The problem isn’t that we’re less cultured than other countries (though many Europeans will gladly tell us how crude, loud, and insensitive we are.) No, our trouble is that we’re really not sure question: “What are good manners for?”

American manners resemble those of other western nations, but always with a more casual manner. We don’t bow to nobility, we don’t respect privilege, and we think ourselves the equals of anyone, which can seem barbaric to people from more tradition-bound nations.

Norman Vincent Peale  identified three elements of good American manners in his 1975 Post article, “Courtesy: Key To A Happier World”:

“A strong sense of justice… courtesy often it nothing more than a highly developed sense of fair play…

“Another ingredient… is empathy, a quality that enables a person to see into the mind or heart of someone else, to understand the pain or unhappiness there and to do something to minimize it…

“Yet another component of politeness is the capacity to treat all people alike, regardless of status or importance.”

They’re all good principles, but they still require interpretation for each occasion. A further complication is our country’s highly fluid society, which is continually re-defining what is acceptable. Consider all the changes that emerged in the past generation. Within a few years, telling ethnic and sexist jokes fell from acceptable to taboo. The courtesies of offering and lighting cigarettes for others were suddenly unwelcome. Even the act of men opening doors for women could be misinterpreted.

In addition, society changes with every major technology. American developed new codes of behavior for railway travel, using a telephone, and driving automobiles. Today there is a new set of manners emerging for using cell phones, e-mail, or Facebook.

The constant change has produced a rewarding market for publishers of etiquette books. One of the most famous was “Emily Post’s Etiquette,” first published in 1922. The full title of the first edition was “Etiquette in Society, in Business, in Politics, and at Home.” It was an ambitious topic for any author, particularly the area of etiquette in politics, which I didn’t even know existed.

The book quickly made Emily Post the country’s leading authority on good manners. But 16 years later, Margaret Case Harriman noted how out-of-date the advice sounded:

“The bachelor girl can, on occasion, go out alone with any unmarried man she knows well, if the theater she goes to, or the restaurant she dines at, be of conventional character,” Mrs. Post’s book stated tranquilly in 1936. “The strict rules of etiquette demand that the divorced meet as total and unspeaking strangers” it set forth in another chapter, and “A lady having her portrait painted always takes a woman friend, or her maid, who sits in the studio, or at least within sight or hearing.”

And yet…

All over the country, bachelor girls were going out alone with unmarried men they knew only slightly, in the hope, perhaps, of getting to know them better; divorced people were greeting each other, when they met accidentally, with just as much kindliness as though they had never been married; and whatever ladies were having their portraits painted had very few women friends, or maids either, who were content to spend a whole afternoon just sitting within sight or hearing. But Mrs. Post pretty thoroughly ignored the modern trend.

The 1936 edition of Etiquette also contained an entire chapter devoted to the Chaperon, and, although she was, in fact, referred to as “the Vanishing Chaperon,” the reader could hear in those simple words an echo of the authors own wistfulness over the whole hellish situation.

In her Post article, “Dear Mrs. Post” [May 15, 1937], Ms. Harriman quickly dispelled the assumption that Emily Post was a fussy old maid, or a prim matriarch intent on ridding the world of bad posture, poor grammar, and vulgar table manners. In fact, Ms. Post had never sought to become the arbiter of propriety.

When the publishing firm of Funk & Wagnalls suggested that she write the book, she was skeptical; she disliked the word “etiquette” as being both fancy and phony, and she felt uncomfortable about setting herself up in print as an authority on correct social behavior, which was something she had always taken more or less idly for granted. [Editor] Richard Duffy pointed out that, although there were plenty of etiquette books on the market, none had been written by a woman of recognized social position… He followed up his argument by sending Mrs. Post all the current books about etiquette he could lay his hands on, and a few days later she telephoned him.

“These people,” she said, referring to the etiquette writers, “don’t seem to know what they’re talking about.”

“Well, you tell ‘em,” said Mr. Duffy simply.

Goaded, Mrs. Post sat down on a high stool at the architect’s drafting table she likes to write on and, in the next ten months, turned out 250,000 words on etiquette.

Emily Price had learned the rules of polite society by growing up in affluence and becoming a New York debutante.

She will tell you, with an air of mild astonishment, that nothing ever happened to her until she was nearly fifty, but that is not quite true. Things started happening to her more than thirty years ago, when she became a double-barreled pioneer in New York society by divorcing her husband in New York State—a pretty bold move at the time—and by going to work for a living. Nothing in her life up to that time had promised such unconventional goings-on and for a little while even her intimate friends were shaken to the core.

She was the first divorcee to combine her maiden name with that of her ex-husband; and it was as Mrs. Price Post that she went tot work, after the divorce was granted, to earn enough money to buy clothes for [sons] Ned and Bruce, and to educate them.

Emily Price Post was surprised as much by the success of her “Etiquette” as by the vast amount of misinformation on the subject reflected in readers’ letters.

When letters kept coming in, asking whether it was true that bread must be broken into pieces exactly one inch in diameter before it was eaten, and whether, when passing your plate for a second helping, you must hold your knife and fork in your hand, Mrs. Post began to realize that here, in this vast unsuspected throng of seekers after polite behavior, was her real public.

Almost all the letters from her readers are addressed to “Mrs. Emily Post,” which is incorrect. Her name on the flyleaf of Etiquette is followed by “Mrs. Price Post” in parentheses, but she realizes that to those readers of her column who haven’t bought the book, she is known by no other name than Emily Post. It still gives her a slight turn, however, to see “Mrs. Emily Post” on an envelope. She is not fussy about small matters of behavior, beyond the occasional mild recoil in the face of bad manners that is instinctive to any woman of taste, and she likes to think, and to impress upon her readers, that “etiquette” is a question of common sense and consideration rather than a study of how to speak to a visiting prince or eat an ear of corn on the cob. “No rule of etiquette is of less importance,” she has written patiently, time and time again, “than which fork we use.” And once, when she got fifteen letters in one day asking which fork the writers should use when confronted with several, she answered all fifteen grimly in four word: “Oh, use any one.”

When some of her conservative friends murmured that writing was a pleasant hobby for a woman of gentle birth, but that taking money for it seemed to them not a little crass, Emily Post pointed out that Mrs. Wharton was doing well in a literary way without noticeably losing caste, and that the Duer girls were still asked to decent people’s houses, although they gladly accepted pay for whatever they wrote whenever they could get it. The Duer girls were Alice, who later became Alice Duer Miller, and Caroline, who wrote a book of etiquette of her own a few years ago.

Read “Dear Mrs. Post” by Margaret Case Harriman, published May 15, 1927.

Next: “Why I Like American Manners,” by Alice Duer Miller

Making Sense Of American Manners The Saturday Evening Post

Top 5 Tips from the American College of Emergency Physicians:

Safe Meals: Use a meat thermometer. Cook fresh poultry to 165 F, hamburgers to 160 F, and beef to at least 145 F. Refrigerate all perishable food within 2 hours, 1 hour if the temperature outside is above 90 degrees F. Keep uncooked meats away from other foods.

Safe Grilling: Thoroughly clean a grill of any grease or dust. On gas grills, check tubes leading into the burner for any blockages from insects or food grease and replace connectors if needed. Do not use a grill in a garage, breezeway, carport, porch, or near any surface that can catch fire. Always follow the manufacturer’s instructions that accompany the grill.

Safe in the Water: Don’t drink alcohol when swimming or boating. Wear a lifejacket whenever you are on a boat. Make sure young children are supervised at all times when near the beach, on a boat, or by a pool or hot tub. Don’t swim alone or in bad weather. Learn to swim and teach your children to swim. We also recommend that you learn CPR in case of an emergency.

