Spam (madbodger) wrote,

A little while back, I found myself unable to sleep, all too aware of an all-too-familiar pain. I put up with it for a while, but I was in bad shape and fizzygeek was worried. It sure seemed like that old bugaboo pancreatitis was back to plague me again. I figured that if I went to the ER, they'd just stick needles in me (I'm needlephobic, so I avoid this strenuously), and then just admit me for the usual regimen of bowel rest (no food or liquids) and painkillers. I figured I could manage bowel rest at home, and avoid the expense, bother, discomfort, needles, sleeplessness, and likely pneumonia associated with a hospital stay.

However, the pain continued to get worse until I decided that the possible dangers and discomfort outweighed my reluctance to deal with the ER. As per usual, we got to sit around and wait for quite some time, then get jabbed with needles and wait some more. The lab results told the story clearly enough: my serum lipase, with an expected range of 23-300 U/L, was 13951! That pretty much confirmed the physician's and my suspicions. So I got the usual dose of painkillers, a scrip for oral painkillers, and instructions for bowel rest and to see a local GI specialist. And they unplugged me and sent me home!

I didn't feel so hot, but much preferred being in my own bed with my own cats, able to get some decent sleep. The doctor I was told to see was out of town, so we tried calling another GI specialist I had seen and liked when I had been in the hospital with pancreatitis a few years ago. He wasn't available, but someone else at his practice was. My motivation to get to the bottom of this was renewed, as this episode was markedly worse than the previous ones. The doctor we saw agreed, and also was gung-ho to chase down the cause. He ordered an MRI and MRCP, so we went to the local imaging center to schedule an appointment. But there weren't any openings for several days!

At fizzygeek's urging, we went back to the ER to see if we could obtain imaging sooner that way. They jabbed me again, and I got a CT scan which showed (unsurprisingly) an inflamed pancreas. The lipase levels looked markedly improved. We got discharged again (whew) and went back home.

A few more pain-ridden days went by in a blur, then we went to get the MRI. I amused myself during the long, boring procedure by trying to guess when the magnet would buzz next so I wouldn't be breathing at that point (I was only coached briefly at the beginning), and trying to analyze the drive waveforms from the sounds they made. I never did figure out what the irregular loud pumping noise was, I'm guessing it's part of the magnet cooling system. I told them I'd want a copy of the results and they said I could drop by on Monday to pick up a CD.

A few more days go by, and I'm slowly trying clear liquids and then easy to digest foods. fizzygeek whomped up some rice cooked in chicken broth, which was filling and made me feel noticeably better. I did try going back to work on Monday (with fizzygeek driving), and things seemed to go okay. The next day, I drove myself, and swung by the MRI place to pick up my CD. The MRI desk was closed, so I went to the main desk, where they sent me back to Files. I suspect my CD was either forgotton or left at the MRI desk, because it seemed like they went and burned a CD for me while I waited.

We read the written report, which (unsurprisingly) gave a diagnosis of uncomplicated pancreatitis. The other study didn't produce results due to too much patient motion. I suppposed I guessed wrong as to when to hold my breath. Holding my breath for the entire 20-minute procedure is beyond even my abilities. I should probably go mention this to them, but I darkly suspect their control software decides on its own when to do scans, and doesn't give the operator any advance notice. Which is, of course, idiotic.

I didn't hear anything back from the doctor for a few days, so I called the practice, which has a fairly bewildering automated attendant. I finally navigated to the "talk to a nurse" option, which took a voice mail. That's when I discovered that the "doctor" I'd seen was actually a nurse practitioner. No matter, as long as I get a diagnosis. I tried viewing the CD, but the files were in a format I didn't recognize, along with some Windows-only software. More on this in another post.

I eventually got a call back from the doctor's office, saying the results don't show anything unexpected, other than a slight dilation of the gall bladder, and a mumbled suggestion that perhaps we might want to do some sort of additional gall bladder test, and that they'd be there all day the next day to take calls. I called back the next day, and was again greeted with the unhelpful automated attendant, and left another message inquiring about these gall bladder tests. I'm guessing that this is either an HRCP (whatever that is), an endometrial ultrasound (a fairly unpleasant procedure where they insert an ultrasound probe down the esophagus, through the stomach, and image the combined bile and pancreatic duct from the intestinal end), or another procedure where the gall bladder is induced to contract, and its ability to contract is measured (which can indicate the presence of fine sandlike gallstones).

The doctors really want the root cause to be gallstones. They've asked all the standard questions (I have zero risk factors for gallstones), and done the usual imaging (these gallstones, if they exist, are invisible to X rays, MRI, CT scans with and without contrast dye, and ultrasound). I can follow their logic, as the pancreas and gall bladder's efferent ducts merge into a shared opening into the intestines, and a blockage in this opening would tend to distend both organs, as we've observed. I'm not averse to having my gall bladder removed, if it would avoid further recurrence of the pancreatitis, but all the evidence available is circumstantial.

Tags: health
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