Foreword xiii
Introduction 1
About This Book 1
Foolish Assumptions 2
Icons Used in This Book 2
Beyond the Book 3
Where to Go from Here 3
Part 1: The Who, What, and Why of Crohn’s and Colitis 5
Chapter 1: Crohn’s and Colitis One Step at a Time 7
Defining Crohn’s and Colitis 8
Getting the Treatment You Need 9
Recognizing That You’re Not Powerless 9
Living a Full Life with the Disease 10
Managing Special Cases: Advice for Pregnant Women and Kids 11
Chapter 2: Defining Crohn’s and Colitis 13
Figuring Out What Crohn’s and Colitis Are 13
Looking at the big picture: Inflammatory bowel disease 14
Zeroing in on Crohn’s and colitis 15
Noticing the Signs and Symptoms 20
Blood in stool 22
Diarrhea 23
Abdominal pain 24
Urgency 24
Tenesmus 24
Other symptoms 24
Identifying Other Parts of the Body Involved in Crohn’s and Colitis 25
Bones 25
Joints 26
Skin 28
Liver and gallbladder 28
Kidneys and bladder 30
Eyes 30
Complicating Things 31
Intestinal complications 31
Nutritional complications 35
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 esophagus 44
The stomach 44
The small intestine 45
The large intestine 46
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 54
The Role of the Immune System in Crohn’s and Colitis 54
An immune system primer 55
When your gut’s immune system goes awry 57
Environmental Factors 58
Food 59
Air 60
Hygiene 60
Other environmental factors 61
Genes Gone Bad: The Role of Genetics 63
Considering family history 64
Calling out key genes for Crohn’s and colitis 64
Getting a genetic test 65
Part 2: 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
When you get to your first visit 71
Rounding Up Other Key Players 73
Your primary care physician 73
Nurses 74
Physician assistants 75
Registered dietitians 76
Psychiatrists 76
Surgeons 77
Friends and family 77
Chapter 6: Getting a Diagnosis 79
Preparing for Your First Visit 79
Charting your signs and symptoms 80
Assembling your medical records 84
Talking to Your Doctor 85
Getting over the embarrassment 85
Communicating your symptoms 85
Being realistic about your expectations 86
Knowing What to Expect during a Physical Exam 86
General physical exam 87
Focused physical exam 87
Rectal exam 87
Being Poked and Prodded for Medical Tests 88
Blood tests 88
Stool tests 89
Scans 91
Endoscopy 92
Identifying Other Diseases That Mimic Crohn’s and Colitis 93
Chapter 7: Achieving Remission with Medications 95
Rejoicing for Remission 96
Types of Remission 96
The role of symptom control 97
Using Steroids 98
Types of steroids 99
Side effects of steroids 100
Turning to Aminosalicylates 101
Types of aminosalicylates 102
Side effects of aminosalicylates 104
Getting Involved with Immunomodulators 104
Types of immunomodulators 105
Side effects of immunomodulators 105
Battling Your Disease with Biologics 107
Types of biologics 107
Side effects of biologics 109
Loss of response to anti-TNF therapy 110
Benefits of biologics 111
Targeting Crohn’s and Colitis with Small Molecules 112
Types of small molecules 112
Side effects of small molecules 113
Attacking Your Illness with Antibiotics 113
Types of antibiotics 113
Side effects of antibiotics 114
Considering Other Medications 114
Antidiarrheals 115
Bile salt binders 116
Analgesics 116
Iron 117
Calcium and vitamin D 117
Vitamin B12 118
Chapter 8: Considering Surgery 119
Determining When You May Need Surgery 119
For Crohn’s disease 120
For ulcerative colitis 121
Understanding the Types of Surgery 121
Resectioning the small intestine 121
Repairing a stricture 123
Treating fistulas 123
Draining abscesses 124
Resecting the colon 126
Pouch surgery 128
Considering Complications from Surgery 130
Short-term complications 130
Long-term complications 132
Defining Ostomy: What It Is and How to Deal with It 135
Types of ostomy 135
When you may need ostomy 136
How to care for your stoma 137
Your ostomy pouch 137
Coming to terms with Ostomy complications 139
Listing Some Ostomy Resources 140
Part 3: Healing and Dealing with the Disease 143
Chapter 9: Paying Attention to hat You Eat 145
Considering the Impact of Nutrition 146
The impact on your immune system 146
The impact on wound healing 147
Identifying the Nutrients You Need 147
Macronutrients 148
Micronutrients 152
Wondering about Fiber 156
Types of fiber 156
Why fiber matters 157
Fiber’s role in Crohn’s and colitis 158
Considering Specialized Diets for Crohn’s and Colitis 159
Liquid diets 159
Low-residue diets 160
Lactose-free diets 162
Elemental diets 163
Specific Carbohydrate Diet 163
Mediterranean diet 164
Low FODMAP diet 164
Choosing a diet that suits your body’s needs 165
Getting Nutritional Support: When You Can’t Go It Alone 166
Feeding through a tube 166
Feeding directly into your veins 167
Boosting your diet with supplements 168
Chapter 10: Preventing Health Problems 171
Getting Vaccinated 172
Why vaccination matters 172
Which vaccines you need 172
Caring for Your Skin: It’s Not Just Cosmetic 176
