August 27, 2025 • 50 mins
For two decades, Rachel Gebhardt has navigated the complex terrain of Crohn's disease with a refreshing perspective shaped by her father's experience with the same condition. Where her father let illness define him, Rachel chose a different path—one filled with humor, openness, and resilience—despite her case being more medically severe.
Rachel's journey encompasses four bowel surgeries and fourteen hospital admissions since 2020 alone, including a colostomy she affectionately named "Whoopie." With disarming candor, she shares the moment her surgeon showed her a photo of a woman in an American flag bikini with a matching ostomy bag cover as encouragement—a moment that eventually inspired her own celebratory beachside photo years later. Through skin infections, bowel obstructions, and dietary restrictions, Rachel maintains her commitment to living fully and modeling positive coping for her children.
The military healthcare system presented unique challenges, but also connected Rachel with Dr. Anish Patel at Brook Army Medical Center, who became not just her gastroenterologist but her advocate and ally. Their relationship exemplifies the profound difference compassionate, specialized care makes for patients with complex conditions. Rachel details her experience with hyperbaric treatments, medication complications, and the surprising remission she experienced only during pregnancy and breastfeeding—highlighting the understudied connection between hormones and IBD.
What resonates most deeply is Rachel's transformation from initially viewing her ostomy as "the end of the world" to embracing it as a source of freedom. Now training for a half marathon and hiking mountains previously inaccessible when bathroom urgency controlled her life, she's become an outspoken advocate for ostomy awareness. Her message is clear and powerful: life with an ostomy can be not just manageable, but genuinely good—a perspective desperately needed by those facing similar paths. For anyone navigating IBD or supporting someone who is, Rachel's story offers both practical wisdom and heartening hope.
Links:
- United Ostomy Association
- Our episode with Dr. Anish Patel
- Pregnancy and Crohn's - video from Brigham & Women's IBD Center
- Pregnancy & Breastfeeding info- Crohn's Colitis UK
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi, I'm Alicia and I'm Robin, and you're listening
to Bowel Moments, the podcastsharing real talk about the
realities of IBD Serve on therocks.
This week we talked to RachelGebhardt.
Rachel is living with Crohn'sdisease and her dad also had
Crohn's disease.
They took very different pathsin dealing with and managing
(00:20):
their Crohn's disease throughouttheir lives, and so we hear
about her story of growing upwith Crohn's disease throughout
their lives, and so we hearabout her story of growing up
with Crohn's disease in thefamily and how she decided to
change how she deals with herCrohn's disease with her family.
Rachel also has a verycomplicated case of Crohn's
disease, and so we talked to herabout how she decided to get an
ostomy and what it was like todeal with her Crohn's disease
while also navigating themilitary healthcare system
because of her husband being inthe Air Force.
(00:40):
And we talked to her about howshe met and is working with our
friend of the show, dr AnishPatel, at the Brook Army Medical
Center and what that has donefor her care and so much more.
We had such a greatconversation with Rachel.
We know you're going to loveher as much as we did, cheers.
Speaker 2 (00:55):
Hi everybody, Welcome to Vow Moments.
This is Robin.
Speaker 1 (01:01):
Hi everyone, this is Alicia and we are really, really
excited to be joined by RachelGebhardt.
Rachel, welcome to the show.
Hello, thank you so much forhaving me.
We are very excited to have you, but first of all, we want to
ask you a very unprofessionalquestion of what are you
drinking?
Speaker 3 (01:17):
I am drinking my 19 Crimes Cabernet.
Speaker 1 (01:21):
Yes, I like a 19 Crimes's, like a good, like
solid choice.
Robin.
What about you?
You are traveling, so I amtraveling.
Speaker 2 (01:29):
I am attending um the child life professional
conference this weekend indowntown la, and so time zones
are hard and they have an illycoffee shop in this very fancy
hotel where I'm staying, and soI went and got fancy coffee for
this call yeah, and again, I'm afan of illy coffee, so so
that's a.
Speaker 1 (01:47):
That's a yummy one.
Well, yesterday I had a friendcome over and we hadn't seen
each other for a little bit, andmy husband, who is a kind, kind
soul, put a bottle of VouvClicquot in the fridge, and so I
am drinking fancy champagnetonight, and so.
I'm feeling very, very, verylike a boss over here.
I'm feeling very, very, verylike a boss over here.
So, but, and it is delicious,I'm a giant fan.
So cheers, guys.
Speaker 3 (02:07):
Yes, cheers.
Speaker 1 (02:09):
So, rachel, next question for you is tell us your
IBD story.
What brings you into ourcommunity?
So?
Speaker 3 (02:16):
interestingly enough, dr Patel, my gastroenterologist
, reached out to me and he was aprevious guest on your show and
Dr Patel has come almost like abest buddy of mine.
He tells me he can recognize meby pictures of my colon.
So he has been my doctor foreight years now and this is
(02:36):
actually my 20th yearanniversary of being diagnosed
with Crohn's disease.
But Crohn's has been kind of astaple, just name that I've
always understood since I was ayoung child, because my dad also
had it and he passed away young.
He did not take care of himselfand sadly was not able to get
the medications that we havetoday.
He got diagnosed back in the70s, where they handed you
(02:58):
prednisone and opioids to dealwith Crohn's disease, and so
after years of that he hadosteoporosis by the time he was
50.
And then he passed away by thetime he was 55.
And my Crohn's has been muchworse than my dad's, but I just
have an entirely differentattitude about it.
My dad, kind of like, becamehis illness.
He was always sick and wantedeveryone around him to be
(03:20):
miserable too, and that's sadlywhat I remember of him in my
childhood.
And so when I got diagnosed andmy husband and I decided to
have kids, I always said that Iwas going to be as lighthearted
about it as I could be, becauseI never wanted my kids to look
back and be like, oh man, momwas a drag when she was sick.
Sadly, I have had four bowelsurgeries and 14 hospital
(03:43):
admissions since 2020.
I ended up with a colostomy andI have had every complication
that you can ever imagine fromthe colostomy.
Eight of those hospitaladmissions were last year alone
due to skin infections and I hada bowel obstruction.
I had kidney stones, which wereentirely unrelated, but this
(04:05):
entire journey, I've always beenable to joke about it.
I am one for a really good poopjoke and that's why I get along
with Dr Patel so well, becausehe loves to tell those and he's
taken me under his wing and isjust making sure that I get the
best care and the best treatmentpossible.
And so, despite the illness anddespite this long journey with
(04:25):
Crohn's disease, I feel like Ihave a really good attitude and
a really positive outlookbecause I do have such great
medical care and I am gratefulfor that because, again, my dad
did not have that and so I feellike his life may have been
different had.
He have had all the care andthe options that I have.
But I love to talk about Crohn'sand IBD and especially
(04:45):
colostomies, because it's kindof a taboo subject.
People don't talk about havinga colostomy, they're almost
embarrassed.
And it's one of the firstthings that I bring up when I
meet people, because I neverknow if it's going to make a
noise and I don't want to behumiliated.
So I tell people hey, just soyou know, I have a colostomy.
So if you hear me rip, onetotally have no control over it.
And then I tell everybody mykids helped me, picked out the
(05:07):
name Whoopie.
My colostomy's name is Whoopiebecause it's like a Whoopie
cushion.
So we call it Whoopie and wehave a code word.
If I spring a leak, our codeword is mom is being a party
pooper and that means we have togo.
So I am really blessed that mykids have been along on this
journey with me and it's beenmore of like a humorous one.
If anything.
(05:27):
I've definitely had some scareswhere I'm not sure I'm going to
make it out of the hospitaljust because they're not sure
what's going on or I have arandom infection that they don't
know.
They've had to call ininfectious diseases a couple of
times, but I keep coming out ontop and I'm just so grateful to
be here.
I'm grateful to be with my kids, to have this time with my kids
, and to Dr Patel, whoi wasactually just talking to him
(05:49):
earlier.
I'm one of his few patientsthat he texts back and forth
with because that's how closewe've gotten.
I've been pretty frustrated withthe medical system.
You know, in the militarySometimes you feel like herded
cattle and I kept gettingbounced around and couldn't get
an appointment.
You know, I kept gettingbounced around and couldn't get
(06:11):
an appointment.
They'd be like, oh you havethis going on, but our next
appointment's in 12 weeks.
So Dr Patel gave me his numberand now he just personally walks
me in and schedules me, becausemy journey has been such a
tough one and I go from feelinggreat one day just to completely
falling into a flare.
But one day I was getting aninfusion and Dr Patel came and
sat next to my bedside while Iwas getting an infusion for an
hour and just talked to me andkept me company.
And that's how I knew that hereally cared, because most
(06:33):
doctors don't do that and tothis day he has a vested
interest in making sure that I'mgetting good care and that I
can live my life to the fullestso I can be here for my kids.
So I'm really appreciative tohim.
I was actually messaging withhim because last week I had
another colonoscopy.
I get those every single year.
I still have my rectum intact,so they go in and do those once
(06:55):
a year just to make sure there'sno cancer or anything in the
pouch.
So they called it.
I didn't even know it wascalled a pouch until this last
colonoscopy.
But the doctor said they weregoing to check up in my pouch
and I said, great, okay, andthey did.
At this last one they foundanother stricture in my bowel
that they've already had todilate three times.
(07:16):
So that's more than likelygoing to call for another bowel
surgery.
But it is what it is.
I'm just going to keep chuggingalong until I can't anymore.
Speaker 2 (07:25):
Pretty intense, okay first of all, we love some anish
patel around here, yes, yes.
And second of all, I have someclarifying questions, and it's
just because I'm curious.
So you said you have acolostomy.
So you have.
Your ostomy is in your colon,not your small intestine which
is not usual.
That's not usual, and usuallythey, you know they have to take
out more of the colon orsomething.
(07:46):
And so for everybody who'slistening, who doesn't have an
ostomy, you have an ostomy withyour colon or an ostomy with
your small intestine or yourileum, and so you've heard me
say ileostomy, and a lot of ourguests say ileostomy because we
don't have any of our largeintestine left, and so the
ostomy we have was with thesmall intestine, and so yours is
with your what's left of yourlarge intestine or your colon.
(08:08):
But they left your rectum andall.
They didn't give you a Barbiebutt.
Speaker 3 (08:12):
Nope.
They decided that the recoveryfor that was going to be really
intense, and at the time my kidswere seven and five and we are
military, we don't have familyclose, and so the colorectal
surgeon said why don't we go in?
So what caused me to get thiswas I developed a fistula, and
so they decided to reroute thebowels, you know, through my
(08:35):
colostomy and which would wouldstop the fistula and would heal
it, and so I did a temporarycolostomy at the time.
Then I went and did treatmentsin the hyperbaric chamber and
then they started me on Remicadeand Remicade is currently the
only FDA approved drug that willtreat or prevent fistulas and
so that's why they put me on it.
But I developed an immuneresponse to the Remicade.
(08:59):
After being on it four years Istarted just breaking out into
rashes and got what looked likechemical burns all around my
stoma, and last year that's whatput me in the hospital eight
times.
I ended up developingcellulitis that went down into
the fatty tissue in my stomachand I had to be treated several
times for that, and that waspretty horrific.
(09:20):
I think what little dignity Ihad left, having Crohn's disease
and having to get thiscolostomy, having to have a
nurse bathe me with a spongewith no bag on was probably one
of the lower points in my lifeand I didn't know if they were
going to be able to fix it.
They had no idea what wascausing it, but thankfully they
figured out.
A med student, of all people,went and looked back into my
(09:42):
records and figured out that myskin would flare and have these
spikes of just rashes all aroundright after I would get my
Remicade infusion.
So when they took me off theRemicade within two weeks my
skin was completely healedaround my colostomy.
But the bummer about that is nowbecause I've had a fistula.
A fistula can come back at anytime.
So Dr Patel had to take agamble and he said the two new
(10:04):
ones out on the market were SkyRizzy or Ren Vogue, and he felt
like Ren Vogue had more supportin showing that it would be able
to handle a fistula.
So I'm currently on that.
I can't say for sure if it'sworking because I have this,
this strictured area in my smallbowel and it's got two bleeding
ulcers next to it.
But I'm really hopeful that ifthey can resect that and get it
healthy again ulcers next to it,but I'm really hopeful that if
(10:26):
they can resect that and get ithealthy again, that the RENVO
will be able to keep on top ofit, which I'm just going to have
to live on a prayer for that,because I've tried everything
else I've been on Simzia, I'vebeen on Humira, I've been on
Remicade, I've been on Pentassayou name it, I've been on it and
now Antivio I was on that onetoo, and so Remicade was
(10:46):
actually working very well forme in managing the Crohn's
disease, but then it was causingso many other adverse side
effects, like migraines and theskin issues, and so they did
determine that it was best totake me off of that.
