Is this Chronic Pancreatitis? 10 years later

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In 2007 and was flying from a business trip and had several shots of whiskey.  I fell asleep and woke up with some abdominal discomfort, a sense of fulness and lost of appetite. I went to the ER and blood test revealed mild elevations of serum lipase (less than twice the normal). Amylase was normal. I was referred to the GI for further evaluation.  GI recommended that gallbladder was removed as a precautionary measure. Three weeks ager the gallbladder was removed, I still had elevated levels of lipase while amylase remained normal.  (still not pain, except the post surgery pain once feel).

In 2008 a CT scan was performed which showed no abnormalities in the pancreas. An EUS was also perfomed which showed three minor criteria for Chronic Pancreatitis. The diagnosis was labeled "indetermined"

I decided to move on with my life and for the past 10 years I have feel relatively well. I stopped drinking but never placed restrictions on my diet. I may have had sporadic episodes of pain during the course of the last ten years, but nothing significant. 

In recent weeks, however, I have experience mild pain on the upper left side of the abdomen. Sometimes I feel in in the middle of the night or after a meal but it only last 10-15 munutes and it is intermitente. I went to the ER and a CT scan was performed which showd no abnormalities in the pancreas but lipase is still slightly elevated and amylase was perhaps 10 points outside normal.  I have not had an EUS in ten years,

What should I make of all of this? Is it possible that my CP is not progressing or that it is so mild that it has not produced significant damages. I would think that ten years of inflamation, some changes should have come up in the CT scan with contrast? 

I would really appreciate your input,

Oscar

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  • Posted

    Hi Oscar.  Obviously not being a doctor I can't say for sure however the way I took the 'indetermined' note you mentioned is that you weren't actually diagnosed with CP 10 years ago.  Chronic Pancreatitis progresses, you've been pretty stable so I'm not sure you have CP. 

    Your increased lipase and amylase being a tad off key can indicate that your pancreas is inflammed which might mean an attack of Acute Pancreatitis is coming on.  I'd start on a low fat diet and reduce red meat and see if that makes a difference to the pain you're experiencing, and stay off alcohol of course.  Well done you for giving it away way back when your trouble started btw.

    I wonder whether removing your gall bladder was actually necessary.  

    I've had so many 'spare' bits removed for various reasons throughout my weird medical journey (not just pancreatitis) that I've been told later were unnecessary it makes me angry.  Always made the doc's feel better/useful anyway.

    See how you go with a change of diet Oscar and drink more water.  As well get a referral to a good GI for a thorough follow-up.  I'd be interested to hear how it all pans out, good luck.

     

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    • Posted

      Reefsider - Thank you for your response and words of encouragements. How are you doing now, a lot of pain? Has your weight remained steady? How about diabities? I don't even want to think about the prospects of advancing to a more severe stage considering the horror stories discussed in this forum. 

      I will have an EUS and MRCP later this month to check for any changes. The CT scan I had last week showed no abnormalities after 10 years. If I have it and it is progressing, it is moving slow. I hope I can squeeze another 10 years without progression. 

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    • Posted

      I hope you don't advance Oscar, I can say with certainty that it's no fun at all.

      Thanks for asking how I am, you'll wish you hadn't haha.  I wish I could say everything's fine, that being careful with my diet and otherwise following protocol translates to feeling  tickety-boo but I can't, in fact I've been having issues for a couple of months now, pain is becoming a regular thing as well as increasing physical weakness??  Is that even a CP symptom?. 

      No issues with diabetes so far, I see my GI in a couple of weeks when I'll have tests repeated I guess.  I just feel awful most days, no energy at all and nauseous and I'm told I look terribly uncomfortable all the time.  Actually 'uncomfortable' is a pretty comprehensive assessment.   I've put on weight, the Creon's working I suppose but I'm not stable enough to venture too far from a bathroom still. 

      I'm finding that having become a recluse because of all this I now feel very stressed when anyone tells me they're coming to visit, I get pain and feel sick.  Stress is a pain in the butt.

       

      I'm no longer well enough to have my little grandson (with serious medical issues of his own), stay over longer than one night, even that is becoming too much for me.  A big change from a couple of months ago when I could give my daughter a 2 or 3 day break every 2nd week.  That makes me sad.  I've gone from resenting how anti-social this disease makes me to desiring solitude, that's how messed up I am right now.  There is no doubt that my CP is rapidly progressing.  I want to stamp my feet and throw a tantrum and shriek and yell.  I'm not accepting it at the moment.  I'm angry.

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  • Posted

    I wish I had an answer for you. I am similar in that I have had consistently mild elevated amylase and lipase for going on two years with left side pain. No known cause have been found but I am told I do not have CP that the levels are not consistent with CP. I have had CT and MRCP which show nothing I am scheduled for an EUS in June. I am 36 pretty healthy workout, don't drink much, never smoked but have not felt 100% in almost two years. One doctor has suggested it could just be that I have elevated levels with know known cause not common but not impossible. Frustrating to say the least. Prayers you get answers.

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    • Posted

      Hi E92425 - There is a pancreatic condition called hyperlipasemia in which the pancreas produces slightly more enzymes than the normal range. No medical explanation has been offered. My GI at Georgetown believes that I have this condition. However, we have to consider symptoms as well. In most cases,  hyperlipasemia is asymtomatic. If there is a medical explanation as to why 10 years laters my CP has not advance (if I have it) is perhpas because I have abstained from drinking and adpted a healthy life style. However, I think that is a weak medical explanation because most people who are diagnosed with CP don't drink and they still advance fairly rapidly.

      I hope your EUS results don't show significant changes. And even if it does, please take it from me, I had 3 criteria for CP and 10 years laters, pancreas looks normal, at least the CT scan says it is. 

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  • Posted

    This sounds mild.  You may be able to help yourself stay healthy by using a low fat diet (20 grams of fat per day, no fried foods, no cheese, no chocolate - yeah it's a drag but doable) and drinking lots of liquids -- ease up on carbonated beverages and if you can, stop drinking alcoholic beverages completely.  See if your symptoms disappear again.  You'll know when they are serious enough to get thee to the ER.  

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  • Posted

    In other words, yeah it could be progressing at a very slow rate.  We need to hear from people like you in this forum because it helps us to know these things, especially folks who may have only had an acute attack.  
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    • Posted

      Dianne - I will stay in touch. I have modified my diet somewhat. I don't drink or smoke. If I had to guess, based on clinical presentation, I have CP but it may be progressing at a very low pace. 

      While CT scan shows normal pancreas after ten years, EUS show three minor criteria te years ago. Also, this abdominal pain on the left middle side is weird. It is mild and I don't feel I have to take any meds for the pain. Nevertheless, I think I on the edge of the precipice 

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