Prabha, more often known endearingly as “Sipi” Bhandari, is a lot of things. Previously, general counsel of Deutsche Bank Securities Inc., and global head of its mergers and acquisitions (M&A) business, Sipi recently transitioned to senior vice president, principal deputy general counsel at the federal home mortgage company, Freddie Mac, where she specializes in mortgage securitizations, corporate securities, disclosures, and corporate tax. Sufficient enough to state, Sipi is an incredibly successful lawyer. In addition, Sipi is a devoted mother of two young children, both of whom she lovingly deems, “city kids” as they’ve spent their entire lives growing up in Brooklyn, New York. She loves to cook and aspires to be half as good a chef as her mother, who can whip up anything out of practically nothing, with the results being consistently and amazingly delicious. More than anything, Sipi loves to be outdoors with her husband, their 10-year-old daughter and 13-year-old son, whether locally or on their many travels. Most recently, she is learning the rewards and frustrations of gardening, an activity she has picked up during these quarantine times. Alongside all of these things, Sipi is one of 750,000 people in North America living with ulcerative colitis (UC), a chronic inflammatory bowel disease (IBD) for which there is currently no cure.
Similar in nature to Crohn’s disease, an IBD which affects the upper part of the colon, ulcerative colitis results in the formation of painful ulcers on the lower part of the colon. People suffering from UC describe their experience with the disease in terms of “flares” and “remission”. During flare-ups of UC which last for days or weeks at a time, patients experience severe, sometimes debilitating, symptoms such as diarrhea, blood and mucus in stool, abdominal and rectal pain, an intense urgency of bowel movements. The period of time for patients of UC wherein active flare symptoms subside is known as “remission”; windows of which vary greatly in duration but can range between months, years, and even decades. One of the hardest parts about ulcerative colitis for those living with the condition is the knowledge that they could have a flare-up at any moment and anywhere. For Sipi, this means always taking steps to be prepared for a flare by keeping underwear and an extra change of clothes on her at all times and making sure, wherever she goes, she always knows where the nearest washroom is. Long-term, UC can lead to osteoporosis, increased risk of blood clots in veins and arteries, and a heightened risk of colon cancer. Accordingly, all individuals living with UC are advised to have regular colonoscopies to make sure any signs of colon cancer are detected early on.
Like most individuals diagnosed with UC, Sipi first experienced symptoms of the disease in her early 20s. As a senior in college, Sipi was preparing for her last set of final exams when she began having severe abdominal pain and an urgent need to go to the bathroom that she had never experienced before. To her great surprise, Sipi began finding blood and mucus in her stool. “A lot of college students don’t have the life experiences to understand how to deal with something like that,” Sipi said, “and I was one of those people”. While managing the stress of her imminent final exams and graduation, and being hundreds of miles away from her parents, Sipi found herself completely unsure of what to do next nor how to react to what she was seeing and feeling. She was, in her own words, “kind of freaking out”. Fortunately, the father of her former classmate (and now husband) was a general surgeon who insisted she come to him so that he could diagnose her and provide her with good care. It was then that she was diagnosed with the condition, ulcerative colitis. In some ways, it was a relief to have a diagnosis. In other ways, it was rather scary.
This was Sipi’s first “flare-up” in a series of the many more she would experience throughout her life. Moreover, it was representative of those that followed in that it was centered around a major stressor in her life. While there is no concrete evidence regarding what causes ‘flares’ or even what causes UC in general, it is common to hear patients of UC voice that, just like Sipi, their symptomatic flares tend to be triggered and/or exacerbated by extraordinarily high levels of physical or emotional stress. It shouldn’t come as a surprise, then, that Sipi’s next flare happened to occur just as she was finishing up law school, right before she was to take two bar exams.
In addition to stress, there are several factors, both genetic and behavioral in nature, that are suspected to cause and/or contribute to more severe flares of UC. Yet, at the end of the day, so little is known or scientifically proven about the nature of IBDs like ulcerative colitis and Crohn’s disease that most people who live with these conditions are left largely on their own to figure out what treatments and lifestyles work for them. Many patients are advised by medical professionals to stop consuming certain foods that are high in spice or fiber and/or that contain dairy or caffeine, but most of this advice is rooted in purely anecdotal evidence rather than scientific proof. Sipi has found reducing her consumption of raw leafy greens, nuts, gluten, and other hard to digest foods during flares to be most effective in managing the intensity of symptoms and shortening the duration of her flares. Unfortunately, the types of foods that are most disruptive are also the foods Sipi tends to like the most!
