We all have goals in life. Inflammatory bowel disease (IBD) can sometimes get in the way. It’s not ideal, but that’s the reality.
However, the goal of treatment should be to get us back to doing what we love to do, and minimize the effects of Crohn’s disease or ulcerative colitis on our lives. Our doctors also have goals for us. These goals might be different, but they’re all important in getting symptoms and inflammation minimized and living life on our terms again.
The Treat to Target Strategy
We call the strategy of identifying goals and working to achieve them treat to target. But what is treat to target and what does it look like in practice for patients and healthcare providers?
I decided to talk to Dr Neil Nandi, Associate Professor of Clinical Medicine and IBD specialist at the University of Pennsylvania, Perelman School of Medicine and Jacklyn Green, ulcerative colitis patient, writer, and IBDMom, about the idea of treat to target from both sides of the question. We recorded our conversation for About IBD Podcast Episode 109 – Colitis Conversations: Treating to Target.
When I asked for a definition, Dr Nandi replied that “Treat to target means that doctors have certain goals of care when it comes to helping a patient with inflammatory bowel disease feel better and get better.” He goes on to describe how this can include checking markers of disease and ensuring that they’re moving in the right direction to support achieving both short-term and long term goals.
Dr Nandi describes some of those tools, including:
- Colonoscopy to check for mucosal healing
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- Fecal calprotectin
Starting With Baby Steps
For the sickest patients, such as those who are malnourished and aren’t on the right treatment yet, that can look like “baby step goals.” Dr Nandi points out that this “…might just be, let’s introduce nutrition, let’s gain weight, let’s get physical therapy going, let’s get you back to less times in the bathroom. Just small goals, but making progress.”
Patient advocate Jacklyn Green remembers when she lost a lot of weight and muscle mass and the small goals she set for herself to get back to her life. “I had a corgi and it was nothing to pick him up and carry him upstairs,” she remembers. “When I got home from my stint in the hospital, I couldn’t pick him up. And so my goal became getting strong enough to pick my dog up again. And then from there, it was, can I do a plank? Can I get back to yoga? Can I make it this far without running to the bathroom?”
Once on the path to getting inflammation and symptoms under control, Dr Nandi points out that this is the time to think about going further. “Once we’ve rebuilt you and you have done all the work that it takes to get there, which a lot of the credit goes to our patients for taking the meds, and going to the visits, and getting the labs and stool studies done, once they’ve done that and they’ve gotten better, then we can start thinking about even bigger goals.”
Jacklyn Green relates how she took the idea of treat to target and used it to motivate herself. “When you’re making the goals,” she advises,”be honest, and then you have to keep those appointments and take the medication, follow the plan. If there’s a problem, bring it up.” She says that she found an element of empowerment in this path as well. “I just think you really have to use your voice and speak up for your body or, who else is going to do it?”
Keeping the Target in Sight
It’s true that the way back from a flare-up can be a long journey, and that it is sometimes filled with both ups and downs. But Dr Nandi provides hope. “It’s a heavy weight, it’s frustrating,” he acknowledges. But I think redirecting and saying, no, I will get there: It’s just going to take steps to get back up there, incremental steps…and you will.”
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Prefer to read a transcript? You can read a transcript of About IBD Episode 109 – Colitis Conversations: Treating to Target here.
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