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ERCP

I am a 32 year old female with a recurrent problem! I had my gallbladder removed in September.  10 days later, I was admitted into the hospital with severe pain that turned out to be acute pancreatitis from retained stones in the common bile duct.  While hospitalized, I had an ERCP to remove the stones, and was told "the stones are gone."  After going home, I continued to experience chronic pain in the upper right quadrant that was sometimes a mild ache, sometimes a sharp stabbing pain.  I returned to the doctor for treatment in November, had another ERCP in mid-December, followed by another attack of acute pancreatitis that I was hospitalized again for 3 days.  This time the doctor removed 5 stones from the cystic duct (he called them "hidden stones").  When I was released, the doctor said that any new stones that I form, or any that are still "hidden" should fall right out because I had a complete spincterotomy.  In the three weeks since I had the last ERCP, I have continued to have pain, severe belching throughout the day, and the inability to eat much (I have lost 10 pounds).  On New Year's eve I went to the ER with what I thought was a pancreatitis attack (it disapated after 15 minutes), and all the tests performed there were normal, including CT Scan, lipase and amylase, x-rays and urine tests.
I have either diarrhea or no bowel movements at all.  I'm desperate for an answer, and the doctors seem clueless, or unavailable.  I'm tempted to try natural remedies. Is there anyone out there that has been through a similar ordeal? I'm an alarmist and have concerns about having chronic pancreatitis, so am reluctant to have another ERCP unless absolutely necessary.
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Avatar universal
I am so thankful I stumbled onto this web site.  

I have been sick since September 05 with horrible pain on my right side & major weight loss (63 lbs. so far, and I'm not that big of a person) since almost everything I eat puts me on the floor with pain.  I have been to 3 GI's.  The first one said I had IBS and dismissed me, the second told me it was in my head and I walked.  The third doctor, I believe, will help me.  I have S.O.D, pancreatic insufficiency, and common bile duct stones.  I am scheduled for a HIDA Scan Monday morning and in the afternoon, an ERCP, with removal of stones and placement of a stent.  The next day I see pain management experts.  After reading some of the entries, I am a little hesitant about the ERCP.  I do know that I cannot live like I have had to for the past 6 1/2 months.  Would it not be worth the pain in the short term instead of living in constant pain for the long term?  I have no relief.  I have a constant nagging side ache.  When I eat, it is much worse.  I have learned what I can eat and how much to avoid severe pain.  My Doctor put me on enzyme replacement, which has helped some.  I do have a little more energy and I do not have the feeling of starvation soon after eating.  The weight loss has also slowed.  Only 1/2 lb. in 4 days.  Not bad when it was averaging 1/2 lb. per day.

