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 per cent 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 upsetting. 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.
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鈥檚 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鈥檓 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.
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Dear Dr. Roach: I have been taking Zoloft for almost 10 years now. My psychiatrist believes I should stay on the medication for the rest of my life due to three serious episodes of depression. Now that I go regularly for counselling, I am starting to see the root of the depression and am aware of the triggers. As I get older, I worry about the long-term effects of this drug. Are there any studies about long-term effects of Zoloft and similar medications? I鈥檓 also interested in your view on the necessity of anti-depressants as a permanent solution for people with my condition. I鈥檝e read that antidepressants are not proven to be better than placebos.
N.M.
Depression can be a terrible disease, but for most people there are effective treatments. Zoloft is in the class of medications called SSRIs, and these work in the brain where nerve cells communicate with each other.
There are some studies and a听lot of experience with using these medications long term. They are mostly safe, better than placebo and certainly better than the risk of recurrent depression, which after three episodes is very high. Counselling (psychotherapy) is another effective treatment. Effective counselling may reduce the risk for recurrent depression, but I would not stop the medication without being carefully followed by your counselor and psychiatrist.
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