Pancreatitis: Gland digests itself
DEAR DRS. DONOHUE AND ROACH: I'm recovering from pancreatitis. No one can give me an explanation of how I got it. Let me answer one question right now: No, I don't drink alcohol. Everyone else has asked me, so I figured I'd give you the answer right off. What might have been the cause? -- R.I.
ANSWER: The pancreas has two functions. One, it makes insulin to control blood sugar. Two, it produces enzymes that digest food. The enzymes reduce food to a state where it can be absorbed.
As with all "itis" words, pancreatitis is an inflammation of the gland. The two most common causes of this inflammation are excessive alcohol and gallstones. I get the message -- we can eliminate alcohol. Gallstones are still a candidate cause. The pancreas and gallbladder share a drainage duct into the small intestine. A gallstone can migrate from the gallbladder down to the common duct and block it. The pancreas's digestive juices cannot leave the gland. They begin to digest it -- pancreatitis.
Other causes are possible. One is an extremely high level of blood triglycerides, a form of fat. Viruses are another cause. Mumps, chickenpox, coxsackie (a widely distributed virus responsible for intestinal problems) and the hepatitis B virus target the pancreas. And finally, there's idiopathic pancreatitis -- inflammation for which no cause is found.
Acute pancreatitis gives rise to severe, upper-abdominal pain that often bores into the back. Nausea and vomiting are common. The pain doesn't come and go. It's steady and can last for days to a week.
Treatment is resting the gland by not stimulating it with eating. Nourishment is provided through intravenous feeding. Pain medication is essential. One of the complications of pancreatitis is infection of the gland. That's the reason why some doctors prescribe antibiotic therapy from the start.
About 10 percent of acute pancreatitis patients go on to have a chronic inflammation of the gland. Looked at with more upbeat statistics, 90 percent of patients are completely well after the acute condition has been controlled.
DEAR DRS. DONOHUE AND ROACH: I think all the hot weather we have had this summer turned me into an ice-cream addict. The addiction didn't last long. I believe it caused me to have diarrhea. Have I developed an allergy to ice cream? -- P.P.
ANSWER: It's more likely that you have a lactase deficiency. Lactase is a digestive-tract enzyme that processes lactose, milk sugar. As infants, we have an abundant supply of it. We need it then to thrive on a milk-based diet. With age, the supply of lactase dwindles. That makes digestion of milk products difficult for older people. Without enough lactase, milk sugar causes diarrhea.
If you're up to it, you can make your own lactose-free ice cream by treating milk with the lactase enzyme. If that idea doesn't thrill you, you can buy ice cream that's been pretreated with lactase. Major brands supply it.
DEAR DRS. DONOHUE AND ROACH: My left testicle is much larger than the right one. It doesn't hurt. It looks funny. Could this be cancer? I'm 79. -- B.M.
ANSWER: Testicular cancer happens to men at much younger ages. You most likely have what's called a hydrocele, a collection of fluid between two layers of the testicle's lining.
If you go into a dark room with a flashlight, and place the light on the back of the testicle, you'll see the light shine through the front. That indicates that the swelling is clear fluid.
A distant diagnosis is, at best, a guess. Confirm this with your family doctor. You don't have to do this on an urgent basis. You can make it at a time that is convenient for you and the doctor.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.
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