Most doctors have difficulty diagnosing pancreatitis, acute or chronic, without the pancreas slapping them in the face and saying “hey dummy I’m inflamed, that means pancreatitis.”
Diagnosing Pancreatitis Took 14 Doctors!
One of the reasons diagnosing pancreatitis can be difficult is simply that when it comes to pancreatitis doctors can be dumber than bags of barber hair or at least seem to be because they don’t listen. They are in too big of a hurry to see their next patient, are thinking about their golf tee time or simply don’t give a shit because it isn’t them who is in agony.
Another reason diagnosing pancreatitis is difficult for many doctors that they THINK they are omnipotent, know your body, its symptoms (what you are experiencing) a lot better than you do and if you beg to differ they simply chalk you up as a hypochondriac or a lonely person in need of attention. Yet …
Another reason diagnosing pancreatitis presents a real challenge to many doctors is because they have difficulty diagnosing anything unless it slaps them in the face (CT scan showing horrendous damage due to necrotizing pancreatitis or cysts the size of watermelons). Horrendous damage and internal bleeding helps them arrive at a diagnosis of pancreatitis but if you don’t have those types of complications yet, and trust me on this, you don’t want those easy to read signs but …
You have moderate to severe gastrointestinal symptoms and have yet to have a doctor give you a correct, common sense diagnosis make sure you persevere in finding a gastroenterologist who received his/her degree from somewhere other than a Cracker Jack box, is able to recall what they learned in medical school and use common sense (you know – if it walks like a duck, quacks like a duck, looks like a duck it most likely isn’t a damn frog right?) along with the modern diagnostic tools. I know I am asking a lot because …
Finding a good doctor with great diagnostic skills is like locating a huge placer gold deposit but …
I know there are at least one in 14 (7%) who have brains, and diagnostic ability (know how to read tests and have common sense). In fact here’s one who wrote an article about Chronic Pancreatitis and Current Problems of Diagnostic Criteria
Doctors used to be able to use their knowledge plus common sense now they rely solely upon diagnostic equipment and some idiot’s scoring criteria. This fact has done nothing but create so many variables that people who do not meet the criteria slip through the cracks. Plus …
They Think They Know Everything …
Including what your symptoms are even before you tell them. When you TELL them, they don’t listen. They already KNOW! You have to understand that doctors think they are omnipotent (God complex) but they are not. That is why they call their business a “practice.” They want you to think they can do no wrong or never make a mistake while they practice on you. And …
The tests (blood work, scans etc …) are only as good as the people who interpret them. If you are lucky enough to get a moron radiologists that couldn’t read a newspaper and understand it the first time, trying to read your MRI, CT Scan, etc …
Chances are they will miss what another more observant doctor may catch and then there is the chance that the person reading your test may be nothing more than a tech who just got out school and wouldn’t know scar tissue or beading unless the damage carried a big red sign. Then …
You also have to contend with the average ER doctor who simply doesn’t know anything to speak of about pancreatitis and so doesn’t recognize the symptoms for what they are, only draws blood once when you arrive (which may be to early for amylase and lipase levels to rise) and of course is too egotistical to ask someone else for a consult. Then …
Even if you have a decent doc he/she may not know that a small percentage of patients don’t even present with high elevations in enzyme levels and of course if they suspect pancreatitis but your enzyme levels don’t rise then they rule out pancreatitis even if ALL the symptoms scream AP. Then …
There are those patients who have SEVERE pancreatitis and yet do NOT have the severe pain that even a mild attack of AP usually presents with so they don’t catch that either because they may not know this fact. And …
Who pays for this lack of knowledge and/or common sense?
YOU. So …
Keep looking for quality care. Find a doctor who will dig until they find out what’s wrong with you. I know that is asking a lot because those doctors are really hard to find. An accurate diagnosis is important otherwise everyone is simply guessing.
Dude you hit this article right on the nail!!! I just want to thank you for writing this article because I have been going from doctor to doctor complaining about stomach pain for years and all they could diagnose me is with acid reflux. The docs completely missed the underlined problem for years and now after countless doctors of being FED UP with I finally said, “adios douche bags.” Now the pain is so severe that I finally did some digging and came up with suggesting to this new doctor and told him to test my pancreas because it really seems like all the symptoms were there. The test showed pancreatitis. I will need additional testing to confirm my diagnosis. I can’t wait for more bad news, ugh. However, I will take your advice and try to heal with liquid veggie juice. Also keep up the sarcasm it’s hilarious and the real deal!!
