Chronic Pancreatitis – Is there any hope?

[jdinasia]

Questran has been useful in patients that have problems with reabsorption of bile (yes I know -- gall bladder) --- I was diagnosed with Habba syndrome and it worked perfectly. The pain I had (note past tense) was brutal. During the episodes, which now recur very rarely the amitryptaline made bearable.

you have my sincerest hopes for relief from your symptoms, and my suggestions should only be treated as such. If the meds are not contra-indicated by your other meds , in your shoes I would try them.

[Sheryl]

I have had type 2 for over 25 years. I became insulin dependant about 22 years ago. My maternal grandmother was type 1 and my mother (decd), sister and brother are/were all type 2.

My profile seems to fit type 2 rather than the type 3 as described in the scholarly article

I just think that I was pre-disposed to have adult onset diabetes and the cp has been caused by a chronic drinking problem, but who knows for sure?

Sent from my GT-N7100 using Thaivisa Connect Thailand mobile app

Yes, if you have had it for a full 25 years then likely not caused by the pancreatitis (though that may be aggravating it).

[Sheryl]

Questran has been useful in patients that have problems with reabsorption of bile (yes I know -- gall bladder) --- I was diagnosed with Habba syndrome and it worked perfectly. The pain I had (note past tense) was brutal. During the episodes, which now recur very rarely the amitryptaline made bearable.

you have my sincerest hopes for relief from your symptoms, and my suggestions should only be treated as such. If the meds are not contra-indicated by your other meds , in your shoes I would try them.

He does not have gall bladder disease nor problems with bile reabsorption. He has pancreatic insufficiency due to chronic pancreatitis.

[Hedghog]

Sheryl.

Astounding posts.

You are indeed a mine of information.

I take my hat off to you.

Thank you.

[Lefty]

Mobi,

Just a long shot, I am currently in Houston and have for a week or so been watching a commercial for Victoza which is an injectable to treat type 2 diabetes. It may contribute/cause pancreatitis. Possibly other injectable diabetes medicine also has similar issues.

Here is the warning for Victoza---

Do not use Victoza^® if you are allergic to liraglutide or any of the ingredients in Victoza^®. Serious allergic reactions can happen with Victoza^®. If symptoms of serious allergic reactions occur, stop taking Victoza^® and seek medical attention. Pancreatitis may be severe and lead to death. Before taking Victoza^®, tell your doctor if you have had pancreatitis, gallstones, a history of alcoholism, or high blood triglyceride levels since these medical conditions make you more likely to get pancreatitis.

Stop taking Victoza^® and call your doctor right away if you have pain in your stomach area that is severe and will not go away, occurs with or without vomiting, or is felt going from your stomach area through to your back. These may be symptoms of pancreatitis.

Before using Victoza^®, tell your doctor about all the medicines you take, especially sulfonylurea medicines or insulin, as taking them with Victoza^® may affect how each medicine works. If you use Victoza^® with insulin, you may give both injections in the same body area (for example, your stomach area), but not right next to each other.

Also tell your doctor if you have severe stomach problems such as slowed emptying of your stomach (gastroparesis) or problems with digesting food; have or have had kidney or liver problems; have any other medical conditions; or are pregnant or plan to become pregnant. Tell your doctor if you are breastfeeding or plan to breastfeed. It is unknown if Victoza^® will harm your unborn baby or if Victoza^® passes into your breast milk.

Your risk for getting hypoglycemia, or low blood sugar, is higher if you take Victoza^® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. The dose of your sulfonylurea medicine or insulin may need to be lowered while taking Victoza^®.

Victoza^® may cause nausea, vomiting, or diarrhea leading to dehydration, which may cause kidney failure. This can happen in people who have never had kidney problems before. Drinking plenty of fluids may reduce your chance of dehydration.

The most common side effects with Victoza^® include headache, nausea, and diarrhea. Nausea is most common when first starting Victoza^®, but decreases over time in most people. Immune system related reactions, including hives, were more common in people treated with Victoza^® compared to people treated with other diabetes drugs in medical studies.

