Questions to ask GI

[Guest guest]

Hi Group!

I have an appt with my GI on Weds. I would like to sound half way

intellegent when I talk to him. So, I would like some help with

questions I should ask. RE: Results of CT scan, results of pseudocyst

aspiration, blood work, whats next? (what Ive had so far & any I should

have)I'm still not real sure of my diagnosis. He eluded to CP last time

I was in but?

I would appreciate any help.

Thanks,

Rhonda

[Guest guest]

Hi Rhonda,

I am not too familiar with your history so if I make some

assumptions or ignore something that is specific for your

condition please bear with me.

The questions that I would ask concerning your CT scan are

based on what the condition of your pancreas is by this modality.

If he says that the CT looks " normal " then I would question him

about doing more specific imaging tests like the MRCP or even

the ERCP. If the CT comes back abnormal, I would make sure

he gives you an indepth explanation about what is abnormal,

what that specifically means to you, what follow-up he will do to

monitor and treat your condition, how often you should have

repeat CTs (if any) and how likely it is that the CT is protraying

the condition of your pancreas acurately (that is, is it missing

other things? and if so, is an ERCP, EUS or MRCP warranted to

get a better picture of your pancreas). In addition, if there is an

abnormality detected, you need to find out if it is something that

can be corrected by an ERCP or even surgery or needs to be just

left alone.

The pseudocyst aspiration....I am assuming that it was

submitted for histology / cytology analysis which would indicate

benign or malignant components......if it was truly a pseudocyst

and not a cystic lesion then this report will probably come back

with the typical findings of inflammatory cells and non-specific

debris. If however there are malignant components to it (which

is rare in a pseudocyst I think) then you need to discuss all the

implications of that. Treatment, prognosis, etc....But I wouldn't

worry too much about this as at the time of the aspiration, they

would have had a suspicion that things were not looking good.

My understanding is that a solid lesion or csytic lesion vs a

pseudocyst is pretty well known at the time of aspiration for the

most part. I guess you just need to know how likely it is to recur,

which I do not think can be too acurately predicted. I guess the

question will be if it does come back, then what? Surgery,

stents, .....????

As far as blood tests.......I guess it depends on what they are and

what they found. Any abnormality detected should be followed up

so do not let him gloss over any. Make sure you have an answer

to the question: when should I have these repeated? If they are

normal, you probably still need to ask this question, especially if

you are still having symptoms. Remember that amylase and

lipase do not have to be elevated for him to make a diagnosis of

CP, so if these are normal, do not let him rule out CP based on

these labs alone. I am not sure what specific types of labs

should be ordered to follow the health of the pancreas. Diabetes

profiles? Liver enzymes? nutritional status? electrolytes? WBC

&diffs?

I would also keep in mind that there is convincing published

literature that states that early stages of CP are almost always

undetectable by imaging, blood tests and physical exams.

Some researchers report that signs will appear after four years

or so....others state that it can take up to ten years. So, on this

basis, if all of your tests come back normal, I would try to pin

down your GI on the fact that you want to be periodically

followed....that you want blood work and imaging studies done

every so often (whatever timeframe that you both agree on) and

that you want a firm understanding with him that if things get

worse, that you expect aggressive and timely intervention. I

would not accept a " everything looks fine, call me if you have any

trouble in the future " attitude. That is a brush-off and makes you

feel like you have been left out in the cold with no help.

The fact that you have had a pseudocyst aspirated means that

he will most likely be taking your case very seriously. I think that I

would make sure that all of the issues surrounding the cause,

treatment and recurrence of it are covered thoroughly. And that

you and the doctor have a clear understanding of what you

expect from him, and what he expects from you (that is, what

symptoms should be followed up on, etc...)

Not sure if this is the type of information that you are looking for,

but these are all things that I have tried to pin down with my

doctors. I hope you are more successful with this than I have

been!

Laurie