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Pancreatitis

Dear Dr. B: When you have pancreatitis does it show up in a urine test? My son was having urine problems. He could not control it. He was seen at walk-in clinics and by his doctor and the urine test did not show anything. Then he turned yellow and he was seen by a doctor in emergency department. My son was diagnosed to have pancreatitis. It took a month for the doctors to make a diagnosis. My son survived but I am disappointed that it took so long to find out what was wrong with him.

Answer: The best way to discuss this question is to talk about pancreatitis in general and then talk about diagnosis and treatment. The information provided in the question is not sufficient enough to know why it took so long to make a diagnosis. Urinary frequency is not a classical presentation of pancreatitis.

The pancreas lies in the upper abdomen behind the stomach. Its function is to produce digestive enzymes and hormones such as insulin.

Pancreatitis is a chemical inflammation of the pancreas caused by its own digestive enzymes. Pancreatitis has two forms: acute and chronic. Most common causes of pancreatitis are gallstones and alcohol abuse. Sometimes no cause can be found. That leaves the patient and the doctor frustrated.

Patients with acute pancreatitis present with abdominal pain, nausea, vomiting, fever, and a rapid pulse. The diagnosis is made by a blood test to measure blood level of enzyme lipase. All pancreatitis patients require intravenous fluids, oxygen and pain killers to stabilize their condition. If the condition is due to gallstones then the patient will need surgical removal of the gallbladder.

An abdominal ultrasound is taken to look for gallstones and a CAT (computerized axial tomography) scan to look for inflammation or destruction of the pancreas. CAT scans are also useful in detecting cyst formation in the pancreas.

In about 20 percent of cases, acute pancreatitis can be severe, with many complications. Severe cases may cause dehydration and low blood pressure and the condition may become life threatening. The vital organs such as heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.

Chronic pancreatitis can present as episodes of acute inflammation in a previously damaged pancreas. There is intermittent or persistent abdominal pain. The chronic destruction of pancreatic tissue causes malabsorption of fat and diabetes.

Chronic pancreatitis is most often caused by alcoholism and alcohol abuse. Sometimes the cause of chronic pancreatitis cannot be determined. But any condition that causes repeated episodes of acute pancreatitis may result in chronic pancreatitis.

A quote from my friend George:

“Youth is not a time of life; it is a state of mind.” Anonymous.

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Doctor, Heal Thyself First

Well, I am home now. I have been grounded by my cardiologist. I have to stay off work for two weeks and then get back to normal activities slowly.

If you read my column last week, you will recall that I was suddenly taken ill and admitted to the intensive care unit of the Medicine Hat Regional Hospital (MHRH). I went there on a Tuesday. I was diagnosed with unstable angina. On Thursday, I was flown by air ambulance to Foothills Hospital (FHH) in Calgary.

Unstable angina is a condition in which chest pain occurs at rest or minimal activity because coronary vessels are narrow and the blood supply to the heart muscle is compromised. But the heart muscle is not damaged as it would have happened if I had a heart attack.

Within an hour or two of arriving at FHH, I underwent coronary angiography. This is an imaging technique in which X-ray pictures are taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. My angiogram showed two areas of narrowing in the right coronary artery. Immediate angioplasties and insertion of two stents were carried out to keep the blood flow to the heart.

Angioplasty is carried out by inserting a balloon-tipped catheter (thin tube) in the diseased narrowed blood vessel. The balloon stretches the blood vessel improving blood flow through it. A stent is a mesh of thin metal which helps keep the blood vessel open.

On Thursday night I was kept on Unit 103B of the FHH for close observation to monitor for any complications like chest pain or bleeding from the groin where the catheter was inserted. My stay was uneventful. Next day I was transferred to Unit 4W substation at the MHRH for more observation and blood tests. I was discharged on Saturday.

I was lucky that I did not have a heart attack or a stroke. I was fortunate to have everything done in five days. In Calgary, within 24 hours, I was seen and taken care of by four cardiologists. The staff in the angiogram room, Unit 103B (FHH) and 4W substation (MHRH) and paramedics in Medicine Hat and Calgary took excellent care of me. I am grateful to them and other health care workers who do an excellent job under difficult circumstances.

What do I have to worry about now?

It is important to remember that coronary angioplasty and insertion of a stent is not a cure for coronary artery disease (CAD). Research shows that narrowing in the coronary artery will recur within six months in one out of five people who have had coronary angioplasty. My aim will be to prevent this from happening.

How can I do that?

I should try and control the process called atherosclerosis. Athero in Greek means paste and sclerosis means hardening. In atherosclerosis, there is a deposit of fatty substances, cholesterol and other substances to form a plaque which makes the blood vessel narrow. It is usually a slow, complex disease that typically starts in childhood and often progresses when people grow older. Like arthritis, it is a progressive disease.

The underlying risk factors for atherosclerosis are: family history of heart disease, high bad cholesterol (LDL), exposure to tobacco smoke, high blood pressure, diabetes mellitus, obesity and physical inactivity. The only risk factor I have is bad genes. I cannot change that. My LDL is within normal range but my cardiologist wants me to reduce it further. This can only be done with pills. I am not obese but I can afford to lose some weight. Otherwise, I don’t have other risk factors.

