Huge archive

HI!! Reading the post on Prozac brings up another question I've
always had in the back of my mind. I don't know if anyone will have
a answer for this or can relate but, I doesn't hurt to ask. Back in
my senior year of high school I was hospitalized for bulimia. I was
in the hospital for three weeks and put on Prozac. I was on the drug
for almost 6 months when I started to get horrible nightmares and I
would wake my mom up screaming in my sleep and sweating. So, of
course my mom had the doctors take me off Prozac.
Heres my concern, I will always be recovering from a eating disorder
and I actually am doing pretty well with controling it. But, did
having this since I was 16 years old and going on Prozac help bring
on my pancreatitis? (along with the birth control pill)Cause you have
to imagne what I've done to my body from purging for years. If
anyone can help me with this!!!! I am sorry if the subject does
bother anyone, I know a eating disorder is a hard subject for some
people to understand.
Thanks, Stacey

Hello Everyone,
I received this email from Marge and I believe it was intend for the group.
marge grubb <mgrubb2356@...
Date: Fri, 7 May 2004 06:56:36 -0700 (PDT)
From: marge grubb
Subject: hi
To: reeann@...
hi,
just wondering if anyone out there developed pancreatitis from having an ERCP?
that's how mine came about, and just about everyone else i hear from developed
it otherwise.
thanks for your help.
marge in Ohio

