up at home and feel much better physically.  I’m feeling better emotionally too.  The pain and bloating have decreased.  Also I can hear and feel food moving through my digestive system.  However that was true on the previous two mornings too, so I’m not assuming I’ve over this particular issue.  I’ve been able to drink some fluids with no ill effects and I’ll try eating something with protein and carbohydrates in it later this morning.

I was able to eat 1 McDonald's hamburger and a small fry with apple juice.  The choice of food wasn't the best (too much sodium doesn't help with the edema from the prednisone) but at least I got some calories with protein.

Later in the afternoon, I started feeling "woozy", a peculiar lightheaded sensation as if the world was spinning.

I also spoke with my Doctor’s assistant and he advised me to remain at 50 mg/day of prednisone and to call back on Monday with an update.  The negative side-effects of the prednisone are beginning to seriously affect me.  My skin has become very oily and I've begun to break out, my legs and arms are swelling and my joints feel as if they're under pressure, I've been getting tingling and pinprick sensations all up and down my arms and legs but especially in the joints.

Diary of Crohn’s Flare: Stuffed!

I’m still learning to deal with the symptoms of this Crohn’s Flare.  They are unlike the symptoms I dealt with when my Crohn’s was active back in the 1990s.  One recurring symptom for me over the last 3 weeks has been after eating only modest amounts of food (solid or liquid) feeling absolutely stuffed, as I had eaten a large Thanksgiving dinner, accompanied by prominent abdominal bloating.

Since my visit to the hospital almost 2 weeks ago, this sensation after eating had ameliorated somewhat.  However, last Tuesday (3/25) after eating only ½ of a sandwich the full sense of being “Stuffed” came back.  The sandwich was a relatively benign (low-residue) affair with roast beef, French bread, Havarti cheese, salad dressing, and a tomato.  Since eating that sandwich I’ve felt persistently felt stuffed with only mild reprieves each morning.

Wednesday morning, I assumed that the reduced sensation meant that I was past whatever has caused the sensation, so I ate a moderate breakfast of scrambled eggs, bacon, and a bagel (all low-residue).  However, the stuffed sensation resumed and I wasn’t able to eat anything the rest of the day and was able to drink only about 12 oz of water through the day.

This morning (Thursday), I awoke with a much less pressure and bloating in my abdomen too.  However, I tried to incorporate my lesson from the previous day.  I only consumed a cup of coffee, about 10 oz of apple juice, and an Ensure nutritional shake.  This did not seem to aggregate the condition but I haven’t gotten any better either.

During my flight home, I broke down and ate some Cheetos and French fries.  Initially they seemed to sit OK but as I write this blog, I can feel the bloating and sense of feeling stuffed return.

I honestly can’t figure out what is causing this sensation.  Since I’m flying, I also don’t have the opportunity to do any internet research on the topic.

My main concern now is that if I can’t even stay properly hydrated with this symptom, how am I going to remain functional for work?  It also means that I won’t be permitted to taper from 50 mg / day of prednisone.  I am already beginning to feel the prednisone affect my body adversely (edema, jittery, problems sleeping, acne, and night sweats).  This too will affect my ability to work.

I had hoped to use the prednisone to bridge me through the eight weeks or so required for the azathioprine to take full effect.  I’m coming to the realization that I don’t have that much time and the choice is being taken out of my hands.

If I don’t see improvement in a few days, I may be forced onto Remicade or Humira to treat this flare.  I’ve already spoken with my doctor about both Drugs and due to cost considerations, I plan to start with the Remicade first.

If these don’t work, will they resort to intravenous feeding?

This is all brand new and scary territory for me.

Perhaps I should resume writing my ADA letter to my company.  Already my coworkers are completely missing the meaning of what I’m telling them about how this flare is impacting my life and ability to work.

Life Inventory: Finances

If someone must step into your life to ensure your household keeps running, perhaps nothing could be as important as a list of your finances: where the money is and was it is for.