If anyone has any words of wisdom for me, I sure would appreciate them.  Talking to people who have similar problems sure has helped me alot.
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Avatar universal
Hi do you know if the Dr. takes medicade?? And yes its horrible, I'am not the same person anymore, I feel like I aged went from 43mom to 83great-grandmom in 6 months. Email me ***@****
as they will probably close this thread..georgie
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Avatar universal
hello (mostly )girls.
i've found this site tonight and have read your posts with interest and a sense of community.
my SOD - Sphincter of Oddi Dysfunction has brought me here - as your stories have enticed me to post my own drama.
here goes...
after MUCH time passing - lots and lots of visits to the ER and my gastro doctor being exhausted by the extreme pain i was suffering - constantly - for 2 years - i switched doctors....
(why is it that some women - like myself - have some sort of WEIRD loyality to doctors who don't seem to REALLY help?...oh, the tales i could tell - oh - my story that has been woven..WHOA)...anyway....
my new doctor suspected SOD and send me to Indiana University.
Dr Stuart Sherman - who heads the ERCP clinic at their medical school is a famous doctor around the world. that is ALL he concentrates his medical expertise on......ERCP's and the pancreas. He travels the world teaching and lecturing on the problems associated with Sphincter of Oddi Dysfunction and all the other ailments of the pancreas.
my story seems similiar to all of yours. constant pain and constant runs to the ER - only to learn - with practice and extreme frustration that the ER is only a 'patching up' game and the ER docs cannot do much of anything except patch us up - get us - temporarily - out of extreme pain - then pass us on..(i wonder sometimes about those ER docs......such infinate possibilites for pain....i'd think those guys would want to figure OUT the problem instead of being the 'bandaid bandits' - that just drug us UP and show us the doorN)...
so.
after being in constant pain for two years. NOT working and losing ALL of a life - i met Dr. wonder in Indianapolis.
i've been GREAT after my ERCP and some other funky stuff that he did while doing the ERCP - but i cannot pronounce the words - and i don't want to look the fool - but i've been extremely well - with NO pain for about 3 years.
until this past Thanksgiving. then WHAM. the illnesses are back.
full force.
my question - besides the pain and stress of BEING in pain - do any of you feel like you have a LONG case of the flu?..i swear - initially i thought that was all that was wrong with me. i thought that i just could NOT get over the flu. but, then - when the pain became - full force - then i knew i was in trouble again and it was my pancreas.
so. do you guys feel likd you have the FLU. body aches, nausea,
HUGE GENERAL overall feeling of ILL HEALTH?
now.
my REAL reason for this post...have any of you heard of the ERCP clinic at Indianapolis with Dr. Stuart Sherman?
might i suggest that going to a WORLD SPECIALIST on your pancreas might be a good - no  a GREAT idea for your future - if you have found that no other doctors in your area - nor any medical institutions are not getting you - up to par - and feeling better.
tell me - what do you guys think?
signed.
this ART LOVER in Ohio - Elizabeth
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Avatar universal
Well, I've been meaning to find this website in order to update all of you who have been so great in trying to help us with ideas.
It's been a LOOOONG winter here in the South!!!

Update is as follows:
My 10 year old (next week she will be 11!), was in the hospital at Duke for almost 3 weeks. We did the 'backdoor' thing and through ALL of the testing, the final outcome is "Unknown Chronic Biliary Pain" (most likely, nerve damage from her past gallbladder removal/subsiquent bile duct stone's...aka, ERCP's).

This poor child has been through every test under the sun, but they finally ruled EVERYTHING out and put her on Neurontin. It, for now, has been the MIRACLE drug! She takes it 3x/day and is at 9ml's per dose. Hoping to gradually get the dosage down.

They even did another ERCP, even though all of her bloodwork and CT scan was normal. They, like us, felt they were backed against a wall and HAD to rule it out. That was the frustrating part.... all of her tests kept coming back normal! Don't get me wrong we were THRILLED that she didn't have anything wrong like the other children on the floor.... but, it was still frustrating to not KNOW what was wrong with her. She was in such debilitating pain.... It was a relief to find out that she did not have anymore stones. Can you say "NO MORE STONES?!!?!".

The narcotics definately are not something she can handle. According to the NeuroSurgeon, she is one of the 'rare' individuals that reacts with convulsion type movements after a few days on narcotics. She was on a couple of narcotics (for lack of anything else they were able to give her, since she'd start the convulsion movements). Toridol, after the 2nd dose, she became allergic to. The main thing with the narcotics..... it made her pain worse!!!!!!!!! I don't care what ALL the doctor's said, but narcotics effected her pain the most!!!!!!!! Meaning, it worsened!!

Does/has anyone taken Neurontin???? Let me know. I hope you will find some relief in your attacks. This is a 'miracle' for us at the moment. 4 weeks ago.... I felt like I was bringing home my 'disabled' daughter (it took a couple of weeks after being releaased from the hospital for her to have NO breakthrough pain).

She is now back in school and running and playing like the normal child SHOULD be!!!!!

