Re: Re: To: Lily from

[Guest guest]

Lily,

Thanks so much for the info. I saw my surgeon today. He has redeemed himself

in my eyes. I was aggravated with him Tuesday after the colonoscopy. I talked

to him then when I was in agony and he told me he would talk to me the next day

but didn't call. The best we can figure, I ended up with air/gas under the

diaphram after the colonoscopy. My surgeon and internal med doc says that is

horrendously painful for hours when it happens. Anyway, today has been a very

good day. I have felt better than in some time. My surgeon answered every one

of my questions and didn't rush me in the least despite the fact that I was his

last patient and it was after 6 pm when I got out of there.

My surgeon says my problem is sphincter of oddi dysfunction causing acute panc

at times, other times causing only raised liver enzymes, and other times,

causing only severe pain/nausea. The GI says the problem is adhesions.

However, both agree that I need to have the bile duct opened more to keep it

draining. I currently have a stent but it is just temporary. Since I have had

a gastric bypass, my GI cannot do a sphincterotomy by ERCP because my insides

have been re-routed. He was able to put the stent in through ERCP but could not

safely make a cut in the bile duct. He also cannot get to the pancreas or

pancreatic duct to look at them through ERCP.

Okay - here's the latest dilemna. My GI says I need to go to Indiana to a

biliary specialist. I am assuming to Dr. Lehman. My GI is very hard to talk to

unless you are in the office with an appt. The internal med doc referred me to

a biliary specialist at UAB (Birmingham, AL - 100 miles from home) He is Dr.

Selwyn Vickers. He is the head of GI surgery. According to my surgeon, he is

very good and does biliary surgery almost exclusively. He does not do ERCPs.

He would do surgery and a liver biopsy on me. My surgeon said he mentioned Dr.

Vickers to my GI but my GI simply told him I need to go to Indiana not to UAB

and would not elaborate as to why.

According to my surgeon, my GI is very talented at ERCP. He was totally amazed

that he was able to even get to the bile duct. My GI taught the ERCP procedure

to all the other GIs in our area.

Anyway, my options are to see Dr. Vickers at UAB on Oct 21st, go back to my GI

(I have an appt next week) and find out exactly who in Indiana he thinks I

should go to and why should I go there (probably 350 miles away) vs the doc at

UAB.

According to my surgeon going in surgically to cut the bile duct will be much

more difficult on me than doing it by ERCP as they will have to cut through the

duodenum to get to it surgically. However, I have had the best at ERCP in the

state and he cannot cut the bile duct safely through ERCP.

Both ERCPs I've had done recently have been very difficult on me. With the last

one I had dry heaves/vomiting for hours and horrible pain for days. When the

same GI did an ERCP back in 2000 prior to my gastric bypass, I had no problems

at all. The nurses at the hospital say he is the best and most of his patients

have no problems with ERCP because he is so good and is extra careful not to

muck around.

Does anybody have any thoughts or suggestions on which way to go? My husband

and best friend are saying go to UAB and let them do surgery so they can

actually get a good look at my pancreas and pancreatic ducts as well as the bile

duct. Going to Indiana will be very expensive and hard on me and my family.

Re: Re: To: from

> ,

> I wanted to ask you about Dr. Lehman. Any others feel free to chime in.

My GI has said I need to see a biliary specialist and I need to go to

Indiana. He didn't give me a name as I actually got the msg via my surgeon.

My GI had said most of the GIs in this area (or actually Birmingham, AL

which is 100 miles away) trained under him so they are no more experienced

than him and that's why I need to go to Indiana. The internal med doc I saw

says that there is a doctor Selwyn Vickers who trained at s Hopkins and

is now at UAB (in b'ham) and he is a biliary specialist. He is supposed to

be referring me. Anyway, I'm assuming that the biliary specialist my GI is

referring to in Indiana may be Dr. Lehman. Can you tell me about him? How

difficult is it to get into him? Is he actually a biliary specialist? I'm

not even sure I know what makes a doctor a biliary specialist. I'm also not

totally sure why my GI thinks I need to see a biliary specialist. He keeps

saying my problem is caused by adhesions. My surgeon and the internal med

doc, say no way would adhesions cause my liver and pancreas enzymes to be

elevated. The internal med doc thinks I need to see a biliary specialist

and have a liver biopsy because he thinks the biliary system may be the

problem and I may actually have primary biliary cirrhosis - an autoimmune

disease where the bile ducts get sclerosed and then lead to liver damage.

>

> Anyway, just wanted to know about Dr. Lehman and find out how hard it is

to get in to see him. Also, how willing is he to do several things on one

visit for patients traveling a long way to see him?

>

> Thanks for any info you can give me.

>

>

>

>

>

[Guest guest]

,

If I were you, I'd be tempted to go to Indiana, but only if

you were to see Dr. Lehman or a trusted co-worker of his.

Many here in the group have recommended Dr. Lehman (He's a

known quantity). Surgery is a big step, don't let anyone

fool you into thinking it's a quick fix. Recovery from

surgery is quite a while. If I were you, I'd want to see all

my non-surgical possibilities first. Second, you don't know

why the GI wants you to go to Indiana and it might be a good

idea to find out. If it's not a good reason, you can always

decide to go the UAB route after seeing your GI. (No reason

you can't do both.).

Kimber

--

Kimber

Vallejo, CA

hominid2@...

Southwest Representative

Pancreatitis Association, International