Colitis - medication questions

I am a 38 year old male -- I was diagnoised with UC in 1998, took suppositroy Pentesa with no major flares until November 2008, got a very bad flare that I could not get under control.  

Was given Safolak and Saflak suppositories to start, did nothing, It kept getting worse, was given predisone, could not keep it down (throwing up) was admited to the hospital....stayed for 2 weeks and received predisone injections, slowly improved but not completely. Was started on Remicade.

Have had two Remicade injections, and my UC is "fine" however I have had to postpone my 3rd injection (Feb 4) because I came down with pneonomia...turned out not to be pneoomia and is some sort of bacterial infection that I am on antiboticis for (it is not TB I was tested for that after this infection started, they did a lung bioposy).  I am very tired, but I think this is because of all the medication and the fact I have a 6 month old baby at home with my wife.

I will not be able to get my next Remicade until March 9th.  I am decreasing the steroids and am at 7.5 mg.

1) I am so worried of going back into a flare, if I was to increase my predisone would it help?
2) Am I going to be able to continue to get Remicade or is my only option surgery?
3) I am taking calcium, Vitamin D, Folic Acid and probitocis (in addition to the two antibotics)
4)  Would the addition of B12 help me at all?

My GI does not see me for two more weeks.   Any information you can provide would be wonderful.

[Kevin Pho, MD]

To answer your questions:

1) You want to be on the minimum dose of steroids to prevent a flare.  That level is sometimes difficult to determine, and can vary from patient to patient.  Indeed, increasing the dose may prevent future flareups, but at the expense of exposing you to the side effects of a higher steroid dose.  

2) Once the infection is cleared, you should be able to resume the Remicade.

3) B12 should not affect the course of the infection, nor the incidence of UC flareups.  

I would discuss these questions with your personal physician, or in conjunction with your GI doctor.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd