Questions and Answers with Consultant Gastroenterologist Professor Stephen Patchett

By Clara Caslin

Professor Stephen Patchett is a Consultant Gastroenterologist who works in Beaumont Hospital in Dublin. He also works in The Bon Secours hospitals and is an Associate Clinical Professor in the Royal College of Surgeons Dublin. He graduated from UCD and began his training in Dublin before moving to London to train in St Bartholomew's and The Royal London Hospitals. 

He was a Senior Lecturer in St Barts in 1996 and then returned to Ireland to take up his current position in Beaumont in November 1998. He has a focus on diagnostic and therapeutic gastrointestinal endoscopy and therapeutics of inflammatory bowel disease. He is the clinical lead for endoscopy services in Beaumont and The Bon Secours. He is currently the chair of the working group for the national QA programme in endoscopy and represents the College of Physicians on the QA Steering group and the Conjoint Endoscopy Curriculum development group. 

Professor Stephen Patchett

What is your role?

Consultant Gastroenterologist.

When did you realise that being a Gastroenterologist was what you wanted to do? 

When I was a second year junior doctor and started working with a very influential gastroenterologist who subsequently became my mentor.

How many IBD patients do you treat (estimate)? 

1000.

What age group are the patients you treat? 

17-85.

Are all cases different or do you see a lot of similar ones? 

Whilst there are similarities, every patient is different both in the manifestation of their disease and their approach to dealing with their illness.

What do you think people can do to help their IBD?  

Look after themselves physically and emotionally. Eat well, exercise, don’t smoke. Learn as much as they can about their disease through interaction with others and IBD societies.

Do you ever think there will ever be a cure? 

I think ultimately yes but this will be some way off. However our ability to control the disease is improving rapidly and living with IBD will not be the challenge that it use to be.

What sort of lifestyle do you tell patients is best for them? 

Important to stay active and eat well (as we all should). This is the same advice that we would give to the general population.

Do you think IBD is one of the hardest diseases to live with? 

Difficult question as there are many difficult diseases. It really depends on the severity of an individual’s disease.

What would you say to someone who was newly diagnosed? 

Apart from explaining the nature of the disease and its treatment, I would stress that in the vast majority of cases, treatment is very successful and that a very fulfilling and active life is possible. I think a positive outlook is very important.

Image Credit: beaumont.ie

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 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. 

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! 

Clara 

My Story About Being Diagnosed With Crohn's Disease

Hi everyone, I’ve decided to share a personal blog post as World IBD Day is today, May 19^th 2016 and I wanted to share awareness about living with Inflammatory Bowel Disease. I had an extreme fear of doctors, which made me hide the fact that I was extremely sick in 2011. I tried to get out of a moving car once when I was told that I was being brought to the doctor! It got to the stage where I couldn’t avoid it any longer because I was in excruciating pain. My weight was dropping rapidly and I was hiding food because I wasn’t able to eat. I didn’t want to worry anyone around me but it was obvious to others that something was wrong. My symptoms started when I was 12, I noticed that I would pass a lot of blood when going to the toilet. It would happen on and off and I’d just pass it off even though I knew that it wasn’t right.

September 9^th  2011 was the day that my Crohn’s disease began to flare. I was in Manchester at the time and I remember feeling like my stomach was going to burst open. I was suffering with extreme cramps, fever and diarrhea. In the coming months my weight began to drop rapidly because I couldn’t eat without getting cramps and diarrhea. I’m a happy, bubbly person and people thought that I was suffering from depression and an eating disorder. I realise now that I was slowly dying and I was letting it happen but that’s how bad my fear of doctors was.

In December 2011 people were saying that I looked like a skeleton. I could see the shock on people’s faces when they would look at me and see a different person to the Clara that they all knew. I developed a perianal abscess and I was forced to go to the doctor because I couldn’t pass anything from my bowel without looking like someone you see having a baby in a film. It was dramatic to say the least! I went to A&E on the 23^rd of December 2011 and I was admitted immediately and prepped for emergency surgery. The surgeons drained 100ml of poison from the abscess and I was told that I would have died on Christmas Day if I had left it any longer. The poison would have entered into my blood stream and killed me. I got out of hospital on Christmas Day and instead of things getting better, they got worse. I had dressings changed every day in the open wound from surgery for 3 months. The dressings were one of the most painful things I’ve ever gone through. I was still trying to fool doctors when I would go to clinic appointments in the hospital wearing a full face of makeup and a big smile on my face. My mam would plead with me to let them see the girl that she saw every day.