Glad you like my sarcastic sense of humor lol. I’m sorry to hear that you too have had your share of “dumb as barber hair” docs. It never ceases to amaze me how stupid (in real world situations) intelligent people can be. Doctors are “book smart” but when it comes to being on the street, in the trenches, most remind me of fish out of water and I swear couldn’t find their own ass in the dark with a map and flashlight. Just be glad you got a doc that was smart enough to put his/her ego aside and actually check your pancreas as you suggested. Many I have met would have said something like “couldn’t be your pancreas because you haven’t farted once while I’ve been in the room.” Anyway …
Good luck to you and keep in touch. 🙂
I had my gallbladder removed about 6 years ago and since have had “suspected” pancreatitis numerous times… I say suspected since my blood tests would come out okay but would “usually” show on a CT. The pain was right under the right rib cage radiating to back. After reoccurring bouts of suspected “pancreatitis” and numerous tests, endo. ultrasounds, mri’s, etc. I had an ERCP to clear out small stone from primary bile duct along with bile “sludge” and had stents put in the primary bile duct and in pancreas… Yes, I had a mild-moderate case of Pancreatitis after my ERCP too. The stents placed in the ERCP were removed about 1 month ago. I had no pancreatitis with the stents (but they were in for less than 2 months) but still had what only I can describe is right upper quadrant pressure which I can say I have had mostly ever since I had my gallbladder out with varying degrees of intensity. I think the Dr. thought the pressure sensation were due to the stents but I told him I had that pressure before the stents… I had my first acute mild pancreatic attack since the stents were removed and was not sure if my problem is pancreatitis, intrahepatic issues, or what… My dr. doesn’t seem to place any importance on this upper quadrant pressure which although is not painful, it is uncomfortable and since my latest mild acute attack, I do have a very mild lingering pain to go along with that pressure which varies in intensity (usually in response to what I eat). So… I was curious about doing a “liver cleanse” to attempt to “cure” this recurrent bouts of pancreatitis (shows you how little I know) I’ve had since my gallbladder removal… probably 3 real acute severe cases with about 6 mild ones… or maybe I’m just used to the pain? But I’m worrying about frying the Pancreas but my latest blood test (iipase and the other) were normal… Is that normal? And what do you think about these liver cleanses? One step is using a huge amount of olive oil, just the thought of that makes my pancreas hurt. Based on your Pancreatitis diet, I’m sure you’d advise heavily against a liver cleanse? btw, have you heard about that upper quadrant pressure that lingers on and on and on?
Hi Joe – I can understand your concerns in regards to weird, lingering symptoms and the fact your doctor doesn’t place importance on those symptoms. I don’t recall ever having or reading about right upper quadrant pressure but that doesn’t mean it isn’t important in some manner. You said “that pressure which varies in intensity (usually in response to what I eat).” So my next question would be does it feel like indigestion? Do you get nausea after eating, say 15 – 20 minutes later? If so you might need some enzymes to help with digestion. If that isn’t the case then I have no clue except that you damage may have occurred in the head of your pancreas and that is causing the residual effects (symptoms).
You are right about my thoughts on a liver cleanse. Consuming that amount of oil is begging for another acute pancreatitis attack.
I have read about instances where amylase and lipase levels did not raise. It is NOT common but does happen. Usually when the pancreas is so far gone it no longer produces any enzymes but that isn’t always the case. Sometimes, rare as it may be, the enzyme levels do not increase. However they may not show an increase simply because the blood draw was taken to early and never repeated. It takes around 4 hours into an acute attack or continued inflammation such as is found in chronic pancreatitis for amylase and lipase to show increased levels. The increases with chronic pancreatitis may only be marginal.
