Saturday, 16 March 2019

Questions and Answers with Inflammatory Bowel Disease Nurse Angela Mullen

By Clara Caslin

Angela Mullen is an Inflammatory Bowel Disease specialist nurse in the Mater Misericordiae University Hospital in Dublin. She began her nursing in Mercy Hospital, School of Nursing in Cork and then attended the Royal College of Surgeons in Dublin.

Angela Mullen at a photo call for a campaign for IBD nurses to be doubled in  2018.

What is your role?
My role is an IBD specialist nurse. I manage the IBD service, which includes inpatient and outpatient support education and advice. Most of my patients are managed at home. I run an advice email and telephone service, attend outpatient clinics and arrange urgent clinical review and also coordinate all Biological, immunosuppression therapies and educate re all medical treatments.

How many patients do you have?
I have over 1500 patients and growing rapidly.

Are you the only IBD nurse in the Mater?
am the only IBD nurse.

Do you see more cases of Crohns or Colitis?
We see a little more Colitis than Crohns  patients (but not much).

What symptoms do people with IBD have?
Symptoms vary, classically its frequency of bowel motions worse in the mornings or at night with watery diarrhoea bleeding urgency and mucus. Sometimes just pain with altered bowel habit either constipation or diarrhoea not always with blood or mucus.

Do you think we need more IBD nurses in Ireland?
We definitely need more IBD Nurses, the patient’s with IBD Need access to care (sometimes rapid) and unfortunately in some practices they don’t have that.

 How severe can some cases be?
 The severest of cases can be life threatening.

Do you think more people are having surgery or is medication able to "fix" a bad flare?
Medications can certainly treat a bad flare but with the unpredictability of the disease this sometime is not enough and surgery might be the only option totally dependent on the case.

Have you seen an increase in cases of IBD over the years?
 Definitely an increase and more aggressive.

How young and old have you seen patients been diagnosed?
I work in adult services but have diagnosed patients at 16-17 and at the other end in their 70’s.

Is every case different?
No two cases really are the same everyone is different. We follow international guidelines on managements and escalations of treatments but every case is individual .

Photo Credit: Fingal Independent

Tuesday, 5 March 2019

Questions and Answers with Professor of Biochemistry Luke O'Neill

By Clara Caslin

Luke O’Neill is a professor of Biochemistry in the School of Biochemistry and Immunology at Trinity College Dublin. He was educated there where he was awarded an undergraduate degree in Natural Sciences (Biochemistry) in 1985. He completed his postgraduate study at the University of London where he was awarded a PhD in Pharmacology. His research investigates inflammation. For largely unknown reasons it can flare up and cause a range of inflammatory diseases, like Inflammatory Bowel Disease, which remain difficult to treat. I asked him some questions about his studies and the information that he found about Inflammatory Bowel Disease.

Luke O'Neill

What is your title?
Professor of Biochemistry.
How long have you been in your field?
 30 years.

Where did your interest start in it?
In my final undergraduate year in TCD – a project on Crohn’s disease.

What can you tell me about genetics in Crohn’s and Ulcerative Colitis?
Lots of genes have been implicated in inflammatory bowel disease affecting multiple inflammatory pathways. 2 of particular interest to my own research are NOD2 and IRGM. NOD2 is a bacterial sensor, implicating bacteria in disease pathogenesis. IRGM is an inhibitor of an inflammatory pathway involving the NLRP3 inflammasome, which a company I co-founded called Inflazome is developing inhibitors of.

Is there any trends that you have noticed in these diseases?
Both are obviously inflammatory in nature, and most likely involve a disturbance in the gut bacteria. 

Is there anything in your studies that you have noticed leads to shifts of the intestinal bacterial composition in Inflammatory Bowel Disease patients?

Do you think that diet has a lot to do with these diseases? 
Limited evidence of dietary involvement.

What do you think would cause there to be a disrupted immunological response to gut microbiota in genetically susceptible individuals? 
Clearly it is a disease where there is a dysfunction in the how the gut handles bacteria. This then provokes inflammation and the inflammatory process becomes unresolving – a wound that won’t heal.

What causes chronic inflammation in the gut?
Unknown – likely to be a combination of genetics and aberrant handling of gut bacteria, or some yet to be uncovered cause.

What change can be seen when patients are treated with immunosuppressant’s? 
Current therapies show some benefits (eg anti-TNF and mesalamine) but there is a desperate need for new medicines which will limit the inflammatory process locally and promote a healing response.