For many, ulcerative colitis can be very socially isolating. As Sipi states best, “UC is a disease about the bathroom,” and these conditions are not so easy to talk about. Moreover, for many individuals with UC, “flare” symptoms are often made significantly worse by social interaction. The stress of having to carry a conversation or knowing that one will need to interrupt a conversation or social gathering by literally running as fast as one can to a bathroom can lead many to not engage with family and friends in the same way one otherwise would. Working in an office environment is incredibly challenging. Over the course of her career, Sipi has had to put many conference calls on hold or run out of meetings without explanation to avoid accidents.
Sipi experienced a particularly debilitating flare that began on her 35th birthday during a trip to Mexico. Sipi returned early to NYC and was hospitalized for two weeks because she also happened to be pregnant with her first child, and her doctor was concerned about the effects of the UC on the developing fetus. For many patients, pregnancy can actually put a UC patient who has active flares into remission; for a significant minority, however, pregnancy can put an otherwise asymptomatic patient into a flare. Dealing with the combined stress of going through a flare and being pregnant, Sipi did not want to be around any of her friends and family members with whom she otherwise would love spending time with. Not only did she feel slightly embarrassed having to talk about what she was going through, but the pain and urgency she was experiencing were intensely exacerbated when others came to see her. That developing fetus eventually turned into a fully developed boy, who now towers over Sipi 13 years later! A few years later, Sipi was pregnant again. However, in the span of those few years between pregnancies, the medical advice changed with regards to which medications were safe to take to manage UC symptoms during a pregnancy. With her doctors’ knowledge (but not necessarily with their support), Sipi chose not to take any medications to aid in abating her flares, either during the pregnancy or while she nursed her daughter. Accordingly, managing the flare during her second pregnancy and aftermath was particularly difficult for Sipi as she experienced more severe symptoms and feelings of extreme discomfort.
During that hospitalization, Sipi fondly remembers a friend who would come to the hospital during this really hard time and leave Sipi’s favorite (and UC-safe) foods with her nurse each morning without actually insisting on going in to see her. “She understood what I was going through but didn’t get offended by my not wanting to see her,” Sipi explained. “That’s how I knew she really understood how difficult it is”. For anyone with a loved one living with UC, I think this is really the biggest takeaway. While time and space physically by oneself is often necessary for individuals with UC, we must remember that it really takes a village to deal with a chronic illness, such as ulcerative colitis. Going through flares is incredibly difficult, painful, embarrassing and entirely exhausting for individuals living with UC. It’s incredibly important for friends and family to help patients feel as though they are not alone as they live through this often isolating disease, while also being supportive and non-judgmental about both the physical and emotional/psychological effects of the disease. To that end, one of the things that has helped Sipi over the years, particularly in the office, is to educate friends, family and colleagues about her condition and how it could affect social and business interactions. It is this reason that Sipi was particularly excited to talk about her experiences with UC with The Indian Scene. Sipi has been pleased to see an increasing focus on UC and Crohn’s public service announcements in the media too.
In all, Sipi has made sure never to let her UC detract from her life, even to the extent of going to work every single day during one of her most recent flares. While this meant having doctors often reproach her for “doing too much” and expressing shock that she was “living the life that she was living”, Sipi is proud to live every day without letting a chronic illness control her life. “There’s nothing I limit myself from due to my UC,” Sipi explained, “but there are a lot of things I have to do so that I can still live life”. With continuing to take part in the things she loves, such as going out to dinner with family or going on vacations with friends, Sipi has learned to always be prepared. She has learned to always keep an extra packet of underwear in her desk drawer at work and a shawl on her chair, and to keep wipes, toilet paper, and an extra change of clothes in her car in case of a spontaneous flare-up. Yet, even so, Sipi maintains that UC is not something that can ever be fully managed or totally planned for. Accordingly, Sipi believes that living with ulcerative colitis has made her more empathetic and understanding of people who live with all sorts of conditions, be it illnesses or other dynamics. People all around us live with and thrive despite all sorts of circumstances. As Sipi emphasized, we should not judge others, as one “never knows what it’s like to live in somebody else’s shoes.”