The big test was yesterday -- the double-balloon, retrograde enteroscopy. It's a colonoscopy on steroids. The balloon allows the scope to creep through the small bowel after it reaches the colon's end.
Of course, the prep for the test on Labor Day was the worst part. My family eased the pain by taking me to breakfast while I could still eat solids, before 10 a.m. Then, liquids the rest of the day as well as the not-so-yummy laxative mixed with Gatorade. I don't think I'll want blue Gatorade again for a long time. :-( The rest of it -- the diarrhea as the prep did its job -- wasn't that different from a day when I'm having a Crohn's flare.
But the findings of the test were better than I expected. No imminent surgery! Hooray! Here's what the report says:
1) Ulcerated tissue in the ileocolonic anastamosis, ? focal recurrent Crohn's
2) Normal neo-terminal ileum
3) No evidence of obstruction
The examining physician (Martin Radwin) recommended:
1) Await biopsy results
2) Follow-up: GI clinic in 2 weeks
3) Low residue diet
So what does that all mean? Some of it may be obvious, but here's my take.
1) Most of the bowel was visualized, which included the entire colon and 250 cm of small bowel, reaching the proximal ileum. Part of my ileum was removed during the 2004 surgery. The doctor doing yesterday's test reported inflammation at the site where my colon and small bowel were joined (after the scarred and impassable 50 cm were removed) during the surgery in 2004. The rest of the bowel observed showed no sign of problems internally.
2) The other issue was outside of the bowel. The doctor struggled with getting the scope through "exaggerated small bowel bends suggesting extrinsic adhesive disease." In other words, tissue outside of the bowel that was probably disturbed during the surgery in 2004, is squeezing some of the doubling-back loops that are normal in the small bowel, making the bends tighter than normal. Think of a garden hose that gets kinked. Water can still pass through, but not at the same rate or velocity it would have if the hose were loosely curled on the lawn.
Either or both of these problems could have caused the bowel obstruction last month. After a month of Prednisone(a steroid to decrease inflammation), any associated inflammation was probably markedly decreased by yesterday's test. But hopefully, what Dr. Radwin did see along with the results of the biopsies he took, will give Dr. Cutler the information he needs to help me set a treatment course that has the best chance of prolonged wellness.
My appointment to follow up with Dr. Cutler is on Friday, Sept 16. Until then, I'm just trying to stay out of trouble. More Cimzia shots tomorrow. Ouch!
Be well and take care!
Beth
