Re: pancreatic enzymes & Fred back to emergency

[Guest guest]

Dave-

" Pred " - that's pretty cute. Good 'ol Pred, or Fred, had to go back to

emergency today due to severe abdominal pain that radiated to the back,

same as before when we went to emergency on Tuesday night, only this was

more severe. Diarrhea also still pretty bad. They gave him IVs and

dilantin (stronger than morphine, nurse said) for pain. It worked,

praisethelordhallelujah. Emergency room diagnosis was " Acute

Pancreatitis, " after consult with gastro on call.

The pancreatitis diagnosis is getting thrown around like a boomerang.

His lipase today was 723, and serum amylase 388. The same emergency room

dr. saw him both times and said " Pain is DEFINITELY from the pancreas. "

His theory is that the bile duct between the liver and the pancreas gets

intermittently obstructed, causing the pain. Recommended ERCP. So Fred

is back home, resting comfortably, with many thanks to a Percocet rx and

I have to believe, prayers. Fred is a little ticked at his gastro if he

indeed DOES have pancreatitis, as he'd been eating food since Thursday -

a huge no-no if pancreatitis is the culprit.

Perhaps Pred's pred is finally starting to work on the diarrhea. He's at

six hours and holding. A record. We'll be calling the gastro every five

minutes tomorrow until we get an answer as to another hospital

admittance or scheduling outpatient ERCP which stands for End Recurrent

Wife of Pred/Fred, PSC 03/04, UC 03/06, Gastritis, 10/07, Acute

Pancreatitis??? 10/07

[Guest guest]

Whoops - forgot to finish: ERCP is for End Recurrent Continuous Pain!

>

> Perhaps Pred's pred is finally starting to work on the diarrhea.

He's at

> six hours and holding. A record. We'll be calling the gastro every five

> minutes tomorrow until we get an answer as to another hospital

> admittance or scheduling outpatient ERCP which stands for End Recurrent

>

>

> Wife of Pred/Fred, PSC 03/04, UC 03/06, Gastritis, 10/07, Acute

> Pancreatitis??? 10/07

>

[Guest guest]

So Fred is back home, resting comfortably, with many thanks to a Percocet rx and I have to believe, prayers. Fred is a little ticked at his gastro if he indeed DOES have pancreatitis, as he'd been eating food since Thursday - a huge no-no if pancreatitis is the culprit.>>> I'm surprised they sent him home if they really think it is pancreatitis. When I had that dx (with a lipase of 16,000 - yep you read that right) I was NPO for 3 days and hospitalized with IV's. Has tx changed for pancreatitis? On another note, my lipase/amylase are normally elevated when I have cholangitis which throws doctors who don't know my case off track. Does Fred still have his gallbladder? I'm sorry he is having so much pain. It is definitely not fun. Blessings, Barby -

KS UC - 1965, ileostomy - 1972, BCIR (continent pouch) 1994, PSC - 1995, arthritis 2007, listed 9/18/07married 28 years , 5 sons, 2 daughters in law, 1 granddaughter born 6/06 and 2 golden retrievers

[Guest guest]

Hi Barby-

Fred had his gallbladder out in 95.

They said there's nothing they could do for him in the hospital today,

thus just gave him painkillers and said drink clear liquids. Treatment

for pancreatitis is just rest and no food, correct? Just clear

liquids? My other concern was that he was still having diarrhea, but

that seems to finally be better today. He has no fever, but did wake

up in a cold sweat last night. Wonder if it IS cholangitis manifesting

in a bizarre way? Cholangitis was considered, but thrown out, due to

him having classic symptoms of pancreatitis. How do they diagnose

cholangitis? Also through ERCP?

Wishing YOU better days ahead Barby!

16,000?? You WIN! No

>

> I'm surprised they sent him home if they really think it is

pancreatitis. When I had that dx (with a lipase of 16,000 - yep you

read that right) I was NPO for 3 days and hospitalized with IV's.

Has tx changed for pancreatitis?

>

> On another note, my lipase/amylase are normally elevated when I

have cholangitis which throws doctors who don't know my case off

track. Does Fred still have his gallbladder?

>

> I'm sorry he is having so much pain. It is definitely not fun.

>

> Blessings,

> Barby - KS

>

>

>

> UC - 1965, ileostomy - 1972, BCIR (continent pouch) 1994, PSC -

1995, arthritis 2007, listed 9/18/07

> married 28 years , 5 sons, 2 daughters in law, 1 granddaughter born

6/06 and 2 golden retrievers

>

[Guest guest]

and Fred -

I'm so sorry Fred is still so miserable. I'm glad the new pain medicine was helpful - probably Dilaudid, not Dilantin (an anti-seizure medicine). I hope he stays comfortable today - if not, call the doctor back for what to do next! If he is nauseous, the Dilaudid also comes as a liquid. What a crummy month you both have had. Good luck on the ERCP date.

