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This is one of those stories I really don't feel like telling, but ultimately it will be easier for me to simply write once and point people here rather than re-tell the story 100 times. I haven't edited it for grammar or smoothness. As such it probably won't read that well. But I don't care.

Anyway, some of you know I'm on vacation in California visiting my friend David. Got here Wednesday night, and I'm here until Tuesday (tomorrow). On Friday, we were supposed to go up to Big Bear Lake, and we did. We were planning on going fishing and maybe playing some tennis and relaxing. Unfortunately, I started getting sick on Thursday night. Bloating and waves of pain about once every 3-4 minutes. It felt a bit like lactose intolerance, but taking lactase enzyme didn't help, so it obviously wasn't that.

I didn't want to go to the hospital because I knew what they'd do to figure out what was wrong: more barium and a CT scan. I HATE barium. I'd almost rather die than drink barium. More on that later.

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I took this picture a while ago. It's what I take every time my Crohn's flares up. (I had some issues two weeks ago, but I'm fine now.)

The morning pills are on the bottom. From left: potassium, Levaquin 500mg (I have like, $800 worth of Levaquin in my lock box. :rolleyes: ), multivitamin, 3x Pentasa 500mg.

The top is the nightly round: 2x fiber capsules, 3x Pentasa 500mg

For size comparison, a single Pentasa 500mg capsule's length is the same as the diameter of a US quarter.

For whatever it's worth, I find that Levaquin is far more effective in quelling a flare-up than Pentasa or Asacol. But it makes me itch, which hurts because it makes my skin really sensitive. It itches, but when I scratch, it feels like I'm tearing my skin off with a hot piece of 0 grain sandpaper.

And did I mention that it's expensive? Next time I'll go with Cipro, I think. <3 generic drugs.

YUMMAY! PILLS!!! MMMM.

Ugh.

Dr jonboyG, my favorite pharmacologist, gave me a link to the abstract from a new study out on mesalamine. Right now if you were to check Micromedex, this is what is given as its mechanism of action:

Mechanism of action/Effect:

Bowel disease (inflammatory) suppressant:

Uncertain. Mucosal production of arachidonic acid metabolites, both through the cyclooxygenase and lipoxygenase pathways, is increased in patients with inflammatory bowel disease. Mesalamine appears to diminish inflammation by inhibiting cyclooxygenase and lipoxygenase, thereby decreasing the production of prostaglandins, and leukotrienes and hydroxyeicosatetraenoic acids (HETEs), respectively.

It is also believed that mesalamine acts as a scavenger of oxygen-derived free radicals, which are produced in greater numbers in patients with inflammatory bowel disease.

Mostly you can read that it's mostly speculation. Maybe it does this or that. Now it looks like there's some real, reproducible evidence that it, in fact, does something else:

5-aminosalicylic acid (5-ASA) is an antiinflammatory drug widely used in the treatment of inflammatory bowel diseases. It is known to inhibit the production of cytokines and inflammatory mediators, but the mechanism underlying the intestinal effects of 5-ASA remains unknown. Based on the common activities of peroxisome proliferator–activated receptor- (PPAR-) ligands and 5-ASA, we hypothesized that this nuclear receptor mediates 5-ASA therapeutic action. To test this possibility, colitis was induced in heterozygous PPAR-+/– mice and their wild-type littermates, which were then treated with 5-ASA. 5-ASA treatment had a beneficial effect on colitis only in wild-type and not in heterozygous mice. In epithelial cells, 5-ASA increased PPAR- expression, promoted its translocation from the cytoplasm to the nucleus, and induced a modification of its conformation permitting the recruitment of coactivators and the activation of a peroxisome-proliferator response element–driven gene. Validation of these results was obtained with organ cultures of human colonic biopsies. These data identify PPAR- as a target of 5-ASA underlying antiinflammatory effects in the colon.

