Results from a recent retrospective cohort study presented at the American College of Gastroenterology's annual meeting has shown that people with IBD who take a class of drugs called thiopurines are at an increased risk for non-melanoma skin  cancer (NMSC). Two IBD drugs that are thiopurines are Imuran (azathioprine) and Purinethol (6-mercaptopurine).

The risk of NMSC was calculated to be 3 times greater in those with IBD who took a thiopurine when compared to people with IBD who were not taking these drugs. An open question that the study was not able to resolve was whether the risk of skin cancer was due solely to the thiopurines, or if the changes in the immune system caused by the IBD itself contribute to the risk. Because of this risk of skin cancer connected with the thiopurines, the authors of the study recommend that people taking these drugs use broad-spectrum sunscreen daily.

_{Source:
Long M, et al. "New Study Reveals Possible Link Between Therapy for Inflammatory Bowel Disease And Non-�Melanoma Skin Cancer." American College of Gastroenterology 26 Oct 2009. 5 Nov 2009.}

It's been a while since this has happened to me, so last night's dreams were a surprise to me. I was dreaming about bathrooms. For those of us with IBD, it's usually not a pleasant dream, but typically the bathrooms we encounter in our dreams are dirty, unusable, missing doors, or otherwise unavailable to us. Compounding the nightmare-quality is the fact that you are usually in dire need of a bathroom -- immediately (if not sooner). In my dream, some of the restrooms were under construction, so they were unusable, and there were signs over the restrooms, telling us which ones we could use. The line for the "IBD" restroom was long, and I was in terrible pain while waiting. When I finally woke up -- you guessed it -- I needed to empty my j-pouch.

Do we dream about bathrooms because our bodies are trying to tell us something, to wake us up? Or is it because the finding of restrooms takes up so much of our waking life, that it's only normal that it would enter into our dreaming life, too? We might never know the answers. What we do know is that sleep is incredibly important, even more so when you have a chronic condition. Guard your sleep as the precious commodity it is, and learn how to improve your quality of sleep.

More about sleep:

• Dreaming of Toilets
• Does IBD Keep You Up At Night?
• How Do You Get Better Sleep When Your IBD is Flaring?
• IBD and Night Sweats

The Crohn's and Colitis Foundation of Canada (CCFC) has designated November as Crohn's and Colitis Awareness Month. This year, the CCFC is developing an initiative to better understand Crohn's disease and ulcerative colitis in children and adolescents. They are working with pediatric gastroenterologists to create a system to track cases of IBD in kids across Canada. Other events in November include the "Gutsiest Canadian" contest, which will honor seven Canadians who are making a difference in the IBD community, and educational symposia in cities across Canada. If you haven't become involved with the CCFC, this month is a great time to get started!

The Crohn's and Colitis Foundation (CCFA) is holding educational events across the country, sponsored by Centocor Ortho Biotech Inc. The conferences, entitled "Understanding Bowel Disease: What Every Patient Needs to Know," are free for anyone who would like to attend. Experts will discuss various aspects of IBD, including symptoms, disease management, treatments, side effects, and coping. A question and answer session will also be included. The locations and dates are:

• Akron, OH: Wednesday, November 11, 2009
• Baltimore, MD: Tuesday, December 1, 2009
• Bethesda, MD: Tuesdays, November 3, 2009
• Cincinnati, OH: Thursday December 10, 2009
• Columbus, OH: TBD
• Fort Worth, TX: Tuesday, December 8, 2009
• Guilford, CT: Tuesday, December 1, 2009
• New York City/ Queens, NY: Thursday, December 3, 2009
• Poughkeepsie, NY: TBD
  
• Riverhead, NY: Thursday, November 19,2009
• Rochester, NY: Thursday, November 12, 2009
• Sun City, AZ: Wednesday, November 11, 2009

A recent study in the journal The Lancet has shown that people with IBD who take a class of drugs called thiopurines are at an increased risk for lymphoproliferative disorders, including Hodgkin's lymphoma and non-Hodgkin lymphoproliferative disorder. Two IBD drugs that are thiopurines are Imuran (azathioprine) and Purinethol (6-mercaptopurine).

The risk of lymphoproliferative disorders was calculated to be 5 times greater in those with IBD who took a thiopurine when compared to people with IBD who were not taking these drugs. The risk was found to be related to the Epstein-Barr virus (EBV). Of those patients in the study who developed the lymphoproliferative disorders, most of them were associated with the EBV. For younger patients receiving a thiopurine drug for 10 years, the risk of developing a lymphoproliferative disorder is still considered to be very low. However, for older patients and for use of thiopurines for longer than 10 years, the authors stress that more research is needed to understand the risks.