I started collecting this information as means of evaluating our finances, were we improving our lives or making them worse?  To this end, my list of finances included both assets (e.g. checking and savings accounts) but also retirement and debt accounts.

The list of accounts included in my financial spreadsheet includes:

Debts / obligations:

• Mortgage
• Second mortgage, HEL, HELOC, etc.
• Revolving credit (credit cards, etc.)
• Auto loans
• Medical loans
• Money that I’ve promised my kids (e.g. assistance with college)
• Other obligations

Assets:

• Checking account(s)
• Savings account(s)
• Investment account(s) (stocks, bonds, money markets, etc.)
• IRA / Roth Accounts
• 401k Accounts
• Treasury accounts
• 529 Accounts (e.g. college savings)
• Universal Gift to minors (UGTM)
• Custodial accounts
• Any other financial assets

If you intend for someone to use this information to keep your household finances running in the event that you can’t (incapacitation or death), then you need to include all of the information a person taking control of these accounts would need.  The information that I’ve included is:

Important information

• Account Name
• The purpose of the account!
• Account Company
• The type of account
• Account number
• URL
• Account username
• Account password
• Balance (positive / negative)

I do not trust including both the username and password digitally (especially on the same document!), so you should either use an electronic account vault (e.g. KeePass2) or you should put a reminder in for the password and then only write the password on the printed sheet that you pass out to your Financial Power of Attorney.

You must trust the person you assign power of attorney!

Diary of a Crohn's Flare: My new normal?

When first diagnosed with Crohn's Disease, my primary complaints were:

• Anemia
• Diarrhea
• Cramping

I did not have constant pain.  Pain came and went through the day.  I didn't realize it at the time but my more recent experience is that the pain was related to eating.

As my disease progressed, so did my drug treatments, especially the prednisone.  Prednisone at first worked very well, but as time passed, its effectiveness declined and the side-effects increased.  Before my surgery in 1998, I was in pain almost constantly and I attributed much of this to the prednisone.

Since my surgery, I've essentially been in remission.  I've still had plenty of Crohn's related issues to deal with (3 fistulas, 2 kidney stones, constant diarrhea, partial small bowel obstructions, cramping, abdominal pain, etc.) but those have been the exceptions.  In general, I've felt pretty good.

In fact, my normal has been feeling good.  When I feel bad I turn to my various coping mechanisms to get me through the bad part until I feel well again.

Since the beginning of this latest bout (last Wednesday), the only times I've been pain free where after I got the dilaudid injection in the hospital and for a short time this morning before I consumed anything for breakfast.

The unwelcome thought creeping into my mind lately has been "is this my new normal?"

I have reveled in my ability to run and do other things despite my Crohn's Disease but this constant pain is something new to my life with Crohn's.  It provides me with a very strong desire to begin the biological drugs.

I did have a couple of hours pain free this morning and in general I seem to be improving but it seems like it's a 2 steps forward and then 1 back type of situation.

Oh yeah, I started my prednisone taper last night.

Diary of a Crohn's Flare: Post ER doctor's visit.

First a quick update:

I've been in constant pain since last Wednesday (that's 9 days).  The pain varies from merely annoying to all-encompassing.  Eating aggravates it in multiple ways.  Merely taking a single bite of food and swallowing triggers a digestive-wide cascade of cramping that hurts pretty badly.  It also also leads to painful bloating of my abdomen.

Since the ER visit on Saturday, I've now had 4 night sweats.  One on Sunday night (before resuming Imuran), one Monday night (the night after resuming Imuran), Wednesday night, and Thursday night.  Although the first two were moderate night sweats, Wednesday's was bad.  I thoroughly soaked my clothes, bottom sheet, top sheet, and blanket - I did not have to towel off though.

So I put a towel on the bed and changed clothes and went back to sleep.  It was not a restful sleep.

At my Doctor's visit we discussed a lot of topics.  The most important of these was my treatment options.

