July 16, 2004
Question from Ft. Thomas, Kentucky, USA:
My girlfriend is having difficulties getting the necessary care she needs to recover from a bout of ketoacidosis, pancreatitis, and a kidney infection. A mild sickness seemed to develop into a state of ketoacidosis from not being able to eat for a couple days. I took her to the hospital and she was admitted to the ICU (Intensive Care Unit). She was there for a week and was diagnosed with an acute case of pancreatitis. The care was very substandard, in my opinion. It was rare for her to see a doctor, while in the hospital. Upon being dismissed from the hospital, she was not given a prescription for an oral antibiotic and she was given a prescription for Creon. This surprised her regular doctor once she went to her first follow up visit two weeks later. She began to experience severe pain and I, once again, had to take her to the emergency room. Her temperature reached 104.5 degrees F., which worried me a great deal. She was diagnosed with a kidney infection. The kidney that became infected was the one that lays next to the pancreas. This has been a real struggle for her. She wants to get better, but cannot seem to see any of her doctors in a timely manner. She ends up sick and in the hospital again before the proper follow up care. Now, she has not been feeling well again. My biggest worry is that she is not eating properly. She skips meals because she is not hungry. She gets mad at me for telling her to eat. Her spirits are down because she feels the "system" is against her, simply because she has to wait so long to see a doctor. It is then a challenge to find a doctor that really seems to care. Please help me regarding the dangers of not eating. My thinking is that it messes with her blood sugar numbers, making consistency more difficult. She has been in constant pain which a doctor said can also make the blood sugar numbers erratic. This particular doctor wanted her to change from the pain medication that was not working to another. This was not allowed by another doctor. Therefore, the pain continues and the cycle continues.
It sounds like your girlfriend is really going through a rough time. For that, I am very sorry. It sounds like this is a very complicated case made even more confusing because the doctors are not communicating very well. First, the chronic pain sounds like it continues because there is still active inflammation going on. It raises a question as to whether this is from persistent pancreatitis. In many cases, the stomach is put completely at rest and patients are treated with parenteral nutrition (nutrition through the vein). This help decrease the pain. On the other hand, is the kidney infection cleared up? Finally, there is a way to treat with insulin, whether she eats or has nutrition through the vein. Not eating at all will weaken her ability to recover from the illness. I agree with you that eating intermittently does not allow for any type of plan to give her insulin and this does not allow good control, which she also needs to recover. In a case like this, I would ask for another opinion or have a meeting with the responsible physician so that you know the plan and choices of treatment. Through this type of advocacy on your part, there might be improved communication and a call for a higher level of care. I agree that doing nothing or allowing things to stand as is will not be in her best interest.