What is Inflammatory Bowel Disease? Part One: Crohn’s Disease


I have been sitting here thinking about what to write and it hit me that I don’t think I have ever done a post on just what Crohn’s Disease or IBD is.  So, what better time then now to talk about it.

WHAT IS CROHN’S DISEASE?

Let’s start with IBD or Inflammatory Bowel Disease.  IBD is a broad term used for many diseases.  They are chronic and incurable disease and usually make life a living hell for many of us.  The two main diseases under the umbrella of IBD is Ulcerative Colitis and Crohn’s Disease.  I won’t get into Ulcerative Colitis or UC yet.  Maybe on another post.

Crohns

Crohn’s Disease was first described in 1932 by a number of doctors in a paper.  Because the author’s were listed alphabetically, Dr Burrill B Crohn was listed first and the disease got named after him.  The other doctors involved were Dr. Leon Ginzburg and Dr. Gordon D Oppenheimer.

Crohn’s Disease can affect any area of the digestive tract from the mouth to the anus.  It is most commonly found in the intestines and usually affects the end of the small bowel (ileum) and the beginning of the colon.  CD can affect the intestines in a number of different ways.  Of course, the most obvious is that there is inflammation.  It can affect the thickness of the intestinal wall.  One major thing about this disease is that it can skip areas.

SYMPTOMS

When active, there are many symptoms that can occur.  They can include some or all of the following:

  • Cramping and pain in the abdominal area
  • Rectal bleeding
  • Diarrhea
  • Frequent and urgent needs to move the bowels
  • Constipation – this can lead to an obstruction
  • Nausea and vomiting
  • Low grade fever
  • Weight loss
  • Fatigue
  • Night sweats
  • For women – a loss of menstrual cycle

Besides those symptoms, Crohn’s can cause extraintestinal manifestations including but not limited to:

  • Cataracts
  • Mouth sores and ulcers
  • Arthritis
  • Ankylosing Spondylitis
  • Sacroilitis
  • Osteoporosis
  • Gall Stones
  • Uveitis and Episcleritis
  • Pyoderma gangrenosum
  • Erythema nodosum

CAUSES OF CROHN’S

So what causes Crohn’s Disease.  Well, I wish I had a simple answer.  Truth is, no one really knows.  We know it is hereditary and it has been linked to a gene so we can say it is genetic.  Some say it is an autoimmune disease, which means the body is turning on itself and fighting something that isn’t there, however there has never been enough proof on this.  Some say diet will cause it but again, there is no one food or drink that can be linked to the disease.  Stress has been a factor.  So can environmental factors.  Truth is we really don’t know what the trigger for the disease is and the number of patients with the disease is growing every year.

So you suspect you might have the disease but you don’t know.  Well, the way to find out is to see a doctor.  For your initial diagnoses I would suggest seeing your internist first and let them rule out other illnesses and problems.  If they suspect IBD, then the next person to see is a gastroenterologist or GI.   They will preform a number of test and will most likely include a colonoscopy.  This entails inserting a think flexible tube called a colonoscope into your anus and up into the colon.  The scope has a small video camera on it and is used to take pictures of your colon.  Your GI will most likely take biopsies of your colon to test it for IBD as well as other issues like cancer.  While other tests are also used, like stool tests, MRI’s and sigmoidoscopies, the colonoscopy gives the best view of the intestines.

colonoscopy

Once diagnosed, you will go through many emotions.  You might feel like your life is over.  You might feel relieved to have answers.  You most likely will still feel sick because even though you are diagnosed, you haven’t been treated yet.  This leads me to treatment options.  Now as I said earlier, Crohn’s is not curable (as of yet) so you will have to be on some sort of medicinal treatment for the rest of your life.  I know some people will argue with me over this, but we won’t get into that just yet.

MEDICINES

As far as medicine goes, there are a bunch of different types.  For this I will quote from The Crohn’s and Colitis of America’s page:

 

Several groups of drugs to treat Crohn’s disease today. They are:

Aminosalicylates (5-ASA)

These include medications that contain 5-aminosalicylate acid (5-ASA).Examples are sulfasalazine, mesalamine,olsalazine, and balsalazide.These drugs are not specially approved by the Food and Drug Administration (FDA) for use in Crohn’s. However, they can work at the level of the lining of the GI tract to decrease inflammation.They are thought to be effective in treating mild-to-moderate episodes of Crohn’s disease and useful as a maintenance treatment in preventing relapses of the disease. They work best in the colon and are not particularly effective if the disease is limited to the small intestine.

