decisions - need counsel

[Guest guest]

Greetings!

My last ERCP (#2) was in July - and they cut the sphinkter of

Oddi - I did have the complication of Pancreatitis and I had a

horrible hospitalization and was in the hospital for 8 days. I

only had relief for a little while and then pain returned and

increased over time. About a week ago I went to clear liquids only

and my pain subsided some, and I'm starting to slowly reintroduce

food again, and my pain is returning. Yesterday I saw Dr. Catalano

and he's suggesting another ERCP. I'm trying to make a good

decision. I don't want to cause my pancreas more problems, and at

the same time I don't want the problems I had last time, and

honestly I don't really know how to access the risks. He wants to

do the surgery next week, and I have to let them know by Friday.

Anybody have any thoughts? Please email me -

on_the_move4ever@...

Rick Nickles

[Guest guest]

Hi Rick,

Well first of all I am a little confused by your post. If you are being

advised to have surgery by Dr Catalano, I would absolutely seek

a second opinion before going that route. Surgery is a serious

undertaking with some risk. You need to be sure that you are at

that stage first...that no other less invasive option is available.

However, if you are still looking at the ERCP route, then you have

a little room for making decisions. Stenting is less risky than

surgery and can leave you with more options down the road if

things get bad again. In my opinion, though, if you are able to

seek another opinion outside of the state, I would advise that you

do this. But, if you feel confident and comfortable with Dr

Catalano and St Luke's Hospital and you feel that you have no

other option as far as insurance is concerned, then you should

do ok as long as you are firm over what you expect out of him

and force him to communicate with you and to not push you out

the door too soon.

My experience with him was not very good and I just learned that

St Lukes isn't all that it is cracked up to be either. When picking

up my radiology films from them from last week (my three

ERCPs done by Dr Catalano), I found out that they stamped my

films with someone else's name. Not Dr Catalano, the radiology

tech in the room nor the radilogist who dictated the report caught

that the name on the film didn't match the name of the patient. My

confidence in the system there has been shaken and I have a

hard time recommending them to anyone. However, if you know

ahead of time that things happen like this, and are able to

forcefully advocate for yourself, you may be able to prevent this

kind of mix-ups (and to give them credit, the radiology supervisor

was very apologetic).

Ideally, if you can afford to go out of state and you can wait two

weeks to get an appointment I recommend that you consider

going to Indianapolis to see Dr Lehman. I am seeing him in a

couple of weeks and another former Catalano / St Luke's patient

also sees him and she is absolutely convinced that there is no

comparison between the two systems. I have yet to experience

the Dr Lehman touch but everything that I have heard about him

makes me believe that he may be the perfect match for you too.

Now, as far as the stenting procedure goes....if he is stenting

your common bile duct you should get through that with

minimum risk for pancreatitis. If he is stenting your pancreas

duct, then the risk for pancreatitis goes up. Depending on how

difficult it is to insert the stent into the pancreas duct will

determine how likely it will be that you get pancreatitis. The fact

that you have a history of post-ERCP pancreatitis also increases

your risk. However, because he knows this, there are things that

he can do to reduce your risks - techniques and meds that he

can give you. So, you need to find out exactly what procedure he

intends to do...if he is going to do EUS too as well as imaging

the pancreas. Will he cut the sphincter going into the major duct?

Will he dilate the duct with the balloon? Will he insert a

temporary stent or one that needs to be removed in 8 weeks? All

of those things will help you figure out how risky your procedure

may be. With me, out of 4 ERCPs I had post - ERCPpancreatitis

2 times and both times it was when he did cuts or dilation.

Simply inserting the stent or just looking at the biliary tract and

not the pancreas didn't cause any complications. There is no

guarantees but this can be a guideline for you. Usually, biliary

stenting is alot easier than pancreatic...and stenting alone can

be less risky than sphincterotomy or dilation or injecting dye into

the pancreas ducts.

Laurie