All posts by Bob Keller

Turmeric as an anti-inflammatory

Crohn's, Health

Yesterday I had my follow-up appointment with Erin. As I’ve said before, Erin is a Nurse Practitioner. She can do pretty much anything an MD can do, but is nicer. So anyway, I’m just going to refer to her as my doctor.

I expected that this post would be about the questions and answers around going on Humira and that was mostly what my appointment was about. Erin was great at explaining how Humira works on Crohn’s and answering my questions about side effects, costs and alternative treatment approaches. But there was one small detail that stood out for me. When I asked her about diet she mentioned that turmeric had been shown to be an effective anti-inflammatory agent.

“What?!?” This took me aback because she has been very much toeing the party line of western medicine. She’s given me straight answers about the body of research around Crohn’s and the treatments for it. So if she would even mention something that you can buy in the health supplement section of HyVee, there must be something to it.

I did some research and it turns out that this little rhizome has some pretty impressive health benefits.

What is turmeric?

Turmeric, the spice, is made from the rhizomes and roots and bulbs of the turmeric plant. turmeric is a relative of ginger and the rhizomes look very similar to ginger rhizomes, but when cut open they are bright warm yellow on the inside. It is a main ingredient of curry and is used in many asian cuisines. It’s what gives the yellow color to curry dishes. It has long been known for it’s medicinal qualities and is a major part of Siddha medicine of Southern India.  Incidentally, my daughter Quinn was WWOOFing at Hale Akua farm on Maui, where the main crop is turmeric. The Hawaiian word for turmeric is ‘olena, which is also the word for yellow.

Curcumin is the compound in turmeric that gives it it’s health benefits. This article from the University of Maryland Medical center is a good list of curcumin’s benefits, from indigestion to heart disease, and the state of research into each.

Needless to say, as soon as I got home from the doctor, I headed over the HyVee and got a bottle of turmeric capsules.

 

Colonoscopy

Crohn's, Health

golytlelyColonoscopy day, everyone’s favorite day. Mine was last week. I’m lucky I get to have one every five years instead of the recommended 10 for those of us over 50. Thanks again, Crohn’s disease. There are few things easier to put off than having a camera up your ass. In fact I was about 3 years behind (no pun intended) schedule, so of course I was sure that there was some nasty malignancy brewing in there, undetected because of my procrastination.

For those of you who haven’t yet had the pleasure, this might be hard to imagine, but the procedure itself isn’t bad at all. The start out by shooting you up with Versed and Fentanyl. Which is to say they send you to Happyland. Besides you get to watch the live video of the journey up the poop chute, it’s almost like science fiction.

No it’s not the rubber tube being threaded up my ass that I dread. It’s the prep. They want your colon to be squeaky clean when they make their entry. If you’re going to go diving for treasure you want it to be in a clear spring fed river, not a murky Minnesota mud lake. So the day before you get to fast and flush. And by flush I mean drink a gallon of a foul-tasting liquid that has the most ironic product name in the universe, Golytly. There is nothing lyte about it’s effects. As the instructions say, “Expect to experience diarrhea, stay near a toilet.” Even a person like me, with forty plus years of Crohn’s, will be shocked by the purgative effects of this intestinal rocket fuel.

After the fun part was over and it was time to move on to the procedure itself, I got an extra bonus dose of discomfort. It’s become aware that I’m a difficult subject for I.V. poking. It’s hard to find a usable vein in my skinny arms. It took three tries to get me hooked up. The first two nurses failed so they had to call in the top gun to do the job. Maybe they could have had the expert go first. Just sayin’.

This time around the captain of the anal explorer wasn’t my usual G. I. doc, because we wanted to get in as soon as possible. Since my usual butt surfer is a guy not much younger than me, I was expecting a younger person, but when he showed up he looked like a clean-shaven Santa Claus. Maybe young people just aren’t taking up anal exploration as a specialty anymore.

So the spelunking began, the camera went into the cavern, some polyps were found and clipped off and everything seemed to go just fine. I got the report the next day that the polyps were just from inflammation, they weren’t malignant and would not become malignant. So good news. The bad news is that because there was active inflammation, they were unable to take biopsies for an assessment of the Crohn’s disease progress. It’s kind of funny how the report stated it. It said a follow-up would be required, but a couple of paragraphs down it said “This is an optional procedure.” OK, I pick the “not doing it” option.

Tomorrow I have a follow-up appointment with Erin, the NP that I saw a month or so ago. She’s going to give me the Humira pitch. I’m going to be a tough sell.

I’d love to hear suggestions for questions to ask about treatment options.

 

Hypochondriac Humor

Crohn's, Health

If someone asked me to name the scene a movie that most resonated with me, this would be it. My name is Bob and I am a hypochondriac. My gravestone will read, “I told you I was sick.”

So of course the fact that I was suffering from pain and bloating over the weekend, and that the NP thought I needed a CT scan to check for an obstruction sent me on a wild spiral of anxiety.  Nevermind that I’ve had all the symptoms before and it proved to be nothing more than constipation, I convinced myself that I had a huge tumor lurking in my intestines and that I should stop buying green bananas.