Please click here for Prescribing Information and Medication Guide.

Novo Nordisk provides patient assistance for those who qualify.
Please call 1-866-310-7549 begin_of_the_skype_highlighting 1-866-310-7549 FREE end_of_the_skype_highlighting to learn more about Novo Nordisk assistance programs.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch , or call 1-800-FDA-1088 begin_of_the_skype_highlighting 1-800-FDA-1088 FREE end_of_the_skype_highlighting.

Good Luck

Lefty

[Sheryl]

The OP has a long history of alcohol abuse so there is no mystery as to why he has chronic pancreatitis. Alcoholism is the most common cause of this.

[Mobi]

The OP has a long history of alcohol abuse so there is no mystery as to why he has chronic pancreatitis. Alcoholism is the most common cause of this.

I have been injecting Humalog and Lantus insulin for many years.

Both types are made by major international drug companies and are used by millions of diabetics throughout the world.

to my knowledge, there has never been any suggestion that these insulins can have any of the side effects as suggested by Lefty.

But I thank him for his concern.

[jdinasia]

Questran has been useful in patients that have problems with reabsorption of bile (yes I know -- gall bladder) --- I was diagnosed with Habba syndrome and it worked perfectly. The pain I had (note past tense) was brutal. During the episodes, which now recur very rarely the amitryptaline made bearable.

you have my sincerest hopes for relief from your symptoms, and my suggestions should only be treated as such. If the meds are not contra-indicated by your other meds , in your shoes I would try them.

He does not have gall bladder disease nor problems with bile reabsorption. He has pancreatic insufficiency due to chronic pancreatitis.

Aware of that, Sheryl hence the "(yes I know--gall bladder)" -- just thought the medicine that helped with the diarrhea that I suffered at the time MAY help.

Same with the Amitryp ... just thoughts on symptom relief.

[Mobi]

Following the revelation that I should include fat in my meals in order to make PERT (pancreatic enzyme replacement therapy) more effective, I did just that last night.

I ate a stir fry meal of vegetables and lean pork, using a little oil for cooking, and also added a fried egg.

I also increased the amount of enzyme capsules that I took with the meal, which was not very large.

​RESULT: One of the most painful pancreatic attacks I have had since I returned form the UK. The pain killers wouldn't touch it, and I was in agony for much of the night. I am now zonked out as I had to overdose slightly to get the pain to subside.

During the past week my diarrhoea had slightly improved. Some days my bowels didn't open at at all, and on others I would pass slightly formed faeces before they reverted to water in subsequent bowel movements. It may not sound much, but for me it was an improvement. Three bowel movements per day instead of 4 or 5, with the first being semi-normal.

Today I am back to violent diarrhoea - just water.

So while I am not challenging this new theory that increasing the fat content of meal improves the effectiveness of the meds, I simply cannot go along with it as It is too painful and distressing.

I will try to make contact with Dr Supot at Siriraj hospital, but not until all the troubles in Bangkok have died down. So it will probably be New Year, at the earliest.

In the meantime I think I will stick to a very low fat diet as at least I seemed to be making some progress, however small.

[Mobi]

Questran has been useful in patients that have problems with reabsorption of bile (yes I know -- gall bladder) --- I was diagnosed with Habba syndrome and it worked perfectly. The pain I had (note past tense) was brutal. During the episodes, which now recur very rarely the amitryptaline made bearable.

you have my sincerest hopes for relief from your symptoms, and my suggestions should only be treated as such. If the meds are not contra-indicated by your other meds , in your shoes I would try them.

He does not have gall bladder disease nor problems with bile reabsorption. He has pancreatic insufficiency due to chronic pancreatitis.

Aware of that, Sheryl hence the "(yes I know--gall bladder)" -- just thought the medicine that helped with the diarrhea that I suffered at the time MAY help.

Same with the Amitryp ... just thoughts on symptom relief.

