If you're living with a chronic illness, you're in the right place.

Tuesday, April 30, 2013

Gut Directed Hypnotherapy for IBS

10:06 AM Posted by Tiffany Taft , ,
Today is the last day of Irritable Bowel Syndrome (IBS) Awareness Month, which brings attention to a chronic condition that impacts up to 20% of the U.S. population.  I've spent a lot of time working with IBS patients and know from their stories how awful of a condition it can be.  Unfortunately there aren't many treatment options available, especially in terms of pharmacological interventions.  Many of the IBS medications are not much better than placebo in controlling symptoms, and some have even been pulled from the market due to safety concerns.  Thankfully emerging data on the effectiveness of other treatments are offering hope for those affected by IBS who have, to date, struggled with getting it under control.

I saw on Twitter today a new research study on the effectiveness of Gut Directed Hypnotherapy for IBS.  Gut directed what?

I'm not sure how this is relaxing.
Hypnotherapy, contrary to stage, TV, and movies, is a treatment that is widely used for a variety of maladies.  It gained considerable attention as a way to help people quit smoking, all without making people run around and bark like a dog or cluck like a chicken.

Hypnotherapy involves deep relaxation combined with a "post hypnotic suggestion" that targets the problem area - so with IBS, it targets pain, discomfort, and motility in your digestive system.  You are always in control of your experience.  I like to describe it to people as the state we all get into right before we fall asleep, where our mind is quiet and we're just about to drift off.  Hypnotherapy can be effective in treating chronic pain, nausea, insomnia, migraine, and even overeating that leads to obesity.  I've heard of dentists who use it with people in lieu of anesthesia (Yikes!).  But what about its role in treating IBS and other chronic digestive problems?

Dr. Olafur Palsson at the University of North Carolina is a pioneer in the development of the effective use of hypnotherapy to treat IBS.  While at Northwestern, I became certified in hypnotherapy and learned the "Palsson Protocol" and witnessed first-hand how powerful of a treatment this can be.  Caveat:  It doesn't work for everyone, but most people I've done hypnotherapy with have received some benefit.  Some have had complete remission of their symptoms, while others described them as more tolerable.  Not too long ago I received an email from a former client about how hypnotherapy had helped her GI symptoms immensely:

For two years prior to our meeting I suffered tremendously with symptoms of my Mixed Connective Tissue Disease. The effects of the disease on my digestive tract made me miserable. Difficulty with swallowing made it almost impossible to eat, drink, or sleep. The throat discomfort prevented me from speaking most of the time. Dr. X was my last hope in easing some of my misery. I am so grateful to the two of you! It took just three weeks to notice a vast improvement in my comfort level. And now, one year later, I continue to practice the therapy every day.

Hypnotherapy can help.  It's not for everyone, so finding a practitioner who is trained in using it specifically for IBS or other health issues is key.  There are a lot of people out there who claim to be hypnotherapists and the level of training (and quality/lack of weirdness) can vary considerably.

I aim not to have a heart attack mid session.
Dr. Palsson has a website that explains gut-directed hypnotherapy for IBS in more detail, with reviews of the research that has been done to date and a directory of medical professionals who are certified to use it.

Dr. T

Friday, April 19, 2013

Guest Post: Navigating the World of IBD Diets

10:47 AM Posted by Tiffany Taft , , ,
We're thrilled to have a guest post by Beth Doerfler, MS, RD, LDN who writes about specialized diets and Inflammatory Bowel Disease (IBD).  I've known Beth for almost a decade now, and she is truly a great dietitian with leading expertise on the role of diet in chronic digestive conditions.  She's also just an all around awesome human being.  Beth and I worked together at Northwestern in the Center for Psychosocial Research in GI, where she sees patients in the gastroenterology division and helps them adjust to eating with a less than stellar digestive system.  Thank you, Beth, for this great article!

