Inflammatory bowel disease
Following a colonoscopy in September 2004, Suler was diagnosed with ulcerative colitis, an inflammatory bowel disease.

“IBD is a group of inflammatory conditions of the large intestine, and in some cases the small intestine,” said Dr. Greg W. Galler, a board-certified gastroenterologist at Kelsey-Seybold Clinic’s main campus. “The main forms appear as Crohn’s disease and ulcerative colitis.”

The biggest difference between the two diseases is the location and nature of the inflammatory changes, Galler said. Crohn’s can affect any part of the gastrointestinal tract. Ulcerative colitis is restricted to the colon and rectum. Bleeding sores called ulcers form along the digestive tract. This causes severe abdominal pain and bloody diarrhea. It most often occurs between ages 15 and 40.

More than 1 million people in the United States have IBD. (Source: The Crohn’s and Colitis Foundation of America.)

The cause remains unknown but theories include environmental, genetic and immunological influences.

“Over the course of a person’s life, IBD can come and go,” Galler said. “Medicine can usually control the symptoms, but for patients with severe IBD, surgery is sometimes necessary.”

IBD should not be confused with irritable bowel syndrome, which is much less severe and rarely requires surgery.

“It’s not always easy to diagnose,” Galler said. “The diagnosis is made by a combination of signs, symptoms, blood work, radiological evaluations, and endoscopic procedures such as a colonoscopy with biopsies.”

Colonoscopy is a covered benefit in the city’s health plan. Different copayments apply depending if it is for diagnostic or procedural purposes. A routine colorectal screening has no copayment. “An annual well-man, well-woman exam includes a colonoscopy every 10 years if the patient is over 50 or has a family history of colorectal cancer,” said HMO Blue Texas customer advocate Ivan Flake.

There is a $200 copayment for a medical procedure to treat or remove something discovered in the exam.

The test is performed under sedation, usually taking less than 10 minutes. It examines six feet of rectum and colon, using a flexible scope. The copay applies if the patient is under 50.

“There is not a single test that is definitive for IBD as other diseases can mimic it,” Galler said. “Rather, it is the entire picture that is important as well as the patient’s response to medication therapy.”

The main warning signal is diarrhea, especially waking at night to move bowels, persisting for two or more weeks, Galler said. Other symptoms include unexplained weight loss.

Occasionally, rashes, anemia, arthritis, and certain liver diseases can be present, Galler said.

Galler advises early treatment for the best outcome.

“I cannot stress this enough. Early treatment is the key. It prevents most of the complications with the disease,” Galler said.

Suler’s condition had become a “worst case scenario.”

While Galler was examining her after that dreadful night, her colon perforated. She was rushed into surgery for an emergency ileostomy, performed Jan. 13, 2006, at St. Luke’s Episcopal Hospital.

Sixty-six inches of Suler’s ulcerated colon were removed. She spent five days in the hospital and went home with a new addition to her body: an ostomy bag adhered to her side to collect bodily waste.

She returned to work three months after surgery.

Now 46, she said she’s never felt better and is living life to the fullest. She has become a certified scuba diver and dive master.

“I can even dive with my ostomy bag,” Suler said. “Of course I don’t wear a bikini. Only a one-piece from now on.”

She eats a healthy diet that’s low in fat, and power walks one hour each morning with 1-pound hand weights.

On Nov. 12, she celebrated her one-year anniversary since quitting smoking.

“God gave me a second chance at life. I wasn’t gonna blow it away in cigarette smoke,” Suler said.

Approximately 24 percent of patients with ulcerative colitis will have surgery to remove the affected part of the colon within 10 years of diagnosis. (Source: Crohn’s and Colitis Foundation of America.)

There is no known cure for IBD. But there are new medications and new treatments.

“Now, we treat it aggressively right from the beginning,” Galler said.

“The mainstay of treatment in the past was steroids. They worked great but had long-term side effects. This is going away as the biologics are proving to be safe.”

Newer medications include oral 5-amniosalicylates (5-ASAs), such as Colazal, Asacol, Pentasa, and Dipentum. These are Tier II, preferred brand-name drugs in the city’s formulary.

The goal is to have the patient lead a normal life, and this is happening more often,” Galler said. “Some patients will require surgery, but even so, a normal life is certainly attainable.”

“People suffer in silence because of embarrassment,” Suler said. “Don’t do it. There’s nothing to be ashamed of. If you think you’ve got it, get to your doctor, get treatment and get on with your life.

“You’ll be glad you did.”

For more information, visit the Crohn’s & Colitis Foundation of America at
www.ccfa.org.

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