At one time in my life hypochondria almost took over my life. Every little lump or sore was a death sentence that I would obsess over relentlessly. I obsessed over the possibility that I was insane because I was obsessing so much. Finally I went to a shrink and he put me on Celexa, an anti-anxiety and anti-depression medication. I got almost instant relief. I probably started dangerously ignoring symptoms. But alas the drug had some unpleasant side effects. Imagine that. So a few months ago I decided to wean myself off of it, which I did over a period of a couple of months. Until now the I’ve not been obsessing about my health. But Crohn’s and gut problems always get me worked up so I was spinning down the rabbit hole of paranoia for a few days.

The scan came back clean. You might have seen me skipping down 4th Avenue yesterday afternoon.

I’m not whining. Am I?

Crohn's, Health

doubtIt dawns on me these recent posts on Crohn’s might come off as whining. Poor me, I have a chronic condition and it’s going to cost me a lot of money to treat it. If that’s the impression I’ve given, I apologize.

I don’t have anything to whine about really. My Crohn’s is about as mild a case as you can get. I’ve never had surgery or even been hospitalized for it. Sure I’ve crapped in my pants a few times and have gone through some miserable periods, but all you  need to do is follow the Crohn’s hashtag on Twitter and you will realize I’m lucky. You can die from this. Young people are hospitalized and having colostomies and finding themselves unable to work. Not eating for days because it causes too much pain. So really I don’t have much to complain about. I should be thankful.

I have a couple of reasons to write about my Crohn’s disease adventures. One is that I need something meaningful to write here, and although talking about one’s shit is pretty personal, it gives me the opportunity to talk about things beyond what I had for dinner and what TV I’m watching. The other is that I hope I can help others with Crohn’s by providing information and telling my story.

I won’t be writing exclusively about Crohn’s here. I’ll probably still write about TV and what I had for dinner, review a book or movie, post some artwork and keep you posted about my battle with the bunnies who use my garden as a smogasbord.

Can I even afford to go on Humira for Crohn’s?

Crohn's, Health

First, I’ve created an aggregated feed of Crohn’s disease on social media. Check it out!

My last post I talked about the resurgence of my Crohn’s disease. After three years of remission it’s suddenly returned and I’ve been dealing with the symptoms a couple of months now. After the usual period in which I just hope that it will go away, I finally made an appointment with the doc. My usual GI guy wasn’t available so I saw a nurse practitioner. In forty-five years I don’t think I’ve ever had someone sit down and talk to me about my Crohn’s as long and thoroughly as she did. I recommend going to nurse practitioners, because they will take the time to listen to you. My GI doc is a really nice guy, but he always seems like he’s in a rush to get out of the room.

Last night I was calculating how much Humira would cost. I came up with $8000 a year. But that’s not right. The direction of this post has changed since I started writing it. I emailed James Romeo, the agent that handles my supplemental Medicare insurance. He got back to me within the hour and walked me through the coverage and the dreaded “donut hole” in Medicare prescription coverage. I’ll try to explain that in a future post. I already had a pretty good handle on that, but our conversation revealed that I’d made a mistake when I was calculating the cost in my head. Hell, it would only cost around $4000 a year. Whoopee! James says it’s the most expensive medication he’s run across. Do I get a prize?

I suppose you could make the argument that the folks at AbbVie spent a lot of money on R&D to develop Humira and they need to get that back and make a profit. I’m not too worried about them, Humira sales grossed $14 billion last year. That’s with a ‘b’.

We have saved for retirement and I thought we were going to be in great shape financially, but that number could mean we wouldn’t be able to do all the things we’ve been looking forward to.

One of the things the NP said was  that continuing without more aggressive treatment might result in requiring surgery. When I think about it, from my standpoint surgery would be more cost effective than the drug. With the Medicare coverage that I have I could get to the deductible pretty fast. I could just roll the dice and hope that I didn’t have to have surgery too often. After all it hasn’t happened yet. Another argument was that I wouldn’t want to go on prednisone four or five times a year. Well I’ve needed prednisone only a handful of times in 45 years, maybe twice in the same year one time. Another temptation to just roll the dice.

Currently there is a class of drugs coming on the market called biosimilars which work like Humira and the other biologicals, but presumably would be less costly. But the bigger question is whether they work and what are the side effects.

Update on my condition

I reported in with an update for the doc, mentioning that I had pain and bloating, so now she want me to come in for a CT scan next week. Bah.

 

The straight poop

Crohn's, Health, Life

Some time ago I wrote about what I would and would not write about here. I stated that I my intention was to avoid politics and not talk about my health, specifically Crohn’s disease. I really don’t think anyone wants to read about me obsessing about my bowel movements. There’s that apocryphal story of Eskimos having a hundred words for snow. Well I could have the same diversity of vocabulary for my stools. No one wants to read about that.

But events have taken a turn lately and I’ve decided to change direction with them. My reason is that I’ve reached a crossroads where I need to make some decisions about how I treat this annoying companion I’ve had since I was 23. But first a little background.

