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App-Solutely

girl texting friends on her smartphonePicture this: you’re waiting for class to begin, or an elevator to open, or for a cashier to call you to the counter. Sound familiar? Welcome to my life. With a fair amount of time spent waiting, I often (along with the vast majority of my contemporaries) pull out my smart phone and start sifting through text messages and checking (and re-checking) my email. It kills a few minutes, and before you know it, class is starting or the elevator comes or the cashier calls out, “Next in line!”

 

Three summers ago after I returned home energized from my freshman year of college, I began a summer job as a babysitter to three one-year-olds. I love kids and these little ones – a pair of identical twin boys and a little girl – were as precious as they come (besides nap time when the boys would cry until their faces were red). I so enjoyed watching them discover the world and interact with myself and each other. I had just started a new biologic medicine before leaving school for summer break – it was going to be ‘the one’ (sadly, ‘the one’ in the chronic illness world rarely refers to a significant other, but instead the lofty potential of a medication to bring on the sought-after remission).

 

Spoiler alert: it was not ‘the one’ and one evening I found myself at the mouth of a toilet throwing up. I banged on the ceramic tile floor of the upstairs bathroom to get my parents’ attention downstairs in the kitchen, and after they ran up the stairs to see what the matter was, they found me in tears pleading to them that something just wasn’t right. A scope and lots of sedation later, the answer: severe inflammation throughout my colon. There’s a lot of ways to say it, but it came down to one thing – farewell colon.

 

There was a park a little ways away from the kids’ house and we would often walk there to play (note: a triple stroller with three kids is super heavy!). I recall walking home from the park one day and needing to go to the bathroom, immediately.   I considered going to a random house and demanding to use the bathroom but decided against it. I made it back to the kids’ house and soon found myself housebound there with my three charges, herding them in the bathroom so I could watch them every time I needed to go (which was quite often). Between bathroom breaks I can remember standing in the kitchen with an Oreo on my tongue, trying to find the energy to play with the kids.

 

The question soon became how did I get so sick so quickly? The answer was complicated – first and foremost, I had never really been well. Secondly, and perhaps more importantly, I had become so accustomed to feeling ill and dealing with symptoms that the feelings of wellness, health, and energy were merely distant memories. I could talk about them, but could not really physiologically remember what it was like to be well. Going to the bathroom existed solely as a horrifying painful experience, but it was my daily reality. And somewhere along the way, my disease had made the transition from uncomfortable and unpleasant to unbearable and unrealistic.

 

Having Crohn’s isn’t my fault – but it is my responsibility to do my best to take care of myself. After some initial denial, I was a conscientious patient who asked a lot of questions and adhered to my medications and spoke honestly with my doctors.  But I said farewell to my colon anyway.  What had I done wrong? How could I have better predicted the steep descent of the flare that eventually took my colon? Another spoiler alert: it all ended up just fine, as I was able to squeeze in my ostomy surgery a month before my sophomore year; I returned to college that semester and I love my bag. But the whole experience made me think, there must be a better way to track my symptoms so that I can catch myself when I’m starting to slip down the mountain; so I can alert my doctors and put up the CAUTION signs and figure out a strategy to rescue me from a debilitating flare.  You know, even without a colon, I still get flares.Screenshot Ginger.io app

 

Now picture this: you’re waiting for class, the elevator, or the cashier. You reach for your phone, but instead of texting a friend, or checking the weather, what if you took two minutes to track your symptoms? Well, luckily for us, there’s no ‘what if’ because it is real. It being Ginger.io, a smart phone app and ICN innovation that does a few super cool things. In honor of Ginger.io, I’ve made a list.



Ginger.io is Super-Cool Because…

 

1) It looks cool – it’s a sleek app that’s easy to use (in research geek-speak: it has a great deal of clinical utility because it’s feasible for participants to navigate).

 

2) It sends you push notifications when the surveys (which take an average of 2 minutes) are ready to complete, so you’ll never miss a beat.

