Am I allowed to drink alcohol once I have been diagnosed with pancreatitis?
If pancreatitis was caused by excess alcohol use, you should abstain from alcohol. If other causes of acute pancreatitis have been addressed and resolved (such as via gallbladder removal) and the pancreas returned to normal, you should be able to lead a normal life, but alcohol should still be taken only in moderation (maximum of 1 serving/day). In chronic pancreatitis, there is ongoing inflammation and malabsorption — patients gradually lose digestive function and eventually lose insulin function — so regular use of alcohol is unwise.
What kind of diet is recommended to avoid flareups of pancreatitis?
In chronic pancreatitis, the pancreas gradually loses its ability to function properly, and endocrine function will eventually be lost. This puts patients at risk of type 1 diabetes. Patients should avoid refined sugars and simple carbohydrates, and instead consume complex carbohydrates and whole grains. High protein, moderate fat balanced diets are best in general.
Why is it that sometimes I can eat certain foods and other times those same foods cause problems?
Many people experience this phenomenon, although it is not well understood and there is no clear answer. It is important to remember to regularly take pancreatic enzymatic supplements to be sure a lack of enzymes is not the cause.
Do I have to take my pancreatic enzymes even if I'm feeling good?
Yes. As the function of the pancreas decreases , it is important to have the enzymes for nutrition. In addition, your doctors will often prescribe the enzymes to avoid stimulation of the pancreas and therefore pain. The pancreas is stimulated to release pancreatic enzymes when there is undigested food in the intestine. The enzymes start predigesting while food is in the stomach, so it gives the pancreas a break.
Are there other vitamins or supplements I can take?
Patients with chronic pancreatitis are at risk for chronic malabsorption, so they must be tested regularly for nutritional deficiencies. Vitamin therapies should be based on these annual blood tests. In general, multivitamins, calcium, iron, folate, vitamin E, vitamin A, vitamin D, and vitamin B12 may be supplemented, depending on the results of blood work.
What types of pain management are available?
The goal is to keep living life not in the hospital, but to be awake and functioning. Many patients take a regimen of more than one kind of medication. Oral medications include narcotics such as Percocet and oxycodone, and these may be used in conjunction with non-narcotic medicines such as muscle relaxants and antidepressants. Once an oral regimen is established, acute flareups can be managed by adding medications. If oral medicines can't be tolerated, you may need to be admitted to the hospital for intravenous medications. Nerve blocks may be used to manage pain for several months at a time: nerve blocks entail the insertion of a needle through the skin in the back to block the main nerves going to the pancreas. This procedure can also be done endoscopically, in which the bundle of nerves to pancreas is injected (through an endoscope in the stomach) with long-acting pain medication that lasts several months. Nerve blocks destroy the nerves, but in time they grow back so patients need repeated treatments. Another approach to managing pain is the use of implantable pain pumps in the spine. Most implantable pumps deliver constant low doses to keep pain manageable, and they may be used in conjunction with oral medications. Oral methadone is a very good medication for managing chronic pain.
If I take prescription drugs long term, will I become addicted?
Physiological addition and psychological addiction are two different things. The layperson's concept of addiction refers to the psychological addiction. However for patients with pancreatitis, severe ongoing pain needs to be addressed, and the need for pain medication does not constitute a psychological addiction. Some patients must always use medications, because chronic pancreatitis does not go away and the pain needs to be managed in order for them to function. If the body becomes accustomed to a certain pain medication, you can't just stop it suddenly: it will need to be withdrawn slowly and under close supervision of your physician. If the issue with chronic pancreatitis is ongoing microscopic inflammation of the pancreas, pain is always going to be there, and managing the pain does not constitute a social addiction, but rather it is a needed therapy like taking blood pressure medication. Our team tries to use constellations of different medications in order to keep narcotic dosages as low as possible.
If the pain from my disease becomes more than my pain medications can handle, what other options will I have?
Other options include pain pumps, implantable nerve stimulators, and in some cases, surgical strategies. The best approach is determined according to each person's specific disease process and anatomy.
