RE: frequent pancreatitis in a non-drinker

[Guest guest]

Thanks for passing it on.you are welcome, I hope it helps.

Merav Levi, RD, MS, CDNA dietitian, not the food police.

http://www.linkedin.com/in/meravlevi

" Life is not measured by the number of breath you take, but by the moments that

take your breath away. " - Carlin " People don't forget the truth, they just

become better in lying " (Revolutionary Road)

> To: rd-usa

> From: nrord1@...

> Date: Sat, 5 Feb 2011 18:59:18 -0500

> Subject: Re: frequent pancreatitis in a non-drinker

>

> Will run it past her...thanks Merav. I do want to add that she did throw

> out a compliment out about Dietitians always being so thoughtful and

> helpful. She is a lay person and has always been impressed with Dietitians.

>

>

>

> >

> >

> >

> > Very interesting.All I can add from what you sent, as per Pancreatic CA

> > seminar I just attended - sometime it is missed in CT scan and requires PET

> > scan. If that would be me or someone I cared about I would insist on a PET

> > scan, especially since 3 CT scans didn't show anything. One last thought -

> > what are the possibilities of binge-eating d/o? One of the complications is

> > GI problems and your friend did mention that it happened after bigger

> > high-fat meals. referring to this part: " prior to each attack, I did consume

> > much more fat than usual. In one> case, burger and fries, in another, egg

> > salad consisting of five eggs eaten> all at once, in another case, lots of

> > pulled pork left over from a work food> event. Doctors did not pay much

> > attention to that fact. "

> > BEDO pts would be " dieting " most of the time and have episodes of bingeing,

> > therefore no diarrhea involved in-spite of 30,000 Lipase (?) and would

> > normally not use much wt or at all. Hope not - but, just a thought.

> >

> >

> > Merav Levi, RD, MS, CDNA dietitian, not the food police.

> > http://www.linkedin.com/in/meravlevi

> >

> > " Life is not measured by the number of breath you take, but by the moments

> > that take your breath away. " - Carlin " People don't forget the truth,

> > they just become better in lying " (Revolutionary Road)

> >

> > > To: rd-usa <rd-usa%40yahoogroups.com>

> > > From: nrord1@... <nrord1%40gmail.com>

> > > Date: Sat, 5 Feb 2011 08:01:56 -0500

> > > Subject: Re: frequent pancreatitis in a non-drinker

> >

> > >

> > > Answers:

> > >

> > > 1. Yes, pancreatic CA ruled out; also cysts. The pancreas itself is in

> > > pretty good shape, they said.

> > >

> > > 2. I did not lose significant weight--only about 5 pounds

> > >

> > > 3. CT scans were done 3 times

> > >

> > > 4. Not a smoker since 1999

> > > 5. Attacks requiring emergency treatment:

> > >

> > > 1st attack in July 2009;

> > >

> > > 2nd April 2010 (improved while in emergency room and sent home);

> > >

> > > 3rd attack May 2010;

> > >

> > > 4th attack Jan 29 2011.

> > >

> > > Accompanied by nausea and vomiting each time. Initial pain a 9-10 on a

> > > scale of 1-10.

> > >

> > >

> > >

> > > - Attacks #1,2, and 4 required hospitalization for four days each and

> > were

> > > similar in length and treatment: Dilaudid q 4 hrs prn, NPO first 3 days

> > > (until enzymes levels approached normal),

> > >

> > > - Rapid improvement and return to work within a week each time.

> > >

> > > - No diarrhea normally or during attack

> > >

> > > - No pain at meal time or any other time-- only when experiencing an

> > acute

> > > attack that requires emergency treatment

> > >

> > > - I adhere to a relatively low fat diet with small frequent meals, and

> > take

> > > Omega 3s.

> > >

> > > - Prior to each attack, I did consume much more fat than usual. In one

> > > case, burger and fries, in another, egg salad consisting of five eggs

> > eaten

> > > all at once, in another case, lots of pulled pork left over from a work

> > food

> > > event. Doctors did not pay much attention to that fact.

> > >

> > >

> > >

> > > Blood work showed normal triglycerides and liver function. No gall

> > stones.

> > >

> > >

> > > On Fri, Feb 4, 2011 at 10:30 PM, Ortiz

<nrord1@...<nrord1%40gmail.com>>

> > wrote:

> > >

> > > > Thanks ladies - I will have to go back and ask her (female) those

> > questions

> > > >

> > > >

> > > > On Fri, Feb 4, 2011 at 10:23 PM, Lori Wyble

<lowyble@...<lowyble%40yahoo.com>>

> > wrote:

> > > >

> > > >>

> > > >>

> > > >> When I worked inpatient I met a young male that had recurrent

> > pancreatitis

> > > >> secondary to familial hypertriglyceridemia. We put him on a calorie

> > > >> controlled, consistent cho diet, with low fat/sat fats. He also took

> > > >> omega3s.