Tuesday, 8 May 2018

Losing My Dad As A Teenager

Yesterday, it was nine years since my Dad passed away. When you’re younger, you never think that you’re going to have such a short time with a parent. You imagine your Dad being there for your birthdays, graduating from school, starting and graduating college, walking you down the aisle and being there when your children are born. I only had 15 years with my Dad. What I want to talk about in this post is the importance of dealing with a parents passing. Before I get into that I’m going to give some background into what happened.

I remember the morning that he died like it was yesterday but it also feels like a lifetime ago. My Dad never drank or smoked so it came as a huge shock to find out in April 2009 that he had terminal cancer. He was diagnosed with an extremely rare cancer that one in a million people are diagnosed with that had spread from his stomach to his liver, lungs and esophagus. His symptoms had started around Christmas time in 2008 when he was suffering with a lot of indigestion and he couldn’t eat much so in turn he lost a lot of weight. 

We were all so concerned because this huge character in our home had become quiet and withdrawn. My Mam pleaded with my Dad to go to the doctor but he was afraid of going. Eventually, he had to give in and go. The doctor sent him to the hospital the same day for an endoscope and blood tests, which came back the same day with the result that nobody was prepared for, cancer. 

I remember my Nana collected my brother and me from school that day and it was very quiet, I could tell by the atmosphere that something serious was going on. The way I found out about the cancer diagnosis wasn’t ideal. I was being nosey and had a look at my Mams phone where I saw the words, “John has cancer”. I remember nearly collapsing in the kitchen and running into my mam and nana saying “Does dad have cancer, tell me now”. After it was confirmed, I went up the stairs to my Dad who was resting in their bed. I lay down beside him and he gave me a cuddle. I started crying but I was trying to hide the fact that I was because I didn’t want him to feel worse than he already did, if that was even possible. 

He comforted me even though he was going through every person’s worst nightmare. That was the last time my Dad and I shared a cuddle. He had to go to the hospital for a week and even then when he was so weak, he was making jokes to the nurses about where the gym was and walking to meet my brother and I at the ward doors. He came home at the very end of April. The next week was spent making sure he was comfortable and being there for anything he wanted. He couldn’t talk very much because of the cancer in his lungs so his breathing was very bad.

The Tuesday night, which was the 5th of May, was the last time he was able to come down the stairs. The doctor came on Wednesday because his breathing was really bad. I tried to get him to eat some beans but he wasn’t able so I left him alone after that to rest. The next morning, we were woken early and he passed away surrounded by my Mam, Brother and me at home where he wanted to be.

We rushed to the hospital and I remember just being in shock. Family came to the hospital and I remember from the moment we left I switched into this mode where tears didn’t exist. I wanted to be there for everyone else but disappear so I wouldn’t have to have any sort of conversation about it. I use to dread when people would ask me about how I was feeling and now I realise it was because I was in some sort of denial. Family tried and tried to get me to talk about my Dad but I would shut the conversation down or leave the room. I was just too heart-broken to talk about it and to process the feelings that I was feeling deep down, so I shut them out. I got extremely sick in 2011-2012 and spent a lot of time in the hospital (which you can read about here) where I only started talking about my Dad. 

There was a night in May 2012 around his anniversary were I was closing a window in my room and I looked out and saw the room where my Dad had stayed in the hospital and from then I opened up more and more. Whatever it was about that and being so sick, it was being so vulnerable that it made me talk about him a lot. It was really a healing. Now, I speak about him everyday. We say at home that it’s just like he’s just in a different room. It’s so important to speak about the passing of a parent because if you don’t, it just shuts you away from people and your true emotions. 

A lot of my family thinks that I got sick from the suppression of my emotions. I definitely agree that your health can deteriorate but I don’t think it’s what caused me to have Crohns. I know what it’s like to watch people with their dads and wanting to cry because you can’t do that or someone’s dad ringing them and knowing my dad will never ring me again or that he never got to see me grow into an adult or that I’ll never see him come home or give me a goodnight kiss and cuddle ever again. 

My advice to anyone going through the death of a parent as a teenager or any age is to talk about it. You don’t have to always be so strong for everyone else. Don’t be embarrassed about your feelings. It’s ok to cry – you’ll feel a lot better after letting it out. Don’t feel like talking about it is looking for attention just because your friends haven’t been through the same thing as you. Your friends will want to be there to support you and of course your family will always be there to support you and if you don’t want to speak to family or friends there is plenty of other support out there for you so there’s always an option. 

For anyone lucky enough to still have their parents hug them tighter, call them more, spend as much time with them as you can and tell them you love them everyday. It only takes a second for everything to change. 