Is there a specialized diet for IBD? Yes and no. Contradictory as it may sound, you have likely met with health professionals and family who have said “diet has nothing to do with your Crohns or colitis…eat whatever you can tolerate”. On the other hand, you can’t help but find great testimonials about people who have tried specialized diets like gluten free or the specific carbohydrate diet and are feeling better than ever. Often patients will ask: What should I do? Should I be on a specialized diet?

I would like to use this space to highlight some questions that I typically discuss with my patients as well as my 2 cents on how they can be helpful or harmful. At least they can be discussion topics for your next doctor or nutritionist visit.

Should I try the Specific carbohydrate diet?

This diet was developed by biochemist Elaine Gottschall and the premise is to limit complex carbohydrates and raw items (to start) as a way to decrease diarrhea and inflammation in the bowel.

There are currently no controlled clinical trials studying the efficacy of this diet in adults with inflammatory bowel disease. Despite promising testimonials it is hard to be a guinea pig. However, 2 GI centers are studying this diet in kids and adults but currently we don’t know if this diet is a good idea or not in IBD. What if you want to try it, what should you know?

• There are 5 stages to the book and try not to stay in the early stages too long (stage 1 for example is designed for 3-5 days of bowel rest and consists of soups, pressed juices )

• Cooked veggies vs. raw are a good idea in any stage of this diet or any other diet as the fibers are hard to break down in our gut. Peeling skin on certain fruits is a good idea as well

• Do the best you can. While the SCD advocates home-made highly fermented yogurt you can certainly try store bought Greek yogurt with no added sugars. Adding some fresh fruit can sweeten it up nicely. We have no evidence to suggest this is inferior.

• If you notice the diet is interfering with your quality of life or you are losing unwanted weight abandon the diet, loosen the restriction or seek more individualized help from your doctor or dietitian.

Should I be juicing?

Yes if you feel like it but it is not superior to eating vegetables and fruits! Juicing is a great way to get vegetables in through a format that is generally pretty GI friendly. However, it can be time consuming and costly. Purchasing a pre-prepared juice cleanse can run people ~ $60.00/day.

Here are some pointers on this topic:

• Eating cooked veggies, vegetable juice and fresh fruits (peel skin if you have a sensitive stomach or issues with diarrhea) are a great approach.

• Research focusing on benefits of fruits and vegetables looks more at total consumption rather than the form (i.e raw vs. cooked). Bottom line: get them in how you can whether it is from juicing or cooked veggies.

• If you are juicing, don’t forget to add dietary protein to your day to keep those muscles thriving. You can do any type of lean protein that works well for including poultry, fish, tofu, eggs, beef, Greek yogurt or protein powders made from whey, soy or pea protein.

How do I put this all together? 

In general you have read that diet needs to be individualized and that is true. There are some key factors that work well for most people including moderate fiber, low lactose and lean proteins. Feel free to experiment with the amount and type of carbohydrate and sugars in your diet to get the best balance. If you need help putting a diet plan together or if you want to make sure that you are achieving nutritional balance while on a specialized diet do seek the help of a registered dietitian to compliment your efforts. Look to www.eatright.org to find a specialist in GI nutrition.

Wishing you good health and happy eating!

Bethany Doerfler MS, RD, LDN is a clinical research specialist who provides medical nutrition therapy to improve weight, overall health and digestion. She is currently participating in clinical research in the Division of Gastroenterology at Northwestern Memorial Hospital and serves as adjunct faculty at Loyola University Chicago. Ms. Doerfler earned a bachelor’s of science in nutrition from Michigan State University and a masters of science in nutritional epidemiology from the University of Illinois at Chicago. Ms Doerfler has co-authored several book chapters and journal articles on diet and lifestyle modification in disease management. She has presented to corporate, medical and academic audiences throughout Chicago.

Versatile Blogger Award? What?

9:28 AM Posted by Tiffany Taft , , ,
When I woke up this morning....I heard a disturbing sound.  Wait, brain, stop quoting The Blues Brothers.

