I had to stop my Crohn’s disease medication (Humira) in October of 2017 due to complications.  I was on Humira for over a year and did really well on it, especially after failing three other medications.  Starting a biologic initially scared me, but at the same time, flaring during medical school was a huge concern.  Thankfully, Humira, in addition to the Autoimmune Paleo/Specific Carbohydrate Diet and lifestyle, brought me into a wonderful remission.  My symptoms became very manageable, and my first year of medical school went smoothly.

Thankfully, when I came off of Humira, I was still in remission and feeling well.  My doctors told me that I could never take a traditional biologic or immunosuppressant again.  Entyvio (vedolizumab) was an option, since its immunosuppression is targeted to the gut and spares the rest of the body.  I wanted to give my immune system a chance to recover and hold off starting Entyvio as long as I could.

The stress of medical school and not being on any medication was a major concern.  I decided that if I were going to be off medication, I had to be all in.  There was no being half in, partially in, or mostly in when trying to keep an autoimmune disease in remission, while keep up with arguably the hardest year of medical school.  So about two months ago, when I started “flirting with a flare” (a wonderful new term I learned from my good friend Jessica from The Feel Good Days), I did everything I could to avoid falling into a deep flare that would completely consume my energy, health, and life in general.

I have never been 100% symptom free, but I can tell the difference between IBS-like symptoms and Crohn’s inflammation symptoms.  One of the biggest indicators that I am in a flare is if I have joint pain at rest, specifically knee pain.  This knee pain is very achy, especially when I wake up, lay in bed, or am sitting in a chair.  Other flare clues include significant digestive symptoms dispute following my normal diet, mouth sores, low-grade fevers, and significant fatigue.  Stress, not sleeping enough, and certain foods are my biggest flare triggers.

After several days of digestive troubles, fatigue, and very sore joints, I knew I was starting to flare.  The following is what I did to nip this flare in the bud.

The first day, I gave my digestive system rest and really only consumed bone broth, tea, 100% fruit juice, and butternut squash soup.  Anything more would have been too much for my irritated intestines to handle.  If I feel any symptoms of a blockage, I will fast (or do a liquid fast) until the extreme distension and nausea subsides.

Once my symptoms start improving, I slowly start to diversify my diet.  Chicken vegetable soups, bone broth, butternut squash, turkey patties, mashed carrots, bananas, banana n’ice cream, collagen smoothies, some fruits, and plain white rice are my staples during a flare.  For a complete list of foods I enjoy on a flare, check out my Flare Guide.  It may take days or even weeks to add in more foods, but it is worth it to slowly reintroduce foods and actually tolerate them without symptoms.

I won’t go into detail about which supplements I take, as every patient is different.  A couple important supplements I do take that many other IBD patients take are probiotics, fish oil (or vegan DHA), vitamin D, and magnesium.  I work with an integrative doctor in addition to my traditional team of doctors to help support my body naturally.  My integrative doctor is the most compassionate physician I have ever met.  He truly empathizes with his patients, his office is completely zen, and he greets all of his patients with a tender hug.  This doctor gave me his cell number, so I can call or text him at any time, which is incredible and almost unheard of.  I will admit that my traditional gastroenterologist also gave me his personal number, which is equally impressive.

Slowing down is one of my biggest challenges.  As a medical student, there are certain days I need to attend mandatory classes, see standardized and real patients, and keep up with my extra-curricular activities.  Additionally, I need to keep up with the class material, so I do not fall behind.  It does not take much to fall behind, and once behind, catching up can seem nearly impossible.

During a flare, I focus on resting as much as I can, going to bed early, and listening to my body.  This may mean I study in my apartment so I do not waste too much energy getting to school, plus I have easy access to the bathroom.  As hard as it is to say no, I may need to cancel or modify plans in order to heal and not worsen a flare.  Not sleeping enough one night messes me up for days and exacerbates a flare, so I do my best to hang out during the day and early evening but get to bed early when I can.

I am thankful to have a treadmill in my apartment, a wonderful gym in walking distance, plus a beautiful park down the street.  It may seem odd, but with certain types of stomach aches, moderate exercise improves and sometimes eliminates the pain completely (endorphins for the win!).  My knees also seem to ache more at rest, so simple walks are really helpful.  Furthermore, exercise helps my sacroiliac pain so much, especially swimming.  I also feel so amazing after doing yoga and really need to make it a regular priority.

To manage my stress, in addition to exercising, sleeping, and eating healthy, I try to meditate, talk to my mom, and keep up in school.  My biggest stress comes from feeling overwhelmed with school and activities, especially when I am already not feeling well.  If I do not sleep enough, I fall into a vicious cycle of staying up late, not eating as healthy, not exercising enough, and feeling worse.  Catching up on sleep, staying caught up in school, and eating healthy are generally sufficient to manage my stress.  I enjoy making lists and prioritizing what I need to get done.  I feel accomplished when I check items off my list, but need to be realistic and not overly ambitious when creating these lists.

I am so thankful to have an incredible support system from my friends to my family to my boyfriend.  Furthermore, my autoimmune paleo/SCD/Crohn’s & colitis family is instrumental to my healing.  These fellow autoimmune warriors know exactly what I am going through and many of them share similar healing protocols and mentalities.  Being surrounded by such a supportive, healing community encourages me to stay positive and gives me the strength to keep fighting.

My biggest advice for anyone in a flare is to listen to your body.  Resting my gut by reverting to a toddler diet, focusing on sleep, stress management, and light exercise works well for me.  However, it will not work for everyone.  I am thankful to be in a place right now where I am managing well without medicine, but there is no shame in taking medicine.  Some with IBD require a lifetime of strong immunosuppressants to avoid serious complications and surgeries no matter how diligent they are with diet and lifestyle.

Humira brought me into remission, and my last scopes in 2016 looked beautiful.  I was scared of flaring when I stopped my medication, but now I feel strong and empowered.  Mindfulness, self-care, nutrition, and lifestyle have kept my disease under control without medication for nearly 6 months now.  I am excited to see what the future has in store.  I do keep in contact with my doctor, especially during a flare, in case my symptoms worsen.  For now, I am happy, strong, and healthy, but there may be a day when I need to take medication.  My Entyvio infusions are all set to go with insurance.  All I have to do is make an appointment with the infusion center if I choose.