Questions Answered By Expert
Sushila Dalal, MD
Assistant Professor of Medicine
A: Treatment of depression and anxiety are very important parts of your care, and very important parts of your overall well-being. However, anti-depressants cannot control the inflammation caused by your UC. Amitriptyline may have helped slow the diarrhea, but again it was not treating the underlying immune over-activation that is causing inflammation in your colon. In addition to treating the anxiety and depression, it is also important that you get on effective medication to treat your UC. From the medications listed, it does not appear that you are currently on any UC therapy, and it will be important to work with your gastroenterologist to find an effective therapy for your to control the inflammation, and, in turn the diarrhea. hide answer
A: Vitamin B12 is an important vitamin needed for red blood cell production, proper functioning of nerves, and even making DNA in new cells. The human body cannot make its own vitamin B12, and in the diet vitamin B12 comes in the form of animal based foods. Most B12 is absorbed in the distal terminal ileum of the small intestine, an area often affected by Crohn’s disease. Lab measurement of B12 levels is not exact, and we usually aim for levels >300 pg/mL in order to be on the safe side because B12 is so important. The most reliable method of supplementing vitamin B12 is through shots, but it is also possible to take high dose pills (1000-2000mcg a day), pills that go under the tongue and are directly absorbed into the blood, or by nasal spray. No good studies have been done comparing the efficacy of these methods in Crohn’s disease patients, so it is important to have the B12 level re-checked after you and your doctor have selected a way to supplement your levels. Vitamin D is important for bone health, and may be involved in the immune response as well. We generally aim for vitamin D levels above 30ng/ML, which can likely be achieved by taking a daily oral supplement of Vitamin D3 600-1000 IU daily if you level is between 20-30. hide answer
A: Pyoderma gangrenosum is a rare skin condition that can be associated with UC. Because it is rare, there is not much data available. We do know that the rates of response to Infliximab (Remicade) and Adalimumab (Humira) have been high, though unfortunately, nothing is 100%. The information we have is limited to a few people, but it suggests that patients often saw some improvement with a few weeks of starting an anti-TNF medication like infliximab or adalimumab. However, complete healing often takes several months. hide answer
A: HIdradenitis suppurativa(HS) is not a symptom of Crohn’s disease, but there does seem to be some relationship between the two disease—people who have one of the two conditions are more likely to also have the other. HS is often treated by dermatologists, as it is a condition of the skin. Some possible treatments include antibiotic creams, steroid injections, or oral antibiotics. For more severe disease, treatment with medications that are also used for Crohn’s disease, such as infliximab (Remicade) and adalimumab (Humira) have also been used. hide answer
A: When an abscess develops, this indicates that the Crohn’s inflammation has burrowed all the way through the intestine wall, and has actually made a hole in the intestine wall. The little hole in the intestine allows the contents of the intestine to leak out into your abdomen, and you body defends itself by walling off the area and creating an abscess. Surgery is required to fix that hole in the intestine wall, because medicines are not able to do that. hide answer