When I woke up this morning and checked my email I found a very pleasant note that we've been nominated for the Versatile Blogger Award  by our fellow-blogger, Amanda Kasper.  Check out her blog about her journey with chronic illness. This is pretty swell and a great way to kick off a weekend.  It's always nice to be recognized for the work we do, so a big thank you to Amanda for nominating us!

Part of being nominated includes us sharing 7 things about ourselves. Since it's Friday, and considering the events still unfolding in our country, I figure a little levity is in order. Here goes nothing:

1. When I was in 1st grade and we were all sitting around our teacher, Miss Zurich, as she read a story to us, I let go a rather loud fart.  Then I tried to play it off like it wasn't me and was incredibly embarrassed.  Miss Zurich gave me a hug and said that everyone toots.  

Indeed, everyone toots and nobody dies.
2. I was a vegetarian for about 17 years, until I became pregnant.  Then I craved cheeseburgers like you wouldn't believe.  I think I ate 2 or 3 a week for 37 weeks.  I should probably get my cholesterol checked.
The ONLY place in Chicago to get a burger.
3. I tend to laugh at inappropriate times.

4. My favorite movie of all time is The Blues Brothers.  I can recite the entire thing from start to finish.  Now there is some useful stuff taking up valuable real estate in my brain.

Do you see the light?
5. While in Munich in 2009, I felt compelled to keep up with a random German in full lederhosen, smoking a crooked cigar, and speaking no English, in beer drinking.  Let's just say the train ride to Frankfurt and flight home the next day were quite unpleasant.  

Now that's skill.
6. When I was growing up, we were the Griswolds.  Driving all over the country, to Mexico and Canada.  All we were missing was a wood-paneled station wagon.  I didn't go on a plane until I was 14.

Why aren't we flying?  Because getting there is half the fun!
7. My favorite quote for life is from the movie Ferris Bueller's Day Off. Wise words and something to live by:

"Only the meek get pinched, the bold survive."
Have a great weekend, everyone!

Dr. T

Tuesday, April 16, 2013

Some Thoughts on Boston

5:34 AM Posted by Tiffany Taft , , , ,
Yet another day of incessant news coverage of carnage, this time affecting our friends in Boston at its annual marathon and Patriot's Day celebration.  I'm not going to use this space to express my opinion on what happened.  Lord knows there are plenty of armchair FBI agents and tinfoil hat wearers on the internet to keep you occupied for a month.

I'm a runner.  I'm sitting on my sofa in my 13.1 shirt from the first half marathon I did in Chicago in 2010.  There's something strange about putting your body through a longer distance run.  My husband was just questioning my sanity the other day when I said I was considering another half this year, the Chicago CCFA Team Challenge event, after I'd sworn them off after my 2nd one last year as being painful, torturous events that only a fool would do.  I have no aspirations to do 26.2, and have great reverence for those who do.

Thinking about organized running events and the finish lines along the chute that you pass into after crossing the little speed bump that will register your time, they're always packed with people cheering you on.  Complete strangers patting you on the back with their words of encouragement, handing you a bottle of water, and your finishing medal. The feelings you experience when you finish a race are usually a swirling mess of pain, relief, pride, and euphoria with a side of sweat running in your eye.  Why wouldn't you want to do it again?

Yesterday that usual swirling mess of emotions included terror, confusion, shock, and hysteria.  An 8 year old boy is dead, his sister maimed and mother gravely injured.  Two others taken before their time.  Hundreds injured. And for what?  We don't know, yet, who was responsible.  What their twisted motive was.

If I had to guess, I saw that Fred Rogers quote about looking for the helpers at least 20 times in my Facebook feed.  Fred was a wise man.  I grew up watching him put on his shoes and sweater, feed his fish, and send his trolley to the land of make-believe.  He died in 2003.  I can't help but think he'd be pleased that his words are serving as a source of comfort as our nation faces yet another tragedy. Fred's legacy was his desire to help society by teaching children to be happy and productive citizens, to try to offset the negative in the land of reality with lessons of friendship, good-will, compassion, and empathy (all vital to our Emotional IQ) in the land of make-believe.