Good luck to you all. Our prayers are with you........
your Southern Belle pals!!!!
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Avatar universal
I'am relieved to know there are others! We may not be exactly the same but we share some common ground!!  
Cwwgirl, listen I believe your Dr. has to be wrong about the narcotics!!  I would sneeze as a youngster when given cough meds w/ codeine, for coughing.  When I got older I had a severe back injury(I mean severe) went on vicodan and percodan. Guess what had to go on dilantin, cause I was having grand-mal seizures in my sleep. Funny I needed detox for the pain meds, but when I got off, seizures stopped!! Sorry to say that I did go back to pain meds, and I take seizure meds, Gb out in 2002, but had pains in that area for years, pain subsided for about 6 months, then came back.  MaryRoe I beg you to e-mail me, I like you had dilated ducts, was so scared from everything I read on the internet, still am, I had to have the ercp to make sure no tumors, they did several biopsies they were benign, my gastro wasn't scared but I was glad he did the biopsies. Patty my pain seems to be like yours dull and can last awile but pain meds definately aggravateit. I want to speak to my dr. about helping me get off pain pills, been on them so long, It would be easier if the detox drs. believed me but it is not necassary for me to succeed. MeMej- I also sometimes get the pain under the breastbone, sometimes interferes with breathing!!  My email is
***@****   I really hope to hear from you especially Maryroe, I believe you can really help me
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Avatar universal
When my attacks started soon after my gallbladdeer surgery many moons ago...no one knew why..not even the surgeon.  But, I recognized that certain meds could trigger these S/O attacks. EVEN over the counter LOMOTIL.  ALL opiods and derivitives pain meds, i.e. morphine, vicodin, percocet, codeine and this family of meds, will set the stage for a repeat performance. I avoided them like the plague and will never touch them.  I was introduced to a Torodol pain injection a few years ago and that med is the only med that did not start an attack. About 5 years ago a well known surgeon asked me about these pains.  He recognized them and then I knew what they were called....Sphincture of Odie spasms (closes up) causes delayed emptying in the bile duct and yes...narcotic pain meds can cause these horrific attacks.  Why?  God only knows. I feel your pain.  I will go to the other site you mentioned.
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Avatar universal
This has been me all along.. ever since I had my gallbladder out last year in april. I keep having these attacks and the pain pills I take always seemed to make it worse. I never knew if it was just me because no one else I have talked to ever had this problem. I have tried vicodin,darvocet, and percocets....and all seemed to make my attacks worse. I have had tons of tests and my next one is suppose to be ERCP. I also have the attacks if I go with out eating,stress, smoke to much, or certain foods. Its so nice to read others like me, is there any sites that tell what pain pills cause these attacks? I would love to print it out and take it to my doctors. I am also on a web site for people with SOD and pancreatitis.....they have been great but none of them have had the problems with the pains pills like me. If any one wants to chat more about this the group is called TPP, or the pancreatitis place. Also you can email me at women_2020***@****. Would love to talk to others with this problem. Thanks so much.....
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Avatar universal
I have had 2 ERCP's the first one They found the "Oddi" value need to be cut.  When this did not relieve my symptoms completely my GI sent me to his mentor at University of Chicago.  Where he could also measure the pressure build up of the pancreatic value.  He then had to cut the pancreatic value and also cut more of the "S Oddi" valve.  After the 2nd procedure I continued to have what felt like a release within my abdomen for more than a year.  This would occur and last only seconds but pain was pretty severe.  I do not have the pain any more except for maybe once every 2-3 weeks.  You may want to find out if the pancreatic valve was check when they cut "S Oddi".

Good Luck and God Bless..
Amelia
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Avatar universal
You are right. Most ER rooms will give you a shot of "something" to quiet the pain, tell you to see a GI doctor in the morning or ASAP and send you home. Been there.  Done that.

I have lived with this mess for over 25 years.  They tried giving me Nitro many years ago and I refused it as I figured it was for the heart and not the belly.  Well, it can be used for both the heart and the GI tract.  I haver since been on Nitro now as I can pretty much distinguish my heart pains from the Bile Duct spasms.  I will pop a Nitro if I tink I am having a heart related pain and it works 100% of the time for heart pain but if I take one (did a test) for tummy pain...it did not work as well.  Barely touched the pain.  Wjen I had my ERCP they also triggered an attack and I htought I would fly off the table but they quickly gave me something to quiet the pains.  They did not do any cutting but told me to go toa place in racine, Wisconsin to get the Sphincture cut.  I did not go there as I was petrified to leave home.

I gave CCgirl the name of the borland-grover clinic in Florida and what I have heard they are suppose to be experts in this.

Get on their website and read up on all they do and who their doctors are.  You may want to consult with them via mail and also tell your doctor about them.  They very well may be able to help you.  I live in a Big City but to my knowledge there is no one here that knows much or better yet...can do much for this problem.  This is why my ears perked up when I heard about the clinic in Florida but then I had heart stsents put in and I am not sure if these doctors would take me on as a patient.

Paty and I mentioned that seemingly an Injection of Torodol really helps with these attacks and does not cause a Sphincture of Odie attack which is WORSE than having a 10lb delivery with no epidural.  These attacks are brutal.  I passed a kidney stone and it was a breeze to these attacks.  Good Luck to you.
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Avatar universal
maryroe,
i just read your post, and what you have sounds alot like what i go through. I will be doing okay, then, out of the blue, I start having attacks, this squeezing feeling under my breastbone, I have to get a couple of pillows and bend across my bed to even get through these attacks. These all started a couple of years ago, I had already had my gallbladder removed, then these started, they checked me out for everything!! I finally found a gastro dr that did a ercp, and while I was under anesthia, they made me have a attack, so while in there, they clipped that muscle half into. Now these attacks are coming back. In Nov, while trying to learn to snow ski, I fell and cracked my arm, they prescribed a pain medication, forgot what it was, I took one that night and spent the next 4 hours having attacks at home!! It was horrible!! Now the attacks seem to be coming more frequently, I notice I seem almost bloated like, dont go the restroom very regularly, and it seems if I get just a little hungry, it can bring on a attack, I just hate this, I thought after them cutting the muscle, it would be fixed. They did give me nitroglicerine tablets to keep with me  to place under my tongu when I have an attack, but they give my AWFUL headaches, and it seems like sometimes it dont really knock the attacks out. I'm so discouraged, my husband wants me to go to the ER when I have one, but I figure they wont help me, I figure by the time I get there, it will have eased up or something, I just never know. Its just amazing that someone else has what I have. But, yet no doctors seem to usderstand it, or that there is nothing they can do.
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Avatar universal
Thanks! I will look into it. J'ville is only 2 hours from where we are located, so that could be great!

Good Luck to you, as well....
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Hi there.  I found it.  AND, it is not in the midwest.  It is in Jacksonville, Florida.  

Here is the website:  http://www.borland-groover.com/

I may be contacting them myself.  You may want to read up on them and perhaps discuss this with your doctor or make a call about your daugthter's case.   Good Luck to you.
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Avatar universal
Would love to know the place you refer to in the Midwest. Let me know, if you think about it. OK?

I love your spunk! Your comments made me smile....
Thanks!
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Avatar universal
Hey there Ms. Southern gal too...lol   Bring that Fellow on.
I will meet him  anywhere.

I recently had an apology from a Fellow here at the heart center.  Yes, most  have BIG EGO's and think they know it all.  What they do not teach in  Med School is COMMON  SENSE!!!

I use to think doctor's were GOD and believed every single word they told me as Gospel truth.  Gads, I needed my head examined.  Now, they don't like me as I question every syllable out of their mouths.  And you need to also.  The most precious thing in  life is a Child.  She is Crystal and Gold and cannot be replaced. Remind them of this, often.  

I need to locate that place in  the midwest that specializes in bile ducts/gallbladder. etc. etc. and post it.  I am not endorsing it but heard a lot about the place and may be something you want to check out...

Good Luck to you.
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Avatar universal
Hey there Ms. Southern gal too...lol   Bring that Fellow on.
I will meet him  anywhere.

I recently had an apology from a Fellow here at the heart center.  Yes, most  have BIG EGO's and think they know it all.  What they do not teach in  Med School is COMMON  SENSE!!!

I use to think doctor's were GOD and believed every single word they told me as Gospel truth.  Gads, I needed my head examined.  Now, they don't like me as I question every syllable out of their mouths.  And you need to also.  The most precious thing in  life is a Child.  She is Crystal and Gold and cannot be replaced. Remind them of this, often.  

I need to locate that place in  the midwest that specializes in bile ducts/gallbladder. etc. etc. and post it.  I am not endorsing it but heard a lot about the place and may be something you want to check out...

Good Luck to you.
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Avatar universal
THank you, maryroe, for your support.

I think he is being stubborn and his ego is playing a role in this situation. I should clarify that those comments were not made by the 'top dog', but the dr. who is a "fellow" under him. He does not seem to like the fact that I am doing my homework in order to try and figure out what is wrong with my child. He, of course, does not have children - so therefore, he can not relate. Can you tell I am not happy with him?!!!

