Repeat Post: Amylase & Lipase Levels / Letter To ER

[Guest guest]

,

Here is the repeat post:

Steve,

You wrote, " .. the blood counts are no longer ever elevated with regard to

the Amylase and Lipase. The ER MD's no longer admit me because they say I

am

not " acute " . "

That is so unfortunate. I am sorry that you had to go through that. It

certainly makes me feels even worse when my sense of well-being is

determined by a

lab value vs a physical exam or subjective history. This happens all too

often, throughout the US, Canada, and other parts of the world.

What I learned shortly after being diagnosed, August 4, 1999, was this

issue

of elevated Lipase and Amylase levels and my ability to have my complaints

of pain taken seriously and receive adequately. There is excellent

documentation on the web which supports that enzyme levels cannot be

utilized to

determine the degree of chronic pancreatitis and exacerbation of painful

episodes.

One of the most respected lab values website on the Internet is

_http://www.labtestsonline.org/_ (http://www.labtestsonline.org/)

In regard to chronic pancreatitis, it states,

" ... Over time, the pancreas tissue becomes increasingly scarred and the

cells that produce digestive enzymes are destroyed, causing pancreatis

insuffiency (inability to produce enzymes and digest fats and proteins)...

Pain with

chronic pancreatitis may be severe and continual or intermittent. "

In regard to enzyme levels, it states,

" ....Amylase also may be monitored with chronic pancreatitis, it will often

be moderately elevated until the cells that produce it are destroyed. "

" ...As cells are destroyed with chronic pancreatitis and as lipase

production drops to less than 10% of the normal level, steatorrhea (fatty,

foul-smelling stools) will form. "

Educating ER physicians is difficult. First of all timing is short and

their

attention span doesn't avail them to spend lengthy time with you other than

delivering their exam and care (to say anything is not important). What the

PAI has done in Indianapolis is to take chronic pancreatitis handbooks to

the

local ER's to provide them with information they could read later.

Now, in lieu of this, what the PAI encourages you to do to ensure that your

needs are met when going to your ER is to:

1) Discuss this problem with your GI. Presuming your GI is a

pancreatologist, then we can assume that the GI will understand and agree

with the

situation. If they do not, then at this point find a pancreatologist who

understand

the facts quoted above.

2) Request a short letter of medical necessity briefly stating,

" Mr. Steve Ashton is a patient who has chronic pancreatitis,

diagnosed ___. Unfortunately, the disease has progress and the pancreas

tissue has

become increasingly scarred destroying the cells that produce digestive

enzymes, resulting in pancreatis insufficiency. Therefore, serum Amylase or

Lipase

levels no longer reflect absence or presence of exacerbation of episodes

chronic pancreatitis. Mr. Ashton has confirmed chronic pancreatitis and any

complaints of pancreatitis pain should be taken seriously and treated

appropriately. Please call me for any questions or concerns. "

3) Telephone your GI prior to leaving your home to go to the ER. Request

the GI to call ahead and notify them of your arrival and to telephone in

orders, primarily reminding the GI of the Amylase and Lipase routine.

4) Prior to leaving the ER, the ER should call the GI to request

permission to discharge you. If you are not free of pain and are leery of

being

discharged, request permission to talk to the GI and verbalize these fears

to the

GI.

5) If you are not on a long acting, slow release pain medication as

well

as having an excellent medication for breakthrough pain, request your GI to

request the ER doctor to write something until you can get into the office

to

see the GI. This is because, your GI cannot call in this level of

prescription, therefore a hard copy prescription needs to be handed to you

by the ER

doctor.

Hopefully these tools will be of help to you the next time you are in this

predicament. If you need any additional support, please let me know.

Karyn E. , RN

Executive Director, PAI

Indianapolis, Indiana