Doc: Pregnancy possible with ulcerative colitis
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?
Dear L.M.O.S.: 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 percent 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: I am a female, 86 years old and in good health. In the past 20 years, I have noticed my alkaline phosphatase numbers climbing. My primary doctor had been concerned over the years but could not find the reason nor evidence that it was affecting my health. He consulted other doctors who agreed with him to keep an eye on it, but there seemed to be no great concern. He has since retired, and in the past few years, the numbers keep going up.
My most recent labs showed alkaline phosphatase of 252 units per liter, and the bone isoenzymes were 176 and liver 76. Can you help explain what’s going on?
Dear M.C.R.: Alkaline phosphatase is an enzyme that is made in several organs of the body, including the liver, bone and placenta. When the level is elevated, it is often assumed to be coming from the liver, since that is most common, but one of your doctors was compulsive and found that it’s the bone form that is responsible for your elevation, since your liver isoenzyme level is normal, and the bone level was high (normal is 12-43 in most labs).
An elevation in bone alkaline phosphatase can happen due to bone injury (such as a healing fracture), too-high thyroid levels, abnormal parathyroid hormone levels and bone tumors. However, by far the most common cause for someone your age, at least in my experience, is Paget’s disease. This disorder of bone metabolism often comes without symptoms, although some people will have pain. The cause is unknown, but it involves accelerated bone remodeling by the special bone-absorbing cell, the osteoclast.
I recommend you ask your new doctor about a referral to a Paget’s disease specialist, such as an endocrinologist, to determine if the diagnosis fits and whether treatment is necessary. Treatment depends on the number and location of active bone lesions. If necessary, it’s usually treated with a course of a bisphosphonate, the same kind of medicine often used for osteoporosis.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.