I was trying to think of an appropriate title to this e-mail update, and “body trade-in” came to mind, but God doesn’t work that way, so I’ll have to settle for a rebuild. You all probably sense by now that I write these not so much to show off my writing talent or lack thereof, or share my bodily function setbacks with my family and friends, but to put into words what is coursing through my brain so I can sleep at night.

I had my follow-up visit with the gastroenterologist yesterday. He sees patients in Hastings two half days a week and leases space from Diane (Dr. Ebaugh to you non-townies). His schedule is typically behind (npi) and yesterday was no exception. My appointment was at 12:30 and there were two people ahead of me. I got in to see Dr. Papp at 2:10.

One of the people ahead of me was a young man in his early to mid thirties with two active boys I would guess were around 4 and 6. They completely rearranged Diane’s waiting room and turned the six chairs in the center of the room around to make a fort. They took every magazine in the room over to Dad to read, stayed attentive for about five seconds and went and got another one.

After me, a family came in…three adults and three children…two girls ages 6 and 8 and a boy about 10 with a Mohawk haircut. Only one of them, the mother or grandmother, had an appointment with Dr. Papp. I can’t imagine taking all those people in to listen to the Dr. tell you about your digestive problems.

The guy with the two boys was beside himself because the Dr. was running late. He talked on the phone to his wife/girlfriend three or four times. The last time he told her “I’ve told you ten times. If I walk out now the Dr. will probably walk in right after I leave and I will have wasted all this time.” After a short listening period he followed by saying “I don’t want to hear it. I’ll talk to you later,” followed by a quick hang-up. Four seconds later when his cell phone rang he turned the ringer off and buried the phone in his pocket.

About ten minutes later Dr. Papp showed up and called his first patient, Martha, which infuriated the young guy. He gathered up his kids and stormed out the door. About ten minutes later he walked back in and sat down with the kids. About five minutes after that, Dr. Papp poked his head in the room and called my name. I looked over at the young guy and didn’t move a muscle. Dr. Papp said “Oh, Jim, you’re back. Come on in. I’ll take you first.” The guy got up and started walking in. The kids had gotten under his skin, probably due to the Dr. being late, and he had to take it out on someone. One of the kids was dawdling and Dad gave him a gentle nudge towards the open door. Of course the boy played it for all it was worth and did a face plant on the floor right in front of me. Has father, I’m sure, felt like a jerk and probably thought everyone had him pegged as a child abuser.

So my appointment was one of those good news bad news talks, or at least that’s the way I took it. He told me what I already knew and had read about but in much more detail and we talked in detail about the options for treatment. I have a lot of admiration and respect for Dr Papp…being a “butthole doctor” can’t be the most fun job. The good news is that I’m feeling better and it looks like this “flare-up” will soon be under control. The bad news is that I’ll have to continue taking the medication (three capsules three times a day) maybe indefinitely.

No, they don’t know what causes it and, no, it’s not curable. What happens is that your immune system is always looking throughout your body for things to protect you from (my apologies to the English majors out there for a poorly constructed sentence). When it gets to the lining of your large intestine, it mistakenly thinks it’s foreign, and sends “the Sheriff” (white blood cells) to run the rascals out of town. The lining gets inflamed from the “friendly fire” attack, often bleeds, secretes mucus, and causes the muscles to cramp. When food and fluids get there, they encounter the inflamed colon and get “the bum’s rush” out the door.

People tell me to watch what I eat and I’ll be fine, but what you eat has nothing to do with flare-ups. They just happen. Once you have a flare-up, there are certain foods, which are different for everyone, that cause discomfort as they pass through quicker than normal. For me it’s jalapeno peppers or pepper jack cheese which have caused me discomfort on my best days. Through trial and error I’ll find out what things cause me discomfort and I’ll stay away from them or pay the price a couple of hours later.

So, there’s no special diet…I can eat fruit like I always have…I can get back into my training as long as the “runs” (npi) don’t interfere…I can do a long race (half or full ironman) if I want knowing that if I have a flare-up the week before the race I MUST NOT DO THE RACE. If I keep taking the medicine I’m on I may have an average of 2.5 flare-ups a year. If I go on a different medication (IV at the doctor’s office every two months) I can expect an average of .5 flare-ups a year. (There were tons of things to remember so I may not have these occurrences exactly right). Everyone is different and I may have more or fewer problems than the average.

So I’m bummed that this can’t be fixed and I won’t be back to normal again before I know it. But I’m relieved (npi) that we know what it is, how to recognize the symptoms before they get too bad, how to differentiate between a flare-up and a “stomach virus”, and when to call the doctor’s office for reinforcements.

I talked to Dr. Papp and told him this would be a good time for me to lose the extra pounds I’ve put on with limited exercise and the extra foods and sports drinks necessary to get the electrolytes back in line. He thought it would be a good idea and suggested I not try the fad diets (Atkins, etc.) or diet pills. I told him it would be a reduced calorie diet with moderate exercise (a normal triathlon training schedule with no speed work for a while and lower mileage) and he thought that would be fine.

So if you see me and I’ve lost weight, it’s not because I’ve been sick. If I haven’t lost weight, that’s the story of my life.

