Stress and Crohn’s disease

The last four months have been an adventure. Between major life changes and a health scare in my family, during June and July I was facing an overwhelming amount of stress that led me to sobbing in the shower and brought my Crohn’s disease out of remission for about three months.

In mid-June, my husband and I made the decision to pack up our life in Texas and move to Florida for his work. Even though we were excited for the move that would allow us to live close to open water and be surrounded by palm trees, we knew it was going to be stressful. With our decision made, there was no reason to wait. I already had a trip to Utah planned for the end of June, so we booked our house-hunting trip in Florida for early July.

Then, the countdown clock started. 

We immediately hired a realtor to sell our house in Texas and had our place listed online within a week. We chose a realtor in Florida to help us find our new home and the listings started flooding our inboxes from day one. Every minute outside of our work schedules, we packed, we cleaned, we sold our belongings and we searched for new homes late into the night. We were burning the candle at both ends and I could feel myself getting run down. I forced myself to do more each day, keeping the end goal in sight. “Put your head down and drive on,” was the mantra from my Army days that I kept repeating in my head. And after two weeks, my intestines started to bleed. It was the first time in about five years. 

At the same time, my brother-in-law went in for surgery. There were complications, and for the next month my family and I oscillated between hope and grim thoughts as we all held our breath, waiting for better news each day. Fast-forward to today, he is doing well, but still recovering and has a long road ahead (this is his story to tell, so I will leave it here for now). 

The stress and worry about my brother-in-law, combined with the ups and downs of selling and buying a house, was about all I could take. My intestines continued to bleed more and more, but I never went into a debilitating Crohn’s flare-up. I was still able to leave the house and go through the motions of everyday life. In late July, I decided to take the advice I would have given to any other person in my shoes and I called my gastroenterologist. Technically, I didn’t call, but I logged into the online portal I use to reach my providers at the hospital. Unfortunately in this instance, the Audie L. Murphy Memorial Veterans’ Hospital is a teaching hospital and the gastroenterologist assigned to me was a fellow who only saw patients at the VA hospital one day each week. So, my message sat in waiting for almost the full week.

When the gastroenterologist called me after receiving my message, he ordered some labs and I went in to have my blood drawn. But, because I waited so long to reach out to him, it was less than two weeks until we were scheduled to head out to Florida and there wasn’t enough time to do anything else. When my labs came back, the only thing of note was my low hemoglobin; same as always. He urged me to try and get established with the gastroenterology clinic at the VA hospital in Florida as soon as possible, and then he said something that I don’t think I’ll ever forget. He reminded me that when symptoms of Crohn’s disease arise, it can be like standing on the edge of a cliff — the slightest thing might send you over the edge and into a serious flare-up. 

I’ve been lucky to spend the past five years in remission. Having spoken to so many different people with Crohn’s disease over the years, I know that things can change in the blink of an eye. Even though I do a lot of things (sauna sessions, meditation, exercise, fasting, etc.) to help improve my health, I know that when it comes to inflammatory bowel disease (IBD), our best efforts are sometimes just not enough. It is frustrating to not have control of a situation, and equally frustrating to feel like I always find myself in a strange purgatory where I’m not sick enough to receive treatment or helpful advice from my doctors, but yet there’s visible blood coming from my intestines and I don’t feel good. It’s no wonder why I questioned whether I should call my gastroenterologist before leaving Texas, the bleeding and low hemoglobin lab result didn’t actually require me to do anything other than talk about it. 

The rational side of me still says it was a good idea to reach out to my doctor, after all, things can change fast with IBD. But the part of me that knows I’ve gone through this song and dance before is just tired. Therefore, I find myself turning back to the things I can control — outside of conventional medicine — to be as healthy as possible and get back into remission.

With my blood draw done and no other appointments to attend, we finished packing up our house in Texas, piled into the RV and headed out to Florida in early August. Since we weren’t scheduled to close on the purchase of our new home until the end of August, I didn’t call the VA hospital in Florida because I didn’t want to jinx anything. (I’m not superstitious per se, but I didn’t want to take any chances on our new dream home falling through.) 