It is hard to predict the future. I am getting back to normal slowly. I have received many messages of good wishes and that has helped in the recovery process. Staying at home means I have more quality time with my family. I am enjoying that. See you in couple of weeks.

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Musings from an ICU Bed

I am sitting in the intensive care unit (ICU) of the Medicine Hat Regional Hospital and feeling sorry for myself. I am not here as a doctor but as a patient. An impatient patient!

The other day I was driving to work and felt unwell. I reached my office and felt my condition getting worse. So I turned back and went straight to the hospital emergency department. I was stabilized and then admitted to ICU. The attention and care I have received from the wonderful doctors, nurses and other health care workers has been outstanding.

You see, I have been under the weather for the last couple of weeks. But like a typical male-patient and a doctor-patient, I was treating myself and postponing my visit to my family physician as long as I could. And that is a stupid thing to do.

In some of my recent columns, I have mentioned 2005 being a good year for me in many ways. I was lucky to have many wonderful things happen to me. I also wrote how I try to adhere to the principles of ELMOSS (exercise, laughter, meditation, organic healthy food, stress relief and no smoking). And my plan was to continue to adhere to these principles for 2006.

But somebody had different plans for me. As I drove to work that day, I realized I needed help. I could not postpone it anymore.

So here I am, lying on an ICU bed with oxygen prongs in my nostrils. Millions of cables running from my hairy chest (ouch!) running to the cardiac monitor. An intravenous catheter is in my right wrist. A name tag and allergy tag on my left wrist.

My vital signs are monitored every two hours. Thank goodness they don’t use rectal thermometers anymore. And not every patient admitted to the hospital needs an enema. That is called scientific progress.

My smiling nurses and physicians keep me stable and amused with their care and visits. My wife and children are concerned but very supportive and patient. Their visits are a great strength to me.

But I still feel miserable and sorry for myself. The invincible Dr. B is in the hospital again! I had to cancel my office and several procedures for the rest of the week. Some patients had gone through that ghastly bowel prep for their colon check in my office that day. They will have to drink the stuff again. I had to cancel several vasectomies for that week. These young fellows take time off and get themselves psyched up for the procedure. Now they will have to go through all that again. Several patients were to see me for consultations and follow-up. They will have to wait little longer.

But if I don’t get better now then I may not see any patients ever. “So doctor, heal thyself first,” says my doctor. Here I am trying to be a model patient. Trying to enjoy the wonderful care I am getting. I am also waiting for Calgary to phone as my internist wants me to have more tests and treatment which is available in Calgary. He has been making phone calls and we hope to hear from Calgary as soon as a bed is available.

I hope to be back at work very soon. Probably by the time you read this column I will be working. I hope to be back on my ELMOSS schedule. I hope to be optimistic again about 2006. I will consider this episode as a hiccup in my pursuit of happy and healthy life. Let’s think positive. Life could worse.

Let me end by thanking all the nurses, doctors and other health care workers who took care of me in the emergency department and ICU. I greatly admire the people who work in the Medicine Hat Regional Hospital. They do a good job. Keep it up. And now that I have shared my feelings and experience with you, I feel better already. Sharing is caring.

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New Year’s Thoughts

I hope you all had a very good Christmas and new year.

Now, what’s your plan for 2006? Made any resolutions?

I don’t have big plans for this year. I am going to apply the KISS (keep it simple stupid) principle. I will continue to focus on my mental and physical health. I will continue to follow the principles of ELMOSS about which I have written frequently. ELMOSS stands for exercise, laughter, meditation, organic healthy food, stress relief, and no smoking.

I do not smoke so I don’t have to worry about that. I exercise three to four times a week on regular basis. I would like to do it five times a week if possible. As we all know stretching and exercise is very important for maintaining good physical health. But you have to know your limitations and check with your doctor before you embark on exercise you are not used to. Walking and swimming is simple, cheap and usually safe.

I am lucky to be surrounded by friends and family who make me laugh. I like funny movies and some comedy shows on television. I enjoy reading cartoons and comic strips.

I like to meditate. Couple of times a week I sit in meditation for 20 to 30 minutes. Most lunch hour I shut my eyes for few minutes and relax and sometimes I snore! That is my kind of meditation. Important thing is to sit in a quite place and shut your eyes for few minutes.

Eating healthy and sometimes organic food is not a big problem for me. I am lucky that my wife takes care of that. She buys fruits and vegetables in abundance and buys the leanest possible meat. We eat fair amount of chicken but not enough of fish. We do not eat pork or ham. Once a week or so I get on the scale and see if the scale is still lying!

Recently, stress has not a big factor in my life. I have made significant amount of changes in how I work. Now I am able to spend more time at home with my family and I have more time to look after my health. To achieve this kind of freedom, I had to make some sacrifices. But I have survived and life goes on.

Come to think of it, it is not very difficult to follow the principles of ELMOSS. You can do little at a time and build it up. It is difficult for smokers to give up their addiction. But if there is a will then it can be done. There is plenty of help available. If you are serious about quitting then you can do it. The desire to quit should come from within you.

Whatever you plan to do with your time and money in 2006, do it well. Work hard, enjoy, stay safe, stay healthy and be happy. Keep it simple.

Good luck and all the best for 2006.

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