Huge archive

Dear TPP Member,
It has come to my attention in the last few days that another
Pancreatitis group has been soliciting TPP members for their group.

Low Fat Chocolate Chip Cookies
Serves 24 (1 serving = 2 cookies)
1/4 cup butter
1/2 cup sugar
3/4 cup packed brown sugar
1 egg
1/3 cup nonfat yogurt
1/3 cup unsweetened applesauce
2 teaspoons vanilla extract
2 cups sifted all-purpose flour
1 teaspoon baking soda
1/2 teaspoon salt
6 ounces miniature semisweet chocolate chips
Preheat oven to 350 degrees F.
Spray a Teflon coated cookie sheet lightly with canola oil.
In a large bowl, cream butter with sugar and brown sugar. Add egg and
mix well. Add yogurt, applesauce, and vanilla. Mix well and set
aside. In a medium bowl, combine flour, baking soda and salt. Add to
creamed mixture and mix well. Add chocolate chips. Refrigerate dough
until well chilled.
Measure 1 1/2 tablespoons dough per cookie and place 2 inches apart
onto cookie sheet. Bake in oven for eight to ten minutes until
cookies begin to turn golden on the edges. Let cool before removing
from pan.
NOTE: For crispier cookies, freeze dough for at least two hours
before baking.
Facts per Serving:
Calories: 138 Fat: 4g Carbohydrates: 24g
Cholesterol: 14mg Sodium: 110mg Protein: 2g
Fiber: 1g % Cal. from Fat: 26% % Cal. from Carbs: 70%
Source: Canyon Ranch Health Resorts
***Note: This recipe is not diabetic friendly

The Fat Epidemic: He Says It's an Illusion

Weight training improves diabetic nerve function
study to see
if

Getting Around to Accepting Diabetes
Dealing With the Diagnosis
Where Do You Go From Here?
by Kenneth Ruge, D.Min.
I began to wonder how two people of similar age and with essentially
the same health concerns could react so differently. I began to see
that either approachviewing diabetes as a wake-up call or a curseis
a choice that each person decided to make. And it is a choice you can
make, too. Armed with the right information and attitude, you can
still make the most of your life despite diabetes, and you can even
change your life for the better.
Shock and reorganization
Whether you've known for a while that you have diabetes or were
recently diagnosed, you already know that this challenging condition
requires you to rethink a lot of your life. How you engage in that
process might be the key to whether you become a Paul or a Sarah as
you restructure your life and move on. To explain this kind of
learning experience, Virginia Satir, one of the pioneers of family
therapy, created the Shock and Reorganization Model.
Shock occurs when you suddenly get new information, such as finding
out you have diabetes, that conflicts with your sense of who you are.
Life as you know it is suddenly disrupted by profound new issues that
you have no choice but to deal with, whether or not you understand
them at the time.
Reorganization follows, in response to the initial shock. You find a
new way to put the pieces of your life back together, reorganizing
your self-image, activities, and relationships.
I see these steps at work in the life of a friend who recently
learned he has diabetes. It was indeed a shock. The news ushered in a
period of profound personal adjustment, which was made more difficult
by the fact that his life seemed to be in perfect order before the
diagnosis. Steve is a successful stockbroker who is happily married
and has two wonderful young children. Suddenly, he feels his health
has been taken away from him. Steve acts like someone grieving the
loss of a loved one. He is sometimes difficult to live with at home.
He says he feels exhaustednot so much because of his diabetes, but
because of the stress of adjusting to change. Yet even in these tough
days, he's beginning to put his life back together in a thoughtful,
constructive way. As Steve learns to deal with changes in his
physical health, his attitude is turning back toward more positive
thoughts. His wife and friends know that he's going to adjust and
that he'll be all right.
But will Steve merely cope with diabetes, or will he reach some
better, transformed life, as my friend Paul did? Perhaps the answer
to that question lies in the writings of Dr. Elisabeth Kübler-Ross, a
psychiatrist and authority and counselor on issues related to death.
Stages of change
According to Dr. Kübler-Ross, when people confront a significant loss
or major life change such as the onset of a chronic illness, the loss
of a loved one, the loss of a job, or a divorce, they adjust to the
change in a series of predictable stages. Regardless of the source of
distress, most people go through the stages of denial, anger,
bargaining, and depression before reaching the final stage of
acceptance.
Denial. This is the first, ostrich-like response. When someone first
learns that he has diabetes, for example, he is likely to react by
sticking his head in the sand and saying, "This is not happening!
This can't be happening to me! This is not who I am!" When confronted
with any life-altering news that doesn't fit a person's sense of who
he is, this is a natural first response.
Anger. In this second stage, the person begins to wonder, "Why me?
This is unfair! What did I do to deserve this? Why is my health being
affected?" He may even become angry at God (who serves as a handy
scapegoat for unwanted life changes), or he may blame his spouse,
friends, or family members for his new problems.
Bargaining. In this stage, people begin to consider making changes.
The newly diagnosed person with diabetes may have thoughts such
as, "If I don't eat Snickers bars for the next six months, then
everything will be fine and I'll be back to normal. And I'll walk
every day, too. OK, is that a deal?" Of course, watching your diet
and maintaining an exercise program will help blood sugar control,
but you know that diabetes will not go away. Even though such
thoughts usually do not result in changes that improve the situation,
bargaining allows people to grapple with how they are going to change
their lives. Yet it isn't the ultimate answer, since people cannot
erase changes in their lives.
Depression. As people start to accept the permanence of these
changes, they usually get the blues. They lose hope, lack energy,
experience trouble sleeping, or see a drop in libido. At this point,
many people also report that they're just going through the motions
of daily life. "The horizon seemed a kind of bleak gray," one woman
recalls, "and I thought it would stay that way forever." Such
depression saps their sense of hope and sense of the future. But
after they have gone to this dark place, the gloom lifts and they can
move on.
Acceptance. A new day dawns somewhat gradually. People begin to
accept the new changes and they envision a futurea new life that
takes diabetes into consideration. They can see new possibilities and
new options for themselves. With the support of family and friends,
advice and guidance from health-care professionals, and some healthy
reevaluation, they can move ahead with a restored sense of hope.
How these stages help
Knowing about these stages of change is helpful because it provides a
framework for people to understand their feelings and lets them know
that others have had similar experiences.
Knowing about these stages also lessens the chances of getting
stalled in one stage and not moving on. It's easy and seductive, for
instance, to get stuck denying one's diabetes by not taking
medicines, not exercising, and not monitoring your blood sugar. It's
equally tempting to get stuck in depression and self-pity, casting
yourself as a victim of a capricious God, your genetic makeup, or
your past habits. Denying your feelings of anger or depression is
another way you can get stuck moving through the stages. But if you
realize where you are in the process, you stand a better chance of
breaking out, moving on, and finding new meaning and rewards.
If you're going through such a process (or if you're supporting
someone who is), it may help to know that people usually work through
the five stages several times over and not always one after the
other. In fact, most people spiral back and forth through the stages,
gravitating slowly toward acceptance. One day they're working on
acceptance issues, then the next day they're bargaining, angry, or
depressed. It takes time and patience and inner courage to accept
your feelings as you move this process along.
From acceptance to mastery
Once a person with diabetes reaches acceptance, he can view diabetes
not as a loss, but as an opportunity to reorient his life and
priorities. That's clearly what Paul did. He incorporated all his
changes and restructured his life magnificently.
When people reach acceptance, they often say they now occupy a new
kind of landscapea place that's different from where they lived
before all the changes took place. Often, they start to review the
past.
When you have reached this stage of the change process, you too may
find yourself considering how you've lived your life up to this time.
What's been important to you? What would you have done differently?
You're really starting a new chapter! Another characteristic of this
stage is that time may become more precious to you. We're not
immortal. And our choices may be limited. But these thoughts aren't
necessarily limiting or morose. In fact, they may be an invitation to
take risks and redirect our lives to where we really want to be.
As that new horizon becomes brighter and better defined, many of us
can focus on what is truly important to us. An exercise developed by
Stephen Covey (author of several books, including Seven Habits of
Highly Effective People) can help you achieve that level of insight.
In this exercise, imagine yourself sitting in the back pew at your
own funeral service. No one can see you as you listen to eulogies
about you delivered by four different people. The first eulogy is
given by a colleague, who talks about what you were like at work. The
second speaker is a friend, who talks about you as a member of your
social circle. The third is a relative, who describes your home and
family life. The fourth is a member of your religious community, who
recalls you in that context. Listen closely as you sit in your
imaginary pew. What would those four people say, honestly, about you?
Is that the kind of eulogy you would like to hear? If not, what are
you going to do about it?
Certain questions will arise in your mind as you go through this
exercise. What qualities would you like to be remembered for? What is
most important in your life? What are your values? What do you stand
for? Are you living your life according to those values and beliefs?
These questions offer an opportunity to orient yourself toward a more
authentic you.
Creating a spiritual tie
As you set your life back on center and start moving ahead, you might
also want to bring another level of self-discovery into the process.
You might say, "OK, I'm in a new place. My health is back in my
control. I'm sorting out my values. But are these new life changes
also a spiritual opportunity for me?"
They probably are. In the words of author Paula D'Arcy, "God is in
the detours." She means that any cataclysmic life change offers an
opportunity to ask the spiritual questions, "What am I supposed to be
doing with my life?" and "What does God intend for me?"
I recall my own father working out those issues. Dad faced hurdles
and losses like the rest of us, but he still somehow managed to
reorient his life toward a more spiritual plane. For one thing, he
had diabetes back in the days before many of the medical advances
that are available today. For another, he lost his wife at a
relatively early age. I recall that he went through stages of loss
similar to those I describe abovecertainly through anger and
depression. Yet through it all, he defined a new role for himself as
a teacher and spokesperson in a 12-step recovery program. Helping
other people became a very meaningful opportunity for him to put his
diabetes in perspective and to get his life back in order after my
mother's death. Despite the difficult challenges, he used them to
open doors to new ways of thinking that were both meaningful and
personally authentic.
Finding your path
So, where are you supposed to go as you begin this new chapter in
your life? It may mean drawing closer to family and friends. It may
mean discovering and following your passionwhether it's a long-
deferred dream or some new interest. It may mean taking a new role as
you encourage acts of healing and reconciliation among your family
members and friends. Or it may mean an increased devotion to
spirituality or health or nature. Life is an open book. You can write
your own story.
As you navigate your unique journey, try to remember that your path
may not be exactly what it at first seemsa hard road, blocked by
high obstacles and tough challenges. It is really an opportunity for
you to redesign your life in a fuller and more authentic way. As you
walk this new walk, I wish you good luck, good friends, and Godspeed

"Brown Sugar"
sugars!

