Flaring for my 23rd birthday and at the start of my new career

If you missed my last post recapping what I have been up to over the past few months, feel free to check that out here.

I started my new job on July 11th, one day before my 23rd birthday. I flew to St. Charles, Illinois, for a ten-day new hire training. I work in tax for a multinational, Big 4 accounting firm, and knew that the expectations would be more intense than a regular 9-5. I figured that since I had maintained a semi-state of remission with my Crohn's disease that I would be well enough to handle the demands of public accounting... I was wrong.  

The ten, sometimes twelve, hour days of training got to me. I require at least 9 hours of sleep to function at a baseline level. If I don't get my sleep, my body fights against me. I also have a proven track record of running into issues with traveling in general, probably due to a combination of stress, new environments, and unfamiliar food options. Despite my best efforts to get adequate sleep and nutrition during training, I began noticing my hallmark symptoms of a flare: fevers, headaches, leg swelling/rashes, and rectal bleeding.  
Of course I brought my Humira injection with me to take as scheduled and was staying on my daily Azathioprine. I limited my caffeine intake, drank lots of water, ate healthy food, but that was not enough.  

I passed on several social opportunities while at training because I did not have the energy to keep up with the other twenty-something-year-olds. Instead of visiting Chicago for the weekend with some new friends, I stayed in my tiny hotel room and tried to rest as much as possible. I had to go back to my room to nap during lunch breaks over the course of training. I didn't go out for drinks or attend karaoke night with all the other new hires because I needed to go to sleep. Although I am used to this type of isolation during flares, the feeling of being left out, removed from group texts and plans, always stings.  

So what exactly happened? Right off the bat on the second night of training, which also happened to be my birthday, I developed a pinpoint, red rash all over my lower legs. This was a new issue for me, and at first I did not even attribute it to my Crohns. It was not painful, so I just took note of it and moved on. I also was bruising very easily on my legs; indentations from chairs or anything I touched would remain as marks for far too long. I did not become concerned until later that week when I noticed what I fear the most: a painful lump on my leg. 

I tend to exhibit systemic, or extra-intestinal, manifestations of Crohn's disease, which is a bit different from what one may expect me to deal with. In other words, no, I was not running to the bathroom 24/7. Not many are familiar with erythema nodosum, which is one of my main symptoms during a serious flare.  In short,  it means I develop red, painful lumps on my lower legs (and sometimes feet and knees) that start out looking like bruises. One "bruise," within hours or days, turns into multiple bruises, accompanied by severe swelling. If not caught and treated early, the erythema nodosum becomes so painful and extreme that I cannot walk. This also causes a fever, which may dually indicate inflammation elsewhere in my body.  

I anxiously noticed my legs swelling and a headache and fever developing. I was also very nauseous and food tasted disgusting. By this time, I had only a few days left of training, but I knew if I waited too long, I would end up in the hospital (as indicated by my track record with this type of flare progression). I was so disappointed in my body for betraying me yet again... and at the very start of my big-girl career nonetheless. 
I called my GI doctor who advised me to either go to the ER in Chicago or get on the next flight home. I'm quite stubborn and was planning on sticking out the last few days of training, but I came to my senses and decided it would be in my best interest to return home early.  

I was nervous to reach out to the training program coordinator, but of course she was extremely understanding and accommodating. I was able to book a flight home early the next morning. I was confident in my decision to leave training  because I knew the sooner I get prednisone into my system, the sooner I would feel better. 

There it is, the p word: prednisone. I hate prednisone. If you aren't familiar with the long list of side effects that accompany this steroid, some of my personal favorites include but are not limited to: insomnia, extreme agitation, depressive and anxious thoughts, decreased immune system function, abdominal pain, slowed healing. Not to mention that I have previously developed abscesses, fistulas, and even shingles at the end of a taper. Yay! 

With time I have learned to accept the lesser of evils, and in this instance, prednisone is what I needed. I flew home early in the morning on July 20th and spent the day in the ER getting blood tests done to primarily check my inflammation levels. The best possible outcome ensued, as I was able to walk out that night with a prescription for prednisone and a follow-up appointment the next day with my favorite GI doctor.  

At my appointment we (and I say "we" because thankfully I have found a doctor that actually considers my input to be valid) decided that I would begin a prednisone taper. I also will be increasing my dose of Azathioprine. The possibility of switching my maintenance treatment regimen entirely was brought into question; I would prefer to stay on Humira/Azathioprine for as long as I can because I don't want to exhaust my options too quickly. However, my GI assured me that there are several new and developing biologic medicines to look forward to when Humira fails me, which was reassuring to hear. I will cross that bridge when I get to it. 

Within a day of being on prednisone, my legs were less swollen and my headache/fever/nausea diminished. I was able to rest a lot and was in a good enough place for my first real day of work this past Monday. Thankfully, I did not need to fly to any trainings and only have an hour daily commute in the car.  

I definitely feel the increased energy from the prednisone, which has enabled me to power through my work days so far this week despite a few subpar nights of sleep. I'm still adjusting to my new position, and the prospect of tax busy season as a person with a suppressed immune system deeply concerns me, so for now I am just taking things one day at a time. 

Side note: if you are reading this and have IBD, I would sincerely love to know what you do for work and how you manage to balance your health with a personal life and a career.  

So in short, what could have developed into a nasty flare was halted in its tracks because I was proactive about my health. Thankfully, the experience I have with this disease allows me to know what needs to be done to prevent symptoms from escalating.  

As I get back into blogging, I would love to know what topics are of interest to you as a reader either with IBD or with a loved one who suffers. You can reach me via email at aeesper@gmail.com. 

visit www.ashleyesper.com for helpful articles and tips!
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