PAIN BELOW RIB CAGE AND TO THE RIGHT

[SANDIE121]

FOR 3 WEEKS I HAVE BEEN HAVING PAIN IN THE RIGHT UPPER PORTION OF MY STOMACH...FROM THE CENTER OF THE CHEST UNDER THE RIB CAGE ON THE RIGHT...I CAN NOT EAT WITHOUT THIS AREA FEELING LIKE IT HAS SPASMS ABOUT 10 MINUTES AFTER I HAVE EATEN, THEREFORE I HAVE NOT BEEN EATING MUCH, AND AM LOSING WEIGHT..I SAW THE DR. 2 WEEKS AGO, AND HE SAID IF IT CONTINUES THAT I SHOULD HAVE A LAPAROSCOPY...MY CONCERN IS THAT I AM ON COUMADIN AND I WORRY ABOUT BEING CUT OPEN AT ALL...I ALSO HAVE PARKINSONS DISEASE AND AM ON MEDS FOR THAT...I HAD A STROKE IN APRIL OF THIS YEAR AND THAT IS WHY I AM ON THE COUMADIN...I HAD THE ULTRASOUND WHERE I DRANK THE BARIUM AND HAD THE INJECTION OF DYE...THEY SAID IT ALL LOOKED NORMAL...ARE THERE OTHER TEST I COULD HAVE THAT COULD FIND THE PROBLEM WITHOUT SURGERY? I AM A 54 YEAR OLD FEMALE...I HAD MY GALLBLADDER REMOVED IN DECEMBER OF LAST YEAR...I HAVE BEEN TOLD IT COULD BE ADHESIONS, ALSO.. THANK YOU
SANDIE121

[spike1951]

DO NOT overlook Chronic Pancreatitis. It is very hard to diagnose in some cases and causes extreme upper right quadrant pain radiating to the back. It cause a lot of symptoms, some different in different people.
This is so coincidental.  My wife has had major abdominal problems for 15 years.  

In September of 1998 she had her gallbladder removed because of upper right quad. Pain and trouble eating -- causing pain in that area.  She was semi-OK till February of 1999 and started having upper right pain much worse and when she ate anything but especially "heavy" foods it would be terrible pain.  (See copy from another post of mine)


My wife is completely debilitated and in tremendous pain and goes on IV Dilaudid every month or more for 5 days. It often gets worse as time goes by.

Don't fool around with local doctors! Go to a GI clinic, like Mayo, in Florida, Shands at Univ. of Fl is good, etc.

My wife spent 9 months with local GI doctors and was diagnosed with everything from Pelvic floor dysfunction to IBS and more. NONE WERE CORRECT.

Search the web for Chronic Pancreatitis and read up on it. It hits more males than female and often in the 40's age range. My wife never drank but drinking is a leading cause of Chronic Pancreatitis.

May not be your case but I'd look it up and get to a real "clinic"

[spike1951]

PS.  Not saying don't have surgery.  Nevertheless, Chronic pancreatitis can not be diagnoesed with a Laperoscopy.  Needs tests like ERCP, and doctors who specialize in Pancreatitis.

[Nanny]

If chronic pancreatitis is in question, it can sometimes even be detected by a simple bloodtest to check the amylase and lipase levels.  Often a CT-scan will show chronic pancreatitis, that's how mine was found.  An ERCP is good, too, but the patient needs to be aware that it is an invasive procedure and can actually cause a pancreatitis attack.

The symptoms of CP are very similar to what you describe, some people have pain on the right where the head of the pancreas and main duct is, others in the middle or on the left, it just depends where the problem is.  Back pain, nausea and vomiting often accompany this also.   Too many people get misdiagnosed with IBS.

There are some other good GI hospitals that Spike failed to mention, such as the Cleveland Clinic in Cleveland and MUSC in Charleston, SC.  Also John Hopkins in Baltimore.

Nanny

[spike1951]

Also, if this persists and not other cause if found via ERCP, etc.  30% of all Chronic Pancreatitis suffers have a type like my wife has called Idiopathic.  That means there is no know cause for the disease but it is as real as any other cause and is often more painful.

