In 2008, after the second misdiagnosis of the terrible wasting disease that had me bedridden and wretched, I sought the opinion of a colorectal surgeon. He did a cursory (yet still excruciating) examination and pronounced me “severely diseased,” a horrifying phrase to hear while lying on a doctor’s table. He said that when I found a new gastroenterologist we needed to reconsider the possibility that I had Crohn’s disease. Which, of course, I did. I started monoclonal antibody treatment for it in 2009 and began to improve. Crohn’s does flare intermittently, but I’ve responded well to the biological medications, and in the last few years suffered only rarely.
Yesterday I had my first colonoscopy since I was originally diagnosed. It was possible that my doctor would find evidence that my disease was still active–not enough to be symptomatic, but still enough to require more medical intervention. That didn’t happen, though. From looking at my colon and ileum, he couldn’t even tell I had Crohn’s. The words I get to take away from this examination are, “complete remission.” That’s a phrase I like much better.
This is our target: tumor necrosis factor alpha. This cytokine has been identified as the molecule the enemy is using to regulate its illegal inflammatory actions. Without TNF-alpha, the insurgents will be unable to continue clear-cutting our villi and ulcerating our viscera. Their hidden macrophages will be rendered impotent, their detestable engines of apoptosis will grind to a halt. We have the intelligence we need to end this war. And, soon, we will have the means to act on it. But we can’t do it alone; to strike this blow, we will need to accept help from an unusual source.
The operation, code named “Project Humira,” will involve the introduction of an extra-corpus produced molecule called adalimumab. It is an antibody designed to target TNF-alpha directly. We currently lack the means to manufacture this antibody ourselves, but we have negotiated what we believe will be a steady supply, to be introduced into the circulatory system from without. It is our belief that, with this antibody at our disposal, we can downregulate the insurgents’ inflammatory activity and finally end their destructive madness. The unique and irreplaceable tissues of the digestive tract will be preserved for the appreciation and benefit our daughter cells and their daughter cells after them, down through the generations. We will know homeostasis in our time. Victory will soon be ours.