Thank you kindly for your response. I have been doing some research and in addition to some of the supplements you suggested, I was suggested to try a product bought at any health store (sprouts, whole foods, etc) called Wobenzym N …. I take about 1 – 3 tables about 1 / 2 hour before eating and have been doing that in addition to taking the daily supplements and have noticed a great improvement. I have also switched over to a regimen of very low fat – – but not fat free – but certainly no read meat, pork, butter or cheeses… The pressure has lessened substantially and the intermittent bouts of pain (just right below and a few inches to the right of the sternum) have also decreased dramatically. I’m crossing my fingers. I hope this lasts. Also noted was a great increase in energy and mental alertness… My full list of supplements (in addition to the above Wobenzym) is a liquid vitamin (vital earth mineral super multi), milk thistle w/ dandelion (for liver), Curcumin, and Grape seed extract. My dr. wants to do another MRI with and without contrast to make sure I have no left-over stones in the liver or bile ducts (I have no gallbladder)… He also wants me to try Zenpep (Pancrelipase) with meals, dicylomine (sp??) with pressure sensations and get on a good pro-biotic. As for indigestion… no, it isn’t that or gas… I have felt it frequently off and on after my gallbladder was removed YEARS ago and honestly when they cleared out the stone and sludge from my primary bile duct, I thought that would cure that but it didn’t… In any case, I wanted to thank you again for your response, your blog, etc… which got me thinking in a different direction – one that has finally gotten me some relief that I highly doubt I would ever get from my or any western medical gastroenterologist.
You are welcome and I am glad you are feeling better. And like doctors, which I am not, I am gonna say – keep doing what you’re doing, it seems to be working and that is a good thing. 🙂
Just wanted to update this. Yes. I was having pancreatitis but my pancreas enzymes correct rather quickly so if i wait too long or get the tests done too early, they may discard my symptoms something other.
I must admit that i stayed on a very low fat diet for about five months and then over the course of five months after that, my diet reverted back to a normal American diet. In retrospect, i may have thought i was cured. About four weeks ago, i had bad symptoms and reluctantly went to the er and my pancreas levels were at 2500. Needless to say, they hospitalized me for four days. Interesting fact though was my enzymes had reverted to near normal levels within 24 hours but the symptoms hung around.
They pumped me full of narcotics with very little relief. I begged for anti inflammatory meds so they stated with iv toradol and that’s when things started to get better. It’s four weeks now. I’m still sore and very sensitive to foods but i know this is part of the healing process. I have an endoscopic ultrasound scheduled Feb 19 to assess damage, potential causes (if any) and take biopsies. Ct scan shows some fattiness and mild to moderate atrophy. In short, I’m going to be real strict on low fat diet, supplements, complex carbs, etc. I hope they perfect 3d printing of pancreas’s soon!
Hey Joe – sorry to hear you aren’t doing well again. Some people think I’m too anal when it comes to diet, supplements and some other stuff but you are finding out the hard way (I learned that way too) WHY I am anal lol. They (docs) say that 80% of people who have an AP attack heal with no further problems but IF the pancreas sustained significant damage (who knows what amount is actually significant enough) I find it hard to believe it heals in a few days. It may take months and if the damage does heal it may still leave enough scarring etc to cause permanent problems (CP) even if the docs can’t diagnose CP due to someone not meeting their criteria. Then …
When someone has another attack it may be even worse.
Personally, I have found it is much safer to be anal.
I hope you get better soon, heal up totally and watch what you eat! 🙂
I have been having pain since I was 16 always ruled off as gerd with minimal testing done. I’m now 28. But I learned around 22 alcohol helped the pain so I began drinking 2-4 beers a night. Aided in helping my appetite and decreasing the pain. But 18 months ago the pain came back with a vengence. I too had the right side pressure and pain but multiples doctors wouldn’t stop looking at my gallbladder which was fine and liver enzymes were fine then. Sent me home twice with muscle strain…(from a desk job) so for a year after all my ultrasounds and endoscopies I said forget it. Finally about a year ago I asked my doctor to check liver again this time they were raised 150\156 alt/ast. So he sent me to a different specialist who looked over my records recently and said you were diagnosed with mild pancreatitis a year ago and have some calcifications… The date? You guessed it when I was released with muscle strains.. .. A total joke…. So here I’ve been continuing with my nightly drinking. What gets me is still when I drink my stomach feels 200% better. Shouldn’t pancreatic issues cause me pain when I drink not feel better? My fiance and I are quitting drinking in fact I feel I’m on day 3 of a pancreatic attack even though I haven’t been to the ER. But I have no faith in the local ER and am at a total loss. Just disheartening this could have been an issue for 12 years and I never had a clue. Almost feel like its too late. Thanks for your insight was a good read.
