Germ Olympics: IBD and Infections

microscopic virus
Ugh, I’m down with a cold. It’s some kind of crud that started in my sinuses, moved to my throat and is probably going to finish up in my lungs sometime over the next week. While most people generally acknowledge the hassle of this situation and assume it’s no fault of their own, I see it differently. I feel responsible. I wonder where I slipped up, whose hand I shook, or to what crowded place I shouldn’t have gone. While this might seem paranoid or obsessive to those whose immune systems can handle minor illnesses without undue trauma, it can be quite different for people with Crohn’s or colitis.

Many of the medications we take for IBD alter the immune system—making it easier to catch and harder to fight off infections, even simple viruses. Our prescriptions come emblazoned with warnings about these higher risks. We have been cautioned by doctors that we may recover more slowly from these illnesses and that they can have complications. Bacterial infections can be especially hazardous, as antibiotics can wreak havoc on our sensitive digestive systems. And some of us can’t take non-steroidal anti-inflammatory drugs (NSAIDS), those handy pain-relievers and fever reducers, like ibuprofen, that would otherwise be helpful when we get sick. As a result, in the years since starting on immunosuppressant medication, I have become hyper-vigilant about avoiding colds and the flu. And this is not unusual for IBD patients.

Getting one of those bugs that goes around typically seems like a minor sidestep for most of the population, but for us it’s a different story. We have experience that teaches us to be more careful. When I get a stomach bug and vomit all night I usually end up in the hospital for an IV to get re-hydrated. When I get a cold I usually fight it for twice the time a normal person would. And it’s not just the extra time and hassle; there can be other implications as well. 

Digestive health can suffer severely as a result. One notable example for me began with a mere cold that turned into a sinus infection for which I took antibiotics that made my intestinal balance go cattywompus, leading to the worst colitis flare I’ve ever had. It got so bad that my gastroenterologist began calling me at home every day to determine if I should be hospitalized. It took several weeks of high prednisone doses and a trip to the Mayo Clinic to settle that one down. So, is it worth a little extra effort to avoid these? Absolutely.

What does that mean? Washing hands, using sanitizer, never touching my eyes, nose, or mouth unless I’ve just washed up. It means avoiding parties and crowds when possible. It means driving myself when a carpool mate is sick. It means being attentive to the fact that my wife is a schoolteacher and, on a daily basis, is exposed to seemingly every illness in the history of humankind. And it also means realizing that, regardless of whatever precautions we take, we can’t always prevent infection. While I’d love to have a personal assistant to follow me around and hand me a sanitizing wipe every time I touch something or shake someone’s hand, it also means doing what I can to avoid living Monk’s obsessive-compulsive life if I don’t have to. I don’t want to be imprisoned by paranoia. But I still want to give my best effort to avoid getting sick. I want only the most determined germ to get to me. It’s going to have to overcome all manner of obstacles and perils before it finds its way into my system. It’s going to have to medal in the Germ Olympics to make me sick.

But at some point recently I failed. Somewhere along the line my defenses were weak. My regimen got sloppy. Or I went somewhere foolish. The last time I experienced this it happened after a concert. I came down with strep throat—the kind they don’t have to treat with antibiotics, luckily, but unfortunately that meant I had to just beat it out the old fashioned way, over the course of three weeks. The infection ended up spreading into my eyes for an added layer of misery. My doctor commented that the concert was a likely source: “In a crowd of that magnitude it’s likely you acquired the infection from the ambient air.” Which, translated into normal speak, means: “When you’re in the stands with fifteen thousand people breathing junk out, you’re going to breathe some junk in.” Duly noted.

This time, I guess there’s an equally good reason for catching an infection: I just finished coordinating a regional Science Olympiad competition. I spent the day with hundreds of students, running around with science experiments and engineering projects they’d been touching and breathing and sneezing on, all confined to a couple of gyms on a Saturday afternoon. I was touching their work, judging projects, coordinating people, shaking hands, and having lots of close conversations while trying to hear in a noisy gymnasium.

And guess what? I had no sanitizer with me. I’d left my normal bottle in my other pants, and the spare one seemed to have escaped from my briefcase somewhere. I even ate lunch there [gasp!]. I was also very tired, having worked quite intensely during the weeks prior to organize the competition—so my system was completely drained and probably vulnerable. As I could have expected, it seems the Germ Olympics piggybacked on the Science Olympiad and one of those little critters found its way through, and won a medal. I’d give it a bronze at this point…it’s a good enough performance to cause me some discomfort and inconvenience, but this one isn’t going to knock me out, or so I hope. No, the Gold Medalist germ hasn’t found its way to me yet. And I hope it doesn’t.

Despite my learned instincts to avoid situations like this, there are times when either it can’t be avoided or it’s simply worth the risk. Do I know that being in crowds increases my chances of getting sick? Yes, but do I let that stop me? Well, yes, sometimes when it makes sense and doesn’t involve a significant sacrifice—but otherwise, no, not when the benefits outweigh the risk, and that actually covers most cases. So far, aside from that one terrible scenario from years back, I’ve been lucky enough to manage these episodes without antibiotics or traumatic results. The risks I’ve taken this week were worth it for sure. Handing out medals and trophies to kids, watching them compete using the things they’ve learned in school, and seeing their excitement makes it all worthwhile. I love the Science Olympiad; it’s one of my favorite days of the year. In this case it was a no-brainer, but I am paying a price for it. Hopefully this time won’t be too severe.

There’s risk in everything we do and every place we go. However, we can’t just bow out of everything that seems a little risky. To do so is to bow out of life. It can be all too easy to live like a shut-in at times. But that’s not healthy either. We have to keep going out and being involved, regardless of how fragile we may sometimes feel. Usually it’s not going to hurt us, but sometimes it will. Even so, we can’t let that stop us. That’s the fence we have to walk—balancing safety and adventure, caution and enthusiasm, opting out and opting in. While it can seem easier to stay away, as much as possible, please be sure to keep jumping in, as often as you can. The rewards are definitely worth it—even just to stay active for the sake of staying active. This is how we keep living, despite our challenges.

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About the Author

Andrew Tubesing is an acclaimed advocate and humorist on the subject of inflammatory bowel disease.