http://www.prozacspotlight.org/updates/
March21,2003
From the White House
to the Madhouse
The Bush Administration Joins
Psychiatry in Going Mad
What do you get when you put American psychiatry, drug companies, the
FDA, and the Bush administration all together in the same room? You
get a whole lot of madness that's what. At the center of all this
madness are Prozac, Zoloft and Paxil.
Living up to the title The Lilly Suicides, Eli Lilly, maker of
Prozac, remains the target of product liability actions asserting
that selective serotonin reuptake inhibitors (SSRIs) can produce
agitation, violence, and suicide. In November of last year Lilly
settled another such case, this one involving plaintiff Diane Cassidy
of Monroeville, Pennsylvania. She and her husband Melvin first
attracted attention by picketing Lilly headquarters in 2000, handing
out fliers asking "Lilly, how many people are maimed or dead on your
drug today?" Such animosity came, the Indianapolis Star (November 30,
2002) reports, after Diane Cassidy was prescribed Prozac, not for
depression, but for the "off-label" application of weight loss.
According to the filed complaint, the drug induced suicidal thoughts
in Ms. Cassidy, which led abruptly to her slashing her wrists and
taking an overdose of painkillers. Today she is paralyzed on one side
of her body and suffers from psychological impairment.
As though to take its place, another civil action was filed against
Lilly the same week as the Cassidy settlement, this time in U.S.
District Court in Georgia. The case involved a wrongful death suit
filed by plaintiff William Shell not to be confused with the case
of 60 year-old Donald Schell, who after being prescribed Paxil two
days earlier, shot to death his wife, his daughter, his infant
granddaughter, and then himself. Rather, William Shell is the husband
of the late LaVerne Shell, who, 11 days after starting on Prozac,
shot herself to death at the age of 63. Like Diane Cassidy, Ms. Shell
was not taking the drug for any kind of psychological disturbance,
but for an "off-label" use to treat migraine headaches. The Shell
case also put a new spin on the Prozac-suicide link, arguing that the
longstanding violence associated with the drug occurs because some
small percentage of users are poor metabolizers of the drug - a
problem Lilly has known about for years and for which doctors could,
but do not, test.
As civil actions continue to beat on the door of Eli Lilly no
plaintiff has yet to win an actual case against them in a court of
law other attacks are being launched against the SSRI makers by
researchers and mental-health professionals. In good part due to the
work of British public health advocate Charles Medawar, head of the
consumer group Social Audit, the British Committee on Safety of
Medicines has put together an expert working group to re-assess the
safety of SSRIs. The conclusions of the group are likely to be
influenced by several new studies, including recent findings from
psychiatrist and historian David Healy.
David Healy is perhaps the most knowledgeable person on the subject
of SSRIs and suicide, and his latest report on SSRIs appeared this
year in the journal Psychotherapy and Psychosomatics. The UK
psychiatrist has once again found that SSRIs present an unusual risk
of inducing both agitation and suicide when compared to either
placebos or other anti-depressants. This is an effect, the report
states, that is dose related, which means that these risks increase
with dose; it's also related to the quality of the study in that the
more careful the study, the stronger the link to suicide. This
finding is also encountered when the individual on the drug is
a "healthy volunteer." Similar findings were also published in the US
a few months earlier.
As reported in Insight on the News (October 15, 2002), Arif Khan, an
adjunct professor of psychiatry at Duke University School of
Medicine, carefully examined clinical-trail data for the SSRIs
gathered from 1985 through 2000, including the results of over 71,000
participants. Like Healy, Khan found unusually high rates of suicide
and attempted suicides with the SSRIs. He noted as well that such
findings are remarkable because clinical trials actually exclude
those who have a history of suicidal ideation or suicide attempts.
While the general population has a suicide rate of about 11 per
100,000, Khan found a rate for individuals on SSRIs to be 718 per
100,000. Robert Whitaker, author of Mad in America, has said about
the Khan study that, "You shouldn't be seeing four to five times the
suicide rate in drug-treatment groups, especially when these drugs
are supposed to prevent this."
Suicide and violence are of course not the only dangerous "side
effects" associated with SSRIs. Just as Eli Lilly and Prozac lie at
the center of the controversy over SSRIs and violence,
GlaxoSmithKline (GSK) and Paxil (branded Seroxat in the UK) lie at
the center of a growing storm over SSRIs and physical dependence. A
number of civil actions, including some class-action suits, have made
the case that terminating one's use of SSRIs can have severe and
dangerous physical and psychological consequences, including nausea,
dizziness, sleep disturbances, and agitation. These consequences can
make it very difficult for an individual to discontinue the drug,
thereby creating a physical dependence on it. Moreover, a 1997 report
by the World Health Organization shows how GSK's Paxil appears to be