As I've mentioned previously, Crohn's has 5 main treatment options:

1. ASA (Asulfadine, Pentasa, Dipentum, et al)
2. Steroids (suppress immune system, reduce inflammation)
3. Azathioprine (and 6 MP)
4. Biologicals (Remicade & Humira)
5. Surgery

I'm now using 1, 2 & 3 of these and the doctor suggested that #4 may be needed.  Some other factors include the fact that it takes 8 weeks or more for the azathioprine to build up effectiveness but that my flare symptoms seem moderately bad right now.  The steroids might help bridge that time period.


Since I've only had one surgery, the immediate flare symptoms may be receding, and I'm otherwise in good health, the doctor said I can take my time and decide for myself.

I really want to just feel normal again and am beginning to think that the biological might not be a bad choice.  Can I stick it out for another 7 weeks?

Diary of a Crohn's Flare: How did it start

I was originally diagnosed with Crohn's Disease in April of 1990 (about 3 days before my wedding). 

More than a year earlier, this my mother noticed that I suffered from nearly constant diarrhea.  This led to a series of general practice doctor's appointments and a verdict of irritable bowel syndrome and recommendation to add a lot more fiber into my diet.

I met my future wife over the summer of 1989 and we got pregnant a few months later (I'll leave the details for another entry :) ).  In December we decided to get married and set the wedding date for April.

All through this period we suffered a variety of crises some minor / some major as I worked on my master's degree while working full time and she worked 3 part time jobs.  Throw in a bad case of flu (for her) and a case of the chicken pox (also for her) and we have a very stressful several months.

All this time I had felt very run down and just totally beat.  Not unexpected given all that we were doing.  Only I hadn't realized that the level of tiredness I experienced was abnormal.  I couldn't stand for more than a few minutes without getting terrible headaches.  Nine hours of sleep wasn't nearly enough.  I was extremely pale, etc.

One day that I wasn't feeling particularly worn out, I went down to give blood at a blood drive.  The hemoglobin screen indicated that I was severely anemic and the technician recommended that I see a doctor in the very near future (though they didn't actually tell me why).

My doctor conducted a blood test and found that I was severely anemic and conducted another battery of tests (fecal occult blood in my stool).  So he referred me to a GI doctor.  I went through several office visits and described my symptoms.  I omitted night-sweats because I didn't think they were related and my doctor didn't ask because he didn't want to ask leading questions (duh! on both our parts).

After 2-3 weeks of diagnostics procedures (which did not include a colonoscopy) they hadn't found the cause of the bleeding but knew it was in my digestive tract.  We were down to the week before my wedding and they were down to just two scheduled diagnostics: colonoscopy and exploratory surgery.  Luckily on the Tuesday before the wedding, they performed the colonoscopy and found my Crohn's Disease - so I didn't require the exploratory surgery.

From that time until my bowel resection (8 years) I had good days and bad days.  But generally I felt worse over time.  By the end of this period of this period, I felt bad most of the day and almost everyday.  When I say bad, I mean pins & needles in my legs, pain and cramping through my entire gut, constant diarrhea, severe cramping every time I ate, having to get up 2-3 times to use the toilet every night, extreme fatigue, and taking medications 4 times a day on a regular schedule sometimes requiring 64 or more pills in a day.  It got so bad that I had to take medications to counter the side effects of medications that I had to take to counter the side effects of therapeutic medications (e.g. prednisone).

The surgery relieved all of these symptoms so much that I actually felt a sense of loss.  Although I felt very much better, I got to stop doing all of the work I put into remaining functional and that made me into a different person.

I bring all this up because I want to talk about that in my next entry.

Returning to Running: Week 5 Day 3

Almost a week late but I did get a mild work out in today.  My wife took me for a 1 mile walk.  I could have done more walking but I'm glad I did no running today.

After painful episodes of Crohn's flare my entire abdomen feels bruised inside.  I find the jostling from running to be very uncomfortable when that happens.  I usually wait for several days or until the bruised feeling recedes before trying another run.

