Q: I have an unusual problem I hope you can help me with. My previously healthy 78-year-old mother has gotten sick very suddenly. She has gotten this awful pain and was rushed to the hospital. To our surprise, doctors diagnosed her with a condition known as pancreatitis. They explained that, although many people get pancreatitis from alcohol, in my mom -- who does not drink at all -- this was most likely side effect of one of her medications. They stopped all of the medications and kept her in the hospital for a week. She was in so much pain. She slowly got better and was able to return home. She did not want any nursing home stay whatsoever.
Here is the issue -- she still has some pain, but will not take any pain medications. She is suffering -- we all see it -- yet she stubbornly refuses to do anything to ease her pain. She also will not restart her other medications, even though her doctors told her many times it is OK to do this. Some of the medications were for her high blood pressure. I was told that, if not treated, this can cause stroke. We do have a blood pressure machine and I have been taking my mom's. It is very high. I am really worried about her. She lost a lot of weight. How can she bounce back? What arguments do I need to use that she will listen to? She says it is not uncomfortable when she is eating, which is why we cannot figure out why she is eating very little. No one in the family really knows what to do. We are all at the wits end.
A: Thank you for your letter and concern about your mom. Rest assured, she can be helped and will get better.
Your mom has had a traumatic event. It has affected her deeply. She is like a soldier after war -- she needs time and help to get better.
Just so all the readers understand, let's talk briefly about pancreatitis. The pancreas is an elongated gland in the upper part of the digestive system that drains the substances it produces to the blood and to the small bowel. It produces juices -- we doctors call them enzymes -- to help break down or digest food. Some of these substances are strong. As a rule, enzymes come out of the pancreas in an inactive state and get activated once they are inside the gut. The pancreas also makes insulin, which is the substance or a hormone regulating the level of sugar in our body. People who do not have enough insulin, or whose bodies do not respond to insulin correctly, have diabetes.
As you can see, the pancreas is quite important. One can live without it, but it is difficult. When a patient has pancreatitis, the juices or enzymes start breaking down our own tissues, meaning they get activated before moving to the gut. In a sense, the body starts digesting itself. The gland becomes inflamed -- that is what the "itis" added to the word pancreas in pancreatitis means.
As you can imagine, this is very painful. What causes this situation? The main reason for pancreatitis is usually overuse of alcohol. Alcohol damages the protective mechanism that keeps the enzymes from activating too early. Another cause of pancreatitis can be gall stones. Some medications can cause it as well, but that is rare. A high level of calcium in the blood may be responsible as well. This condition can also run in families. Smoking can precipitate it and can also make it worse. Very rarely, pancreatitis may be the first sign of a cancer. There are also situations in which we just do not know what has caused pancreatitis.
There is no true medication to reverse the damage done by pancreatitis. The body just has to be given time and support to heal itself. The best approach is to do this in the hospital, at least initially as patients can be really sick. Abnormalities in the blood need to be corrected. Some people may need nutrition through the veins instead of the stomach, to keeping from provoking pancreatic juices to act.
The majority of people with non-alcohol-caused pancreatitis do get better. That is what happened to Sonia's mom. But, because her mom was told that the medication might have been responsible, now she is afraid to take any medications.
The good news is that Sonia's mom's body is healing, though she needs to resume eating. Her avoiding food is just a reaction to her illness. She may be becoming slightly depressed. Her doctor needs to make sure this is addressed. I am quite certain that this is already being done, but, if not, please make her a series of appointments with her primary doctor to follow her very closely. There may be a need to ask for a visit with Sonia's mom and her doctor to talk about the pain treatment. No one should be in pain, especially if this stops them from enjoying day-to-day life. At this juncture, the pain is probably not from active pancreatitis, which does not mean that it should not be treated.
When it comes to the other medications that were stopped and not resumed, the best way to proceed is to go over the consequences of not taking them. The risk of stroke and/or heart attack can be quite high if high blood pressure is not treated. It is Sonia's mom's decision, but this risk is probably higher at this point than the risk of repeated inflammation of pancreatic gland. Again, the primary doctor can make sure that only the safest choices of blood pressure medications are considered for the use by Sonia's mom.
Sonia's mom is fiercely independent. This is great. Being able to return home without the stay at the nursing home means she is able to start functioning independently again. The goal of returning to the independent life should be used in discussions. It is hard to be independent after a stroke, which could be used as motivation to get Sonia's mom to treat her high blood pressure. Let's hope that this motivation is stronger than the fear of this horrible disease -- pancreatitis -- happening again.