Thank you. Your explanation of pancreatitis secondary to gall stones is the best I have seen, and better than the explanation I got from the doctors (who will operate in two weeks).

May I ask two questions?

1.  I have been told to live on the white diet.  White rice, white bread, the white part of potatoes etc until surgery. Does this mean low fiber as well as low fat? (No fresh fruit or vegetables? ) Are acidic (lemons, tomatoes) food okay?

2.  Have you ever known anyone to have black stools (not necessarily diarrhea) with gall bladder /pancreatitis? There was no blood evident on rectal exam.

Thanks so much, even without these answers I am grateful for all the answers you DID provide.

You are wise to get those gall stones out now before your pancreatitis gets chronic, extremely painful and possibly incurable.  Thank God that now days with "buttonhole surgery", the operation is usually not much worse on the patient that have a bad wisdom tooth pulled - no day in the park, but nothing like it was twenty years ago.

First, I found a useful guideline from the Ohio State University Medical Center entitled:  Restricted Fat Diet for Pancreatitis and Gallbladder Disease.  You will need Adobe Reader to view it, but most computers already have it loaded (it's free).

I have never heard of the "white diet".  I cannot find a reference to it on the internet.  There's more info out there about pancreatitis in cats and dogs than in people.   Perhaps you need a further explanation, especially about veggies and fruits.  I do know some basic guidelines, though, that will help your pancreas heal and also help your body prepare for surgery.

• No alcohol at all - not a single glass of wine or sip of beer, nor any "tonic" which contains alcohol.  This is poison to a "sick" pancreas.
  
  
• If you smoke, stop right now.  Smoking stresses the body's natural defenses, and can  contribute to the damage to the pancreas.  You won't be able to smoke in the hospital, anyway.  Smoking damages the body in other ways that makes surgery riskier.  Even a couple of weeks without ciggies will help.  Same for other drugs, legal or illegal.  Don't even take an aspirin or other pain reliever, herbal supplement or vitamin right now without checking with your specialist.
  
  
• Follow a very low fat diet or as instructed by your Dr.  Most doctors do not recommend a totally fat free diet, but if yours did so, go along with it.  Some skim milk is fortified with extra milk solids, plus cultured with acidophilus, increasing the flavor, digestibility and nutrition.  (I buy Publix brand; it's delicious.)   Fat free cheddar or mozzarella slices,  used with white bread and a little cooking spray, makes a great low fiber, low fat grilled cheese sandwich.  Use low fat or fat free yogurt, cottage cheese, sour "cream" and fat free cream cheese, or fat free "butter" or mayonnaise to dress up bread, potatoes and rice.  Use egg whites but not the yolks.  Use cooking spray for all cooking, and no fried foods or greasy, salty snacks!  Avoid saturated or hydrogenated fats completely or anything with any significant amount of cholesterol.  
  
  
• Use very little meat, and certainly no fatty ones, or pork.  Perhaps your doctor has forbidden all meat until you recover.  There's no harm in this.  For those allowed some meat, boiled or broiled chicken breast, turkey breast or fish are best choices.  Nor does such a diet have to be bland and disgusting.  For instance, try the Salad Olivier:  skip the peas, olives and raw veggies.  Use only fat free mayonnaise, and poach your own chicken breast.  Use egg whites, but give the yolks to the dogs.  This is one delish dish even with the fat taken mostly out.  
  
  
• Eat small meals frequently.  If you are overweight, under-eating a little bit won't hurt.  But don't try to diet radically just now to lose weight this close to surgery.
  
  
• Drink lots of water, but avoid coffee, caffeine and sodas.  Water will help flush out your system.  Also, a low fiber diet may cause constipation, which extra water should help avoid.
  
  
• Beans, peas, corn and many other vegetables are high in healthy fiber.  But your digestive system needs to rest, so don't eat them.   Seeds and nuts are out!   While seeds are healthy for most people, those recovering from pancreatitis shouldn't indulge.  Clear soups are good, or those low in fiber, fat and hopefully lower in sodium (hard to find).  Veggies and fruits, especially cooked ones without seeds, fiber, membranes  or skin, should be okay in small quantities, but tomatoes, citrus and other acidic foods MAY cause irritation or acidity and you probably ought to ask your doctor or dietitian about fruits and veggies in general and acidic ones in particular.  If they give you the okay, try them in small quantities.    Also avoid spicy seasons, black or hot peppers, for instance.  Anything that gives you gas, acid stomach, nausea, heartburn or pain should not be repeated even if a doctor had given you the green light; everyone's system and illness is a little bit different.   Once your gallbladder is removed, the pancreas will finish healing, at which time you will be able to go back to a more normal diet.   I would encourage you to use a dietitian's help if available through your medical provider, both now and after the surgery.  