It is never to late. Doctors are human, make mistakes (way to many) and some are simply nothing more than – what is that phrase I am looking for? Oh yes, educated idiots. Anyway, alcohol can cause the pancreas to react quickly or after a time. It is good you are quitting. About the calcification – I have often wondered and mentioned this to someone before whether chelation with edta may be beneficial for pancreatic calcification. I HAVE NO CLUE IF IT WOULD WORK OR IS EVEN SAFE but there are some M.D’s and O.D.’s out there who use chelation on their heart patients (atherosclerosis plaque build up) to get rid of arterial plaque. One of the components of plaque is calcium. Supposedly the edta chelates (claws out) the calcium and thereby removes the plaque. IF that is the case it would seem that edta could also “claw out” the calcified areas of a pancreas. IF it were me I’d check into it further. I’d also start watching my diet and taking some supplements that help heal the pancreas. You can find all that stuff on this blog. It isn’t the end of the world. You are alive and kicking and that means you can keep living. Diet and supplements. Good luck John. 🙂
Love this article. I feel exactly the same way about my doc, they seem to blow off every thing you say it makes me not want to go back to the docs office. Thank you for this blog!
You’re welcome. Thank you for the kind words. 🙂
Thank you sooooooooo much for this website!!!! My goodness I feel blessed and slightly more sane having found your information. In Jan. 2014 I woke up feeling nauseated and swore I had food poisoning. I sent my child off for the day and I stayed home rather than work. I felt sick so I laid in bed all day sipping water, convinced if I threw up it would finally “pass”. Well by 7pm I was developing a headache and I took two ibuprofen with a piece of plain toast. I think the toast sent me over the edge and the ibuprofen, based on what you have written, probably stopped it from being worse. I suddenly felt like I couldn’t breathe, severe pain in my upper back and shoulders. My neck felt so heavy. I started sweating and was terrified. I went to ER and WAITED forever. I really believed I was going to die there as I was getting dizzier by the second. Finally the ER doc came in for blood work and quickly said my pancreas levels were 5,000. Normal, by his book, is 100. I was admitted. It took 3 days of no water, except by IV, and no food. No other meds were given. All my levels went to normal and I was sent home. Clearly this condition is a war and we must fight. Thank you so much for sharing your battle and tips.
Hi Rebecca – you’re welcome. hope the info helps you. It doesn’t sound like you were having fun last January. Hopefully your pancreas has healed up and you feel much better now.
Is it possible to have pancreatitis without raised lipase and amylase level?
Hi Erin – Yes it is possible. Rare but possible. Infact here is a case study of an 84 year old man who presented at the hospital with recurrent abdominal pain, jaundice and vomiting. Lipase was normal. CT scan showed acute inflammation of the pancreas. They killed him with a sphincterotomy. Article
Here are more case studies – article
Thank you for the information. I had pancreatitis four years ago. Having the same feeling again but blood levels were normal and CT scan showed no inflammation. So they told me its nothing but it certainly does not feel like nothing. Finding it difficult to get answers and feeling very frustrated.
you’re welcome. get well 🙂
Hi, It has been 4 years of varying degrees of pain, pressure and discomfort in my left side under my ribs, radiating to my back. Along with indigestion, heart burn and a lot of gas. I have seen 2 different Gastroenterologists, one diagnosed me with Acid Reflux, 4 years ago. The other one a year ago thought I had arthritis in my back. I just had a CT Scan with contrast last month, and all is normal. I do think it is pancreatitis and have been taking the supplements for 4 years, but not at the levels you suggest, and when I have pain that is above what I can tolerate, I take 400 to 800 mg of Advil. I do try to eat low fat for the most part, but it is so difficult to do all the time. I just want a diagnosis, because I know if I know for sure what my issue is I will be more apt to stay on the straight and narrow, Do you have any suggestion on what doctor in the Philadelphia area I can go see to get a conclusive diagnosis?
Hi Lorie – sorry to hear you have been feeling crappy for so long. I’m gonna quote you so I can ask a question: “have been taking the supplements for 4 years, but not at the levels you suggest, and when I have pain that is above what I can tolerate, I take 400 to 800 mg of Advil. I do try to eat low fat for the most part, but it is so difficult to do all the time.”
Have the diet, supplements and Advil been helpful?
I think there is a Mayo Clinic in the Philadelphia area.
Yes, when I strictly follow the regimen I feel pretty well, just the gas heartburn and pressure I was talking about, but not terrible. I will be more vigilant and stick to the plan and hopefully things will get better. Thanks for your site and the wealth of knowledge you share. I am hoping because I have been doing so much of what you recommend, the doctors are not able to detect anything through the tests. Unfortunately Mayo Clinic is not in Philadelphia area… it is in Arizona, Minnesota and Florida, I will make the trek if I have to someday.
Lorie – you are welcome. I am glad to hear you are feeling better! I thought there was a Mayo Clinic in Philly, sorry.