especially problematic in this regard.
Because of these withdrawal experiences, GSK has also found itself in
a bit of hot water over its promotion of the drug. In October of last
year, Britain's Guardian (October 12, 2002) reported that GSK had
been found by the Prescription Medicines Code of Practice Authority
to be in violation of the industry code of conduct in their marketing
of Paxil. By playing down the dangers of taking the drug, GSK was
found by the UK authority to have failed in three ways: not limiting
themselves to evidence-based claims, misleading the public about the
safety and effectiveness of a drug, and failing to present claims in
a balanced manner. Charles Medawar of Social Audit responded to the
decision by stating in The Guardian that "this is an important ruling
which casts doubt on GSK's claims that [Paxil/Seroxat] is not
addictive." This ruling follows on the heels of a US District Court
in California, which found Paxil television spots to be misleading.
The ruling was overturned, however, with the help of the FDA and the
US Justice Department, which brings us to the dubious role of the
Bush Administration in all this madness.
Here's where another drug joins our story of SSRI associated suicide:
Pfizer's Zoloft. The name of the victim: Victor Motus. His story is
an especially interesting one. Late in 1998, Victor Motus was
scheduled to fly to Washington, DC to accept an award from President
Clinton. A Filipino-American, Motus was being recognized for work he
had done while serving on a local school board in Cerritos,
California. On the day he was to arrive in Washington November 12,
1998 Motus was found in a pool of blood by his wife Flora. Like a
number of users before him, he was dead from a self-inflicted gunshot
wound. Motus had been taking Zoloft for six days. Prior to his death,
he had complained to his wife Flora that the drug made him
feel "crazy."
Although Lilly has never lost such a lawsuit, Pfizer was especially
concerned with the Motus suit because it was filed just after GSK
lost the Schell SSRI suicide-murder case in Wyoming. As detailed in
an excellent report from the Boston Globe (December 22, 2002), Pfizer
responded to this concern by soliciting the legal assistance of
lawyer Daniel E. Troy. Not merely a lawyer familiar with the
pharmaceutical industry, Troy is also a lawyer who had recently been
appointed chief legal counsel to the FDA by President Bush.
Immediately prior to the appointment, Troy was working as a Pfizer
lawyer against the FDA. It can hardly be viewed as a surprise that,
following Pfizer's solicitation of Troy's help on the Motus case, he
filed a brief stating that the FDA did not support the view the SSRIs
put some users at greater risk for suicide. When asked about the
Schell case, in which a court determined that indeed there was such a
risk, Troy responded, "I'm not familiar with the case." Thus, while
Victor Motus was to be honored by President Clinton, his memory was
in the process of being trashed by the reckless pro-corporate
administration of President Bush.
The Schell case had involved Paxil and GSK, and while Troy may not
have been interested or informed about it, he was certainly
interested in helping GSK with their current legal problems
concerning drug withdrawal. In fact, Troy filed an FDA brief on their
behalf, stating that the FDA sided with GSK in concluding that Paxil
does not produce physical dependence, which makes it habit forming,
but rather produces, like many psychiatric drugs, a "discontinuation
syndrome." From this position, the FDA also went on to argue that
GSK's ads for Paxil were not misleading. In fact, Troy was the one
who filed a brief against the US District Judge of California, which
led her to lift the temporary order that had taken GSK's ad off the
air.
As the Globe report makes clear, the appointment of someone like Troy
can greatly determine policy even though his appointment does not
have to be approved by Congress. In the case of Troy, one such
appointment is having a huge impact. Another example: after arriving
at the FDA, Troy changed the policy regarding the FDA warning letters
that are sent out to drug companies when their advertising is
questionable or false. Now all warnings were to pass through Troy's
office, with the subsequent effect that, in 2002, the number of
warnings decreased by two-thirds.
The Globe report also suggests that Troy's office is hoping now to
ease regulations restricting a drug company's promotion of "off-
label" use. Before joining the FDA, Troy and associates sued the FDA
over its "off-label" policy, arguing that drug companies should at
least be able to do workshops and send out articles that supported
new (unapproved) uses. Drug makers often favor "off-label" use
because it allows the expanded use of a drug without the company
having to test whether that use is safe or effective; since all this
is happening without the company's official recommendation, they are
generally viewed as not responsible for a drug's effectiveness. The
deregulation of this off-label use by Troy would mean the almost
immediate return to the days of 19th century patent medicines
when "drug companies" could advertise anything, regardless of the
validity of its merits, and with little or no liability. As the
Cassidy and Shell civil actions make all too clear, where each case
the use was "off-label," such an idea is like the drug companies
themselves reckless and dangerous.