Jonathan is sending me the fulltext. MCP doesn't have online access to the fulltext for Journal of Experimental Medicine, unfortunately.

So I got my biopsy results. They think I have Crohn's disease so I'm going to be taking a shitload of Pentasa for probably the rest of my life. I'm not too thrilled: three capsules three times a day. You've got to be fucking kidding me.

Pentasa is basically a topical NSAID formulated to be released in the small intestine. At this point, I could use it because I'm tired of my ileum kicking my ass.

I had my colonoscopy today, and it was one of the worst experiences I've ever had. I was talking to the nurses when they gave me the Versed and Fentanyl. Anyway, that's always a nice feeling as the euphoria and warmth hits you.

So I probably fell asleep except for the last, worst part. Going through my colon was no problem, I don't remember that at all, which means I was probably asleep. Then all of a sudden incredible pain. I remember jerking up (I was laying on my side) and one of the nurses caught me. They turned me on my back with my legs spread, and the pain stopped just as quickly as it had come.

Anyway all of a sudden it started again and I ended up trying to get up, The nurse caught me again and pinned me down, and I remember yelling and begging them to stop, and I bit her shoulder. I remember them saying a few minutes later that they were done, and I was awake while they took the scope out, which was painless.

It turns out that the pain hit when they entered the small intestine, which is apparently still inflamed — which likely means Crohn's. I am not happy about this. Anyway, it was the worst most awful feeling ever because the pain is deep way up inside of you and all you want to do is make it stop but you can't. I didn't cry but I sure wanted to. I have to say, that nurse was pretty fucking strong, because I'm pretty strong and she had no trouble holding me down. They took some biopsies, and I'm supposed to call them in five business days to get the results.

She was cool about it afterwards and said I did fine. I dunno — maybe I did, but I felt like I acted like a baby. Honestly it hurt so bad I can't even describe it. The cramps that sent me to the ER were nothing compared to this pain. Nothing.

They wheeled me to the recovery room and I slept for *maybe* five minutes. The nurses thought that was weird — they had given me all of the drugs that they'd brought (which is unusual), but I was still up and about much quicker than most people. Most people sleep for 30 minutes at least, but I was raring to go as soon as they were done. Same story with my wisdom teeth: as soon as they were done I wanted to go. Anyway, I left about 15 minutes after they were done. I don't really remember much until about an hour after the procedure. I was awake and interacting with people, but they're all little snapshots as though I was sleep walking it.

I'm a little tired now, but I made a shitload of home-made potato chips and a steak, and I'm full and happy for the first time in a few days.

I'm so glad it's over, I don't want to repeat the experience, and if I do have to do it again, complete anesthesia is the only way I will do it. No more of the conscious sedation bullshit. It hurts WAY too much.

Random note: My heart skipped a beat while I was attached to the EKG machine and it sounded completely normal. I thought that was weird. It was just before I went under — I was idly wondering what it would sound like if I skipped one, and then it happened. Completely normal. I find that reassuring.

So hungry.

The douchebags at Beth Israel moved my colonoscopy from 9.30am to 2.30pm. That means no food for an extra four hours because I have so much more weight that I can afford to lose.

Thanks a lot, fuckers!

I think I'm going to have steak for dinner tomorrow. And maybe some pork chops and home-made french fries. Home-made french fries rule.

$6488.

That's what my week-long stay at Beth Israel cost Blue Cross. All-in-all much less than I expected. It is likely that Blue Cross gets preferred pricing, while those without insurance pay the most. I don't have to pay that amount, I just wanted to know for my own benefit how much it ended up costing.

Hooray health insurance!

Well it seems that I now know the reason that my sense of taste is somewhat screwy lately, and why I can be hungry but not feel like eating. It seems that Flagyl causes dizziness, and Levaquin causes dizziness and taste perversion in some people. That's kinda cool.

Now if only Flagyl would cause taste perversion to the point where it doesn't taste like ass…