Life Without Limits

What does it take to change a life? A new job? A new house? For Beth Toppins, it was an operation. "I was so used to being sick," she says, "I didn't know what it was like to be well."

Difficult to believe, looking at the face of this young West Virginia native. But in 1995, while an undergraduate at Marshall University, Beth Toppins fell victim to waves of baffling and embarrassing symptoms. There was fever. There was diarrhea. There was rectal bleeding.

"After several tests," she says, "they diagnosed my condition as ulcerative colitis."

Ulcerative colitis is a chronic inflammatory disease that affects the lining of the large intestine. The inflammation is characterized by tiny ulcers and small abscesses that flare periodically and cause bloody stools and diarrhea. For a college student, embarking on a life of friends and activities, it was devastating.

"It limits your social life, the places you can go, or the distance you can travel," recalls Ms. Toppins. "You can never stray to far from a restroom."

Nonetheless, Ms. Toppins completed a pre-med program at Marshall, and went on to medical school. Even healthy students find medical school grueling. Having ulcerative colitis, Ms. Toppins began missing as much as a week at a time. Her West Virginia gastroenterologist recommended that she go to The Cleveland Clinic.

Ulcerative colitis cannot be cured by medicine. In especially severe cases, the treatment involves the surgical removal of the entire colon and rectum -- especially since ulcerative colitis is associated with an increased risk of colon cancer. It was determined that Ms. Toppins would require this procedure.

Most patients who have their colon and rectum removed emerge from the operation with an opening, or stoma, in their abdominal wall. These patients must wear an external pouch for the rest of their lives, to collect the body's wastes.

However, there is a newer procedure that avoids the stoma or external pouch. It is called the pelvic pouch, or ileal pouch anastomosis (IPAA).

In this procedure, after the colon and rectum are removed, the small intestine is used to form an internal pouch or reservoir that will serve as a new rectum. This pouch is stitched to the anus, allowing for nearly normal bowel movements. Depending on the shape, the reservoir is called a J-, S-, or W-pouch. This procedure is frequently done in two operations and requires a temporary ileostomy in between.

While it is a big improvement over having to wear an external pouch, up until 1997, the pouch procedure still left patients with problems of continence and control. However, in that year, The Cleveland Clinic introduced an important variant on the procedure involving surgical staples that overcame these problems.

"The pouch procedure is just one option in the treatment of ulcerative colitis," says Victor W. Fazio, M.D., chairman of The Cleveland Clinic’s Department of Colorectal Surgery. "It may not be for everyone. But in following our patients after their surgery, and measuring the quality of their lives, health, restoration of energy and function, the success of the pelvic pouch is well established."

Ms. Toppins, now Dr. Toppins, was the 2000th Clinic pouch surgery patient. Today, she continues her post-graduate medical training at Cabell Huntington Hospital in West Virginia. She has perfect control of her intestinal function. "I haven't missed a day of work during my residency," she says. "And I haven't had a sick day related to this condition."