_{Source:
Beaugerie L, Brousse N, Bouvier AM, et al "Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study." Lancet 2009; DOI: 10.1016/S0140-6736(09)61302-7. 26 Oct 2009.}

Medical marijuana has been victim to a catch-22 -- state laws may allow it, but federal laws did not. This left users of medical marijuana open to prosecution by federal laws, even if it was technically legal in their state.

Elizabeth Hartney, About.com Guide to Addictions reports that Obama has allowed more leeway in the federal restrictions on marijuana. This should help restrict prosecution to those who abuse the drug, rather than those who are legitimate medical distributors. Crohn's disease is one of the conditions that might benefit from the use of medical marijuana.

More about medical marijuana:

• White House Change in Medical Marijuana Policy
• What is Medical Marijuana?
• Medical Marijuana FAQ

There are a lot of questions surrounding the H1N1 (swine) flu and the vaccine that is starting to become available. People with IBD, especially those that have suppressed immune systems because of the drugs that they are taking, are at increased risk for complications from the H1N1 flu. You may have heard that you should not get a flu shot (either seasonal or H1N1) if you are taking drugs such as prednisone, azathioprine, or 6-MP. Actually, you CAN -- what you should NOT get is the live vaccine. Your health care professional can help you to make sure you get the right vaccine as soon as it becomes available.

More About H1N1 Flu:
H1N1 (swine) Flu Vaccine and Immune-Supressing Drugs
Poll: Will You Get the H1N1 Flu Vaccine?

Most women now know that folic acid is important to prevent neural defects and other complications in unborn babies. This is why so many breads, cereals, and other foods are fortified with folic acid. For women planning a pregnancy, it's recommended that you "act" pregnant before you are -- take a prenatal vitamin, watch your intake of caffeine, quit smoking, and take other similar steps to improve your health.

Some drugs, including Azulfadine (sulfasalazine), Methotrexate, and cholestyramine, have the effect of reducing the amount of folic acid that is absorbed by the body. A recent study from Israel shows that women who took these drugs in their first trimester of pregnancy had a higher risk of congenital malformations in the fetus. This risk was double that of women who did not take these types of drugs.

What does this mean for you if you're taking these drugs? If you are considering pregnancy, talk to your obstetrician/gynecologist and your gastroenterologist regarding your folic acid intake, and how you can make sure you are getting enough. If you become pregnant -- while taking these or any other drugs -- speak to your physicians right away to find out how you should proceed with your medications.

Source:
Matok I, Gorodischer R, Koren G, et al. "Exposure To Folic Acid Antagonists During The First Trimester of Pregnancy and the Risk of Major Malformations." British Journal of Clinical Pharmacology Accepted Article DOI: 10.1111/1365-2125.2009.03544.x 16 Oct 2009.

I was recently thinking that we should be rewarded for getting this uncomfortable, yet useful and life saving test: the colonoscopy. For those of us with IBD, it becomes just one more part of our self-care. However, you may know people who are at risk for colon cancer who would rather do anything than have a 'scope (I myself know more than a few!) and have been finding ways to avoid it. When someone finally takes the plunge, I propose that the event be celebrated with a party. (A few days after the 'scope, of course!)

You can start the entire process a few days before the party with this tee: "Be Nice to Me...I'm Prepping for My Colonoscopy." You can invite your guests to your party with these fun "I'm Ready for My Next Colonoscopy" cards. Stock up on paper goods such as the "Look Who's All Grown Up and Ready for a Colonoscopy" cups and napkins. Guests could choose from a variety of fun buttons to wear, including "Colonoscopies Are a Gas" and "Get Your : Checked." Entertain your party-goers with stories from the book, "Colonoscopy: It'll Crack You Up." And don't forget to offer your friends something to nosh on, which could range from cans of Ensure to high-fiber, colon-healthy foods such as Date Filled Oatmeal Cookies, Navy Bean Soup, and for dessert, a Raspberry Chocolate Trifle.

More about colonoscopies:

• How to Prepare for Your Colonoscopy
• What to Expect During a Colonoscopy
• Colonoscopy Risks
• All About Virtual Colonoscopies

IBD is largely a disease of young people -- most people are diagnosed as young adults. That means having IBD during your child-bearing years, which in turn leads to lots of questions. Can women with IBD have children? What medications are safe during pregnancy? Will the IBD get worse, better, or stay the same during pregnancy? These are just a few of the questions that young men and women have about pregnancy and IBD. What questions do you have about having kids and having IBD? Ask them in the forum!

• Frequently Asked Questions About Pregnancy and IBD
• Taking Prednisone During Pregnancy
• Hemorrhoids During Pregnancy
• Can Breastfeeding Protect Against IBD?