Calcification in tail of Pancreas

[Mom2one]

I am a 35 year old female.  Over the past couple of years, I began experiencing abdominal pain in a very specific area of my upper left abdomen about two inches to the left of my midline below ribs.  I saw my general doctor about this pain a couple of years ago, and was told I was probably just constipated, or it could be stress.  Went back maybe 6 months later for the same problem, got the same response, but this time some swelling in my leg was noted, with several purplish veins all over my calf.  A d-dimer was done.  It was high.  That d-dimer has been repeated over the past 1 1/2 or so several times, and it is always high.  I've had a clear VQ and doppler.  Went to hematologist that couldn't figure out why dimer would be high other than an underlying malignancy that wasn't really presenting itself at that time.  This pain in the upper left has increased tremendously over the past year.  In May of '05 I went back to  doctor, told him the pain was getting worse, and I also had this pain and swelling in my hip and lower left abdomen region that circled around my back.  It is as though there is fluid accumulation there.  Again, not too concerned, but sent me for a cat scan.  The impression from the scan in May '05.
CT of the chest....
*Soft tissue density at the anterosuperior mediastinum suggestive of residual thymic tissue.
*Small mediastinal lymph nodes at the a-p window. Lymph node to the left of the aortic arch inferiorly.
*Small peripheral nodular density at the left lung base laterally which abuts the pleural surface. Few small pleural based densities.
*Spleen and liver at upper limits in size
CT of Abdomen and Pelvis
*Calcification in the region of the tail of the pancreas and inferior stomach.
Small cystic structres in the right ovary.
The report said that if no intervention is planned, a follow up in 6 months should be done.
I started to have diarrhea in the beginning of August of '05, and with undigested food for two weeks now. Went back beginning of September to same doctor, told him that the abdominal pain was waking me up in the night now, nothing helps it, I am more exhausted than ever.  Simply plagued by horrible fatigue with no energy.  Sent me for a CT scan.  The office lost my chart, so I found a new doctor, had the report sent to him, and the findings were the same as in May.  So..Sunday evening I had another abdominal ct scan with pancreatic protocol.  I phoned the office on Thursday afternoon, and the doctor called me back.  Said that there is this calcification in the tail of the pancreas, but there was no mention of a "tumor".  He said he'd have his medical assistant schedule me for an upper endoscopy to get a further look. She called me after scheduling the upper endoscopy which will be on NOVEMBER 23.  I am concerned that this upper endoscopy is not what I need.Should I call new doctor to speak with him personally about my concerns?  I am truly desperate.  Would like to find good doc in Mich. Thank you.

[Kevin Pho, MD]

The upper endoscopy is a reasonable next test to evaluate for other possible causes of your symptoms - including GERD, an ulcer, or inflammation of the upper digestive tract.  

If you continue to have concerns, you should always discuss them with your doctor.  Calcification of the pancreas can be from chronic pancreatitis.  If further evaluation is needed, an endoscopic ultrasound as well as an MRI can be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[Mom2one]

All tests have (generally) been normal.  I've had mild neutropenia, and a consistely slightly low rbc and high rdw, yet nothing to alarm anyone.  The tests you mentioned, fibrinogen, ptt, were all within normal limits.  The only test that has been high is the d-dimer.  When I saw the hematologist, he said it was DIC, but that he didn't want to take any measures since all of the other tests were normal. He thought maybe the purplish vein-type marks on my lower leg could be elevating the dimer results.  9 days ago, my husband took me to the ER because pain woke me from a deep sleep, and actually made me cry.  I was absolutely miserable.  The pain was worse, again in that one isolated area of my upper left abdomen, than the first day after my c-section when they told me to walk around!  The ER doctor ran cbc, amylase and lipase tests, all of which were normal.  He said that maybe I had a kindey stone from the appearance of all the blood in my urine.  I had to chuckle because I told him, "Well, that's probably because my menstrual cycle started today".  He said he didn't know what was going on, and to check-in with my general doctor.  This whole not feeling well every day is absolutely draining me.  The diarrhea every day is hard, too, and now with the passing of undigested food as of late doesn't help.  Gosh, I really thank you for taking the time to read my little scenario.  I know I'm not the only person with these sorts of troubles.  I empathize will everyone who suffers.  I just honestly feel like I am gravely ill.  My mother was diagnosed with acute leukemia two years ago.  For the several months before her diagnosis, she was told she had some sort of flu bug, a virus, and the latest was anxiety over whether or not to retire.  Well, it was none of the above.  Anyways, thank you, again.

