Crohn's Disease's impact on career and work-life

A recent study conducted by Crohn's and Colitis UK and funded by the pharmaceutical company revealed the disheartening outlook adopted by most IBD sufferers when questioned about their perceived career prospects. 75% of respondents suffering from Crohn's Disease, one of the two most common forms of IBD, agreed that the condition had negatively affected their productivity in the past seven days with 53% stating that it prevented them from reaching their full potential in the workplace and 54% regarded the disease as a significant hindrance to progressing in their chosen careers.

"When considering typical Crohn's symptoms, the results come as no surprise. Causing the body's immune system to regard food, bacteria and other materials mistakenly as foreign substances, white blood cells are dispatched to the intestines in defence, ultimately causing chronic inflammation. Crohn's disease can affect any part of the gastrointestinal tract but in most patients the last part of the small intestine (or ileum) and colon are involved with common symptoms including abdominal pain, diarrhoea and fatigue. Some patients experience extra-intestinal manifestations of the disease such as arthritis, causing joint pain, stiffness and reduced mobility.

"Living with Crohn's disease is tough, excelling in one's career is very challenging," explains Dr David Epstein, a gastroenterologist in private practice at Vincent Pallotti Hospital, Cape Town.

The study also found that the disease dictates career choice with the majority of respondents (56%) agreeing that they would rule out certain professions that they would otherwise have considered. Dr Epstein agrees. "Crohn's is unique in that it affects gastrointestinal function, which may be embarrassing in the work environment. Frequent bathroom visits, excessive flatulence or rumblings from a stoma bag can be very embarrassing for a Crohn's patient during a meeting or in an open office setting. A career involving travelling will be exceptionally difficult for most Crohn's patients."

One of Dr Epstein's patients, a 46-year-old businessman, has first-hand experience of the anxiety and career limitations that goes hand-in-hand with the disease. "If I was not familiar with a client's offices, I would find two key locations immediately after arriving. The first would be the nearest bathroom and the second, a quiet office to recover from the predictable onset of exhaustion or incessant shivering. The indescribable fatigue also meant that I was unable to keep up with the pace of corporate life, further exacerbated by a low level of awareness and understanding from my employer," he explains.

Some work harder

In contrast, some of Dr Epstein's patients believe that the disease has enabled them to push themselves harder when it comes to their career. One patient says, "I give more effort at work to make up for any shortcomings that result from my IBD." The sentiment is mirrored in the Crohn's and Colitis UK and AbbVie Pharmaceuticals' study with 57% of respondents suffering from Crohn's Disease stating that they work harder to compensate for their condition.

More often than not, the extra effort translates into significant lifestyle and dietary compromises, as patients attempt to ensure they can cope with a working environment that is generally not geared to their disease and its unique challenges.

Regular meals essential

According to Adéle van der Merwe, registered dietician in private practice at Donald Gordon Medical Centre, specialising in bowel surgery from Crohn's, ulcerative colitis or cancer, the last thing a Crohn's patient should do is skip meals in an attempt to keep symptoms of diarrhoea and nausea at bay.

"Regular, small meals, especially starchy snacks are key and will actually improve symptoms of diarrhoea and complications like strictures. I typically advise these patients to follow a light to moderate soluble fibre diet that is low in fat and strong spices. Seeds, pips and skins should be avoided as far as possible, as these foods could further aggravate both diarrhoea and constipation. Supplements are also exceptionally important if you suffer from Crohn's with Vitamin D and Calcium supplements an absolute must."

Other lifestyle changes that can make a world of difference, says Dr Epstein, include quitting smoking, keeping stress levels as low as possible and incorporating a mild-intensity exercise regime into your daily routine. "While there is no cure for Crohn's Disease, recent medical advancements, particularly in the field of biologics, have also widened the field of treatment options and subsequently, the potential of leading a normal life and ultimately limiting the condition's impact on patients' careers."

HR role needed

The role of corporate South Africa, says Dr Epstein, cannot be ignored. "Employer education is key in resolving many of the work-related problems Crohn's patients will encounter throughout their journey. Sadly, most employers and HR personnel have little to no knowledge of the disease and are often unaware that they can make a considerable difference in the life of a Crohn's patient."

Flexible working hours, acknowledging that Crohn's patients may experience unpredictable flares or facilitating access to a bathroom are small, but significant, changes. "One of my patients experiences flu-like symptoms following injected treatment and may work from home on these days. Another patient's cramps and diarrhoea are more prevalent in the mornings and her employer agreed on flexible hours to accommodate her condition. Other patients have been given exclusive use of certain bathrooms in the office to assist with the disease's sometime embarrassing symptoms. While these examples may seem immaterial to most, they are of indescribable value to an employee who suffers from Crohn's," Dr Epstein concludes.

For more information, go to www.ccfa.org.