So I've been on the Renvoguenow for the past three or four
months and I feel like I'm doingpretty good on it, minus the
stretcher area.
Speaker 2 (11:03):
We know somebody else that has been on the show that
is on renvoke because of afistula, and it was the only
thing that helped them.
So fingers crossed, yes,fingers crossed that it works
for you too, although, um, thereis such a thing as renvoke acne
, so just if you start to,that's the renvoke, just so you
know.
In advance.
Speaker 3 (11:22):
Good to know, because I have gotten it all over my
arms and back and the doctorsput me on steroid cream to help
with that, which is helping.
But it's like any other drugyou take it for one thing and
then you get 50 side effects.
Speaker 1 (11:36):
I think I'm still a little bit confused anatomy-wise
, and you can tell me if youcan't explain this.
But so when they did yourcolostomy like there's the other
part that's still connected toyour rectum, like did they like
sew up the end of it or is itjust floating around?
Like that doesn't feel likethat's a good idea, but I don't
know.
I'm also not a medicalprofessional.
So, yeah, yeah, I'm confused,like what's happening?
Speaker 3 (11:57):
Yeah.
So what they did?
They originally went in and dida temporary colostomy, but I
was having a lot of leakageproblems with that because the
colorectal surgeon explainedthat the temporary ones they
have to keep pretty flush withthe skin and so, because it was
so flush with my skin, I wasleaking all the time.
So four months after I had thetemporary one done, I went in
(12:17):
and got a permanent endostomydone, because when they had gone
up through the rectum for thefirst surgery, it was so
diseased down there that thecolorectal surgeon said I am not
hopeful that you'll ever beable to be successfully
reconnected.
He said we could reconnect youat some point, but it would
probably include a lot of likebowel incontinence, and wound
(12:40):
care would be an issue too thatthey would be concerned about
for healing.
So he said, honestly, you couldgo through the reconnection
process and go through all ofthat, and I give it six months
and you'll be back in hereneeding another ostomy just
because my Crohn's became soaggressive and we don't know
what made it aggressive.
I had my first bowel resectionin 2015 in my small bowel and I
(13:01):
had a stricture there and theytook it out thinking, oh,
they'll reconnect the healthytissue and then this will be
great.
Well, it had the oppositeeffect.
It spread.
It jumped from my small boweland went down into my rectum and
my colon and just startedspreading everywhere down there.
And then I got the fistula in2020, and the fistula became an
emergent thing because I spikeda fever and started having just
(13:24):
symptoms of infection and sothey had to go in and thankfully
they were able to schedule it,so it wasn't like an emergency
colostomy, but they admitted meand then two days later, I had
the surgery and, even thoughI've had all the complications,
I am grateful for it because,surprisingly, it does give me a
better life than what I hadbefore it.
I used to go to the bathroom 10,11 times a day.
(13:44):
My life was controlled byneeding to always know where the
bathroom was or when we wouldget on the road to take a road
trip 30 minutes in.
I'd be like, oh, I got to go tothe bathroom and it was like
that urgency of I can't wait.
I got to go and now I go into abag and it's great, and I've
developed a routine of I canfeel when I'm about to go, I
(14:04):
empty the bag at certain times aday.
I'm a pro ordering my suppliesand now I can't imagine like
what my life would be withoutthe ostomy, if that makes sense.
That's why I'm so glad thaty'all had me on here to talk
about it, because I love tellingpeople about ostomies, mainly
because there's so many peopleon like the Facebook support
pages I'm on that feel like it'sa death sentence.
(14:25):
They feel so embarrassed aboutit but they feel so humiliated
by it and I can't tell you howmany people say like this makes
me want to commit suicide or Ifeel like my life is over, and I
am the person that has hadevery complication that you can
get with them and I still thinkmy life is better with it.
My husband will tell you lifeis better with it and I just
want people to know that youdon't have to be scared about
(14:47):
getting one of these.
Your life is not over.
Yes, it's something to learn,just like riding a bike or
learning how to write cursive.
There's a learning curve withanything that you do and there's
so many support groups outthere.
There's even YouTube shows onhow to dress with an ostomy or
what to wear, how to style them,and I love talking about it,
and I love talking with peoplewho've had one before and,
(15:08):
believe it or not, there are somany people who have had them
and get a reversal, or they havethem, but they're just too
embarrassed to talk about it,and so I feel like the more we
talk about it, the more itbecomes a normal thing and
people don't have to be ashamed.
Speaker 2 (15:21):
Agreed.
So I'm going to ask you aclarifying question for Alicia's
sake, because we've had this onbetween an end ostomy, which
you said.
So when you said the temporaryone, they gave you a loop which
had to be close to the skin.
Those look I don't want toscare anybody, but loops are
really hard to manage.
Loop ostomies are really hardto manage.
Like you said, they're close tothe skin.
(15:50):
They leak a lot.
I have had an ostomy twice.
I had an ostomy when I wasfirst diagnosed and then again
in 2020.
And the first time I got an endand I was like this is the best
thing ever and I had a baby,not a no-transcript, yes.
(16:31):
So yes, I'm glad that you saidthat, because that loop man, it
could be a bugger sometimes.
Speaker 3 (16:37):
Yeah, now that I have this end colostomy, they tied
off the part of the bowel thatwould go down into the rectum.
But the only reason they leftthe rectum intact was because it
was going to be such a majorsurgery and so they wanted to
give me a little bit of time toget my kids older and I actually
set a five-year goal with mysurgeon.
I'm going to make it five moreyears with my rectum and this
(16:59):
April was five years and I'mstill going strong.
The surgeon that operated on methree times he's no longer at
BMC but I have two new ones thatI see and they said they're
optimistic that as long as I dothe colonoscopy once a year and
they go and check, I could keepmy rectum as long as I want to
keep it.
They did say the Barbie buttsurgery is major recovery,
(17:21):
especially if you have likeslower healing wounds because
you think about like when youwalk in, that wound rubs and, um
, I have a friend who had acolostomy that had the Barbie
butt surgery and it took her ayear to really get back on her
feet.
And I'm just a busy mom rightnow.
I don't have a year.
I I live in the car, driving mykids everywhere, and I can't
imagine like not being able tosit on my rear end for a year,
(17:42):
you know.
So my goal is to make it untilthey, like, get to college and I
can just veg and, just, youknow, have Barbie butt surgery,
you know.
Speaker 2 (17:53):
Um, it's good that you get that surveilled every
year, because wasn't it Courtneywho didn't get it surveilled
and then she ended up having a?
She ended up having to have theBarbie butt because she yeah.
So, anybody listening, this isgreat news, but you have to get
it surveilled.
It's too many things that cango wrong down there.
Speaker 1 (18:10):
Even if it's not in use, unfortunately.
Speaker 3 (18:13):
Yes, I know, and when they went up there they said
like the last time they went upthere they said that the tissue
just looks like white and I meanlike what?
What you would imagine liketissue that never gets used
anymore, like that's what itlooks like.
I've been lucky.
A lot of people who still havetheir rectum intact with in
colostomies still get quite abit of like mucus that comes out
and you still feel that urgencyLike you got to go.
(18:33):
Mine is only like once a month,very small amount.
So that's good.
I've been blessed in thatregard that I don't have a lot
of that.
But on my support groups I seeother people have a lot of
issues with that and a lotcoming out.
So I'm thankful that mine'sbeen pretty manageable with that
.
But it's crazy how so manypeople have had these and
usually it's Crohn's or colitisor cancer colon cancer that
(18:56):
causes people to get them andpeople either love them or they
hate them.
It's like there's no in between.
So I just try to have thementality that because I have
this, I'm here and I'm spendingtime with my kids and I decided
to take it from a positiveperspective early on and that's
definitely helped me be able tomanage having one of these, just
(19:16):
being as positive as I can andalso having really good spouse
support or your spouse or yourpartner.
I know a lot of people thathave these deal with having
troubles with their marriage ortheir partners grossed out by it
.
And I will never forget about aweek after I got my colostomy I
was having all sorts of leakageissues and we decided to have
(19:36):
some friends over.
They wanted to bring dinner tous because I was still
recovering and I went into thebathroom to change my or to
empty the bag and it ended upjust going everywhere Like the
bag came off.
It looked like a crime scene.
When you walked into thebathroom and I had my phone with
me and I texted my husband andI said 911, please come to the
bathroom now.
(19:57):
And he walks in the bathroom andhe opens the door and the look
on his face.
It looked like he'd walked into, like a scene from Dateline.
I mean there's just pooeverywhere because unfortunately
when it falls on tile itsplatters everywhere.
So it was just everywhere, onevery surface.
So he said stay still, I'll beright back.
And he goes in the living roomand he tells our friends.
(20:17):
He said hey, rachel needs somehelp in the bathroom.
I might be a minute, but y'allstay here, enjoy some wine.
You know I'll be right back.
And then he came back into thebathroom and he scrubbed every
inch of that bathroom with wetwipes, then he got bleach and
then he helped clean me up.
And I just stood there I mean Iwas completely mortified, but
he didn't even miss a beat, hejust hopped in and did it.
(20:38):
And, yeah, he was helping me atthat point to still change my
bags.
And then one day Whoopi decidedto blow air right in his face
as he was leaned over helping mechange the bag.
So that put an end to that.
Then I got a real quick lessonon YouTube on how to change it
myself, because he's like neveragain.
Speaker 2 (20:58):
That has happened over on my side.
We were Matt and I were justtalking about that.
He was like man, that gas fromthat ostomy yeah, Brutal, Brutal
, it's bad, it's bad.
I mean, let me just say this wesay that you don't stink
walking around wearing an ostomybag, Like you don't know if
your bag is closed.
You don't smell like a walkingbag of poop.
(21:20):
You're not smelling like poopas you're walking down the
street.
It's only when you empty thebag or, in my case, when you
have a lot of air.
If your bag fills with air likea whoopee cushion does, and you
just try to release some of theair, then but it's, it's just
like anybody else passing gas.
So, but you don't smell likepoo as you're walking down the
street.
Speaker 3 (21:40):
No, no, and it took me a good couple of years and an
obsessive hoarding problem withpoopery and a lot of therapy to
get to that place that I cansay I'm good, like I don't smell
.
Sometimes I feel like I cansmell a smell on myself and I'll
ask my husband oh my God, doyou smell that?
Do you smell that?
He's like no, I don't smell it.
And that's gotten better overtime.
(22:00):
But I kid you not that firstcouple of years I did, I
struggled with anxiety anddepression.
After getting this I feel likeanxiety and depression go hand
in hand with Crohn's diseaseanyway, especially just because,
like when you're when you feelsick, you feel sick and your
life changes and you just youcan barely get out of bed, you
know.
So I've always battled that.
But getting the ostomy was whenit I hit a very low point,
(22:24):
especially when I was having allthe skin issues and they
weren't sure what was going onor how to fix it.
And I did.
I told Dr Patel, I said I'mreally struggling mentally, like
I'm, I'm in a really low place,and so that's why he's like,
he's fierce, he's like we'regoing to, we're going to fix
this.
There's no delaying, there's nooutpatient this out, like I'm
admitting you and we're figuringthis out, you know, and I just
(22:46):
am so thankful to him for thatbecause they did figure it out
and so I am in a really goodplace with it now.
I can say I wasn't a couple ofyears ago, so I definitely can
identify those people that dostruggle with it or do struggle
with the news of getting it.
I know what that feels like andit's almost like you know
people who they lose a leg orthey they have a disability.
(23:09):
It's just because you can't seeit, it is still there and
you're self-conscious about it.
You feel like, oh my gosh,people are going to notice.
I mean, even even today, Istill do not like to wear
something so form fitting thatyou can see the ring of the bag
through it and nobody would knowlike I don't even think anybody
would look or even care.
But it's just something aboutme, I just want to keep it
disguised.
I am not to that point of peopleon my support groups are like,
(23:30):
oh, they have a whole bag, whatbag thing that they talk about?
And it's people who postpictures of themselves all
glammed up or looking great andit's like you can't even tell
they have a bag.
A lot of people who say, bagwhat bag?
They let a bag.
A lot of people who say, bagwhat bag, they let their bag
hang out.
They're at the gym, liftedweights and a sports bra.
I will probably never be thatperson that has the
(23:50):
self-confidence to do that, butgood on those people that do.
I love that I have bought somany bag covers.
I will post pictures of all mybag covers.
I have a lady that custom sewsthem for me, so I have all
different holiday ones and Ilike to get the ones with the
puns.