 

3) It leverages your smartphone’s location services with the idea that when you’re feeling well, you’re moving all over, and when you’re feeling icky, you’re staying in bed with some Netflix (okay, so maybe the latter is just me….). The app literally tells you how much you travel so you can have a clue as to whether or not your ‘moving and grooving’ habits have changed (but don’t worry, it doesn’t creepily stalk you!).

 

Screenshot Ginger.io app4) Daily surveys capture the details of whether your pain is getting worse or better, whether you’re going to the bathroom more or less – in other words, it helps you become more conscious of your disease and any changes in your symptoms (i.e., giving you and your medical team the power to stop a flare in its tracks).

 

5) You get your info – you have a chance to receive a monthly graphic report of your answers to bring to your next doctor’s appointment.

 

6) It pays! A little moula never hurt anyone! Since you’re helping with research, there’s a financial incentive for every survey completed – and no, it’s not monopoly money!

 

Would my disease and surgical history have been any different if Ginger.io had been around 3 years ago? Maybe. But my point isn’t about rewriting my history; it’s about my ability to get engaged by tracking my symptoms and about being involved in health care innovation research in a way that is directly beneficial to me (and hopefully many others who live with chronic illness every day). In a busy world, Ginger.io is an efficient use of my time.  I don’t mind spending a few spare minutes here and there to catch up on my health and assess how I’m doing.

 

Your mission, should you choose to accept it, sign up for Ginger.io.  Take a few minutes to dedicate to your health on a daily basis (and hey, it will come in handy when you’re bored and staring at your phone), it’s an app-solutely great idea!

 

Jennie


To Little Jennie

To my 12-year-old, newly diagnosed self:

Jennie David on the 4th of July just a couple months before being diagnosed with Crohn's disease

For a long time, you will regret your decision to tell your parents that you were hurting. You will wish you had kept the pain and the blood and the fear a secret so that you wouldn’t be different and sick.  You will wish it very much, using up your wishes on birthday cakes and fallen eyelashes. But first, let me tell you, you did the right thing and that not telling your parents would not have kept you from getting sick.

 

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Jennie and Sami LIVE

C3N ImproveCareNow Patient Scholars to participate in LIVE Webcast on June 27, 2013Hear the voices behind the blogs - Patient Scholars Jennie David and Sami Kennedy will chat via LIVE Webcast with Dr. Peter Margolis about their work with the C3N Project and the ImproveCareNow Network this Thursday, June 27.  Jennie and Sami are part of the Patient Advisory Council (PAC), where they collaborate with a diverse group of patients to help their generation and the next by working alongside researchers, clinicians and families.  What does a PAC member do?  You’ll have to tune in Thursday and hear for yourself.

 

Find out more about the PAC here, and make sure to bring comments and questions to the LIVE discussion - register now!

 

C3N LIVE Webcast | June 27, 2013 | 12 PM ET

 

Not available to join the Webcast?  Follow and join the discussion in real-time on Twitter.


because these things will change.

Sami_scope

 

Hey.

 

Breathe. I know you want to scream right now, because it hurts so bad. I'm sorry.

 

I know you struggled to sit through that presentation. I know you didn't leave because you were afraid you'd get in trouble. You didn't want to be embarrassed. You wouldn't know what to say. You have diarrhea and it's really bloody, and I know that scares you. I know there's no way to say that easily, so you keep quiet. Some days, it's just blood. I know you wish you could talk about it. One day, you will.

 

I know you're scared. Scared that next time, you won't make it. Scared that the line outside the stall will start to get impatient. Scared that everyone will notice it's you giving off that smell. I know you wish you had more hands, so you could plug your nose, grip the rail, and hold your aching belly at the same time. I know you worry that one day, the pain won't pass, and you won't be able to wipe and stand up and just leave. You don't know what you'll do then. You're scared to look down, afraid of what you'll see. It's getting worse. The doctor said it would get better. I know it doesn't make a lot of sense to you now. You're eating only the most basic foods. It's a bagel every day for lunch, maybe white rice and a banana for dinner. You're staying hydrated before you run. That was supposed to make it all better. No matter what you eat, the pain makes you moan and cry and scream, but you know you get through it every time. You're going to get a break soon. It will be okay.

 

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You're going to face something even worse than that pain, too. Bad doubt, worse than the worst of your pain. It will hurt you more than anything. Trust yourself. Your pain is real, and you are not weak. You are loud and smart and spunky. Be that girl, even through the pain. I know you think letting people do nice things for you will make you not-a-grown-up, but let them. It's not baby-ish to need a hug or do a silly craft. Keep that in mind...say, two weeks from now. That was a hint. Hey. Really. You're being more of a grown-up than you know right now, even right within that stall.

 

I'm sorry. I'm sorry that the field trip you've been anticipating for months had to go this way. I'm sorry that you couldn't eat at lunch. I'm sorry that when you get on that school bus to go home, you're going to sit alone and lay your head against the window, clutching your stomach, wincing with every bump in the road, hoping you see the school before it's too late. I'm sorry that when you go to track practice, you're going to be the last runner to cross that finish line again. I'm sorry that you're going to have to keep running all the way inside to the field house bathroom. I'm sorry that you're going to have to get back in a car to go home. And come back tomorrow to go through the pain and confusion and loneliness again. I'm sorry that you haven't had the normal freshman year you so badly wanted.

 

14

 

I know you're not wondering why you, but you are wondering why, and I am sorry that even I can't tell you that. No one can. But, one day, you are going to dream of finding the answers to questions you don't even know to ask yet. You are going to read books and hear stories about cells and pathways in your body that sound too incredible to be real. But, they are. And you will love those stories so much that you will want to learn every detail of those stories and write your own, too. You will have dreams you cannot even fathom yet. Dreams bigger than the stories and bigger than the pain.

 

I know it bothers you that I'm apologizing. I know if you were feeling better, you'd probably even be angry that I'm being so unclear about everything. This is our story, and you have to live it out to become me. Believe me, you'll like who you become. I'm sorry that you have to feel this pain, and that it's worthy of a letter, but know this: one day, you will speak about this pain, and the crowd will stand up and applaud, and it will be one of the happiest moments of your young life.

 

Hey. Don't look down. Just this one time. You know what's there. Look up. You don't know what's ahead yet or even what your problem is, but one day, you're going to be part of the solution. I know.


Defining and Defying

As of today, I joined ‘the real world’ - aka started my first real-world-full-time-look-I’m-an-adult-honest-to-goodness-getting-paid job. Today went as follows: 1) I ran into the PI of the study (who’s the head of the division, and who I’ve worked for the past couple of summers) and he gave me a hug (the day was off to a good start) 2) Got my ID badge which officially says “Jennie David, Cardiac Surgery, Research” - AWESOME 3) Found out that my ID badge gave me access to the OR (unnecessary, but totally cool nonetheless) 4) Geeked out with a co-worker over the research studies 5) Nearly drooled on my computer at an abstract that’s being presented at an international conference in a couple of weeks where I’m listed as a co-author.

 

Graduating from college is more or less synonymous with the phrase, “Here comes the real world!” To paraphrase a speaker at graduation, if this is the real world, where was I living for the past 21 years? The dictionary defines real as, “actually existing as a thing or occurring in fact; not imagined or supposed.” I would therefore like to argue that my entire life has actually existed and occurred in fact and has neither been imagined or supposed - so I would like to believe it’s all been quite real. The question becomes - what does joining ‘the real world’ mean?

 

For those of us living with chronic illnesses, we joined ‘the real world’ a long time ago, often years before our contemporaries. I would gander to think that ‘the real world’ refers to a certain consciousness, when you are acutely aware that your actions have consequences, that things matter, that responsibilities have weight, that bills need to be paid on time, and that if you put dark jeans in with white laundry you will dye all of your underwear blue. To quote Joan Didion in ‘Goodbye to All That’, a favorite essay of mine (that I highly suggest you read if you find yourself entering ‘the real world’), “That was the year... when I was discovering that not all of the promises would be kept, that some things are in fact irrevocable and that it had counted after all, every evasion and every procrastination, every mistake, every word, all of it.”