As I said, I was first diagnosed when I was 23. I had just gotten back to Minneapolis from Northern Idaho, where I’d spent the summer working for the U.S. Forest Service. That fall I suddenly started having nasty diarrhea, that lasted longer than what could be explained by a bad taco. After about six months of tests and doctor bouncing, I finally got a diagnosis. I’ll talk more about that later. Crohn’s is an inflammatory disease of the intestinal tract. It’s an autoimmune condition; in other words you immune system attacks your own body. They don’t know what causes it and there’s no cure. It can manifest itself in various ugly ways, the most common is a really nasty case of the shits, accompanied by painful cramps in the gut. It can also cause inflammation in other parts of your body, including joints and other internal organs, as well as skin rashes. It can even do a symptomatic flip-flop and cause constipation when your inflamed poop chute contracts to the point of obstruction.

I’ve been lucky, I have a pretty mild case. I’ve gone all these years without being needing surgery, being hospitalized or worse. It can kill you. It comes and goes, a few months of remission, a few months of hell. It seems to really like to flare up in the fall. Stress seems to be a factor. Although there are some foods I’ve learned to avoid, diet doesn’t seem to be that much of a factor, but I intend to look into that aspect more thoroughly in the near future.

Three years ago I went into a remission that lasted until a couple of months ago, when it came back with a vengeance. I took my usual “ignore it and it might go away” approach until a couple of weeks ago when I decided I needed to come in from the cold and see my gut doctor. We did the usual drill of making sure it wasn’t some kind of bug and I started a course of prednisone to knock down the inflammation. I’m just starting week three of treatment.

Here’s the kicker. The doc wants me to start taking a more aggressive kind of medication. A new form of treatment referred to as a biologic, specifically in my case Humira. It works by dumbing down the immune system, which somehow just doesn’t sound like such a great idea to me. It has some nasty side effects, not the least of which is poverty. That’s right, poverty; because of something called the donut hole in my Medicare Part D coverage, I figure it’s going to cost me $8000 a year to use the drug. I can put up with a lot of shit for that kind of money.

This is getting a little long so I’m going to continue later. In my next post, I’m going to explore the conundrum presented by the next stage of treatment and my changing views of western medicine, the cost of health care and how I think about my health.

What would Frank do?

Movies, Spirituality

FrankUSMain

Alert: minor spoilers ahead. 

Our latest TV binge has been Shameless, the american version of the dark British comedy, starring William Macy as Frank Gallagher. The series is perfectly named because Frank, a serial substance abuser, is truly shameless. He shamelessly lies, cheats and connives to support his habits without lifting a finger to work. I guess if he’d been born in a better neighborhood, he would have made a great CEO.

Shameless behavior isn’t limited to Frank, Steve/Jimmy steals cars and lies to his family and his lover. Sons Ian and Lip steal, swindle and deal to bring cash to their strapped family, the list goes on. But Frank is the most blatant and narcissistic. He’s a perfect role model.

We love the show. The producers shamelessly break every taboo of TV. Sometimes it’s so gross I have to look away. And then there are times when I can’t stop watching. If you’re disturbed by the human anatomy, don’t watch. The acting is stellar. Macy; Emmy Rossum as the oldest daughter valiantly trying to hold the family together; Joan Cusack gives a comedic performance for the ages as Frank’s sometime girlfriend; Emma Kenney as prepubescent daughter Debbie, leaves you wondering how such a young actor can be that good. There are no weak links in the cast.

Lately I started to think about adopting the motto, “What would Frank do?” I’ve been kind of drifting in life and I feel like having a guiding principle like that would be just what I need to straighten myself out.

For example, I was on a conference call the other day with some of my college classmates, planning our 45th reunion. We were brainstorming of ways to get more people to show up. Our school is kind of the NCAA champ of reunion attendance and people really get in the spirit, so the pressure is on if you’re a committee member. Most of the committee consists of the kind of achievement oriented, serious folks that you would expect from a school like ours. And then there’s me. Kind of a slacker by comparison, then and now.

One of the ideas we were tossing around was how to attract class athletes that might not come because of the class itself, but to the feelings they had for their team and the experience they had playing sports.

The idea, doubtlessly inspired by Frank, came into my head to get a list of all the athletes and send them notifications that they would be inducted into the Class of ’71 Sports Hall of Fame. Never mind that you rode the bench your entire career, it was your inspirational contribution to practices. Who could resist?

But, you say, we’d have to put together an award ceremony and have trophies and gimcrack of some kind. Stop being so negative! Frank wouldn’t even consider that a problem. After you get them to sign up and they arrive on campus expecting their moment of glory, just tell them, “Oh, yeah… We had to cancel that. Lack of interest. Sorry.”

But, alas, I don’t have the steadfast dedication to shamelessness that Frank displays. Too many times I’ve experienced the icy silence that follows the blurting of a brilliant, if out of box, idea. I held my tongue.

I can only dream of achieving Frank’s level of shamelessness.