Diet Detective: Are there really 'good' and 'bad' carbs?

Study: Junk about one-third of U.S. diet
Wednesday, June 2, 2004 Posted: 10:53 AM EDT(1453 GMT)
WASHINGTON (Reuters) -- Junk foods such as sugary sodas and chips
make up
nearly one-third of calories in the U.S. diet, researchers said.
A study of 4,700 adults showed that, despite the increased popularity
of
low-carbohydrate diets, soft drinks and pastries pile on more
calories in the
daily diet than anything else.
"What is really alarming is the major contribution of 'empty
calories' in
the American diet," said Gladys Block, a professor of epidemiology
and public
health nutrition at the University of California, Berkeley, who led
the study.
Writing in the June issue of the Journal of Food Chemistry and
Analysis,
Bock and colleagues said that sweets and desserts, soft drinks and
alcoholic
beverages account for nearly 25 percent of all calories consumed by
Americans.
Salty snacks and fruit-flavored drinks add another five percent.
"We know people are eating a lot of junk food, but to have almost one-
third
of Americans' calories coming from those categories is a shocker.
It's no
wonder there's an obesity epidemic in this country," Bock said in a
statement.
Bock used data from a U.S. government survey called the National
Health and
Nutrition Examination Survey. She analyzed the answers of 4,760 adults
interviewed in 1999 and 2000.
They were asked to report all the foods they ate in the previous 24
hours.
Sodas contributed 7.1 percent of the total calories eaten. Sweets
topped the
list, followed by hamburgers, pizza and potato chips.
"It's important to emphasize that sweets, desserts, snacks and
alcohol are
contributing calories without providing vitamins and minerals," said
Block.
"In contrast, such healthy foods as vegetables and fruit make up only
10
percent of the caloric intake in the U.S. diet. A large proportion of
Americans
are undernourished in terms of vitamins and minerals," Block added.
"You can actually be obese and still be undernourished with regard to
important nutrients. We shouldn't be telling people to eat less -- we
should be
telling people to eat differently."

FOOD GROUP EXCHANGE LIST
* STARCH LIST

HI Kimber,
Girl I am so very sorry you having to deal with this new issue of
your sight. Being visual impair I can understand what you gar going
though. I pray this doesn't take months to correct itself and in the
mean time you be very careful even around your home.
Our thoughts and prayers are with you Kimber and hope you better real
soon.
With Warmest Regards & God Bless
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

Hello Kelly,
I am so sorry you have to deal with your doctors who seem to know
nothing about Pancreatitis at all, and hope the chief will get back
to you very soon. Seems you have to be the teacher here Kelly and
make sure you take care of number one YOU As for DROP THE BALL this
simply means someone hasn't done their job - let you slip between the
cracks in the systemREALLY. LOL I think we already know that one
with the way you been treated. And for taking you off the meds and
making you go cold turkey, what kind of morons do we have here??
Anyway, they have to send the fecal part of the test by FedEx to a CA
lab. Kelly, I hope you get some kind of good care very soon for your
pain Hun. And I hope the later chapters of you book get better.
Looking forward to hearing how things turn out for you.
Break through pain is when you take a extended release pain med -
something that lasts 12 hours or more, and you still have pain. Often
times, especially if you are a narcotic, you will have some kind of
fast release medication for the pain that happens with the 12 hour
pill. (Ree helped me with this one).
If I need to call the chief just let me know I be glad too
ReeAnn and I will keep you and Mike in our prayers. Take Care
With Warmest Regards & God Bless
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

http://www.gicare.com/pated/edtgs11.htm
Low Fat Diet
Purpose
For a regular healthy diet, it is recommended that of the total
calories eaten, no more than 30% should come from fat. However,
certain diseases and medical conditions can make it difficult for the
body to tolerate even that much fat, so a low-fat diet may help
people with these conditions.
Gallbladder Disease: Bile secreted from the gallbladder helps the
body break down and absorb fats. When gallstones or gallbladder
diseases are present, a low-fat diet is often used to prevent
complications.
Delayed stomach emptying (Gastroparesis) is a condition in which the
stomach empties food into the intestine too slowly. This can cause
bloating, nausea, and even vomiting. Normally, fat in foods delays
stomach emptying, so fats make gastroparesis worse.
Diarrhea can be caused by many conditions. When it occurs, it can be
aggravated by eating fatty foods.
Malabsorption of nutrients: Absorption is the transfer of nutrients
into the bloodstream from the intestine. In some diseases of the
pancreas and small intestine, patients have trouble absorbing
nutrients from the diet, including fat. A low-fat diet may help to
control symptoms until the cause of malabsorption can be diagnosed.
Fatty Liver: For a number of reasons, fat may accumulate in the
liver. Fat is not normally stored in the liver, and in some cases
this can cause damage to the liver. A low fat diet and weight
reduction may be helpful.
Nutrition Facts
In most cases, this diet provides all the nutrients required by the
National Research Council's Recommended Dietary Allowances (RDA). In
some cases, however, the physician may prescribe supplements. Women
of childbearing age and those people with malabsorption may need to
take certain vitamin and/or mineral supplements.
Special Considerations
Be careful how foods are prepared. Trim all visible fat from meats.
Bake, steam, or broil meats and fish instead of frying. Toppings for
potatoes and pastas should contain no fat above the three allowed
daily servings.
This low-fat diet should be used until the underlying medical
condition is controlled or corrected. The physician will give any
individual instructions, and tell you when you no longer need to use
the low-fat diet.
Food Groups
Group
Recommend
Avoid
Milk & milk products (2 or more cups daily)
skim milk, evaporated skim milk, skim buttermilk, nonfat sour cream,
yogurt made with skim milk (3 gms fat or less/oz, maximum of 3
oz/day), fat-free cheeses, low-fat cottage cheese, part skim
mozzarella cheese, part skim or skim ricotta cheese
whole milk, cream, sour cream, non-dairy creamer, whole milk cheese,
cheese spreads
Bread & grains (4 or more servings daily)
whole grain and enriched breads, cold cereal, whole grain cereals
(except granola), saltines, soda crackers, low-fat snack crackers,
rice cakes, unbuttered popcorn, low-fat muffins, plain pasta, barley,
oatmeal, home-made pancakes without fat, French toast made with egg
substitute and skim milk
breads containing egg, cheese, or made with fat; biscuits; sweet
rolls; pancakes; French toast; doughnuts; waffles; fritters; muffins;
granola-type cereals; snack crackers; potato chips; packaged
stuffing; fried rice; chow mein noodles
Vegetables (3 or more servings daily)
all vegetables (steamed, raw, boiled, or baked without added fat)
fried vegetables or those in cream, cheese, butter sauces, dips
Fruits (2 or more servings daily)
all other fruits
avocado
Meat or meat substitutes (5 to 6 oz daily)
poultry (without skin); veal; lean beef trimmed of fat (USDA good or
choice cuts of round, sirloin, flank, and tenderloin); fresh, canned,
cured, or boiled ham; Canadian bacon; lean pork (tenderloin, chops,
cutlet); fish (fresh, frozen, canned in water); eggs (boiled,
scrambled without added fat); luncheon meat at least 95% fat free
any fried, fatty, or heavily marbled meat, fish, or poultry; beef
(USDA prime cuts, ribs, ground beef, corned beef); pork (spareribs,
ham hocks); fish (canned in oil); eggs (fried in butter, oil, or
margarine); luncheon meat less than 95% fat free
Beverages (4 to 6 cups or more daily)
decaffeinated or regular coffee or tea, cocoa made with skim milk,
fruit juices, soft drinks, water
beverages made with high fat dairy products
Soups
fat-free broths, consommés, bouillon; soups made with fat-free
broth, skim milk, evaporated skim milk
cream soups, soups with added oils or meat fats, soups made from
stocks containing meat fat
Fats & oils (3 servings daily, each listed is one serving)
avocado 2 Tbsp or 1/8 medium, margarine 1 tsp,
diet margarine 2 tsp,
salad dressing 1 Tbsp,
diet salad dressing 2 Tbsp, vegetable oils 1 tsp,
nuts (raw or dry roasted):
almonds 6, peanuts 20 small or 10 large, whole walnuts 2, whole
pistachios 18, sesame seeds 1 Tbsp, sunflower seeds 1 Tbsp,
saturated fats: bacon 1 strip, butter 1 tsp, dried coconut 2 Tbsp,
cream cheese 1 Tbsp, sour cream 2 Tbsp, other fats: olive oil 1 tsp,
peanut oil 1 tsp, large olives 10, peanut butter 2 tsp
any fat in excess
Sweets & desserts (servings depend on caloric needs)
sherbet made with skim milk, non-fat frozen yogurt, fruit ice,
gelatin, angel food cake, vanilla wafers, ginger snaps, graham
crackers, meringues, puddings made with skim milk, tapioca, fat-free
cakes and cookies, fruit whips made with gelatin or egg whites, hard
candy, jelly beans, jelly, jams, marmalades, maple syrup
ice cream, pastries, cakes, cookies, pies, doughnuts, pudding made
with whole milk, cream puffs, turnovers, chocolate

Hey There Denise,
Now we're talking girl, "Low Fat Candy Bar Pies" This sound like a
winner to me, as many of you know I have many names like The Pudding
Man and Farm Gary, kindly given to me by my very good friend Bruce.
LOL. Well looks to me that ReeAnn, needs to make a trip to the
grocery store before Sunday's chat. Maybe this will keep me form
fallen asleep in the chat room before Bruce gives me another handle.
One more think ReeAnn 8 serving is not enough so doubles the recipe
girl. Farm Gary is a growing boy..
I hope every one well and have a pain free day.
With Warmest Regards & God Bless
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

***Notice this is not diabetic friendly***
Low Fat Candy Bar Pie
4 ounces fat-free cream cheese, softened
2 cups plus 1 tablespoon skim milk
4 small reduced-fat chocolate toffee candy bars (Sweet Escapes)
8 ounces fat-free whipped topping
2 small boxes instant chocolate fudge pudding mix
1 prepared chocolate graham cracker pie crust
In a medium-size mixing bowl, combine softened cream cheese with 1
tablespoon skim milk. Mix on medium speed of an electric mixer.
Gently fold 1 1/2 cups of whipped topping into the cream cheese. Set
aside.
Place candy bars into the bowl of a food processor. Process until the
candy bars are crumbled. Fold half of the crumbled candy bars into
the cream cheese and whipped topping mixture.
In a separate mixing bowl, combine chocolate pudding mix with skim
milk. Mix on medium speed for a minute. Fold remaining whipped
topping into the pudding mixture. Pour half the chocolate mixture
into the bottom of the pie crust.
Top with a layer of the cream cheese/whipped topping mixture. Spread
the remaining chocolate mixture on the cream cheese layer. Top with
the remaining crumbled candy bars and refrigerate overnight before
serving.
Makes 8 servings.