As to the black stools, keep in mind that Pepto-Bismol and certain other medications, iron and some other mineral supplements, and even spinach, can turn the stools black.  In addition, you asked if I've ever heard of such a thing; the answer is yes.  But it was many years ago before scans, electron microscopes and other 'scopes, and when exploratory surgery was dangerous and to be avoided.   Accumulation of fluids was called "dropsy" whether caused by kidney failure or heart failure.  High blood pressure with eschemias or mini-strokes or even just plain red-in-the-face, incoherent rage were all called "apoplexy".   But I remember that in cases of indigestion, pain, and abdominal inflammation (as a catch-all of conditions were called) and which included black stools, according to folk medicine, one had to "cleanse the liver of excess bile".  All a bunch of hooey, of course.  Probably a lot of these people had colon cancer, perhaps spread to the liver, and others may have had conditions similar to yours.  If they didn't find blood in your stool, I wouldn't worry.  Just look forward to getting past the surgery and healing up, and I'll bet the condition will correct itself.  Let's hear back from you; keep us posted.

Also, fat-free plain yogurt, perhaps with a little honey or jelly, might be digestible as the little microbes that make yogurt also pre-digest it to quite a degree so it is better tolerated by persons with lactose intolerance, since the lactose is greatly reduced.  If the doctor nixes Lactaid products you might try a spoonful of yogurt at a time.   Live culture yogurt is also very beneficial for the whole digestive system, providing it with friendly flora, something that you will need, I think, after following an "all white diet" for a couple of weeks.

I think most sorbets have about the same amount of acid; the balance of sweet and sour is what makes these foods attractive, and if a fruit is too bland, the manufacturer will add something like citric acid.  Therefore your peach sorbet is probably about as acid as the lemon.  Unless they contain pieces of fruit or visible pulp, they shouldn't have fiber, however. 

No, Pepto-Bismol wouldn't still be in your system.  But remember your whole digestive system is abnormal right now.  The best thing to do is put it right out of your mind until after you heal from the surgery and pancreatitis.  Betcha it will disappear!  (If not, you can deal with it then.) 

I agree it's great your doctor is so frank.  Until he takes a peek inside he cannot tell if your gall bladder can be removed safely with the button-hole approach, or if he sees something else he wishes to take a look at.  It's a good sign that you were able to pass the stone, and are still strong enough to keep on working.  Activity should help, as long as you get sufficient rest;  a sedentary lifestyle is very bad for the digestive system in general and for the gallbladder in particular.  Like as not you'll wake up after the operation with a couple of tiny holes, a bit stiff and sore, and on your way to full recovery.

In addition to your physical health, you might wish to practice relaxation and deep breathing techniques, starting immediately.  A relaxed attitude will carry you through in better shape and help with a speedier recovery.  Some people get permission to listen to favorite soothing music on a small portable CD or tape player and earphones, before, during and after the operation.  

 Do keep us posted.

I would like some guidelines or diets to follow concerning chronic pancreatitis.  I am already on pancreatic enzymes. 

Other that the suggestions here by readers and by me, I have no other advice.  Pancreatitis is such a serious disorder that anyone suffering from it should have a consultation with a dietitian.  Ask your doctor or hospital for recommendations and availability.

Thank you for your Q & A column. It's really been the only helpful thing I have been able to get.  I went to urgent care for abdominal pain and was diagnosed with severe pancreatitis that came on after a flu-like sickness with projectile vomiting.  I did not eat for 7 days and only drank an ounce of Pedialyte every 30 minutes.  I switched back to a local physician, recommended by Urgent Care, who told me I could "go ahead and eat" but did not explain what I could or could not have.

I have not had follow up care and am getting better.  I dread the next episode and feel it will probably kill me.  I do not have insurance so I cannot get more lab work or x-rays or anything done so I don't know what brought this on.  I may or may not have gall stones.  The urgent care Dr. did not think I did as the pain was entirely left and middle sided.  I am 63 years old and work part time.  I thought I could make it safely to 65 when I could get Medicare but apparently I was wrong.

When I was working full-time that employer decided he didn't want to pay health insurance any more and took it way, and gave me a raise so I could buy my own.  Problem was that I was turned down because I have had several non-malignant tumor surgeries and I have an irregular heartbeat.  Because of all this, I have routinely exercised, kept my weight down, and 3 years ago I started using low-fat, high fiber diet plus take vitamins and mineral supplements.