http://www2.eckerd.com//RxAdvisor/showtext.aspcpnum=259&monotype=full&
match=F&gname=Fluoxetine&r=9999
Fluoxetine capsules or tablets
What are fluoxetine capsules or tablets?
FLUOXETINE (Prozac® and Prozac® Weekly) is an antidepressant. It
helps improve a person's mood. Fluoxetine can also help people with
anxiety, obsessive compulsive disorder, eating disorders, panic
disorder, and post-traumatic stress. Fluoxetine is marketed as
Sarafem® for the treatment of premenstrual dysphoric disorder (PMDD),
a severe type of premenstrual syndrome. Generics are available for
some products. While most forms of fluoxetine are taken daily,
Prozac® Weekly capsules are taken just once a week, and no generic
is available for this formulation.
What should my health care professional know before I take fluoxetine?
They need to know if you have any of these conditions:
diabetes
heart disease
kidney disease
liver disease
receiving electroconvulsive therapy
seizures (convulsions)
suicidal thoughts
an unusual or allergic reaction to fluoxetine, other medicines,
foods, dyes, or preservatives
pregnant or trying to get pregnant
breast-feeding
How should I take this medicine?
Take fluoxetine tablets or capsules by mouth. Follow the directions
on the prescription label. Swallow the pills with a drink of water.
You can take fluoxetine with or without food. Take your doses at
regular intervals. Do not take your medicine more often than
directed. Do not stop taking except on your prescriber's advice.
If you are taking Prozac® Weekly: Take your dose on the same day of
the week each week. These capsules have a special coating. Swallow
the capsules whole. Do not cut, crush, or chew them.
What if I miss a dose?
Regular Prozac® capsules or tablets: If you miss a dose, take it as
soon as you can. If it is almost time for your next dose, skip the
missed dose and go back to your regular dosing schedule. Do not take
double or extra doses.
Prozac® Weekly: Try not to miss your scheduled weekly dose. You may
want to mark a calendar to remind you for that day of the week. If
you miss a dose, and it is still the day you normally take your
medicine each week, then take it as soon as you can. If it is another
day, then take the dose as soon as you remember and then adjust your
weekly doses to the new day from that day forward. Do not take double
or extra doses. There should be one week between each dose.
What drug(s) may interact with fluoxetine?
Fluoxetine has the potential to interact with a variety of
medications, check with your healthcare professional. The following
list contains some of these interactions.
Do not take fluoxetine with any of the following medications:
astemizole (Hismanal®)
cisapride (Propulsid®)
pimozide (Orap®)
terfenadine (Seldane®)
thioridazine (Mellaril®)
medicines called MAO inhibitors-phenelzine (Nardil®),
tranylcypromine (Parnate®), isocarboxazid (Marplan®), selegiline
(Eldepryl®)
Fluoxetine may also interact with the following medications:
alcohol
amphetamine
buspirone
carbamazepine
certain diet drugs (dexfenfluramine, fenfluramine, phentermine,
sibutramine)
certain medicines for migraine headache (almotriptan, eletriptan,
frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan,
dihydroergotamine, ergotamine, methysergide)
cimetidine
cyproheptadine
dextroamphetamine
dextromethorphan
dofetilide
ergonovine
furazolidone
linezolid
lithium
metoprolol
molindone
medicines for anxiety or sleeping problems, such as diazepam or
alprazolam
medicines for mental depression
medicines for mental problems or psychotic disturbances
methylergonovine
phenytoin
propafenone
St. John's wort
voriconazole
warfarin
Tell your prescriber or health care professional about all other
medicines you are taking, including non-prescription medicines,
nutritional supplements, and herbal products. Also tell your
prescriber or health care professional if you are a frequent user of
drinks with caffeine or alcohol, if you smoke, or if you use illegal
drugs. These may affect the way your medicine works. Check with your
health care professional before stopping or starting any of your
medicines.
What should I watch for while taking fluoxetine?
Visit your prescriber or health care professional for regular checks
on your progress. Continue to take your capsules even if you do not
immediately feel better. It can take several weeks before you feel
the full effect of fluoxetine. If you get suicidal thoughts, extreme
agitation, or inability to sleep or sit still, call your prescriber
or health care professional at once.
If you have been taking fluoxetine regularly for some time, do not
suddenly stop taking it. You must gradually reduce the dose or your
symptoms may get worse. Ask your prescriber or health care
professional for advice.
You may get drowsy or dizzy. Do not drive, use machinery, or do
anything that needs mental alertness until you know how fluoxetine
affects you. Do not stand or sit up quickly, especially if you are an
older patient. This reduces the risk of dizzy or fainting spells.
Alcohol can make you more drowsy and dizzy. Avoid alcoholic drinks.
Do not treat yourself for coughs, colds or allergies without asking
your prescriber or health care professional for advice. Some
ingredients can increase possible side effects.
Your mouth may get dry. Chewing sugarless gum or sucking hard candy,
and drinking plenty of water will help.
If you are going to have surgery, tell your prescriber or health care
professional that you are taking fluoxetine.
What side effects may I notice from taking fluoxetine?
Side effects that you should report to your prescriber or health care
professional as soon as possible:
difficulty breathing
dizziness or lightheadedness
fast talking and excited feelings or actions that are out of control
flu-like symptoms (fever, chills, cough, muscle or joint aches and
pains)
irregular heartbeat (palpitations)
seizures (convulsions)
skin rash or itching (hives)
unusual tiredness or weakness
vomiting
Side effects that usually do not require medical attention (report to
your prescriber or health care professional if they continúe or are
bothersome):
agitation or restlessness
anxiety or nervousness
blurred vision
difficulty sleeping
daytime drowsiness
diarrhea
dry mouth
flushing
headache
increased sweating
indigestion
increased or decreased appetite
sexual difficulties (decreased sexual desire or ability)
stuffy nose
tremor (shaking)
Where can I keep my medicine?
Keep out of the reach of children in a container that small children
cannot open.
Store at room temperature between 15 and 30 degrees C (59 and 86
degrees F). Throw away any unused medicine after the expiration date.
NOTE: This information is not intended to cover all possible uses,
precautions, interactions, or adverse effects for this drug. If you
have questions about the drug(s) you are taking, check with your
health care professional.