Safe in the Sun: Protect against sunburn and heat stroke. Wear sunscreen with an SPF of 15 or higher and apply it generously throughout the day. Wear a hat outdoors and UV-blocking sunglasses to protect your eyes. Drink plenty of water, especially when in the sun or sweating heavily. If you feel faint or nauseous, get into a cool place immediately.

Safe on the Road: Don’t drink alcohol and drive or travel with anyone who has been drinking. Wear your seatbelt at all times. Make sure your vehicle has been properly serviced and is in good working shape before a long road trip. Familiarize yourself with your surroundings and know the location of the nearest emergency room in case of an emergency.

“Many of the factors that will determine your safety over Memorial Day weekend—and any time this summer—come down to good decision-making and common sense,” said Dr. Gardner. “As someone who sees the consequences up close, my best advice is: know your limits, be mindful of certain risks and stay smart.”

Plan Now for Safety The Saturday Evening Post

The biggest mistake people make when they put their home up for sale is doing “nothing at all!” says the home staging expert and designer for HGTV’s hit show Designed to Sell. “People tend to let their egos get in the way with the notion that, ‘If it’s good enough for me, it’s good enough.’ ” Yet LaPorta is quick to point out that people stop noticing things in their home that send up red flags to an objective eye. She recommends asking a friend (or former friend) to do a walk-through as if they were the potential buyer. “You know that person you no longer talk to because they’re too blunt? Invite them over for a fresh set of eyes.”

When it comes to staging your home in a competative market, design expert Lisa LaPorta stresses the importance of removing personal clutter for a fresh and modern look. Before (above), after (top image).

Next, make a list of obvious maintenance needs, including rooms that will require special attention, keeping in mind that “curb appeal, kitchens, and baths are what sell a home,” LaPorta explains. But before tackling the wear and tear items, give your home a good bath-from the outside, in. Power spraying walkways, windows, patios, or porches can make big impact on curb appeal. Dress up the front door (and shutters) with a fresh coat of paint-a bold accent color perhaps-and some shiny new hardware, taking into consideration the overall style and architecture of the home. Accessorize the entrance with simple oversized pots planters. For the porch and patio, the designer offers this cleaning mantra: “Never underestimate the power of vinegar and water for cleaning outdoor furniture.”

Inside, clear out the clutter and neutralize your personal style as much as possible. “Most people have too much furniture-lots of little tables, accent pieces, inherited furniture,” she notes. “Pack it up and store it away. Clean out the closets, too. Overstuffed closets are an indication to buyers that there is not enough storage space in the home.” If it’s not practical for you to rent a storage unit, designate one area (or the garage) for storage.

Revive kitchen and bathroom cabinets with a colored stain. Although the idea is to use neutral tones, a wide assortment of attractive stain colors are often overlooked. “It doesn’t always have to be brown, oak, or cherry; you can get some beautiful reds, sage greens, blue-greys, or oyster.”

Kitchen before

As with any new do-it-yourself project, it’s advisable to begin in a less noticeable area. For example, stain the inside of a cabinet first to practice your technique and see how it’s going to look.

“Next, clean, clean, clean!” LaPorta is quick to repeat. People tend not to notice the filth and dust in their own homes, so pay close atention to the dirty details.

Once your home is spotless, look at the arrangement of the furniture. People are often guilty of pushing their furniture up against the walls. “For some reason, they think this makes a room look bigger, when in fact, it draws attention to the boundaries of the space,” the designer says. “Try floating sofas across from one another in such a way as to create inviting viewpoints.”

But be cautious when moving heavy furniture. A petite home stager herself, LaPorta uses furniture discs to position heavy furniture.

If you’re new to do-it-yourself projects such as staining, painting, or tiling, many big name hardware stores offer workshops and classes for beginners. Even on a budget, with a little labor and a strong will, you can set the stage for a show-stopping performance.