 

Definitions are, in virtually every way, relative and changing. Entering adulthood is different for everyone, just as living with an illness is or even a person’s preferences for candy. ‘The real world’ - or the awareness that you have a choice in making things the way you want them - isn’t something that’s prescribed only to the cohort of recent college graduates, it’s something that can happen at any time to any of us. For me, I was 12 and newly diagnosed and began to realize that I had the ability to define what Crohn’s meant for me and to defy what others thought it meant.

 

There is a difference between being chronically ill (a physical reality) and living with a chronic illness (the emotional experience). Today, in the midst of loving my new ID and reading over papers, I was temporarily bothered by the psorasis sprouting along my arms and legs and the ache in my abdomen compliments of my inflamed guts grumbling. Does it mean I didn’t enjoy my first day? Does it mean I can’t be successful at my job? Of course not. I’m just a girl who has a lot of goals and dreams and will work my butt off to get there - step one, doing my best at my research job, step two, getting where I want to go. I’m someone in my own right, and my Crohn’s fits in, but it does not define me in and of itself.

 

I remember the first time I ever heard the term ‘glass ceiling’ and thinking it was a funny way of talking about limitations. After all, even if it’s a glass ceiling, you can see the sky, so is it really that bad? But I think that’s the point - you can see what’s out there, but you’re boxed in and can’t get out. We all have preconceived notions about what it means to live with a chronic illness - we might think it means we can’t have a job, or a significant other, or move away from home, and so on. But at the end of the day, we are free to choose our own definitions - and they can change - and we are free to defy the expectation that a life of illness is a life of suffering.

 

So go ahead - defy expectations, define yourself according to yourself, shatter those glass ceilings. You’re already living in the real world, so go out there and do a downright gutsy job of it.

 

Jennie


Take Steps and Super Heroes

Alex8799 and his take steps team pictureThis past week I took part in the Cincinnati Take Steps walk for the third year in a row. Each year we design a new shirt as a way to come together as a team. This year’s team shirts were superhero-themed; the team name merged with the superman symbol. Seeing the sea of purple at the walk and all those superhero shirts got me thinking about my heroes and how they have helped me cope with my disease.

 

What makes someone a hero in my eyes?  They need to inspire me.  They should make me think beyond what’s normal and make me challenge the status quo.  Heroes change the perspective. They do not let limitations stand between them and what they want to do.  One of my heroes is Alicia Lang; she lived most of her life with Cystic Fibrosis. She was in the hospital for weeks at a time and half of her lifetime. Yet she always had a smile on her face and did not let her disease stop her from helping others. I met her at the Cincinnati Children’s Hospital Patient Advisory Council. She would roll into our meetings every month and you could not help but feel her presence in the room. Now the PAC meetings feel emptier without her smile. She lost her battle with Cystic Fibrosis, but her influence lives on.  She taught me that the tough times are the best times; it is a time for kindness, a time to step it up a notch, a time to smile, and a time to be a hero.

 

Heroes also inspire.  Jennie David and Sami Kennedy are two other inspirational heroes.  They inspire others by spreading their story.  They help others through their own fight by sharing their experiences; sometimes this is with humor (sharing opinions on what toilet paper is the best), other times sharing their experiences while going to college.  They have set high expectations for themselves and have made a lifelong goal of helping others with IBD. They have taught me that I can talk about poop as much as I want to, and that no matter how high the goal I can achieve.  They have taught me that, despite my Crohn’s disease, going to medical school is not out of the question; and that I am not going to accept anything less than a life as a pediatric gastroenterologist.

