DEAR DR. DONOHUE: I have a good friend in the hospital being treated for pancreatitis. He has had parts of his pancreas removed. How does a person survive without a pancreas? – G.B.

ANSWER: The pancreas, which lies beneath the stomach and next to the duodenum – the first part of the small intestine – has two important functions. It makes insulin, and it makes digestive enzymes for food absorption.

Pancreas inflammation – pancreatitis – derails both functions. Blood sugar rises without insulin, and foods can’t be digested without enzymes. In addition, pancreatitis produces abdominal pain, often severe enough to double people over. The pain is above the navel and frequently bores through to the back. Nausea and vomiting can accompany the pain. Inflammation causes the release of digestive enzymes into the gland itself, so the basis of injury is self-digestion of the gland.

Resting the pancreas by not allowing patients to take any food by mouth quiets the inflammation. Intravenous fluids supply nutrition. In less-severe cases, pain is over in a week or less. In more-severe cases, like your friend’s, parts of the pancreas die, and bacteria find those places to be a haven for colonization. Antibiotics are needed, and often the dead pancreatic tissue has to be surgically removed.

Are you sure that your friend’s entire pancreas has to be taken out? That’s not usually necessary. However, life is possible without a pancreas. The person would have to go on injectable insulin, as many diabetics do, and the person would have to take digestive enzymes in pill form.

What causes pancreas inflammation? Alcohol in large amounts over long periods of time can do it. A gallstone stuck in the drainage duct shared by the gallbladder and the pancreas is another cause. Viruses are another possibility. And, as always, there are those instances when a cause cannot be found.

This is an abbreviated account of a complex issue. I have omitted many important details.

DEAR DR. DONOHUE: My 13-year-old granddaughter is slightly tall and thin. She hasn’t started having periods. I am very concerned about the fact that she hasn’t. I have mentioned it several times to her mother (my daughter), who doesn’t seem concerned. I am worried because my other daughter, age 46, had few periods over the years and cannot have children. What should my granddaughter do at this time? – W.P.

ANSWER: She should remain calm, cool and collected.

Girls have their first menstrual period anytime between the ages of 9 and 16. The average age is 12.3. Your granddaughter is still within the norms. If she hasn’t had a period by 16, then the doctor should investigate the matter.

Puberty is more than menstrual periods. The first sign of puberty is breast buds — firm, round discs of tissue beneath the nipples. They make their appearance between 8 and 14. The next signs are underarm and pubic hair. Then comes menstruation.

Does your other daughter have a name for the cause of her infertility and few menstrual periods? If she does, write back. I can tell you if it’s an inherited condition or not.

DEAR DR. DONOHUE: I am writing for my husband. He’s a truck driver and spends the majority of his time sitting in his truck. He recently told me there was blood in his stool. Could he have hemorrhoids? If so, what are they, and why do they happen? – M.C.

ANSWER: Hemorrhoids are dilated rectal veins, similar to varicose veins of the legs. The force of gravity, hard stools, straining to eliminate stools and pregnancy are some of their causes. Often, no cause can be found for them.

Hemorrhoids might bleed. They’re near the surface and are easily damaged.

However, rectal bleeding must be investigated. There are many other causes for it. One of those causes is cancer. I don’t mean to alarm you, but this is a sign that shouldn’t be ignored. Your husband must see a doctor. Neither of you should guess at the cause.

DEAR DR. DONOHUE: I am writing regarding your discussion of artificial sweeteners. I used one, and it put me in the hospital with a kidney infection. I used another, and it caused blood in my urine. When I stopped using them, I had no more kidney problems. A friend became sick to her stomach from using artificial sweeteners. Two other women had bladder infections from them. I wanted to tell you about my experience with them. – F.J.

ANSWER: I expected many letters from the artificial-sweetener item, and I got them.

I can’t argue that a substance – just about any substance, including some foods – can make a few individuals sick. That’s due to the great genetic diversity among humans. However, foods or medicines should not be banned based on the reactions of a very few. If that were the case, nothing would be available.

I respect your opinion. I must, however, raise a question about artificial sweeteners causing urinary tract infections. That’s impossible. Bacteria cause urinary tract infections. Louis Pasteur, in the 19th century, proved the germ theory of infections.

I might grant you that an artificial sweetener irritated the bladder and made people think they had an infection. But a real infection? I don’t think so.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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