Question about Lipase and Amylase Levels

[Guest guest]

Sam,

You wrote, " Is it true that if your levels are not elevated, you can still

be having an acute attack of pancreatitis. ... Why do the doctors run this

test if it does not matter how high or low your levels are? If it is not a

determining factor in diagnosis pancreatitis, why do they even run the test? "

Kimber addressed the issue of pancreatic burn out and the inability to

produce pancreatic enzymes. When this topic came up a few months ago, someone

else

brought up another important point. It is the other end of the spectrum from

complete burn out. It may be that the pancreatitis only affects a small area

of the pancreatic tissue; it is significant enough to cause pancreatitis,

but not enough to cause elevation of pancreatic enzymes. I wish I could find

the reference where that was obtained, as it was explained much better.

The reason why the (ER) doctors use pancreatic enzyme levels (lipase and

amylase) as the diagnostic measure is purely the absence of any other objective

tool. Current medical school textbooks still have the ‘old’ school of

thought that the “gold†standard of diagnosing pancreatitis is an elevated

enzyme

level. This may in fact be a measurement tool for acute pancreatitis. Chronic

pancreatitis is a different disease process, one that is commonly not

followed in acute care. Therefore, this is not often seen by residents.

Aside from the enzyme levels, the remaining option for the ER doctor is the

subjective complaints of pain by the patient. Just as the enzyme levels are

" gold standards " , there are also, " classical " signs of pancreatic pain, such

as mid sternal pressure pain and sharp radiating pain to the left. As we know,

pain can differ with as many people there are here. I quickly learned that

if my pain did not reflect this " classical " complaint as indicated in the

medical textbooks, then sharing where the pain really was often brought about

looks by the doctors that they did not believe it was really pancreatitis. I

once heard someone say, " If she is going to fake pancreatitis, she should at

least get the pain right. " Whenever I complain of back pain, they want to work

me up for a kidney infection.

There are, of course, diagnostic tools such as the CT scan, MRCP, ERCP, and

Endoscopic US that will often indicate pancreatic damage without

corresponding elevation in enzyme levels. These, however, are not available to

the ER

doctors and few patients carry results with them. The PAI does recommend that

these are included in the patient H&P that are always kept up to date by the

patient. In lieu of copies of results from these tests, the PAI recommends that

the patient carry a letter from their pancreatologist stating that they have

chronic pancreatitis, and that their enzyme levels will most likely not

result in elevation, even during the period of a “flare-Up†or

“attackâ€.

Karyn E. , RN

Executive Director, PAI

_www.pancassociation.org_ (http://www.pancassociation.org/)

[Guest guest]

Thank you for the insight. It is good to know that we have the same problems as

everyone else. I think it is really a shame that Doctors especially ER doctors

are not more educated on this disease! Next time we have to go to the ER, I

will bring with me all of his pain medication, which he could of course take and

overdose, but of course he choose not to do that.

Thanks again.

Sam

jethrotullvermont wrote:

---------------------------------

[Guest guest]

Karyn:

Wow, Thanks for the information. I am definately going to get a letter from

Brock's doctor, stating that he has pancreatitis and that he has had a Frey

Procedure. Maybe then they will get it through their heads that he really does

have pancreatitis and his levels will not register!

Do you take any enzymes? If so, do you feel that they help. Right now Brock is

not taking any enzymes and I really want him to, but he refuses to do so. He

has not seen his Gastroenterologist for quit sometime. I think that he thought

since he was doing so well for about two months that he was " cured. " I now

understand that this will more than likely never go away.

Thanks for the information.

Sam

KarynWms@... wrote:

__________________________________________________

[Guest guest]

Kimber: Yes Brock does see a Pain Management Doctor. He was doing really well

for about two months, he gained weight and was taking minimal amounts of the

Roxicodone that his pain management doctor prescribed. Then his Lipase rose to

about 800 and the doctor's were very hesitant to admit him. They said " Most

people can tolerate this level at home without the need for intravenious drugs. "

They admitted him anyway. He was there for about 4 days, came home on Saturday,

went back to the ER on Sunday and Monday and was admitted last night. I think

that they released him to early, and that he probably should have stayed longer.

The reason I said I was worried that he was drug seeking was because he is now

claiming that the Roxicodone is no longer working for him. He started saying

this the day he got home from the hospital (Saturday). I just could not

understand why after all this time it worked great for him and the second he

gets admitted into the hospital and receives intravenious drugs the pancreatitis

flares up. I have also noticed that if he does not get enough sleep or has

several nights of restlessness, he goes to the ER. Sometimes, I think that he

does this just to help him sleep after so many nights of not sleeping. I think

that he has been on ambien and valum for so long that it no longer is working

for him. They started him on a new anxiety medication called Soma, so maybe

this will work for awhile for him.

You said that your pancrease has reached total burn out. Does this mean that

you are Diabetic? We have never been told that his pancrease has reached burn

out. His blood sugars are always normal, which I thought was an indicator that

your pancrease was functioning.

Also do you take any enzymes? Brock does not take any at this time. I don't

think that he has taken enzymes for at least 2 years. I really want him to take

them so that it will aid in digestion, but he won't do it. He has not seen his

Gastroenterologist for quit a while. I think that we need to get an appointment

with him ASAP, and talk about the enzymes and also test how well his pancrease

is functioning.

Thanks for the information and advice.