Kitchen after. This opaque stain in Winter White applies like normal paint but is technically a stain. Using a semi-transparent stain allows some of the wood grain to still show, whereas painting hides wood grain.

Six Secret Solutions

Fresh Floors: Peel-and-stick vinyl tile is an affordable way to modernize an outdated floor. When placing the tile, make sure to switch up the direction and placement of the tiles to mix the tones.

Shower Power: Instead of replacing a grimy glass shower door, clean it by mixing one part muriatic acid and about 10 parts water. Scrub it with steel wool and wipe it down for a door that sines.

Fired Up: Scrub the fireplace with soap and water. Polish bricks with a tone color enhancer to make them shine. To update the screen, remove and dust it thoroughly. Mask off the windows and use a can of heat-resistant spray paint to give the screen a fresh look. Hold the can about 18 inches away and use long strokes.

Top It Off: Granite countertops, although expensive, are a good investment. Save money by requesting a 9- or 12-inch squares. Easier to install than running-foot slabs, they often cost less.

Kitchen Update: Resurface old appliances for under $20 by removing the front panels and cleaning them. Then, apply a stainless-steel stick-on covering and cut it to fit.

Creative Curtains: Dress up a window for $12 with this easy trick using place mats: Apply a hook-and-loop fastener to each place mat; attach them in a row to a basic curtain rod; and pin them together at the bottom for a stylish valance.

Setting the Stage The Saturday Evening Post

“For some, happiness is a bottle of wine shared with your romantic interest. For others, happiness is a silent walk on the beach in a light rain. Whatever your particular definition of happiness may be, we believe that the idea of being beautiful really comes down to two big umbrella concepts: First, love the people in your life and practice trusting and forgiving them. Second, and equally important, love yourself and all of your imperfections (many of which you’re working to correct, right?).

“Opening your world up to look beyond the cursory perceptions is what really gives you the inner strength and beauty to find happiness. Ask yourself:

“Do you have relationships that are strong and healthy and contribute to your happiness?

“Have you found ways to give to others and show gratitude for the gifts you’ve been given?

“And are you able to go beyond the superficiality that surrounds you in your day-to-day life, to explore and connect with the deeper and more meaningful purposes in life?

“Those questions really lie at the center of making ‘beauty’ a full-circle concept. The more beautiful you look and feel, the happier you are. And the happier you are, the more beautiful you look and feel and the more you can share with others your purpose in life. And that’s a beautiful thing.”

Be Beautiful The Saturday Evening Post

My husband has had sleepless nights since ending chemotherapy in July 2007. He has tried prescriptions, herbal teas, and over-the-counter sleep aids. He may sleep for a couple hours upon going to bed but lies awake the rest of the night. He does not have sleep apnea, and all his blood tests are fine. Can any of your readers suggest help for this condition?

Thomas
Send your letters to Medical Mailbox, 1100 Waterway Blvd., Indianapolis, IN 46202 or e-mail: medicalmailbox@satevepost.org.

Please include your mailing address. Medical Mailbox and From the Pharmacy supplements the advice of your health care provider, whom you should consult for personal medical problems.

Sleepless in South Carolina The Saturday Evening Post

Navigating the web for the first time is like visiting a new city, like Paris, for the first time. Everything is new and different, wonderful and amazing, and you’ll soon be asking yourself why you didn’t get here sooner.

I remember the first time my grandmother emailed me, back when I was in college. My father — computer engineer that he is — set her up with a laptop and email. A traditional woman who grew up in the “roaring ’20s,” she was skeptical and hesitant at first. Before long she was instant messaging my siblings, cousins, and me, trying to stay in touch with all of us scattered across the United States.

Whether this is your first time or the 1,000th on the Internet, here are some tips that will hopefully make it easier for you to navigate the web and use your computer more efficiently.

