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Sat, Oct. 19

Dr. Roach: Enzyme replacement, diet both important in pancreatitis treatment

DEAR DR. ROACH: My son-in-law recently was diagnosed with pancreatitis. He used to drink more often, but in the past year he has imbibed only on weekends, socially. He was quite overweight and ate a lot of junk food before he became ill. The emergency doctor told him to watch his diet, and his general physician gave him medicine for pain and told him to watch his diet. The gastrointestinal specialist gave him some kind of enzyme medicine to help him be able to eat more foods. He has lost a lot of weight. My daughter said she noticed that his eyes and skin are getting more jaundiced. I know he is having a very hard time dealing with this diet, in that he eats what he likes as soon as he feels a little better. My concern is that they are not taking his condition more seriously. He is only 34 years old, and they have two small children. Should he at least have been referred to a dietitian? — B.H.

ANSWER: They should be taking his condition very seriously. Pancreatitis, inflammation of the pancreas, can have many causes, but in those with a history of heavy alcohol use, the alcohol is the most likely cause. Someone with a history of alcoholic pancreatitis should never drink again — not socially, not on weekends, never. The jaundice is likely to represent liver damage, and I am sure the GI doctor is aware of this (well, I fervently hope so, anyway).

Weight loss comes about when the pancreas cannot make enough enzymes to digest food, especially fat. The fat then passes through the body, causing diarrhea, which is oily, floats in the toilet and may require several flushes. Pancreatic enzyme replacement can make a dramatic improvement in the ability to digest fats, and in the overall quality of life and ability to gain and maintain weight. “Junk food” often is high in fats and sodium, which need to be minimized in people with chronic liver and pancreas disease.

A registered dietician nutritionist is an ideal choice to help educate your son-in-law about how to eat and how to use the enzyme replacement properly in terms of timing with food. That would be an important component of his treatment.

DEAR DR. ROACH: I am a senior living alone. Is there anything I could do if I am alone and start choking on something? I do try prevention by chewing thoroughly. There is no one here to do the Heimlich maneuver should it be necessary. — A.B.

ANSWER: The Heimlich maneuver has saved countless lives when performed by a trained bystander, and it is easy to learn. It also can be done on oneself. It can be performed with one’s own hands, as it would be on someone else, but I was taught how to administer it with a chair, using the edge of the chair to push upward into the abdomen.

There have been cases when a person who was choking has left their friends due to embarrassment and then died. It’s important to learn how to do it on yourself. Ask your doctor to demonstrate it, or take a CPR class and learn how to help yourself and others. Call 911 as soon as you can, if able (or ask someone to), then attempt the maneuver on yourself.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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