DEAR DR. ROACH: I went to the emergency ward this weekend with severe chest pains and bloating. I was sure I was having a heart attack. After tests, a CT scan revealed I had pancreatitis (they mentioned a number 222 for some enzyme or something); also, my potassium was low and sodium was critically low, at 113. I am 62, 5 feet, 9 inches tall and weigh 210; I have Type 2 diabetes with an A1C of 6.7 and high blood pressure.
I was discharged after four days with no restrictions other than to eat light and refrain from alcohol 100 percent for the rest of my life to avoid another occurrence. I had never heard of pancreatitis, and it was devastating news to me. I make wine, and have for years. I do not drink anything except wine, and the thought of never being able to drink again is very disturbing.
Is there a possibility that I may be able to drink wine again in the future? The doctor’s assessment seemed pretty harsh to me. — J.C.
ANSWER: Acute pancreatitis is an inflammation of the pancreas, an organ that makes digestive enzymes and insulin. Acute pancreatitis can be very severe, even life-threatening on occasion. There are many causes, but the most common in North America are gallstones and alcohol. The diagnosis is made from the history and physical exam, and an elevated pancreas enzyme level, usually amylase or lipase. These often are elevated into the thousand range. A CT scan also can help confirm the diagnosis.
Before concluding that alcohol is the cause of the pancreatitis, it’s important to make sure there is nothing blocking the pancreatic and common bile duct, such as a stone or tumor. The CT scan is good, but if there is doubt, an endoscopy may need to be performed.
If your doctor determined that the cause is alcohol, then I’m afraid I have to agree that no amount of alcohol is safe. Drinking even modest amounts of wine, even months or years later, could bring about pancreatitis again. In addition to the pain and suffering that go with an episode, the more episodes of acute pancreatitis you have, the more likely you are to develop chronic pancreatitis (with constant pain), pancreatic insufficiency (leading to inability to properly digest food) and worsen your diabetes.
DEAR DR. ROACH: My husband is 61, and has twice had to take a course of vitamin D, 50,000 units weekly. I don’t understand why he isn’t taking a daily dose. — L.D.
ANSWER: It is commonly recommended for physicians to treat very low levels of vitamin D with vitamin D-2 at the high dose of 50,000 units once weekly for six to eight weeks. However, I have seen many people who, like your husband, take the course of therapy and then don’t take any daily vitamin D and just become deficient again. In most cases, I recommend vitamin D-3 at 800-1,000 units daily, then rechecking the level. Some people need even more, especially if there is poor absorption, such as after gastric bypass surgery or in people with celiac disease.
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. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.