1. If unfamiliar with computers and the Internet, you can go to the library or borrow a friend’s computer. Today’s computers are so user-friendly that you’ll quickly discover how easy computers are to use and navigate. If you decide to purchase a computer, experts offer some simple advice before you buy. First, decide what you want to do on it. This can be challenging initially if you are new at it. Most computers are so advanced that you can do the basics on any model that starts at $500, says Matt Dworkin, a 32-year-old “Double Agent” for Best Buy’s Geek Squad who has installed and set up hundreds of customers in the Washington, D.C., metro area for more than four years. If unsure what you want, go to any of the various “big box” stores and test out several to figure out what you like best. Don’t hesitate to ask for help.

2. Once you have a computer, Dworkin recommends setting up bookmarks. You can hire someone for an hourly rate during your initial computer set-up, ask for help from a friend or relative, or do it yourself. Bookmarks (sometimes called favorites) are tabs, just like the name indicates, that “mark” places on the Internet that you frequently enjoy using. Depending on what type of computer you purchase (P.C., or personal computer, used more frequently by the business world, or an Apple brand Mac or Macintosh, used by “creative types” like graphic designers who enjoy editing lots of photos or creating home movies), you will have different web browsers that allow you to navigate the Internet. Most people use web browsers like Internet Explorer, Firefox, Safari or Netscape. How to save a bookmark depends on your web browser, but once you know how, it will be easy to do again and again.

3. Secure your network. It’s very important to have several security features while on the Internet, including a firewall, says Jean Westcott, who coauthored with her husband, Sean, the book Digitally Daunted: The Consumer’s Guide to Taking Control of the Technology in Your Life. Buy, install, and use an antivirus program like McAfee and Symantec’s Norton AntiVirus. Just make sure that you don’t use both because the programs will cancel each other out, and you won’t be protected. Make sure you have the automatic updates turned on so your computer will automatically install the latest upgrades. Also install a Spyware program, such as Spybot, that will help prevent advertisers from tracking your movements on the web. Make sure you save all installation CDs and booklets, says Westcott, because you may need them in the future if you ever have trouble with your computer and need to re-install programs. If you need help, I strongly suggest using an A+ certified computer technician.

4. Set up an email account. An email is an electronic message sent from one computer to another that allows you to communicate extremely quickly with people around the world at any time. There are several email services. My favorite is gmail.com, which is Google’s version of email. Just be leery of anyone asking for money. Banks, the IRS, and other legitimate institutions won’t contact you over email or request your personal information or password. If you aren’t sure, don’t open the email. Again, a healthy dose of skepticism is important because, unfortunately, there are many “phishing” emails from people who are looking to get rich quick from the ignorance of others. Even if an email comes in from a friend, if the email doesn’t sound or look right, don’t believe it. Sometimes a virus can automatically send out emails from people you know.

5. Having trouble reading the Internet computer screen? Find the magnifying glass on your computer. On a PC, go to the start button, click on the control panel, and look for accessibility options. You can also enlarge text size. For more information on how to set it up on your PC or Mac, visit the website: www.aging.state.pa.us and click on “Enlarge Text.”

6. Struggle with typing? Both Macs and PCs with Microsoft Windows Vista programs have a text-to-speech program. This tool can work as a secretary and type what you say, read to you information from websites or simple word documents. You usually can change the automated voice to fit your comfort level. A speech recognition program will allow you to say things such as “open Internet Explorer,” or write down what you are speaking. This program helped a retired Navy man that Dworkin was assisting. “He stormed the beaches of Normandy and wanted to write a memoir but couldn’t because of his arthritis,” Dworkin says. “So he’d sit there and dictate to the computer. He had a friend edit it afterwards to make sure the word ‘meet’ wasn’t written as ‘meat’ or ‘mate.’ The program’s not flawless, but it can really help to minimize the amount of typing.”