One surgical option is stenting, which can be done endoscopically. With chronic inflammation, parts of the pancreatic duct can become strictured or narrowed. When the pancreas is stimulated by food in the intestine, it works hard to pump the digestive juices past that narrowing, causing pain and exacerbation. Placing a stent in the duct can keep the narrowed area more open, preventing or reducing pain.
In extreme cases, removal of the entire pancreas (pancreatectomy) may be performed in order to reduce or eliminate the pain associated with pancreatitis. Pancreatectomy relieves pain in 90% of cases, but causes patients to become diabetic. To address this, the Pancreatitis Program now offers an innovative process of extracting the patient's own insulin-producing cells and then reinjecting them into the liver after removal of the pancreas. Called autologous islet cell transplantation, this procedure allows patients to retain some of their insulin-producing function, preventing the difficult-to-treat form of diabetes known as brittle diabetes.
Will I be able to do normal activities?
You may need an array of maintenance medicines, but if pain and other symptoms are properly managed, you should be able to live a normal life.
Will daily stress have an impact on my disease?
We do not have conclusive data on this, but experience suggests that stress does exacerbate symptoms of chronic pancreatitis.
Does the Pancreas Center offer a support system to patients suffering from chronic pancreatitis?
Our center will connect patients who are at different stages of disease, as there are patients who are willing to talk with others about coping strategies.
Will smoking impact my disease?
Yes. In general, smoking is bad for our health as we all know. Smoking increases risk of pancreatic cancer, and pancreatitis increases the risk of pancreatic cancer, so we want to minimize risk factors.
How long does an episode last?
Acute episodes may be as short as one day, while patients with chronic pancreatitis may experience episodes of pain that last for weeks or longer.
What can be done to prevent episodes?
Ability to prevent episodes will depend on the cause of each person's disease. Possible approaches may include removal of the gallbladder, abstinence from alcohol, a low fat diet, stopping medicines that may cause pancreatitis, and more.
What can be done to limit the length of an episode?
The best way to minimize an episode includes hydration and nutritional support. Temporarily stopping oral intake of food will allow the pancreas to rest.
When I have an episode, will I be hospitalized?
Patients may be able to manage exacerbations at home with increased doses of pain medications or by taking a clear liquid diet for several days. If you are unable to manage the pain or to eat or drink anything, you need to be admitted to the hospital.
I have been having symptoms but am afraid to call the doctor because my tests are negative and I don't want to bother him/her. What should I do?
You should call your doctor. Your doctor may need to alter your regimen of pain medications or enzymes.
I can handle the pain — do I really need to call the doctor?
You should call the doctor if the pain becomes intolerable, if you can not eat or drink, or if you develop fever or jaundice.
If the symptoms warrant a hospital stay, how long will I be in the hospital?
You may need to be in the hospital for a matter of days or weeks, depending on your situation.
How do I handle embarrassing situations like gas and diarrhea?
In addition to prescribing digestive enzymes, your doctor can suggest appropriate over-the-counter medications such as simethicone or lomotil to help with these kinds of symptoms.
All my diagnostic tests are normal, but my symptoms are there. Does it mean I don't have pancreatitis anymore?
No. At some point, the pancreas may become scarred and stop producing enzymes, so blood tests appear normal despite having pancreatitis.
Why do I experience waves of nausea when I have no pain?
Alterations in your digestion can cause nausea, bloating, and other symptoms.
Will I have to have surgery?
What kind of surgery? The most common procedures for pancreatitis include drainage procedures and removal of part or all of the pancreas. Whether or not you will need a procedure will depend on many factors and would need to be discussed individually with your doctor.
Does pancreatitis occur in children?
Pancreatitis is very rare in children. It is sometimes diagnosed in young adults who have a history of bellyaches. Usually, a stomachache is a stomachache — but in rare instances, could indicate pancreatitis, particularly when pain is associated with eating, occurs after eating fatty foods, if the location of pain radiates around to back around the shoulder blades, and if the child experiences recurrent episodes.