My husband and I spent the next three weeks living in the RV with our two dogs. Finally, we were able to close on the new home and moved in with just a few days left in August. Then, with my brother-in-law on the mend and our new house purchased, just as quickly as it had come on, my stress disappeared. Over the next two weeks, my intestines slowly stopped bleeding and the sunshine, open water and palm trees were helping me to feel more energized than I have in years. By mid-September, the bleeding had stopped. 

It’s early October now, and while I still get run down easily, I feel happier and healthier in Florida. There is something that centers me as I stare out across the bay, feel the sunshine on my face and watch palm fronds swaying in the breeze. I was also able to get set up fairly quickly at the VA hospital here in Florida. I had a virtual appointment with my primary care provider a few weeks ago and she was able to put in new referrals for me to see the gastroenterology and renal clinics here. I see my new nephrologist this week and gastroenterologist next week. I’m curious and anxious to see how my new doctors will respond to me and what they will say about my labs. I worry that they will look at me with the same disbelief I’ve seen on so many faces before, and I worry that I’ll be dismissed. In the meantime, I’ll just keep doing what I’m doing. 

One thing this summer has taught me, though: If you know what and where your happy place is, get there.

Fatigue

Steph holding a bottle of pills

Some of you have asked, so here it is. Time for Crohn’s talk again: Fatigue.

Overall, when people ask how I’m doing, I’m doing fine — not optimal, but certainly not anywhere close to being at my worst. My GI symptoms are minor, which, once you’ve had an IBD flare up, anything short of that seems to be tolerable, and my kidney function continues to hang out where it’s been for the past couple of years.

The one symptom that I continue to fight, however, is fatigue. For those of you who also feel the effects of autoimmune fatigue: I get it, I’m in the same boat. Some days are better than others, but every day is just a scale that ranges from tired to exhaustion. Some days I feel like I’m on the brink of getting sick — the inside of my head feels cold and my body is run down. Other days I feel like I’ve been awake for 36 hours, when in reality I just woke up. And, some days, I feel the desire to just stick my head in the sand. I wake up two to four times a night and each time, the first thought that pops into my head is, “I’m so f*&%^ing tired.” I think I’m starting to forget what it feels like to not be tired and I think I’ve now recalibrated what “feeling good” means.

In any case, I keep telling my doctors (primary care, GI, and nephrology) that I’m tired and, to their credit, they keep running tests looking for the reasons why. On my most recent visit to GI clinic just about three weeks ago, my doctor ordered 100 different tests (urine, stool, and blood) and an X-ray. I didn’t hear anything for a week; then, I got an email notification that a new prescription just shipped. When I looked up what it actually was: fiber.

So, frustration seems to be the second worst symptom that I fight after fatigue. A day after the prescription fiber tablets arrived, I got a letter from my doctor that explained she prescribed that after my X-ray showed I was, well literally, full of crap. 😒

As for the rest of the test results, the letter explained that she (my doctor) would send another letter once all the results of the various other tests were in. I actually have access to my lab results as they are done, they get added to a section in the online MyHealtheVet portal that the VA offers, but I obviously don’t have the credentials to fully assess what they mean. Which leaves me guessing and Googling until I hear from my doctor. The only thing I’ve been able to decipher so far is that a few of the immunoglobulin tests were high, which makes sense to me with two autoimmune diseases, one of which is named immunoglobulin A (IgA) nephropathy.

Perhaps fiber is all that I will be prescribed. I should be hearing soon from her on whether the results will warrant us changing course. In the meantime, I constantly work on being present and grateful for the energy (whatever level it is) that I do have. I recognize that, realistically, it will continue to decline as I age, especially if my autoimmune diseases get worse. While I may not be signing up for any more Tough Mudder runs, I’ll continue to do what I can and appreciate each day.

So when you ask how I’m doing and I say fine, now you know what what fine means.