http://tinyurl.com/6kkv5
http://tinyurl.com/6dmgp
http://tinyurl.com/5l4wk

Hello Everyone,
Just wanted to do a quick post and let everyone I am still alive and
kicking. I am way behind on reading my digests - it has been a VERY
hectic week. Take that back - a hectic month!! I normally average
1 doctor's appointment per week. This month I have had 12-13
appointments!! Still have two to do next week. Anyway, I am
hoping that I can spend the day Sunday answering some posts. Won't
be home all day tomorrow.
Tomorrow we are entering Crystal in a costume contest sponsored by
the SPCA. Before I found out about the contest, I crocheted her a
Jack-O-Lantern Sweater, complete with cap and pumpkin stem. She is
so cute!!! This evening I finished making leggins that are green -
suppose to be the grass. Will get a pic of her and post it on the
website.
Gary and I are thinking about dressing up for this event too. This
year Gary will be a hippie and I will be a nun. Hope the paper
mache dries on his Cheech & Chong sized "joint". Will get some
pictures of the 3 f us and get them posted on the board.
In the last 10 days I have started taking 2 new drugs - both anti-
anxiety meds. One is Buspar and the other is Loraepam. Any one
have any expereince with either of these? Please let me know how
you made out with them.
Well I am beat tonight. Promiseto spend Sunday catching up on
posts. You all are in my prayers!!
Lots of Gentle Hugs,
ReeAnn ~ Virginia
(434) 409-7162 or
(434) 979-0176
Founder ~ ThePancreatitisPlace
Home Page (www.thepancreatitisplace.org)

http://edcp.org/factsheets/handfoot.html
Hand, foot, and mouth disease is caused by one of several types of
viruses
Hand, foot, and mouth disease is usually characterized by tiny
blisters on the inside of the mouth and the palms of the hands,
fingers, and soles of the feet. It is commonly caused by
coxsackievirus A16 (an enterovirus), and less often by other types of
viruses.
Anyone can get hand, foot, and mouth disease
Young children are primarily affected, but it may be seen in adults.
Most cases occur in the summer and early fall. Outbreaks may occur
among groups of children especially in child care centers or nursery
schools. Symptoms usually appear 3 to 5 days after exposure.
Hand, foot, and mouth disease is usually spread through person-to-
person contact
People can spread the disease when they are shedding the virus in
their feces. It is also spread by the respiratory tract from mouth or
respiratory secretions (such as from saliva on hands or toys). The
virus has also been found in the fluid from the skin blisters. The
infection is spread most easily during the acute phase/stage of
illness when people are feeling ill, but the virus can be spread for
several weeks after the onset of infection.
The symptoms are much like a common cold with a rash
The rash appears as blisters or ulcers in the mouth, on the inner
cheeks, gums, sides of the tongue, and as bumps or blisters on the
hands, feet, and sometimes other parts of the skin. The skin rash may
last for 7 to 10 days.
There is no specific treatment for the virus that causes hand, foot,
and mouth disease
Help prevent and control the spread of hand, foot, and mouth disease
by:
Washing hands well, especially after going to the bathroom, changing
diapers and/or handling diapers or other stool-soiled material.
Covering the mouth and nose when coughing or sneezing.
Washing toys and other surfaces that have saliva on them.
Excluding children from child care or school settings if there is a
fever, or ulcers in the mouth and the child is drooling.

http://tinyurl.com/5xonu
Hand-Foot-and-Mouth Disease
Topic Overview
What is hand-foot-and-mouth disease?
Hand-foot-and-mouth disease is a viral infection that causes sores in
and on the mouth and on the hands, feet, and sometimes the buttocks.
Children under the age of 10 years are most commonly affected. The
disease occurs most often in the summer and autumn months, but may
appear at any time.
Hand, foot, and mouth disease is not the same as foot-and-mouth
disease (sometimes called hoof and mouth disease) or mad cow disease
(bovine spongiform encephalopathy, or BSE), which are infections that
occur almost exclusively in animals.
What causes the disease?
The disease is caused by a viral infection with an enterovirus,
usually Coxsackie 16 or, less commonly, enterovirus 71.
Hand, foot, and mouth disease is contagious. It can be passed to
others through contact with saliva, mucus, or feces. Children are
contagious throughout the duration of the disease (7 to 10 days) and
may be contagious for several weeks longer because the virus may
remain present in their feces.
Hand-Foot-and-Mouth Disease
Topic Overview
What are its symptoms?
The main symptoms of hand-foot-and-mouth disease include fever, sore
throat, and fluid-filled blisters that appear on the hands, feet,
mouth, and sometimes the buttocks. The blisters develop from small
red spots or a skin rash that can break open and become crusted over.
The sores heal in 7 to 10 days.
Symptoms develop 3 to 6 days after exposure to the virus. Your child
may at first feel tired, develop a sore throat, and have a fever of
around 101 °F(38.33 °C) to 103 °F(39.44 °C) for 1 to 2 days. Skin
sores then begin to appear. These sores can be painful, especially in
younger children.
How is it diagnosed?
Your child's doctor can usually diagnose hand-foot-and-mouth disease
by asking you questions and by examining your child. Laboratory tests
are rarely needed to diagnose the disease.
How is it treated?
Treatment for hand-foot-and-mouth disease is not usually needed
because it most often goes away on its own in about 7 to 10 days. You
may give your child a pain reliever, such as acetaminophen (for
example, Tylenol), or a nonsteroidal anti-inflammatory drug (NSAID),
such as ibuprofen, to relieve discomfort from fever, sore throat, or
open blisters. Do not give aspirin to anyone under age 20 unless
directed to do so by your health professional because of the risk of
Reye's syndrome.

http://www.drgreene.com/21_1103.html
Hand-Foot-Mouth Disease
Related concepts:
Coxsackievirus A16
Introduction:
A miserable child who has lost interest in eating solids? Perhaps the
child has hand-foot-mouth disease.
What is it?
Hand-foot-mouth disease is a common childhood illness featuring mouth
sores, fever, and a rash. Similar-sounding "foot-and-mouth disease"
is a disease of cattle and is not related to this condition.
Hand-foot-mouth disease is usually caused by a virus called
coxsackievirus A16. However, many children with coxsackievirus A16
infections do not have all of the features of hand-foot-mouth
disease. Some have no rash, some have no mouth sores, and some even
have no fever. A variety of other viruses in the Enterovirus family
can also cause hand-foot-mouth disease (the coxsackieviruses are
enteroviruses).
Who gets it?
This disease is most common among young children but is seen with
some frequency up until puberty. Adults can get it, but this is much
less common. Once people have had coxsackievirus A16 they are
generally immune, but they could get another case of hand-foot-mouth
disease from one of the other, less common viruses. Most infections
occur in the summer or early fall, with the peak between August and
October in the northern hemisphere.
What are the symptoms?
Children with hand-foot-mouth disease usually start to feel crummy 3
to 7 days after they were exposed. Often, the first thing parents
notice is their children's decreased appetite for solids. Children
may also have a fever and a sore throat. A day or two later, many
children develop sores in the mouth. They begin as small red spots on
the tongue, gums, or mucous membranes. They may blister or form
ulcers.
A skin rash may also develop over a day or two, with flat or raised
red spots. Unlike with many rashes, the spots are often found on the
palms and soles. Also, it is common to have the rash on the buttocks.
Often, the red spots will form tender blisters (although not on the
buttocks). Unlike with chickenpox, the rash does not itch.
Usually the rash disappears and the child feels better within about 1
week.
How is it diagnosed?
Usually the diagnosis is made based on the history and physical exam.
Lab tests are available for the coxsackieviruses and other
enteroviruses, but they are not usually necessary. Hand-foot-mouth
disease is sometimes confused with strep throat, which can also begin
with a fever and sore throat. It is sometimes mistaken for chickenpox
because they both have blisters. It might be confused with any of the
childhood exanthems. Also, many children with hand-foot-mouth disease
are diagnosed with ear infections because the eardrums may appear red.
How is it treated?
Antibiotics do not help with hand-foot-mouth disease. The important
issues are pain relief and plenty of fluids.
How can it be prevented?
The viruses that cause hand-foot-mouth disease are present both in
the stool and in the respiratory secretions. It can spread by fecal
oral transmission, droplet transmission, contact transmission, and by
means of fomites. Hand cleansingespecially after diapering/toileting
and before eatingcan help reduce its spread. Children are often kept
out of school or daycare for the first several days of the illness,
but it is not clear this prevents others from becoming infected.
Other children in the class are probably contagious even though they
will never develop symptoms.

Hey Gang,
Here is chapter 3 of the saga that my life has become!!!!!!!
On the 18th I had another appt. with the PA over the pain clinic. As I
have said before this is the same guy who accused me of being a "drug dealer"
and who jerked me completely off all meds cold turkey!!!!!! Well, this time as
I am sitting there and he starts asking questions, he then tells me that between
he and the internal medicine doc someone"dropped the ball where you are
concerned!"
I am sorry but I have always thought myself as intelligent but WHAT EXACTLY
DOES THAT MEAN? DROP THE BALL????????
Now he has restarted me on Darvon 65mg twice a day for breakthru pain.
Breakthru what???? I have no other pain meds. Only as needed as well.
I just can't get over this.
I then asked if he would do the fecal fat test that is the "gold standard"
for diagnosing pancreatitis. He questioned me alot but finally gave in only to
find out that the "state of the art" lab doesn't for sure know what he is
talking about, had to do research on it real quick then order the container
because they didn't have it on hand. Well, I got the phone call this morning
that the container was finally in and can come and get it anytime. Will get it
Monday but will start test as soon as possible.
Anyway, I hope this finds everyone in as little pain as possible. I also
still haven't gotten a response or acknowledgement from the chief about the
letter I sent to him about this whole ordeal.
Will stop boring everyone now.
lots of hugs and kissess.
hoping for painfree days and restful nights (soon),
Kelly from Oklahoma

Good morning all,
I have a question and need some help. This morning my day care boys
dad tells me the boys have been exposed to hand and mouth disease. I
looked it up on the net but my worry is that last year, Chelle got
the same cold the rest of us got, but it affected her pancreas and
sent her to the hospital. If Chelle is careful with hand washing, do
you think I should worry about her around the kids? The net said
kids new born to 10 can be affected. Should I be more concerned?
She is 11, but I never know how this pancreas thing deals with other
disease. Could anyone help me here. She is in pain this morning
anyway, I would hate to see it get worse. Help!!!!! lol
Blessings,
Christine
Denton, TX.