Saturday, 25 November 2017

Chatterbox Clara Goes To Dèjá Vu in Malahide

After a morning stroll along Malahide beach, the first thought that comes to mind is food. There is such a tremendous selection of cafes and restaurants in Malahide but the place that stands out to me in this quaint town is Déjà Vu on Old Street.

It was 11:30am on Sunday morning and I arrived to the extremely busy, Parisian style restaurant with the sweet smell of pastries drifting out the door and the soothing sound of Ella Fitzgerald floating through the air. You walk through a ruby-coloured, velvet curtain into the restaurant and the plush, red, velour décor transports you back to a 1920s state of mind.

Following a warm welcome by the hostess, I was brought to a table by the window and looked through the Brunch and Lunch menus, which are served from 9am to 4pm daily and my eyes were immediately drawn to the Pain Perdu which is a French toast made with sweet brioche, served with bacon and maple syrup. I noticed the family next to me tucking into it so that sealed my decision.

I was feeling extra peckish so I also opted to have a Chicken Caesar Salad, which is served with pulled chicken breast, crispy cured ham, avocado, baby gem lettuce, caesar dressing and parmesan shavings. It was one of the many gluten free options on the menu and there was an ample choice of vegetarian options such as the popular Veja Vu Breakfast of avocado, spinach, poached egg, potato cake, Portobello mushroom, cherry tomatoes and toast.

One of the features of the restaurant that I found visually pleasing was the fact that the kitchen was visible from the seating area and you could see the chefs cooking your food. After a wait of around 15 minutes, the Pain Perdu was served. The brioche was fluffy, the bacon crispy and the syrup tied the flavours together. I found it the perfect balance of sweet and savory.

The Chicken Caesar Salad was deliciously blended. The crispy cured ham stood out to me and as I don’t normally like cured ham that was unexpected. The waiter recommended the sticky toffee pudding and I couldn’t turn down my favourite dessert! It was served with a scoop of vanilla ice cream on top and drizzled with toffee sauce. It was a splendid treat for the palate! 

I asked for the bill and the meal came to a total of €26. The Pain Perdu was €8.50, the Chicken Caesar Salad €12.50 and the Sticky Toffee Pudding €5. I decided to have a glass of Prosecco, priced at €6 to finish off my dining experience in Dèjá Vu. I sat back, opened my book and listened to the soothing French music playing in the background. I highly recommend Dèjá Vu for an authentic Parisian experience. Bon Appetit!

Thursday, 27 October 2016

Gym Update: My Third Month Of Personal Training

Hi guys!

Thanks so much to everyone for all of the comments about my article that was featured in The Irish Times on Tuesday. The response was amazing :) I've wanted to write a post about how the gym has been going and I finally have a break from assignments to do it! 

In August, I started personal training with Marcus Bertels at the Ben Dunne gym in Northwood and I can't believe how much my strength and stamina is after building up since then. If someone had said to me last year that I'd be doing 100-kilo leg presses, I would have laughed in their face. 

Over the past three months, I've lost nearly half a stone. I wasn't overweight but I wanted to lose fat, gain muscle and tone up, which is what I've done. I don't count calories but I try to keep my carb intake low and my protein intake high. I think giving up fizzy drinks has been one of the main factors in my weight loss. I used to drink something fizzy nearly every day and now it's a treat when I do. 
When I think about it, my whole diet has completely changed and I have so much more energy because of it. My skin has improved and it's definitely down to what I put into my body. Two of my friends that I hadn't seen in a couple of months saw me the other day and commented about my skin and weight loss and it really encourages you to keep going when people compliment you about the change.

I could talk about the benefits of going to the gym forever but getting out there and joining a gym is one of the best things you can do for yourself; physically and mentally. I can guarantee that once you find a workout routine or class that you enjoy it will become something that you can't live without! 

I wrote a post about a colonoscopy that I had last month. I'll be back soon to update you all about the results of it as the biopsy results are back next week! 

Have a great Halloween! 


Saturday, 17 September 2016

My Experience Of Having A Colonoscopy!

Hi everyone,

If you read my blog then you'll know that I was diagnosed with Crohn's Disease just over four years ago. In August, I was in the hospital for a routine check-up and met a new doctor on the team. We were chatting about my case for a while and all seemed ok. Two weeks later, I received a letter in the post informing me that I had an appointment to have a colonoscopy done two days later! I had an appointment the day that it was scheduled so I had to reschedule it. I received another letter a few days later from the doctor that I met telling me that the team had discussed my case and wanted me to have a couple of tests done quite urgently. 

