Phil's medical notes

Here are today's medical notes.
We went to the family doctor today to get a referral to get a second opinion for another GI doctor. Just to get a second pair of eyes to see if anyone missed anything.

We saw a new family doctor because Phil's regular doctor is out for 4 months cover at the wound care center. We really like the new PA. She took her time. Read the notes, read back the notes, wrote more notes, offered some different ideas that we didn't even think about.

While we wanted to get a referral to a neurologist, all the signs and symptoms still point to Chronic Pancreatitis.
What is Chronic Pancreatitis (even though Phil has had this diagnosis for over a year, I'm still not completely sure what this entails)?
Chronic Pancreatitis is (taken from www.ncbi.nlm.nih.gov)
Inflammation of the pancreas that does not heal or improve, gets worse over time, and leads to permanent damage.
Symptoms include:

Abdominal pain

Greatest in the upper abdomen

May last from hours to days

Eventually may be continuous

May get worse from eating or drinking

May get worse from drinking alcohol

May also be felt in the back

Digestive problems

Chronic weight loss, even when eating habits and amounts are normal

Diarrhea, nausea, and vomiting

Fatty or oily stools

Pale or clay-colored stools

Treatment:

People with severe pain or who are losing weight may need to stay in the hospital for:

Pain medicines

Fluids given through a vein (IV)

Stopping food or fluid by mouth to limit the activity of the pancreas, and then slowly starting an oral diet

Inserting a tube through the nose or mouth to remove the contents of the stomach (nasogastric suctioning) may sometimes be done. The tube may stay in for 1 - 2 days, or sometimes for 1 - 2 weeks.

Eating the right diet is important for people with chronic pancreatitis. A nutritionist can help you create the best diet to maintain a healthy weight and receive the correct vitamins and minerals. All patients should be:

Drinking plenty of liquids

Eating a low-fat diet

Eating small, frequent meals (this helps reduce digestive symptoms)

Getting enough vitamins and calcium in the diet, or as extra supplements

Limiting caffeine

The doctor may prescribe pancreatic enzymes, which you must take with every meal. The enzymes will help you digest food better and gain weight.

Avoid smoking and drinking alcoholic beverages, even if your pancreatitis is mild.

Other treatments may involve:

Pain medicines or a surgical nerve block to relieve pain

Taking insulin to control blood sugar (glucose) levels

Surgery may be recommended if a blockage is found. In severe cases, part or all of the pancreas may be removed.

Prognosis:

This is a serious disease that may lead to disability and death. You can reduce the risk by avoiding alcohol.

Complications include:

Ascites

Blockage (obstruction) of the small intestine or bile ducts

Blood clot in the vein of the spleen

Fluid collections in the pancreas (pancreatic pseudocysts) that may become infected

Poor function of the pancreas

Diabetes

Fat or other nutrient malabsorption

Vitamin malabsorption (most often the fat-soluble vitamins, A, D, E, or K)


Since I was having trouble figuring out what Chronic Pancreatitis was...I thought I'd clue you in on what I know about it.

While this will probably be with Phil the rest of his life, we were pretty optimistic after his appointment today.
Although the specialist could tell us more about this "disease", she was pretty reassuring that if they hadn't found any abnormalities in his blood work just yet, he at least doesn't have cancer. WAHOO. When the doctor told him this, Phil turned white. Whiter than I had ever seen him in my life. I guess that has really been weighing on his mind. So he feels a little better about all this doctor business stuff.

So the notes from today went something like this.
I have a note book that I take so I can take notes at his doctors appointments.
I first listed his symptoms which have over the past two weeks include:
Fevers
Chills
Sweating
Nausea/vomiting
Trouble sleeping
Excessive pain that won't go away with pain medicine
No response to the Celiac Plexus

Our goal at this appointment was to:
Get a referral to get a second opinion at another GI
Question if we should see any other specialist
Any other auto-immune disorders (we will ask the specialist to test for auto-immune diseases)

The outcome of our appointment was:
Continue with Pain Management- best bet to get through this
Get Splanic neurotomy (like the Celiac Plexus but will permanently kill his nerves and if nerves grow back they should not be painful).
Referral request sent in for another GI
Request an Ultrasound/scoping for the pancreas

SSRI's can cause Chronic pancreatitis (did not know this before talking with this doctor)