It would be fabulous if I could get you both to tell him a thing or two. Don't think he'd be denying the pain's exist then! :-)

BTW, I'm a Southern girl. We can be VERY determined when we need to be! LOL
I am not giving in, just because I don't have the same degrees as they do.

Thanks, again.
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Avatar universal
Today we are going to try a Chriorpracter(?). A friend's Dr's just KNEW he had kidney stones for severe pain, and long story short... the Chriorp. realigned him and he has been FINE since then. It's worth a shot. Even if some of the pain disaptes.

Duke can't get her in until April, but we are trying several different places. So far, several Dr's don't want to 'disagree' with our famous Dr's findings. Hope to get some ideas soon. This is really weighing on all of us.

Thanks for your ideas you have given me, thus far. BTW, the GI Dr. told me yesterday that 'narcotic's were never proven to be a problem'. And, that those studies were 'outdated information'. HMMMM?! But, there are real folks I'm finding through this website and others that would disagree! :-)
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Avatar universal
Hi there.

I think Paty in SCalifornia and this Texas Gal would Love to meet your GI doctor and tell him how the cow ate the cabbage.

Every single doctor I have met and discussed my situation knows that certain  drugs can cause a bile duct blockage and delayed empyting thus resulting in  severe pain.  

I wonder if your poor GI doctor is on the same page as all the other doctors...Hmmmmmm!!  Poor thing.
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Avatar universal
Sometimes a combination of different drugs can cause pain, and an unexplained reaction.  I wouldn't venture a guess what is causing her continued pain, but you can just about be assured it's NOT "in her head"...I HATE WHEN DOCTORS FALL BACK ON THAT EXPLANATION!

If she were my daughter and the pain continues, I would enlist the help of a physician who specializes in pain management....I have known this to solve the pain issue for several patients who could find no other way to control the pain...
Paty
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Avatar universal
Thanks Paty for your reply.

Yes, my daughter is 11 years old. When this journey began in 2004 with gallstones, we thought 'how could this be?'. Of course, all of the nurses and Dr's were amazed, as well. But, apparently, it can happen in children (mostly in teens) who are otherwise healthy with no diseases such as sickle cell, etc.

Anyway, I am curious now in regards to your statement regarding the 'Tylenol Cold'. In the past 3 weeks her list of med's that have been given are the following (OF COURSE, they were given at different times and with hospital/Dr. supervision):
Brovex HC- cough/narcotic
Tylenol-Extra Strength
Omnicef-antibiotic
Demerol-pain
Torodol-pain
Diladid- pain/narcotic
Motrin alternating with Tylenol- pain
Zofran - nausea

Since being out of the hospital (discharged with unexplained pain) she continues to be on Motrin alternating with Tylenol for pain.

My question is could this pain still be continuing after 3 weeks due to the med's she has recieved? Or, maybe even the Tylenol is still adding to the problem? I, also, wonder if the Dr's would have been able to tell if she was having a "SOD" attack having had all of the tests done that she did (MRCP, CT, etc). Or, are these attacks just pain and unable to be seen/diagnosed by the eye/tests? Some of the Dr's seem to think it is a 'phsycological' thing, to some degree. I know it is not, you can see it in her eyes, etc. At the same time the Dr's want to 'blame' her, they are the first to say "We just don't know the answer. All of the tests we've done are normal. Just manage her pain at home".

Any thoughts are greatly appreciated!!! Yes, it is such a stressful time not having any answers. Not just for my husband and me, but for her. She/we wants life to be normal again!

Thanks!
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Avatar universal
WOW!  If I'm understanding your posting correctly, you have an 11 year old with gall stones...I've never heard of anything like that..it must be driving you, your daughter and her doctors crazy!

My GI doctor explained the bad reactions to narcotics (and other drugs and substances) this way...the narcotics cause shrinking, or contraction, of some mucous membranes and other body tissues..you know how your mouth gets dry when taking pain-killers...that is ths same thing...

Since the sphincter to the pancreas is a small tube-like body part, when it is caused to contract (from the drugs), there is a backup of the pancreatic juices and enzymes, causing the pain and other resulting problems.  This is a really simplistic explanation, and I apologize for any incorrect explanation in medical, terchnical terms.