Take care

Joanne H

(, Ca., mom of , 17, UC/PSC 2-06; JRA 1998)

(Sorry, I can't figure out how to shorten the message - any clues?)

-----Original Message-----From: [mailto: ]On Behalf Of HusseySent: Sunday, October 21, 2007 1:52 PMTo: Subject: Re: pancreatic enzymes & Fred back to emergency

Dave-"Pred" - that's pretty cute. Good 'ol Pred, or Fred, had to go back to emergency today due to severe abdominal pain that radiated to the back, same as before when we went to emergency on Tuesday night, only this was more severe. Diarrhea also still pretty bad. They gave him IVs and dilantin (stronger than morphine, nurse said) for pain. It worked, praisethelordhallelujah. Emergency room diagnosis was "Acute Pancreatitis," after consult with gastro on call.The pancreatitis diagnosis is getting thrown around like a boomerang. His lipase today was 723, and serum amylase 388. The same emergency room dr. saw him both times and said "Pain is DEFINITELY from the pancreas." His theory is that the bile duct between the liver and the pancreas gets intermittently obstructed, causing the pain. Recommended ERCP. So Fred is back home, resting comfortably, with many thanks to a Percocet rx and I have to believe, prayers. Fred is a little ticked at his gastro if he indeed DOES have pancreatitis, as he'd been eating food since Thursday - a huge no-no if pancreatitis is the culprit.Perhaps Pred's pred is finally starting to work on the diarrhea. He's at six hours and holding. A record. We'll be calling the gastro every five minutes tomorrow until we get an answer as to another hospital admittance or scheduling outpatient ERCP which stands for End RecurrentWife of Pred/Fred, PSC 03/04, UC 03/06, Gastritis, 10/07, Acute Pancreatitis??? 10/07

[Guest guest]

Joanne-

You're correct - Dilaudid! LOL.

If you're talking about shortening your entire message, just highlight

all the stuff you want deleted by clicking your mouse and then hitting

" delete. "

>

> and Fred -

> I'm so sorry Fred is still so miserable. I'm glad the new pain

medicine was

> helpful - probably Dilaudid, not Dilantin (an anti-seizure medicine). I

> hope he stays comfortable today - if not, call the doctor back for

what to

> do next! If he is nauseous, the Dilaudid also comes as a liquid.

What a

> crummy month you both have had. Good luck on the ERCP date.

>

> Take care

>

> Joanne H

> (, Ca., mom of , 17, UC/PSC 2-06; JRA 1998)

> (Sorry, I can't figure out how to shorten the message - any clues?)

>

> Re: pancreatic enzymes & Fred back to emergency

>

>

>

[Guest guest]

I have tried highlighting and for some reason, it won't let me - the computer program acts like I'm trying to change the page layout, but can't simply delete.

Joanne

Re: pancreatic enzymes & Fred back to emergency> > >

[Guest guest]

Treatmentfor pancreatitis is just rest and no food, correct? >>> Maybe the tx has changed but I wasn't even allowed clear liquids although I did sneak a few sips of water when they weren't looking. My Hep won't do an ERCP when I have cholangitis. I'm not sure of a way to dx it for sure except for the pain and elevated white count. Wouldn't both pancreatitis and cholangitis need antibiotics? Guess it is hard to tell but I just wanted to let you know that at least in my case my pancreatic enzymes can be elevated even up to nearly 1000 and they don't sock me in the hospital labellilng me with pancreatitis. We are all different and I'm obviously very different. lol Hang in there - Your Fred should have some good days coming very soon. Blessings, Barby-KS

[Guest guest]

Maybe your son could help? All teenagers were born with computer chips

in their brains and seem to be able to fix lots of stuff. Have you

tried going to your computer " help " option and typing in " delete " in

the search window?

- or else maybe Arne

>

> I have tried highlighting and for some reason, it won't let me - the

> computer program acts like I'm trying to change the page layout, but

can't

> simply delete.

> Joanne

>

>

>

[Guest guest]

,

I am so sorry to here that Fred is having such pain. Dilaudid was a great pain

killer for Todd and pancreatitis. But when Todd had pancreatitis he was NPO for

almost 10 days...that included no food or fluids. They kept him hydrated with

ivs, but he was literally starving. But if pancreatits is what Fred has I would

just ask about the fluids. Good luck tomorrow and I hope you get the answers you

need.