However, the walk today was a good opportunity to get out and active without aggravating my pain.

Diary of a Crohn's Flare: Random Observations

Something that came to my attention with this round of issues is that my abdominal pain causes issues.

What I mean by this is at my ER visit last Saturday, I noticed first when the doctors gave me some morphine that my gut responded by allowing fluids to pass again.  Then when they gave me the dilaudid later, it caused the same response: that after administering the pain medicine, my gut became more active again.

Normally, the opiate pain relievers are supposed to immobilize your gut and cause constipation but for me when they reduce the pain, my gut starts moving again.

This has happened to me again at home with the much less powerful pain relievers.  When I take pain medications, my gut becomes active again.  Furthermore, as long as my gut is active, it reduces the amount of pain I experience.  So taking pain medications leads to a very good feedback loop of allow my gut to process foods and preventing further pain.

Some other observations that I've had: lying on my left side tends to immobilize my digestive tract.  I have no idea why this might be but I've noticed on multiple occasions that my gut noises reduce and pain levels increase when I lie on my left side.  So for the next week or so I'll only lie on my right side.

I resumed my azathioprine (btw I apologize for switching back and forth between the generic name and brand name for this drug, Imuran) last night.  I also had a moderately bad night sweat.

I found out that I do have the enzymes required to properly metabolize the drug.  This doesn't preclude the chance that I can have severe side-effects from it but it does reduce the odds that I'll have problems with it.

I assume that my pain from last Thursday was just part of the Crohn's gut pain that lead to me going to the hospital on Saturday and that it was simply radiating away from my Crohn's site.

Over the course of the last couple of days I've mostly experienced a general discomfort an pain through my entire gut.  The feeling makes me want to avoid food.  Even when I'm taking pain medication, I often continue to experience some pain right at the Crohn's site.  My pain levels range from barely noticable (a sub 1 on the pain scale) to high enough to wake from sleep (say a 6 or 7) - which has happened every night except Saturday night (that dilaudid really knocked my pain back for a long time).

The only foods which don't seem to exacerbate my pain levels are sherbert and peppermint candies.  Both of these seem to sooth my GI tract.  The peppermint actually helps and can completely eliminate the GI tract discomfort for short periods of time.  I remembered that these had helped me decades ago but I forgot how effectively they could help me.

I'm going to try to keep a bag of these candies in my backpack at all times.  They could be a life saver.

So far I've only tried liquids and low-residue foods.  As long as my GI tract keeps "locking-up" with even these foods, I have no desire to try anything more substantial.  However, I'm going to have to try to get some vegetable matter through my system somehow.  I'm going to try some V8 or equivalent vegetable juice pretty soon.

My gut still hurts enough just from the constant lock-up that I won't consider running.  However, I'm going to go with my wife and do a little walking later today.

Diary of a Crohn's Flare: Partial Bowel Obstruction, Imuran, or just plain Crohn's

My abdominal pain which began Wednesday continued through Saturday.  Although I'd been eating lighter foods, I hadn't adopted a low-residue diet completely.

By Saturday the pain had gotten bad enough that it woke me from my sleep and I had to take a Norco (5 mg hydrocodone + 325 mg acetaminophen).  I assumed I was experience a partial small bowel obstruction - which I can normally deal with from home by restricting myself to a fluid diet and treating myself with pain medication.

Through the morning of Saturday, I ended up taking another 3 full pills (in 1/2 pill doses).  By 2 pm, my pain medication was not controlling the pain and I decided that I needed to get to the hospital for evaluation and pain management.

The hospital performed a number of blood tests.  I believe they checked CBC, renal (kidney), hepatic (liver), and pancreatic enzymes (imuran).  Pretty much everything came back clear.  They performed a CT scan and found no blockage but did say that the Crohn's was more involved.  I didn't get clarification about what exactly this meant - more tissue involvement, larger affected area, both, something else?

