The Subject

This blog follows my own battle with Crohn's disease (CD) for which I was diagnosed in 2001 (I'm presently in my mid 30s).  Crohn's disease is a type of inflammatory bowel disease (IBD) characterized by an immune system response that attacks the body's gastrointestinal tract.

My symptoms present as abdominal pain, rectal pain, diarrhea, fecal incontinence and malabsorption.  And that's on a good day. On particularly bad flares I also have frank blood and mucus stools, fatigue and flu like symptoms including fever and chills.

Findings from colonoscopies and upper GI endoscopy have found: 
Inflamation in the sigmoid colon (no ulceration); abnormal upper GI consistent with Crohn’s disease involving ileum and duodenum

; 
inflamation from the rectum secondary to Crohn’s disease.

For me prednisone has historically worked well to induce remission (or at least suppress symptoms) but maintaining remission has always been challenging.  My diet seems to have very little effect on remission - I have tried a vegetarian diet, a milk-free diet, and a gluten-free diet but none offer any relief.  I have no known food allergies.  The only thing that I have observed in my own diet is that during a flare low fiber foods are less painful to digest than high fiber foods. I've found the best solution is simply not eating: no food; no pain.  CD literature suggests there's something to this - one effective CD treatments is enteral nutrition or an elemental diet, which essentially bypasses some of the digestion process [Grover 2013, Zachos 2007, Day 2006].

With respect to maintenance drugs I have had the best success with asacol (mesalamine) but in recent years my symptoms have become more persistant and flares more common even with asacol.  I have also tried other formulations of mesalamine, antibiotics, and very recently 6MP (mercaptopurine).  None of these drugs has a great track record for maintaining remission; often no better than placebo [Change 2013, Chambrun 2012, Bjerrum 2011].  Despite having taken a genetic marker test and getting frequent blood tests 6MP put me in the hospital after almost eliminating my white blood cells and platelets.

The next options for me include biologic immunosuppressants such as humira and remicade but these have serious risks and side effects and relatively poor efficacy in maintaining remission.  And while steroids have worked extremely well for inducing remission they don't support maintenance well and have serious long term side effects.

One promising treatment that I will be exploring in this blog is using helminths to down regulate the immune system response.  This is part of a body of thinking called "The Hygene Hypothesis."  The hypothesis suggests that in sanitizing our environment and reducing exposure to bacteria, microbes, and parasites we, as a society, are upsetting a natural symbiotic balance.  Some studies have suggested that hookworm and whipworm exposure may support remission maintenance better than existing solutions [Kabeerdos 2011, Croese 2006, Reddy 2008, Weinstock 2005, Summers 2003].  But this is still science in progress and studies on this approach have been promising but small.  Unfortunately I don't feel that I have time for the science to be settled and in this blog I'll examine how well it works on me.

Words of warning: I am an academic but I am not a medical doctor and nothing on this blog should be considered medical advice.