Just (Insert Your Own Butt Joke Here) Jack

 npi = no pun intended

It’s time to set the record straight. Many of you who see me often probably have noticed that I’ve been somewhat subdued lately (which, for me, is one step above a coma). I know there are rumors flying around about why, so here it is, from the horse’s mouth.

If you have a weak stomach or don’t want to read anything gross and disgusting, STOP READING NOW, DELETE THIS MESSAGE, and you will sleep better tonight.

Without going into too much detail, I’ve been having some digestive problems. Not the ordinary “Boy, I wish I hadn’t eaten that burrito”, but something more intense and persistent with bleeding that started at 2 AM the day of the Bayshore Marathon (Saturday of Memorial Day weekend). I didn’t tell anyone I was having problems because I thought they would pass (npi), but they got worse.

I finally went to the doctor on June 22nd. O.K. I told everyone I was going (npi) because of my ankle problem, but that wasn’t really true, although I did tell him it was sore (the ankle, not my ….Oh, never mind). I knew I was in for a not so pleasant exam and I was right. The digital exam was a piece of cake compared to the contraption he used to look farther than any human should ever see.

I was given two specimen containers to take stool samples to the lab. Luckily I had a meeting in Lansing the next day so I dropped them off while most everyone was sleeping. But that’s not the end (npi) of it. He asked me to keep track of, and write down, all of my bowel movements for the next week including date, time, consistency, and other things too gross to mention. Of course, being the anal (npi) person that I am, I did it on an excel spreadsheet. I titled it “The Tales of the Turds” or, subtitled, “What a Bunch of Crap”.

I had some trouble with the consistency descriptions, but settled on terms like Au Jus, Mashed Potatoes Without Lumps, Mashed Potatoes With Lumps, Hot Chocolate With One Brown Marshmallow…. O.K. You get the picture. Dr. Weatherhead knew I was in a lot of discomfort, but could tell my sense of humor hadn’t been affected.

By the next appointment, things had gotten worse. Dr. Weatherhead scheduled me for a CT scan and gave me another container for a stool sample. This time I borrowed the Baptist Church Bus, wore a fedora hat, put on a trenchcoat, donned a fake beard and sunglasses and dropped off the sample. Even at that people know who you are and, since you are carrying a sample wrapped in a grocery sack, know it’s either a stool sample or a semen sample. And, odds are, there aren’t many 58 year old men carrying semen samples to the lab.

I had to keep track of BMs for a second week and did it the same way. This one was titled “The Fecal Matrix Revisited” or, subtitled, “Some Turds Roll Downhill Faster Than Others” (a takeoff on the saying *%#@ Flows Downhill).

At the next doctors appointment I knew what was coming. The stool samples and CT scan eliminated a lot of really bad things, but didn’t identify what was causing the problems, so he ordered a Colonoscopy. The preparation the day before, as many of you know, is no fun at all. The procedure itself is relatively straight-forward but I have a complaint about the sedation. They use Versed (sp) which keeps you conscious but you forget everything. WRONG!! I was in so much pain with intestinal cramping that inflating me with air was excruciating and I do remember it.

The other complaint is that, when the doctor comes out and tells you what he found, you do forget that part, so I’m passing (npi) the results on by way of Jean, a not so detail oriented person. She said that he said I had “a full blown case of ulcerative colitis”. I’m not going into what that really is. If you wonder, ask Diane or look it up on http://www.webmd.com/ . Dr. Papp Jr. (next time it’s my turn to bring the candles, flowers and a bottle of wine) prescribed two new medications, much stronger than the ones I had been taking.

With one I take three capsules three times a day (9 pills total) with 12 refills printed on the prescription bottle. With the other, I’m still trying to figure out the best way to take it. The directions say, before retiring (too late for me…I retired three years ago), start out with your knees, head and forearms on the floor, reach around, insert the applicator tip and squeeze out the contents. Hold that position for 30 minutes to allow the solution to disperse and try to retain it all night. (If picturing that in your mind doesn’t cause nightmares, I don’t know what will). I have 28 of those with 4 refills.

So with all those refills, it sounds like this won’t be a quick recovery. The worst part of the whole thing is that, on the discharge instruction sheet, someone wrote, as a joke I’m sure, “No Swimming San Fran Bay At This Point”. Jean says Dr. Papp said that several times, but I don’t believe it. He’s really a nice guy and wouldn’t do that to me. He must have coerced that information from me while I was under sedation with my butt pointed toward him and him holding a 10 foot flexible tube.  Jean says that Dr. Papp is afraid of cramping and dehydration due to the inability to absorb fluids until this thing is under control.

On the one hand I argue that I’ve been swimming a mile and a half three days a week for quite a while and this should be no different. But then I recall the story of Chris Legh, a multiple Ironman Triathlon winner, who lost part of his colon due to dehydration during a race. Then I think maybe doctors do know better than we do and it isn’t worth the risk. We’ll see.

So there you have it. The End (npi).

Let’s get all the jokes out of the way now like:

Your problems are all behind you now.

Everything comes out in the end.

All bad things will pass.

After all those tests, the doctors finally got to the bottom of the problem.

No, I don’t want to talk about it so don’t ask. And please don’t look at me with that Cheshire Cat smile. Something tells me my history of including many of you in my e-mails against your will is coming back to bite me in the butt (pun intended).

Just (I’m Getting Tired of This Crap) Jack