The thing is - and I admit I don't totally understand these things - is it good to take something to relieve the symptoms without taking care of the underlying cause?

My GI specialist gave me some 'diarrhoea pills' but warned me to use them sparingly as my stomach would become bloated. In other words all the meds do is stop bowel movements and the 'stuff' just builds up inside my stomach.

If the pancreas isn't working and the food isn't properly digested, then the result is diarrhoea. Stopping the resultant mess from being excreted doesn't solve the problem.

That's my take on it.

Maybe I'm wrong.

[Kalbo]

Hang in there , Mobi, even though it's not so easy. For those who have never experienced a pancreatic attack, the pain is indescribable. Absolutely horrible.

[Sheryl]

Questran has been useful in patients that have problems with reabsorption of bile (yes I know -- gall bladder) --- I was diagnosed with Habba syndrome and it worked perfectly. The pain I had (note past tense) was brutal. During the episodes, which now recur very rarely the amitryptaline made bearable.

you have my sincerest hopes for relief from your symptoms, and my suggestions should only be treated as such. If the meds are not contra-indicated by your other meds , in your shoes I would try them.

He does not have gall bladder disease nor problems with bile reabsorption. He has pancreatic insufficiency due to chronic pancreatitis.

Aware of that, Sheryl hence the "(yes I know--gall bladder)" -- just thought the medicine that helped with the diarrhea that I suffered at the time MAY help.

Same with the Amitryp ... just thoughts on symptom relief.

The thing is - and I admit I don't totally understand these things - is it good to take something to relieve the symptoms without taking care of the underlying cause?

My GI specialist gave me some 'diarrhoea pills' but warned me to use them sparingly as my stomach would become bloated. In other words all the meds do is stop bowel movements and the 'stuff' just builds up inside my stomach.

If the pancreas isn't working and the food isn't properly digested, then the result is diarrhoea. Stopping the resultant mess from being excreted doesn't solve the problem.

That's my take on it.

Maybe I'm wrong.

You are correct re the anti-diarrheals. reserve them for things like long trips where it is essential to temporarily stop things up.

Do not take any additional medication except as prescribed by a GI specialist thoroughly conversant with your medical history.

lost of well meaning suggestions here but they do not appear to be from people familiar with the pathology involved in your specific case.

[Sheryl]

P.S. Is the Creon enteric coated? If so may do better to break open and sprinkle on food. From what you describe you are not absorbing enough lipase.

[Mobi]

Hang in there , Mobi, even though it's not so easy. For those who have never experienced a pancreatic attack, the pain is indescribable. Absolutely horrible.

Thanks Kalbo. You were the only one who suspected I might have chronic pancreatic when I still believed it was gallstones.

As you said to me in a pm, the pain is "akin to having a hot knife stuck in my gut and twisted around"

I have seen no reason to argue with that very apt description.....

[Mobi]

P.S. Is the Creon enteric coated? If so may do better to break open and sprinkle on food. From what you describe you are not absorbing enough lipase.

Yes it is.

I think I will have try increasing the dosage first, and only consider opening up the capsules as a last resort.

The good Doctor Supot in his 2013 paper states:

"This dosage of 40 000 U per meal is what being recommended by the Australian Pancreatic Club recommendations, the Italian Consensus Guidelines for CP, and some experts. However, it should be kept in mind that this dosage is the minimum one. One study has shown that with this dosage of lipase, fat digestion could be normalized in only 60% of cases. Two recent studies that prescribed the dosage of lipase 75 000 U or 80 000 U per meal demonstrated an increase of CFA to only 78% and 86%, respectively, which remained abnormal. Thus, increasing the dosage of lipase to 90 000 U per meal or higher maybe required in some patients."

I started taking 40,000 for small meals and 50, 000 for larger meals but I now take 50,000 for all meals.

I think my next step is to increase the dosage to 60,000 per meal and if no better, to 70,000 and so on up to 90,000 per meal.