Hello Loretta,
Hope you are having a Great Birthday!!!! How old did you say you
were ? 20 ? :) Don't eat too much cake. Have a Very Happy Birthday
Girl.
Denise

Yay!!
Ed had his initial post heart attack exam last night.
He passed with flying colors and will return to work
on Monday.
It's truly amazing in that he had the attack just over
a week ago.
-Ellen Grove
NY

Orange Turkey Stir-Fry
3/4 cup orange juice
1/4 cup orange marmalade
2 tbsps reduced-sodium soy sauce
2 tbsps cornstarch
1/8 tsp ground ginger
1/8 tsp hot pepper sauce
1 lb turkey tenderloin, trimmed and cut into 1-inch strips
1/4 cup all-purpose flour
2 tsps vegetable oil
4 green onions, cut into 1-inch pieces
1/2 cup coarsely chopped green pepper
1 seedless orange, peeled, sliced and halved
Hot cooked rice, optional
In a small bowl, combine the first six ingredients; set aside. Dredge
turkey
in flour; shake off excess. In a 10- in. skillet, heat oil over
medium-high
heat. Cook turkey in three batches until tender and lightly browned
on all
sides. Remove and keep warm. Add onions and green pepper to the
skillet;
cook and stir for 1 minute. Stir in orange juice mixture. Bring to a
boil;
reduce heat and simmer for 3 minutes. Add turkey and oranges; heat
through.
Serve over rice if desired.
Serves 4
Calculated without rice: Calories 289;Fat 4g;Chol 54mg;Sodium
353mg;Carbs
35g;Protein 30g
Taste of Home's Low-Fat Country Cooking Volume 4

This really helps to know that I am not being selfish for taking
care of myself. I have noticed that my mom is very proud of me and
that she is starting to be more involved in me adn the last few days
she has been better, well at least to me. I will be in touch.
Thanks again,
Ann

Hi all,
sorry I've been offline the past couple of days. First, I had a problem
with my vision on Friday with extreme double vision. I was able to get
an appointment on Monday with my eye doctor. It seems I've develope a
kind of palsy on the nerve that moves your eye from side to side. My
left eye is currently stuck looking at my nose. He says that it usually
goes away in 4-6 months. I'm trying to get an appointment with the
binocular vision specialist to see about getting some temporary prisms
so I can see normally agin. Currently I have to close one eye to see
properly. Very disorienting with the double vision. Then, yesterday I
had a cut on my left ear that wouldn't stop bleeding, slugglishly, not
gushing, (I'm on blood thinniers). I had to go to the doctors to get a
topical oinment put on it and I've got to keep a bandage on my ear for
two days. Looks funny. My cats had evidently run over me during the
night and somehow scratched my ear. Oh well. Just one thing after another.
Kimber
--
Kimber Allen
Vallejo, CA
hominid2@...
Note: All advice given is personal opinion, not equal to that of a licensed
physician or health care professional.

Christine,
Just a post to say hello to you and Michelle. Hope this week find
Michelle feeling much better. Thanks for posting pictures, I love
the pictures of you both. Looks like you have a little ham in your
family :-)
Amanda and Alex are out of school rest of week on Fall Break. Amanda
is feeling good and happy for the days off.
Take care
Rhonda
Tulsa, OK

Loretta,
Wishing you a year of happiness! Enjoy your day.
Rhonda
Tulsa, OK

Good October Morning to you. Hope this day finds you and Robert both
good. Amanda has been feeling pretty good the last two weeks (PTL).
Her only issue lately issue lately is some recurring headaches. What
a pain those are! Kids wrapped up the first 9 weeks of school this
week and are actually out of school today and tomorrow for fall
break. Lucky them! Wish I got a fall break from work...ha ha.
Fall is trying to arrive here in Oklahoma. Cooled off last week,
only to have warm days sneak back in this week. Makes it hard to
know what kind of clothes to wear each day :-)
I think of you guys often and read posts almost everyday. I pray
that your bp is under control these days. Jeff had a physical
earlier this week and found his bp very high. We are watching
everyday right now and it seems to be staying high. The doc wants to
start him on daily medication. Jeff is hating the idea of starting a
medicine that is a lifelong deal, but I am saying it sure beats the
alternative. Scary stuff.
Wishing you a good day and a great weekend.
your friend,
Rhonda
Tulsa, OK

Ann,
Hello, my name is Rhonda and I have a 12 year old daugher who suffers
from pancreatitis. She has had mostly recurrant acute attacks over
the last 6 years which means she feels good in between attacks.
I just wanted to post to you about taking care of yourself. Congrats
on your new job, that can be an exciting time. Don't ever feel
guilty about doing things for yourself that takes you away from your
Mom for a little while. In fact, I think taking time to yourself
makes you a better caregiver. You can come back to your Mom
refreshed and have new stories to share with her. Plus, I am sure
she wants you to take this opportunity and is very proud or you.
Your Mom is lucky to have you around. Take care and good luck on the
new job.
Rhonda
Tulsa, OK

THank you to all of you that replied to my first message. I now
feel that I am not alone and I have someone who understands what is
going on with me. I will be in touch and give you updates on my
mom. I am not going to give up on her. I love her so much. She is
having a good day today..so i am going to go and spend some time
with her. On monday I start a new job, good for me but bad for my
mom. I have been the primary ne taking care of her for the past few
months because my dad is laid up with a broken foot. I just feel
that everytime I try to take care of myself, I am hurting of mot
taking care of my mom in some way and I feel guilty. Does any one
else have this problem? Well I am going to go and if anyone wants
to write back that would be great. All os your stories are going to
help me out so much.
Thanks again,
Ann

Hello Rita,
So glad to hear from you. I have been wondering how Beauford was
doing. I am sorry to hear that he is not doing so well. Depression
comes hand in hand with pancreatits. Has his doctor put him on
anything for it yet ? If not, maybe you could ask him to. Did he have
this surgery at MUSC ? Thats quite a drive from this upper part of SC
we both live in. I sure would like to meet one day, seeing we live so
close. How is your back these days? Mine hurts me on a daily basis:
Sorry you had to put your beloved pet down. That is so hard. My dog
is 9 years old and blind, but seems to be in good health otherwise.
Animals sure know how to wrap themselves around your heart!!! I have
been putting up a low fat recipe every day, if you would like me to
put a particular type of recipe up...Just let me know and I will try
and get it up for you. Please give Beauford a hug from all of us and
always remember, You and your family are always in our thoughts and
prayers.
God Bless
~*~Denise~*~
deniseatdiabetes@...
Co-Founder-All Diabetic International
sdhammett@...
http://www.thepancreatitisplace.org/

Hi Lori and Mike,
I am so sorry that Mike is having a hard time and we will keep
your family in ours prayer tomorrow. Having chronic pancreatitis and
diabetes is a lot to have to deal with for Mike and yourself as
well. Yes there are many sad stories here and every one has their
own to tell, but we are a family here so you just hang in there and
we'll be here for you Lori and Mike. If you need any thing just give
us a yell Lori.
With Warmest Regards & God Bless
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

Lemon Baked Sole
Serves 4
16 ozs Sole Fillets (4 fillets)
2 tsps Butter or Margarine melted
2 tsps Lemon Juice
2 tbsps Flour
2 tsps Parsley Sprig chopped
1/8 tsp Black Pepper freshly ground
1/8 tsp Paprika
Rinse fillets thoroughly in cold water; pat dry with paper towels,
and set
aside. Combine melted butter or margarine and lemon juice in a small
bowl.
Combine flour, chopped parsley and pepper in a shallow container. Dip
fillets in margarine mixture and dredge in flour mixture. Transfer
fillets
to a nonstick baking sheet, and drizzle any remaining butter or
margarine
mixture over fish. Sprinkle fillets with paprika. Bake at 375 deg F
for
15 to 20 minutes or until fish is golden brown and flakes easily when
tested
with a fork
NOTE: If a crisper texture is desired, broil baked fillets 4 inches
from
heat for 1 minute. Garnish each fillet with a lemon wedge and fresh
parsley sprigs, if desired.
136 Calories;3g Fat;22g Protein;3g Carbs;60mg Chol;112mg Sodium;0g
Fiber
Exchanges: 3 Lean Meat; 1/2 Fat

Gary Morris <gwm4d@...
Hi to our Newbe's
If you are new to this illness, here's a site that may help you as a
caregiver to have a better understanding of Pancreatitis.
What is the pancreas and why is it there?
At one time or another, most of us have experienced stomach pains.
Dull or sharp abdominal pains may come and go as we challenge
ourselves with new foods or undergo periods of stress. Sometimes,
though, stomach pain indicates a more serious problem. Many organs in
your digestive system can create problems, including the pancreas.
(Read about "Digestive Diseases and Conditions")
http://www.health-news-and-
information.com/3saintmarysreno/libv/i48.shtml
With Warmest Regards & God Bless
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

Hi ANN, My name is Brenda. Im a 31 year old, married and have two
small sons. that just had a pain pump put in, (Medtronic infusion
pump) on Aug.10th two months ago. I've had pancreatitis for 4 yrs
now and i was taking lots of medication to keep the pain under
control, which still wouldnt help because my body was gettingimmuned
to the pain medication.
From pain to vomitting..to even
smelling food would cause pain. When they first gave me a trial run,
which was no fun. Because people with pancreatitis can not take
morphine. it makes the pain multiply. my pain management doctor
convience me that it was a different type..so i went for it..when
they put in the permanent pain pump..it was suppose to be a
overnight stay at the hospital..they put in morphine, i stayed in
the hospital for four days. then i went home was in bed for two more
weeks. My husband went with me to my follow up visit with the
doctor and literally had to threaten him but i was sooooo weak and
could not function....So they changed the pump medication to
Dialudid (a type of synethetic morphine)..which is what Robert (TPP
Member) recommended me to tell the doctor , because he had the same
problem..but my doctor said it was procedure to try the morphine
first. To close this long story Jimmy...I am so much better now..i
recommended this pain pump to everyone. the recovery would have been
better if my doctor would have listen in the first place. I used to
be in pain 24 hours 7 days a week..now about 4 to 5 hours a day
still take one pain pill a day instead of 8 to 10 of them.
If u have any more questions please feel free to ask anything ..
Take care..and i wish u pain free days
Brenda from FLorida

