DEAR DR. GOTT:
My son, who is in late 50s, has had perfect health all his life. Now, suddenly, he has developed what his doctors call “pancreatitis”.
More than a year ago, he started having attacks of incapacitating, excruciating abdominal pain about every two weeks. Each attack lasts a few days and then goes away.
He has no health insurance and waited a long time before seeing a doctor. He was told that he needed gallbladder removal because the doctor was 98% sure that this was the problem. However, after having the surgery, the attacks returned every two weeks, exactly as before.
DEAR READER:
Pancreatitis is inflammation of the pancreas (a gland that produces digestive juices, insulin and glucagon). There are two types of pancreatitis, acute and chronic, both of which can be life-threatening.
Acute episodes usually come on suddenly and disappear after a few days with treatment. During an episode, the digestive juices attack the pancreas leading to tissue damage. Most cases are the result of gallstones. Other causes can include severe, chronic alcoholism, infections, tumors, genetic pancreatic abnormalities, medications, and abdominal trauma.
Symptoms during an acute attack may include upper abdominal pain, swelling and tenderness, fever, nausea, vomiting, and an increased pulse rate.
Treatment includes hospitalization for intravenous fluids, antibiotics and pain medication. It is also important not to eat or drink during the attack to allow the pancreas time to rest and heal. If vomiting is present, it may be necessary to remove fluid and air from the stomach with a naso-gastric tube which may need to stay in place for several weeks.
It is also important to avoid smoking, alcohol and fatty foods which can exacerbate symptoms and potentially lead to another attack.
Chronic pancreatitis is so named because the pancreas does not improve or heal, eventually leading to permanent damage. It is usually the result of severe, chronic alcohol abuse, that is some cases, can be triggered by a single acute attack. Other causes include medications, high cholesterol or triglyceride levels, some autoimmune disorders, high blood calcium levels and more.
Symptoms are abdominal pain (which usually goes away as the condition worsens), nausea, vomiting, diarrhea, oily stools, and weight loss.
Treatment is similar to that of the acute form and includes hospitalization, IV fluids and so forth. However, the after care is different. While it is still important to avoid fatty foods, smoking and alcohol, it may also be necessary to take supplemental pancreatic enzymes. Consultation with a dietician may be beneficial to devise a meal plan that is low in fat and includes several small meals per day rather than two or three larger ones.
Complications can include permanent damage leading to diabetes and malnutrition (due to the body’s inability to digest and absorb nutrients properly).
I urge your son to be seen by a specialist who can test and diagnose him. It is vital that the reason behind the repeated attacks is found before serious damage occurs, if it has not already. I also urge your son to work out a payment plan with his physicians and the hospital. He should attempt to apply for emergency state aid that may help him reduce or eliminate his medical fees. He will have to meet certain requirements but if his income is low enough not to be able to afford medical insurance, he will likely qualify.
About Dr. Gott