Why is Don in the Hospital?

On Tuesday, December 27th, I was admitted to Moses Cone Memorial Hospital in Greensboro, NC. Several people have seen posts on Facebook and have heard through the grapevine that I have been in the hospital over the past couple of days, and I know that many people have been asking questions about why I am in the hospital. Today, I decided that it would be helpful to lay out all of the information to help answer some questions that you have in this blog post.

What's Wrong with Don?
I have an inflammatory bowel disease (IBD) known as ulcerative colitis (UC). Ulcerative colitis is a disease in which the lining of the colon (large intestine) becomes inflamed and develops sores (ulcers), leading to bleeding and diarrhea. I was initially diagnosed with the disease when I was 20 years old as a junior at Bucknell University. It is fairly common for the disease to manifest itself in young adulthood, and you don't know that you have it until you start experiencing symptoms. There is some history of the disease in my family, but doctors are not sure why the disease develops in some people and not others. Since the beginning of November, I have been experiencing a severe ulcerative colitis flare, which consists of frequent (8-10) bowel movements per day consisting of bloody diarrhea and moderate to severe stomach cramping.

What Happened?
My flare started out mildly in the beginning of November, but progressively got worse near the end of November. It is not known what triggered the flare, but once it started, it didn't stop. I have had flares in the past, but I have usually been able to get them under control within a few weeks by taking various kinds of medication prescribed by my GI doctor (doc who specializes in the digestive system). Unfortunately, this time my flare was not responding to the medications that I was taking from home, and I was maxed out on my doses about a week before Christmas. My symptoms got worse during Christmas weekend, and I saw my GI doctor on Tuesday, December 27th. Since my flare was not improving, he admitted me to the hospital right after my appointment so I could receive some different medicine via an IV to try to stop my flare.

What's Been Going on in the Hospital?
I went to the hospital on the afternoon of Tuesday, December 27th, one day before my 32nd birthday. Am I still in the hospital, but I'm hopeful that I can be released as early as Tuesday, January 3rd.
Tuesday, December 27th
- Appointment w/ GI doctor early afternoon - ordered to be admitted to the hospital right after my appointment
- Several tests performed to rule out infections as the source of my symptoms (chest/abdominal x-rays, blood tests, and c-diff tests administered) - found out next day that all tests came back negative confirming that I am having an ulcerative colitis flare
- Started IV steroids
- Frequency of bowel movements reduced from 10 to 6 for the day
- Energy level low
Wednesday, December 28th
- Continued IV steroids
- Frequency of bowel movements reduced from 6 to 4 for the day with no blood
- Feeling much better and optimistic about leaving the hospital by Friday
- Energy level high
Thursday, December 29th
- Stopped IV steroids in the morning
- Started back on prednisone (oral steroids) in morning
- Frequency of bowel movements reduced to 1 for the day with no blood
- Energy level high
Friday, December 30th
- Ulcerative colitis flare started again at midnight with bloody diarrhea and cramping
- Frequency of bowel movements increased from 1 to 9 for the day with moderate to severe abdominal pain
- Stopped taking prednisone and placed back on IV steroids later in the afternoon
- Additional tests (chest x-ray, blood tests, and tuberculosis test) administered to prepare for a new medication called Remicade next week if my symptoms don't improve over the weekend - test results came back on Sunday and confirmed that I should be able to take Remicade if needed
- Felt pretty down and depressed throughout the day
- Energy level very low
Saturday, December 31st
- Continued IV steroids
- Frequency of bowel movements reduced from 9 to 2 with blood and cramping going away
- Started an exercise routine by walking the halls for 20 minutes, stretching, and doing a few exercises like push ups and curl ups in bed
- Energy level high
Sunday, January 1st
- Continued IV steroids
- Frequency of bowel movements increased from 2 to 4, but there is no blood or cramping
- Continued exercise routine by walking the halls for 30 minutes, stretching, and doing a few exercises like calf raises, push ups, and curl ups
- Energy level high

When Does Don Get To Go Home from the Hospital?
I am hopeful that I will be able to go home from the hospital as early as Tuesday, January 3rd. This will only be the case if I do not have any more bloody diarrhea. Most likely I will be taken off of the IV steroids on the morning of Monday, January 2nd and put back on prednisone (oral steroids). If I make it 24 hours without a flare, I should be able to go home on Tuesday (Wahoo!!!).

What Happens If Don Gets Worse Again?
If I have another flare after going off of the IV steroids, I will most likely be starting a new medication called Remicade which has some pretty serious side effects and risks. Fortunately, most patients respond well to the medicine, and it is generally very good at putting and keeping ulcerative colitis in remission. To receive the medicine, I will have to go back to the hospital for a few hours to receive it through an IV, but I shouldn't have to stay in the hospital overnight.

What Can You Do To Help?
Please continue to keep me and my family in your thoughts and prayers. Especially keep Steph in your prayers. Caring for a loved one with a chronic illness takes a tremendous emotional toll, especially when you are juggling the responsibilities and worries of being a wife, mother, and doctor at the same time.

History of Don's Ulcerative Colitis

• Fall 2000 (age 20) - First sign of ulcerative colitis occurred during my junior year at Bucknell University
• Winter 2000 (age 20) - Diagnosed with ulcerative colitis in the end of my digestive tract (rectum) via a colonoscopy - Treated with some medicine for a month or two and symptoms went away
• Spring 2004 (age 24) - Had an ulcerative colitis flare while living in NYC - colonoscopy revealed that I my colitis had moved up my digestive tract into the first few centimeters of the colon (large intestine) - put on a medication called Asacol to keep my colitis in remission
  
• Spring 2008 (age 28) - Had a colonoscopy - ulcerative colitis was in remission, but it had progressed a few more centimeters up the bottom portion of the colon
• Spring 2009 (age 29) - Ulcerative colitis flared again - had a sigmoidoscopy and found that my ulcerative colitis progressed through the entire sigmoid colon (bottom portion of large intestine) - put on a different medication called Lialda and treated the flare with a medication called Rowasa - flare subsided within a few weeks
  
• Fall 2009 (age 29) - Ulcerative colitis flared again - added prednisone (oral steroids) to my medication for about a month to calm down the flare - about a month later, I began experiencing severe pain in my left hip due to an effusion which was later attributed to my ulcerative colitis, and I had the effusion drained with a very long needle (I swear that needle must have been at least a foot long)
• Winter 2010 (age 30) - Added a new medication to treat my ulcerative colitis called azathioprine over the long term in addition to taking Lialda
• Spring 2011 (age 31) - Had a colonoscopy in April which revealed that my ulcerative colitis had progressed through the entire left side of my colon. I had a minor ulcerative colitis flare shortly after my colonoscopy, and it was treated with prednisone (oral steroids) and a hydrocortisone enema for about a month when it eventually subsided
  
• Fall 2011-Present (age 31) - Severe ulcerative colitis flare - treatment with max doses of Lialda, prednisone, azathioprine, and Rowasa enemas could not get the flare under control - admitted to the hospital on December 27th since I was having 8-10 bowel movements a day with bloody diarrhea and moderate to severe abdominal pain - placed on IV steroids in the hospital - first round of IV steroids helped initially but flare resumed within 12 hours of being taken off of the IV steroids - put on a second round of IV steroids for twice as long
  

Additional Information About Ulcerative Colitis
If you are interested in learning more about ulcerative colitis, here a couple of links that contain some useful information. I have no problems talking to you about my disease if you have questions.
LivingwithUC - http://www.livingwithuc.com/
EverydayHealth - http://www.everydayhealth.com/ulcerative-colitis/ulcerative-colitis-basics.aspx
UpToDate - http://www.uptodate.com/contents/patient-information-ulcerative-colitis?source=search_result&search=ulcerative+colitis&selectedTitle=7~150
MedicineNet - http://www.medicinenet.com/ulcerative_colitis/article.htm


Thank you for all of your love and keeping me and my family in your thoughts and prayers. I am especially grateful for Steph's mom helping Steph out the past 5 days while I have been in the hospital. Also, thank you to Steph's dad and brother for getting some projects done around the house earlier this week.

-Don