I chuckled as my patient explained that a highly respected, but recently retired local dermatologist once told him he was allergic to his own sweat. He has suffered for many years from many different skin disorders, including psoriasis, eczema, seborrheic keratosis. He even required excision and a skin graft for a squamous cell carcinoma of his groin. Now he was complaining of dry, itchy skin in both of his groins and around his anus. I recommended some ointment with zinc oxide in it.
I went to the hospital to make rounds. The patient I was seeing had a severe exacerbation of ulcerative colitis. This chronic inflammatory condition of the colon had been well controlled for two years with anti-inflammatory suppositories. When my patient fell ill with a virus that she caught from her daughter, she grew severely dehydrated from vomiting and the symptoms of her colitis flared. She had days and days of uncontrollable bloody diarrhea. Being a firm believer in alternative medicine, and convinced that her symptoms had been allayed for two years by herbal remedies and acupuncture, she drank Gatorade, swallowed vitamin supplements and refused to go to the hospital.
When she grew so weak she could not get out of bed, her husband called an ambulance and brought her to the Emergency Room. She was admitted to the medical service, resuscitated with IV fluids and started on high dose intravenous steroids. Her severe electrolyte imbalance was slowly corrected, but her diarrhea continued. Even after a week of steroids the inflamed lining of her colon forced out bloody, watery, mucoid stools seven to ten times a day. She grew weaker, afraid to eat. Her blood count dropped. Her legs swelled as her nutritional stores were depleted. She was incontinent, unable to get to her bedside commode to meet her explosive stools. She asked me to pray for her.
My partner tried to insert a central venous catheter into her subclavian vein so we could pour high protein, high calorie liquid nutrition into her system to try to make up for all the food she could not eat and all the fluids she was continually losing. His bedside attempt was unsuccessful. We relied on the interventional radiologists who were able to thread a catheter into place using fluoroscopy.
Now it was time to start talking about surgery. Because of the drastic nature of the surgery to correct this disorder, it is usually reserved for the most severe, life threatening cases. It would involve removing the entire colon and rectum, leaving her with either a permanent ileostomy, where the small intestine is brought to skin level and waste exits the body into a bag on the abdominal wall or a connection between her small intestine and her anus. Neither of these options would make her completely normal. Her stools would always be frequent and loose. Any lesser surgery would leave her at risk for persistent inflammation and cancer.
My patient was in better spirits as I entered the room. Not quite as weak, tolerating some soft, bland foods, perhaps seeing the prospect of surgery as a light at the end of the tunnel. She wondered out loud why this was happening to her, how all the herbal supplements, the vitamins, the acupuncture and her family’s prayers could have failed her.
I sat on the edge of her bed and began to explain, “It’s almost like you are allergic to your own stool…”
