likelihood that the disease will progress or worsen depends, to some degree, on the extent of intestine involved. In general, disease that is more extensive — for example, Crohn’s disease that affects long segments of both the small and large intestines — may be more likely to remain active or worsen.
Can My Condition Improve?
The severity of Crohn’s disease and ulcerative colitis can fluctuate significantly over a period of days, weeks, and months without any apparent reason. Just as a flare can occur in someone who has been quite stable for many months or years, the symptoms of disease can mysteriously improve without any intervention on the part of the doctor and without an obvious cause. Individuals with mild disease may be able to afford to take a chance and wait a little while to see if their situation improves without treatment. That being said, it is unusual for someone with severe disease to improve without any treatment.
Successful Treatments
Most patients experiencing a flare of ulcerative colitis or Crohn’s disease require and request treatment. Patients are often given nutritional advice, with special diets being recommended in specific cases. They may also receive psychological support for managing their symptoms. Although IBD cannot be cured by drug therapy, a number of medications are helpful in reducing inflammation, reducing symptoms, and, in some cases, producing a full remission whereby the patient is free of symptoms. In some cases, surgery may be required, which often has a successful outcome in eliminating or managing symptoms. These various successful treatment strategies are discussed in detail in Part 2 of this book.
Spontaneous Recovery
Mild flares of IBD can sometimes go away without any additional treatment. This phenomenon has been well shown in clinical studies where patients with IBD receive placebo (inactive medication) as a means of comparing a new treatment to no treatment at all. Interestingly, the studies have shown that anywhere from 5% to 30% of patients treated only with placebo will experience improvement. The improvement is not necessarily complete, leading to remission, but it does indicate that the disease can improve without medication.
There have been a number of theories proposed to explain this spontaneous improvement, but no one knows for sure what factors are behind it. Improvements that occur without medication or without the addition of new medication could be due to changes in diet or stress levels, or possibly just a natural day-to-day or week-to-week fluctuation in an individual’s immune response. Researchers are working to determine why disease flares occur and how spontaneous improvements occur. This information may help to develop new ways of preventing disease flares and treating IBD.
Remission
In studies of patients with Crohn’s disease and ulcerative colitis, a proportion of the patients who receive no treatment will predictably experience improvement in their symptoms, and, in some cases, this improvement may be complete (although not necessarily permanent). This spontaneous improvement is more commonly seen in individuals with mild flares or mild symptoms. Simply monitoring a patient with a very mild flare may be a reasonable management approach in some instances.
Can I Still Go to School?
Because school-age children and young adults are the ones who are often diagnosed with Crohn’s disease or ulcerative colitis, these diseases can potentially interfere with getting an education.
Let your teachers know that you have IBD and explain the symptoms so they understand that you may be absent from school because of flares and doctor appointments. Teachers can accommodate students who may need to be excused during class or during an exam to go to the bathroom. If you need to be away from school for a prolonged period of time, for hospitalization or surgery, you may be able to arrange for assignments to be brought to you by friends or classmates. Some hospitals provide Internet access for patients who want to keep up on their studies. Some schools use the Internet extensively to post assignments and to provide a forum for feedback from teachers.
However, when you are sick and in hospital, you may not feel up to working or reading. Your ability to concentrate may be reduced. If you happen to be away from school for many weeks at a time and have not been able to keep up with work from home or hospital, you may require additional help from the teachers or tutors in order to catch up. In postsecondary education, because of the intensive nature of the workload and the relatively short semesters, catching up may not always be possible. In some instances, you may need to take a leave or drop some courses and make them up the following term. You can ask your doctor to write a supporting letter. Although it may take you longer to complete your degree or diploma requirements, you will be less stressed and get more rest.
No Reason to Despair
While IBD can pose challenges for students, they can be managed in cooperation with the school. There is no reason to despair or set your goals lower just because you have IBD.
Discrimination
You may fear that prospective employers will disqualify you for a job once they learn about your condition. However, you are not required to disclose illnesses or disabilities to a prospective employer, nor can the employer discriminate against someone based on a disability. In the province of Ontario, for example, the Ontario Human Rights Code prohibits discrimination in employment based on disability. In the United States, the federal disability laws forbid most employers from asking about the medical conditions of an applicant, although the United States Supreme Court has ruled that an employer can refuse to hire someone who has a chronic condition that may be made worse by the job. Precise laws and rulings vary from jurisdiction to jurisdiction, so it is best to check with human resources specialists, career or hiring coaches, or lawyers when deciding on whether to disclose your condition to a prospective employer.
A minority of students have symptoms that are severe enough or persistent enough to cause them to have to change their educational objectives. It is the unpredictability of the disease that causes IBD patients to change their school plans. Frequent disease flares in people with more severe disease can require relatively long absences from school, which can, in turn, have a negative effect on grades.
Can I Get and Keep a Job?
There are many IBD sufferers who have successfully completed their education and gone on to a variety of successful careers as teachers, executives, entrepreneurs, lawyers, professors, engineers, police officers, farmers, doctors, nurses, authors, artists, and professional athletes. IBD does not necessarily mean that you will be limited in your choice of careers or that you cannot excel at your job.
Disclosure
Employers may feel deceived if the condition is not disclosed to them during the interview process and the applicant then becomes ill or incapacitated shortly after hiring. You can take this opportunity to educate your employers about your condition, though you don’t need to give the details of all of your symptoms. In the end, you have to decide for yourself how much to disclose to the employer during the job interview process.
Keep in mind the perspective of your employers. They may not know much about the condition and may wonder if it will affect your work performance, if the disease is likely to progress, if the job will impact upon your condition, and if any modification in schedule or duties is required. Be prepared to answer these questions honestly. In addition to developing a more trusting relationship with the employer, disclosure may result in a more flexible work schedule or work conditions. Alternatively, you can make it clear that you don’t expect any special treatment.
