Q: My husband is 35 years old and has ulcerative colitis. He's had it on and off for seven years. He's currently taking asacol 400 mg, four pills, three times a day; prednisone, 25 mg; and purinethol, 50 mg once a day.
He is still in a lot of pain and doctors have suggested having his colon removed. He would have a colostomy on for four to six months then go in for a second operation and they would reconnect his intestine to his rectum.
The purinethol has very bad side effects such as hepatitis, pancreatitis and leukopenia. He has a blood test every two weeks to monitor his liver and white blood cell count.
Do you have any other suggestions? Can you give us a detailed version of ulcerative colitis and what would cure it? -- D.T., Deltona, Fla.
A: These past few years could not have been easy for your husband or for you.
Ulcerative colitis is an inflammatory condition that causes ulceration of the lining of the large intestine. The cause of this disease is not known, and there is no specific drug treatment that cures it. The condition starts for most people in their 30s and is characterized by periodic flare-ups and remissions.
Many sufferers are able to control ulcerative colitis by medicines such as the ones you named, which relieve symptoms and hold down inflammation. These ulcerative colitis sufferers can lead close-to-normal, productive lives.
But from what you've told me, your husband is one of the more than 25 percent of the unfortunate people with ulcerative colitis for whom the medications don't do the total job. The bad news is surgery must be considered; the good news is the surgery will take care of the problem.
Although removal of the affected part of the intestine (called a colectomy) will almost always take care of the problem, it's important to weigh the positive and negative aspects of the surgery. One of the negatives is, of course, the ostomy bag. Understandably, it's of concern in terms of the impact it will have on your husband's self-image and social life.
However, your husband's doctors have laid out a surgical plan that requires he have the ostomy bag only for a relatively short time, after which they will do a reattachment of the small intestine directly to the rectum. That does mean he will have changes in his bowel habits, which you need to talk about.
To help your husband better deal with his concerns, urge him to talk with his doctor again. He can then thoroughly review all the benefits and possible risks, as well as openly discuss any of the more personal concerns such as wearing an ostomy bag.
Q: A few years ago, my testicles swelled up as large as an orange and were red in color. I had quite a lot of discharge. I was told it was an infection. Could this be sexually transmitted?
I have since developed prostate cancer and bladder cancer. Would there be any connection? -- J.W., Alberton, Prince Edward Island
A: It sounds like the problem you had a few years ago was a bacterial infection of the epididymis, a gland attached to each testicle. I'm sure it was painful and you were more than a little anxious about it.
This condition, called acute epididymitis, can be caused by one of two forms of bacterial infection. The sexually transmitted form typically occurs in men under age 40. The non-sexually transmitted form typically occurs in older men and is associated with urinary tract and prostate infections.
Symptoms include pain and swelling of the scrotum, which may be accompanied by fever. The non-sexually transmitted variety may be related to physical strain or trauma; the sexually transmitted variety is directly related to unprotected sex.
Oral antibiotics taken for 10 to 21 days are almost always effective in treating sexually transmitted epididymitis. However, these bacteria may be resistant to the first type of antibiotic tried and treatment with a different one may be required. The non-sexually transmitted type usually requires 21 to 28 days of oral antibiotics.
To answer your second question, I know of no evidence that links epididymitis to prostate or bladder cancer. But undetected changes in your prostate may have influenced your getting epididymitis.
I also want to get on my soapbox for all the male readers of this column and those who care about them. We all know the importance of breast self-examination for women. But regular testicular self-examination is also quite important for men.
Please take the time to learn more about how to do testicular self-exams. It should be a part of every man's self-care routine on a monthly basis.
Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Avenue, Suite 1400, Chicago, IL 60611.