Thursday, August 7, 2014

Fear is the Greatest Motivator

When I had my colonoscopy on July 15, Rich spoke with Dr. Sigmon following the procedure. This is how the conversation went: 

Dr. Sigmon: It is really really really inflamed in there.

Rich: It is?

Dr. Sigmon: Oh yeah. This is one of those things where it's almost hard not to take this personally. As the physician when we see inflammation like this, it's hard for me to explain it. But we want it to look better and to be good.

Rich: Right.

Dr. Sigmon: She had so many hopes I think before we did this that we were going to find nothing, or minimal inflammation. And I'm telling you, it was nasty looking, especially over in the sigmoid over here on the left side. It was so inflamed over there that I used a pediatric colonoscope and I wasn't sure I would get through that area it was so swollen and narrow. I just sort of held the scope there and waited for sort of the motility of the colon to sort of carry me through that area. And it was quite an anxious feeling because you don't want to cause a problem there but it was really really inflamed in there.

Ulcerated, ademidous, and mainly over in here there were some ulcers scattered about. The rectum looked normal. The ileim which is the terminal ileum of the small intestine looked normal. I did biopsies but it looked normal. But this is the type...I haven't send any meds yet but I think she needs to at least until we can get the biopsies back and can talk about options get back on her Asacol and she probably needs to be on a couple antibiotics because I'm worried about that inflammation in there.   And that antibiotic one of them would be Flagl or Metrodnidazole and the other Zifaxin.

Rich: What's the purpose of the antibiotic?

Dr. Sigmon: Because there's so much inflammation in there and the biopsies and stuff that you just don't want the bacteria to get invaded into the wall of the colon. With that amount of inflammation she's a bit at risk for perforation. So I don't want that to happen obviously.

I think that what she's going to need medicine wise is the full course press and I mean is one of the biologic agents because it is so inflamed in there. We can't, ummm, we can only be so dogmatic about  these things to patients. We can't dictate the therapy, we can make big time recommendations, but I'm just afraid if we don't check this or get this under control, it's going to be a bad thing. Inflammation can result in scarring because Crohn's is a full thickness disease, and if you get scars there. You can't fix scars except by surgery and if you get a stenotic area there.

Rich: What do you do about that?

Dr. Sigmon: About the stenosis?

Rich: Yeah, the stenosis?

Dr. Sigmon:  You have to have surgery.

Rich: To remove that part?

Dr. Sigmon: Ummm humm.

Rich: There's no reducing it once it becomes too thickened?

Dr. Sigmon:  No, but. Well no we could. It's inflamed right now, but I'm worried that over time if we don't do something about we're going to end up with a scar.

Rich: Inflammation would just be like temporary thickening as with scarring would be more permanent thickening.

Dr. Sigmon:  Correct, correct.

Rich:  Okay.

Dr. Sigmon:  I've got one lady I have to do some procedures on next, but I think I'd like to talk to her for a little bit before she scoots out of here just to sort of give her my take on this.

Rich: So the two big questions is, one of them is, is she in remission, well obviously the answer is no.

Dr Sigmon: No

Rich: The other is, she's been trying to deal with this through the natural, you know...

Dr. Sigmon: And I respect that.

Rich:  ...watching everything and quite frankly it has been keeping her symptoms pretty well, but then the worry is that even though your symptom free, you don't really know what's going on.

Dr. Signmon: Right, we talk about clinical remission, or clinical evidence of disease and endoscopic evidence of disease. And we know that endoscopic evidence of disease and clinical evidence of disease do not correlate one to one. Okay? So she might feel better, but her colon looks like, yuck.

Rich: Okay.

Dr. Sigmon:  It's not a scientific word, but...

Rich:  I understand. It gets the point across.

Dr. Sigmon:  It makes me sick on my stomach I mean when I was in there I was like, oh my gosh! You know because I get all buoyed up too thinking, oh yeah, maybe this is going to look good, but realistically, I know man, I don't know how in the world it's going to look good because she hasn't been on any medicine to speak of off and on for a while and her sed rate was out the wazoo this last time, I mean it was way up there, index of inflammation. So I know something's going on, and I dodn't think she'd been on medicine long enough, or potent enough medicine long enough to get that inflammation under control. But man, we'll take it. If it's in remission, we'll all go celebrate together, but, that's why I mean I take it personally because when I see that and you're like...

Rich: So the sed rate is that a big indicator.

Dr. Sigmon:  It's an indicator of inflammation. 

Rich:  Right

Dr. Sigmon:  You can't just follow that solely.

Rich:  Right

Dr. Sigmon:  But, in this case it was spot on.


Dr. Sigmon:  I know. Belive me I hate this. It's the one thing I hate bout this job.

Rich:  Yeah, I understand.

Dr. Sigmon: We can't all come back and say it's great. We have to come tell the news. But we want to make it better

Rich:  Right, right.  So I now there are different levels of the medication. 

Dr. Sigmon:  Yeah.

Rich:  You kind of start off at one and my understanding is that over time a period of time it loses its effectiveness

Dr. Sigmon:  It's a pyramid. And it's called step up versus top down therapy. She needs to go from the top down. I mean it's that inflamed. 

Rich:  Okay.

Long pause...

Dr. Sigmon: That's my recommendation, so you know.

Rich:  Okay.

Every time I get tempted to do something that will not be good for my colon, I will remember or play parts of this recording. By typing it out here for you to read, I hope it will help give me the will power to do what I need to do. 

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