DEAR DR. GOTT: My 19-year-old son was recently diagnosed with ulcerative colitis. He has been so severe right from the start, it always gets him into the emergency room at least twice a week and lately, even more frequently than that. In the last three weeks he also had a piece of his large intestine removed because one of the ulcers just didn’t want to quit bleeding. It also made his blood septic and now the doctors are telling him that his left ventricle on his heart is damaged from being septic for so long.
Doctors are telling him not to be working at all so his heart can repair itself. Is that even possible? He is a young man and finally got a job at an airport — something he has wanted for a long time now. He also was going to school to be an air traffic controller which he just found out he cannot be now due to his heart condition. The airport wants him to resign from work since they are afraid something will happen to him.
Isn’t there anything we can do to make his life somewhat better? All he wants is to be working at the airport and go back to school which he couldn’t do this semester due to the surgery. You once stated ulcerative colitis runs in families but we have nobody with this illness, only an uncle of my son that passed away from colon cancer.
DEAR READER: For my other readers, ulcerative colitis (UC) is a chronic inflammatory bowel disease. It can be debilitating and can have severe complications that develop over time, rather than suddenly.
Symptoms depend on the specific location of the disease. For example, proctosigmoiditis refers to the lower section of the colon and rectum. Left sided colitis affects the upper left portion of the abdomen. Ulcerative proctitis occurs in the area closest to the rectum. Pancolitis can affect the entire colon. Finally, fulminant colitis is a rare but life-threatening form of colitis that affects the entire colon.
The exact cause of ulcerative colitis is unknown. Some scientists believe it is triggered by a virus or bacterium. Others believe the immune system simply responds abnormally without the presense of a microorganism. Genetic makeup may also play a role with some individuals having a family history; however most do not.
Treatment with either medication or surgery is aimed at reducing signs and symptoms. Long-term remission has been gained through these means. Certain anti-inflammatory drugs are commonly the first step in what can be a long process. These include corticosteroids, sulfasalazine, mesalamine, balsalazine, amd olsalazine. Medication is followed by surgery that may ultimately mean removal of the entire colon and rectum. In this instance, thanks to progressive research, a surgeon can construct a pouch from the end of the small intestine that is attached directly to the anus, allowing for waste to be expelled in the normal manner. This is certainly more advanced than wearing a small bag over an opening in the abdomen to collect stool.
Your son has received a double whammy because of his septicemia that can be caused by bacteria and other infections that can begin anywhere in the body. My guess is your son has endocarditis, inflammation of the lining of the chambers and valves of the heart. The most common reason for this to occur is through a bacterial or fungal infection. Long-term intravenous antibiotics are often necessary to arrest the bacteria. The antibiotic used is chosen to specifically attack the organism that caused the heart infection. Surgery may be necessary in the instance of heart failure, if there is organ damage, or if the infection breaks off and results in a series of strokes. Early treatment of endocarditis greatly increases the probability of a good outcome.
Given his current state, I don’t believe your son’s UC is being well-managed. While he wants to work, at that time, I don’t believe this is feasible. He must first get his health stable and his UC under control. With his health relatively fragile at this point, working and other strenuous activity may prove hazardous. I urge your son to seek out another gastroenterologist, one familiar with treating severe cases of ulcerative colitis. Perhaps a teaching hospital or clinic would be his best bet.