[Mom2one]

Sarah, forgot to answer...I'm not familiar with the ventilation perfusion scan.  Is that the VQ scan of the lungs?  If so, it was negative.

[Mom2one]

Sarah, thank YOU for your time.  Yes, sed rate and CRP have always been within normal limits. The only other tests I've forgotten to mention are Hepatitis, all of which were negative.  My "gut feeling", though I'm not a medical professional, is that something is going on with my pancreas. The abdominal pain in that area, undigested food, pain in back.  Could this calcification in the tail represent something sinister (e.g. islet cell, or other cancer?) The new doctor that I began seeing a month ago was wondering if I had Trousseau's syndrome.  However, from what I know, the upper endoscopy does not explore the pancreas.  On my last scan, my liver and spleen were also noted to be at the upper limits in size.  Just wondering if there is a connection with that.  No, they've never mentioned the vena cava or hypertension.  I had a time during the summer where my alt and ast were doubled, but they've since gone back to normal.  By the way, I still have this curious fluid collection around left hip, lower left abdomen that carries around to my back area.  Thank you very kindly, Sarah, for your help.

[TJV]

You said . "Endoscopy isn’t the preferred method to visualize the pancreas"

Upper endoscopy doesn't visulize the pancreas at all. :)  Endoscopy looks at the esophagus , stomach and duodenum.

The doctor ordered it  i would imagine to evaluate symptoms of persistent upper abdominal pain..... which would be very reasonable to rule that aspect out.

[TJV]

Not clear  if the doctor ordered an  ERCP or an  esophagogastroduodenoscopy . .... because it was stated the doctor ordered an endoscopy to get a better look at the pancreas...... and an esophagogastroduodenoscopy obviously can't see that.

[Mom2one]

Sarah & TJV,
I truly appreciate both of you taking the time to help me.  What compassion and kindness you've shown.  My new doctor is only in on Tuesdays and Thursday, so I plan to phone him Tuesday to see if he's available to talk. I'm certain the medical assistant scheduled me for an upper endoscopy.  Today, for example, my left leg literally fell asleep while driving because my leg/foot are so swollen, making my shoe fit like a scuba suit, and my foot went numb.  Scary.  I've thought about writing a detailed letter to the doctor, and just dropping it at his office Tuesday morning, expressing my concerns.  What do you think about that?  I certainly don't want to offend him, as I am obviously not a docotr, but I think that a patient's "instincts" should not be ignored either.  Many thanks, again.  I need all the help I can get!  Do ulcers and GERD, as the good doctor Pho indicated, present such symptoms that I am having?

[susannak]

Good thing the internet is still up and running in Pakistan, what with all the thousands killed, still trapped in the massive amounts of rubble, and dying--good thing you are still able to help those suffering over here in your spare time.

[TJV]

:)

Lady with pain, yes , the upper ab pain could be attributed to GERD / ulcers/ inflamation (inflammation) as the doctor said.     IBS could cause it too . As for the remaining symptoms,  you should definately express all of your concerns to your doctor.

[TJV]

Also  meant to mention the d-dimer test which you were concerned about because it was elevated. An elevated d dimer "alone" means nothing really , lots of people have an elevated d dimer.