You know any.
I love any good poop jokes.
I talk about stuff like that,but yeah, as far as wearing it
out, I don't do that.
(24:11):
I keep it pretty concealed andtucked in.
Speaker 2 (24:13):
The favorite thing I've seen was a Halloween
costume that was like a sharkbite out of the side.
They made it look like a sharkbite with the ostomy.
That's my favorite thing thatI've seen.
It was pretty creative.
Speaker 3 (24:25):
Yes, I love that.
I think I've seen that.
I do have a funny story.
I can tell you about the day Ifound out I needed it.
My colorectal surgeon was a guy, absolutely brilliant.
He would never look you in theeye.
He was real, you know, kind ofkooky, real funny, and he was
very blunt and he told peoplehow it was, you know.
And so I come in and I sit downand they asked me this was after
(24:46):
they found out I had thefistula and my
gastroenterologist that I wasseeing at the time did not give
me a heads up whatsoever thatthey would even consider doing
an ostomy as a treatment for afistula.
I thought it was going to besomething like a string.
There were different thingsthat I read that they could do
and so I went in there planningon I'm going to go to this quick
(25:08):
doctor's appointment and I'mgoing to spend the rest of the
afternoon shopping and it'sgoing to be a great day.
So I go to this appointment andthey asked me what my goals are
for Crohn's disease and I saidmy goal is to never have to get
an ostomy bag.
I said that would be like theend of the world for me and it
got real quiet in the room andboth surgeons that were in there
said so.
(25:28):
That's the thing.
The only way we're going to beable to treat this specific kind
of fistula is you need anostomy.
And I literally it was like therug got pulled out from my feet
and I just started bawling LikeI was crying and sobbing.
And these surgeons they're notused to this, they're brilliant
minds and they were like veeringheadlights and all at once, his
(25:50):
name is Dr Chauvier.
He ever hears this.
Just know, I love you, drChauvier.
But Dr Chauvier got real quietand he was on his phone and he
was scrolling and he looked upand he said, hey, I know it's
not good news right now, buteventually this could be you.
And he shows me a picture of askinny blonde standing on the
beach in an American flag bikiniwith an a matching American
(26:13):
flag ostomy bag cover.
And I just died laughing inbetween the sobs and the snot
coming out of my nose.
I was just like, oh my God,that's so funny.
And I always remember thatbecause he tried to relate to me
and he tried to show me that itreally wasn't as bad as I had
worked it up to be in my mindand so now I can laugh about it,
because now I'm in that placewhere I do see that it is such a
(26:35):
great thing and it does help somany people.
And so last year for the 4th ofJuly I wore an American flag
bikini with a bag cover and Itook a picture of myself wearing
the bag cover.
So that was a huge milestonecould get Tricare to pay for it.
If I ever needed another surgeryI would go see him because the
(27:06):
guy is brilliant.
He writes down his plans onnapkins and then shows you like
he did a hernia repair for me.
That by far was the worstsurgery I've ever had in my life
.
So if anybody ever needs ahernia repair around an ostomy,
prepare yourself.
It's brutal but you willsurvive.
But I ended up having to have 60sutures that were sewn into my
(27:28):
abdominal wall and the suturesthat they use feel like thorns.
So he said it literally willfeel like a thorn in your side
for six months until theydissolve.
And he drew up this plan of howhe was going to do the surgery
on a napkin and handed it to meand I'm like okay, and I trusted
him because he had alreadysaved me twice, you know.
So I'm like great, I trust you.
(27:49):
Surgery went great and mostpeople who have had hernia
repairs around their ostomy havea pretty high reoccurrence rate
.
I believe it's like a 30 or 40%reoccurrence rate within two
years and I'm four years out sofar.
I should probably knock on somewood, but I'm four years out
and I'm still doing great andhave not needed another repair.
Speaker 1 (28:08):
I mean, does he know that notebooks exist?
I mean, do we need to send himone, maybe like a picture of you
in your bikini and also like anotebook to be like I know I
know, I've always thought aboutthat.
I should just mail him hisoffice a picture of me in my
(28:29):
bikini and say, hey, you saidone day this would be me.
And look, it is, I'm here.
I love that.
I support this fully.
I think you need to, because Ibet he would be so stoked.
And now I also wonder who thisblonde woman was.
Now I want to know who she wasso that we can send her the
picture.
To be like you know what, Iknow you were an inspiration
that moment.
Speaker 3 (28:42):
Yeah, I know, I don't even think I can find the photo
now.
It was just like one of thoserandom Google images he pulled
up on his phone in the moment,you know, and you had to have
been there.
I mean, it's like he's got amed student standing next to him
who's like, oh my God, I don'tknow how to process this woman
crying, you know.
And then him, yeah, it just itreally.
It really changed the changedthe day for me and made things
(29:04):
like so much better.
And I wasn't laughing about itthen.
Believe me, I was a littlehorrified then, but now I'm like
okay, that was hilarious andthat's.
I wish I could tell everybodythat, like, your definition of
beautiful, like being beautiful,doesn't change just because you
have a piece of your intestinehanging out now, or or you've
lost a leg, or whatever.
Beauty is in the eye of thebeholder, but it's also in the
(29:26):
eye of the way you see yourselfin the mirror, and it's taken a
lot of time for me to get there,but I feel like I can look in
the mirror again and not becompletely disgusted.
Speaker 1 (29:34):
Well, and there is something to be said about the
beauty of having quality of lifeimproved.
Being able to live your lifemakes you feel more beautiful.
It definitely does.
If you're sick on the couch andyou're not able to do anything,
that's not helping.
Speaker 3 (29:47):
Yeah, yeah, I've been able to do so many more things
that I was never able to do.
I've been training for a halfmarathon and I got to hike.
It was my goal to hike up OldBaldy at Garner State Park in
Texas.
I got to do that.
I would have never been able todo that before because I always
had to use the bathroom, so Iused to have to just stick
(30:07):
really close to bathrooms, andso now I've been able to do that
and we're traveling a whole lotmore.
I successfully just took myfirst trip for a four-day trip
with a carry-on, and so that ishuge for the colostomy supplies,
because I tend to panic when Itravel and think, oh my gosh, I
need like 12 changes of suppliesfor a two-day trip, and so I
(30:29):
end up having to check a bagthat is mostly ostomy supplies,
but this time I did it withpre-cut wafers and everything
just in one small little bag anda carry-on, and so it's things
like that that you realize arelike huge milestones for you too
when you have one of these.
Speaker 1 (30:43):
Well done, that's impressive.
Four days on a carry-on for meis difficult, so I, but I also
travel with too many shoes, notas a difference.
You are the first person we'vetalked to that has used, I think
, hyperbaric treatment to dealwith skin issues, so can you
talk about what the heck that isand what might people expect if
(31:03):
this is proposed to them?
Speaker 3 (31:05):
So they actually used the hyperbarics to try and
treat the fistula in addition tothe temporary ostomy, and the
belief is that the hyperbaricsincreases the oxygen and
increases cellular regeneration,and so their hope was that me
being able to do the hyperbaricchamber would heal that fistula
(31:25):
faster.
Unfortunately, I was only ableto do about three treatments,
and the reason why is thepressure in there.
If you have like issues withyour sinuses or you can't ever
really clear your nose or yourears, the pressure can be
unbearable.
And so I made it the first twotimes and it was pretty painful
but I like I suffered through it.
But then the third time it gotso bad I felt like my skull was
(31:49):
being crushed and it I mean youjust the pressure is so much on
those sinuses.
It's almost like being on anairplane when your ears get
really clogged and then thepressure starts building in them
.
So I had to tell them to stop.
They had to stop the treatmentand I had to get out and
unfortunately I wasn't able todo all the sessions.
They had ordered like sixmonths of sessions for me and it
(32:10):
was going to be hard becauseyou would you have to do it like
three or four times a week andit was like a commitment to be
able to go and do this to getthe healing.
But I just I couldn't tolerateit.
And Dr Chauveur was like youknow, I'm not going to make you
miserable trying to heal this.
You know fistula.
So and then at that time we hadalready decided that ostomy
life was better for me and so Iwas going to be getting the
(32:32):
permanent one anyway andultimately the fistula did heal
without the treatment.
But hyperbarics are definitely anewer thing.
At BAMC they have them for the?
Um.
Most of the people who use themare like burn patients.
Um, it helps their their skinheal faster and it helps them
grow new skin faster.
So a lot of burn patients useit.
But there's just so many thingsthat they've been exploring
(32:54):
using hyperbarics for, so Idefinitely think it's neat.
I wish I could have done itbecause I probably would have
been healed faster, but I'mthankful for the people who are
able to do it because it isreally beneficial.
What's a chamber like?
So it actually you feel likeyou're on an airplane.
It feels like you're walkingonto an airplane.
It even has like the same, likeleather type seats, and I
(33:15):
believe there was six or sevenseats in it and you get in and
everybody sits in their seat andthey lock the door and then you
can see it's got dials that'llshow you the pressure, the
pressure that's changing andthey put it to a certain
negative pressure and then whatthey do is, while you're in the
treatment, they just play amovie, or you can bring a book
(33:35):
or an iPad or whatever and sitthere and no, actually you can't
bring a tablet.
So I remember I had to bringbooks, actual physical books.
But yeah, you feel like you'rejust on an airplane ride and the
treatments are usually about anhour and a half long.
So it was, it was perfect timing.
You could I.
Sometimes I slept, but thepressure was so bad that it was
a hard.
It was hard sleeping for me, soI would just try and sit there
(33:55):
and read to take my mind off ofit.
But yeah, like I said, I onlymade it through three.
It just it was too much.
Speaker 1 (34:02):
I didn't realize that you did this with, like other
people.
That is so wild.
I guess I'm thinking of like Idon't know, like float chambers
or whatever.
Where are they?
Like thinking I didn't realize.
Like legit seems like you wouldjust boarded an airplane for an
hour and a half yeah.
That's weird yeah.
Speaker 3 (34:14):
They did have private ones for people who who needed
it if they had like aninfectious disease or or like
severe burns.
They did have like privatechambers that you could do, but
this one was just kind of like agroup one.
And yeah, it was.
It was definitely neat.
It's not something that you seeall the time or hear about, so
it was pretty cool.
Bamc is the place to be when ithits the fan for you.
(34:36):
And it's crazy because we cameto San Antonio because my
husband he's in the military andhe was deployed, and our
daughter had some health issuesand I was up in living in Utah
by myself with two toddlers inthe winter while my husband was
in Afghanistan and my husbandreturned home.
On my 30th birthday on May 4thand May 10th, I had to have my
(34:57):
first Valerie section becausethe stress of all of it, I just
couldn't manage it.
I've never been like one ofthose military wives who has,
like you know, my kids, you myfirst Valerie section because
the stress of all of it, just Ijust couldn't manage it.
I'm I've never been like one ofthose military wives who has,
like you know, my kids, you knowwalk in a straight line like
little ducks in a row and I haveit all together.
No, I've never been that.
I I'm like I need my husbandhere because all the bad stuff
always happens to us when he'sgone.
So he decided to interview umand got a permanent job with the
(35:22):
gunfighters.
He's an F-16 pilot at Lackland.
He was able to come and get apermanent job here.
I got assigned to BAMC.
We were told BAMC is where yougo when it hits the fan.
That's how I met Dr Patel.
He's definitely who you want togo to if you have really,
really bad Crohn's disease,because he knows the ins and
outs of all of it.
Speaker 2 (35:43):
And he's always trying to learn new stuff.
I mean he doesn't just rest onhis laurels and say, like I know
all this stuff, he's alwaystrying to.
If something new is coming up,he's one of the first ones to
sign up to learn what'shappening.
Speaker 3 (35:56):
Yeah, he actually just did a long course in like
Crohn's specific nutrition andit's funny because they gave me
a referral after my bowelobstruction.
They gave me a referral to gosee a nutritionist in the
hospital and Dr Patel laughed.
He's like, don't waste yourtime, they don't know anything
(36:18):
about Crohn's disease, I'll helpyou.
And so he's been helping meWith this ostomy.
Now that I've had the bowelobstruction, there's actually a
lot of foods that I can't eatanymore and it's pretty similar
to the foods that I reallyshould have stayed away from
just anyway having Crohn'sdisease.
But a lot of people don'trealize.
Like I can't eat nuts anymoreunless they're really really
like finely ground up like freshpineapples off the table, any
like fresh vegetables.
(36:38):
I have to have everythingsteamed or cooked or softened,
because they explained to methat every bowel surgery that
you have creates scar tissue inthe bowels.
Explained to me that everybowel surgery that you have
creates scar tissue in thebowels.