When things like this happen, my mind goes to figuring out how I can move to New Zealand or perhaps somewhere in Scandinavia.  In my reading about Fred Rogers' life, I came across Resolution 111, which was passed by the US House of Representatives (back when things passed the House of Representatives), honoring Mr. Rogers and

His legendary service to the improvement of the lives of children, his steadfast commitment to demonstrating the power of compassion, and his dedication to spreading kindness through example. 

The reality is I'm not going to move half way around the world any time soon, so I need to find something more productive to do.  Because terrorism is well beyond my control and is a problem I directly cannot solve by making it go away.  During these times, we look for what we do have control over.

I'm going to channel my inner Mr. Rogers every day with my young daughter to prepare her for this crazy world the best I can.  I'm going to continue to help those who come my way professionally to deal with their personal struggles.  I'm going to buy my friends a beer, laugh, and not live in fear of the unknown.

And I'm going to run.

Dr. T

Friday, April 5, 2013

The Search for Meaning

11:37 AM Posted by Tiffany Taft , , , ,
When I was in grad school, I read "Man's Search for Meaning" by Viktor Frankl.  If you haven't heard of him, Dr. Frankl was an Austrian psychiatrist that was deported to the Theresienstadt ghetto in the Czech Republic in 1942 with his wife and parents.  He spent time in Auschwitz, where his mother and brother died. Dr. Frankl was separated from his wife when he was moved to a satellite camp of Dachau (Turkheim) while she was sent to a different camp, where she later died.

In "Man's Search for Meaning" Dr. Frankl tells the story of his life in Nazi concentration camps in vivid detail, but what is so striking about his writing is how he explored one seemingly simple concept - attitude - and how this often made the difference between life and death in the camp.  Those who were able to accept their circumstances as beyond their control while seeking some form of meaning in their experiences fared far better than those who fell into depression and despair.

“When we are no longer able to change a situation, we are challenged to change ourselves.” 

Last week I wrote about a concept called "Emotion Focused Coping" which can be useful when we face a problem without a solution, something that people living with chronic medical illness often face.  We can do so much to improve our health and treat our symptoms, but there are some aspects of chronic illness that are beyond our control.  Trying to solve unsolvable problems can drive one batty (that's a technical term).

A third type of coping is something called Meaning Focused Coping.  While Dr. Frankl didn't come up with this term, it embodies his perspectives that came from his experiences in the camps.  When we face a negative situation, we find enriching, meaningful elements in them and focus our attention there.  For some it's appreciating the little things in life.  For others it may involve advocacy efforts or blogging about their condition.  There is no right way to engage in meaning focused coping.  The point is to find meaning in your situation, no matter how bad it may seem.  Preliminary research suggests that people who use meaning focused coping strategies have better long term health outcomes.

“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” 

Yes, I'm telling you that finding meaning in your illness will help you feel better.  However, meaning focused coping is probably the most challenging of the 3 strategies I've talked about.  So how the heck do you do it?
  • Find some benefit from your illness.  Since you were diagnosed, are you more patient?  Have you learned to slow down in life?  Do you appreciate the people in your life who are truly there for you? No matter how small it may seem, there is usually at least one positive change that happens when we're forced to live with an illness.  For me, I've met some amazing people because of Crohn's disease - my practice partner, Steph, Andrea & Megan from The Great Bowel Movement, my Camp Oasis family to name a few.
  • Adapt your goals.  Lets face it, having an illness can throw a wrench in a lot of our plans.  Evaluate your goals in light of your new circumstances and make adjustments.  It's OK to give up on goals that may no longer be feasible and substitute them with viable alternatives.  Forgive yourself for having to make these changes if it feels like you're giving up too easily.
  • Reorder your priorities.  Things that are important in life move up and down the priority ladder all the time.  You can do a little exercise here by drawing a ladder on a piece of paper with several rungs.  On each rung, write down your priorities before you were diagnosed.  Repeat this process for your life as it is today.
  • Don't discount the little things.  Yes, it's a bit cliche.  But it's true.  Take time out of each day to stop thinking about anything but the present moment.  Turn off your cell phone and stare out the window for 10 minutes, taking in the scene in front of you and not thinking about all the things you need to do.  This is a little strategy we call Mindfulness Meditation.  You can read more on that here.
“A human being is not one thing among others; things determine each other, but man is ultimately self-determining. What he becomes - within the limits of endowment and environment- he has made out of himself. In the concentration camps, for example, in this living laboratory and on this testing ground, we watched and witnessed some of our comrades behave like swine while others behaved like saints. Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions."