[Mom2one]

Hello, and thanks for writing, TJV.  Just wondering what your thoughts might be on the calcification in the tail of the pancreas.  It concerns me.  I've never smoked, drank, or been on prescription or taken over-the-counter meds.  I knew a young woman who had islet cell cancer (in the tail of her pancreas) and was told she had IBS.  By the time they discovered the cancer, it was too late, and she passed away.  That has been the story with all of my immediate family members.  Medicine is tricky.  My mother had a wonderful doctor treating her that said medicine was a bit of a craft, almost like putting the pieces of a puzzle together.  Anwyas, thanks for writing.  You're quite kind to share your time.

[TJV]

Hi Lady with pain.  I can understand your concern about pancreatic cancer , but you have had pain for 2 years now, so it's very unlikely.  Pain happens in the latter stages. You would be dead right now if your 2 year old pain was indeed cancer.  

Half of all people with this type of cancer have jaundice ( have you had liver blood tests? ) All of your blood tests are ok too. Your risk factors are low too, as you don't drink , smoke etc. and have no fanily history of this cancer,.   There are several types of islet cell tumors of the pancreas. The most common is insulinoma, with extremely low malignant potential.

My personal opinion ( not a medical opinion) , is that I would be concerned as well.   If i were in your shoes,  the first thing i would do now -- would be to  talk to my doctor about getting an MRI , which is  better test for this.  The  above suggestion by Dr Kev of an endoscopic ultrasound is also a very good idea. The images are far superior to those produced by standard ultrasound.

  I would also have some stool testing done for malapsorption, etc.  I'd have my thyroid and glucose  levels checked too.

Both of your cts give an indication that there are some things that i would want to be followed up because they may ( or may not)  have the potential to cause problems in the future.  So i would definately follow up in 6 months time with repeat testing as the radiologist suggested.

All you can do is remain vigilant about your health , and treat your body well. Anything outside of that , we  can't control.    You can't do anything more than that.     I know it's a huge worry, but worrying about health problems only makes us feel worse, and there are no mental or physical health benifits attained from worrying. Take Care :)  
  
    

[googmonster]

What the?  I don't understand any of this.  Just looking for info on pancreatitis.  I'm new to this and don't get it.  Psychotic?  ru talking about me?  why cant I see my last post?

[Reality123]

Dear TJV & susannak,
I had a chance to read “Sarah Connors” last post which was in fact a reply to your sarcastic attitude. Had been an ardent reader and admirer of her medical knowledge so saved her replies. Sorry to say and no offence intended but your attitude will deny many people of sensible straight answers to their miseries. If its removed again would email it on your request.

Take care, Hugs & Peace.



"QUOTE":

• Would like to clear a few facts.
• Firstly am just a member in these forums like all.
• Secondly in none of my posts did I write that I was a med student for your info.
• Yes in some of my replies did mention writing terms such as, in my own clinical experience, practicing as a doc for decade plus, when I worked in hepatobiliary medicine, if I were your treating doc, presently am in Pakistan etc.
• These terms were never mentioned with any mal intent or to show myself.
• As regards to have a limited knowledge about subjects, the answer to that is that I try mostly, replying to those posts to which no one has replied (& before Kevin too, cause there is no challenge left after his response, plus his responses lack clinical touch, they are more text book like), selected topics & don’t try not to interfere in topics which are being replied my co members.
• Like one member gives a belated response that d dimer can be raised in many normal individuals. Well great & right but my queries to her are:
• What took her so long to mention that? Was she trying to search some website trying to know the meaning of d dimer & its applications etc?
• Didn’t the Hematologist earlier find the d dimer raised & know that its raised in some people with out any underlying illness (despite normal PT, PTT, FDPs) but still was thinking on the lines of DIC?
• What actually am trying to say is that med is an art, as stated by the lady in pain & to me it’s a jigsaw puzzle. One doesn’t treat signs, symptoms, and lab results (whether normal or abnormal) & give a diagnosis based on them.
• Rather one sees the patient as a whole, correlates all data like a CPU & than gives the best possible logical diagnosis/ opinions.
• Where was she all this time? She was scrutinizing my letters, words, posts & when by mistake I just wrote that Endoscopy isn’t the preferred method to visualize the pancreas, the aim actually was to tell the lady in pain that Endoscopy scheduled by her doc wouldn’t help see the pancreatic problem if she has or had, there she made her first post with her website knowledge.
• I very graciously thanked her for correcting.
• That was it. From there one she started giving her website collected data/ advice to the lady in pain. She is more than welcome but where was she all this time? Never ever did she try to give one cause of her problems, whether write or wrong. Because she has no education what to talk of attending med school, experience, just shallow website bits & pieces.
• I know about myself, am confident, bold, experienced & well qualified.
• I take time to help people here, with my mind & experience, not website knowledge. People aren’t stupid, that they can get too. They want possible answers to their questions.
• They want logical provisional diagnosis, if you know what that is. Till your last post you were just either correcting me or telling about d dimer or what info you gained from Kevin’s response. Nothing from your own grey white matter, if you have any.
• Feel that you suffer from severe inferiority complex & morbid female jealousy & that’s too hard for you to swallow. I won’t reply to any posts in future. At least shall make you happy.
• I have better & more important things that replying to psychotic remarks.