05/07/04
Hi ReeAnn,
Can you tell me if they can test your pancreas to
see if you are allowed to have an Islet Cell
Regeneration or not. I know already that the head of
my pancreas is completely damaged and the disease has
started to spread to the tail. Do you know if I would
be a candidate for this type of procedure?

http://www2.eckerd.com//RxAdvisor/showtext.aspcpnum=757&r=9999&match=B
&infotype=&ixid=1173&ix=Metoclopramide*tablets&gname=Metoclopramide&la
st=
Metoclopramide tablets
What are metoclopramide tablets?
METOCLOPRAMIDE (Reglan®) has a number of uses. Metoclopramide
increases the movements of the stomach and intestines. It can help
treat heartburn in patients who suffer from a backward flow of
stomach acid into the esophagus, often called "GERD". It is also used
for diabetic gastroparesis, a condition in some diabetics that causes
discomfort, heartburn, náusea, and a feeling of fullness after meals.
It can also be used for other purposes, like hiccups. Generic
metoclopramide tablets are available.
What should my health care professional know before I take
metoclopramide?
They need to know if you have any of these conditions:
asthma
breast cancer
depression
high blood pressure
kidney disease
Parkinson's disease or a movement disorder
pheochromocytoma
seizures (convulsions)
stomach obstruction, bleeding, or perforation
an unusual or allergic reaction to metoclopramide, procainamide,
sulfites, other medicines, foods, dyes, or preservatives
pregnant or trying to get pregnant
breast-feeding
How should I take this medicine?
Take metoclopramide tablets by mouth. Follow the directions on the
prescription label. Swallow the tablets with a drink of water. Take
metoclopramide on an empty stomach, about 30 minutes before eating.
Take your doses at regular intervals. Do not take your medicine more
often than directed.
What if I miss a dose?
If you miss a dose, take it as soon as you can. If it is almost time
for your next dose, take only that dose. Do not take double or extra
doses.
What drug(s) may interact with metoclopramide?
alcohol
bromocriptine
cyclosporine
digoxin
medicines for diabetes, including insulin
medicines that treat diarrhea
medicines for hay fever and other allergies
medicines for mental depression
medicines for mental problems or psychotic disturbances
medicines for Parkinson's disease, like levodopa
medicines for sleep or for pain
Tell your prescriber or health care professional about all other
medicines you are taking, including non-prescription medicines,
nutritional supplements, or herbal products. Also tell your
prescriber or health care professional if you are a frequent user of
drinks with caffeine or alcohol, if you smoke, or if you use illegal
drugs. These may affect the way your medicine works. Check with your
health care professional before stopping or starting any of your
medicines.
What should I watch for while taking metoclopramide?
It may take a few weeks for your stomach condition to improve on this
medicine.
You may get drowsy or dizzy. Do not drive, use machinery, or do
anything that needs mental alertness until you know how
metoclopramide affects you. Alcohol can increase drowsiness or
dizziness; avoid alcoholic drinks.
If you are going to have surgery, tell your prescriber or health care
professional that you are taking metoclopramide.
What side effects may I notice from taking metoclopramide?
Serious or limiting side effects are uncommon, but may include:
breast enlargement in men or women, or production of breast-milk in
women who are not breast-feeding
change in the way you walk (shuffling feet)
difficulty moving, speaking or swallowing
drooling, lip smacking, or rapid movements of the tongue
involuntary or uncontrollable movements of the eyes, head, arms and
legs
irregular heartbeat or palpitations
muscle twitches and spasms
skin rash
unusual tiredness or weakness
Side effects that usually do not require medical attention (report to
your prescriber or health care professional if they continúe or are
bothersome):
depression
diarrhea
difficulty sleeping
drowsiness
headache
menstrual changes
restlessness
sexual difficulties (decreased sexual desire or impotence)
Where can I keep my medicine?
Keep out of the reach of children in a container that small children
cannot open.
Store at room temperature between 15 and 30 degrees C (59 and 86
degrees F). Throw away any unused medicine after the expiration date.