And so a person that hashealthy bowels, their bowels
feel real slick on the insideand you just you know everything
just glides through them.
Scar tissue makes you have likethese like fibers kind of come
(37:00):
out and makes the inside of yourbowels rough and so anything
that you swallow that can't bedigested easily.
What gets passed through thatdamaged bowel with the scar
tissue can get caught on thattissue and so basically, I would
have the perfect life if Iwould just drink liquid
everything.
And I felt great for the month Iwas on a liquid diet because I
(37:23):
didn't have to really work atdigesting.
I lost so much weight and Ifelt great.
But then I also like reallymissed food.
But that's what that strictureis causing.
I'm not able to eat like moresolid meats, like steaks, or
even like the steak fajita meats, and so anything that takes my
body longer to digest and it'salready hard to break it down.
(37:43):
I'm supposed to completely stayaway from that and I'm not
supposed to have anything withfiber in it unless I'm drinking
it.
So I've been doing like greensmoothies with like the green
powder.
Those have helped a lot andthose they just go straight
through me.
They help, you know, keep meregular and I can eat like
chicken and ground beef.
Things like that are fine.
(38:04):
But anything too solid and it'svery painful to digest and I
struggle with that.
Speaker 2 (38:09):
When I had the ostomy the second time, I was so
looking forward to having anostomy again because I hadn't
been able to eat fruit for like20 years and I went really hard
and ate a lot of fruit andvegetables and I was it was like
mulch coming out in the ostomy.
I was texting Stacey Collins,friend of the show, stacey,
(38:30):
because we actually had our Jpouch surgeries at rally like
around the same time and I waslike I just I just went too hard
.
I ate fresh vegetables too closeto the sun and now I just am
producing mulch and she's likeme too many, too many vegetables
, but I was like I don't, I'monly going to have this ostomy
for a little while and I don'tknow if I'm going to ever be
able to eat it again, so I can'tstop.
(38:50):
I feel like in my situationwith the J pouch like I have a J
pouch now I am finding that I'mhaving to be very mindful when
I'm eating.
I'm pausing a lot, thinkingabout how to put that so I don't
scarf food down.
But because of some of thechallenges that I've been having
(39:11):
, like we've talked about, whenwe first got our J pouches,
stacey was on the show and wetalked a lot about gas and we
were laughing about gas andtexting each other about PSIs,
like the force of the gas comingout of our bodies, kind of
thing.
But I'm several years in and I'mstill experiencing a lot of gas
and recently I had a smallintestinal bacterial overgrowth.
(39:32):
That was the first time forthat and the amount of gas that
was produced there.
And she's like let's start withlike, chew your food even more
to help, like with thatdigestive process, to make it
easier on your body.
So I'm like every time I take abite, I just sit here and chew
until I'm like okay, this ispretty much like digested in my
mouth.
I don't know, I just chew somuch to try to help with the gas
to slow down the PSIs.
Speaker 3 (39:54):
So I did the same thing, like, especially popcorn
is like the biggest, you know,like no-no.
Speaker 2 (40:00):
I don't care, I'm eating it, I know I did too, but
I'm still eating it.
Speaker 3 (40:08):
I'm still eating it.
Yes, I did too, up until so.
I had my bowel obstruction inJanuary.
I'm telling you what I thoughtI was dying.
That was the worst pain I'veever had in my life, and so now
I'm like I'm a littletraumatized by that.
So now I'm like scared to eatthis stuff because I really
don't want to get another bowelobstruction.
Speaker 2 (40:21):
It was bad and I was that's true when the pain is bad
.
I, the couple of times that Iprobably had bowel obstructions,
I, yeah, just laid in the bed,and my husband the last time he
was like if this ever happens toyou again, I'm taking you to
the hospital, like I'm not goingto sit here and let you talk me
out of taking you to thehospital.
I'm like I'm fine and look,everything worked out, it's fine
(40:44):
.
Speaker 3 (40:44):
Yeah, I had a couple of them that weren't like a
complete obstruction, they werejust like they took some CT
scans and they're like girl, youare loaded, you just need to
like go.
I had a couple of those andeven after those I still ate the
popcorn and did all the things.
But this one we were all out ata military graduation down on
the river walk in San Antonioand I literally thought I was
(41:05):
like what is going on?
This hurts, and I made it fourhours with this pain and then I
had to go home.
I just I had to go home and Iended up getting sick when I got
home.
Well, that made it worse and Iended up collapsing and not able
to move.
It was awful and my husband hadto call an ambulance and they
got me into the hospital andthen I laid there for a week
(41:26):
with an NG tube down my nose andI'm like I was like God, I will
never eat popcorn again if youjust get this tube out of my
nose.
Speaker 2 (41:34):
Yeah, I do understand that.
Speaker 3 (41:35):
Yeah, I still got some PTSD going on from that.
But I did take my son to themovies a couple of weeks ago and
I did have some popcorn and itwas worth every bite.
It was that good.
Speaker 1 (41:47):
It was so good, apparently, chew it really well.
Yes, like Robin's tactic andjust chew and chew and chew
until it's basically popcornbutter, and then you're fine.
Speaker 3 (41:56):
Yes, and drink a ton of fluids with it too, and drink
water and you flush all thatout.
It goes right down.
Speaker 1 (42:02):
We do not provide medical advice on this show.
Everyone that's listening.
We are not providing any sortof medical or nutritional advice
.
Please consult with your doctor.
Speaker 2 (42:09):
Don't, especially me.
If you have listened to thisshow at all over the past four
years, you know that I do what Iwant.
I love it.
So definitely don't takemedical advice from me unless
I'm saying get a second opinion,because I feel very strongly
about that.
Speaker 3 (42:26):
Oh yeah, second opinions don't exist for us in
the military.
So that's why I am glad I haveDr Patel, because we don't get
second opinions unless we wantto pay a hefty fee.
Speaker 1 (42:36):
Yeah, and it is a shame that I know Dr Patel has
talked about how, like he's kindof the only guy in the military
, like he's like the one IBDspecialist and it would be great
if other people could get flownto see him.
I'm curious about that, though.
So like when you were in Utahand you were struggling with
this, did you?
You had to go to the militaryhospital system and you had to
just see their general GI.
(42:56):
How did that work?
Speaker 3 (42:57):
So we were at Hill Air Force Base in Utah and they
did not have a military hospitalclose and so in that
circumstance you're able to evenif you have TRICARE Prime, you
are able to still see what theyconsider like an off-base
provider because you have to be,I believe it's like 50 miles
away from the nearest militaryhospital.
If you do not live within 50miles of one, then they allow
(43:20):
you or they give you a referralto see an off-base provider.
So I just saw a generalgastroenterologist at that time.
My Crohn's was pretty wellmanaged when I was living in
Utah, especially when I waspregnant with my daughter and
then nursing.
Believe it or not, that was theonly time since I'm 18 years
old that I was in remission waswhen I was nursing my daughter.
(43:40):
I think the human body is justcrazy and can do amazing things
and I nursed her for up until ayear and had I had known the
Crohn's would have come backlike tenfold.
I probably would have been thatmom that like nursed until she
was a toddler just to givemyself some extra time, but
because I felt great and then amonth after I stopped nursing, I
(44:01):
got a stricture and ended uphaving to have the first
resection surgery in my my ileum, but yeah, so at that point I
didn't really need like anexpert, it was just like, yep, I
got Crohn's.
It's pretty well managed.
It had been managed at thatpoint with like Humira and
Simsia and just the injectionsand it was always just a really
small spot when they would findit, but when it spread
(44:23):
everywhere, that's when Istarted seeing Dr Patel.
So I have been blessed.
I know not everybody has thatand it is hard when you go see a
regular gastroenterologist andyou get a bill for $800 and they
talk to you for five minutes.
So I really am blessed.
And my husband's about toretire and we're considering
moving to the Houston area andone of the big reasons on our
(44:47):
list of why we want to stay inSan Antonio is Dr Patel, because
he's kept me alive this longand I I keep saying like when I
move I'm never going to have mygastroenterologist number again.
You know what I mean.
Like nobody gets that.
So I just feel really blessed.
Speaker 2 (45:00):
You mentioned that you were well during breast
feeding and this is I wanted tostop you and say any researcher
who's listening hormones,women's hormones and IBD please
study.
It doesn't necessarily have tobe focused on pregnancy or
menopause.
It should be hormones in thefemale body and IBD, because I
can tell you before I wasmenopausal, hormones affected
(45:23):
how my IBD was, even when it wascontrolled.
Speaker 3 (45:26):
Oh, absolutely, I 100% agree.
I mean I ended up having tohave an ablation because my
periods would be so heavy that Iwould lose so much blood and
then I was anemic.
And so I was anemic until I hadthe ablation done and then I
was able to stop getting ironinfusions.
At that point that was hormones.
And then, I find it interesting, I have this stricture in my
(45:50):
small bowel.
Well, I had my first mammogramon Christmas morning.
I woke up and found a suspiciouslump on my breast and I went
and saw my PCM who put in for meto get a sonogram done.
And I went to BAMC to get thesonogram done.
And BAMC automatically has aprotocol that they won't just do
a sonogram, they also do amammogram.
Even if your doctor doesn'torder it, they still do the
(46:12):
mammogram.
And I'm so glad that they didbecause they found two
suspicious lumps, one in eachbreast, and they turned out to
be benign Thank you, God forthat but one of them tripled in
size.
So I had to have a lumpectomylast month to get it cut out.
And I've had so many other likehormone issues going on and I'm
(46:34):
, I guess, flaring at this pointbecause of the structure.
So I definitely think hormonesand Crohn's disease and IBD go
hand in hand for sure.
Speaker 1 (46:42):
I mean I would be curious for the women who are on
the show, like whether whenyou're tracking, like in your
cycle, what happens, kind ofwhen you're having these
different hormone fluctuations,we're going to do our own
research study on bowel moments.
Speaker 2 (46:54):
We're just going to have everybody track their
period and let us know, are yougoing to be the primary
investigator?
Speaker 1 (47:00):
I mean, listen, yes, you and I primary investigators,
pis.
You know what?
No, we'll make Anish Patel that.
We'll make him do it, and we'llget Venetia to help with this,
and then you and I can beco-authors.
How about that?
Yes, that sounds great With youhaving a dad with IBD, with
Crohn's, and you have Crohn's.
Are you the most hypervigilantof your children's?
Speaker 3 (47:19):
poop ever.
It's funny that you say that,because my daughter is actually
having abdominal issues and bothof my kids are on the
pediatrician's watch list tostart watching for IBD symptoms.
My son is lactose intolerant.
He's old enough now he knows ifhe eats lactose.
The doctor told him she's likeI know you love that ice cream,
but you're probably going toblow the toilet out afterwards.
(47:41):
So you decide you know, and sohe still eats the ice cream.
That's his deal.
My daughter got diagnosed withsomething I don't know if y'all
have ever heard of it.
Most people who hear it arelike whoa, I've never heard of
that.
My daughter, when she was seven, got diagnosed with abdominal
migraines.
Sadly, they have found thatlike 90% of the cause is
constipation, and so my daughteronly goes if she's not on
(48:04):
Miralax every day.
She only goes to the bathroomonce a week and it's very
painful for her to pass.
And so the pediatrician said,because she's already having
these issues, that it couldlater turn into IBD, which I'm
praying so hard for her thatit's not.
I don't want her to have this.
When she was seven she missed26 days of first grade from
(48:27):
vomiting, just constant.
They typically call themabdominal migraines or cyclic
vomiting syndrome, but we'vebeen able to each year get it
down less and less because wehave a really good action plan
with our doctor.
Yeah, so I am like veryhypervigilant because I do know
that it runs in the family.
Speaker 2 (48:45):
Rachel, thank you so much for coming on the show and
sharing so openly about yourexperience with your ostomies
and having kids and our love,our mutual love of Dr Patel.
But it is time for me to askyou the last question.
So what is the one thing thatyou want the IBD community to
know?
Speaker 3 (49:00):
I want the IBD community to know that, no
matter what you're going through, there is always people out
there that are also goingthrough it and that are willing
to help.
If you are someone like me whoneeds an ostomy, do not think
that it is the end of the world.
Life can actually be great withthem and my life is great with
it and I can laugh and joke andI'm really living a great life.
(49:21):
So I just am really thankful toyou guys for having this group
and this podcast to get thisinformation out to the community
about all things IBD.
I love it.
Speaker 1 (49:31):
Oh, thank you for that.
We appreciate it.
We have so much fun getting toknow all of our guests and we've
had so much fun getting to knowyou as well.