Diabetic neuropathies are a family of nerve disorders caused by
diabetes. People with diabetes can, over time, have damage to nerves
throughout the body. Neuropathies lead to numbness and sometimes pain
and weakness in the hands, arms, feet, and legs. Problems may also
occur in every organ system, including the digestive tract, heart,
and sex organs. People with diabetes can develop nerve problems at
any time, but the longer a person has diabetes, the greater the risk.
An estimated 50 percent of those with diabetes have some form of
neuropathy, but not all with neuropathy have symptoms. The highest
rates of neuropathy are among people who have had the disease for at
least 25 years.
Diabetic neuropathy also appears to be more common in people who have
had problems controlling their blood glucose levels, in those with
high levels of blood fat and blood pressure, in overweight people,
and in people over the age of 40. The most common type is peripheral
neuropathy, also called distal symmetric neuropathy, which affects
the arms and legs.
Causes
The causes are probably different for different varieties of diabetic
neuropathy. Researchers are studying the effect of glucose on nerves
to find out exactly how prolonged exposure to high glucose causes
neuropathy. Nerve damage is likely due to a combination of factors:
metabolic factors, such as high blood glucose, long duration of
diabetes, possibly low levels of insulin, and abnormal blood fat
levels
neurovascular factors, leading to damage to the blood vessels that
carry oxygen and nutrients to the nerves
autoimmune factors that cause inflammation in nerves
mechanical injury to nerves, such as carpal tunnel syndrome
inherited traits that increase susceptibility to nerve disease
lifestyle factors such as smoking or alcohol use
Symptoms
Symptoms depend on the type of neuropathy and which nerves are
affected. Some people have no symptoms at all. For others, numbness,
tingling, or pain in the feet is often the first sign. A person can
experience both pain and numbness. Often, symptoms are minor at
first, and since most nerve damage occurs over several years, mild
cases may go unnoticed for a long time. Symptoms may involve the
sensory or motor nervous system, as well as the involuntary
(autonomic) nervous system. In some people, mainly those with focal
neuropathy, the onset of pain may be sudden and severe.
Symptoms may include
numbness, tingling, or pain in the toes, feet, legs, hands, arms, and
fingers
wasting of the muscles of the feet or hands
indigestion, nausea, or vomiting
diarrhea or constipation
dizziness or faintness due to a drop in postural blood pressure
problems with urination
erectile dysfunction (impotence) or vaginal dryness
weakness
In addition, the following symptoms are not due to neuropathy but
nevertheless often accompany it:
weight loss
depression
Types of Diabetic Neuropathy
Diabetic neuropathies can be classified as peripheral, autonomic,
proximal, and focal. Each affects different parts of the body in
different ways.
Peripheral neuropathy causes either pain or loss of feeling in the
toes, feet, legs, hands, and arms.
Autonomic neuropathy causes changes in digestion, bowel and bladder
function, sexual response, and perspiration. It can also affect the
nerves that serve the heart and control blood pressure. Autonomic
neuropathy can also cause hypoglycemia (low blood sugar) unawareness,
a condition in which people no longer experience the warning signs of
hypoglycemia.
Proximal neuropathy causes pain in the thighs, hips, or buttocks and
leads to weakness in the legs
Focal neuropathy results in the sudden weakness of one nerve, or a
group of nerves, causing muscle weakness or pain. Any nerve in the
body may be affected.
Neuropathy Affects Nerves Throughout the Body
Peripheral Neuropathy
toes
feet
legs
hands
arms
Autonomic Neuropathy
heart and blood vessels
digestive system
urinary tract
sex organs
sweat glands
eyes
Proximal Neuropathy
thighs
hips
buttocks
Focal Neuropathy
eyes
facial muscles
ears
pelvis and lower back
thighs
abdomen
Peripheral Neuropathy
Peripheral neuropathy affects the nerves in your arms, hands, legs,
and feet.
This type of neuropathy damages nerves in the arms and legs. The feet
and legs are likely to be affected before the hands and arms. Many
people with diabetes have signs of neuropathy upon examination but
have no symptoms at all. Symptoms of peripheral neuropathy may include
numbness or insensitivity to pain or temperature
a tingling, burning, or prickling sensation
sharp pains or cramps
extreme sensitivity to touch, even a light touch
loss of balance and coordination
These symptoms are often worse at night.
Peripheral neuropathy may also cause muscle weakness and loss of
reflexes, especially at the ankle, leading to changes in gait
(walking). Foot deformities, such as hammertoes and the collapse of
the midfoot, may occur. Blisters and sores may appear on numb areas
of the foot because pressure or injury goes unnoticed. If foot
injuries are not treated promptly, the infection may spread to the
bone, and the foot may then have to be amputated. Some experts
estimate that half of all such amputations are preventable if minor
problems are caught and treated in time.
Autonomic Neuropathy
Autonomic neuropathy affects the nerves in your lungs, heart,
stomach, intestines, bladder, and sex organs.
Autonomic neuropathy affects the nerves that control the heart,
regulate blood pressure, and control blood glucose levels. It also
affects other internal organs, causing problems with digestion,
respiratory function, urination, sexual response, and vision. In
addition, the system that restores blood glucose levels to normal
after a hypoglycemic episode may be affected, resulting in loss of
the warning signs of hypoglycemia such as sweating and palpitations.
Unawareness of Hypoglycemia
Normally, symptoms such as shakiness occur as blood glucose levels
drop below 70 mg/dL. In people with autonomic neuropathy, symptoms
may not occur, making hypoglycemia difficult to recognize.
However, other problems can also cause hypoglycemia unawareness so
this does not always indicate nerve damage.
Heart and Circulatory System
The heart and circulatory system are part of the cardiovascular
system, which controls blood circulation. Damage to nerves in the
cardiovascular system interferes with the body's ability to adjust
blood pressure and heart rate. As a result, blood pressure may drop
sharply after sitting or standing, causing a person to feel light-
headed--or even to faint. Damage to the nerves that control heart
rate can mean that it stays high, instead of rising and falling in
response to normal body functions and exercise.
Digestive System
Nerve damage to the digestive system most commonly causes
constipation. Damage can also cause the stomach to empty too slowly,
a condition called gastroparesis. Severe gastroparesis can lead to
persistent nausea and vomiting, bloating, and loss of appetite.
Gastroparesis can make blood glucose levels fluctuate widely as well,
due to abnormal food digestion.
Nerve damage to the esophagus may make swallowing difficult, while
nerve damage to the bowels can cause constipation alternating with
frequent, uncontrolled diarrhea, especially at night. Problems with
the digestive system may lead to weight loss.
Urinary Tract and Sex Organs
Autonomic neuropathy most often affects the organs that control
urination and sexual function. Nerve damage can prevent the bladder
from emptying completely, allowing bacteria to grow in the bladder
and kidneys and causing urinary tract infections. When the nerves of
the bladder are damaged, urinary incontinence may result because a
person may not be able to sense when the bladder is full or control
the muscles that release urine.
Neuropathy can also gradually decrease sexual response in men and
women, although the sex drive is unchanged. A man may be unable to
have erections or may reach sexual climax without ejaculating
normally. A woman may have difficulty with lubrication, arousal, or
orgasm.
Sweat Glands
Autonomic neuropathy can affect the nerves that control sweating.
When nerve damage prevents the sweat glands from working properly,
the body cannot regulate its temperature properly. Nerve damage can
also cause profuse sweating at night or while eating.
Eyes
Finally, autonomic neuropathy can affect the pupils of the eyes,
making them less responsive to changes in light. As a result, a
person may not be able to see well when the light is turned on in a
dark room or may have trouble driving at night.
Proximal Neuropathy
Proximal neuropathy, sometimes called lumbosacral plexus neuropathy,
femoral neuropathy, or diabetic amyotrophy, starts with pain in
either the thighs, hips, buttocks, or legs, usually on one side of
the body. This type of neuropathy is more common in those with type 2
diabetes and in older people. It causes weakness in the legs,
manifested by an inability to go from a sitting to a standing
position without help. Treatment for weakness or pain is usually
needed. The length of the recovery period varies, depending on the
type of nerve damage.
Focal Neuropathy
Occasionally, diabetic neuropathy appears suddenly and affects
specific nerves, most often in the head, torso, or leg. Focal
neuropathy may cause
inability to focus the eye
double vision
aching behind one eye
paralysis on one side of the face (Bell's palsy)
severe pain in the lower back or pelvis
pain in the front of a thigh
pain in the chest, stomach, or flank
pain on the outside of the shin or inside the foot
chest or abdominal pain that is sometimes mistaken for heart disease,
heart attack, or appendicitis
Focal neuropathy is painful and unpredictable and occurs most often
in older people. However, it tends to improve by itself over weeks or
months and does not cause long-term damage.
People with diabetes also tend to develop nerve compressions, also
called entrapment syndromes. One of the most common is carpal tunnel
syndrome, which causes numbness and tingling of the hand and
sometimes muscle weakness or pain. Other nerves susceptible to
entrapment may cause pain on the outside of the shin or the inside of
the foot.
Preventing Diabetic Neuropathy
The best way to prevent neuropathy is to keep your blood glucose
levels as close to the normal range as possible. Maintaining safe
blood glucose levels protects nerves throughout your body.
For additional information on preventing diabetes complications,
including neuropathy, see the Prevent Diabetes Problems series,
available from the National Diabetes Information Clearinghouse at 1-
800-860-8747.
Diagnosis
Neuropathy is diagnosed on the basis of symptoms and a physical exam.
During the exam, the doctor may check blood pressure and heart rate,
muscle strength, reflexes, and sensitivity to position, vibration,
temperature, or a light touch.
The doctor may also do other tests to help determine the type and
extent of nerve damage.
A comprehensive foot exam assesses skin, circulation, and sensation.
The test can be done during a routine office visit. To assess
protective sensation or feeling in the foot, a nylon monofilament
(similar to a bristle on a hairbrush) attached to a wand is used to
touch the foot. Those who cannot sense pressure from the monofilament
have lost protective sensation and are at risk for developing foot
sores that may not heal properly. Other tests include checking
reflexes and assessing vibration perception, which is more sensitive
than touch pressure.
Nerve conduction studies check the transmission of electrical current
through a nerve. With this test, an image of the nerve conducting an
electrical signal is projected onto a screen. Nerve impulses that
seem slower or weaker than usual indicate possible damage. This test
allows the doctor to assess the condition of all the nerves in the
arms and legs.
Electromyography (EMG) shows how well muscles respond to electrical
signals transmitted by nearby nerves. The electrical activity of the
muscle is displayed on a screen. A response that is slower or weaker
than usual suggests damage to the nerve or muscle. This test is often
done at the same time as nerve conduction studies.
Quantitative sensory testing (QST) uses the response to stimuli, such
as pressure, vibration, and temperature, to check for neuropathy. QST
is increasingly used to recognize sensation loss and excessive
irritability of nerves.
A check of heart rate variability shows how the heart responds to
deep breathing and to changes in blood pressure and posture.
Ultrasound uses sound waves to produce an image of internal organs.
An ultrasound of the bladder and other parts of the urinary tract,
for example, can show how these organs preserve a normal structure
and whether the bladder empties completely after urination.
Nerve or skin biopsy involves removing a sample of nerve or skin
tissue for examination by microscope. This test is most often used in
research settings.
Treatment
The first step is to bring blood glucose levels within the normal
range to prevent further nerve damage. Blood glucose monitoring, meal
planning, exercise, and oral drugs or insulin injections are needed
to control blood glucose levels. Although symptoms may get worse when
blood glucose is first brought under control, over time, maintaining
lower blood glucose levels helps lessen neuropathic symptoms.
Importantly, good blood glucose control may also help prevent or
delay the onset of further problems.
Additional treatment depends on the type of nerve problem and
symptom, as described in the following sections.
Foot Care
People with neuropathy need to take special care of their feet. The
nerves to the feet are the longest in the body and are the ones most
often affected by neuropathy. Loss of sensation in the feet means
that sores or injuries may not be noticed and may become ulcerated or
infected. Circulation problems also increase the risk of foot ulcers.
More than half of all lower limb amputations in the United States
occur in people with diabetes--86,000 amputations per year. Doctors
estimate that nearly half of the amputations caused by neuropathy and
poor circulation could have been prevented by careful foot care. Here
are the steps to follow:
Clean your feet daily, using warm--not hot--water and a mild soap.
Avoid soaking your feet. Dry them with a soft towel; dry carefully
between your toes.
Inspect your feet and toes every day for cuts, blisters, redness,
swelling, calluses, or other problems. Use a mirror (laying a mirror
on the floor works well) or get help from someone else if you cannot
see the bottoms of your feet. Notify your health care provider of any
problems.
Moisturize your feet with lotion, but avoid getting it between your
toes.
After a bath or shower, file corns and calluses gently with a pumice
stone.
Each week or when needed, cut your toenails to the shape of your toes
and file the edges with an emery board.
Always wear shoes or slippers to protect your feet from injuries.
Prevent skin irritation by wearing thick, soft, seamless socks.
Wear shoes that fit well and allow your toes to move. Break in new
shoes gradually by wearing them for only an hour at a time at first.
Before putting your shoes on, look them over carefully and feel the
insides with your hand to make sure they have no tears, sharp edges,
or objects in them that might injure your feet.
If you need help taking care of your feet, make an appointment to see
a foot doctor, also called a podiatrist.
For additional information on foot care, contact the National
Diabetes Information Clearinghouse at 1-800-860-8747. Materials are
also available at http://ndep.nih.gov/materials/pubs/feet/feet.htm.
Pain Relief
To relieve pain, burning, tingling, or numbness, the doctor may
suggest aspirin, acetaminophen, or nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen. (People with renal disease should
use NSAIDs only under a doctor's supervision.) A topical cream called
capsaicin is another option. Tricyclic antidepressant medications
such as amitriptyline, imipramine, and nortriptyline, or
anticonvulsant medications such as carbamazepine or gabapentin may
relieve pain in some people. Codeine may be prescribed for a short
time to relieve severe pain. Also, mexiletine, used to regulate
heartbeat, has been effective in treating pain in several clinical
trials.
Other pain treatments include transcutaneous electronic nerve
stimulation (TENS), which uses small amounts of electricity to block
pain signals, as well as hypnosis, relaxation training, biofeedback,
and acupuncture. Walking regularly or using elastic stockings may
also help leg pain.
Gastrointestinal Problems
To relieve mild symptoms of gastroparesis--indigestion, belching,
nausea, or vomiting--doctors suggest eating small, frequent meals,
avoiding fats, and eating less fiber. When symptoms are severe, the
doctor may prescribe erythromycin to speed digestion, metoclopramide
to speed digestion and help relieve nausea, or other drugs to help
regulate digestion or reduce stomach acid secretion.
To relieve diarrhea or other bowel problems, the doctor may prescribe
an antibiotic such as tetracycline, or other medications as
appropriate.
Dizziness and Weakness
Sitting or standing slowly may help prevent the light-headedness,
dizziness, or fainting associated with blood pressure and circulation
problems. Raising the head of the bed or wearing elastic stockings
may also help. Some people may benefit from increased salt in the
diet and treatment with salt-retaining hormones. Others may benefit
from high blood pressure medications. Physical therapy can help when
muscle weakness or loss of coordination is a problem.
Urinary and Sexual Problems
To clear up a urinary tract infection, the doctor will probably
prescribe an antibiotic. Drinking plenty of fluids will help prevent
another infection. People who have incontinence should try to urinate
at regular intervals (every 3 hours, for example) since they may not
be able to tell when their bladder is full.
To treat erectile dysfunction in men, the doctor will first do tests
to rule out a hormonal cause. Several methods are available to treat
erectile dysfunction caused by neuropathy, including taking oral
drugs, using a mechanical vacuum device, or injecting a drug called a
vasodilator into the penis before sex. The vacuum and vasodilator
raise blood flow to the penis, making it easier to have and maintain
an erection. Another option is to surgically implant an inflatable or
semirigid device in the penis. A constriction ring or penile sling
may be helpful.
Vaginal lubricants may be useful for women when neuropathy causes
vaginal dryness. To treat problems with arousal and orgasm, the
doctor may refer the woman to a gynecologist.
Points to Remember
Diabetic neuropathies are nerve disorders caused by many of the
abnormalities common to diabetes, such as high blood glucose.
Neuropathy can affect nerves throughout the body, causing numbness
and sometimes pain in the hands, arms, feet, or legs, and problems
with the digestive tract, heart, and sex organs.
Treatment first involves bringing blood glucose levels within the
normal range. Good blood glucose control may help prevent or delay
the onset of further problems.
Foot care is another important part of treatment. People with
neuropathy need to inspect their feet daily for any injuries.
Untreated injuries increase the risk of infected foot sores and
amputation.
Treatment also includes pain relief and other medications as needed,
depending on the type of nerve damage.
Smoking significantly increases the risk of foot problems and
amputation. If you smoke, ask your health care provider for help in
quitting.