Identifying the skin complications you may face 177
Recognizing and reducing your risk of skin cancer 178
Caring for your skin “down there”: Perianal skin care 179
Boning Up on Bone Health 180
Opening up about osteopenia and osteoporosis 181
Seeing what Crohn’s and colitis can do to your bones 182
Managing bone loss 183
Screening for Cancers 184
Colon cancer 184
Cervical cancer 186
Chapter 11: Alternative and Complementary Therapies 187
Let’s Get Physical: Exercise 188
Looking at how exercise can help with Crohn’s and colitis 188
Gathering some useful exercise tips 190
Working Over-Thyme: Herbal Therapy 191
Healing with herbs 191
Identifying beneficial herbs for Crohn’s and colitis — and knowing which herbs to avoid 192
Homing in on Homeopathy 194
Exploring the pros and cons of homeopathy 195
Using homeopathic remedies for Crohn’s and colitis 195
Tapping into Traditional Chinese Medicine 196
Understanding traditional Chinese medicine 196
Controlling Crohn’s and colitis with traditional Chinese medicine 196
Mulling over Mind-Body Intervention 197
Cognitive behavioral therapy 198
Aromatherapy 198
Yoga and meditation 199
Support groups 199
T’ai chi and Qigong 199
Wondering about Worm Therapy 199
Putting worms to work for your health 200
Seeing how worms can help Crohn’s and colitis 200
Part 4: Living and Coping With Crohn’s and Colitis 203
Chapter 12: Living with Crohn’s and Colitis 205
Dealing with Your Diagnosis 205
Stage 1: Denial 206
Stage 2: Anger 207
Stage 3: Bargaining 209
Stage 4: Depression 209
Stage 5: Acceptance 210
Keeping Your Relationships Going Strong 211
So, what’s new with you? Telling people about your diagnosis 211
Come here often? Dating with Crohn’s and colitis 213
Like a horse and carriage: Keeping your marriage strong 214
Caring for a Loved One with Crohn’s or Colitis 216
Finding little things that help a lot 216
Helping during a flare 216
Helping after surgery 217
Getting the help you need for yourself 218
Chapter 13: Avoiding Triggers 219
Quitting Smoking 220
Deciding to Medicate 222
Non-steroidal anti-inflammatory drugs 222
Antibiotics 223
Stressing Out 223
Craving the culprit: Food, Glorious Food 225
Artificial sweeteners 225
High-fat foods 226
High-fiber foods 226
Caffeine 227
Dairy products 227
Alcohol 229
Inviting the Sandman 229
What sleep does for your immune system 229
The effect of sleep on Crohn’s and colitis 230
How to get a good night’s sleep 230
Traveling at High Altitudes 232
Chapter 14: Working and Traveling with Crohn’s and Colitis 233
Work It Out: Doing your job When You Have Crohn’s or Colitis 233
Coordinating your job hunt around your disease 234
Telling your employer and coworkers about your condition (or keeping it to yourself) 235
Starting your day off right 235
Planning your commute 236
Packing an emergency kit 237
Speed Bumps Ahead: Coping with Job-related Challenges 238
Responding to symptoms when they get in the way 238
Handling your coworkers’ less-than-understanding attitudes 238
Taking advantage of the Family and Medical Leave Act 239
On the Road Again: Traveling with Crohn’s and Colitis 240
Assembling a vacation survival guide 240
Getting immunized before you travel abroad 241
Packing for your trip 241
Avoiding traveler’s diarrhea 242
Finding a bathroom — fast! 244
Part 5: Considering Special Populations with Crohn’s and Colitis 245
Chapter 15: Kids with Crohn’s and Colitis 247
Identifying How Crohn’s and Colitis Are Different in Kids than they are in Adults 248
Sex 248
Symptoms 248
The impact on growth and development 249
Getting a Diagnosis 251
Managing Crohn’s and Colitis in Kids 252
Monitoring medications 252
Paying attention to nutrition 257
Vaccinating your child 257
Growing Up with Crohn’s and Colitis 259
Surviving school 259
Turning 18: Adulthood begins (at least in theory) 261
Going off to college 262
Chapter 16: Having Sex and Getting Pregnant with Crohn’s and Colitis 265
Sex and Fertility 266
Sexual activity 266
Contraception 267
Your menstrual cycle 269
Fertility 270
Pregnancy 271
Pregnancy planning 271
While you’re pregnant 273
The big day and beyond 277
Part 6: The Part of Tens 281
Chapter 17: Ten Myths about Inflammatory Bowel Disease 283
Myth#1: Diet Is the Cure 284
Myth#2: Kids Get It from Their Parents 284
Myth#3: It’s Caused by Stress 285
Myth#4: You Can’t Get Pregnant if You Have It 285
Myth#5: Steroids Are a Magic Potion 286
Myth#6: If You Have It, You’re Guaranteed to Get Cancer 286
Myth#7: You’re Responsible for Your Flares 287
Myth#8: Surgery Cures It All 287
Myth#9: You Can Stop Taking Your Medications if You Feel Better 288
Myth#10: You Have to Stop Taking Your Medications during Pregnancy 289
Chapter 18: Ten Reliable Resources 291
The Crohn’s and Colitis Foundation 291
The United Ostomy Associations of America 292
WebMD 292
Mayo Clinic 293
About IBD 294
IBD Passport 294
IBD School Videos 295
Nutritional Therapy for IBD 295
South Asian IBD Alliance (SAIA) 295
Trustworthy Twitter accounts 296
Index 297