So big thanks to Dr Patel forsending you to us, because I
think this has been such a funconversation to have with you
and I really really appreciateyou sharing both the like, the
part that started low and whereyou've been able to come,
because I think sometimes youknow, people put the brave face
(49:53):
on and they're like everything'sgreat I love my ostomy but they
don't always acknowledge thedifficulties they had in getting
to the place they are now, andso I think you providing that
light at the end of the tunnelfor some folks is going to be
super, super helpful, you know,because there's definitely some
people that are maybe in thattrough right now that are going
God damn it.
This isn't what I wanted, youknow, and this was my, my worst
(50:15):
case scenario, and now I'm I'mhaving to live my worst case
scenario.
So thank you for that.
I really that's not easy, Iknow it's not easy, so I really
appreciate you doing that.
So thank you, rachel, for beingon the show, thank you
everybody else for listening andcheers guys.
Speaker 2 (50:27):
Cheers, everybody Cheers.
Speaker 3 (50:32):
Hi, this is Rachel.
If you enjoyed this show,please rate, review, subscribe
and share it with your friends.
Hi, I'm Alicia and I'm Robin, and you're listening
to Bowel Moments, the podcastsharing real talk about the
realities of IBD Serve on therocks.
This week we talked to RachelGebhardt.
Rachel is living with Crohn'sdisease and her dad also had
Crohn's disease.
They took very different pathsin dealing with and managing
(00:20):
their Crohn's disease throughouttheir lives, and so we hear
about her story of growing upwith Crohn's disease throughout
their lives, and so we hearabout her story of growing up
with Crohn's disease in thefamily and how she decided to
change how she deals with herCrohn's disease with her family.
Rachel also has a verycomplicated case of Crohn's
disease, and so we talked to herabout how she decided to get an
ostomy and what it was like todeal with her Crohn's disease
while also navigating themilitary healthcare system
because of her husband being inthe Air Force.
(00:40):
And we talked to her about howshe met and is working with our
friend of the show, dr AnishPatel, at the Brook Army Medical
Center and what that has donefor her care and so much more.
We had such a greatconversation with Rachel.
We know you're going to loveher as much as we did, cheers.
Speaker 2 (00:55):
Hi everybody, Welcome to Vow Moments.
This is Robin.
Speaker 1 (01:01):
Hi everyone, this is Alicia and we are really, really
excited to be joined by RachelGebhardt.
Rachel, welcome to the show.
Hello, thank you so much forhaving me.
We are very excited to have you, but first of all, we want to
ask you a very unprofessionalquestion of what are you
drinking?
Speaker 3 (01:17):
I am drinking my 19 Crimes Cabernet.
Speaker 1 (01:21):
Yes, I like a 19 Crimes's, like a good, like
solid choice.
Robin.
What about you?
You are traveling, so I amtraveling.
Speaker 2 (01:29):
I am attending um the child life professional
conference this weekend indowntown la, and so time zones
are hard and they have an illycoffee shop in this very fancy
hotel where I'm staying, and soI went and got fancy coffee for
this call yeah, and again, I'm afan of illy coffee, so so
that's a.
Speaker 1 (01:47):
That's a yummy one.
Well, yesterday I had a friendcome over and we hadn't seen
each other for a little bit, andmy husband, who is a kind, kind
soul, put a bottle of VouvClicquot in the fridge, and so I
am drinking fancy champagnetonight, and so.
I'm feeling very, very, verylike a boss over here.
I'm feeling very, very, verylike a boss over here.
So, but, and it is delicious,I'm a giant fan.
So cheers, guys.
Speaker 3 (02:07):
Yes, cheers.
Speaker 1 (02:09):
So, rachel, next question for you is tell us your
IBD story.
What brings you into ourcommunity?
So?
Speaker 3 (02:16):
interestingly enough, dr Patel, my gastroenterologist
, reached out to me and he was aprevious guest on your show and
Dr Patel has come almost like abest buddy of mine.
He tells me he can recognize meby pictures of my colon.
So he has been my doctor foreight years now and this is
(02:36):
actually my 20th yearanniversary of being diagnosed
with Crohn's disease.
But Crohn's has been kind of astaple, just name that I've
always understood since I was ayoung child, because my dad also
had it and he passed away young.
He did not take care of himselfand sadly was not able to get
the medications that we havetoday.
He got diagnosed back in the70s, where they handed you
(02:58):
prednisone and opioids to dealwith Crohn's disease, and so
after years of that he hadosteoporosis by the time he was
50.
And then he passed away by thetime he was 55.
And my Crohn's has been muchworse than my dad's, but I just
have an entirely differentattitude about it.
My dad, kind of like, becamehis illness.
He was always sick and wantedeveryone around him to be
(03:20):
miserable too, and that's sadlywhat I remember of him in my
childhood.
And so when I got diagnosed andmy husband and I decided to
have kids, I always said that Iwas going to be as lighthearted
about it as I could be, becauseI never wanted my kids to look
back and be like, oh man, momwas a drag when she was sick.
Sadly, I have had four bowelsurgeries and 14 hospital
(03:43):
admissions since 2020.
I ended up with a colostomy andI have had every complication
that you can ever imagine fromthe colostomy.
Eight of those hospitaladmissions were last year alone
due to skin infections and I hada bowel obstruction.
I had kidney stones, which wereentirely unrelated, but this
(04:05):
entire journey, I've always beenable to joke about it.
I am one for a really good poopjoke and that's why I get along
with Dr Patel so well, becausehe loves to tell those and he's
taken me under his wing and isjust making sure that I get the
best care and the best treatmentpossible.
And so, despite the illness anddespite this long journey with
(04:25):
Crohn's disease, I feel like Ihave a really good attitude and
a really positive outlookbecause I do have such great
medical care and I am gratefulfor that because, again, my dad
did not have that and so I feellike his life may have been
different had.
He have had all the care andthe options that I have.
But I love to talk about Crohn'sand IBD and especially
(04:45):
colostomies, because it's kindof a taboo subject.
People don't talk about havinga colostomy, they're almost
embarrassed.
And it's one of the firstthings that I bring up when I
meet people, because I neverknow if it's going to make a
noise and I don't want to behumiliated.
So I tell people hey, just soyou know, I have a colostomy.
So if you hear me rip, onetotally have no control over it.
And then I tell everybody mykids helped me, picked out the
(05:07):
name Whoopie.
My colostomy's name is Whoopiebecause it's like a Whoopie
cushion.
So we call it Whoopie and wehave a code word.
If I spring a leak, our codeword is mom is being a party
pooper and that means we have togo.
So I am really blessed that mykids have been along on this
journey with me and it's beenmore of like a humorous one.
If anything.
(05:27):
I've definitely had some scareswhere I'm not sure I'm going to
make it out of the hospitaljust because they're not sure
what's going on or I have arandom infection that they don't
know.
They've had to call ininfectious diseases a couple of
times, but I keep coming out ontop and I'm just so grateful to
be here.
I'm grateful to be with my kids, to have this time with my kids
, and to Dr Patel, whoi wasactually just talking to him
(05:49):
earlier.
I'm one of his few patientsthat he texts back and forth
with because that's how closewe've gotten.
I've been pretty frustrated withthe medical system.
You know, in the militarySometimes you feel like herded
cattle and I kept gettingbounced around and couldn't get
an appointment.
You know, I kept gettingbounced around and couldn't get
(06:11):
an appointment.
They'd be like, oh you havethis going on, but our next
appointment's in 12 weeks.
So Dr Patel gave me his numberand now he just personally walks
me in and schedules me, becausemy journey has been such a
tough one and I go from feelinggreat one day just to completely
falling into a flare.
But one day I was getting aninfusion and Dr Patel came and
sat next to my bedside while Iwas getting an infusion for an
hour and just talked to me andkept me company.
And that's how I knew that hereally cared, because most
(06:33):
doctors don't do that and tothis day he has a vested
interest in making sure that I'mgetting good care and that I
can live my life to the fullestso I can be here for my kids.
So I'm really appreciative tohim.
I was actually messaging withhim because last week I had
another colonoscopy.
I get those every single year.
I still have my rectum intact,so they go in and do those once
(06:55):
a year just to make sure there'sno cancer or anything in the
pouch.
So they called it.
I didn't even know it wascalled a pouch until this last
colonoscopy.
But the doctor said they weregoing to check up in my pouch
and I said, great, okay, andthey did.
At this last one they foundanother stricture in my bowel
that they've already had todilate three times.
(07:16):
So that's more than likelygoing to call for another bowel
surgery.
But it is what it is.
I'm just going to keep chuggingalong until I can't anymore.
Speaker 2 (07:25):
Pretty intense, okay first of all, we love some anish
patel around here, yes, yes.
And second of all, I have someclarifying questions, and it's
just because I'm curious.
So you said you have acolostomy.
So you have.
Your ostomy is in your colon,not your small intestine which
is not usual.
That's not usual, and usuallythey, you know they have to take
out more of the colon orsomething.
(07:46):
And so for everybody who'slistening, who doesn't have an
ostomy, you have an ostomy withyour colon or an ostomy with
your small intestine or yourileum, and so you've heard me
say ileostomy, and a lot of ourguests say ileostomy because we
don't have any of our largeintestine left, and so the
ostomy we have was with thesmall intestine, and so yours is
with your what's left of yourlarge intestine or your colon.
(08:08):
But they left your rectum andall.
They didn't give you a Barbiebutt.
Speaker 3 (08:12):
Nope.
They decided that the recoveryfor that was going to be really
intense, and at the time my kidswere seven and five and we are
military, we don't have familyclose, and so the colorectal
surgeon said why don't we go in?
So what caused me to get thiswas I developed a fistula, and
so they decided to reroute thebowels, you know, through my
(08:35):
colostomy and which would wouldstop the fistula and would heal
it, and so I did a temporarycolostomy at the time.
Then I went and did treatmentsin the hyperbaric chamber and
then they started me on Remicadeand Remicade is currently the
only FDA approved drug that willtreat or prevent fistulas and
so that's why they put me on it.
But I developed an immuneresponse to the Remicade.
(08:59):
After being on it four years Istarted just breaking out into
rashes and got what looked likechemical burns all around my
stoma, and last year that's whatput me in the hospital eight
times.
I ended up developingcellulitis that went down into
the fatty tissue in my stomachand I had to be treated several
times for that, and that waspretty horrific.
(09:20):
I think what little dignity Ihad left, having Crohn's disease
and having to get thiscolostomy, having to have a
nurse bathe me with a spongewith no bag on was probably one
of the lower points in my lifeand I didn't know if they were
going to be able to fix it.
They had no idea what wascausing it, but thankfully they
figured out.
A med student, of all people,went and looked back into my
(09:42):
records and figured out that myskin would flare and have these
spikes of just rashes all aroundright after I would get my
Remicade infusion.
So when they took me off theRemicade within two weeks my
skin was completely healedaround my colostomy.
But the bummer about that is nowbecause I've had a fistula.
A fistula can come back at anytime.
So Dr Patel had to take agamble and he said the two new
(10:04):
ones out on the market were SkyRizzy or Ren Vogue, and he felt
like Ren Vogue had more supportin showing that it would be able
to handle a fistula.
So I'm currently on that.
I can't say for sure if it'sworking because I have this,
this strictured area in my smallbowel and it's got two bleeding
ulcers next to it.
But I'm really hopeful that ifthey can resect that and get it
healthy again ulcers next to it,but I'm really hopeful that if
(10:26):
they can resect that and get ithealthy again, that the RENVO
will be able to keep on top ofit, which I'm just going to have
to live on a prayer for that,because I've tried everything
else I've been on Simzia, I'vebeen on Humira, I've been on
Remicade, I've been on Pentassayou name it, I've been on it and
now Antivio I was on that onetoo, and so Remicade was
(10:46):
actually working very well forme in managing the Crohn's
disease, but then it was causingso many other adverse side
effects, like migraines and theskin issues, and so they did
determine that it was best totake me off of that.
So I've been on the Renvoguenow for the past three or four
months and I feel like I'm doingpretty good on it, minus the
stretcher area.
Speaker 2 (11:03):
We know somebody else that has been on the show that
is on renvoke because of afistula, and it was the only
thing that helped them.
So fingers crossed, yes,fingers crossed that it works
for you too, although, um, thereis such a thing as renvoke acne
, so just if you start to,that's the renvoke, just so you
know.
In advance.
Speaker 3 (11:22):
Good to know, because I have gotten it all over my
arms and back and the doctorsput me on steroid cream to help
with that, which is helping.
But it's like any other drugyou take it for one thing and
then you get 50 side effects.
Speaker 1 (11:36):
I think I'm still a little bit confused anatomy-wise
, and you can tell me if youcan't explain this.