On the subject of enteric-coating, Dr Supot writes:

"Enteric-coating enzymes are now preferred to conventional enzymes because of the availability of preparations that contain large dose of lipase, and the presence of enteric coating will preclude the need of co-therapy with proton pump inhibitor (PPI) as being required in the case of conventional pancreatic enzymes. Some enteric-coated preparations also have microspheric forms that may more effectively mix with food than those in the tablet forms."

He goes on to write:

"Nonresponders.

.... Then, increase the dose of lipase to 90 000 or 1000 U of lipase/kg/meal should be tried. In case the patient had previous upper gastrointestinal surgery or anastomosis that may interfere the mixing between pancreatic enzyme and the food, opening the capsules and administering the enzyme granules directly with meals may solve the problem."

As I have not had "previous upper gastrointestinal surgery or anastomosis that may interfere the mixing between pancreatic enzyme and the food" (at least I don't think I have), then maybe opening capsules is a bit down the line for me.

By far the best plan is to try and obtain a consultation with the good doctor, but what with Bangkok riots and the festive season nearly upon us, I think I will leave it until New Year to try and make contact.

In the meantime, i will steadily increase the medication - notwithstanding the fact that the cost is slowly bankrupting me - and see how it goes..

[RWA]

Malaysian researcher finds diet can reverse Type 2 diabetes

A Malaysian endocrinologist, Dr Lim Ee Lin, is part of a clinical research team at Newcastle University which has discovered that Type 2 diabetes can be reversed by an extreme low calorie diet alone.

Dr Lim, who graduated from Newcastle University Medical School in 2000 and completed her specialty training in Endocrinology and Diabetes earlier this year, carried out the study as part of her postgraduate doctoral degree is working with the team led by Professor Roy Taylor.

“To have people free of diabetes after years with the condition is remarkable and all because of an eight week diet, which also regains the body’s ability to make insulin, ” said Dr. Lim.

In an early stage clinical trial of 11 people, all reversed their diabetes by drastically cutting their food intake to just 600 calories a day for two months and three months later, seven remained free of diabetes.

Click here to read details about the trial which showed diet can reverse Type 2 diabetes and click here for full information on the diet for patients with Type 2 diabetes and their GPs or medical teams.

Currently an estimated 1.4 million Malaysians, or one in six adults above the age of 30, have diabetes. Of those, 98% have Type 2 diabetes, which is a long-term condition caused by too much glucose – a type of sugar – in the blood.

“This is a radical change in understanding Type 2 diabetes. It will change how we can explain it to people newly diagnosed with the condition. While it has long been believed that someone with Type 2 diabetes will always have the disease and that it will steadily get worse, we have shown that we can now reverse the condition,” said Dr. Lim.

Traditionally, it had been thought that as a progressive condition, Type 2 diabetes can be controlled by diet initially then tablets, but would eventually require insulin injections; and the findings of the Newcastle University team now provides a news perspective to treating it.

Type 2 diabetes, which was once known as adult-onset diabetes, is now also found in young adults and children as a result of the pancreas not producing enough insulin to break down excessive glucose or due to the body not reacting to the hormone, known as insulin sensitivity.

Under close supervision of the research team, the 11 adults were put on an extreme diet of just 600 calories a day consisting of liquid diet drinks and non-starchy vegetables. They were matched to a control group of people without diabetes and then monitored over eight weeks, while the insulin production from their pancreas and fat content in the liver and pancreas were studied.

After just one week, the team found that their pre-breakfast blood sugar levels had returned to normal while a special MRI scan of their pancreas revealed that the fat levels in the pancreas had returned from an elevated level to normal (from around 8% to 6%), allowing it to regain the normal ability to make insulin which reduced blood sugar after meals.

The volunteers then returned to three months of eating normally but received advice on portion size and healthy eating. When re-tested, seven remained free of diabetes.

“We believe this shows that Type 2 diabetes is all about energy balance in the body,” explained Dr Lim, “if you are eating more than you burn, then the excess is stored in the liver and pancreas as fat which can lead to Type 2 diabetes in some people. What we need to examine further is why some people are more susceptible to developing diabetes than others.”