Corticosteroids

Prednisone and methylprednisolone are available orally and rectally. Corticosteroids nonspecifically suppress the immune system and are used to treat moderate to severely active Crohn’s disease. (By “nonspecifically,” we mean that these drugs do not target specific parts of the immune system that play a role in inflammation, but rather, that they suppress the entire immune response.) These drugs have significant short- and long-term side effects and should not be used as a maintenance medication. If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to add some other medications to help manage your disease.

Immunomodulators

This class of medications modulates or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators generally are used in people for whom aminosalicylates and corticosteroids haven’t been effective or have been only partially effective. They may be useful in reducing or eliminating the need for corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take several months to begin working.

Antibiotics

Antibiotics may be used when infections—such as abscesses—occur in Crohn’s disease. They can also be helpful with fistulas around the anal canal and vagina.  Antibiotics used to treat bacterial infection in the GI tract include metronidazole, ampicillin, ciprofloxacin, others.

Biologic Therapies

These medications represent the latest class of therapy used for people with Crohn’s disease who have not responded well to conventional therapy.  These medications are antibodies grown in the laboratory that stop certain proteins in the body from causing inflammation.

One medicinal treatment I won’t go into, but has helped many, is medicinal marijuana.  It isn’t legal in every state so it isn’t an accepted practice yet.  However for people that have used it to treat their Crohn’s will swear it is probably one of the best things to help them.

Besides medicine, many people found by changing how they eat can help with pain and help bring on and stay in remission.  Again, there are a lot of different diets, like drugs, and there is no one diet that works for everyone.  Some of the biggest diets used though are the Paleo diet and Gluten Free diet.

SURGERY

When everything fails, and you just don’t get better, surgery might become an option.  With UC, it has become a sort of cure because once you remove the disease part of the intestines, you remove the disease.  With Crohn’s though, this isn’t true.  As I mentioned earlier, the disease can jump around and skip areas.  Surgery with Crohn’s is usually the last option because even if they remove the area that is bad, there is nothing from having it appear elsewhere.

Some things to know about surgery:

  1. About 70% of people with Crohn’s will at some point require surgery
  2. Approximately 30% of patients who have surgery experience recurrence of their symptoms within 3 years and up to 60% will have a recurrence within 10 years

Now there are a number of reasons to have surgery.  One reason is to help correct and treat for fistulas, fissures or obstructions.  Some people will have their colons removed and may get a J pouch or an ostomy.

Types of Crohn’s

Now you know a lot more about this one disease and I will now throw you a curve ball.  Crohn’s disease can be called a number of different names.  This is because they usually call it based on where the disease is and this can change over the years.  to best describe the names I will again quote from the CCFA:

The following are five types of Crohn’s disease, together with their presenting symptoms:

Ileocolitis

The most common form of Crohn’s, ileocolitis affects the end of the small intestine (the ileum) and the large intestine (the colon). Symptoms include diarrhea and cramping or pain in the right lower part or middle of the abdomen. This type is often accompanied by significant weight loss.

Ileitis

This type affects only the ileum. Symptoms are the same as ileocolitis. In severe cases, complications may include fistulas or inflammatory abscess in right lower quadrant of abdomen.

Gastroduodenal Crohn’s disease

This type affects the stomach and the beginning of the small intestine(the duodenum). Symptoms include loss of appetite, weight loss, nausea, and vomiting.

Jejunoileitis

This type is characterized by patchy areas of inflammation in the upper half of the small intestine (the jejunum). Symptoms include mild to intense abdominal pain and cramps following meals, as well as diarrhea. In severe cases or after prolonged periods, fistulas may form.

Crohn’s (granulomatous) colitis

This type affects the colon only. Symptoms include diarrhea, rectal bleeding, and disease around the anus (abscess, fistulas, ulcers). Skin lesions and joint pains are more common in this form of Crohn’s than in others

So there it is in a nutshell.  You now know what I have been blogging about for a number of years now.  The one thing I do want you to take away from all of this is if you do get IBD…your life is not over.  Yes there are some that do die from the disease and there are others that have a lot of issues and problems and find living a major hassle.  For the majority of people though, we do what we have to and live our lives.  There is a lot of support out there and you just have to reach out if you want it.  The IBD community is really big and we love to support one another.