But so when they did yourcolostomy like there's the other
part that's still connected toyour rectum, like did they like
sew up the end of it or is itjust floating around?
Like that doesn't feel likethat's a good idea, but I don't
know.
I'm also not a medicalprofessional.
So, yeah, yeah, I'm confused,like what's happening?
Speaker 3 (11:57):
Yeah.
So what they did?
They originally went in and dida temporary colostomy, but I
was having a lot of leakageproblems with that because the
colorectal surgeon explainedthat the temporary ones they
have to keep pretty flush withthe skin and so, because it was
so flush with my skin, I wasleaking all the time.
So four months after I had thetemporary one done, I went in
(12:17):
and got a permanent endostomydone, because when they had gone
up through the rectum for thefirst surgery, it was so
diseased down there that thecolorectal surgeon said I am not
hopeful that you'll ever beable to be successfully
reconnected.
He said we could reconnect youat some point, but it would
probably include a lot of likebowel incontinence, and wound
(12:40):
care would be an issue too thatthey would be concerned about
for healing.
So he said, honestly, you couldgo through the reconnection
process and go through all ofthat, and I give it six months
and you'll be back in hereneeding another ostomy just
because my Crohn's became soaggressive and we don't know
what made it aggressive.
I had my first bowel resectionin 2015 in my small bowel and I
(13:01):
had a stricture there and theytook it out thinking, oh,
they'll reconnect the healthytissue and then this will be
great.
Well, it had the oppositeeffect.
It spread.
It jumped from my small boweland went down into my rectum and
my colon and just startedspreading everywhere down there.
And then I got the fistula in2020, and the fistula became an
emergent thing because I spikeda fever and started having just
(13:24):
symptoms of infection and sothey had to go in and thankfully
they were able to schedule it,so it wasn't like an emergency
colostomy, but they admitted meand then two days later, I had
the surgery and, even thoughI've had all the complications,
I am grateful for it because,surprisingly, it does give me a
better life than what I hadbefore it.
I used to go to the bathroom 10,11 times a day.
(13:44):
My life was controlled byneeding to always know where the
bathroom was or when we wouldget on the road to take a road
trip 30 minutes in.
I'd be like, oh, I got to go tothe bathroom and it was like
that urgency of I can't wait.
I got to go and now I go into abag and it's great, and I've
developed a routine of I canfeel when I'm about to go, I
(14:04):
empty the bag at certain times aday.
I'm a pro ordering my suppliesand now I can't imagine like
what my life would be withoutthe ostomy, if that makes sense.
That's why I'm so glad thaty'all had me on here to talk
about it, because I love tellingpeople about ostomies, mainly
because there's so many peopleon like the Facebook support
pages I'm on that feel like it'sa death sentence.
(14:25):
They feel so embarrassed aboutit but they feel so humiliated
by it and I can't tell you howmany people say like this makes
me want to commit suicide or Ifeel like my life is over, and I
am the person that has hadevery complication that you can
get with them and I still thinkmy life is better with it.
My husband will tell you lifeis better with it and I just
want people to know that youdon't have to be scared about
(14:47):
getting one of these.
Your life is not over.
Yes, it's something to learn,just like riding a bike or
learning how to write cursive.
There's a learning curve withanything that you do and there's
so many support groups outthere.
There's even YouTube shows onhow to dress with an ostomy or
what to wear, how to style them,and I love talking about it,
and I love talking with peoplewho've had one before and,
(15:08):
believe it or not, there are somany people who have had them
and get a reversal, or they havethem, but they're just too
embarrassed to talk about it,and so I feel like the more we
talk about it, the more itbecomes a normal thing and
people don't have to be ashamed.
Speaker 2 (15:21):
Agreed.
So I'm going to ask you aclarifying question for Alicia's
sake, because we've had this onbetween an end ostomy, which
you said.
So when you said the temporaryone, they gave you a loop which
had to be close to the skin.
Those look I don't want toscare anybody, but loops are
really hard to manage.
Loop ostomies are really hardto manage.
Like you said, they're close tothe skin.
(15:50):
They leak a lot.
I have had an ostomy twice.
I had an ostomy when I wasfirst diagnosed and then again
in 2020.
And the first time I got an endand I was like this is the best
thing ever and I had a baby,not a no-transcript, yes.
(16:31):
So yes, I'm glad that you saidthat, because that loop man, it
could be a bugger sometimes.
Speaker 3 (16:37):
Yeah, now that I have this end colostomy, they tied
off the part of the bowel thatwould go down into the rectum.
But the only reason they leftthe rectum intact was because it
was going to be such a majorsurgery and so they wanted to
give me a little bit of time toget my kids older and I actually
set a five-year goal with mysurgeon.
I'm going to make it five moreyears with my rectum and this
(16:59):
April was five years and I'mstill going strong.
The surgeon that operated on methree times he's no longer at
BMC but I have two new ones thatI see and they said they're
optimistic that as long as I dothe colonoscopy once a year and
they go and check, I could keepmy rectum as long as I want to
keep it.
They did say the Barbie buttsurgery is major recovery,
(17:21):
especially if you have likeslower healing wounds because
you think about like when youwalk in, that wound rubs and, um
, I have a friend who had acolostomy that had the Barbie
butt surgery and it took her ayear to really get back on her
feet.
And I'm just a busy mom rightnow.
I don't have a year.
I I live in the car, driving mykids everywhere, and I can't
imagine like not being able tosit on my rear end for a year,
(17:42):
you know.
So my goal is to make it untilthey, like, get to college and I
can just veg and, just, youknow, have Barbie butt surgery,
you know.
Speaker 2 (17:53):
Um, it's good that you get that surveilled every
year, because wasn't it Courtneywho didn't get it surveilled
and then she ended up having a?
She ended up having to have theBarbie butt because she yeah.
So, anybody listening, this isgreat news, but you have to get
it surveilled.
It's too many things that cango wrong down there.
Speaker 1 (18:10):
Even if it's not in use, unfortunately.
Speaker 3 (18:13):
Yes, I know, and when they went up there they said
like the last time they went upthere they said that the tissue
just looks like white and I meanlike what?
What you would imagine liketissue that never gets used
anymore, like that's what itlooks like.
I've been lucky.
A lot of people who still havetheir rectum intact with in
colostomies still get quite abit of like mucus that comes out
and you still feel that urgencyLike you got to go.
(18:33):
Mine is only like once a month,very small amount.
So that's good.
I've been blessed in thatregard that I don't have a lot
of that.
But on my support groups I seeother people have a lot of
issues with that and a lotcoming out.
So I'm thankful that mine'sbeen pretty manageable with that
.
But it's crazy how so manypeople have had these and
usually it's Crohn's or colitisor cancer colon cancer that
(18:56):
causes people to get them andpeople either love them or they
hate them.
It's like there's no in between.
So I just try to have thementality that because I have
this, I'm here and I'm spendingtime with my kids and I decided
to take it from a positiveperspective early on and that's
definitely helped me be able tomanage having one of these, just
(19:16):
being as positive as I can andalso having really good spouse
support or your spouse or yourpartner.
I know a lot of people thathave these deal with having
troubles with their marriage ortheir partners grossed out by it
.
And I will never forget about aweek after I got my colostomy I
was having all sorts of leakageissues and we decided to have
(19:36):
some friends over.
They wanted to bring dinner tous because I was still
recovering and I went into thebathroom to change my or to
empty the bag and it ended upjust going everywhere Like the
bag came off.
It looked like a crime scene.
When you walked into thebathroom and I had my phone with
me and I texted my husband andI said 911, please come to the
bathroom now.
(19:57):
And he walks in the bathroom andhe opens the door and the look
on his face.
It looked like he'd walked into, like a scene from Dateline.
I mean there's just pooeverywhere because unfortunately
when it falls on tile itsplatters everywhere.
So it was just everywhere, onevery surface.
So he said stay still, I'll beright back.
And he goes in the living roomand he tells our friends.
(20:17):
He said hey, rachel needs somehelp in the bathroom.
I might be a minute, but y'allstay here, enjoy some wine.
You know I'll be right back.
And then he came back into thebathroom and he scrubbed every
inch of that bathroom with wetwipes, then he got bleach and
then he helped clean me up.
And I just stood there I mean Iwas completely mortified, but
he didn't even miss a beat, hejust hopped in and did it.
(20:38):
And, yeah, he was helping me atthat point to still change my
bags.
And then one day Whoopi decidedto blow air right in his face
as he was leaned over helping mechange the bag.
So that put an end to that.
Then I got a real quick lessonon YouTube on how to change it
myself, because he's like neveragain.
Speaker 2 (20:58):
That has happened over on my side.
We were Matt and I were justtalking about that.
He was like man, that gas fromthat ostomy yeah, Brutal, Brutal
, it's bad, it's bad.
I mean, let me just say this wesay that you don't stink
walking around wearing an ostomybag, Like you don't know if
your bag is closed.
You don't smell like a walkingbag of poop.
(21:20):
You're not smelling like poopas you're walking down the
street.
It's only when you empty thebag or, in my case, when you
have a lot of air.
If your bag fills with air likea whoopee cushion does, and you
just try to release some of theair, then but it's, it's just
like anybody else passing gas.
So, but you don't smell likepoo as you're walking down the
street.
Speaker 3 (21:40):
No, no, and it took me a good couple of years and an
obsessive hoarding problem withpoopery and a lot of therapy to
get to that place that I cansay I'm good, like I don't smell
.
Sometimes I feel like I cansmell a smell on myself and I'll
ask my husband oh my God, doyou smell that?
Do you smell that?
He's like no, I don't smell it.
And that's gotten better overtime.
(22:00):
But I kid you not that firstcouple of years I did, I
struggled with anxiety anddepression.
After getting this I feel likeanxiety and depression go hand
in hand with Crohn's diseaseanyway, especially just because,
like when you're when you feelsick, you feel sick and your
life changes and you just youcan barely get out of bed, you
know.
So I've always battled that.
But getting the ostomy was whenit I hit a very low point,
(22:24):
especially when I was having allthe skin issues and they
weren't sure what was going onor how to fix it.
And I did.
I told Dr Patel, I said I'mreally struggling mentally, like
I'm, I'm in a really low place,and so that's why he's like,
he's fierce, he's like we'regoing to, we're going to fix
this.
There's no delaying, there's nooutpatient this out, like I'm
admitting you and we're figuringthis out, you know, and I just
(22:46):
am so thankful to him for thatbecause they did figure it out
and so I am in a really goodplace with it now.
I can say I wasn't a couple ofyears ago, so I definitely can
identify those people that dostruggle with it or do struggle
with the news of getting it.
I know what that feels like andit's almost like you know
people who they lose a leg orthey they have a disability.
(23:09):
It's just because you can't seeit, it is still there and
you're self-conscious about it.
You feel like, oh my gosh,people are going to notice.
I mean, even even today, Istill do not like to wear
something so form fitting thatyou can see the ring of the bag
through it and nobody would knowlike I don't even think anybody
would look or even care.
But it's just something aboutme, I just want to keep it
disguised.
I am not to that point of peopleon my support groups are like,
(23:30):
oh, they have a whole bag, whatbag thing that they talk about?
And it's people who postpictures of themselves all
glammed up or looking great andit's like you can't even tell
they have a bag.
A lot of people who say, bagwhat bag?
They let a bag.
A lot of people who say, bagwhat bag, they let their bag
hang out.
They're at the gym, liftedweights and a sports bra.
I will probably never be thatperson that has the
(23:50):
self-confidence to do that, butgood on those people that do.
I love that I have bought somany bag covers.
I will post pictures of all mybag covers.
I have a lady that custom sewsthem for me, so I have all
different holiday ones and Ilike to get the ones with the
puns.
You know any.
I love any good poop jokes.
I talk about stuff like that,but yeah, as far as wearing it
out, I don't do that.
(24:11):
I keep it pretty concealed andtucked in.
Speaker 2 (24:13):
The favorite thing I've seen was a Halloween
costume that was like a sharkbite out of the side.
They made it look like a sharkbite with the ostomy.
That's my favorite thing thatI've seen.
It was pretty creative.
Speaker 3 (24:25):
Yes, I love that.
I think I've seen that.
I do have a funny story.
I can tell you about the day Ifound out I needed it.
My colorectal surgeon was a guy, absolutely brilliant.
He would never look you in theeye.
He was real, you know, kind ofkooky, real funny, and he was
very blunt and he told peoplehow it was, you know.
And so I come in and I sit downand they asked me this was after
(24:46):
they found out I had thefistula and my
gastroenterologist that I wasseeing at the time did not give
me a heads up whatsoever thatthey would even consider doing
an ostomy as a treatment for afistula.