Me in 2016 on the left and April 2012 on the right

In March 2012, my weight had dropped from 56 to 47 kilos. I’m 5ft 7 so I was tremendously underweight. I developed a limp and when I felt a large lump in my stomach I knew it was time to seek help. I was rushed to Beaumont hospital and hooked up to an ECG machine because of how high my heart rate was and sent for numerous scans which showed a mass the size of a melon in my psoas muscle. It was blocking all of my organs. The surgeon told me that they had three options for me and there was no guarantee that any of them would be successful. I asked him if I would live and he said, “I don’t know". It was then that I realised I was at deaths door and I received my last rites. I had a drain fitted internally for two weeks and it drained out the poison from the abscess in my abdomen. The CRP levels (which is the marker of inflammation) in my blood were over 600, normal is between 2-10. I also had Strep G and E-Coli in my blood. After three weeks I was discharged but after a few days, I knew that the mass was back. I remember packing a suitcase at home because I knew that I was going to be in hospital for a very long time and part of me didn’t know if I would ever come back home again.

The next day, I was admitted and brought straight to the ward where I was prepared for surgery. There was no more time to waste. I was put on a feed called TPN and marked up for two stoma bags on the morning of major surgery. I remember being brought down to theatre not knowing what my body would be like when I woke up. After seven hours, I was brought back up to the ICU unit. It’s all a blur because I was on a morphine pump but I remember wires and tubes were coming out of my body everywhere and that the surgeon told me that I had no stoma bag. I struggled for weeks after the major surgery, which included a bowel resection. I had some blood transfusions because of cell levels in my blood and because of what I had lost during surgery. It would take me 15 minutes to sit up and I was unable to eat, wash or walk. My mam was brilliant but my dad passed away when I was 15 so it was hard that he wasn’t around as a support for my mam, brother and me.

After suffering a major reaction to medication, I thought it was the end. I knew that I was going to have to fight to survive. I was vomiting non-stop and couldn’t hold anything in my bowel. In the photo I’ve included I had half of a biscuit in my hand and went straight back up to the ward and vomited uncontrollably. My hair had started to fall out and my weight continued to drop. I was 6 and a half stone and wasn’t able to walk properly. I was always significantly worse at night when there wasn’t enough staff to look after the amount of people that needed help so I used to pray that I’d make it through the night until my mam would come back the next day. Slowly, I started eating some toast and seeing how my stomach would react and just when I thought that things were improving I got bad news about my white blood cells. A surgeon came around and mentioned leukemia and having to open me back up. The next day my white cells had increased slightly. After that setback, I started to improve daily and they felt that they could send me home after being in for a month.

It didn’t last as I was back in after a few days. My temperature spiked and it was back up to 39.5. I was admitted and put into isolation as I had contracted the hospital bug Clostridium Difficile. I felt more myself this time and knew that with the right medicine I could fight because I was building my strength back up. My temperature continued to spike and the surgeons mentioned opening me up again because they couldn’t understand what was wrong. I started eating little bits even if it made me feel sick and slowly but surely I began to build up my strength. I was able to wear makeup for the first time in months and I felt more confident in myself. Day by day I improved and after three weeks I knew that I was getting better. I had an appetite, which was something that I hadn’t had in a year.

After having an MRI scan on May 25^th, 2012, my surgeon told me that I’d won the battle and could go home. I was diagnosed just before my 19th birthday in June 2012 with Crohn's Disease. Since then, I’ve had four surgeries because they found that I had a fistula but I had my final surgery in May 2014 and I haven’t been admitted to hospital since. Soon after I was released, I developed alopecia areata, which is a type of hair loss but my hair eventually grew back where the bald patches were. I have to take autoimmune suppressants every day and have days where I struggle with the symptoms of IBD. Living with Crohn’s can be extremely challenging but I feel blessed to be alive. I also no longer have my fear of going to the doctor!! IBD awareness is so important today because there are so many people suffering from IBD symptoms and they have no idea where to seek help. For more information on Inflammatory Bowel Disease please visit http://www.iscc.ie

Clara