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What’s Your Trigger


Lately I have been thinking about how lucky I am in the food categories, compared to many others with IBD.  I see people on TPN or liquid diets and think, “Well, at least I can eat solid food”.    Even though I have some restrictions, every day I feel like I am lucky to be in the position I am in.

But today, I really thought about it and I have started to question, “Am I really lucky”.  After my major flare, eggs which were a safe food for me became an enemy.  So did bananas.  I also realized that gluten products were not helping me to get well.  I went gluten-free and cut out eggs.  But, cravings would hit.  I found the egg issue was a big one.  After talking to others with digestive issues, I found out about Papaya Enzymes.  I started taking them every time I ate eggs and they really helped.  I would get no pain, wouldn’t have to rush to the bathroom 10 times a day and my outlook on food changed.

But now, there is a shift in my life.  I take 5 enzyme pills when I eat eggs (bottle recommends 2-3).  They used to help but now lately I have been getting some pains when I eat eggs.  I know that means my body is adjusting to the pills and the efficiency of them is diminishing.  Along with eggs, salad has now also become an issue.  I used to be fine with any leafy vegetable.  But now within less than an hour it runs its course and comes out almost as fast as it goes in.  Slowly, my dietary choices are getting slim.  I am back to trying to lose weight so I have to watch what I eat and my choices are shrinking.

So I was sitting here this morning, eating scrambled eggs and thinking, am I still lucky.  As many of you know, I love food.  I enjoy the flavors and smells.  I love the entire experience surrounding food.  I don’t feel I can survive on a very strict diet but that is where I am heading.  Things I onced love to indulge in I can no longer eat.  It has been almost 2 years since I had a slice of NY pizza or a bagel, chinese dumplings or pastries.  So many foods that I took for granted I might never eat again.  And that scares me.  I am trying not to feel depressed over this but it is hard.  I went to school originally to be a chef and I work in the hospitality industry.  I buy food every day for work.  It is my life.  To look at a bounty of great looking food and know that I can’t touch it really saddens me.

Some of you might think this is self pity, and part of it is.  I know there are others worse off than me.  But most people don’t realize just what food means to me.  It isn’t just a nutritional, life sustaining thing.  It is a way of life and is a part of mine.  I feel like today, a part of me has died. 

So where does this leave me know.  I am still struggling with my weight and trying to eat healthier.  I am trying to diet.  But this latest development hurt things.  But I can’t give in and I won’t.  I am done with excuses.  I will find a way to get to my goal and overcome my obstacle.  Hopefully, my passion for food will rise like the phoenix and renew itself.  There are so many new foods out there to try.  It might be time to explore options and see just what my diseased body can handle.

And worst case…as I am sure a friend of mine might suggest…there are always gummy bears to live off of.  But that, is another story.

Absence Makes The Heart Grow Fonder


I want to start off by apologizing.  It has been over a month since I have posted and for anyone looking for a new posts to come here and find none I am sorry.  Life has been very busy and sadly I haven’t had the time to get online to write a post.

Now that the summer is winding down and autumn is on the horizon, things will start to slow down a little.  Work has been very very busy but after September all will quiet down there.  At home, I am still doing board of director stuff and again, in October that might slow down also.

One thing I want to talk about while I have the chance is diet.  As many of you know, weight has been an issue with me.  I have talked about my journey with weight loss and doing a diet through Weight Watchers.  This past year had me so busy that I stopped going to meetings and eventually stopped the program.  I had hoped that I would finally be ok and keep the weight off.  Sadly, I am now back in the boat of weight gain.  It is slowly coming back and like Crohn’s…it is annoying the F out of me.Weight

Like IBD which can flare up at any time, weight gain comes when it wants.  So I am back with my demons trying to figure out what to do.  I am still Gluten Free and that makes my diet issues even worse.  I feel so loss on what to eat and what to do.  As anyone knows, when you feel loss you feel stress.  Stress then causes me to eat and the vicious cycle starts.  Stress also makes IBD worse and causes flares.

Overall, I am still doing well with my CD.  I see my GI in just over a week and I know it will be an uneventful meeting.  He will probably won’t have me return for 6 months (I hope) which means my next visit after this could be the colonoscopy time.  Ugh!!  I am still on LDN though so I am curious how it is affecting my insides and if it has helped in the healing processes any.  I feel great so I hope there is some significant healing.

