Re: Excess acid / Questions for the doctor

[Guest guest]

Hi Sandi,

I was just corresponding with someone who had a Gastrogram, a test that

measures the amount of Hcl acid in your stomach. It is an interesting test,

but I feel that it si looking at the problem backwards. Your complaints of "

constipation too, chronic 'belly aches' that feel like a punch in my upper

stomach, just under my breastbone, " these sound like my symptoms associated

with Chronic Pancreatitis. There are many reasons for excessive acid in the

stomach.

One of the reasons we swell or bloat after we eat is that the Pancreatitis

causes us to have impaired production of VIP, a hormone secreted by the

pancreas that affects proper digestion. It is rarely spoken about. Even

though everyone doesn't have " Diabetes, " everyone with Pancreatitis has some

degree of insulin insufficiency. This can result in Gastroparesis, or a

slowing down of stomach and bowel motility. This causes the food you eat to

remain 'dumped' into the stomach, for an extended period of time. The

'compost', as such decomposes producing an acidic environment, which also

produces gaseous byproduct, making the stomach bloat, and giving us 'acid'

indigestion. That is why TUMS or any other 'antacid " medications makes us

feel better, it lowers the pH of the stomach making it more alkaline.

It is important to go to a new GI if you are feeling comfortable with who you

have. You are fortunate to have a choice. You asked about what to ask the

doctor. One of the most important things I pursue with a new doctor is to get

a sen.se of their medical philosophy and where they stand on the current

standards of practice. You can tell those who go strictly by the book, or

those who are very laid back. I think it is important to find someone in the

middle of the road. When I am seeing a new doctor I ask them questions

pertaining to common misconceptions regarding Pancreatitis; I can tell pretty

quickly how informed they are at that moment.

For example, as patients, we all know how misinformed the textbooks are

regarding symptoms, quite frankly we are living examples that the textbook

cases of Pancreatitis are long gone. This has happened primarily due to the

advancements in diagnostic technologies. When most of the textbooks were

written, it was not possible to diagnosis Pancreas Divisum.

Any way, some questions, are:

1. I understand Pancreatitis is pretty rare, do you have any other

Pancreatitis patients.

( I look for a response that would indicate that the doctor is aware that

this disease is much more prevalent than once suspected. I want to know if I

am their first patient. They are more likely to answer the question you

asked, rather than asking if you are their first. This will begin to give you

a sense of their ego. My doctor has two patients with Pancreatitis, but she

is the first one to admit that she is flying by the seat of her pants,

because she in no GI or pain management specialist, but she is willing to be

my primary care doctor, if we can work together with the help of my other

doctors.)

2. What do you think causes most of the cases of Pancreatitis?

( I look for signs of prejudice that everyone with Pancreatitis is an

alcoholic. And, if it is caused by alcohol, I look to see if there is any

sense that the doctor will not prejudge the patient, if it is. Of course,

this will be addressed if the first thing they say is referencing the fact

that they assume you drink too much. My experience is that if they are so

misinformed about the causes of Pancreatitis, then they will be misinformed

about the treatments.)

3). How does my lab work look? Is there anything else that I need to have?

( I am looking for their understanding of serum blood enzyme levels. If they

reference the Amylase or Lipase levels being low and say anything towards it

indicating there isn't Pancreatitis, it is apparent that they do not

understand the pathophysiology of the disease. It is impossible for a disease

pancreas to produce adequate enzymes.)

4. What kind of treatments are available? Can this be cured?

(I am looking for their understanding of whether they feel that treating the

symptoms is going to address the cause, meaning a stenosed duct or occluded

duct due to stones is not the problem. Opening the duct and inserting stents

does not address the reason why their are stones. It is understood that if

the duct is stenosed then that would cause the drainage to be sluggish and

then precipitate stone development. But it rarely has been a permanent

solution.)

5. I heard there was a pancreas transplant, can you tell me more about that.

(I am looking to see what their philosophy is about transplants. It also

tells me how concerned they are about the development of diabetes. Many say,

that's crazy, there are more deaths than successes. I have read the studies

and know that isn't true. Others say yes, they do them in a handful of places

across the country. I want to know if they would ask me if I am interested in

that direction. Because before you know it, it will no longer be an option.

My particular doctor never gave me the options.)

6. If the doctor doesn't support transplant, I would ask, " Aren't my islet

cells going to die with this disease? Shouldn't I save them before they are

all gone?

(I am interested to see if the doctor would say, not to worry about that you

can treat diabetes with insulin, or if they would show some sense of concern

and acknowledge that more people die from Pancreatitis induced diabetes than

from Pancreatitis.)

7. I would ask the doctor about any depression I had.

(I would look for his understanding that their have been studies done that

indicate that Pancreatitis causes depression from the disease process alone,

much less form the situational and quality of life changes occurring. I would

hope that the doctor would be an advocate of mental health, and either

encourage me to seek counseling or make a referral, as well as initiate an

antidepressant if I wasn't already on one.)

8. I would ask the doctor how I was to manage the pain, would it last

forever?

(I would hope the doctor was a proponent of pain management clinics, and

acknowledge that Pancreatitis pain is one of the most painful diseases there

is. I would look to see if the doctor instructed me to avoid all aspirin or

Tylenol containing products, and instead order me something that was not a

combination drug, such as low dose Oxycontin, or Morphine. Some people think

that is pretty dramatic to start with, but the truth is that Percocet,

Vicodin, Hydrocodone, all have opioids in them.)

9. I would ask if I should be concerned about my blood sugar or diet?

(I would hope that the doctor would understand that persons with Pancreatitis

should all be prescribed a glucometer to monitor their blood sugars on a

random basis at home, dietary recommendations should encourage low fat, no

large amount of sugar foods, preferably sugar free foods, and absolutely no

alcohol. The doctor should encourage you to keep a dietary log book and work

up something that works for you, as it is a highly individual thing. It is

important to realize that anyone with Pancreatitis is by nature of the

disease going to be endocrine insufficient and that you shouldn't wait until

your blood sugar is excessively high to make adjustments in your diet.)

10. Lastly, I would mention my concern about what things cost. Does the

doctor take Medicare / Medicaid?

(I would hope that the doctor would not say, " Oh, don't worry about that, it

is covered by insurance. Any bill that comes our way comes out of our pocket

one way or another. The doctor should be very concerned about a lifetime max.

Since almost everyone will eventually be on disability, it is important to

know if that doctor will continue to take care of you since with disability,

you get Medicare.)

I don't know if this was anything you were asking for. The deal is that most

of us know so much from our reading, that what we are looking for in a doctor

is someone who is sensitive, understanding, recognizes the relationship as a

partnership towards hope, and that the doctor will be someone that can

develop trust in you and will do whatever needs to be done to keep you as

comfortable as possible, and as informed as possible to any breaks in

technology that could lead towards a cure.

I would definitely amend these questions to be the things that concern you.

And, before you go to the doctor, look at the answers and decide what things

are important for you.

Good luck,

Karyn E. , RN

Exec. Director, PAI

Indianapolis, IN

The PAI serves as a means of support, information, and advocacy. The PAI

cannot offer medical advice or direction nor substitute for your health care

provider.