From the archives of "All Diabetic International"
Diabetic Diet Food Pyramid
If you have diabetes, base your diet on the following Food Pyramid
guidelines.
THE FOOD PYRAMID
1. Fats, Oils, Sweets
(Eat sparingly)
2. Milk, Yogurt, Cheese Group
(Eat 2-3 Servings/day)3. Meat, Poultry, Fish, Beans, Eggs & Nuts Group
(Eat 2-3 Servings/day)
4. Vegetable Group
(Eat 3-5 Servings/day)5. Fruit Group
(Eat 2-4 Servings/day)
6. Bread, Cereal, Rice & Pasta Group
(Eat 6-11 Servings/day)
Eat a variety of food to get the vitamins and minerals you need. Eat
more
from the groups at the bottom of the pyramid, and less from the
groups at the top.
See also: How Many Calories Should I Eat Each Day?

Hi to our Newbe's
If you are new to this illness, here's a site that may help you as a
caregiver to have a better understanding of Pancreatitis.
What is the pancreas and why is it there?
At one time or another, most of us have experienced stomach pains.
Dull or sharp abdominal pains may come and go as we challenge
ourselves with new foods or undergo periods of stress. Sometimes,
though, stomach pain indicates a more serious problem. Many organs in
your digestive system can create problems, including the pancreas.
(Read about "Digestive Diseases and Conditions")
http://www.health-news-and-
information.com/3saintmarysreno/libv/i48.shtml
With Warmest Regards & God Bless
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

We are sorry you are feeling so bad. We hope you get to feeling much
better very soon. Please see a doctor if things do not improve.
Thoughts and Prayers,
Robert
Founder "All Diabetic International"
General Manager "The Pancreatitis Place"
rehammett@...

Dave,
I tried that to, when it was possible. When I was working the smell
of it created problems at times when I was in meetings. I have used
it with heating pads also. I do not think you were nuts for doing
this, pain-relief is not nuts it is a way of life!!!!!
God Bless,
Robert
Founder "All Diabetic International"
General Manager "The Pancreatitis Place"
rehammett@...

