Lipase is elevated - should I be in the hospital?

[Guest guest]

Now, for the rest of my story. I had done well pain/nausea wise on both

Christmas Eve day, Wed., and Christmas Day, Thurs. I steered clear of meat

and ate very light. Thought I had finally found the secret to staying away

from the ER. I should have known that sometimes there is no secret and it

just doesn't matter what you do or do not eat. When you have cp, you are

sometimes going to have bad attacks no matter what you do. I was in bed and

almost asleep when the pain hit around midnight. I barely made it to the

bathroom before throwing up. This was a 10+ attack and I was in so much

pain I could barely move. Bud had just fallen sound asleep and was in a

deep sleep. I called his name over and over (from the foot of our bet) and

he didn't move a muscle. I finally had to make my way to the bed so I could

touch him to wake him up. After throwing up a few times, I managed to get

zofran and oxycodone down with a sip of water. After laying curled in a

ball on the bed for a few minutes the pain improved for just a bit.

However, just a few minutes later, it was back to a 10+, so the ER was

calling me! We tried to go to the local hospital (5 minutes away) but found

out the ER doc I'll filed a complaint against was there and I just said,

" Never mind. We'll go to Crestwood in Huntsville. " We made the 45-60

minute treck with me in misery. They got me in immediately and it wasn't

that long til the doc had the nurse give me a shot of dilaudid and

phenergan. She accessed my port a cath, drew the blood, and then started an

IV at 400 cc/hour. She had done the blood pressure test to see if I was

dehydrated and probably was because of the drastic drop in my blood pressure

standing vs sitting. It didn't take long for the shot to kick in and I fell

asleep since it's about 3 a.m. at this time. Around 5 the doctor came in

and told me he was letting me go. I assumed all my labs were okay and I was

much better, so going home sounded good to me. I asked if he would give me

one more dose of med for pain and nausea before I left so I could get a few

hours sleep before needing to take oral meds. They gave me another shot of

dilaudid/phenergan. The nurse told me he wanted it given IM vs IV because

it would last longer. No problem and the pain that was at about a 5 was

quickly down to a 2 (about as good as gets for me). I was ready to go and

asked for a copy of my labs. They were not horrible, but they were not

normal either. My lipase was elevated to 665, one liver enzyme, AST, was

110 (almost 4 times normal), total protein, globulin, RBC, HGB, and HCT were

all low. When I saw that, I told the ER doc, he should call my internal med

doc because even though I was much better at that point, that from past

experience, if my lipase was elevated, as soon as the shot wore off and I

even began clear liquids, I'd be back at the ER. The ER doc said, " but you

said you were feeling better " . I told him I was but I just didn't want to

have to come back a few hours later. I could tell he wasn't happy (but he

was nice enough) but he said he called my internal med doc and the internist

said that since i was feeling better we shouldn't go by the numbers, we

should go by my symptoms and since I was better I should try to make it at

home. I agreed that I would give it my best shot at home. They told me if

I got worse again to come back.

I decided I will do nothing but clear liquids for the next day or two and

see if I can manage with just my oral meds. I am scheduled to have another

celiac plexus block on Monday. The hope is that even though the first one

didn't really do much to help, the second one will do more.

I called both my internist's office and my GI/Hep's office and both offices

are closed today. It ends up that my GI/Hep is the one on call for his

group this weekend. I asked the answering service to have him call me so I

can tell him what's going on. It was 9 a.m. when I called the answering

service and I haven't heard from him yet. I am hoping that if I do get

worse, he will do a direct admit and not make me go back through the ER.

I was given the shot of dilaudid/phenergan at about 5:30 a.m. and it is

wearing off, but it lasted longer than I expected. I've had only ice chips

and a popsicle, but they've stayed down. I went ahead and took my morning

meds when we got home at about 7 a.m. The meds included MS Contin 30 mg and

phenergan 25 mg tablet. I am allowed 3 MS Contin daily and also 4 oxycodone

5 mg per day. I'm going to take an oxycodone and another phenergan tablet

in hopes of keeping the pain/nausea at bay.

My last two hospitalizations, my amylase and lipase were normal. That's

when both the GI and internist told me that since I have CP, my enzymes may

never elevate again so we have to just go by symptoms. My amylase has not

been above normal since Oct 2002. My lipase has not been elevated since

August 2003. Since Oct 02, my amylase has been almost dead center normal at

around 45-55. This time it was 73, not above normal but higher than it has

been in over a year.

I don't know if I'm over reacting, but from past experience, I really feel

that since my lipase is elevated, I probably need to be on IVs and NPO for

at least a day or so. Hopefully I am wrong and I'll manage fine with my

clear liquids and oral meds.

