Skip to main content

When I'm 64

As I approach my 43rd birthday this December, I've been thinking about what life might be like in a couple of decades.  Not a mid-life crisis, there's no new convertible in my garage.  My kids will hopefully be functioning adults. I'll be contemplating retirement.  The usual stuff most people face as they age.

I'm thinking about what the hell is my digestive system going to look like when I'm 64?

(For the young readers, "When I'm 64" is a Beatles song.  The Beatles are a pioneering rock-n-roll band from the 1960s.  They're on Spotify.)

If you haven't read my blog before, I have 2 chronic digestive diseases - Crohn's disease and eosinophilic esophagitis.  Neither are great things to have, but I am fortunate to have what I'd consider relatively mild to moderate disease.  For some people these diseases are a complete shit show.  I've had 1 surgery and 1 hospital stay.

But CD and EoE are somewhat progressive.  When I'm 64, I'll have had CD for almost 40 years and EoE for about 30 years.  At 42, the EoE has caused my esophagus to produce "normal" swallows 20% of the time.  Twen-ty percent.  WTF is that?  My esophagus is already retired for all intents and purposes.  If the EoE isn't controlled, it'll continue to screw everything up until my esophagus is about as useful as a barbecue at a vegan convention.

A screen door on a submarine.

A one-legged man in an ass kicking contest.

The Kardashians.

You get the idea.

So because I'm a research nerd I fired up PubMed and looked for longitudinal (meaning, over a long period of time) study on IBD as people age.  The great news is I came up with exactly ZERO results.

There are some studies on elderly onset IBD, but I could find nothing about how IBD progresses over the lifespan.  If someone knows of anything, PLEASE @ me on the Twitter (@OPBMed).

A 2018 review (Link: https://www.ncbi.nlm.nih.gov/pubmed/29563038) noted several interesting, and somewhat concerning, points. But, again, these are in people who developed IBD after age 60 who:
  • Tend to have more colonic disease
  • Overall have milder disease with rare disease progression
  • Can't tolerate the inflammation they have as well as younger patients
  • Are at high risk for adverse events from both the disease and its treatments
  • Frequently develop colon cancer within 8 years of diagnosis
  • Are wholly underrepresented in clinical trials
  • Have more infection risks when taking anti-TNF medications
  • Have more hospital-related complications when taking steroids
I also saw the mantra for treatment is "start low and go slow" in elderly onset IBD.  So what does that mean for those diagnosed at a younger age, already on biologic medications?  Generally it's not advised to go backwards in terms of treatment, but would it be once I'm 64?  One review on deescalation of IBD therapy says it is important to consider the risks of serious complications versus continuing a biologic medication in the elderly with IBD (Link: https://www.ncbi.nlm.nih.gov/pubmed/24957164).

Then I went on to search PubMed for studies on EoE in the elderly and this showed up on my screen:


So I'm left wondering about what things will be when I'm 64 without much guidance from the medical world. I'm sure I'm not alone in this, and gastroenterologists are mindful of how diseases go across the lifespan.  But often disease management is very present focused, put out the fire today, get them in remission. Without this, we're less likely to age in the first place. 

There's not much worrying about this can do for me, so I'll put it on the shelf, maybe a bit in my line of sight as I work to keep my digestive system healthy. But focusing on what's enjoyable today.

--T2

Popular posts from this blog

Let's Talk About "All In Your Head"

If I had to vote for a phrase, just 4 short words, that cause more problems in our society than most others it would be these:
All in your head.
To hear these words as a person with medical symptoms brings about such a cascade of thoughts. Anything from "My doctor doesn't believe me" to "Are my symptoms really happening?" with corresponding emotions of anxiety, confusion, anger, even rage.
I spend a lot of time undoing the damage these 4 words can do in the patients I see. They've been told, either directly or indirectly, their disease is psychologically based. And that means it's really not that bad, that they should just get over it and move on. It's a running thread in most of the patients with any "functional" diagnosis I've seen, such as irritable bowel syndrome, but also appears in those with "organic" conditions - those diseases perceived as real like inflammatory bowel disease.
These 4 words are part of the fundamenta…

Bubbles

I've been thinking a lot about how we live in an era of infinite access to infinite information (thanks, internet tubes!) yet we still fall into many of the well-established psychological laws, if we can call them that, of human behavior.  Don't worry, this isn't going to be some drawn out post on social psychology. Wikipedia is great for that.

I want to talk about bubbles.  Information bubbles, that is. And how each one of us lives in one to some extent, no matter how educated or enlightened we see ourselves to be. And even if we know we live in said bubble, it takes being shown information that directly conflicts with how you think things are, or should be, and the result is you feel kinda ew - the technical term for "ew" being cognitive dissonance.

I live in a bubble.

In my bubble is the world of academic medicine, academic health psychology, and a circle of psychologists dedicated to people living with chronic digestive illness.  I live in Chicago, a major me…

Medical PTSD

“It is just an illusion here on Earth that one moment follows another one, like beads on a string, and that once a moment is gone, it is gone forever.”  - Kurt Vonnegut, Slaughterhouse Five 
A few years ago, my gastroenterologist wanted me to have something called an esophageal manometry to better understand how my newly diagnosed eosinophilic esophagitis may have been affecting how the muscles in my esophagus were functioning.  I work with the guys who wrote the book on esophageal disease, and these guys do a lot of manometries. I know all about esophageal manometry.

My mind immediately went to images of a small bowel enteroclysis I'd had at least a decade prior. My body grew tense and it was almost as if I was back in that cold room with the cold metal table and the cold radiologist, who just didn't believe me when I told her how bad my gag reflex was before she placed a tube down my throat to inject my small intestines with barium.

It took what seemed like forever to get th…