appt with biliary surgeon

[Guest guest]

Below is an e-mail I sent to my PCP regarding my appt with the biliary

surgeon. I just spent another 2 days in the hospital because of severe pain,

nausea, and vomiting. I am at the end of my rope and don't really know what to

do at this point. I had to delete my e-mails as I had over 700. I hope this

finds everyone having a better day than I've had.

Dr. Boone,

Warning - this is long.

I thought I'd just send you an e-mail to let you know how my appointment with

Dr. Vicker's (biliary surgeon) went. He reviewed the ERCP films from Dr.

Sigman(GI)/Montclair Hospital and also the films from the repeat CT scan he

wanted done at UAB.

The CT scan required a different IV line. They said they couldn't use the PICC

line because the dye is so thick. It took 4 tries but they got the IV started

in a very tiny vein on the side of my thumb. They told me the dye would hurt

because of the location. It felt as though my entire hand was immersed in

boiling water. As I suspected, the CT scan at UAB also showed nothing, so it

was a big waste of time, money, and pain.

Dr. Vickers said that it seems my problem is not as straightforward as he had

hoped. He said if he had a clear cut indication that the problem was the bile

duct, he would not hesitate to do surgery. He said he does not agree with Dr.

Sigman's assesment of the pain being caused by adhesions. He said if adhesions

were the problem, my pain would likely be constant. He also said he does not

believe adhesions would cause my liver and pancreas enzymes to elevate. He

said that if the problem actually is adhesions, any general surgeon could

handle the surgery and he felt Dr. DeWitt (surgeon that did my gastric bypass)

should do the surgery if adhesions really are the problem. Dr. Vickers said

that the only thing that really makes sense in causing the pancreas and liver

enzymes to be elevated is that there is something wrong with the bile duct.

However, the fact that I have episodes of the same pain with normal enzymes

complicates the issue. He discussed having Dr. Sigman remove the stent from

the bile duct and waiting to see if I get even worse without the stent.

He called Dr. Sigman and then told me he wants me to see Dr. Sigman next week

and then see Dr. Vickers again in two weeks. He said he wants to see if Dr.

Sigman can come up with more information as to what is causing the problems. I

am not really sure if I am to see Dr. Sigman in his office or if he is just

going to schedule another ERCP to remove the stent. Dr. Sigman did tell Dr.

Vickers that in his opinion a surgeon needs to do an explorative laparotomy to

get a good look at my pancreas and pancreatic duct (since he cannot get to them

via ERCP) and look for adhesions that need to be removed. Dr. Sigman told Dr.

Vickers he believes there is an adhesion that is causing the sphincter of oddi

to malfunction, but Dr. Vickers says that would be unlikely.

Dr. DeWitt's opinion is that the sphincter of oddi is malfunctioning (despite

the fact that I had two sphincterotomies in 2000). He says that would explain

the episodes of severe pain and nausea both with and without liver/pancreas

enzyme elevation. Dr. DeWitt said that he does not feel he has enough

experience to do the surgery on the bile duct and/or sphincter of oddi.

Dr. Vickers said that if Dr. Sigman cannot come up with anything else we may

have to just handle this through chronic pain management. I asked Dr. Vickers

if my liver enzymes continued to elevate would we not need to do something to

prevent liver damage. He replied that if my liver enzymes continued to

elevate, we would need to do something different.

At this point, I feel that seeing Dr. Vickers has been nothing but a waste of

my time and money and having the repeat ct scan caused me unneccesary pain. I

really see no point in another office visit with Dr. Sigman. He has already

given his assessment and other than removing the stent, there is nothing he can

do for me. Dr. Sigman's nurse will call me Monday to let me know if Dr. Sigman

wants to see me in the office or simply do another ERCP and remove the stent.

I'm not really sure if I am willing to go through another ERCP just to remove

the stent and see if I get sicker. Both of the ERCPs that Dr. Sigman did in

July and Aug caused me several hours of excrutiating pain that was not relieved

by medication as well as several hours of vomiting and dry heaves. I don't

know that I am willing to go through that sort of agony just to see if I will

get sicker without the stent.

I really don't know what to do at this point. It is not that I am totally gung-

ho on someone cutting me open but I cannot continue with the way things have

been since July. I have wondered if maybe I am just imagining the pain. It

feels very real but maybe I am doing something to cause it. However, the fact

that my liver enzymes and pancreas enzymes have been elevated with several of

the episodes makes me think that something must be going wrong in my body. My

liver enzymes have been elevated to the 500 + range three different times and

my pancreas enzymes have been elevated twice (three times if you count the

recent episode where the amylase was only slightly elevated).

Bud and I had discussed the possibility of me re-applying for a disability

retirement. We had decided that if Dr. Vickers could not tell me that he could

do something for me in my appointment today, that I would begin the process for

a disability retirement. At least with the disability retirement, I would have

some portion of my income and be able to keep my health insurance. I will need

a letter from you providing a general synopsis of what's been going on since

the acute pancreatitis attack on July 18th. It will take about 3-4 months for

the paperwork to be processed. I feel pretty sure it will be approved since

they had approved my disability retirement before but I turned it down because

my health had improved substantially. If you would be willing to write a letter

stating that I will need to be out of work intermittently for the next 3-4

months, I would greatly appreciate it.

If you have any suggestions on where I should go from here, please let me know.

On another note, I wanted to let you know that I have been displeased with some

of the nurses at Athens hospital on my last two admissions. On several

occasions I have had to wait up to two hours for pain medication. I never

complained during my last hospitalization. On this recent hospitalization, I

ended up throwing up because I had to wait over 1 1/2 hours after asking for

phenergan before they gave it to me. I complained to the nurse and she just

said, " Well, just wait. It's only going to get worse if the hospital keeps

treating us the way they have been. "

Also, when I have asked them to advance my diet, they have refused telling me

that you only ordered clear liquids. Both times I told them you had told me you

had changed the order to diet as tolerated and that you had told me to advance

my diet as I felt I could tolerate more than clear liquids. During this last

hospitalization, the nurse refused to check the chart and insisted that all I

could have was clear liquids since that was what was in the computer.

I am typically a very tolerant patient. I rarely complain about nurses because

I worked at Huntsville hospital as a ward secretary when I was younger. I saw

how hard the nurses work. Prior to my last two admissions, I have always told

everyone that Athens hospital has some of the best nurses. I have to admit

that the majority of the nurses were kind and caring. However, with my last

two hospitalizations, there were 2-3 nurses that definitely didn't fit the kind

and caring category.

Thank you for the kindness and compassion you and your staff have shown me

throughout this ordeal. Thank you, also, for your continued prayers.

W