Dear Liz,
I have been one Amitriptyline, aka Elavil, for several years and I wish I never
started on it. Like you I started on on the 10mg dose. I was told it helps
with pain by changing the way the brain precieves pain. Also it was supposed to
help me sleep. Over the last three years the dosage has slowly been increased
up to 75mg.
At my last appointment with the PCP he changed it to Mirtazapine 15mg. The one
thing my PCP didn't tell me about was the migraine headaches that come with
stopping the Amitriptyline. So I been slowly trying to wean myself off of them
before starting the Mirtazapine. I know the headaches come from the
Amitriptyline because if I missed a dose, I would get the headaches. They would
ease as soon as I took one.
So I have been cutting the 75mg tabs in hlaf. Started with the larger halves
and now taking the smaller halves. Pill cutter isn't the best in the world...
As soon as I can get by for a few days without a headache, will cut them into
quarters. So far I been trying to get off them for 3 weeks now. Will take at
least another 2 weeks before I can start the Mirtazapine.
Just think you should know about this BEFORE you start taking them. I guess you
could call it an addiction in the purest form of the word. Though I did NOT
take them to "get high". My body craves them beyond my control.
While on the topic of medications, I want to once again warn everyone about the
dangers of Reglan. This drug is intended for short term use only, i.e. 4-6
weeks. I have been on it since 2000 and I am facing lose of my teeth because of
it. It causes involuntary movements that can manifest in a variety of ways -
like Parkeson's disease. And it does not stop with discontinued use of Reglan.
For me it meant gritting my teeth. This got so bad at night I bought a sport
mouth guard to wear at night. I found this so uncomfortable that I couldn't use
it. I also find myself gritting my teeth during the day and no matter how hard
I try to break this habit, I still do it. So far I have lost one tooth. Had a
pressure sensitive toothache in the molar. The dentist said the teeth gritting
contributed to the problem and I will be losing others as well. Now several of
my other teeth are now giving me problems. Hoping I can put off getting them
pulled as long as possible, but beginning to accept that I will eventually lose
all my teeth. I am awaiting a referral to a Movement Specialist Neurologist for
this problem.
So PLEASE if you are on Reglan, talk to your doc about stopping this drug before
it is too late!! The side effects do NOT go away even after stopping the drug
and are life long. I know one person who is having problems with the entire
left side of their body.
If you are taking Reglan and have noticed similar side effects, please send me a
private email and I can provide you with more information.
ReeAnn M. Betts-Morris - VA
Owner, ThePancreatitisPlace
434-409-7162

Dear Brenda,
We are so lucky to have you. Missed you in chat Sunday night!!! I
feel that you may been having it very rough lately... Talk with you
soon, hopefully in the am.
Saying a 2am prayer for you,
With many thoughts and prayers since way back,
Robert
A Founding Member of TPP,
roberthammett@...

Rhonda,
It is good to hear from you!!! How are the baseball games going? I
hope Amanda is good great and able to get outside and enjoy the
Spring weather. Your whole family deserves a break. We are working on
getting more low-fat diets out and also diabetic diets in the near
future.
Thoughts and Prayers,
Robert
A Founding Member of TPP,
roberthammett@...