They did treat me with pain medication.  Dilaudid did an excellent job in knocking the pain back and actually kept me at minimal pain levels for more than 12 hours.

• They elected to put me on a heavy dose of prednisone.
• My GI doctor instructed me to resume the azathioprine.
• I have an appointment to see my GI doctor on Thursday.
• I found that my genealogical tests show that I do have the enzyme for metabolizing imuran.
• I canceled my travel reservations for work this week and am not only working from home, I'm working from bed :)

I'm sad to say that this is putting my running on hold for the near future though.  I'm still in nearly constant pain from the Crohn's.  I can do things to tamp down the pain (peppermint candies, norco, etc.) but at this point I think I need to allow pain to be my guide on what to do and not do.  If it's too painful to run without something to reduce the pain, then I'm not going to run.

My current medications for Crohn's Disease:

• 60 mg Prednisone per day
• 150 mg Azathioprine per day
• 1000 mg sulfasalazine twice a day
• 10 mg Bentyl as needed for cramping
• 0.375 mg Levsin as needed for cramping
• 0.5 mg Hydrocodone + 325 mg Acetaminophen as needed for pain (I take these as 1/2 pills)
• 1 ml of injected B12 per month

Running with Crohn's Disease: and another thing / bowel obstruction

So if you've followed my blog you know that I've been trying to get back into running since my abdominal abscess last December.  With my recent partial small bowel obstruction, I'm going to have to put my running on hold for several days at least.

At this point I think I've got a 50% chance of requiring hospitalization.  I think this for two reasons, 1) this "episode" is far more uncomfortable than my partial small bowel obstructions over the last couple of years and 2) this episode has already been going on for several days and hasn't resolved on its own.

I'm restricting myself from eating (only allowing myself clear fluids), restricting myself from physical activity, and monitoring my temperature to ensure that I get the hospital quickly if I show any signs of another perforation.

Anyway, I think that this may put more than my running on-hold :(

Return to Running: Week 5 Day 2

This day (Tuesday), I managed to leave the office a little early.  It was a beautiful day (in the 60s & sunny) and with the change to daylight savings time, I had plenty of sunlight to do a trail run.

Which is exactly what I did.

I did a 1/2 mile walking warm-up, a 4 mile trail run on a soft surface, and a 1/2 mile walking cool-down.  I completed the running portion in about 41-42 minutes (a great time for my trail runs).  Towards the end of the run, my heart rate just started moving into zone 5.

The next day, the only parts of my legs that were sore were the small ankle muscles used to stabilize my legs.

It was a fun run and I was very happy to finish this distance!  I find trail runs to be more difficult than treadmill runs so I count the 4 miles I completed here as equivalent of almost 5 miles on the treadmill.

Returning to Running: Week 5 Day 1

I traveled this day (a Monday) and I also had work.  During the trip, I received multiple messages from work that indicated I'd have to work late into the evening.  I took this to mean that I would not get to run at all on this planned running day.

However, my flights were delay just enough that I wouldn't get into the office until a little after 5 pm.  So I reasoned that since I was going to miss my co-workers, I'd run first and then go into work.

So I did!

I did a 3.1 mile treadmill run in about 31 minutes (I took it easy because I planned my next run to be the longest of the week).

I admit that it was a bit tough.  I never did get a second wind but I'm very happy to have finished it.

Diary of a Crohn's Flare: Imuran & Partial Small Bowel Obstruction

I began having pain in my abdomen Wednesday of this week around lunch time.  The pain didn't feel like other pains I've had with Crohn's Disease and my various medications.  Anti-cramping meds only provided minimal relief.

The pain, bloating, discomfort, and full feeling severely suppressed my appetite and over the course of Wednesday afternoon through Thursday at bedtime, I ate the equivalent of 1 - 1.5 full meals.  Towards the end of this period of time, the pain began to feel like a radiating pain in my upper left quadrant and a mild burning sensation there too.

I called the doctor's answering serviced and they advised me to stop taking the Imuran / azathioprine (there's concern about it causing pancreatitus).

The pain continued through Friday but had lessened.  I felt a little better and managed to eat a bit of food (1 pancake).  By noon I didn't feel any pain and felt very famished, so I ate 2 bagels with cream cheese and ham.  After eating this food I began to hurt again and experienced the other sensations (feeling full, bloating, etc.).

The feeling of fullness continued through dinner, where I was only able to eat 1/2 or less of the food on my plate.  I went to sleep normally but the pain woke me by 2 am and it was powerful enough to prevent me from going back to sleep.  At this point I knew the problem was what I call an "episode" but medically it's called a partial small bowel obstruction.  Since I had the abscess last December, I've decided it will be prudent for me to monitor my temperature.  So far, I've had no temperature spike.

I suspect that I've had a partial small bowel obstruction since lunch on Wednesday.  I'm not sure why I had the different sensations for this one.

If my temperature spikes, the pain spikes, or the partial small bowel obstruction doesn't resolve by sometime tomorrow afternoon, I'll check myself into the hospital.

In the meantime, I'm only permitting myself to drink water and coffee.

The pain remains pretty high and I'm must take a 1/2 - 1 Norco tablet every 4 - 6 hours to remain comfortable.  I'm also forcing myself to reduce my activity and have spent most of this (Saturday) morning in bed.

This will interfere with my planned business trip next week.

The difference between a partial small bowel obstruction and a complete bowel obstructions is that with a partial small bowel obstruction some food / stool can pass through the obstruction.  With a (complete) bowel obstruction nothing can get past the obstruction.  Until last night I continued to pass stool (albeit at a much lower frequency and quantity than normal).  Since early this morning, I've not been able to pass any stool.

Returning to Running: Week 3 Day 3

Last weekend was another weekend I was unable to run or even walk.  Like previous weekends, my only opportunity to get my heart rate up over the weekend was by shoveling our horse shed.  It took me 20-30 minutes last Saturday.

I'll wear my heart rate monitor the next time I must use this as my third work out for the week.

Most of these weeks (including week 4), it was time that forced me to use this chore as a work out.

Diary of a Crohn's Flare: Imuran, bleeding, and night sweats

Since resuming my Imuran (azothioprine), I've been trying to monitor its affects on me.  I have noticed a link between taking Imuran and intestinal bleeding over-night.  In most cases the symptom of bleeding was that it had turned my stool black, however, one case, my stool was actually red.

By coincidence one night I took the drug earlier in the evening.  The next day my stool was normal colored.  Since then I've been experimenting with taking Imuran at different times and I've found that if I take the Imuran earlier in the evening with food that I don't experience any symptoms of bleeding.

So that's been my goal.  So far, I haven't done any bleeding that I can detect when I've taken the Imuran earlier in the evening with food.

When I first started taking the Imuran, I also experienced night sweats almost every night I had taken the drug.  Since resuming the drug, I've had only one moderate and one mild night sweat over the last two weeks.  I think this is a good sign.

One other thing of note, my rectal area still hasn't recovered from the bowel prep.  It remains inflamed and sore.  I've occasionally been treating it with diaper cream.  This provides a lot of soothing relief but I can't tell if it's been aiding in the healing of the area.

Returning to Running: Week 4 day 2

Short version: a 1 mile unconventional work out

Long version:

I had to travel on Thursday.  My flight was the last flight out of my starting city and the last flight to my destination city, so I planned on getting no workout done on Thursday.

However, my first flight was delayed and it was looking like I would miss my connection.  Since it was the last flight home, I thought I'd have to overnight in Charlotte.

When we landed I gathered up my gear and did the airport dash.  Approximate distance was 1 mile and I covered it in just 8 minutes while wearing an almost 30 pound backpack.

I'm counting this as one of my workouts, dammit!  :)

I'm hoping to get another workout in today (Saturday).

Returning to Running: Week 4 Day 1

Short version: I got 4.5 miles in with 1 mile of walking for warm-up and cool-down.

Long version:
I intended to perform this run on Monday evening.  However, my flight was canceled and my replacement flight got me to the hotel after 10:30 pm.  By the time I got to the hotel it was too late for me to run.

So I planned to run my first work out of the week on Tuesday, only by Tuesday evening my Crohn's Disease was acting up and caused me tremendous pain in the gut.  I had trouble even eating Tuesday evening.  So I didn't run on Tuesday evening either.

So I planned to run my first work out of the week on Wednesday.  I was very grateful that by Wednesday evening I felt good enough to run.  On prior weeks I planned the first run as a 3 miler.  Since I was worried that this evening might be my only night to run, I went ahead and ran my longer distance.  When I started I planned to run 4 miles.

During the run though, I felt tired and out of breath.  In fact I despaired that I'd be able to run the whole distance so I mentally permitted myself to only run 3 miles.

By the time I got to the 3 mile mark, I must have gotten my second wind and had started to feel very good.  I extended my run out to 4 miles.

As I got to the 4 mile mark, I still felt good and pushed it out to 4.5 miles.  When I got there I still felt good but I decided that I didn't have enough time to spare to continue the run and I wanted to lift weights and I didn't want to injure myself, so I finished at that distance.

I was very pleased with the results!

Returning to Running: Week 3 Day 3

Short version: I didn't do anything I can count as aerobic activity, not even unconventional work like chopping wood or shoveling my horse shed.  :(

Long version is that when I'm at home I've been nearly 100% occupied with activities to support my immediate (wife and kids) and extended family (parents & grandparents).

Diary of a Crohn's Flare: Colonoscopy results

1. My fistula has reopened on the outside, although it is not apparent where it opens from the inside.
2. I have a stricture in the ileum right at the ileocecal valve.  The stricture is small enough that the doctor wasn't able to get the scope past it.
3. They found a polyp, probably benign, in my cecum (this is new)
4. They found erythematous (inflammed, red tissue) in both the rectum and sigmoid colon (this is new)
5. I have inflammation on the cecum side of the ileocecal valve (this is new)

Diary of a Crohn's Flare: Colonoscopy prep tips

Since 1990, I've had more coloscopies than I can track.  My guess is that I've had 10-15 by now.


What to expect:
The day before the procedure.
Morning
You are supposed to not eat any solid foods on this day.  You should only consume clear fluids that contain no red.  My favorites are apple juice and chicken broth but Popsicles and Jello also work.


By mid-afternoon (2 pm ish)
You should take the two recommended laxatives (my doctor told me to take Dulcolax).

By early evening (5 pm ish)
You should begin to take the prep fluids (used to flush out your intestines).  Use the prep recommended by your doctor but ask if you can use the Miralax prep, this is by far the easiest prep I've taken.

If you've ever suffered from severe diarrhea due to the flu or food poisoning, then this should be your guideline to how you'll do with the prep.  Your rectal area will get very sore and may even start to spot bleed.  To help with this I use (generic) Preparation H wipes and before I start the process I use diaper cream or Preparation H ointment on my rectal area.  Both help prevent the inflammation and soreness that accompanies a bowel preparation by a lot.

Also, the bowel prep makes me feel cold.  So I dress in warm, loose fitting clothing for the whole evening (typically flannel pajamas or cotton sweats).  This helps me stay comfortable.  If you can, you might try to warm up the bathroom prior to starting.
After taking the prep for a while
It will seem like the prep isn't doing anything for you at first.  However, once your bowels start moving, you'll have to spend several hours in the bathroom.  With the Miralax prep the urgency to go wasn't as severe as it was with the other preps I've used.

At bedtime
I never quite feel like the prep has finished, so I end up going to bed feeling full and bloated like I'll have to have another bowel movement at any time.  I actually did have to get up for the bathroom three times.