7. Consider using Skype. Make calls from your computer to another computer for free, anywhere in the world. Even Oprah uses this now to interview some of her guests. You buy a special headset that typically costs $20 to $50 at any electronics store. You dial the phone number by pressing buttons on your computer and the other person picks up, so it’s just like a normal phone call. You can also call, unlimitedly, a landline or cell phone anywhere in the United States for $3 a month if you sign up for the service.

8. What is instant messaging (IM)? Imagine writing notes back and forth to someone — that’s what IM is like. It’s like writing one or two sentences or phrases on a Post-It type note that is instantly sent to someone else. There are a variety of free programs that do this, including: Google, AOL, MSN, and Yahoo

9. What’s a blog? Blog is short for web log. Most are free. People use them for various reasons — from keeping a public diary to writing about niche topics, such as politics, celebrities, sports, traveling, or dieting. Many people prefer WordPress.com or typepad.com.

10. Social networking. This buzzword became big in the past five to seven years. There are dozens of sites that fit various needs. Think of it as water cooler talk for the Internet. Linked-In.com is a business website where you can post your resume, credentials, and give or receive recommendations. It’s a great networking tool. Facebook.com can also be used for business networking or personal use. Many people use both, keeping one personal and one professional. MySpace.com is also used by many and was originally started as a way to promote bands on the Internet.

A Buyer’s Guide – Consider buying a laptop.

If you have problems, you can take a portable computer to someone else to have it fixed or call for home service. Plus, you can also go to places such as the library, many restaurants, and coffee shops that offer free Internet hookup. Most computers now come with Wi-Fi access that allows for a wireless connection to the Internet — I recommend it. Also, consider a built-in webcam that will allow you to see and talk to your children or grandchildren in real time. When buying a computer, ask yourself: do you enjoy music; want to edit photos; build a social network; create photo albums or home movies?

Noteworthy websites

Bookmark the following sites to make your Web use easier.

• saturdayeveningpost.com – Find fun features, health stories, favorite Rockwell art, blogs, humor, recipes, news that you can use, and much more.
• familysearch.org – Doing genealogy research? Start here.
• flickr.com – View some of the most interesting photographs from around the world.
• youtube.com – Watch Gene Kelly perform “Singing in the Rain” or Bono and Pavarotti perform Ave Maria on this video website.
• cnn.com – Just one of many great news sites. Google your favorite magazine or newspaper (New York Times is nytimes.com or try washingtonpost.com) and get even more information.
• bloomberg.com – Get financial news here.
• weather.com – Want the essentials? This site has been around for 12 years and frequently updates.
• mapquest.com – Type in an address and print out a map. Get driving directions, too.
• sidestep.com – This travel website, along with orbitz.com, travelocity.com and kayak.com will help you comparison-shop for flights and hotels.
• yelp.com – Find information on a restaurant, shop or business.
• overstock.com , eBay.com and amazon.com – Great places to shop.
• stubhub.com – Find tickets for concerts and sporting events.
• earth.google.com – View satellite images of anywhere in the world, even your home.
• craigslist.com – It’s the online version of the classified ad, only it’s free. Find everything from jobs to dating personals. Use it to sell or buy anything.
• freecycle.org – Trying to get rid of something or want something for free? Sign up for your neighborhood and add your request.
• espn.com – By far the most comprehensive sports website.
• charitynavigator.org – An independent charity evaluator.

10 Tips for Navigating the Web The Saturday Evening Post

In general, consuming up to 100 mg of vitamin B6 in supplements and foods every day is considered safe. The important nutrient supports the nervous and immune systems and helps maintain blood sugar within a normal range. It may, however, interact with a drug used for Parkinson’s disease called L-dopa. In addition, very high doses may damage nerves in the arms and legs.

Experts note that this type of nerve damage may be reversible, and stopping the supplements is a simple way to test for ill effects. Foods that add B6 to one’s diet include fortified breakfast cereals, salmon, pork, chicken, bananas, beans, peanut butter, and many vegetables.

