Is the test different for acute vs. chronic pancreatitus?

[DigitalMan]

We are still trying to find the cause for my wife's attacks of massive upper abdominal pains that are below the rib case in the front and radiate around the back. Every time she has gone into the ER they have done blood tests and none of them have shown pancreatitus. She has had two ERCP's and both times they gave her pancreatitus and the pain felt identical to her attacks. In those cases, her levels showed she did have pancreatitus, but not any other time. I thought I may have read somewhere that the test for acute pancreatisus won't show chronic pancreatitus, or vice versa. Is this true? What tests do they do to test for each? I'm wondering if she has chronic pancreatitus and they have only been testing for accute all along of something like that.

Thanks,
Guy

[aniee1]

Hi
I have changed my diet drastically. I consume no more than 20 grams of fat a day. I eat alot of veggies and fruits and drink only water and applejuice and one cup of coffee in the morning. I haven't had a glass of wine in 6 months. I gave up smoking 4 years ago. I've switched to Lactose-free dairy products. I get enough fiber, vitamins and minerals daily. I don't know what else to do.  It was the spasms in my common duct area that night that caused my toes to curl downward. The spasms happened the same time as the toe curling. There must also be some nerve entrapment. I have a large scar in that area from the gallbladder surgery. It may be possible that adhesions are also playing a part with this pain. The stone that caused all my problems years ago was located in the bile duct.  It was a servere attack that brought me the hospital the first time but I had no insurance and they didn't know what caused it at first so I waited 2 years. It eventually got to the point I was living on baby food.  It was dumb, huh! But I had four children to support and couldn't afford to be out of work.  Live and learn.........Aniee

[Nanny]

They "say" that refined sugars are not supposed to be good for pancreatitis, but I do cheat with low fat or no fat products, in moderation.  I love jelly belly's, and strawberry twizzlers....I know it's not supposed to be good for us, but gheez, you've got to have some fun on this low fat regimen! Those are something I will treat myself to once a week or so.   I also occasionally treat myself to Healthy Choice chocolate ice cream (Rocky Road), it's got 2 grams per miniscule serving (1/2 cup).  So far this occasional cheating has not seemed to make my pain any worse.

I eat lite yogurt all the time for lunch, it's no-fat and doesn't seem to bother me, and helps keep my weight balanced, since the enzyme supplements do cause weight gain.

Coffee is also another no-no, but I've been addicted to it since my teenage years, and it's hard to give up, so I've reduced consumption of that down to two cups in the a.m.  On days that my pancreas is acting up, I don't drink it at all.

[seashoretracks]

about the diet - do you know if once in while it is OK to eat lowfat or nonfat sweets?  What about yogurt does that cause a problem?  Also is coffee OK?  What about some type of non-fat chocolate dessert once in a while?

[Nanny]

I know you've had a lot of tests done, but have any of these doctors ever checked your amylase and lipase levels? Sometimes they'll show elevation with pancreatic problems, but not always.   LFT's are liver panels, right?  I was reading back through some of the posts and also saw that there was the possibility of SOD with you after a procedure several years ago, but they thought it was caused by one of the chemicals used in the procedure and wasn't accurate?  Was that your comment?

I guess I'm just mystified why the doctor's wouldn't even consider the possibility of chronic pancreatitis after hearing about your symptoms and the mention of possible SOD problems in your past.  There are other procedures that can be done to get a firm diagnosis, and sometimes you have to keep looking until the cause is found.

Have you done anything on your own to make it easier for yourself, like a strict low fat diet, abstaining from all alcohol, staying away from fried foods, etc., and has any of that made any difference in how you felt?

Just trying to help you find some answers.  And of course there is always hope, even if it is chronic pancreatitis.  I've got CP, it's not the end of the world, it just means some adjustments to diet and lifestyle, and it means finding a really good, compassionate gastro to recommend the proper treatment and pain maintenance to make things easier.
Nanny

[taylee]

Yes, Ainee, I have the exact same thing happen to me during the painful attacks that you described. I have severe charlie horse like feeling in my right leg all the way down to the toes and they curl under. I told my dr's about the leg cramping during an attack and they dismissed it as nerve pain, not related to the attack.
I too, have had the pain become more constant in nature and less cramping in the leg and toes. But my belly blows up like a balloon after eating the second meal of the day and for the remainder of the day it keeps bloating.
I have asked over and over about chronic pancreatitis and not a single doctor thinks I could have it due to normal LFT's.
I sit here at a computer, reaching out to you guys, because I have gone before so many doctors and have just suffered like an animal without relief.
I wish I could find an answer too. I feel sorry for everyone going through this misery. I want a life again, and to get rid of the pain.
If it was chronic pancreatitis,would there be any hope? I am losing my resolve.
Taylee

[Nanny]

These previous attacks do sound like SOD attacks, and what is happening now sounds like pancreatitis problems.  The bloating after meals and raised liver levels are both symptoms.  It is good that you are seeing a specialist, I would suggest that you tell him about the problems two years ago and what is happening now.  Ask the specialist to consider SOD and arrange to have you tested for it.  The best diagnostic tool for this would be an ERCP with manometry to check the pressure on the sphincter.  It is not always an easy condition to detect.

Do understand that with chronic pancreatitis many patients do not always have elevated amylase and lipase levels anymore during an attack.  My levels do not elevate during milder attacks, only during acute attacks and then not always.  The doctors may need to do further tests to make a firm diagnosis.

As far as the numbness and cramping in your toes...these SOD attacks can be quite severe, it may be that during the attack your clenched your toes and may have pinched a nerve, sort of like a charley horse affect, and that those nerves are still pinched or are still bruised.  I wouldn't worry too much about that at this point, it they should return to normal with time.  You need to be more concerned with the pancreas problem right now.  Good luck.
Nanny