Just wanted to get an opinion from the group.

thanks,

[Guest guest]

<snipped>

>I was ready to go and

> asked for a copy of my labs. They were not horrible, but they were

not

> normal either. My lipase was elevated to 665, one liver enzyme,

AST, was

> 110 (almost 4 times normal), total protein, globulin, RBC, HGB, and

HCT were

> all low. When I saw that, I told the ER doc, he should call my

internal med

> doc because even though I was much better at that point, that from

past

> experience, if my lipase was elevated, as soon as the shot wore off

and I

> even began clear liquids, I'd be back at the ER. The ER doc

said, " but you

> said you were feeling better " . I told him I was but I just didn't

want to

> have to come back a few hours later. I could tell he wasn't happy

(but he

> was nice enough) but he said he called my internal med doc and the

internist

> said that since i was feeling better we shouldn't go by the

numbers, we

> should go by my symptoms and since I was better I should try to

make it at

> home. I agreed that I would give it my best shot at home. They

told me if

> I got worse again to come back.

I know my GI, depending on the situation, will go by the symptoms the

patient is experiencing instead of blood work. I can have symptoms,

but my labs are normal, so I may be admitted. There have been a few

times where I've not had much pain, nausea and vomiting, but my labs

were up, so I stayed home.

I've been dealing with my Lipase being between 300- " greater than 400 "

for a couple of months now. I was in the hospital for five weeks

(Oct/Nov), and it stayed up there...still is as of a week or so ago.

Took over four weeks for the Amylase to come down!

>

> I decided I will do nothing but clear liquids for the next day or

two and

> see if I can manage with just my oral meds. I am scheduled to have

another

> celiac plexus block on Monday. The hope is that even though the

first one

> didn't really do much to help, the second one will do more.

One thing my doc has told me for years is, " No broth, no jello. "

There is a protein in both that makes the pancreas work harder. So,

do the ice chips, apple juice, popsicles, italian ice, that type of

thing. When I've told others about the " rule " my doc has, it dawned

on them that each time they would have either of those things during

an attack at home (they were trying to manage at home instead of the

hospital), it made things worse. Heck, I may be having a pretty good

day (rare), and decide I am in the mood for jello, and end up with

more pain from eating jello! So, I only eat it on a rare basis.

>

> I called both my internist's office and my GI/Hep's office and both

offices

> are closed today. It ends up that my GI/Hep is the one on call for

his

> group this weekend. I asked the answering service to have him call

me so I

> can tell him what's going on. It was 9 a.m. when I called the

answering

> service and I haven't heard from him yet. I am hoping that if I do

get

> worse, he will do a direct admit and not make me go back through

the ER.

I hope you were able to stay home.

>

> I was given the shot of dilaudid/phenergan at about 5:30 a.m. and

it is

> wearing off, but it lasted longer than I expected. I've had only

ice chips

> and a popsicle, but they've stayed down.

Great!!!!!

>I went ahead and took my morning

> meds when we got home at about 7 a.m. The meds included MS Contin

30 mg and

> phenergan 25 mg tablet. I am allowed 3 MS Contin daily and also 4

oxycodone

> 5 mg per day. I'm going to take an oxycodone and another phenergan

tablet

> in hopes of keeping the pain/nausea at bay.

Since you have a port, can you talk to your MD about giving you a few

doses of IV Phenergan when needed?? My GI does this for me for when

the oral meds don't work, or I can't keep them down (doesn't happen

often though as I use Zofran ODT). It will also help the pain meds

work a bit better, and keeps me out of the ER.

>

> My last two hospitalizations, my amylase and lipase were normal.

That's

> when both the GI and internist told me that since I have CP, my

enzymes may

> never elevate again so we have to just go by symptoms. My amylase

has not

> been above normal since Oct 2002. My lipase has not been elevated

since

> August 2003. Since Oct 02, my amylase has been almost dead center

normal at

> around 45-55. This time it was 73, not above normal but higher

than it has

> been in over a year.

It was 73 today? As long as it is still within the normal range, it

is still normal, even if it is higher than what you usually have.

Still doesn't mean you weren't having an attack though. I can

usually tell from the pain if it is an attack or not...most of us can

at this point.

>

> I don't know if I'm over reacting, but from past experience, I

really feel

> that since my lipase is elevated, I probably need to be on IVs and

NPO for

> at least a day or so. Hopefully I am wrong and I'll manage fine

with my

> clear liquids and oral meds.

You know your body better than anyone else!

>

> Just wanted to get an opinion from the group.

Hope this has helped. Email me privately, if you would

like...robinmk02 @ aol.com (remove spaces).

Robin