But back to the diet.  I went into a very big IBD chat group on Facebook to find out what other overweight IBDers have done as far as diets.  Sadly, I didn’t get the answers I was hoping for.  I did get some good advice, but overall it wasn’t what I was really looking for.  A big advice was to cut back on carbs, which I will try.  It isn’t easy as I have realized that I have an addiction to carbs.  The other big advice was to increase protein.  It was recommended that for breakfast, instead of cereal to eat leftover dinner protein.  Um….no.  That may be fine for some people and for some foods I can maybe do that…but overall, no.  When I eat breakfast, I am still half asleep and so are my taste buds.  They don’t need a shock of BBQ sauce or Teriyaki  in the morning.

What I am curious, and I hope some people will feel ok to open up, what do some of you with IBD do to lose weight.  I know most automatically lose weight, but for those of you that are like me and still have weight issues, what do you do.  What works and what doesn’t.  Feel free to leave a comment or even email me.  I would love help from everyone and I really could use some direction.

 

The Health Activist’s Writers Month Challenge – Day 9 Caregiving


Patients, what advice or tips do you have for caregivers out there – professional or otherwise!

This is a good topic.  It is so good that it is a repeat of one I did last year.  So, I will pretty much repeat what I said in that post.  Also, keep in mind that I am focusing on caregiving to someone with IBD.

First, and this is one of the most important things a caregiver needs to remember, is that the person they are taking care of has the disease, not the caregiver.  The patient is most likely scared because they have an incurable illness.  What they need most of all is love, affection and some sympathy.  They are probably in constant pain and they might not ever feel “normal” again.  It is your job to help them get back to normal as best as THEY can.

Second, listen to your patient.  Don’t ever assume you know what they are going through or what they are feeling.  If they say they have pain, believe them.  Sometimes they may seem alright, but mos of the time there is pain within their gut.  Think about how you feel when you have a sunburn.  Well, Crohn’s is like a sunburn on the inside of the intestines and it is constantly being touched.

Next, don’t try to force feed them.  An appetite is a tricky thing for someone with IBD.  One day they can be nauseous and not want to eat.  Other days, they will want to pig out.  Some of this is caused by the disease, some of it caused by the meds.  Also, they are going to find that there are a bunch of foods that don’t agree with them.  If they want to try a specific diet, let them.  If they say they can’t eat a certain food….believe them.  Don’t try to make them eat something because it is healthy.  Not everything healthy is good for someone with IBD.

Your patient is not going to like the medications that they are on.  If they are taking Prednisone, there is a good chance that they will get some depression.  You should know right now, they will gain weight.  Their face will swell up and this is called a “Moon Face”.  Just let them know that it is normal, they are still beautiful and handsome, and that it is temporary.  One day they will come off the steroid and their weight will come down.  Now, sometimes if they are in a flare, they might lose weight.  Try to give them some supplemental foods like Ensure to help maintain their weight.  Don’t ever mention how skinny  they look.  They know they are losing weight and don’t want to be reminded of it.

My last advice I can give is never ever ever say they are sick.  They have a chronic illness that will be with them their whole life.  They know how they feel and they want to try to look and act normal.  To them, it is something that is now part of their life.  To them, being sick is like catching a cold or a flu.  Having IBD doesn’t mean your life ends…so why should they think they are sick.  Treat them as you would treat anyone else.  Play with them.  Talk with them.  Give them hugs and kisses.  Let them know that their life will move along and that they have nothing to be ashamed of.

And if ever you have a question, don’t be afraid to ask.  Ask a doctor.  Ask the person you are giving care to.  You can ask me.  There is also a huge community or people with their condition online.  Turn on your computer and look for them.  They will accept you and your patient into their family with no questions asked.

You are now about to embark on a great journey.  Enjoy the ride.

The Great Experiment Part 2


Last January I was in a nasty flare.  I was going to the bathroom 30 times a day.  I was obese with high cholesterol and high blood sugar.  My body was a mess and I wasn’t treating it nicely.  So, I decided to make some changes as many of you already know.  I joined Weight Watchers to lose weight, which I was pretty good with.  For the year I lost about 30 lbs.  I also went Gluten-Free to help with my Crohn’s.  I wanted to give my intestines a rest from the harsh fiber of wheat.  Also, this was supposed to help in reducing my blood sugar levels.  Lastly, and this happened later in the year, I switched meds.  I went off Humira and started Low Dose Naltrexone.

