Thursday, July 24, 2014
Diabetes/pancreatitis and weight loss
My father spent 25 days in ICU recently with acute pancreatitis around the Feb/March timeframe. The condition was caused by gallstones blocking the pancreatic duct. The doctors removed his gallbladder and we thought everything was fine until things started spiraling out of control. My dad had issues with his kidneys shutting down; irregular heart rhythms, and eventually he contracted hospital acquired pneumonia (MRSA). Post pneumonia he has scaring on the lungs and is aspirating when he drinks thin liquids. His weight dropped from 180 to ~ 146 pounds.
Up until one month ago, he appeared to be regaining his strength and was returning to his walking regimen. Then X-rays showed that he an air pocket outside of his lungs and the doctors were stumped on why/how that appeared. It eventually dissipated, but his weight was now at 133 pounds.
Just this past weekend, he experienced a minor stroke. Heart and carotid arteries appear OK. However, his weight is now down to 125 pounds. No one has been able to explain the considerable weight loss. My dad is now anemic, incredibly frail and depressed. He is a diabetic but was never insulin dependent. Now he takes 3 shots a day. The aspiration continues to be an issue but he is eating decent and still has a good appetite. He also suffers from Barrett’s esophagus due to acid reflux.
We seem unable to get any answers on the weight loss and fear other systems will shut down due to his weakened state. Are the doctors missing something? What should we be investigating as potential causes? Any guidance is appreciated.
I'm sorry to hear about what your father has been through - it sounds like a very difficult time. I can give some very general advice but it is hard to be very specific based on the information provided. There are insights that a physician who has followed knows a person all the way through an illness like this can have yet there can also be useful insights that come from a physician who has not been involved all throughout the course can bring, regardless of specialty. It is important to take a broad look in this situation and consider both the factors that are obvious - is there malabsorption from the pancreatitis or inadequate blood sugar control from the diabetes or persistence/recurrence of infection - and factors that are not so obvious - is there an unrelated new problem contributing? Is this person depressed, not eating, giving up? Your father's age and other medical problems will be important factors in assessing this - I hope this will give you some questions to ask that may be helpful. Please feel free to write back - your support and your ability to speak up and ask questions are important for your father at a time like this.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati