After a chaotic morning of having to truck down to Mountain View to get some blood work done for my pancreas specialist appointment on Monday, I had to come back up to San Francisco for my appointment with Dr. Tan at the Noe Valley clinic to get a second opinion on my pancreatic woes.
I reviewed my case with the doctor and went through my existing records and he felt that everything that could be done is being done — and that he’s in agreement with everyone else about my condition. He is not a pancreas specialist, but rather a naturopathic doctor that specializes in digestive and enzyme issues. Without a concrete diagnosis, he is unable to provide any necessary treatment.
He did, however, provide me with some ideas of what might be going on. For example, the fact that I still experience pain when I eat (mild pain for something like chicken broth, severe pain for something like rice) that my pancreas has not in fact healed. That there is still something wrong with it, which is likely why my GI doctor escalated my issue immediately when he heard that I had trouble eating rice and scheduled an emergency appointment with the pancreas specialist for Monday (rather than next Friday).
There are really only a few possible things that he believes could still be causing the pancreas irritation, though each of these may have already been ruled out by a GI or Pancreas Specialist early on in the diagnosis.
These are:
1) A Obstruction in my pancreatic duct which is causing pain when any enzymes are secreted, especially enzymes for digestion.
2) Auto-immune Pancreatitis, whereby my body is attacking the pancreas because it thinks it’s a foreign object.
3) Cystic-Fibrosis, which can be ruled out because I would’ve had this from the day I was born.
For a pancreatic obstruction, something like a gallstone still blocking the duct would’ve been visible on the endoscopic ultrasound, but there are sometimes obstructions caused by swelling and irritation of the pancreatic duct. Which basically constricts the duct in size and thus is painful when anything passes through it. This cannot typically be found through ultrasounds. This could be resolved with a surgical procedure to clear and clean the ducts.
The blood test I had this morning was to check my enzyme levels as well as a screening for auto-immune pancreatitis. If this is the case, it’s not a particularly good diagnosis as there is no clear treatment for this condition.
That said, he is eager to hear what the outcome of my appointment will be with the specialist on Monday and that his role will be much clearer once a clear diagnosis is made and he will be able to help with my recovery and rehabilitation. All in all, I felt the appointment was still productive, even though there is no clear outcome. He thinks seeing the specialist on Monday is the best idea and to update him as it goes.
One thing that has been particularly frustrating with every gastroenterologist that I have seen throughout the last ten years of my life has been their lackadaisical approach to my very severe lactose intolerance. I discovered that I was lactose intolerant about 9 years ago when I found that I was having severe chest pains every night when I’d try to go to sleep — to the point that I felt that I was having a heart attack.