Together in the fight, whatever it takes!

Joanne (mom of Todd, psc 01, crohns 02, tx twice 03, recurrence 05, diabetes 06,

living life to the fullest 07)

Sent from my Verizon Wireless BlackBerry

[Guest guest]

Dilaudid - great stuff. The two times I had pancreatitis, treatment was nothing

by mouth until pancreatic enzymes came down.

Arne

[Guest guest]

-----Original

Message-----

But when Todd had pancreatitis he was NPO for almost 10 days...that included

no food or fluids.

Ditto Ken, except

a few and I mean few ice chips

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (33) UC 91 - PSC 99 - Tx 6/21 & 6/30/07 @ Baylor in Dallas

[Guest guest]

What's weird is Fred's pancreatic enzymes DID come down to normal on

Friday. His LFTs have also been normal for the past week. That's the

first time in about 2 years. Something strange is brewing.

>

> Dilaudid - great stuff. The two times I had pancreatitis, treatment

was nothing by mouth until pancreatic enzymes came down.

>

>

> Arne

>

[Guest guest]

Joanne-

What caused Todd's pancreatitis? Why do people with PSC get it?

(Outside of having ERCP procedures, which are known to cause it). Is

it due to the bile duct between the liver and pancreas being

constricted? Anyone with an answer please chime in!

How is Todd doing now with his overall health?

>

> ,

>

> I am so sorry to here that Fred is having such pain. Dilaudid was a

great pain killer for Todd and pancreatitis. But when Todd had

pancreatitis he was NPO for almost 10 days...that included no food or

fluids. They kept him hydrated with ivs, but he was literally

starving. But if pancreatits is what Fred has I would just ask about

the fluids. Good luck tomorrow and I hope you get the answers you need.

>

> Together in the fight, whatever it takes!

>

> Joanne (mom of Todd, psc 01, crohns 02, tx twice 03, recurrence 05,

diabetes 06, living life to the fullest 07)

> Sent from my Verizon Wireless BlackBerry

>

[Guest guest]

,

I wish I knew the answer to the question of " why " but unfortunately I

don't...all I know is that it really is tough watching a loved one go through

it. I surely feel for you. Todd got pancreatitis so many times the year before

the transplant that he actually was awarded some exception points on his PELD

score at the time. There must be something that goes hand in hand with the

colon and all the rest of the internal organs...it really seems that when one

thing acts up the rest feel the need to follow along.

Todd is holding his own right now. He is very much in love and that seems to

conquer all. He struggles with itching, but is having a few good weeks. We are

all thankful for these good weeks.

My prayers are with you and Fred...may your good days come quickly.

Joanne

Sent from my Verizon Wireless BlackBerry

[Guest guest]

Hi ;

It's possible that Fred may have had a rare reaction to mesalazine (I

think this is the same as Asacol). I remember you saying that Fred

thought that Asacol may have been making him sick (?) [please correct

me if my recollection is wrong].

_____________

Gut. 2002 Oct;51(4):536-9.

Sulphasalazine and mesalazine: serious adverse reactions re-evaluated

on the basis of suspected adverse reaction reports to the Committee

on Safety of Medicines.

Ransford RA, Langman MJ

Department of Medicine, Queen Hospital, Birmingham B15 2TH,

UK.

BACKGROUND: 5-aminosalicylates are extensively prescribed for the

treatment of ulcerative colitis but have a wide range of described

adverse effects. AIMS: To determine whether serious adverse effect

profiles differ for sulphasalazine and mesalazine. METHODS: Analysis

of suspected serious adverse reactions reported to the Committee on

Safety of Medicines of the UK in 1991-1998. Adverse effect profiles

were categorised for interstitial nephritis, pancreatitis, serious

skin reactions, hepatitis and hepatic failure, and blood dyscrasias.

Report rates were calculated using prescribing data from the

Department of Health and compared for mesalazine and sulphasalazine.

Further analysis was undertaken for sulphasalazine according to

disease indication of inflammatory bowel disease or rheumatoid

arthritis. RESULTS: A total of 4.7 million prescriptions were

dispensed for sulphasalazine compared with 2.8 million for

mesalazine. Interstitial nephritis was only described for mesalazine,

with 11.1 reports per million prescriptions. Pancreatitis was

reported seven times as frequently for mesalazine (7.5 per million

prescriptions) compared with sulphasalazine (1.1 per million

prescriptions) (odds ratio (OR) 7.0; 95% confidence interval (CI) 2.6-

18.6; p<0.001). There were no reports of serious skin disorders in

patients prescribed sulphasalazine for inflammatory bowel disease.