And as has been said, 70% of GI doctors will try to pass it off as IBS, tell you to get of all pain meds, and just live with it.  Had an "idiot" doctor tell my wife that, we just walked out and shook our heads at how "uncompassionate" and just plain "stupid" some doctors are!

hang in there and keep looking for a compassionate doctor, there are a few, and probably women.  I am a man saying this.

[5fan]

This is a situation I understand well!  I just spent 7 days in the hospital for pain like described - URQ, follows the rib cage up to the middle of the body and then radiates into the back.  The best way I could describe it to the doctors is having someone punch me in the diaphragm and then not removing their fist.  The pain is worse with food intake - ususally starts like spasms in the right and then the pain increases from there.

I had such severe pain that co-workers had to take me to the ER.  I was on morphine because the GI coctail, Demerol and Phenergan didn't touch the pain and nausea.  I was admitted so they could "find the problem" without having to endure the pain for the time it would take to schedule the tests outpatient.  At the time I went to the ER I had not eaten since the day before and was vomiting bile at the time.  I have been living on Coke heated in the microwave and then stirred until it is flat because it seems to be the only thing that settled my stomach.  I was on either on a clear liquid diet or NPO (nothing) for six of the seven days I was there.  Only the last day was I given a "liquid diet" for two meals and then solids for the last meal.

My amylase and lipase levels were not elevated, my hepatic function tests were normal as was my urine sample.  I went through abdominal x-rays, gastric emptying test, small bowel follow thru, and a MRI that zeros in on the bile duct (the specific name escapes me at the moment).  They were all normal.  

Unfortunately (or fortunately, depends on how you look at it) my Gastro practices in a group with three others.  I never did see my specific Gastro in the hospital.  I did see all of his partners. (I'm a little upset about this - I had to repeat my info every day - like they didn't even bother to review my chart).

Once they ruled out that there was "sludge" blocking the common bile duct (by the MRI) they seemed to decide that that was the end.  I did ask the Gastro who visited me about chronic pancreatitis but he just pushed me off saying that my A&L levels and hepatic functions were normal and that "you don't want chronic pancreatitis".  I guess since I have "perfect cholesterol levels" and am not a heavy drinker he feels that this is not a possibility.  TRUST ME I KNOW THERE ISN'T ONE PERSON OUT THERE THAT "WANTS" CP.  Unfortunately some do have it.  I had pancreatitis when I presented to have my gallbladder out - it took four days to control it.

The pain still continues.  The admitting MD finally put me on Reglan to try to get me to keep three meals down without vomiting.  Once that was accomplished I was discharged.  I was at the point I would have lied and said they stayed down even if they didn't because it was obvious the doctors I had were not going to go any further.  They want to blame it all on the severe gastritis I was diagnosed with.  They have increased the Nexium to 2X a day, Librax to 5X a day (for IBS) and added the Reglan (1/2 hour before every meal).  Luckily I have an appointment with MY GASTRO on 10/15 and plan on it being a long visit.  I WANT SOME ANSWERS.

The surgeon who did my gallbladder surgery (he's a colon and rectal specialist) seems to be more interested in what's wrong than the doctor's in the hospital did and he really doesn't have a lot to do with my care at this point - the surgery is over.  He did want to review my latest CT himself and want's me to return in four weeks (I saw him 3 days before I ended up in the hospital).

I know this is a long post - but part of me just had to vent.

The other question I have for anyone out there is ERCP.  I understand it's not a test that doesn't have potential side effects - they were all explained to me when I was in the hospital in July to have my gallbladder out. I was just wondering if anyone has run into any of the same problems and not had their doctor proceed with an ERCP?

My surgeon even asked if I had had one done.

Thanks for any help.

[bbal]

Help! I had my gallbladder removed 1 year ago and I have had RUQ pain since July. It feels just like my gallbladder attacks. I have had an ultrasound, upper GI, Hida Scan, and a lot of lab work. Everything has been negative. I see my GI doc on 10/7 for a follow-up and he already said that if the scan was neg he would probably have to do an ERCP. I thought about living with the pain but then it flaired up again! The docs tell me it can't be my pancrease because my blood work was normal but my labs were normal when I was in a full-blown gallbladder attack too. My gallbladder was FULL of stones 2-3 cm in size and was both chronically and acutely infected. I have high cholesterol and was on high dose birth control pills for 12 years(just came off them in March). I don't know what to do next. Any suggestions?

