Dear Dr. Roach: I am a 78-year-old woman. In August 2015, I had my gallbladder removed through a laparoscopic procedure.
In January this year, I was having the same symptoms I had before my gallbladder surgery.
I had a CT scan with contrast, which showed that there were two stones in the common bile duct that had to be removed.
It was also discovered, by means of a needle biopsy, that some cysts were present inside the tail of the pancreas. In May, surgery was performed to remove a slice off the precancerous tail of the pancreas that contained the cysts. I鈥檓 happy that no cancer was found in the biopsy of the pancreas. I was told that there were 鈥渁dhesions鈥� around my colon, so six inches of my colon was removed.
I had complications causing pneumonia and sepsis. I went into hospital and recovered. I was put on Zenpep 鈥� 5,000 IU, three times a day 鈥� for the pancreas. What benefit will I get from this medication, and is it necessary and long-term?
J.M.
Surgery on the pancreas can cause complications, so surgeons are rightly cautious about doing it.
The pancreas鈥檚 major job in the body is to make digestive enzymes to help break down food.
However, these enzymes can damage the pancreas and the structures around it, including the intestines, in spite of good surgical technique.
This can exacerbate a condition called chronic pancreatitis, which is often caused by blockages in the common bile duct. (It is called 鈥渃ommon鈥� because both bile from the gallbladder and pancreatic secretions flow though this duct.) Zenpep is one brand of pancreatic enzyme replacement.
Giving these enzymes by mouth (they need to be in a special capsule, so that they won鈥檛 be destroyed by the stomach acid, but will work in the intestine) allows the pancreas to 鈥渞est.鈥�
It is helpful in relieving pain and improving digestion. You need to be on these long term only if you are having abdominal pain or if you are unable to digest fat.
People who can鈥檛 digest fat develop steatorrhea (鈥渟teat鈥� means 鈥渇at鈥�; 鈥渞rhea鈥� means 鈥渇low through,鈥� from Greek), the symptoms of which include greasy diarrhea and weight loss. If you weren鈥檛 having either abdominal pain or fat loss, I wonder if your surgeon gave it to help prevent complications. Your surgeon or a gastroenterologist can answer this question for you.
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Dear Dr. Roach: Your recent article regarding warfarin testing was timely for a question we have been struggling with regarding our 88-year-old mother, who is facing warfarin therapy.
My brother says the lab where he goes for INR testing advised him that the testing monitors blood levels of warfarin. The lab where my mother goes states that the test monitors how long it takes the blood to clot. Could you please advise which is correct?
C.S.
Warfarin works by blocking vitamin K, absorbed from food, which is necessary for the liver to make clotting factors.
The effectiveness of warfarin is measured by the INR (international normalized ratio), a test of blood-clotting time.
Strictly speaking, your brother鈥檚 lab is correct, but the two amount to almost the same thing, since it is the amount of warfarin (as well as the amount of vitamin K taken in) that affects the clotting times.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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