> > > >> Hope they figure it out!

> > > >>

> > > >> Sent from my iPhone

> > > >>

> > > >>

> > > >> On Feb 4, 2011, at 9:39 PM, Merav Levi

<meravls@...<meravls%40msn.com>

> > <meravls%40msn.com>>

> >

> > > >> wrote:

> > > >>

> > > >> Hi ,

> > > >> Few questions if I may:1. Did any one r/o-ed pancreatic CA? I hope it

> > > >> was2. Did he lose significant/continuous unplanned wt?3. Any CT/PET

> > scans

> > > >> done?4. Is s/he a smoker?5. Your friend mentions to be in the hospital

> > for

> > > >> his/her 4th attack. Is that the 4th attack that week? in one month?

> > how

> > > >> frequent or how long ago was the first one?

> > > >> As for the NPO/clear liq diet - it is the common practice in many

> > places,

> > > >> but it is not alway any more. Pt should eat what is tolerated. Yes, at

> > the

> > > >> time of flare-up - if pt does not vomit/nauseated - keep a low fat

> > high prot

> > > >> diet, small frequent meals as tolerated. If diarrhea/steatorrhea is

> > present

> > > >> restrict fat even more or try the clear liquids for few days and try

> > low fat

> > > >> high protein diet again when vomiting stops. What I am getting from

> > the

> > > >> e-mail is that your friend does not suffer with

> > vomiting/nausea/diarrhea (or

> > > >> maybe I am wrongly interpreting) yet the pain could be terrible at

> > meal time

> > > >> - so as I said - all per tolerance. It used to be also PN for acute

> > > >> pancreatitis but again, if pt is able to tolerate PO to sustain self

> > -that

> > > >> is the way to go. Of course - if PN/npo was initiated and was

> > prescribed for

> > > >> more then 5 days we have to be cautious about re-feeding and therefore

> > clear

> > > >> liquids may be the first step (but I didn't get that this what

> > > >> happened to your friend).

> > > >> Let me know what you think.

> > > >>

> > > >> Merav Levi, RD, MS, CDNA dietitian, not the food police.

> > > >> http://www.linkedin.com/in/meravlevi

> > > >>

> > > >> " Life is not measured by the number of breath you take, but by the

> > moments

> > > >> that take your breath away. " - Carlin " People don't forget the

> > truth,

> > > >> they just become better in lying " (Revolutionary Road)

> > > >>

> > > >> To: rd-usa <rd-usa%40yahoogroups.com> <rd-usa%

> > 40yahoogroups.com>

> > > >> From: nrord1@... <nrord1%40gmail.com> <nrord1%40gmail.com>

> >

> > > >> Date: Fri, 4 Feb 2011 18:15:59 -0500

> > > >> Subject: frequent pancreatitis in a non-drinker

> > > >>

> > > >> A friend has had this happen - any other thoughts what could be

> > causing

> > > >> it?

> > > >>

> > > >> Any GI RDs?

> > > >>

> > > >> " I've had four attacks of pancreatitis in the past two years and they

> > > >> don't

> > > >>

> > > >> know the cause ( idiopathic ). It's amazing how the doctors disagree,

> > one

> > > >>

> > > >> saying hypercalcemia (mine is slightly high and has been for years)

> > could

> > > >> be

> > > >>

> > > >> a factor, others saying not. I have pancreatic divisim and some say

> > it's a

> > > >>

> > > >> possible cause and others say it can't be. I got diet advice from a

> > doctor

> > > >>

> > > >> while two were standing in the room. When he left, the other doctor

> > said

> > > >>

> > > >> that I could ignore his advice--diet would make no difference in

> > > >> preventing

> > > >>

> > > >> future attacks.

> > > >>

> > > >> I know why some people get so frustrated with doctors. I'm not

> > frustrated

> > > >>

> > > >> with them, per se, just with the fact that the cause of my

> > pancreatitis is

> > > >>

> > > >> so elusive. They ruled out the two most common causes: gall bladder

> > > >>

> > > >> disease and excessive alcohol intake. I will be seeing a pancreatic

> > > >>

> > > >> specialist soon and also had blood tests run to check parathyroid

> > > >>

> > > >> hormones to diagnose the hypercalcemia .

> > > >>

> > > >> I was in the hospital just this week with my 4th attack (lipase

> > 30,000,

> > > >>

> > > >> amylase 450)and was amazed when my attending physician ordered a

> > clears

> > > >> diet

> > > >>

> > > >> for me right after admission. I consumed some of it and got a lot

> > sicker.

> > > >>

> > > >> The protocol is NPO until enzyme levels approach normal. What was he

> > > >>

> > > >> thinking? "

> > > >>

> > > >> --

> > > >>

> > > >> Ortiz, MS, RD

> > > >>

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