DEAR DR. ROACH: Without trying, I started losing weight, and had terrible symptoms. My gastroenterologist ordered several tests, but couldn’t seem to make a diagnosis. Long story short, it was chronic pancreatitis, which my mom also has (we even had the same doctor).
There seems to be a stigma attached to this disease and a lot of ignorance about it. It can be inherited. I looked up my symptoms online and asked my primary care physician to prescribe Creon, which saved my life.
I have contacted the office of my gastroenterologist to let her know that my pancreas had atrophied and that I was in the process of dying while under her care. She never returned my call. — L.M.S.
ANSWER: Where I trained, the vast majority of the chronic pancreatitis I saw was due to chronic alcohol abuse (which may partially explain the stigma), but there are other causes. There is a hereditary form, which usually appears before the age of 20. Any condition that blocks the pancreatic ducts, such as stones or tumors, can lead to chronic pancreatitis.
Cystic fibrosis commonly causes chronic pancreatitis, as do lupus, hyperparathyroidism and very elevated triglycerides. Smoking increases the risk of chronic pancreatitis.
Symptoms of pancreatitis include abdominal pain, weight loss, diarrhea and steatorrhea. (“Steat” means “fat,” so steatorrhea is fatty diarrhea. It is oily and floats on water.)
The pancreas’ major job is to make digestive enzymes; in chronic pancreatitis, the pancreas cannot make adequate enzymes, especially lipase, which is necessary to break down fat. The fat then is passed undigested through the body. Sometimes fat-soluble vitamins are lost as well (especially vitamins A, D, E and K). The diagnosis is supported by CT or special MRI scan, which usually shows calcium deposits and duct obstruction. Elevated fat can be measured in the stool. However, it can be hard to be certain of the diagnosis early on. (I’m not excusing your gastroenterologist, who apparently missed the diagnosis entirely.)
First-line treatment includes alcohol abstinence (even in people who have other causes for pancreatitis besides alcohol), not smoking and making dietary changes, along with replacement of pancreatic enzymes. Creon is one brand name for pancreatic enzyme replacement.
For people who don’t respond, there are other options, including endoscopic and open surgery. Since pancreatic cancer can look like chronic pancreatitis, it’s important to look for this carefully.
DEAR DR. ROACH: I recently saw on the evening news that some over-the-counter medications have been highly correlated with dementia. I have allergies and have been taking Allegra for several years now. I called my allergy specialist, and was told that they haven’t heard anything about it. Do you have any information about this study? I was thinking maybe I should cut back or possibly discontinue taking it. — J.L.
ANSWER: I think you might be referring to a recent study on anticholinergic drugs, which suggested that some older antihistamines, including diphenhydramine (Benadryl), might be associated with dementia risk. This is a similar study to previous studies on benzodiazepines (like Valium or Ativan) and proton pump inhibitors (like Prilosec), which also are associated with dementia risk.
It’s possible that taking these drugs long term really does increase risk of dementia. However, it’s also possible that people with early dementia are more likely to have health issues treated with these commonly used drugs. The studies support either hypothesis.
In this instance, fexofenadine (Allegra) is considered a safer alternative to the older drugs. I think you should take it when you need to, which for many people is during certain seasons or with exposure to a particular allergic substance.