http://tinyurl.com/43htt
Hereditary pancreatitis: new insights into acute and chronic
pancreatitis
Introduction
Hereditary pancreatitis has recently emerged as an important
pancreatic disease. Although relatively rare, this genetic disorder
has provided major breakthroughs in our understanding of acute and
chronic pancreatitis and pancreatic cancer. Furthermore, study of
this disorder promises additional insights into the pathophysiology
of human pancreatitis, new strategies for developing animal models of
disease, and new therapies to treat or prevent acute and chronic
pancreatitis. A review of recent findings and mechanisms of disease
should benefit scientists who study the pancreas and physicians who
care for individuals with pancreatitis. This report will focus on
acute and chronic pancreatitis.
Clinical features
The first family with hereditary pancreatitis was described by
Comfort and Steinberg in 1952.1 Careful evaluation of four definite
and two probably affected family members revealed an autosomal
dominant inheritance pattern, onset of symptoms between five and 23
years, but no other ". . .earmarks which distinguish it from non-
hereditary chronic relapsing pancreatitis". These observations remain
accurate with the caveat that penetrance, the fraction of patients
with the mutation that eventually express the disease, is 80%.2-6
Attacks of acute pancreatitis usually begin in childhood,7 but age of
onset can range from infancy to the fifth or sixth decade of life.
The acute attacks may vary from mild abdominal discomfort to severe
life-threatening episodes with pancreatic necrosis, splenic vein
thrombosis,8 pseudocysts,9 and death.3 10 Chronic pancreatitis
follows recurrent attacks of acute pancreatitis with all of its
common complicationsunrelenting pain, parenchymal and ductal
calcifications, duct distortion, fibrosis, maldigestion and diabetes
mellitus.3-6 10 11 These features make hereditary pancreatitis
indistinguishable from other causes of acute and chronic
pancreatitis, save the relatively early age of onset, the autosomal
dominant inheritance pattern and lack of other identifiable
aetiologies.
Identification of mutations in the cationic trypsinogen gene
Many investigators pursued the aetiology of hereditary pancreatitis
via access to hereditary pancreatitis kindreds. The cause remained
obscure, however, until modern molecular genetic techniques were
applied to the problem. Using genetic linkage studies, the hereditary
pancreatitis locus was independently narrowed to the long arm of
chromosome 7 by Le Bodic and colleagues12 and Whitcomb and
colleagues13 in 1996, and later confirmed by Pandya et al.14 Within
months, the disease gene was identified by Whitcomb and coworkers15
through mutational analysis of candidate genes within the newly
mapped region. A single point mutation, a G to A transition, was
identified in the third exon of cationic trypsinogen that resulted in
an arginine (R) (CGC) to histidine (H) (CAC) substitution at the 105
amino acid of trypsinogen, which is numbered as residue 117, or R117H
(fig 1). (Note: "cationic trypsinogen" is the same enzyme as
trypsinogen 1,21 trypsinogen II22 23 or trypsinogen 324 and the amino
acid numbering system follows that of the serine proteases as
originally determined for chymotrypsinogen. These mutations have been
classified as protein, serine, 1; (PRSS1) allelic variants
276000.0001 (PRSS1, ARG117HIS), and 276000.0002 (PRSS1, ASN21ILE)).
This cationic trypsinogen R117H mutation was observed in all
individuals affected by hereditary pancreatitis and the obligate
carriers from five kindreds, but not in individuals who married into
the families nor in 140 unrelated individuals. A second mutation in
cationic trypsinogen was also discovered in two families with
hereditary pancreatitis without the R117H mutation. In these kindreds
a point mutation in exon 2, an A to T transversion, was identified
that resulted in an asparagine (N) (AAC) to isoleucine (I) (ATC)
amino acid substitution at residue 14 (amino acid 21 using the common
chymotrypsinogen numbering system (fig 1)), or N21I. The N21I
mutation results in a clinical syndrome of hereditary pancreatitis
similar to the R117H mutation, although the average age of onset
seems to be slightly delayed and the clinical features less severe.10
25 These two, and only two cationic trypsinogen gene mutations were
identified in other families from Italy,15 France,26 Germany,27 28
UK,29 the United States,14 30 and Japan.25 Thus, cationic trypsinogen
mutations seem to play a central role in the common, autosomal
dominant form of hereditary pancreatitis
Unique features of human cationic trypsin
Why do humans seem to be more susceptible to pancreatitis than
animals, and why is cationic trypsin, rather than anionic trypsin,
associated with hereditary pancreatitis? We believe that there are
several unique features of human cationic trypsinogen that may
contribute to these observations.41 In rats, trypsin activation seems
to require the lysosomal enzyme cathepsin B,42 43 which is normally
kept separate from the zymogens, including trypsinogen. Human
trypsinogen does not have this requirement as it has the propensity
to autoactivate.43 44 Thus, for animals to develop pancreatitis
through the trypsin activation cascade, conditions must exist that
allow trypsinogen to interact with cathepsin B (e.g. by lysosome-
zymogen co-localisation45), whereas humans may not have this
requirement.46
There are several differences between human cationic and anionic
trypsinogen that may also be important in human acute pancreatitis.
Firstly, in humans the cationic trypsinogen to anionic trypsinogen
ration is high (2:1)23 compared with animals (less than 1:20 in
rats).47 Secondly, cationic trypsinogen autoactivates more easily
than anionic trypsin.44 Thirdly, cationic trypsin, in the presence of
raised calcium concentrations, is more resistant to autolysis than
anionic trypsinogen.48 Thus, cationic trypsinogen is present at
higher concentrations, activates more readily, and is more resistant
to autolysis than anionic trypsinogen. Because of these
characteristics, other pancreatic defence mechanisms (see review by
Rinderknecht24) may be sufficient to handle mutant anionic trypsin,
but not mutant cationic trypsin, and partially explain why cationic
trypsin, rather than anionic trypsin, seems to be associated with
hereditary pancreatitis.

http://tinyurl.com/3mwaf
Gene For Hereditary Pancreatitis Identified By UPMC Team
PITTSBURGH, Oct. 1, 1996-- Researchers from the University of
Pittsburgh Medical Center (UPMC) announced they have identified the
gene for hereditary pancreatitis, a rare disease that causes
excruciating abdominal pain and serious medical complications as the
pancreas literally digests itself. With the gene, the research team
can now work to develop therapies for this disease, for which there
is currently no treatment. Details of their study of five families,
including one from Kentucky for whom its surname, Slone, has become
synonymous with the condition, are in the Oct. 1 issue of Nature
Genetics.
The cooperation of family members, many of whom convened special get-
togethers to facilitate the collection of blood samples, was key to
identifying the gene, say lead researchers Garth Ehrlich, Ph.D., and
David Whitcomb, M.D., Ph.D. Drs. Ehrlich and Whitcomb and their
collaborators from five other universities found those family members
affected by the disease have a mutation of a gene that codes for
trypsin, the major enzyme that digests proteins in food. Because
trypsin is so potent, the pancreas manufactures it in a form called
trypsinogen that normally remains inactive until it is secreted into
the intestine after a meal. If trypsin inadvertently becomes active
in the pancreas, the body employs an important safe-guard mechanism
that destroys the trypsin and prevents the pancreas from being
digested by its own product.
In hereditary pancreatitis, this self-destruct mechanism is missing.
Patients with this disease produce trypsin that lacks what is called
a cleavage site, the place where the enzyme could be chopped in half
and made inactive by another enzyme. In this indestructible form,
trypsin still digests proteins but begins to digest the pancreas,
piece by piece, as well.
"The mutation of the trypsinogen gene helps us to understand the
molecular basis of hereditary pancreatitis and provides insight into
nonhereditary forms of the disease as well," said Dr. Ehrlich,
associate professor of pathology and otolaryngology at the UPMC and
executive director of the Center for Genomic Sciences at the
University of Pittsburgh, where this study's laboratory work was
performed.
"Trypsin is much like Pac-Man, eating away at protein. But in
patients with hereditary pancreatitis, there is never 'Game Over.'
There is no fail-safe mechanism -- no 'ghost' -- that can stop the
Pac-Man before it devours the pancreas," explained Dr. Whitcomb,
assistant professor of medicine in the division of gastroenterology
and hepatology at the UPMC.
Hereditary pancreatitis typically begins between the ages of five and
10 with an acute attack of abdominal pain. After repeated attacks and
scarring of the pancreas, a chronic condition develops characterized
by constant pain, nausea and vomiting, as well as by weight loss due
to malabsorption of food. It often leads to severe complications,
including diabetes and pancreatic cancer, which occurs at a rate of
more than 50 times higher than in the general population. There is no
treatment for hereditary pancreatitis.
"Now that the disease gene is known, individuals who carry the gene
can be identified before pancreatitis begins. And perhaps, more
importantly, we can now design strategies for preventing or
controlling the development of the disease," said Dr. Whitcomb.
The authors add that their findings have clinical relevance for
other, more common forms of pancreatitis, including those caused by
alcohol consumption and diets rich in fatty foods. These forms of
pancreatitis are diagnosed in about 40,000 Americans each year.
Their work was supported by the Center for Genomic Sciences at the
University of Pittsburgh; the Midwest Multicenter Pancreatic Study
Group, which is comprised of the University of Pittsburgh, the
University of Cincinnati and the University of Kentucky Medical
Center in Lexington; and the National Institutes of Health.
In addition to Drs. Whitcomb and Ehrlich, other authors are: Michael
C. Gorry; Robert A. Preston; William Furey; Michael J. Sossenheimer;
Charles D. Ulrich; Stephen P. Martin; Lawrence K. Gates, Jr.; Stephen
T. Amann; Phillip P. Toskes; Roger Liddle; Kevin McGrath; G. Uomo;
and J.C. Post.

http://tinyurl.com/6v3td
Hereditary pancreatitis is caused by a mutation in the cationic
trypsinogen gene.
Whitcomb DC, Gorry MC, Preston RA, Furey W, Sossenheimer MJ, Ulrich
CD, Martin SP, Gates LK Jr, Amann ST, Toskes PP, Liddle R, McGrath K,
Uomo G, Post JC, Ehrlich GD.
Dept of Medicine, University of Pittsburgh School of Medicine,
Pennsylvania 15261, USA.
Hereditary pancreatitis (HP) is a rare, early-onset genetic disorder
characterized by epigastric pain and often more serious
complications. We now report that an Arg-His substitution at residue
117 of the cationic trypsinogen gene is associated with the HP
phenotype. This mutation was observed in all HP affected individuals
and obligate carriers from five kindreds, but not in individuals who
married into the families nor in 140 unrelated individuals. X-ray
crystal structure analysis, molecular modelling, and protein digest
data indicate that the Arg 117 residue is a trypsin-sensitive site.
Cleavage at this site is probably part of a fail-safe mechanism by
which trypsin, which is activated within the pancreas, may be
inactivated; loss of this cleavage site would permit autodigestion
resulting in pancreatitis.