Kidney disease and my upcoming biopsy

Stephanie Gish talks kidney disease

As I’ve navigated my Crohn’s disease journey over the past 15+ years, I’ve often heard that if you have one autoimmune disease, it’s not uncommon to develop another. After a quick Google search yesterday, I found that according to this article in Maedica, about 25% of patients with an autoimmune disease have a tendency to develop another. Which is where this new chapter in my story begins. As most people will be spending the next few weeks counting down to Christmas and New Year’s, my own holiday countdown just got eclipsed by a new one that ends with a now-scheduled kidney biopsy on January 5, 2021.

Over the past few weeks, I’ve been back and forth to the hospital getting repeat labs done, checking creatinine levels in my blood and testing for protein and blood in my urine. My first set of labs in November was originally done for a January follow-up appointment with my nephrologist — just a typical, annual appointment to monitor how things are going with my kidneys. But, when the results came back and showed my kidney function was trending in the wrong direction, we repeated those labs and scheduled an in-person visit this past week to talk about a biopsy. I’ve now had three sets of labs done in the past month that all showed high creatinine levels in my blood, microscopic hematuria (blood in urine not visible to the naked eye) and proteinuria (protein in urine). My nephrologist is thorough and the watch-and-wait period is officially over. 

At this point, all signs point to an autoimmune form of kidney disease called IgA nephropathy, but only a biopsy can confirm the diagnosis. While this may appear to be sudden, I’m not surprised at what’s happening. I had my first referral to the renal clinic back in 2016 when my gastroenterologist then noticed elevated creatinine levels. But, things settled back down, my labs were OK and time went on. In 2018, things escalated when I saw visible blood in my urine — a first for me — and I wound up back in the renal clinic under the care of a nephrologist. Since then, we’ve just been monitoring my labs and looking for signs of disease progression. Things looked stable for a while with just microscopic hematuria, but now there’s protein and elevated creatinine.  

There are not always obvious signs when kidney function declines, but I can say that for the past three months, I’ve felt pretty crappy overall. I personally view this as serendipitous timing that my labs for my January appointment fell right when I was at my breaking point. There were a few nights in late October/early November that I was in tears because I was so tired of feeling tired, tired of waking up five times a night and tired of feeling nauseous and not myself. I’ve come to know my body well over these years dealing with Crohn’s disease and I knew something wasn’t right, I just had to wait for the labs to catch up to how I felt, finally giving a clear indication of what was happening and what to do next. 

While I’m not looking forward to having a kidney biopsy done and I’m feeling a bit anxious about the whole thing, I know I’m in good hands and it’s the right next step. At this point, I can’t say enough how important it is to have a doctor who is truly a partner with you in your healthcare. My nephrologist spent over half an hour sitting with me and talking about the risks and benefits of having a biopsy and what was happening with my kidneys. The thing that really resonated with me during our conversation is when he told me that he never recommends a biopsy unless he’s at the point where even if the worst-case scenario did happen, there would be no question for him that the biopsy was the right thing to do. I know a biopsy is not a decision to take lightly, but I also know there’s a huge benefit to discovering what is happening and having all the information available so that we can make the best decisions about care going forward. If the biopsy confirms IgA nephropathy, it will also give valuable information as to the aggressiveness of the disease, how much damage has already been done and clear guidance for treatment. 

I don’t think I’m nervous. I feel confident in the abilities of my healthcare team and the facility that I’ll be at, but I am anxious. I feel my stomach tie itself into knots when I think about the actual procedure (confirming to myself that I would make a terrible doctor or nurse, as I would likely pass out for everything). But, one thing I’ve learned from being a part of the inflammatory bowel disease (IBD) community for almost 20 years is that you are not alone in your journey and many others are going through the same thing you are. There is strength in knowing that others have already faced what you are about to, and comfort in knowing that an entire community understands what you are going through. And, on the plus side, I should be nicely sedated for the procedure, so there is that! 

