Comprehensive Care Plan Team

[Guest guest]

,

You wrote, " I have gone through 100 per month. I am just wondering if it is

time for me to see a pain management doc. I am concerned too about my liver

enzymes as they are elevated. Can gallbladder probs. cause liver enzymes to

be elevated? "

The PAI advocates that anyone with pancreatitis have a comprehensive care

plan team as possible. That is even before you actually have a problem. For

instance, even if you see the specialist once a year, everyone should have made

contact with an endocrinologist, therapist, and Pain Management Specialist. It

is important for them to know you before you are terribly ill. That way they

will know your norm. They will also be more willing, particularly, the Pain

Management Specialist to prescribe narcotics as required to get you

comfortable.

Another reason it is good to put together a comprehensive care plan team

early in your disease process is to have the time and energy to 'tweak' it as

necessary. For instance, it may be that you thought you were making a good

decision on who to consult or ask to be on your team, b ut after meeting with

them, you find they are extremely conservative, or basically have different

philosophies on the care and maintenance of pancreatitis, pain, diabetes,

depression, surgery, etc. You may just not like them. It would be important to

change that discipline now, before you actually need their input. The thought of

being on a gurney at the mercy of someone that does not share my medial

philosophy is scary.

In your particular case, if you are requiring this much Tylenol w/codiene or

Vicodin, then it would be recommended to substitute a medication that does

not contain Tylenol, as you are aware of the liver implications of consuming

excessive Tylenol. The fact that you have elevated liver enzymes at this time,

might be a concern, regardless of whether the liver enzyme elevations are

caused by the Tylenol or other factors. When the gallbladder is inflamed it is

common to have subsequent elevated liver enzymes, since both the liver and

gallbladder are within the biliary system. Taking Tylenol complicates the

doctor's ability to rule out the exact cause for the liver enzyme elevations. By

discontinuing all medications that contain Tylenol, that can be ruled out and

the doctor could evaluate other causative factors.

The other thing is that you did not mention is if you are taking a long

acting narcotic. Short acting narcotics are used for breakthrough pain. It seems

that you are most likely taking your medication around the clock in an attempt

to control your pain. Controlling your pain in this manner is difficult as

you never really get a handle on the pain before the medication effect wears

off. Additionally, taking a medication that only last three or four hours is

certain to disrupt your sleep pattern. With pain probably waking you in the

middle of the night, you never get a prolonged period of deep sleep. This is

necessary for many of the bodies processes. It is much more effective to manage

your pain with a long acting, slow release, narcotic as opposed to chasing

your pain with short acting medications.

Karyn E. , RN

Executive Director, PAI

Indianapolis, Indiana