I thought it was going to besomething like a string.
There were different thingsthat I read that they could do
and so I went in there planningon I'm going to go to this quick
(25:08):
doctor's appointment and I'mgoing to spend the rest of the
afternoon shopping and it'sgoing to be a great day.
So I go to this appointment andthey asked me what my goals are
for Crohn's disease and I saidmy goal is to never have to get
an ostomy bag.
I said that would be like theend of the world for me and it
got real quiet in the room andboth surgeons that were in there
said so.
(25:28):
That's the thing.
The only way we're going to beable to treat this specific kind
of fistula is you need anostomy.
And I literally it was like therug got pulled out from my feet
and I just started bawling LikeI was crying and sobbing.
And these surgeons they're notused to this, they're brilliant
minds and they were like veeringheadlights and all at once, his
(25:50):
name is Dr Chauvier.
He ever hears this.
Just know, I love you, drChauvier.
But Dr Chauvier got real quietand he was on his phone and he
was scrolling and he looked upand he said, hey, I know it's
not good news right now, buteventually this could be you.
And he shows me a picture of askinny blonde standing on the
beach in an American flag bikiniwith an a matching American
(26:13):
flag ostomy bag cover.
And I just died laughing inbetween the sobs and the snot
coming out of my nose.
I was just like, oh my God,that's so funny.
And I always remember thatbecause he tried to relate to me
and he tried to show me that itreally wasn't as bad as I had
worked it up to be in my mindand so now I can laugh about it,
because now I'm in that placewhere I do see that it is such a
(26:35):
great thing and it does help somany people.
And so last year for the 4th ofJuly I wore an American flag
bikini with a bag cover and Itook a picture of myself wearing
the bag cover.
So that was a huge milestonecould get Tricare to pay for it.
If I ever needed another surgeryI would go see him because the
(27:06):
guy is brilliant.
He writes down his plans onnapkins and then shows you like
he did a hernia repair for me.
That by far was the worstsurgery I've ever had in my life
.
So if anybody ever needs ahernia repair around an ostomy,
prepare yourself.
It's brutal but you willsurvive.
But I ended up having to have 60sutures that were sewn into my
(27:28):
abdominal wall and the suturesthat they use feel like thorns.
So he said it literally willfeel like a thorn in your side
for six months until theydissolve.
And he drew up this plan of howhe was going to do the surgery
on a napkin and handed it to meand I'm like okay, and I trusted
him because he had alreadysaved me twice, you know.
So I'm like great, I trust you.
(27:49):
Surgery went great and mostpeople who have had hernia
repairs around their ostomy havea pretty high reoccurrence rate
.
I believe it's like a 30 or 40%reoccurrence rate within two
years and I'm four years out sofar.
I should probably knock on somewood, but I'm four years out
and I'm still doing great andhave not needed another repair.
Speaker 1 (28:08):
I mean, does he know that notebooks exist?
I mean, do we need to send himone, maybe like a picture of you
in your bikini and also like anotebook to be like I know I
know, I've always thought aboutthat.
I should just mail him hisoffice a picture of me in my
(28:29):
bikini and say, hey, you saidone day this would be me.
And look, it is, I'm here.
I love that.
I support this fully.
I think you need to, because Ibet he would be so stoked.
And now I also wonder who thisblonde woman was.
Now I want to know who she wasso that we can send her the
picture.
To be like you know what, Iknow you were an inspiration
that moment.
Speaker 3 (28:42):
Yeah, I know, I don't even think I can find the photo
now.
It was just like one of thoserandom Google images he pulled
up on his phone in the moment,you know, and you had to have
been there.
I mean, it's like he's got amed student standing next to him
who's like, oh my God, I don'tknow how to process this woman
crying, you know.
And then him, yeah, it just itreally.
It really changed the changedthe day for me and made things
(29:04):
like so much better.
And I wasn't laughing about itthen.
Believe me, I was a littlehorrified then, but now I'm like
okay, that was hilarious andthat's.
I wish I could tell everybodythat, like, your definition of
beautiful, like being beautiful,doesn't change just because you
have a piece of your intestinehanging out now, or or you've
lost a leg, or whatever.
Beauty is in the eye of thebeholder, but it's also in the
(29:26):
eye of the way you see yourselfin the mirror, and it's taken a
lot of time for me to get there,but I feel like I can look in
the mirror again and not becompletely disgusted.
Speaker 1 (29:34):
Well, and there is something to be said about the
beauty of having quality of lifeimproved.
Being able to live your lifemakes you feel more beautiful.
It definitely does.
If you're sick on the couch andyou're not able to do anything,
that's not helping.
Speaker 3 (29:47):
Yeah, yeah, I've been able to do so many more things
that I was never able to do.
I've been training for a halfmarathon and I got to hike.
It was my goal to hike up OldBaldy at Garner State Park in
Texas.
I got to do that.
I would have never been able todo that before because I always
had to use the bathroom, so Iused to have to just stick
(30:07):
really close to bathrooms, andso now I've been able to do that
and we're traveling a whole lotmore.
I successfully just took myfirst trip for a four-day trip
with a carry-on, and so that ishuge for the colostomy supplies,
because I tend to panic when Itravel and think, oh my gosh, I
need like 12 changes of suppliesfor a two-day trip, and so I
(30:29):
end up having to check a bagthat is mostly ostomy supplies,
but this time I did it withpre-cut wafers and everything
just in one small little bag anda carry-on, and so it's things
like that that you realize arelike huge milestones for you too
when you have one of these.
Speaker 1 (30:43):
Well done, that's impressive.
Four days on a carry-on for meis difficult, so I, but I also
travel with too many shoes, notas a difference.
You are the first person we'vetalked to that has used, I think
, hyperbaric treatment to dealwith skin issues, so can you
talk about what the heck that isand what might people expect if
(31:03):
this is proposed to them?
Speaker 3 (31:05):
So they actually used the hyperbarics to try and
treat the fistula in addition tothe temporary ostomy, and the
belief is that the hyperbaricsincreases the oxygen and
increases cellular regeneration,and so their hope was that me
being able to do the hyperbaricchamber would heal that fistula
(31:25):
faster.
Unfortunately, I was only ableto do about three treatments,
and the reason why is thepressure in there.
If you have like issues withyour sinuses or you can't ever
really clear your nose or yourears, the pressure can be
unbearable.
And so I made it the first twotimes and it was pretty painful
but I like I suffered through it.
But then the third time it gotso bad I felt like my skull was
(31:49):
being crushed and it I mean youjust the pressure is so much on
those sinuses.
It's almost like being on anairplane when your ears get
really clogged and then thepressure starts building in them
.
So I had to tell them to stop.
They had to stop the treatmentand I had to get out and
unfortunately I wasn't able todo all the sessions.
They had ordered like sixmonths of sessions for me and it
(32:10):
was going to be hard becauseyou would you have to do it like
three or four times a week andit was like a commitment to be
able to go and do this to getthe healing.
But I just I couldn't tolerateit.
And Dr Chauveur was like youknow, I'm not going to make you
miserable trying to heal this.
You know fistula.
So and then at that time we hadalready decided that ostomy
life was better for me and so Iwas going to be getting the
(32:32):
permanent one anyway andultimately the fistula did heal
without the treatment.
But hyperbarics are definitely anewer thing.
At BAMC they have them for the?
Um.
Most of the people who use themare like burn patients.
Um, it helps their their skinheal faster and it helps them
grow new skin faster.
So a lot of burn patients useit.
But there's just so many thingsthat they've been exploring
(32:54):
using hyperbarics for, so Idefinitely think it's neat.
I wish I could have done itbecause I probably would have
been healed faster, but I'mthankful for the people who are
able to do it because it isreally beneficial.
What's a chamber like?
So it actually you feel likeyou're on an airplane.
It feels like you're walkingonto an airplane.
It even has like the same, likeleather type seats, and I
(33:15):
believe there was six or sevenseats in it and you get in and
everybody sits in their seat andthey lock the door and then you
can see it's got dials that'llshow you the pressure, the
pressure that's changing andthey put it to a certain
negative pressure and then whatthey do is, while you're in the
treatment, they just play amovie, or you can bring a book
(33:35):
or an iPad or whatever and sitthere and no, actually you can't
bring a tablet.
So I remember I had to bringbooks, actual physical books.
But yeah, you feel like you'rejust on an airplane ride and the
treatments are usually about anhour and a half long.
So it was, it was perfect timing.
You could I.
Sometimes I slept, but thepressure was so bad that it was
a hard.
It was hard sleeping for me, soI would just try and sit there
(33:55):
and read to take my mind off ofit.
But yeah, like I said, I onlymade it through three.
It just it was too much.
Speaker 1 (34:02):
I didn't realize that you did this with, like other
people.
That is so wild.
I guess I'm thinking of like Idon't know, like float chambers
or whatever.
Where are they?
Like thinking I didn't realize.
Like legit seems like you wouldjust boarded an airplane for an
hour and a half yeah.
That's weird yeah.
Speaker 3 (34:14):
They did have private ones for people who who needed
it if they had like aninfectious disease or or like
severe burns.
They did have like privatechambers that you could do, but
this one was just kind of like agroup one.
And yeah, it was.
It was definitely neat.
It's not something that you seeall the time or hear about, so
it was pretty cool.
Bamc is the place to be when ithits the fan for you.
(34:36):
And it's crazy because we cameto San Antonio because my
husband he's in the military andhe was deployed, and our
daughter had some health issuesand I was up in living in Utah
by myself with two toddlers inthe winter while my husband was
in Afghanistan and my husbandreturned home.
On my 30th birthday on May 4thand May 10th, I had to have my
(34:57):
first Valerie section becausethe stress of all of it, I just
couldn't manage it.
I've never been like one ofthose military wives who has,
like you know, my kids, you myfirst Valerie section because
the stress of all of it, just Ijust couldn't manage it.
I'm I've never been like one ofthose military wives who has,
like you know, my kids, you knowwalk in a straight line like
little ducks in a row and I haveit all together.
No, I've never been that.
I I'm like I need my husbandhere because all the bad stuff
always happens to us when he'sgone.
So he decided to interview umand got a permanent job with the
(35:22):
gunfighters.
He's an F-16 pilot at Lackland.
He was able to come and get apermanent job here.
I got assigned to BAMC.
We were told BAMC is where yougo when it hits the fan.
That's how I met Dr Patel.
He's definitely who you want togo to if you have really,
really bad Crohn's disease,because he knows the ins and
outs of all of it.
Speaker 2 (35:43):
And he's always trying to learn new stuff.
I mean he doesn't just rest onhis laurels and say, like I know
all this stuff, he's alwaystrying to.
If something new is coming up,he's one of the first ones to
sign up to learn what'shappening.
Speaker 3 (35:56):
Yeah, he actually just did a long course in like
Crohn's specific nutrition andit's funny because they gave me
a referral after my bowelobstruction.
They gave me a referral to gosee a nutritionist in the
hospital and Dr Patel laughed.
He's like, don't waste yourtime, they don't know anything
(36:18):
about Crohn's disease, I'll helpyou.
And so he's been helping meWith this ostomy.
Now that I've had the bowelobstruction, there's actually a
lot of foods that I can't eatanymore and it's pretty similar
to the foods that I reallyshould have stayed away from
just anyway having Crohn'sdisease.
But a lot of people don'trealize.
Like I can't eat nuts anymoreunless they're really really
like finely ground up like freshpineapples off the table, any
like fresh vegetables.
(36:38):
I have to have everythingsteamed or cooked or softened,
because they explained to methat every bowel surgery that
you have creates scar tissue inthe bowels.
Explained to me that everybowel surgery that you have
creates scar tissue in thebowels.
And so a person that hashealthy bowels, their bowels
feel real slick on the insideand you just you know everything
just glides through them.
Scar tissue makes you have likethese like fibers kind of come
(37:00):
out and makes the inside of yourbowels rough and so anything
that you swallow that can't bedigested easily.
What gets passed through thatdamaged bowel with the scar
tissue can get caught on thattissue and so basically, I would
have the perfect life if Iwould just drink liquid
everything.
And I felt great for the month Iwas on a liquid diet because I
(37:23):
didn't have to really work atdigesting.
I lost so much weight and Ifelt great.
But then I also like reallymissed food.
But that's what that strictureis causing.
I'm not able to eat like moresolid meats, like steaks, or
even like the steak fajita meats, and so anything that takes my
body longer to digest and it'salready hard to break it down.
(37:43):
I'm supposed to completely stayaway from that and I'm not
supposed to have anything withfiber in it unless I'm drinking
it.
