New class of drugs often controls ulcerative colitis
DEAR DR. DONOHUE: I've suffered from ulcerative colitis since I was 16. I am now 21. My mother passed away two years before my diagnosis from complications of the same disease. No medicines helped her. I've taken a laundry list of medications. They work for about three weeks and then stop working.
I can have up to 20 bowel movements a day, occasionally with blood in them. My doctor says the only other medicine that has a chance of working is Remicade. I researched it, and found that most people get relief that lasts only six months to a year, and it has side effects such as cancer and death. I have stopped all medicines for a year and a half, with slight improvement. My stools are still loose, but have dropped down to seven to 10 times a day. Can you give me info on new medicines or new methods to combat this disease? -- P.
ANSWER: With ulcerative colitis, the colon is studded with ulcers (sores). Diarrhea, abdominal pain and weight loss are the manifestation of this illness. Often, it runs in families.
The initial medicines for ulcerative colitis are sulfasalazine, Pentasa and Asacol. If they don't calm the inflamed colon, prednisone is turned to. Cyclosporine is given intravenously when the illness is unresponsive.
Remicade (infliximab) is a newer medicine that soothes the colon by neutralizing a body-made substance called TNF (tumor necrosis factor), a material that promotes inflammation and ulcer formation. It's also used for Crohn's disease (another inflammation of the digestive tract) and for illnesses like rheumatoid arthritis. Many of these patients, including those with ulcerative colitis, have enjoyed a long remission from their illness. Another newer medicine for ulcerative colitis is Humira (adalimumab). It has shown promise for control, should Remicade not work.
Remicade does have serious side effects. Deaths are truly infrequent, infinitely less than automobile deaths. Lymphoma, a cancer of the lymph nodes, has appeared in some users, but the incidence is small.
Have you discussed with your doctor the possibility of colon removal? I know a busy doctor who greatly suffered from ulcerative colitis and had to cut back on his work. He had his colon removed. Now he's practicing at the same feverish pace at which he practiced as a new doctor.
DEAR DR. DONOHUE: I contracted restless leg syndrome. It affects me mainly at night. I take one and a half tablets of pramipexole to allow me to get to sleep. The side effects, however -- tiredness, for one -- last well into the next day. Will RLS be with me for the rest of my life? I am 87. -- P.D.
ANSWER: Restless leg syndrome is a jitteriness and often painfulness that arises in the legs when a person sits or, more often, when the person lies down in bed. The sensations drive a person to get up and move about for relief. Have you tried any nonmedicine treatments, like a warm bath before bedtime along with massage of the legs? You might be able to cut back on the dose of your medicine.
People have told me that their restless legs have become normal in time. Others have told me differently -- their restless legs have stayed with them unless they used medicines on a constant basis. The course of this disorder is unpredictable.
The pamphlet on restless leg syndrome and nighttime cramps explains these common maladies. To obtain a copy, write: Dr. Donohue -- No. 306, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. along with the recipient's printed name and address. Allow four weeks for delivery.
DEAR DR. DONOHUE: Please say something about the treatment for hydroceles. Will wearing a jock-strap supporter help? -- G.G.
ANSWER: A hydrocele is a collection of fluid in a sac within the scrotum. Permanent correction involves surgically removing the sac. A jock strap won't be helpful. If the fluid collection is small and not bothering you, it can be left alone. You should, however, show it to your doctor.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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