Re: SOD cause of periodic pain?

[Guest guest]

Hi Kurt,

Not sure if I can help you but I will try to explain my symptoms

that are related to SOD and biliary colic. A few months ago, we

had a survey type dialog on this subject and I think it ended up

demonstrating that the SOD with biliary colic has it's own set of

symptoms that are separate from but related to the daily pain of

chronic pancreatitis. I know in my case this it true as I went

almost a year without biliary colic while my CP pain increased.

Basically, in my opinion, the biliary colic is a result of a sudden

and probably a complete obstruction of the common bile duct.

This obstruction can be caused by spasms, stones, or masses

impinging on the common bile duct. I mention the masses

because of your history with pseudocysts. If the cyst is near the

common bile duct (which they often are) when it grows it can

compress the bile duct enough to give you symptoms of colic.

And it could be temporay if the cyst changes position or size. So,

it is conceivable, depending on where your cyst is, for that to give

you the symptoms that you are describing. In addition, just a

generalized inflammation of the pancreas can be enough to

compress the common bile duct. But this is all just speculation

on your situation. The common bile duct is basically surrounded

by the pancreas so anything that affects the pancreas can have

ramifications on the bile duct.

The SOD is a condition that some physicians think is a result of

nerve damage to the sphincter of Oddi, or mechanical damage

from scars or inflammation of the sphincter. The way to

diagnose it is to do ERCP with manometry in which they

measure you pressure in the ducts. If it is high, they can cut the

sphincter to create a bigger opening for bile and pancreas juice

to flow freely. The diagnosis is controversial - many physicians

do not believe that a poorly functioning sphincter can create the

pain that people report. I personally believe in it, based solely on

my experience. But I also realize that the " cure " is most likely

only temporary...that once you cut the duct, it seems to

snowball...that is, you have a chance of creating more scarring

which leads to more cutting which could eventually lead to

surgery. However, there really isn't any other option once the pain

from SOD becomes debilitating. Basically the biliary colic that

occurs is a result of the duct being virtually completely blocked.

In my case, it is a sudden, severe and unpredictable pain that is

about the worse that I have experienced. I like to describe it as a

massive heart attack of the abdomen because of the suddeness

and severity of the symptoms. It feels as if a semi truck has run

into my back, then drags me a few miles under its wheels. I

usually get very nauseous and may vomit. Sitting still or laying

down is virtually impossible - pacing seems to help. This will

last about two hours then it will gradually calm down. But the next

week or so I am very sore and achy and have little or no appetite.

I also notice that I will either have dark urine (cola colored) or

pale, colorless stools - both of these are signs of a blocked duct.

This usually only lasts a day, because the blockage is

temporary. When I run my labs after an attack I will usually have

elevated liver function tests, which are very common with

blockage. The best way to think of this, as far as pain levels, is

to equate it with kidney stones that block the flow of urine. Most

people can relate to that kind of pain and it is of the same type: it

is called renal colic.

I hope this helps a little in your case. Your symptoms are similar

to mine other than I usually do not have left sided pain or lower

abdominal pain. Mine is epigastric radiating to the RUQ and has

a rubber band like squeezing feeling around the lower rib cage.

However, with pancreas problems, there is no set rule for pain -

everyone is different. I had my sphincter of Oddie cut early Sept

2003 and it kept me colic free until November of 2004. During

that interlude I only had to deal with my CP pain.....but now the

colic is back, which I understand is not that uncommon with this

type of things. Although it has been reported that many people

who have this done are colic free for years and sometimes even

forever. It sure wouldn't hurt for you to explore this possibility with

your doctors.

Laurie