Sam

Kimber wrote:

__________________________________________________

[Guest guest]

Hi Sam,

Your question as specifically applying to Brock is hard to answer

with any certainty. It is accepted by most knowledgeable

pancreas specialists that chronic pancreatitis, no matter the

cause, can have debilitating flares of pain and nausea without

elevations in pancreas enzymes. So I would think that in Brock's

case, yes it is possible to have sudden and extremely painful

" attacks " needing medical care However, if the enzymes do not

elevate, then by strict medical textbook definition, he is not having

an attack of acute pancreatitis. In cases of known chronic

pancreatitis the designation is usually an acute flare of chronic

pancreatitis. If the enzymes were to elevate, even in known

cases of chronic pancreatitis, then it would be diagnosed as

" acute pancreatitis " regardless of his history of chronic

pancreatitis.

So I guess, the answer is No, elevated enzymes as the indicator

of his need for medical care is not reliable. People with chronic

pancreatitis can be very ill and in a lot of distress with pain and

nausea and have normal levels of pancreas enzymes.

Laurie

[Guest guest]

Sam wrote:

" Next time we have to go to the ER, I will bring with me all of his

pain medication, which he could of course take and overdose, but of

course he choose not to do that. "

EXACTLY. I have gone to the ER with pain flare ups and if I was

prescribed pain medicine that was ineffective at the prescribed dose I

believed I needed to be in a safe place with proper medical

supervision and treatment. And yet when you tell some doctors, I have

a prescription for say 10 mgs. of oxycodone every 4 hours if needed

but that 10 mgs. did not resolve, they seem to feel like you should

just self medicate. Well if I self medicate I am taking a big risk

right? I mean that is how one ends up abusing pain meds. And when one

needs the stronger stuff they also need to be in place where they can

be coded if something happens. It is very unlikely but you never know

that larger dose might be too much and slow your breathing down

dangerously. That is why we turn to physicians to assist us with our

pain issues. Otherwise just let me write my own scripts and take care

of myself. Heh...Some docs, eh?

[Guest guest]

" Basically, by definition, you cannot have " acute " pancreatitis

without elevated pancreas enzymes (amylase and lipase).

However...this does not mean you cannot have an acute flare of

chronic pancreatitis with normal levels. "

Hi Laurie,

I'm a little late on this thread (I get behind on posts quite often), but I

wanted to thank you for your very informative post. I had been about to ask

this same question. I had a mild flare-up a couple of weeks ago (my first since

being diagnosed last Sept)...at least I'm guessing that's what it was. I had

upper abdominal pain, but it didn't radiate in either direction and I had no

nausea or vomiting. It did get worse after a couple of days, even when I

started taking the Creon again w/ my meals. I stopped eating and went to a

liquid diet for about a week and gradually started to feel better. When I had

my blood checked (after I had started to feel better), they said my enzyme

levels were normal. They also suggested I have an ultrasound, but since the

enzymes were normal and I've been feeling better, I haven't gone. I was pretty

confused though, and your explanation makes so much sense to me. I know it's

not that my pancreas has stopped functioning, but maybe the

inflammation was localized and didn't cause the damage that elevated my enzymes

the first time. I know I didn't let the pain get as bad this time..it was

really more discomfort than pain.

This has all been so confusing, especially since I don't present with " classic "

symptoms (as I was told by the nurse practitioner at my gastro-enterologist's

office). Thank you for helping me understand what's going on a bit better.

Falsone

annapolis, md

__________________________________________________

[Guest guest]

Sam,

I'm sorry it took so long for me to answer this, but I was out of town

for memorial day weekend and didn't get back till the Tuesday after

that. Then I forgot my thyroid meds and so I was asleep for about two or

three days and then once I started back on it, my pancreas decided to

join in on the fun and I've been in bad shape until today.

Anyways....

Thanks for explaining why you though Brock may be drug seeking, though

it could just be that his pancreas is more damaged after each flare and

so his normal dosage is not working anymore. I've had this happen about

half the time I've had a major flare up (hospitalization). As for his

sleeping, there is a new non-opiod sleep medication on the mareket

called Lunesta that he may want to try. It's also the first sleep aid

approved for long term use, so it might help him better than what he

taking now. He should at least ask his doctor about it (if you can get

him to see the doctor).

Regarding Burnout:

yes, I am diabetic, though I've been diabetic since before I was

diagnosed with pancreatitis. (they think I had attacks when I was three

and four, so I had a lot of damage early on, only they didn't test for

pancreatitis). I have pancreatitits because of a birth defect, so the

damage has been going on since I was born, basically. Usually people

become diabetic when they hit burn out, but I'm not sure that it is a

guarantee that it happens at the same time. The doctor could probably

better explain the differences of endocrine and exocrine functions of

the pancreas.

Yes, I take enzymes. I take Viokase 8 and ranitidine with it. The

combination of a non-enteric coated enzyme and an acid reducer not only

helps with diagestion, but can also help cut down on pain in some

patients. Viokase 8 is a non-enteric coated enzyme. Creon is an enteric

coated enzymes and doesn't need an acid reducer, but only helps with

digestion. Yes, it definitely seems that Brock should see his

gastroenterologist sometime soon to talk about enzymes and pancreas

function.

Again, sorry I didn't get back to you earlier.

Kimber

--

Kimber

Vallejo, CA

hominid2@...

Note: All advice given is personal opinion, not equal to that of a licensed

physician or health care professional.