A few months ago I had "the flu" or a terrible cold, and I took "Tylenol Cold" or some such thing that contained a decongestant to stop the runny nose...it gave me the same reaction..I think due to the same phenonoum as described above....my doctor was abit sceptical when I told him about it, but I'm convinced that those of us with this unusual reaction to these things have to be wary and cautious about what we merrily swallow!

By the way...we do LOVE Torodol, but it's use is very limited.
Paty
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Avatar universal
Oh,"ozark".. and she was tested for kidney stones and infections... all were normal!

And, the nurse in the ER locally (we live 2 hours from where she had her ERCP and hospital stays) mentioned "TORADOL" to our pediatrician. She took it for the evening and day until we could get to Charleston for her to be admitted. Seemed to be a good thing!
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Avatar universal
Wish I had checked back on this board this weekend....
I can't believe some of the similiarities here!

ERCP, the top rated and 'inventor' of this procedure (in 1971), actually did her procedure. So, I do have confidence in his abilities. Though, we did not understand at the time what ERCP can really involve/mean.

My 11 yr. old has MAJOR reactions to the narcotics (Diladid= 'convulsion' type flalling(?) in the bed so much that we had pillows surrounding her after the 2nd ERCP. This time after 3-4 days on it, same thing. We gave it to her again, since Morphine = severe itching for her.)She can speak to you while shes having a reaction with Diladid. On the 2nd ERCP one, she only had 5-30 second intervals between each convulsion, for 36 HOURS!!!!Until it was out of her system.

Right before this latest 'attack' (which is STILL going on and we're now at 3 weeks!!!!!!).... she had Brovex HC for a cough. I'm thinking the 'HC' stands for Hydrocodeine?? Also, Omnicef for the bronchitus/strep sort of illness. She is allergic to LOTS of things (Amoxicillin/ Z-pack, Citrus foods). When her pain had increased so much by Christmas day, gave her Tylenol with codeine. She started, for the first time ever, severe itching with that too.

Could it be that these med's brought on some sort of Syphinc. of Oddi attack? I still don't know what that it.....
Would it last 3 weeks????? Again, upper rt. quadrant pains. We are now 'controlling' her pain with Motrin/Extra Strentgh Tylenol.
Did I mention before that she did have the syphinctor widened on the 2nd ERCP? He wanted any remaining stones to be able to drain out of the bile duct.
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Avatar universal
No, Maryroe, I am not a Texas Paty, I'm a Southern California Paty.

My pain is on the left side under my rib cage..the first time I can remember telling  my doctor about it was over 25 years ago...it's like a tightness with (usually) mild discomfort, but it doesn't come and go  when it's acting up. ...just stays like that for a few days or weeks..all my CT scans, ultrasounds, MRIs, and all the other tests over the years have been negative, except that it shows an enlarged head of the pancreas (that hasn't changed in size or description for years).  I've had a couple of attacks when my liver enzymes became elevated, but you always know when that happens, as you feel like h---!  

I've had 2 ERCPs..the first one about 20 years ago (BRUTAL!), the last one 2 1/2 years ago by a specialist who does nothing but diagnostic GI testing at UCLA, and it was MUCH easier...not anything I want to do again, but tolerable.  It too, showed nothing unusual.  However...in retrospect, I wish he had done the manometer test to see if there was more pressure in the pancreatic duct, but he didn't..he just examined it, and found it normal, except a tight sphincter...suggesting papillary problem in the Sphincter of Oddi. I am a retired RN, so try to assimilate and understand all this stuff....

From all the reading and research I've done, I don't plan on ever having the ERPC where they cut the sphincter to open it further...too many complications, and lots of pain from what I've read.

When I had my knee replacement last April, the Orthopedic Surgeon had scheduled it as an arthroscopic of knee with "possible" total knee replacement...I don't need to add to the story that I woke up with a new knee, as the damaged cartiledge was more than could be repaired.  In my inner self, I pretty well knew that would probably be the outcome.
Thanks for all your responses....it's very rare when I get to chat with someone who has this Oddi dysfunction PLUS the arthritic knees and hips!
Paty
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