Gordon Parmley, 67, who took part in the trial said: “At first the hunger was quite severe and I had to distract myself and take my mind off food, but I lost an astounding amount of weight in a short space of time. At the end of the trial, I was told my insulin levels were normal and after six years, I no longer needed my diabetes tablets. Till today, 18 months on, I still don’t take them. It’s astonishing really that a diet – hard as it was – could change my health so drastically. After six years of having diabetes I can tell the difference - I feel better, even walking round the golf course is easier.”

[Mobi]

RWA, Thank you for your post.

However, as this is a thread about chronic pancreatitis, may I respectfully suggest that if you wish to discuss type 2 diabetes, then you start a new thread on this subject.

But since you have raised it, I will comment briefly.

There is nothing particularly new about the discovery that sufferers of type 2 diabetes can, in certain circumstances, bring their sugar levels back into line by achieving a dramatic loss in weight.

I recall a similar controlled experiment carried out in the UK a few years ago where volunteers were put through an enforced dieting routine and succeeded in apparently ‘reversing’ their condition.

I also recall the research doctor commenting that if any of the volunteers did put on weight again, there was little doubt that their type 2 condition would return.

So to put this research into perspective, there is a possible ‘cure’ a for a select few who are able to lose a large amount of weight and who were probably only border-line or mildly type 2 sufferers in the first place.(I believe they were all taking tablets as opposed to injecting insulin)

In my case, I have been insulin dependent for nearly 25 years ( I take 4 injections per day) and at the time I was diagnosed I was not over-weight. In my own family, both my mother and brother developed type 2 diabetes, and neither of them were over-weight – in fact my mother was worryingly thin but she still developed the condition.

My sister is also type 2 and like me is insulin dependent.

Clearly there is a faulty gene in my family (my grandmother was type 1 and died from the condition at a young age) and no amount of dieting is going to reverse our conditions.

Due to my pancreatic problems I am dropping pounds in weight like there is no tomorrow, but as yet have not observed any change in the control of my sugar levels. In any case I am having enough problems finding a balanced diet that will work with my chronic pancreatitis, (and not suffer from malnutrition), without embarking upon an extreme low calorie diet to try and cure my diabetes....

I have had two more pain attacks this week already, the last being last night when I had no more than one hour's sleep.

But I do appreciate you bring this to the attention to others who may be interested.

[Mobi]

In the past week I have had 4 severe pancreatic pain attacks – Mon, Wed, Fri, and Sunday (last night)

Each one was worse than the previous one, and last Friday I thought the pain would never stop and I was in sheer agony for over 5 hours.

Then last night the pain started at 9 p.m. and didn’t subside until 9 a.m. this morning – a full 12 hours of searing, unbelievable pain. For most of those 12 hours I was doubled up, moaning in agony, wondering how much more of this I can realistically take before I give up.

I have increased the enzyme meds and am extremely careful with what I eat but nothing seems to make any difference and even doubling or trebling the number of pain killers doesn't touch the pain.

Following Sheryl’s recommendation, I have made an appointment to see a pain specialist in Bangkok on Wednesday, and can only hope she can come up with some meds that are more effective with the pain without turning me into a morphine-addict – although at this stage, I don’t really care any more.

I’d settle for anything if it meant that the pain can be stopped.

There seems little doubt that my condition is rapidly deteriorating. I had my first pain attack back in July, and since then my symptoms just get worse and worse.

The diarrhoea continues unabated, but is accompanied by ever more severe stomach cramps; and the pain attacks have increased in frequency and the pain level is getting worse – if indeed that is possible…

I wish I knew what to do because I cannot live like this for too much longer.

[GaryB1263]

Good luck Mobi. I hope you are better soon.

[canman]

I hope you find some relief Mobi. Nothing wrong with being addicted to morphine or any other drug if it makes life worth living.

[Sceptict11]

Mobi

It begins to sound as though a nerve block is needed.