Well, that's where I am at.  I think the woman who wants to be President should get her facts and figures together and start a campaign for this country to have socialized medicine.  The balance of the power goes to the wealthy.  All the money paid into insurance companies and Medicare could actually support a "Cadillac" healthcare system.

Okay--I am done sounding off!

I agree with your opinion of the medical situation in the USA.   Everyone should have access to basic care (actually, I feel, in relation to how well they are taking care of their own health), including dental, access to a dietitian when needed and a certain amount of counseling, practical and psychological, which in the long run can be cheaper than dosing people with oodles of drugs (I'm thinking about Florida and many other states' foster care system, a disgrace!).

That basic care certainly should have included a better set of exams for gallstones, because you are right, if you have them, your situation is a walking time bomb.   I have a couple of thoughts along this line.  In Florida, we have what's called "Medicaid" which is a government-supported insurance.  I don't know if it's Federal, or if you have something similar where you are.  

In addition, most (not all) counties have at least one hospital with an out-patient care system based on ability to pay.  You have to get a card, wait forever, etc., but that is better than nothing.  Plus, if you have any more symptoms, you'll already be qualified for assistance.

Third, there are teaching hospitals at universities that sometimes (if you keep after them) can offer some assistance.  You really should have had gallstones ruled out, or confirmed and removed.  The "pain test" is only a guess, as many people haven't significant pain in the "right" place, although their gallbladder is an infected or impacted mess.

In your case, you are taking care of yourself, hoping to reach 65 and Medicare, like so many people I know.   You didn't mention if you smoke, and if so, please stop.  Also, get enough fluids and NO alcoholic beverages or greasy food, although a totally fat free diet probably isn't a good idea, either.  Hard to know, isn't it, when you have no positive diagnosis and no safety net?  

Everyone can find themselves without health insurance or access to good care; no one is immune.   We have twice had to take radical action to be sure we had health insurance, once when the kids were in their teens.  The second time my husband had to accept a "buyout" that guaranteed us insurance, but combined with the effects of Hurricane Andrew and other income loss totally unexpected and unpreventable, our income dropped until we almost went under for the three years until hubby qualified for Social Security.  

If enough people put pressure on their officials, writing to their senators and representatives, even picketing, sooner or later a better health-care system must come about.  

Funding?  Tax the dickens out of cigarettes, cigars and non-nutritive or non-nutritious foods, like most candy, cookies, sodas, "fruit" drinks and ades, most chips, and other imitation food with little or no redeeming value.  

Can that happen?  Probably not.  Insurance companies have vested interests, and manufacturers of these sweet and salty substitutes for food make millions.  Both have big pocketbooks, payrolls, and influence on the market and with elected officials.   It's really the people's choice; if the public eats a healthy diet with lots of fruits, veggies, beans, whole grains and lean meat, refrains from smoking and doesn't drink to excess, that would not only improve the nation's health in a giant leap, but ease the burden on the health industry.  Since I can't see that happening, let's at least pressure to have the punishment fit the crime and tax these items to provide health care for persons like yourself, who got caught in a situation not of your own making.  

Let me know how it goes, please.

Have been diagnosed with chronic pancreatitis.  Any suggestions for a not too boring diet?  Can I use olive oil over my veggies or salad (not too much of course).   Can I drink coffee?  Thanks for your ideas.  

It's my understanding (and I could be wrong) that fats will make pancreatitis worse.  Maybe in chronic cases this is not true, if you can tolerate it.  This is something you need to check with your doctor.  Certainly if he or she okays some fat, olive oil would be the best choice.  There are, however, healthful ways to make food less boring - use of herbs, such as dill, oregano, basil, and other leafy herbs.  While hot pepper and spicy foods may not be tolerated well, herbs can often add flavor to the bland diet prescribed for pancreatitis.

The only reference I found on drinking coffee is at The Way Up; it says:

Those with pancreatitis need to avoid large meals, coffee, tea, spices, alcohol, condiments, add Pancreatic Enzyme replacement & sometimes add Bicarbonate.

If you find that some particular herb causes discomfort, write that one off.  There's plenty of tasty, healthy ones out there.   Also, please consider asking your physician for a consultation with a dietitian.

Hi.  My mother has got gallstones and she is waiting to see a specialist at the hospital. She seems to be in incredible pain in the evening, and most nights this pain keeps her up and therefore she gets no sleep. Please could you tell me what foods she should avoid??  Many thanks.