Aside from knowing that I’ll be one step closer to knowing what’s happening with my health, the silver lining I see right now is that I’m still allowed to eat plenty of protein! Those who know me well know that I love a good steak and meat is the one food that is always, reliably, Crohn’s-friendly for me. As we’ve been monitoring my kidneys over the past year, I’ve been increasingly concerned about how much meat I eat and whether it’s adding fuel to the fire. But, even though my body is spilling protein into my urine, eating less won’t stop the disease. With IgA nephropathy, the immune system releases immunoglobulin A (a protein that helps your body fight infections) and those immunoglobulins get stuck in the kidneys and cause inflammation, which then causes the kidneys to leak blood and protein. So, the protein leaking is a symptom, but me eating protein isn’t causing the damage. I’m not going to worry so much anymore about trying to find vegetables that don’t bother my Crohn’s; they seem to be elusive or just nonexistent anyway! 

As I continue to think about my own health journey, I also realize how easy it is to feel helpless. I’ve tried for years to control my Crohn’s disease with just diet and lifestyle. And while I’ve been able to stay in remission for about four years without medications, it appears that while Crohn’s was under control, my immune system was busy launching a coup. We can be doing everything “right” and yet, sometimes, there are things that are simply out of our control. For someone like me — who likes to be in control — that can be a hard thing to accept. To that end, I’m continually astonished that any of us are even here when I find myself constantly contemplating how many things can go wrong. Yet we are here, and we strengthen each other, support each other and care for one another. I’m just one tiny speck on this planet with an entire healthcare team looking out for me and doing everything they can to help me live better and longer. For that, I am truly grateful. 

Today, I choose not to feel helpless. Instead, I will continue to be as healthy as I can in order to give my body the best chance it has to fight whatever comes its way (even if it’s fighting itself). I will continue to look to my healthcare team for their knowledge, care and guidance, and am grateful that I’ve been fortunate to have many different doctors over the years — especially right now — who make decisions with me and work tirelessly to care for me and others like me. 💜💚

Forgetting Crohn’s (almost…)

Some days, I almost forget that I have Crohn’s Disease. Honestly, I don’t think there’s been a single day since my diagnosis 13 years ago–or even since my first symptoms 17 years ago–that I haven’t thought about Crohn’s or digestive issues. But for the most part, my day-to-day life with Crohn’s is well managed…and although I do think about Crohn’s on a daily basis, there are moments during the day when I really do forget that I am battling a chronic illness, and always will be. Which is why this most recent appointment with my gastroenterologist was a bit of a shock back into reality for me. 

Continue reading “Forgetting Crohn’s (almost…)”

Cystoscopy: My fears and anticipation vs. what actually happened

Photo of Stephanie Gish immediately after her cystoscopy

Do you ever find yourself loving Google, yet hating it at the same time? That was the case for me as I spent more and more time researching and looking up information during the two weeks leading up to my cystoscopy earlier this month. My last four urine tests all showed blood in the urine, which was actually part of the reason for my referral back to nephrology. And, although the hematuria is most likely due to IgA nephropathy, my doctors wanted to send me to urology just to make sure everything was good there, since–I later learned–all cases of repeated hematuria not caused by urinary tract infections should be referred to urology. Continue reading “Cystoscopy: My fears and anticipation vs. what actually happened”

“But you don’t look sick.”

 

steph smiling despite battling chronic invisible illness

My heart was racing at 100 beats per minutes. My skin was pale. My hands were cold and clammy…

Let me rewind 48 hours and take you back to Thursday with me.

My legs were weak when I arrived at work and walked down the hill toward the chapel on our school campus. I hadn’t worked out, yet my legs felt wobbly. Our seniors were graduating and every year we hold a Baccalaureate service to honor and celebrate them as they prepare for college and the next chapter of their lives. Continue reading ““But you don’t look sick.””

Kidneys, fatigue, and Crohn’s

inversions

Ironically, two weeks ago I was planning to sit down and write a blog post about how I stay motivated to workout every day. No, I don’t spend 1+ hours in the gym everyday like I did when I trained for my fitness competitions (I’m getting too old for that and have too many other things to do–like drink wine and go boating!), but I’ve been working to refine my efforts so that what I do to stay fit and healthy is enjoyable, effective, and quick–with no room for excuses. But here I sit, writing to tell you that I have not worked out in two weeks. This is rare for me.

Continue reading “Kidneys, fatigue, and Crohn’s”