For the most part everything was working well.  I achieved what seemed like remission.  I lost weight.  I feel good and healthier.  I was finally on the right track.  And then it all came to a crashing halt.  The Dreaded Holidays!!!   Anyone that knows me knows I like to eat.  Well, the holidays give me that opportunity.  Pecan Pie, Pumpkin Pie, Chocolate covered anything.  With New Years Eve, there is a lot of eating, then some drinking, then some more eating and yes, more drinking.

Well, it is now January 2013.  My weight has been fine and I don’t think I have gained too much weight back as my clothes still fit.  However, the past week or so I have been going to the bathroom more.  I am not feeling as healthy as I should and I know the reason.  I have been putting garbage into my body again and have completely looked away from eating right.  I am now paying for it.

So now I know that diet most definitely plays a part in IBD.  Today is Friday night.  This weekend is my last hurrah.  As of Monday I start up my experiment with nutrition and IBD and get back to eating correctly.  I am going back onto the Weight Watchers plan.  I am going to stop putting nasty chemicals into my body.  I am going to start treating my body like it should be treated.

A lot of people still say that nutrition means nothing when it comes to IBD.  I think I might have proven this past year that it does.  When I ate healthy with all natural products I was doing great.  When I started eating junk again, I felt like I was on the verge of a flare.  I have learned a lot in 2012 and I know that I need to stop NOW.  I need to practice what I preach.

So I will continue on my journey come Monday.  I won’t look back.  I won’t second guess myself and I won’t regret it for one minute.  I want to be completely healthy.  I want others to look and me and say, “If he can do it, then anyone can” because I couldn’t do it for so many years.  I denied the nutrition connection and ignored my weight. 

The holidays are done.  My denial is over.  I had my fill and now I need to continue my journey and my experiment.  Welcome to Jeff 2.0.  Time to take all I have learned and put it into practice.  And there is nothing better on a journey than some company…so Who Is With Me?

Post 18 #NHBPM – Write about your advice for someone caring for a patient with your condition


 

Dear Sir/Madam:

This letter is to inform you that you are now caring for a patient with Crohn’s Disease.  There are a bunch of things you should know about the disease and how it will affect your life.

First, remember that the person you are taking care of has the disease, not you.  Right now they are probably scared because they have a uncurable chronic illness.  What they need most is love, affection and some sympathy.  They are in constant pain and will probably never feel “normal” again.  It is your job to help them get back to normal as best as THEY can.

Second, listen to them.  Don’t ever assume you know what they are going through or what they feel.  If they say they have pain, believe them.  Sometimes they may seem alright, but most times there is a pain within their gut.  Think about how you feel when you have a sunburn.  Well, Crohn’s is like a sunburn on the inside of the intestines and it is constantly being touched.  Ah, I see the lightbulb go on above your head…you have an idea now on what they are feeling like.

Next, don’t try to force feed them.  An appetite is a tricky thing for someone with Crohn’s.  One day they can be nauseous and not want to eat.  Other days, they will want to pig out.  Also, they are going to find that there are a bunch of foods that don’t agree with them.  If they want to try a specific diet, let them.  If they say they can’t eat a certain food…believe them.  Don’t try to make them eat something because it is healthy.  Not everything healthy is good for someone with Crohn’s.

Your patient is not going to like the medicines that they are on.  If they are taking Prednisone, they are going to get depressed.  You should know right now, they will gain weight.  Their face will swell up and this is called a “Moon Face”.  Just let them know that it is normal, they are still beautiful or handsome, and that it is temporary.  One day they will come off the steroid and their weight will come down.  Now, sometimes if they are in a constant flare, they may lose weight.  Try to give them some supplemental foods like Ensure to help maintain their weight.  Don’t ever mention how skinny they look.  They know they are losing weight and don’t want to be reminded of it.

My last advice I can give is never ever ever say they are sick.  They have a chronic disease that will be with them all their life.  They know how they feel and they want to try to look and act normal.  To them, it is something that is now part of their life.   To them, being sick is like catching a cold or a flu.  Having Crohn’s doesn’t mean your life ends..so why should they think they are sick.  Treat them as you would treat anyone else.  Play with them.  Talk with them.  Give them hugs and kisses.  Let them know that their life will move along and that they have nothing to be ashamed off.

