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A colonoscopy that comes back normal can feel like relief, until your body keeps proving something is wrong. We sit down with Dr. Matthew J. Simpson, a family medicine physician in North Carolina, to unpack how he lived with Crohn’s disease symptoms for years without a clear diagnosis, and why a perianal fistula finally forced the medical system to see the full picture. If you’ve ever been told your labs look fine while you’re dealing with bleeding, urgency, fatigue, or weight loss, you’ll hear your reality reflected back with empathy and precision. 

We talk about what it’s like to chase answers while living outside a major medical hub: limited local gastroenterology options, slow referral pipelines, insurance approvals, and fragmented care between GI, colorectal surgery, and imaging. Matthew walks us through the flex sig, MRI findings, and the moment he realized he needed an IBD specialty clinic and an academic medical center approach. His story is a clear reminder that “not unreasonable” care can still be the wrong pace when your health is sliding. 

Then we get practical. Matthew explains perianal fistulas in plain language, what a fistulotomy does (and does not do), and why healing often requires treating the underlying Crohn’s inflammation. We also dig into shared decision making for Crohn’s medications, including how he weighed biologic options, risk communication, and the added complexity of carrying a BRCA2 gene mutation. Along the way, we challenge overreliance on single tests like fecal calprotectin and zoom out to the bigger point: algorithms are helpful, but they are not your lived experience. 

If this conversation helps you feel less alone, please subscribe, share it with someone navigating IBD, and leave a review so more people can find the show.

Links: 

• What is anorectal manometry?- Cleveland Clinic
• Fistulotomy- Cleveland Clinic

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