 

So why this blog about my heroes? Heroes are everywhere. They can be your Mom or your Dad, they could be someone that helps you at school or someone that you meet through circumstances that bring you together to fight a common cause.  In this virtual world, they could be a person you’ve not met face to face, but you admire from afar. Heroes are people you can look up to and can help you get through any situation. For me, when times are tough, I just think about all the people I know, my heroes, and those who may have it worse than me. I think about their situations, the experiences that they have shared, and I am thankful and mindful that my situation could be a whole lot worse. Every night I go to bed listening to Zach Sobiech’s song, Clouds, and I think to myself how I can live the next day to the fullest. How can I be a hero?

 

Everyone needs a hero so go out and find one. The hero you have always been looking for could be right in front of you.


Michael Seid, PhD

Michael Seid, PhDI’m a health care researcher interested in making health care work better for kids with chronic illness.  My sister has Crohn's disease and my daughter was just diagnosed last year with Crohn's disease.

 

Twenty five years ago, my sister was diagnosed when her intestine burst. Her bowels were so obstructed and inflamed, that they started leaking into her abdomen. After her first surgery, she found kind and wonderful doctors. My parents did everything they could for her. But her journey was rough. She ended up having three surgeries, a TPN feeding tube, losing all but 3 feet of her small intestine, and having way too much physical and emotional suffering. She never took her meds because she didn’t think they did anything for her. She felt completely alone and was convinced no one could help her.

 

Because my daughter is part of ImproveCareNow, her experience has been different. She was connected early on to other kids her age with Crohn’s. She learned how to track her symptoms so she and her doctor could determine that her meds were helping. And she collaborated with her doctor to figure out that Carnation Instant Breakfast helped reduce her fatigue. I’ve connected online with other parents for ideas about how to help and have shared this information with her doctor. Things aren’t perfect, but my daughter has been able to bear the burden of Crohn’s more lightly, in large part because of the way that ImproveCareNow has enabled us all to be more active partners in helping her stay healthy.

 

Taking ImproveCareNow to the next level is crucial.  I want to make a world where everyone can be part of the solution.  I intend to continue to work to make it easier for more people to make a difference for their health or the health of their children.

 

Michael


IBD and Skin Cancer

Don't Fry Day Logo Skin cancer is the most common type of all cancers according to the American Cancer Society. Check out their excellent infographic.

 

Skin protection and cancer prevention are especially important for kids (and adults) who are taking, or have taken, immunosuppressants (thiopurines as an example) to treat IBD – as the risk of developing non-melanoma skin cancer can be higher for them - according to this article by the American Gastroenterological Society.

 

The National Council on Skin Cancer Prevention has declared the Friday before Memorial Day is ‘Don’t Fry Day’ to encourage sun safety awareness.  As get ready to kick off the Memorial Day weekend, consider these tips to help protect your skin:




    • Do Not Burn or Tan

 

    • Seek Shade

 

    • Wear Sun-Protective Clothing

 

    • Generously Apply Sunscreen

 

    • Use Extra Caution Near Water, Snow, and Sand

 

    • Get Vitamin D Safely



For more information about Vitamin D - including what it is, how much you need and how to get enough - check out Vitamin D - QuickFacts from the Office of Dietary Supplements at the National Institutes of Health.  You can also check out our very first issue of CIRCLE, which featured an article on Vitamin D by Richard Colletti, MD - Network Director for ImproveCareNow.

 


Body Image & IBD

Having your body at the center of ongoing medical scrutiny is not the ideal situation in which to develop an individual and autonomous body image. We make room for scars and side effects, sometimes feeling as though who we are (and who we want to be) shrinks more and more. Developing a positive sense of self and body image is something every kid must face, but especially when it comes to IBD there is a role for everyone to play.

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First and Last

There are evenings like tonight that I am sure I will remember in thirty years. There’s nothing remarkable about tonight, just a quiet evening at home, only it entails being forced to watch the school’s football field undergo a Cinderella transformation into my way-too-soon college graduation. And as such, I am overcome with a simultaneous sense of relief and panic – causing me to nearly freak out at the sight of the stage being built with a near “WAIT, I AM NOT READY TO LEAVE”. But alas, no one would hear me, so I will spare my neighbors the screaming.

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