So I've been doing like greensmoothies with like the green
powder.
Those have helped a lot andthose they just go straight
through me.
They help, you know, keep meregular and I can eat like
chicken and ground beef.
Things like that are fine.
(38:04):
But anything too solid and it'svery painful to digest and I
struggle with that.
Speaker 2 (38:09):
When I had the ostomy the second time, I was so
looking forward to having anostomy again because I hadn't
been able to eat fruit for like20 years and I went really hard
and ate a lot of fruit andvegetables and I was it was like
mulch coming out in the ostomy.
I was texting Stacey Collins,friend of the show, stacey,
(38:30):
because we actually had our Jpouch surgeries at rally like
around the same time and I waslike I just I just went too hard
.
I ate fresh vegetables too closeto the sun and now I just am
producing mulch and she's likeme too many, too many vegetables
, but I was like I don't, I'monly going to have this ostomy
for a little while and I don'tknow if I'm going to ever be
able to eat it again, so I can'tstop.
(38:50):
I feel like in my situationwith the J pouch like I have a J
pouch now I am finding that I'mhaving to be very mindful when
I'm eating.
I'm pausing a lot, thinkingabout how to put that so I don't
scarf food down.
But because of some of thechallenges that I've been having
(39:11):
, like we've talked about, whenwe first got our J pouches,
stacey was on the show and wetalked a lot about gas and we
were laughing about gas andtexting each other about PSIs,
like the force of the gas comingout of our bodies, kind of
thing.
But I'm several years in and I'mstill experiencing a lot of gas
and recently I had a smallintestinal bacterial overgrowth.
(39:32):
That was the first time forthat and the amount of gas that
was produced there.
And she's like let's start withlike, chew your food even more
to help, like with thatdigestive process, to make it
easier on your body.
So I'm like every time I take abite, I just sit here and chew
until I'm like okay, this ispretty much like digested in my
mouth.
I don't know, I just chew somuch to try to help with the gas
to slow down the PSIs.
Speaker 3 (39:54):
So I did the same thing, like, especially popcorn
is like the biggest, you know,like no-no.
Speaker 2 (40:00):
I don't care, I'm eating it, I know I did too, but
I'm still eating it.
Speaker 3 (40:08):
I'm still eating it.
Yes, I did too, up until so.
I had my bowel obstruction inJanuary.
I'm telling you what I thoughtI was dying.
That was the worst pain I'veever had in my life, and so now
I'm like I'm a littletraumatized by that.
So now I'm like scared to eatthis stuff because I really
don't want to get another bowelobstruction.
Speaker 2 (40:21):
It was bad and I was that's true when the pain is bad
.
I, the couple of times that Iprobably had bowel obstructions,
I, yeah, just laid in the bed,and my husband the last time he
was like if this ever happens toyou again, I'm taking you to
the hospital, like I'm not goingto sit here and let you talk me
out of taking you to thehospital.
I'm like I'm fine and look,everything worked out, it's fine
(40:44):
.
Speaker 3 (40:44):
Yeah, I had a couple of them that weren't like a
complete obstruction, they werejust like they took some CT
scans and they're like girl, youare loaded, you just need to
like go.
I had a couple of those andeven after those I still ate the
popcorn and did all the things.
But this one we were all out ata military graduation down on
the river walk in San Antonioand I literally thought I was
(41:05):
like what is going on?
This hurts, and I made it fourhours with this pain and then I
had to go home.
I just I had to go home and Iended up getting sick when I got
home.
Well, that made it worse and Iended up collapsing and not able
to move.
It was awful and my husband hadto call an ambulance and they
got me into the hospital andthen I laid there for a week
(41:26):
with an NG tube down my nose andI'm like I was like God, I will
never eat popcorn again if youjust get this tube out of my
nose.
Speaker 2 (41:34):
Yeah, I do understand that.
Speaker 3 (41:35):
Yeah, I still got some PTSD going on from that.
But I did take my son to themovies a couple of weeks ago and
I did have some popcorn and itwas worth every bite.
It was that good.
Speaker 1 (41:47):
It was so good, apparently, chew it really well.
Yes, like Robin's tactic andjust chew and chew and chew
until it's basically popcornbutter, and then you're fine.
Speaker 3 (41:56):
Yes, and drink a ton of fluids with it too, and drink
water and you flush all thatout.
It goes right down.
Speaker 1 (42:02):
We do not provide medical advice on this show.
Everyone that's listening.
We are not providing any sortof medical or nutritional advice
.
Please consult with your doctor.
Speaker 2 (42:09):
Don't, especially me.
If you have listened to thisshow at all over the past four
years, you know that I do what Iwant.
I love it.
So definitely don't takemedical advice from me unless
I'm saying get a second opinion,because I feel very strongly
about that.
Speaker 3 (42:26):
Oh yeah, second opinions don't exist for us in
the military.
So that's why I am glad I haveDr Patel, because we don't get
second opinions unless we wantto pay a hefty fee.
Speaker 1 (42:36):
Yeah, and it is a shame that I know Dr Patel has
talked about how, like he's kindof the only guy in the military
, like he's like the one IBDspecialist and it would be great
if other people could get flownto see him.
I'm curious about that, though.
So like when you were in Utahand you were struggling with
this, did you?
You had to go to the militaryhospital system and you had to
just see their general GI.
(42:56):
How did that work?
Speaker 3 (42:57):
So we were at Hill Air Force Base in Utah and they
did not have a military hospitalclose and so in that
circumstance you're able to evenif you have TRICARE Prime, you
are able to still see what theyconsider like an off-base
provider because you have to be,I believe it's like 50 miles
away from the nearest militaryhospital.
If you do not live within 50miles of one, then they allow
(43:20):
you or they give you a referralto see an off-base provider.
So I just saw a generalgastroenterologist at that time.
My Crohn's was pretty wellmanaged when I was living in
Utah, especially when I waspregnant with my daughter and
then nursing.
Believe it or not, that was theonly time since I'm 18 years
old that I was in remission waswhen I was nursing my daughter.
(43:40):
I think the human body is justcrazy and can do amazing things
and I nursed her for up until ayear and had I had known the
Crohn's would have come backlike tenfold.
I probably would have been thatmom that like nursed until she
was a toddler just to givemyself some extra time, but
because I felt great and then amonth after I stopped nursing, I
(44:01):
got a stricture and ended uphaving to have the first
resection surgery in my my ileum, but yeah, so at that point I
didn't really need like anexpert, it was just like, yep, I
got Crohn's.
It's pretty well managed.
It had been managed at thatpoint with like Humira and
Simsia and just the injectionsand it was always just a really
small spot when they would findit, but when it spread
(44:23):
everywhere, that's when Istarted seeing Dr Patel.
So I have been blessed.
I know not everybody has thatand it is hard when you go see a
regular gastroenterologist andyou get a bill for $800 and they
talk to you for five minutes.
So I really am blessed.
And my husband's about toretire and we're considering
moving to the Houston area andone of the big reasons on our
(44:47):
list of why we want to stay inSan Antonio is Dr Patel, because
he's kept me alive this longand I I keep saying like when I
move I'm never going to have mygastroenterologist number again.
You know what I mean.
Like nobody gets that.
So I just feel really blessed.
Speaker 2 (45:00):
You mentioned that you were well during breast
feeding and this is I wanted tostop you and say any researcher
who's listening hormones,women's hormones and IBD please
study.
It doesn't necessarily have tobe focused on pregnancy or
menopause.
It should be hormones in thefemale body and IBD, because I
can tell you before I wasmenopausal, hormones affected
(45:23):
how my IBD was, even when it wascontrolled.
Speaker 3 (45:26):
Oh, absolutely, I 100% agree.
I mean I ended up having tohave an ablation because my
periods would be so heavy that Iwould lose so much blood and
then I was anemic.
And so I was anemic until I hadthe ablation done and then I
was able to stop getting ironinfusions.
At that point that was hormones.
And then, I find it interesting, I have this stricture in my
(45:50):
small bowel.
Well, I had my first mammogramon Christmas morning.
I woke up and found a suspiciouslump on my breast and I went
and saw my PCM who put in for meto get a sonogram done.
And I went to BAMC to get thesonogram done.
And BAMC automatically has aprotocol that they won't just do
a sonogram, they also do amammogram.
Even if your doctor doesn'torder it, they still do the
(46:12):
mammogram.
And I'm so glad that they didbecause they found two
suspicious lumps, one in eachbreast, and they turned out to
be benign Thank you, God forthat but one of them tripled in
size.
So I had to have a lumpectomylast month to get it cut out.
And I've had so many other likehormone issues going on and I'm
(46:34):
, I guess, flaring at this pointbecause of the structure.
So I definitely think hormonesand Crohn's disease and IBD go
hand in hand for sure.
Speaker 1 (46:42):
I mean I would be curious for the women who are on
the show, like whether whenyou're tracking, like in your
cycle, what happens, kind ofwhen you're having these
different hormone fluctuations,we're going to do our own
research study on bowel moments.
Speaker 2 (46:54):
We're just going to have everybody track their
period and let us know, are yougoing to be the primary
investigator?
Speaker 1 (47:00):
I mean, listen, yes, you and I primary investigators,
pis.
You know what?
No, we'll make Anish Patel that.
We'll make him do it, and we'llget Venetia to help with this,
and then you and I can beco-authors.
How about that?
Yes, that sounds great With youhaving a dad with IBD, with
Crohn's, and you have Crohn's.
Are you the most hypervigilantof your children's?
Speaker 3 (47:19):
poop ever.
It's funny that you say that,because my daughter is actually
having abdominal issues and bothof my kids are on the
pediatrician's watch list tostart watching for IBD symptoms.
My son is lactose intolerant.
He's old enough now he knows ifhe eats lactose.
The doctor told him she's likeI know you love that ice cream,
but you're probably going toblow the toilet out afterwards.
(47:41):
So you decide you know, and sohe still eats the ice cream.
That's his deal.
My daughter got diagnosed withsomething I don't know if y'all
have ever heard of it.
Most people who hear it arelike whoa, I've never heard of
that.
My daughter, when she was seven, got diagnosed with abdominal
migraines.
Sadly, they have found thatlike 90% of the cause is
constipation, and so my daughteronly goes if she's not on
(48:04):
Miralax every day.
She only goes to the bathroomonce a week and it's very
painful for her to pass.
And so the pediatrician said,because she's already having
these issues, that it couldlater turn into IBD, which I'm
praying so hard for her thatit's not.
I don't want her to have this.
When she was seven she missed26 days of first grade from
(48:27):
vomiting, just constant.
They typically call themabdominal migraines or cyclic
vomiting syndrome, but we'vebeen able to each year get it
down less and less because wehave a really good action plan
with our doctor.
Yeah, so I am like veryhypervigilant because I do know
that it runs in the family.
Speaker 2 (48:45):
Rachel, thank you so much for coming on the show and
sharing so openly about yourexperience with your ostomies
and having kids and our love,our mutual love of Dr Patel.
But it is time for me to askyou the last question.
So what is the one thing thatyou want the IBD community to
know?
Speaker 3 (49:00):
I want the IBD community to know that, no
matter what you're going through, there is always people out
there that are also goingthrough it and that are willing
to help.
If you are someone like me whoneeds an ostomy, do not think
that it is the end of the world.
Life can actually be great withthem and my life is great with
it and I can laugh and joke andI'm really living a great life.
(49:21):
So I just am really thankful toyou guys for having this group
and this podcast to get thisinformation out to the community
about all things IBD.
I love it.
Speaker 1 (49:31):
Oh, thank you for that.
We appreciate it.
We have so much fun getting toknow all of our guests and we've
had so much fun getting to knowyou as well.
So big thanks to Dr Patel forsending you to us, because I
think this has been such a funconversation to have with you
and I really really appreciateyou sharing both the like, the
part that started low and whereyou've been able to come,
because I think sometimes youknow, people put the brave face
(49:53):
on and they're like everything'sgreat I love my ostomy but they
don't always acknowledge thedifficulties they had in getting
to the place they are now, andso I think you providing that
light at the end of the tunnelfor some folks is going to be
super, super helpful, you know,because there's definitely some
people that are maybe in thattrough right now that are going
God damn it.
This isn't what I wanted, youknow, and this was my, my worst
(50:15):
case scenario, and now I'm I'mhaving to live my worst case
scenario.
So thank you for that.
I really that's not easy, Iknow it's not easy, so I really
appreciate you doing that.
So thank you, rachel, for beingon the show, thank you
everybody else for listening andcheers guys.
Speaker 2 (50:27):
Cheers, everybody Cheers.
Speaker 3 (50:32):
Hi, this is Rachel.
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