With that, nothing brings about a sense of meaning like the weekend.  Happy Friday!

Dr. T

Tuesday, April 2, 2013

Research Roundup: 4/2/13

12:01 PM Posted by Tiffany Taft , , , , , , ,
It's been a while since I did a review of some of the more interesting research studies that have been published in the past few months.  This week we focus on how our ancient brain may affect obesity, using text messaging with HIV patients, what IBD patients believe about diet, and what therapy with parent-caregivers actually may help with.  On with the show...

What do IBD patients believe about diet and their disease?  A study published in the January edition of the journal Inflammatory Bowel Diseases found that 58% of participants believed that what they ate could cause a relapse, and 16% thought that diet could be a cause of IBD.  The majority of people (2 in 3) modified their diet, especially when experiencing symptoms, and half said that IBD had caused eating to be less enjoyable.  Foods that are most likely to be avoided are fruits and vegetables, spicy food, dairy, and high fat foods.  Diet changes had a substantial impact on their social life, including not eating out or having to prepare special meals at home.  If you're living with IBD, do you agree that diet has an impact on your disease?  How do you keep it from affecting your social life?

Arch enemy of the IBD-er?
Can text messaging help HIV patients remember to take medication?  A study published in the March edition of the journal Health Psychology found that using text messaging to remind people living with HIV to take their medication was not only well received by participants, but also dramatically increased treatment adherence, decreased viral load, and increased CD4 counts from baseline to 3-month follow-up.  93% reported that they always read the messages, 76% liked the messages, and 39% said that the messages were very helpful. The text messages were designed to provide positive reinforcement, support, and increased attention to the importance of taking medication as it is prescribed.  More evidence on how technology can improve patient care.  But we continue to walk a fine line...

How does the obesity pandemic relate to our ancient ancestors?  A review in the February-March edition of the journal American Psychologist discusses the relationship between modern eating behavior and our ancient ancestors, and how this may be contributing to the obesity pandemic.  The authors suggest that our brains became wired for immediate rewards from eating very tasty foods back in our hunter-gatherer days as a means of survival.  These reward centers in our brain are so powerful that they often override other parts of our brain that try to control over-eating behaviors.  In today's modern society where food is plentiful and easy to get, this primitive brain function doesn't work the way it was designed. Research has also found that the reward circuitry in the brains of people who are obese becomes hyperactive and this over-activity remains even after they lose weight, making it very difficult to sustain weight loss.  To lose weight and keep it off takes considerable cognitive restraint, which is a strongly genetic trait that some people simply are not born with.  This may be one reason why weight loss strategies that only emphasize diet are largely unsuccessful in the long term.

What does psychotherapy with parents of children with chronic illness help with?  An August 2012 Cochrane Review of published research studies evaluating if psychotherapy with parent-caregivers of children with chronic medical illness is helpful found that psychological treatments with these parents can improve outcomes for their children.  Therapy, especially cognitive-behavioral therapy (CBT), with parents resulted in reduced symptoms in children with chronic medical conditions.  This may be related to improvement in the parents' problem-solving skills and mental well-being, highlighting the importance of caregivers taking good care of themselves (see Steph's blog on that here).

That's all from the research front this week.  If there are any topics you'd like us to cover in the future, please drop us a line.

Dr. T.