DEAR DR. ROACH: I need some hope. My 24-year-old granddaughter, recently married, came down with ulcerative colitis. Right now, she is getting two Humira injections a month. She has lost so much weight and her diet is so limited. Do things normally get better? Will she ever be able to become pregnant? It has been about four months. She is presently seeing a GI doctor. Should she be under the care of a specialist? — L.M.O.S.
ANSWER: Ulcerative colitis is one of the inflammatory bowel diseases. The underlying cause is not known, but there is a familial predisposition. Women are more often diagnosed, and the leading time of diagnosis is in the 20s.
There is a wide range of severity, with some people doing well with topical treatments (suppositories or enemas), some needing oral medication, and people with more severe disease needing much more powerful agents, such as the adalimumab (Humira) your granddaughter needs. Fortunately, those kinds of drugs have approximately a 60% to 70% success rate.
Diet is important for people with UC of any severity; however, as the disease becomes better controlled it is likely that she will have a less restricted diet.
A GI doctor is a gastroenterologist, the specialist for inflammatory bowel diseases. There are some gastroenterologists who specialize even further, making IBD their area of particular expertise.
Pregnancy is certainly possible in women with IBD. However, they should be in remission before attempting pregnancy, and her medications may need to be adjusted for maximum safety.
There are many places to get additional information, but I recommend the Crohn's and Colitis Foundation website as an excellent starting point. It can be found at www.crohnscolitisfoundation.org.
DEAR DR. ROACH: Last year, I started getting Raynaud's. I can remember from my youth that my father had it, so it didn't seem too terrible. It's not just the fingertips that turn white, but also some of my toes are affected.
I asked people who know of it or have it how one gets this. What is the cause? No one knows. So I asked my doctor. Even he said he did not know.
How do I get these episodes, and what can I do to prevent them? — R.S.
ANSWER: Raynaud phenomenon is an exaggerated response to cold or stress, causing color changes in the skin of the fingers and toes. There is a long list of causes of Raynaud phenomenon. Often, no cause is ever found (in which case it is called primary Raynaud, which just means we don't know what's causing it). The most common known causes are the autoimmune rheumatic diseases, especially scleroderma, lupus and Sjogren's syndrome. Hypothyroidism is an unusual cause, and some drugs can cause it as well.
The current thinking is that primary RP is caused by abnormalities in the alpha receptors in blood vessels (alpha receptors respond to adrenaline and similar molecules).
Keeping the whole body -- and especially the hands -- warm is the first step. Sudden temperature changes can trigger the effect. Warming the hands in warm water at the onset of an attack can stop it. Anxiety makes it worse, so a positive attitude can really affect this condition. Medications, such as amlodipine, may be necessary for prevention in more severe cases.