I am unaware as to if this is available in Thailand but you should ask.

[moe666]

Wonderful stuff Sheryl. Thanks a million. I will follow up and advise.

I am on creon 10000 as it is the only one available at fascino in pattaya. I take 4 - 5 caps per meal which adds up to around 140000 per day.

At 7 pm I had a beef stew that I cooked myself using lean meat and now, at 12.45 am I am suffering from a severe pain attack. Maybe the meal was too big, or too much meat.This is after two pain free nights.

The doc at Siriraj sounds the right way to go. I'll see what I can do to make contact.

Sent from my GT-N7100 using Thaivisa Connect Thailand mobile app

Do you eat wheat? if so stop for a few days and see if some of your problem is a wheat intolerance. We had a lady staying at our residence here in Chiang Mai who had very painful attacks after a meal I recommended she cut out wheat and she was pain free for a week until she decided that couldn't be it and eat some pizza, big mistake on her part. Its worth a try.

[Mobi]

Wonderful stuff Sheryl. Thanks a million. I will follow up and advise.

I am on creon 10000 as it is the only one available at fascino in pattaya. I take 4 - 5 caps per meal which adds up to around 140000 per day.

At 7 pm I had a beef stew that I cooked myself using lean meat and now, at 12.45 am I am suffering from a severe pain attack. Maybe the meal was too big, or too much meat.This is after two pain free nights.

The doc at Siriraj sounds the right way to go. I'll see what I can do to make contact.

Sent from my GT-N7100 using Thaivisa Connect Thailand mobile app

Do you eat wheat? if so stop for a few days and see if some of your problem is a wheat intolerance. We had a lady staying at our residence here in Chiang Mai who had very painful attacks after a meal I recommended she cut out wheat and she was pain free for a week until she decided that couldn't be it and eat some pizza, big mistake on her part. Its worth a try.

It's not wheat. I have chronic pancreatitis. Its already been diagnosed with an MRCP scan and other tests and the pain is exactly what you get with this condition.

Its not a question of what causes it - we know that - It's a question of how to deal with it.

[Mobi]

Mobi

It begins to sound as though a nerve block is needed.

I am unaware as to if this is available in Thailand but you should ask.

That is the purpose of my appointment with the pain specialist at Samitivej - to see about having a nerve blocker.

However....I have just been reading up on 'celiac plexus block', which the nerve block that is used for sufferers of chronic pancreatitis and I discovered that it cannot be given to people using blood thinners, like warfarin, which rules me out. (I have a mechanical heart valve).

Unless the doc has some other tricks up her sleeve , I may well be be wasting my time.

[Kalbo]

Mobi

It begins to sound as though a nerve block is needed.

I am unaware as to if this is available in Thailand but you should ask.

That is the purpose of my appointment with the pain specialist at Samitivej - to see about having a nerve blocker.

However....I have just been reading up on 'celiac plexus block', which the nerve block that is used for sufferers of chronic pancreatitis and I discovered that it cannot be given to people using blood thinners, like warfarin, which rules me out. (I have a mechanical heart valve).

Unless the doc has some other tricks up her sleeve , I may well be be wasting my time.

I wonder if it is worthwhile looking at removing, or partially removing the pancreas as there are 3 surgical procedures that I know of for painful cases. (The Peustow procedure, head resection and complete removal). Surgery is a last resort as it usually renders the patient to be complete insulin dependent diabetic, but at the risk of sounding callous or insensitive, I don't think such a result would bother you too much. Don't give up, Mobi, as there are still a number of feasible options available.

[Mobi]

After a great deal of deliberation I have decided to cancel my appointment to see the pain specialist tomorrow, partly for the reasons stated above - i.e. it is doubtful that she can do much for me as nerve blocks are ruled out due to my use of blood thinners.

But more than this, I have succeeded in obtaining an appointment to see Dr Supot at Siriraj hospital on 3rd January. This doctor was referred to me by Sheryl and is clearly the foremost expert in Thailand on pancreatic disease and its treatment.