[5fan]

When I was in the hospital they did an MRI that focused on my common bilet duct (for some reason I can't seem to remember the name of it, but would know it if a I heard it) to see if there was "sludge" obstructing the duct.  The doctor's did not find any stones when they took my gallbladder out so they it seemed like they were a little confused as to why I had pancreatitis without stones.  I had a sonogram, x-rays, HIDA scan and CT - no stones showed up.  I was told the night before surgery that they may find them during surgery and have to convert to open surgery.  

Is your doctor concerned that you may have a stone lodged in a duct?  If so have you had the MRI done?  If not, it might be something you want to discuss with him/her before the ERCP.  I'm not sure how doctors feel about the MRI.  I hadn't heard of it until I ended up in the hospital recently.  I don't know why they don't do it as a standard procedure (cost maybe).  Anyway that may be something you want to ask about.

[spike1951]

You need a clinic that specialized in Chronic Pancreatitis.  It's bull that if your amalse & lipase aren't elevated you don't have Chronic Pancreatitis.  Acute Pancreatitis has elevated enzymes NOT CHRONIC PANCREATITIS.  These are almost NEVER elevated with Chronic Pancreatitis.  

If you have IDIOPATHIC CHRONIC PANCREATITIS there is, or can be, no structral problem like blocked or narrowed ducts.  The enzymes just become active and burn like acid in your pancreas.  My wife says, similar to you, it like the worst leg cramp you can imagine times 20 inside your belly, upper right & radiating, and going on for days or in my wife's case years!

  here is my wifes info

DIAGNOSES CONFIRMED VIA:

1. EXAMINATION --- 10/1999  ¡V Dr. C, SHANDS Florida, (30 yrs experience), immediately upon seeing, examination & questioning T based on symptoms ¡§just knew¡¨, T had Chronic Pancreatitis
2. SPECIALIZED BLOOD TEST --- 11/1999  ¡V Dr. C confirmed his diagnoses  with a Trypsin blood level test, (which his own research had documented its relationship to Chronic Pancreatitis)!
3. PANCREAS ENZYMES DIRECT ANALYSIS  --- 12/1999 ¡V Dr. Y, SHANDS, admitted T for multiple tests; Secretion test further confirmed diagnoses!



1. IDIOPATHIC CHRONIC PANCREATITIS
„© Idiopathic chronic pancreatitis, which accounts for approximately 30% of cases. While the cause is not yet known, some evidence points to atypical genetic mutations in CFTR, cationic trypsinogen.
„© Ninety-six percent of those with early-onset idiopathic pancreatitis present with abdominal pain!
2. Maldigestion and malabsorption do not occur until more than 90% of the pancreas has been destroyed.
3. Prior to taking Viokase, T had extreme sensitivity, even to touch, over entire abdomen and pain in most joints.  Both were noted by Dr. C as symptoms that are related for some to Chronic Pancreatitis.  After taking Viokase for several months, saw significant improvement in overall abdomen sensitivity.  Only severe upper right quadrant pain remained and joint pain went almost completely away.

My wife goes on IV Dilaudid at least 5 days a month and lately twice a month of 5 day IV & NPO.  She has a terrible case.  

[5fan]

I am curious about the doctor at Shands in Gainesville.  I live in Central Florida - Orlando area and am supposedly seeing one of the best Gastros in this area.  There are four doctors in the practice and I know at least two (mine included) are supposed to be very good.

If I can't get my doctor to listen to me I am need to move on and would like to know who you contacted to get an appointment at Shands.  If you can help I would greatly appreciate it.  Hopefully it will be a "last resort", but I would like the option if I don't get any answers soon.

Thanks for any help.  I hope you wife is feeling better.  I know what IV antibiotic and NPO for 4 or 5 days can feel like - its not fun!

[anti spaz]

reserch anti fungal ,pro-biotics