Bathroom sprint has a quick fix
Working in remote locations, at odd times and under pressing deadlines is par for the course for film director William Lai. But earlier this year, Lai (whose name has been changed for patient confidentiality reasons) had to grapple with a distracting and disruptive inconvenience: diarrhoea, accompanied by copious amounts of blood.
The intensely driven director was barely fazed, although running for the bathroom five to six times a day was annoying. He shrugged it off as haemorrhoids.
Although Lai also had some abdominal pain and cramping (which disappeared after he went to the toilet), and had lost a little weight, he did not think he needed to see a doctor. He felt fine otherwise, and just assumed the diarrhoea would resolve itself.
But after one month of bloody diarrhoea turned to three and showed no signs of abating, a friend strongly recommended that Lai see Dr Annie Chan On-on, director of the Gastroenterology and Hepatology Centre at the Hong Kong Sanatorium & Hospital, just to be sure that nothing more serious was afoot. Lai finally gave in.
Chan lined up a number of tests. First, blood tests showed that Lai had an elevated white blood cell count of 15,000 per microlitre of blood, instead of a healthy person's 4,000 to 11,000.
He also had mild anaemia: instead of 13-17 grams of haemoglobin per decilitre, he only had 9.9. This meant that he was suffering some blood loss.
More significantly, Lai's blood test showed that he was suffering from inflammation somewhere in his body - his erythrocyte sedimentation rate (ESR), a marker for inflammation, was sky-high at 81 millimetres per hour. Normal levels are only 0-15mm/hr.
While Chan knew that Lai was likely suffering blood loss and inflammation in his colon, she needed to know the cause. She ran a stool sample test, which showed that while there was a lot of blood in the stool, there wasn't any bacterial infection, amoeba or parasite that could have caused Lai's symptoms.
Chan now suspected that Lai had ulcerative colitis - one end of the inflammatory bowel disease (IBD) spectrum, with Crohn's disease on the other end. While ulcerative colitis only affects the large intestine and superficial lining of the intestine, Crohn's attacks the large and small intestines and penetrates deeper into the tissues. The condition can also cause much more severe symptoms and problems such as ulcers, abscesses, and perforation of the intestines.
In ulcerative colitis, the immune system is abnormally and chronically activated in the colon despite the absence of any known invaders that would normally be required to trigger inflammation.
It is very rarely found in the Chinese population, and tends to affect Caucasians. But in recent decades, more and more Chinese have been found to suffer from this chronic condition.
Chan says it is possible that as more Chinese adopt a Western diet, lifestyles and environments, the conditions that predispose one to ulcerative colitis may become replicated. Unfortunately, because the causes of ulcerative colitis are unknown, it is hard to say for certain what those conditions might be.
To confirm her suspicions, Chan performed a colonoscopy on Lai. A flexible tube with a fibre optic camera was inserted into Lai's anus and large intestines so that Chan could visually inspect his bowels. She found that his entire colon was inflamed, meaning that he had pancolitis, or universal colitis. A biopsy confirmed the diagnosis.
In some manifestations of the disease, inflammation can be limited to only certain portions of the bowels, such as the lower part of the colon (rectum), the rectum and a short segment of the colon, or a larger portion of the large intestine.
Thankfully, although the area of inflammation was extensive, the degree of inflammation was relatively mild and could be easily controlled. Lai was given an anti-inflammatory medication, Salofalk, which he took orally. He was also given medication in enema form (an injection of liquid into the colon through the anus), as it is more effective in resolving a bad flare of inflammation, especially in the left-side colon where Lai tended to be more vulnerable.
The medications have successfully controlled the inflammation, and Lai has been diarrhoea-free for four months.
However, ulcerative colitis is a chronic disease without a cure. As such, the medications can only keep the symptoms at bay, and there is always the chance of a relapse.
Because the disease also increases one's chances of developing colon cancer after eight to 10 years, Lai will need to undergo annual colon exams and a colonoscopy in five to 10 years' time.
In the meantime, Lai is back to his hectic lifestyle - relieved of frequent bathroom breaks.