  
   Good bye & enjoy your tiny false world of these forums.

Would advice you to use these forums with a constructive, positive intent/ aims, not for your own personal kicks. If you want those, go log on to some chat rooms.

PS:  A correction to another member & adding to her knowledge, all B 777 & D11 that I fly have internet access for any passenger, whether first or economy class, she must be flying in some obsolete aircraft (If she really does).

[Mom2one]

Dear Reality, Gosh, I just checked back in today to see if any further comments were added to my inquiries, and I found your letter.  Quite honestly, I don't know what is going on.  I do think, however, that if you were there trying to help me, I would like to thank you for your time.  I've been feeling dreadful, and the old cliche that you don't have anyting if you don't have your health is definitely ringing true for me.  Thank you, again.

[Mom2one]

Quick questions about platelets....I've noticed from my blood work over the past year my platelets have been running between 19-300.  Is it normal for platelets to drop 50k in one week?  (This was not during my menstrual cycle).  Same lab by the way.  Last month they went from 298 to 239, all within a week.  Does this mean anything?

[tuff case]

To answer about the platlets, since they can increase due to infection they can change quite significantly in a short amout of time.  They can also be elavated due to pancreatitis, which Dr Kevin suggested the calcification might be from.  Along with elevated plalets your Amylase and Lipase measurements should also be elevated.  I had pancreatitis after an ERCP which examine my biliary ducts and my pancreatic valves.  It did not last long but at the time it was an acute attack.  All three of the above levels were signigficantly increased during my attack of pancreatitis. I am not a medcial professional only speaking from experience and having been through so much in teh past 3 years to get a diagnosis.

Also the most important advice I can give you do not be AFRAID to ask your Dr questions.  If you are not comfortable with answers or how things are going do not leave the Dr. office until you are.  If you have tests done and you get a call saying everything is fine but no answers make another appointment to see the Dr.  The more persistant you are and the more they have to deal with you the more they will realize that something is wrong.

I have been dealing with Dr's for 3 years. And have every test you could image done.  When the GI felt he exhausted every possible test, he felt I was suffering from Stress and teh it was all from IBS and recommended and anti-depressent and when that id not work I was being resistive to treatment and recommending therapy.  I did the therapy only to prove that it was not stress.  this all started in 12/02 and only in 2/05 did I find out ipart of my problem was diabetic medication that my system come to dislike, this was causing nausea.  I also had dizzy spells that a new primary care Dr I started to see wanted to tell me that were anxiety attack, however I insisted that something was wrong he took my blood pressure while laying and then standing and found it drop 30 mmHg.  I was then diagnosed with Diabetic Autonmic Neuropathy.

I did not tell you this for you to think that you have this condition because I am sure you do not.  I only want to say how important it is to be presistant.  You know you body and they do not.  By the way, in the last 3 years I have been in to see Dr's at least 2-3 times a month. My GI, my Primary Care, my Podiatrist, my neurologist and all their staff all know me when I walk in the Door or call because I am persistant.

Good luck, Amelia