Let me tell you a couple of tales first before I give strong advice and warnings (I'm an old granny so I get to do this!).

My late daughter Elizabeth was a very strong-willed, outspoken aggressive kid (guess who she took after?).   She used to walk home with the only black American girl who "integrated" our elementary school, first just because she lived in the same direction, and second because the other kids sometimes taunted and even threw stones at the poor kid, and my daughter on more than one occasion took them on, to their detriment.  The school was in the throes of federal orders to accept a whole bunch of non-English-speaking Cuban refugees, and it was also supposed to be integrated, and I guess this was their token attempt at it. 

On day she walked Gloria home for some reason, and went inside with her.  Her mother was partly disabled with severe diabetes, and they found her almost comatose.  They called an ambulance.  Gloria was nearly hysterical, and Elizabeth was the kind that was take-charge in any emergency.  After Gloria and her mother were taken away to the county hospital (also under orders to attend all blacks) Elizabeth rushed home with a demand to be taken immediately to the emergency room.  When she got there, Gloria's mom was on a gurney in a hallway, still nearly comatose.  This continued for hours, with both Elizabeth and Gloria pleading from time to time for assistance.  The attendant finally told them that if they didn't stop making a fuss, she would have them removed by security.  Elizabeth responded:  "If you don't get a doctor to do something in the next five minutes, I'm going to call the police, and NAACP, etc., etc..."  I'm not sure exactly what all she threatened them with.  In a few minutes, a doctor came, wheeled the lady into a cubicle, and within a few minutes all hell broke loose, with people running everywhere.  Her blood sugar was astronomical, as was her blood pressure; she was also having a heart attack.   Result:  after two weeks in the hospital she came out to be permanently consigned to a nursing home, blind and totally disabled.  Gloria had to move in with relatives and attend another ("colored") school.   And this was in the days before HMO's!

Second:  my baby sister was having pain, vomiting, etc., and finally was hospitalized for a while.   Her doctor failed to diagnose gallstones.  She had gone into pancreatitis.  The obstetrician who had seen her years ago happened to see her records and looked them over, at what point a lot of fuss was raised, she was sent to a larger hospital with better diagnostic equipment, and began a series of surgeries that a couple years later has not ended.  She has a morphine pump, is usually in constant pain from a damaged pancreas, and her whole life has changed in a terrible way.

I assume your mother is part of some medical machinery - HMO, Medicaid, or some such.  Specialists are often underpaid and backlogged, especially at this time of year, and there liable to take their own good time getting to her.  This is NOT ACCEPTABLE!   She either is having repeated gallstone attacks, has a stone lodged in the bile duct, has an infected gall bladder (which can lead to peritonitis) or already is having pancreatitis which is VERY serious.  

If it was one of my loved ones, I'd see to it that every single day or night she was in pain, she was transported to the emergency room (coach her to ham it up a little if required).  After a few trips at the HMO's or whatever agency's expense, they'll see to her problem with a little more speed.  Otherwise, irreparable damage may be occurring while she waits for the medical establishment to set appointments and schedule tests. 

Things she can do (remember I'm not a doctor, please.  These are opinions - mine and expressed by others.):  Drink lots of water.  Don't eat a single molecule of fat.  That includes meats, fatty fish, seeds, nuts or fatty veggies such as avocado.  Mint tea may help - or may not.  Also tea (herbal or other) simmered with one or two "wings" of star anise, but this can reportedly cause heart irregularities in some people if overdone.  If there's small gallstones, medications exist that can relax the duct and assist in their passage.   

Raise heck.  And let us know what happens.

It is with great interest that I read your (everyone's) comments in your forum.   Yesterday I was diagnosed with pancreatitis, & have been on an education rampage since then.  The amount of knowledge out there on this particular disease is pitiful, with no clear causes, only effects.  Yet, I consider myself lucky, especially when I read some of your other contributor's stories/nightmares.  So far, all I have been told is to refrain from alcohol, a no-brainer, and to drink lots, to rid the body of the poisons/toxins in the blood.  Eating does not affect me, and all elimination processes are normal.  All I can feel is the excruciating pain in my back, and the knitting needle in my abdomen.  The Darvon the GP prescribed is not even coming close to the point of proper pain management.  Ahh well, tomorrow is the judgment day.  I get all my ultrasound/X-ray results back.  Maybe more blood tests, who knows.  I'll take it a step at a time. 

Thanks for letting me spout off, and thanks for the diet tips

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