Re: Pseudocyst options to Kurt

[Guest guest]

Hi Kurt,

My main reason in responding to your post is that I seem to feel a little guilt

when I

read your post......I vaguely remember you posting something to us when we were

discussing the basement greenhouse (?). I didn't mean to be rude but I think I

read it

the day I was coming down with this viral thing and it knocked me out completely

for

about a week. I am just now feeling like I am a human being again. So I am

hoping

that with this weekend of resting in bed it will get rid of it completely. I

did chuckle at

your comment about the hazards of growing things in the basement....I had an

incident with our local sheriffs department that was connected with that. A

purely

innocent misunderstanding between my brother, a stolen car and a safety check at

our home......It was quite funny actually! The two Wisconsin ladies that are

growing

fanatics on this board are in the southeast corner. I am a southwest of

Milwaukee - in

sod farm country (which is gettting too citified for my taste now though so we

are

thinking of heading into the northeast portion of Wyoming for our retirement -

near

Gillette or Buffalo). Well I hope that I am remembering your post right...if it

was a

different person from California who mentioned this topic...then I will chalk it

up to

fever fog.

As far as your pseudocysts....I do not have personal knowledge of them but I

have

read up quite a bit. I was going to offer you copies of the literature that I

have

downloaded but it seems that you are well read on all the controversies

surrounding

whether to treat or not treat. You are right that it is a symptom based decision

for the

most part, but I was under the impression that there are other features that

must be

considered too...such as duration, size, location, stability, etc. I have some

articles

downloaded in PDF or MS word format I think, and I have access to several

medical

databases (UpToDate, OVID, ons, Mercks, etc) and I can do a search for you

and send you the ones that I think are relevant (I would just need you to send

my

your complete email address so I can attach the files to the message for you. I

am

goutbuster @ yahoo. com - no spaces of course!). But my understanding is that

if a

pseudocyst is over 6 weeks old, is not diminishing in size over time or is

growing,

etc...that there is a recommendation that it be drained (there is always the

chance

that it could become infected or hemorrhagic, etc). However, as you know,

draining is

no guarantee that things will be ok either. The procedure is a risk, the cysts

could

return, the pancreas could be damaged. It is also worth investigating too if

there is

any chance that the cysts could be malignant. I know that there is great

concern

that pseudocysts could conceal a malignancy or be mis-read as a benign process

so

that may be another reason that you may want to be more aggressive too about

getting a second opinion, although in your case, I bet this is a very small

chance.

I agree that you need a second opinion from a surgeon concerning this. I have no

knowledge of physicians in your area however but hope that your PCP or GI person

will have a list of names that she recommends. I always wonder if there is a

way to

" shop " for a doc with a written letter of introduction before you actually go

through

with an appointment. I have wasted my time so much with seeing doctors who

never

look at your medical chart or any kind of history before they meet you for the

first

time and they end up not having a clue about why you are there and all of their

recomendations are spur of the moment and usually not specific to my situation.

This is why I have given up looking for any doctor who will treat me......I

cannot take

anymore unfriendly, uncommitted and unknowledgeable doctors who can't take the

time to read a patient's medical history before they meet to discuss treatment

options. In your case, I would think that the surgeon could discuss both of

your

surgical needs - the hernia as well as the pseudocyst...as they may be addressed

at

the same time if you decide to surgically manage both of them.....(?)

So basically this long post is really my attempt to ask you if you want me to

research this issue for you (pseudocyst treatment and management) and if so, sen

me your email address and I will see what I can find for you!

Laurie

(oh by the way...my impression with estimating sizes of things via imaging

studies is

that it is not an exact science and there is a big deviation between the

readers, the

examiners and the modality that is used as well as the patient position......It

seems

that your one pseudocyst at least is staying relatively stable (?) )

[Guest guest]

Yeah, Laurie, that was me commenting on you & 's basement gardens. I'm

not sure

what sod-farming is. In my roots area, the Fox River Valley, the top soil was 3

ft deep--

you threw out seeds and jumped back. Totally ruined me for gardening in Calif.

When

we've visited Wyoming, we found every other resident was an ex-Californian, so

be

prepared.

I did ask the surgeon about the MRCP report which said it didn't rule out

malignancy inside

cyst, because too much debris to see clearly. He said if he thought I had a

malignancy he

would have told me.

I do plan to ask my GP if he has any panc doc recos. I think most of the

patients in his

med group are in HMOs, so he's used to referring to specialists in same group as

my

surgeon. I have B/C PPO so can go elsewhere. It would be great if one could

get a

prospective doc to review one's medical record, but most are far too busy for

that.

I'll also ask about hiatal hernia, since the GI's and nurse I've asked don't

know if that's the

lump that sometimes pumps up and down & seem uncertain if hiatal hernia could be

located under lower left rib, just off center. Anyone out there know?

I'm pretty sure the reason needle aspiration is not being considered is because

MRCP &

CTs show heavy debris in my cysts which must be flushed out as part of the

procedure.

Surgeon won't do laproscopy but I don't know if that's because reports say my

cysts are

" complex " , or if its just his preference not to do that way.

I certainly would appreciate anything you can locate on pseudocyst surgical

drainage,

especially if it discusses surgery to do drainage into intestine so I could get

some idea

what my surgeon is proposing, since only info I've seen on that involved an ERCP

approach, and even then cysts wall had to be close to intestine, which I'm told

is not my

case. Email is kurtk@.... Heidi sent me a number of articles in Feb.

These

included:

Draining pseudocysts (Jan 26-28,2001 Symposium)

Panc Pseudocysts in 21st Century

Pseudocyst (9-20-02 Sawyer article from emedicine)

Panc pseudocysts (5-29-02 Lambiase fomr emedicine

???Long Term Outcome of Endosc Drainage - Jan 99

Acute Panc 1-27-01 (from PHOBIA newsgroup)????????

Mngment of Fluid Collections

Minimally invansive treatment of ap - F. Ricci 1997

Laproscopic Panc Cyst-gastrostomy - Quilici

so if any of those you need not duplicate those.

Thankyou, thank you, and I hope you are getting over that virus.

Kurt (CA)

..I vaguely remember you posting something to us when we were

> discussing the basement greenhouse .if it was a

> different person from California >

> As far as your pseudocysts... I have some articles

> downloaded in PDF or MS word format I think, and I have access to several

medical

> databases (UpToDate, OVID, ons, Mercks, etc) and I can do a search for

you

> and send you the ones that I think are relevant (I would just need you to send

my

> your complete email address so I can attach the files to the message for you.

I know that there is great concern

> that pseudocysts could conceal a malignancy ... I bet this is a very small

chance.

> hope that your PCP or GI person

> will have a list of names that she recommends.