Other B vitamins are key to overall health, too. Folic acid is recognized as a major player in protecting babies from devastating birth defects of the brain and spinal cord. Post readers tell us that taking extra B12 boosts energy levels and mood. No overdoses of B12 pills, shots, or nasal spray have been reported in the medical literature.

Reader Suggestion: I will tell you what has completely healed my foot. Clarks shoes! These are slip-on shoes with no strap around the back of the heel. Buy one size larger than usual so the foot rests flat. Good luck. The shoes are a great answer to a terrible problem.

Reader Suggestion:An orthopedic foot specialist advised wearing a knee-high cast prior to doing surgery for severe heel pain. Instead, I purchased a Velcro-type ankle brace to wear every moment except when showering. I also purchased some high-top athletic shoes that I lined with an IsoArch support. Within two weeks I noted improvement, but it took almost six weeks to get rid of the pain completely. Others have had the same success with this therapy. Good luck.

Reader Suggestion: Reading the July/August 2008 edition of Medical Mailbox, I was very empathetic with Edith, who is suffering from bone spurs in her heels. I, too, suffered for about a year. Shots did no good, and neither did very thin orthotics. Finally, a foot doctor made me a pair of good orthotics to be worn with New Balance tennis shoes, model #1123. I was pain free in about eight weeks, and after three years not an ounce of pain. I wear regular flat shoes once in a while, but I pretty much stick to the tennis shoes.

Reader Suggestion:I had a similar problem with heel pain as Edith M. Wubben. It was cured by six acupuncture treatments, and I never had a problem again.

Reader Suggestion: When I had heel spurs, someone advised me to drink one water glass of Ocean Spray Cranberry Juice three times a day. This worked for me after about six weeks. I continued for another six weeks just to be sure they were gone. They have not returned for 12 years. Hope this helps reader Edith Wubben from Virginia. I love this magazine and your column.

Medical Mailbox supplements the advice of your healthcare provider, whom you should consult for personal medical problems.

Heel Pain Advice The Saturday Evening Post

We sent your letter to Dr. Walter Coyle, gastroenterology program director at Scripps Clinic Torrey Pines in LaJolla, California. Dr. Coyle responds:

“Unfortunately, you are not alone. More than 60,000 admissions per year to U.S. hospitals are associated with chronic pancreatitis.

“The pancreas is an organ in your abdomen that is critical to digestion and control of blood sugar. In chronic pancreatitis, the pancreas is damaged and becomes progressively scarred. It often becomes calcified and may contain stones and cysts. In this country, about three quarters of cases are due to alcohol use. Other major causes include hereditary (genetic) diseases, metabolic problems such as high calcium or triglyceride levels, abnormalities or blockages of the pancreatic duct, and autoimmune diseases. Sometimes, the cause is unknown.

“The first key to treatment is eliminating the cause, if possible. This could mean abstaining from alcohol, treating high calcium or triglyceride levels, fixing blockages, or treating the autoimmune disease. Some newer studies suggest that taking antioxidants like vitamin E may help prevent attacks, but there is not yet solid proof. Once the pain and nausea start, however, these measures often do not alleviate symptoms.

“Taking pancreatic enzymes by mouth aids digestion and sometimes helps relieve pain and bloating. Moderate to severe pain usually requires the use of narcotics. Newer nonnarcotic medications can blunt the pain response and reduce the need for high-dose narcotics. On occasion, gastroenterologists can treat pain with new endoscopic treatments to unblock the drainage ducts, remove stones, or drain cysts. Pain specialists may block the main nerve involved, which is called the celiac plexus. In rare cases, we resort to surgery to remove part of the diseased organ or drain the duct.

“Doctors experienced in pancreatic diseases are best equipped to treat moderate-to-severe chronic pancreatitis. I encourage you to seek out a medical center that specializes in diseases of the pancreas.”

Medical Mailbox supplements the advice of your healthcare provider, whom you should consult for personal medical problems.

Chronic Pancreatitis The Saturday Evening Post