Wherein I describe aspects of the biliary system and their (dys)functions
I can't sleep tonight for pain, so what do I do but grab the iPad and research this condition called sphincter do Oddi dysfunction (SOD). The good news (?) is that everything I read meshes with what I experience and what the GI doc has told me, and I see the problem and probable resolution of it.
The most comprehensive information (for those with an interest in such things) seems to be on the Johns Hopkins site (http://www.hopkinsmedicine.org/gastroenterology_hepatology/diseases_conditions/pancreatic_biliary_tract/sphincter_oddi_dysfunction.html), particularly the links under the Patient Resources section. In a nutshell, some 20% of people who have their gall bladders removed (which I did in 2004) -- particularly middle-aged women who are overweight or have elevated cholesterol -- experience SOD. Because it's characterized by idiopathic pancreatitis, it's diagnosed as much by process of elimination than anything else: recurrent, sharp pain in the upper-right epigastric section of the abdomen, particularly after eating, and elimination of other possible problems. Apparently, the musculature that allows biliary enzymes to pass from the pancreas to the duodenum either spasms or blocks passage altogether, thus causing pain. Two years ago when I was hospitalized for pancreatitis, I had all the tests mentioned in the what I've been reading -- CT scans, ultrasounds, and a test I can't remember what it's called that involves ingesting radioactive material and then monitoring its progression through the digestive system with a fluoroscope -- and I believe for the most part, all the tests came out normal. I think. I know when I was hospitalized, I definitely had an inflamed pancreas and abnormal labs, though that passed, and over the past couple years I believe my liver and enzyme labs have been normal. I don't know; no one ever shares this information with me. I either hear nothing, or I hear that something's out of whack. I need to start requesting copies of reports for myself. *sigh*
Anyway, I can see where this is leading now, since the medications the GI doc last prescribed don't seem to be doing the trick. It's what I had tried to avoid before, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) and possibly a sphincter of Oddi manometry, which is basically an endoscopic exam that extends into the biliary duct and tests the reactions of the sphincter muscles to pressure. If it seems indicated at the time of the procedure, they can do a Botox injection to the sphincter or just do an ablation and insert a temporary stent. Either way, there is some risk of pancreatitis, so I kind of have some doubts about it being a quick outpatient thing like most endoscopies. They probably have to monitor your liver and pancreas for a while after the procedure, depending, of course, on just how far they go beyond the regular endoscopy.
So yeah. Looks like I'm headed down that pike soon. Guess I should have just done it two years ago, but at the time, I was asymptomatic and preferred a less invasive treatment. Now, I'm a little concerned with timing, what with the job applications and trying to leave Arizona. I suppose the prudent thing to do would be to stay put for another year so I'm not rushed, I don't have to worry about an insurance gap, and I'm not stressed with a major life change concurrent with a major surgery. Prudent. Yeah, I'll think about it.
Meanwhile, GI doc (Cunningham) is out of town, not expected back until Friday. My doc's assistant (Mary) says my doc (Shelman) spoke to the GI doc's assistant (Angie), and she was supposed to be calling me. That was after a half dozen phone exchanges today, and I never did hear back from her again today. Maybe tomorrow, which is Wednesday. I don't know how much urgency they place on these things -- whether Cunningham will want to check me in as early as next week or if it's something they can hold off and need to schedule in advance. Given the current state of my digestive system, he may want to move quickly. I don't know. I guess I'm as ready as I'll ever be; I just need to have someone take care of Jameson.
*meh*
I don't feel any better, but maybe now I can sleep. Or not. Wish the pain would subside.