Pain in the Absence of Elevated Labs - Rhonda

[Guest guest]

Hi Rhonda

Here is my contribution to the discussion. This is information taken from a

database

that was created by doctors to be used by doctors in making clinical decisions.

It is

called UpToDate. This is what it has to say about CP and elevated (or lack of)

pancreatic enzymes:

" Laboratory studies -

•Serum concentrations of amylase and lipase may be slightly elevated in patients

with chronic pancreatitis, but are more commonly normal for the following

reasons:

•Chronic pancreatitis is a patchy, focal disease, leading to a minimal increase

in

pancreatic enzymes within the blood.

•There is frequently significant fibrosis (show histology 1), resulting in

decreased

concentrations of these enzymes within the pancreas.

•The absolute serum concentrations of amylase and lipase have no prognostic

significance. "

Basically what this is saying is that in chronic pancreatitis, as opposed to

acute

pancreatitis, that the inflammation is occuring in smaller areas so that there

is not

enough released into the blood circulation to cause a measurable elevation in

the

values. In acute pancreatitis, the whole organ is inflammed and thus the

" leakage " of

enzymes into the circulatory system is significant and causes measurable

elevations. In addition, because of the ongoing destructive nature that defines

chronicity, the cells that are being attacked have lost their ability to produce

the

enzymes so as they are broken down, there is no enzymes to be leaked into the

system. So these two mechanisms that are found in the chronic condition

contribute

to the less than impressive effect on pancreatic enzyme elevations. Think of it

as

using a soaker hose as opposed to an outright sprinkler system. The soaker hose

has low volume, low pressure release of water so it stays in the immediate area

-

there is little or no run-off and it is soaked up by the roots of the plants in

the local

area therefore it is not easily detected that water is being released. But the

large

scale sprinkler system broadcasts water over a wider area - more volume, higher

pressure, so there is considerable run-off that is " detectable " by observing the

water

flow in the street or ditch (analogous to the blood circulation). Kind of a weak

analogy

but I thought that this may make more sense.

Now, how to communicate that to your doctor? It depends on how receptive he /

she

is to learning things from his patients. If he is open to discussion I would

direct him

to the database " UpToDate " most big medical centers are subscribers to this (as

well as private practice physicians). Or if you would like, I can send you the

information that I downloaded from that database and you could send it to him

for

future discussion. Otherwise, if he is the type that insists that the doctor

knows best

and the patient is just there tolisten, then I do not think you will be

successful in

educating him. Just my opinion..........

Laurie

[Guest guest]

Rhonda,

I just thought I might add to the discusion with my own personal

experience. One of the reason I had to suffer so long prior to my

getting an adequate diagnosis of my Pancreas Divisum was due to the

fact that my Serum Amalayse/Lipase were never elevated. However,

when once they did go in and perform my initial surgery on my

pancreas, it was found that I only had one functioning pancreatic

duct, while the other duct was so small they couldn't even find it in

any of the many ERCP's I had previously. The one duct that they were

able to locate was " smaller than the tear duct of an infant " ,

according to my surgeon. He said he had never seen such a severe

case of Pancreas Divisum before, yet it still took over 20 yrs for me

to finally get a proper diagnosis! hang in there. If you have to

continually cahnge doctors to get a statisfactory answer to your

health problems, than by all means do so if possible. There is

absolutely no reason for you to have to justify to any doctor why you

are in such pain and discomfort. It is their job to determine the

problem, not to downplay it. It has been my experience that, once I

was able to find a " good " doctor, that was when the problems of

trying to convicnce others that I truly had something wrong that was

causing me inmeasurable pain. While I am not recommending sugery to

determine the extent of your problems, sometimes all of the tests

they have currently still doesn't do an adequate job of isolating the

problem.

Andre'

>

> Hi Rhonda

>

> Here is my contribution to the discussion. This is information

taken from a database

> that was created by doctors to be used by doctors in making

clinical decisions. It is

> called UpToDate. This is what it has to say about CP and elevated

(or lack of)

> pancreatic enzymes:

>

> " Laboratory studies -

> •Serum concentrations of amylase and lipase may be slightly

elevated in patients

> with chronic pancreatitis, but are more commonly normal for the

following reasons:

>

> •Chronic pancreatitis is a patchy, focal disease, leading to a

minimal increase in

> pancreatic enzymes within the blood.

>

> •There is frequently significant fibrosis (show histology 1),

resulting in decreased

> concentrations of these enzymes within the pancreas.

>

> •The absolute serum concentrations of amylase and lipase have no

prognostic

> significance. "

>

> Basically what this is saying is that in chronic pancreatitis, as

opposed to acute

> pancreatitis, that the inflammation is occuring in smaller areas so

that there is not

> enough released into the blood circulation to cause a measurable

elevation in the

> values. In acute pancreatitis, the whole organ is inflammed and

thus the " leakage " of

> enzymes into the circulatory system is significant and causes

measurable

> elevations. In addition, because of the ongoing destructive nature

that defines

> chronicity, the cells that are being attacked have lost their

ability to produce the

> enzymes so as they are broken down, there is no enzymes to be

leaked into the

> system. So these two mechanisms that are found in the chronic

condition contribute

> to the less than impressive effect on pancreatic enzyme

elevations. Think of it as

> using a soaker hose as opposed to an outright sprinkler system. The

soaker hose

> has low volume, low pressure release of water so it stays in the

immediate area -

> there is little or no run-off and it is soaked up by the roots of

the plants in the local

> area therefore it is not easily detected that water is being

released. But the large

> scale sprinkler system broadcasts water over a wider area - more

volume, higher

> pressure, so there is considerable run-off that is " detectable " by

observing the water

> flow in the street or ditch (analogous to the blood circulation).

Kind of a weak analogy

> but I thought that this may make more sense.

>

> Now, how to communicate that to your doctor? It depends on how

receptive he / she

> is to learning things from his patients. If he is open to

discussion I would direct him

> to the database " UpToDate " most big medical centers are subscribers

to this (as

> well as private practice physicians). Or if you would like, I can

send you the

> information that I downloaded from that database and you could send

it to him for

> future discussion. Otherwise, if he is the type that insists that

the doctor knows best

> and the patient is just there tolisten, then I do not think you

will be successful in

> educating him. Just my opinion..........

>

>

> Laurie