I was not at all sure that I could obtain such an appointment, but now that I have, it seems sensible to see him first and see what he has to say about pain management.

Coincidentally, the pain specialist I was going to see tomorrow is also based at Siriraj, so maybe I can see her there as well and save myself a sack load of money. (In my experience Samitivej in Sukhumvit is one of the most expensive private hospitals in Bangkok).

In the meantime I am more or less living on small meals of eggs and rice soup in a desperate attempt to prevent any more excruciating pain attacks. So far so good, but it won't be much of a Christmas...

Edited December 10, 2013 by Mobi

[Sheryl]

Mobi

Do not rule out a pain block. You would need to go off the anticoags for a short time before the surgery, that is all. (Same is true of any other surgery you might need, or even a tooth extraction). Alternatively they can administer Vitamin K which reverses the action of warfarin.

It is your best option, pain-wise.

[Mobi]

Mobi

Do not rule out a pain block. You would need to go off the anticoags for a short time before the surgery, that is all. (Same is true of any other surgery you might need, or even a tooth extraction). Alternatively they can administer Vitamin K which reverses the action of warfarin.

It is your best option, pain-wise.

Thanks Sheryl, duly noted.

However, I hope my experience at Q Sirikit at Sattahip when I had my endoscopy is not repeated.

They were most insistent that I stopped my warfarin prior to the procedure, (presumably to ensure I didn't bleed out in the OR), but there was no follow up afterwards and i was left to my own devices as to decide when and how much warfarin I should take to get INR back up to the acceptable range. They had talked to me about administering some alternative drug (I forget the name) but it all got forgotten about, which frankly didn't really surprise me.

I had to do it by trial and error and it took three weeks before my INR was stabilised.

I hope that the staff at Siriraj are more solicitous and I will discuss this matter with them when I go there.

[moe666]

Wonderful stuff Sheryl. Thanks a million. I will follow up and advise.

I am on creon 10000 as it is the only one available at fascino in pattaya. I take 4 - 5 caps per meal which adds up to around 140000 per day.

At 7 pm I had a beef stew that I cooked myself using lean meat and now, at 12.45 am I am suffering from a severe pain attack. Maybe the meal was too big, or too much meat.This is after two pain free nights.

The doc at Siriraj sounds the right way to go. I'll see what I can do to make contact.

Sent from my GT-N7100 using Thaivisa Connect Thailand mobile app

Do you eat wheat? if so stop for a few days and see if some of your problem is a wheat intolerance. We had a lady staying at our residence here in Chiang Mai who had very painful attacks after a meal I recommended she cut out wheat and she was pain free for a week until she decided that couldn't be it and eat some pizza, big mistake on her part. Its worth a try.

It's not wheat. I have chronic pancreatitis. Its already been diagnosed with an MRCP scan and other tests and the pain is exactly what you get with this condition.

Its not a question of what causes it - we know that - It's a question of how to deal with it.

Yes I understand that but there could also be other issues that affect your health as well. Best of luck to you.

[Mobi]

Apologies for my somewhat curt reply and thank you for your kind suggestions.

Sometimes - most of the time - I'm not exactly in the best of moods and I have to keep telling myself to cheer up and be polite....

While I haven't yet tried a totally gluten free diet, I have substantially reduced the amount of wheat I eat, and there is nothing in my eating patterns that might suggest that wheat is the cause of my pain.

In just about all the occasions which have prompted a severe pain attack, there has not been any wheat in the preceding meal. In fact the other night I ate 3 slices of bread with some seafood for my evening meal and I had a pain free night. Ditto I sometimes eat wheat based cereals for breakfast, and occasionally a sandwich for lunch but have never had a pain attack during the day time. I think I can confidently put it down to eating too much food at night, and it doesn't seem to matter whether it is beef, pork or chicken. My damaged pancreas, even with all the meds, cannot cope with too much meat - red or white.

So as written above I will make the evening meals smaller and smaller and easier to digest.