Blood dyscrasias were reported significantly more often in patients

receiving sulphasalazine for rheumatoid arthritis than for

inflammatory bowel disease (OR 5.31; 95% CI 2.6-11.0; p<0.001), and

there was a similar trend for hepatic disorders. CONCLUSIONS:

Spontaneous reports suggest that within the five sets of disorders

considered, there is no evidence to indicate a safety advantage of

mesalazine over sulphasalazine in the treatment of inflammatory bowel

disease. Pancreatitis and interstitial nephritis appear significantly

more common with mesalazine, and advice on renal monitoring in

patients who receive mesalazine may need reinforcing. PMID: 12235076.

_____________

Pancreatic duct abnormalities are not uncommon in ulcerative colitis,

and it may be that the unfortunate ones with exisiting pancreatic

abnormalities, a bad reaction to mesalazine coupled with dehydration

and/or biles stones, might preciptate pancreatitis?

_____________

Inflamm Bowel Dis. 2005 Oct;11(10):903-8.

Pancreas duct abnormalities in patients with ulcerative colitis: a

magnetic resonance pancreatography study.

Toda N, Akahane M, Kiryu S, Matsubara Y, Yamaji Y, Okamoto M,

Minagawa N, Ohgi K, Komatsu Y, Yahagi N, Yoshida H, Kawabe T, Ohtomo

K, Omata M

Division of Gastroenterology, Department of Internal Medicine,

University of Tokyo, Japan. ntoda@...

BACKGROUND: The presumed etiology and prevalence of pancreatic

abnormalities in patients with ulcerative colitis (UC) have been

controversial. We conducted a controlled (cross-sectional) study of

patients with UC compared with non-UC controls to determine the

prevalence of pancreatic duct abnormalities in patients with UC and

to determine if these are specific to UC using magnetic resonance

cholangiopancreatography. METHODS: Magnetic resonance

cholangiopancreatography was performed on 79 unselected patients with

UC and 45 non-UC controls, without a history of pancreatitis attack,

between February 2000 and May 2003. RESULTS: Among patients with UC,

the prevalence of pancreatic duct abnormalities was 16.4% (95%

confidence interval, 8.3%-24.6%): coexisting dilatation and narrowing

of the main pancreatic duct were found in 5; diffuse narrowing of

pancreatic ducts in 5; and dilatation of pancreatic ductal branches

in 3. These abnormalities were compatible with chronic pancreatitis.

Among the controls, no pancreatic duct abnormality was found.

CONCLUSIONS: Changes in the pancreatic duct were found in

approximately one-sixth of patients with UC, none of whom had a

history of overt pancreatitis. These pancreatic duct abnormalities

are likely to be specific to patients with UC. PMID: 16189420.

_____________

Best regards; and here's hoping for a speedy recovery for Fred.

Dave

> Why do people with PSC get it? (Outside of having ERCP procedures,

which are known to cause it). Is it due to the bile duct between the

liver and pancreas being constricted? Anyone with an answer please

chime in!

[Guest guest]

I have the same problem. I think I will take the suggestion and check these at a time when one of my kids is around. MartiCopper wrote: I have tried highlighting and for some reason, it won't let me - the computer program acts like I'm trying to change the page layout, but can't simply delete. Joanne Re: pancreatic enzymes & Fred back to emergency> > > __________________________________________________

[Guest guest]

> I have tried highlighting and for some reason, it won't let me

> I have the same problem

When you have your Yahoo profile set to " fully featured " , messages can

be very hard to edit. Look at the bottom of one of the messages from

the group and it should say something like:

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Except that if you are set to " fully featured " right now, it will have

a link to change you to " traditional " instead. Try clicking that and

everything will be much, much easier! At least that's what I think :-)

I hate all the fancy stuff that makes it impossible to work with the

message!

Let us know if this solves your problem! I (and maybe some other

people) would be interested to know!

athan

[Guest guest]

Thanks Dave, your recollection is correct. I printed out the studies.

I am believeing " Pred's " gastro was WRONG in her diagnosis. We'll get

a consult with his hepatologist. Fred doing so much better; Percocet

is his new friend.

>

> Hi ;

>

> It's possible that Fred may have had a rare reaction to mesalazine

(I

> think this is the same as Asacol). I remember you saying that Fred

> thought that Asacol may have been making him sick (?) [please

correct

> me if my recollection is wrong].

>