For anyone that doesn't know what a colonoscopy is, it's a test where they place a camera up your you know what so that they can see your rectum and entire colon. It can also reach the last part of the small intestine called the ileum. I've dodged having a colonoscopy done for years but this doctor wasn't letting me away with it! Everyone always thinks it's so strange when they find out that I've never had one done before but the reason I didn't have one done was because there was too much inflammation in my intestines when I was sick and they didn't want to chance that any perforation would occur during the procedure. 

My appointment date came and it was scheduled for last Tuesday which was the day before I started in Dublin City University (DCU). I was quite anxious about it because I didn't know how I would be after the test and I didn't want to miss my first day of a new college. I'm sorry for what I'm about to say to anyone who is going to have a colonoscopy done but I'm going to be completely honest. KLEAN PREP IS THE MOST VILE THING THAT I HAVE EVER HAD TO GO THROUGH. Your preparation starts a week before you have to go for the colonoscopy. You have to avoid certain foods which was grand and then at 3pm the day before the test you have to start drinking Klean Prep. 

You have four sachets that you dilute with a litre of water each and you're supposed to drink 250ml every ten minutes so that your bowel is clear for the procedure the next day. The only way to describe the taste is like swallowing vanilla scented salt water. You can dilute it with mi wadi but I ended up having to drink straight mi wadi before I could take a taste and then I washed it down with more straight mi wadi. I started at 3 15pm and I was still up at 3am finishing it and by finishing it I mean that I got through two and a half sachets in 12 hours!! 

I was annoyed at myself for struggling so much with it but it literally reduced me to tears after half a glass at the thought that I was going to have to struggle through four litres of this crap. Once the Klean Prep starts working, I advise you to stay very close to a bathroom! I gave up at 3am after the two and a half sachets because things were clear (if you get me) and I was really tired too. I wasn't scared about having the colonoscopy, I was more anxious that they would find anything! 

I was in chatting with some women in the dressing room when a nurse came looking for me. I went out and was brought into a room to have the cannula put into my arm and sat up on a bed. It was only after around five minutes of chatting to the nurse that I realised I was in the procedure room! A few minutes later, the doctor put some sedation in the cannula and I felt a bit relaxed but I was still completely aware of what was going on. The colonoscopy began and I watched everything that was being done on a screen and asked about 1,0000 questions (the poor doctor)! There were a few moments of cramping and discomfort but they didn't really bother me as they passed after a few seconds.

My biopsies won't be back for a few weeks but there were no signs of any inflammation anywhere which I was delighted about! That was my experience of having a colonoscopy. In short, Klean Prep is evil and the colonoscopy is absolutely nothing to be worried about! 


Friday, 12 August 2016

Why I Joined The Gym

Hi, everyone!

About a month ago, I went to have a look around a gym and I decided to join and start getting into fitness. I'd been thinking about joining for a long time as I wanted to get fit and change my lifestyle but I thought that I wouldn't like it. It can be intimidating going to the gym for the first time and not having a clue how anything works and worrying that everyone's watching you, just waiting for you to start using a leg machine with your arms!! I felt that it would be best for me to start personal training so that I had someone with me showing me the ropes, pushing me and giving me the best workout for what I want to do with my body. 

Last week, I had my first session with my personal trainer and I left the gym on a high that I hadn't felt in a long time! He made me enjoy every exercise that I was doing and I had fun in the gym! Yes, I was looking around for the first session thinking people were looking at me going "oh my god she can barely do push-ups" but you have to start somewhere! I had my fourth session today and my strength is after building up so much! I never thought that I'd have pushed 80 kilos the first time that I'd ever done a leg press! My confidence is growing each time that I go to the gym and I feel so good after every session. I've completely changed my diet and don't put anything into my body that I know isn't beneficial. The change that I can already see and feel is amazing! I look forward to having a treat or a cheat meal now rather than having something like a chocolate bar or fizzy drink every day. I now snack on things like fruit and veg which is something that I never thought I'd say (as I have such a sweet tooth!).

I suffer from anxiety too and the gym has been the best therapy that I've ever had! If anyone suffers from anxiety and you aren't already going to the gym, I highly recommend that you start. It has been the best thing that I've done for my body and mind! I was meant to take a before photo before I started training but I forgot to so I'm going to take one before my next session and document how things are going every week. Today, I was working a lot on my upper back and arms and I can see my back muscles starting to become more defined. It's crazy how fast the changes happen once you devote yourself.

If you're out there and you're contemplating starting the gym, push yourself and join, join with a friend if you don't want to go alone. It's the best thing that I've ever done!

You can follow my journey by joining me on Snapchat and Instagram. My username on both accounts is chatterboxclara.