http://tinyurl.com/3moq7
Hereditary Pancreatitis:
Trypsinogen Gene Mutations
Frequently Asked Questions, Including Genetic Testing
What is hereditary pancreatitis (HP)?
Hereditary Pancreatitis is a rare genetic condition characterized by
recurrent episodes of acute pancreatitis attacks. In about half of
these cases the problem progresses to chronic pancreatitis, which is
severe scarring of the pancreas. Symptoms of an acute attack include
abdominal pain, nausea, and vomiting. Laboratory test during an
attack usually detect high blood levels of amylase and lipase, which
are enzymes released from the pancreas. The first attack typically
occurs within the first two decades of life, but can begin at any
age. In the United States, it is estimated that at least 1,000
individuals are affected with hereditary pancreatitis.
back to top
Is there a cure for HP?
At this time, there is no cure for HP. Treating the symptoms
associated with HP is the choice method of medical management.
Patients may be prescribed pancreatic enzyme supplements to treat
maldigestion, insulin to treat diabetes, analgesics and narcotics to
control pain, and lifestyle changes to reduce the risk of pancreatic
cancer (for example, NO SMOKING!).
Dietary recommendations to help control pain with digestion include
the consumption of small meals throughout the day that are high in
carbohydrates and low in protein and fat. Pancreatic enzymes such as
Creon, Pancrease, and Violiase are helpful in providing improved
digestion and a reduction in diarrhea and pain for some patients with
more advanced disease.
Exposure to smoking and alcohol are known to dramatically increase
the risk for pancreatic attacks among individuals with HP. Smoking is
strongly discouraged as it doubles the risk for pancreatic cancer.
Similarly, alcohol consumption is not recommended for these patients
because alcohol is a known risk factor for both acute and chronic
pancreatitis. Therefore it is recommended that all HP patients avoid
smoking and alcohol consumption.
back to top
What causes HP?
HP is a genetic disorder, which means that it is usually passed from
one generation to the next.
The symptoms of HP are caused by a change to a specific gene. Genes
are the packages of information that control how our bodies look and
function. A single gene appears to be involved in 60-75% of
hereditary pancreatitis families. This gene produces the "cationic
trypsinogen" enzyme, which breaks down the proteins present in the
foods we eat. (In some research papers cationic trypsinogen is called
PRSS1).
When a change to a gene occurs, the gene may no longer function
properly. These gene changes are called mutations. Currently, there
are two common, and more that 6 uncommon cationic trypsinogen gene
mutations that are associated with hereditary pancreatitis. The major
mutations are known as cationic trypsinogen "R122H", "N29I".
Families with HP might carry one of these mutations, but usually not
more than one type of mutation. It is also possible that a family
with a strong history of HP may not carry any of the currently known
mutations. For this reason, it is believed that additional genes and
mutations that cause HP are awaiting discovery. (Every concerned
person is encouraged to join on going research studies through the
University of Pittsburgh 1-888-PITT DNA, or an affiliated medical
center)
back to top
If I have inherited any of the HP mutations, will I definitely
develop pancreatitis?
HP symptoms can develop at any age, but most patients have their
first pancreatic attack before the age of 20. In addition, there is a
great deal of variability in the frequency and severity of pancreatic
attacks. Some affected relatives may only have a few episodes of
pain, while others in the same family experience more severe
symptoms. The cause for this variation in symptoms is unknown.
Individuals who have inherited either the R122H or the N29I mutation
have an 80% risk of developing clinical symptoms of HP over the
course of their lifetime. Although the remaining 20% of these
mutation carriers do not show any symptoms, it is important to
remember that they still have a risk of having a child who inherits
their HP mutation and is affected with HP.
Much less is known about the other mutations, and it is believed that
are rare in the population. Without additional knowledge about these
mutations, it is not possible to predict how many people will
eventually develop symptoms of pancreatitis.
back to top
What is the risk for my child to inherit HP?
All of our genes come in pairs. We inherit one set of genes from each
of our parents. Hereditary pancreatitis is inherited in a dominant
manner, which means that only one copy of the HP gene needs to have a
mutation in order for an individual to become affected with HP.
When a parent carries an HP mutation in one of their genes, then each
child has a 50% (or 1 in 2) chance of inheriting that mutation. It is
important to remember that this risk to inherit an HP mutation is 50%
for each pregnancy. The risk to have an affected child is actually
less than 50% (it is approximately 40%) since one out of five
individuals with the R122H or N29I mutation remain symptom-free over
their lifetime.
back to top
Genetic testing for HP
Genetic testing for HP is currently available both on a research and
commercial basis.
Commercial testing is conducted through a licensed laboratory for a
specified fee that may be covered by your insurance plan. A small
blood sample is drawn at your doctorís office or hospital laboratory
and sent to the commercial laboratory for testing. Results are then
provided to your referring physician or counselor. One commercial
laboratory that provides testing for HP is Molecular Diagnostics at
the University of Pittsburgh (phone: 412-648-8519). Currently, the
fee for commercial testing through Molecular Diagnostics is $276.50
per person. Check with your insurance carrier to determine whether
genetic testing is covered by your health plan. Testing can only be
done in a laboratory licensed to perform this test. If testing is
being done at other institutions within the United States, please
call the 888- PITT DNA number to be sure that the site is approved.
Research testing is available for a reduced fee for those who qualify
to be enrolled in the HP research study at the University of
Pittsburgh. Research testing is confidential, requires the completion
of several forms and questionnaires, but may be associated with a
longer turnaround period to obtain results.
Genetic testing for any condition is a complex process. Genetic
counselors are available in your local area to help identify the
potential risks, benefits, and limitations of genetic testing for HP.
Referrals to local genetic counselors can be obtained from your
primary care physician. To find a genetic counselor near you, ask
your physician or call us for assistance at 888-PITT-DNA.
back to top
Who might benefit from genetic testing?
ï Individuals who have a relative with a documented diagnosis of
hereditary pancreatitis.
ï Individuals with a strong history of unexplained abdominal pain
that resembles pancreatitis.
See the Genetic Consensus Statement published in Pancreatology
2001;1:405-415, through the Hereditary Pancreatitis Research Study
office 888-PITT DNA, or on www.pancreas.org
back to top
What are some of the risks, benefits, and limitations of genetic
testing?
Before requesting HP genetic test results, we ask that each
participant consider the possible benefits and limitations of genetic
testing.
back to top
Potential benefits of genetic testing:
1. Obtaining a diagnosis of HP.
Some individuals with HP have reported difficulty in obtaining a
diagnosis or explanation of their abdominal symptoms. A positive test
result (i.e. when a person is found to carry an HP mutation) may help
validate or prove that an individual has true medical symptoms that
are hereditary in nature. In short, physicians can use genetic
testing to diagnose HP.
2. Identifying relatives at risk to develop HP.
Once an HP mutation has been found in a family, other relatives can
be tested to determine whether they inherited the same HP mutation.
This type of testing, "pre-symptomatic testing," is conducted for
individuals who have not yet developed pancreatitis but are at risk
of having inherited an HP mutation from either parent. Individuals
who test positive prior to developing symptoms of HP can then be
educated about important lifestyle recommendations to reduce the risk
of developing future pancreatic disease such as pancreatic cancer.
Although pancreatitis cannot be prevented at this time, these
individuals would be recommended to avoid the use of tobacco and
alcoholic beverages, since these exposures are risk factors for
pancreatic cancer in the general population.
3. Reducing feelings such as anxiety or uncertainty.
Test results can often help reduce feelings of anxiety and
uncertainty for individuals with a family history of HP. For example,
an unaffected relative who receives negative test results (i.e. when
a person is found NOT to carry an HP mutation) is likely to feel
relieved from the uncertainty of whether symptoms will ever develop
in the future. Note: negative test results only eliminate the risk to
develop a hereditary form of pancreatitis. It is still possible to
develop pancreatitis due to other causes later in life.
4. Prenatal Genetic Testing.
Genetic testing can provide information that is useful when making
important reproductive decisions. Prenatal diagnosis is a form of
testing that is conducted during pregnancy to determine whether a
developing baby has inherited a specific mutation or other health
problem. Currently prenatal testing is not being conducted.
If both members of the couple have tested negative for a particular
HP mutation, then the risk to pass on that HP mutation is essentially
zero. For example, if your family is known to carry the R122H*
mutation and you test negative for R122H*, then none of your children
(or future pregnancies) would be at risk to develop HP.
back to top
Potential risks & limitations of genetic testing:
1. Genetic discrimination.
As with genetic testing for any type of condition, there is a small
but potential threat for insurance and/or employment discrimination.
We have never heard of a documented case of this type of
discrimination among our research population of over 700 individuals.
Moreover, it is reassuring to known that there are no published cases
of insurance discrimination with regard to hereditary pancreatitis.
Individuals who undergo genetic testing as part of a research study
are generally well protected because of our strict rules of
confidentiality. For instance, no information about an HP participant
is ever released to a third party without written permission from a
participant. All blood samples are identified using a code number
instead of personal information such as names or social security
numbers. Because no research organization can completely eliminate
the risk for discrimination, this potential threat should be
considered before requesting your genetic test results are confirmed
and released to you.
2. Adverse psychological emotions.
Powerful emotions such as anxiety, guilt, and depression can
accompany the process of genetic testing. In addition, genetic
information has a powerful influence on an individualís reproductive
behavior and a lifelong impact on future descendants.
3. Genetic test results cannot prevent or cure HP.
At this time, there is no cure for HP, nor is there a way to prevent
pancreatic attacks in patients who carry HP mutations. Furthermore,
there does not appear to be a difference in medical treatment for
patients who have a hereditary form of pancreatitis versus patients
who have a non-hereditary form of pancreatitis.
4. "Non-informative" test results.
Non-informative test results include any type of test result that is
not conclusive in ruling out a hereditary form of pancreatitis.
Negative test results must be interpreted very carefully, especially
for individuals undergoing pre-symptomatic testing. Pre-symptomatic
testing applied to an individual who is not clinically affected with
the disease, but has at least one parent affected with a dominant
disorder.
When test results for know trypsinogen mutaions are negative,
then . . .
If a mutaion has been identified in another family member.
Interpretation: He/she is not at risk to develop the genetic form of
pancreatitis that runs in the family. Since he/she does not carry the
mutation, his/her children are not at risk either.
Action: Stop
If a mutaion has not been identified in another family member.
Interpretation: Since we do not know what mutation runs in the
family, it is possible that this family carries a mutation that we
cannot yet recognize. Therefore it is possible that this person could
carry the unrecognizable mutation as well.
Action: Enter a research study with the extended family to search
for a new gene mutation.
This information is basen on 2001 data for the cationic trypsinogen
gene (PRSS1)
Disclaimer:This information is intended for general education of
individuals who are interested in hereditary pancreatitis and related
disorders. It in no way can substitute for the evaluation and care
provided to individuals through their trained health care providers.
For further information the following publications will be helpful.

Healthy Exchanges
by JoAnna Lund
Catch of the Day Fish
1/2 cup Kraft fat-free mayonnaise
1 tsp dried minced garlic
1 tsp lemon juice
1 tsp dried parsley flakes
1 tsp JO's Dill Seasoning or any reputable brand or dill weed
16 ozs frozen white fish, thawed and cut into 4 pieces
In a medium bowl, combine mayonnaise, garlic, lemon juice, parsley
flakes
and JO's Dill Seasoning. Spread about 1 tablespoon mayonnaise mixture
on top
side of fish pieces. Place fish, mayonnaise-coated side down, in a
large
skillet
sprayed with butter-flavored cooking spray. Evenly spread about 1
tablespoon
mayonnaise mixture over top of fish pieces. Cook over medium heat for
about
5 minutes on each side or until fish flakes easily. Serve at once.
Serves 4
113 Calories;1g Fat;21g Protein;5g Carbs;353mg Sodium;0g Fiber

Hi Robert
Just read your post to Nancy on heating pads. Believe it or not i use to
rub Ben Gay on my side and i swore it helped with the pain. Everyone thought i
was nuts but it did help.
One Day At A Time
Dave

Hi Jimmy, My name is Brenda. Im a 31 year old that just had a pain
pump put in on Aug.10th two months ago. I've had pancreatitis for 4
yrs now and i was taking lots of medication to keep the pain under
control, which still wouldnt help because my body was getting
immuned to the pain medication. From pain to vomitting..to even
smelling food would cause pain. When they first gave me a trial run,
which was no fun. Because people with pancreatitis can not take
morphine. it makes the pain multiply. my pain management doctor
convience me that it was a different type..so i went for it..when
they put in the permanent pain pump..it was suppose to be a
overnight stay at the hospital..they put in morphine, i stayed in
the hospital for four days. then i went home was