I was trying to think of an appropriate title to this e-mail update, and “body trade-in” came to mind, but God doesn’t work that way, so I’ll have to settle for a rebuild. You all probably sense by now that I write these not so much to show off my writing talent or lack thereof, or share my bodily function setbacks with my family and friends, but to put into words what is coursing through my brain so I can sleep at night.

I had my follow-up visit with the gastroenterologist yesterday. He sees patients in Hastings two half days a week and leases space from Diane (Dr. Ebaugh to you non-townies). His schedule is typically behind (npi) and yesterday was no exception. My appointment was at 12:30 and there were two people ahead of me. I got in to see Dr. Papp at 2:10.

One of the people ahead of me was a young man in his early to mid thirties with two active boys I would guess were around 4 and 6. They completely rearranged Diane’s waiting room and turned the six chairs in the center of the room around to make a fort. They took every magazine in the room over to Dad to read, stayed attentive for about five seconds and went and got another one.

After me, a family came in…three adults and three children…two girls ages 6 and 8 and a boy about 10 with a Mohawk haircut. Only one of them, the mother or grandmother, had an appointment with Dr. Papp. I can’t imagine taking all those people in to listen to the Dr. tell you about your digestive problems.

The guy with the two boys was beside himself because the Dr. was running late. He talked on the phone to his wife/girlfriend three or four times. The last time he told her “I’ve told you ten times. If I walk out now the Dr. will probably walk in right after I leave and I will have wasted all this time.” After a short listening period he followed by saying “I don’t want to hear it. I’ll talk to you later,” followed by a quick hang-up. Four seconds later when his cell phone rang he turned the ringer off and buried the phone in his pocket.

About ten minutes later Dr. Papp showed up and called his first patient, Martha, which infuriated the young guy. He gathered up his kids and stormed out the door. About ten minutes later he walked back in and sat down with the kids. About five minutes after that, Dr. Papp poked his head in the room and called my name. I looked over at the young guy and didn’t move a muscle. Dr. Papp said “Oh, Jim, you’re back. Come on in. I’ll take you first.” The guy got up and started walking in. The kids had gotten under his skin, probably due to the Dr. being late, and he had to take it out on someone. One of the kids was dawdling and Dad gave him a gentle nudge towards the open door. Of course the boy played it for all it was worth and did a face plant on the floor right in front of me. Has father, I’m sure, felt like a jerk and probably thought everyone had him pegged as a child abuser.

So my appointment was one of those good news bad news talks, or at least that’s the way I took it. He told me what I already knew and had read about but in much more detail and we talked in detail about the options for treatment. I have a lot of admiration and respect for Dr Papp…being a “butthole doctor” can’t be the most fun job. The good news is that I’m feeling better and it looks like this “flare-up” will soon be under control. The bad news is that I’ll have to continue taking the medication (three capsules three times a day) maybe indefinitely.

No, they don’t know what causes it and, no, it’s not curable. What happens is that your immune system is always looking throughout your body for things to protect you from (my apologies to the English majors out there for a poorly constructed sentence). When it gets to the lining of your large intestine, it mistakenly thinks it’s foreign, and sends “the Sheriff” (white blood cells) to run the rascals out of town. The lining gets inflamed from the “friendly fire” attack, often bleeds, secretes mucus, and causes the muscles to cramp. When food and fluids get there, they encounter the inflamed colon and get “the bum’s rush” out the door.

People tell me to watch what I eat and I’ll be fine, but what you eat has nothing to do with flare-ups. They just happen. Once you have a flare-up, there are certain foods, which are different for everyone, that cause discomfort as they pass through quicker than normal. For me it’s jalapeno peppers or pepper jack cheese which have caused me discomfort on my best days. Through trial and error I’ll find out what things cause me discomfort and I’ll stay away from them or pay the price a couple of hours later.

So, there’s no special diet…I can eat fruit like I always have…I can get back into my training as long as the “runs” (npi) don’t interfere…I can do a long race (half or full ironman) if I want knowing that if I have a flare-up the week before the race I MUST NOT DO THE RACE. If I keep taking the medicine I’m on I may have an average of 2.5 flare-ups a year. If I go on a different medication (IV at the doctor’s office every two months) I can expect an average of .5 flare-ups a year. (There were tons of things to remember so I may not have these occurrences exactly right). Everyone is different and I may have more or fewer problems than the average.

So I’m bummed that this can’t be fixed and I won’t be back to normal again before I know it. But I’m relieved (npi) that we know what it is, how to recognize the symptoms before they get too bad, how to differentiate between a flare-up and a “stomach virus”, and when to call the doctor’s office for reinforcements.

I talked to Dr. Papp and told him this would be a good time for me to lose the extra pounds I’ve put on with limited exercise and the extra foods and sports drinks necessary to get the electrolytes back in line. He thought it would be a good idea and suggested I not try the fad diets (Atkins, etc.) or diet pills. I told him it would be a reduced calorie diet with moderate exercise (a normal triathlon training schedule with no speed work for a while and lower mileage) and he thought that would be fine.

So if you see me and I’ve lost weight, it’s not because I’ve been sick. If I haven’t lost weight, that’s the story of my life.

Just (Insert Your Own Butt Joke Here) Jack