Thank you for taking the time to read this letter.  I hope it will help you in caring for your new patient.  If you have any questions, feel free to ask me.  There is also a huge community of people with their condition online.  Turn on your computer and look for them.  They will accept you and your patient into their family with no questions asked.  You are now about to embark on a great journey.

sincerely;

Dr. Ira B. Darling

Step out of the Norm


Today I am stepping out of my norm…and I won’t really be talking about IBD.  Today, the thing on my mind is my weight loss and a revelation that I had.

I have mentioned it in some other posts and I don’t hide the fact that I am one of those overweight people with IBD.  When you hear statistics about obesity in America…I am in those statistics.  I never saw myself as obese..but my weight told a different tale.  I am 5 Foot 8 inches and before my weight loss journey I weighed around 240 lbs.  Now I knew I was overweight and had some issues because of it.  My blood sugar was high and my cholesterol was high.  My Crohn’s Disease was out of control and I was in a flare I just couldn’t control.  I knew I had to do something.

One day everything seemed to snap into place.  I was starting to get a new outlook on life with my Crohn’s so I decided to take it another step and control my weight.  I knew this wasn’t going to be easy.  I have been overweight all my life except when I first got sick with IBD.  I knew I had to get my weight down to the 160’s so I had a long road ahead of me.  The trick to this was finding what would work for me.  I have tried eating healthy before (high fiber, whole grains) but that would just anger my CD.  The things my tummy liked were white bleached products like white rice and white bread…the unhealthy stuff.  So this time around I did some research.

At the end of January of 2012, I went Gluten Free.  This was one of the best things I have done in my life for both my health and my Crohn’s.  Besides this, I also joined Weight Watchers..for the 3rd time in my life.  I swore to myself this would be the last time.

Here it is August 2012  and I have done pretty good.  So far I have lost 25 lbs and that is now where the trouble is starting.  The gluten-free diet has been trying some days but I have managed to stay on it.  The Weight Watchers is another story.  One thing they teach you and say you should do every day is track your food.  This helps in keeping tack of your daily points for the day.  Overall I have enough points right now to keep my satisfied.  But lately, I find myself on the weekend skipping the tracking.  Needless to say for the past 2 weeks I have gained some weight back.

Now one of the things they asked us is in a meeting was what keeps you motivated.  WW has this idea of anchors.  You should find something that when you look at it or touch it..it keeps you grounded and remind you why you are doing this.  I felt I never needed an anchor.  My biggest reason for losing weight was not only my bloodwork..but it was to keep my Crohn’s in check.  That is my biggest reason and my main reason to never be overweight again.  However, these past two weeks I have pushed that out of my head and ignored my body.

Last night as I travelled home, I reflected on the past couple of weeks.  I was trying to figure out why I am self sabotaging myself.  I have been doing so well with my journey.   And then it hit me.  All my life I have been overweight.  When I look in the mirror I see a slimmed down version (although still overweight) of myself and I am starting not to recognize him.  All I know is being overweight.  Since I refuse to be that anymore…what is my life going to be like?  How will I survive?  Will I be able to maintain that life?

Some of my thoughts were a little irrational but I know they are in my head so I have acknowledged them.  Whether the thoughts are rational or not, they are there and affecting me.  So I looked into my fear in the eyes.  I stared him down.  I have been sick for too long and I swore I would get better.  So here is this monster with chains in his hands telling me to come with him.  Well…not today.  You can take those chains and find someone else, because you won’t get me anymore.

I want to be healthy.  I want to be in remission.  I want to look in a mirror and say “Damn…who is that sexy guy?”  For years I have wanted to feel like a skinny person.  Well, I am going to get that chance..one day.  I know my fears will come back and haunt me probably for the rest of my life.  But I am done being overweight.  I want to live.  I want to enjoy life.  I want to be around for a long time. 

So, my journey continues.  I have hit a fork in the road and a chose a path.  So far, it is a clear path.  I remember where I am heading and I am back on the yellow bricks again.  My companions are by my side to guide me along.

My courage helped me face those dark fears.  My brains helped me see those fears for what they were.  My heart helped in clearing a path so I can step around the fears.  And my little dog was there to lick my face and show me that everything is alright and I can continue on my way home.  So I take those first steps again on the long road home.  I will get there.  It won’t be a short trip and there will be other obstacle.  And if any of those obstacles are flying monkies..I am running.