It looks like when your pancreas is very damaged and destroyed like
mine, all hopes for the Islet Cell transpalnt is over. Please all of
you in the early stages try to have this done. Brittle Diabetes is
nothing to play with!!! It causes more damage than can ever be
repaired!!!
Robert
A Founding Member of TPP,
roberthammett@...

Rudy and Stacey,
Sometimes during an attack you have to live minute by minute. It is
the only way to get to the next day.
I wish you Pain-Free Days and Nights,
Robert
A Founding Member of TPP,
roberthammett@...

Dear Liz,
That little pill makes me very sleepy. It also gives me a headache if
I miss a dose. I have used it on and off for 15 years. That is not my
favorite to use, ever!!! I also tend to eat more while on it.
Thanks,
Robert
A Founding Member of TPP,
roberthammett@...

Amitriptyline tablets
What are amitriptyline tablets?
AMITRIPTYLINE (Elavil®, Endep®) is an antidepressant. Amitriptyline
can lift your spirits by treating your depression, especially if it
is associated with sleep disturbance. Improvement of sleep patterns
can be the first benefit of treatment. Your prescriber or health care
professional may prescribe amitriptyline for other conditions, such
as relief from nerve pain. Generic amitriptyline tablets are
available.
What should my health care professional know before I take
amitriptyline?
They need to know if you have any of these conditions:
an alcohol problem
asthma, difficulty breathing
blood disorders or disease
diabetes
difficulty passing urine, prostate trouble
glaucoma
having intramuscular injections
heart disease or previous heart attack
liver disease
over active thyroid
Parkinson's disease
schizophrenia
seizures (convulsions)
stomach disease
an unusual or allergic reaction to amitriptyline, other medicines,
foods, dyes, or preservatives
pregnant or trying to get pregnant
breast-feeding
How should I take this medicine?
Take amitriptyline tablets by mouth. Follow the directions on the
prescription label. Swallow the tablets with a drink of water. You
can take the tablets with or without food. Take your doses at regular
intervals. Do not take your medicine more often than directed. Do not
stop taking except on your prescriber's advice.
Contact your pediatrician or health care professional regarding the
use of this medicine in children. Special care may be needed.
Adolescents, 12 to 18 years old, and elderly patients over 65 years
old may have a stronger reaction to this medicine and need smaller
doses.
What if I miss a dose?
If you miss a dose normally taken at bedtime to avoid daytime
drowsiness, it may be better to miss that dose. If you take more than
one dose a day and miss a dose, take it as soon as you can. If it is
almost time for your next dose, take only that dose. Follow your
prescriber's advice on missed doses. Do not take double or extra
doses.
What drug(s) may interact with amitriptyline?
Amitriptyline can interact with many other medicines. Some
interactions can be very important. Make sure your prescriber or
health care professional knows about all other medicines you are
taking. Many important interactions are listed below:
Do not take amitriptyline with any of the following medications:
astemizole (Hismanal®)
cisapride (Propulsid®)
probucol
terfenadine (Seldane®)
thioridazine (Mellaril®)
medicines called MAO inhibitors-phenelzine (Nardil®),
tranylcypromine (Parnate®), isocarboxazid (Marplan®), selegiline
(Eldepryl®)
other medicines for mental depression (may be duplicate therapies or
cause additive side effects)
Amitriptyline may also interact with any of the following medications:
alcohol
antacids
atropine and related drugs like hyoscyamine, scopolamine,
tolterodine and others
barbiturate medicines for inducing sleep or treating seizures
(convulsions), such as phenobarbital
blood thinners, such as warfarin
bromocriptine
bupropion
cimetidine
clonidine
cocaine
delavirdine
diphenoxylate
disulfiram
donepezil
drugs for treating HIV infection
female hormones, including contraceptive or birth control pills and
estrogen
galantamine
herbs and dietary supplements like ephedra (Ma huang), kava kava,
SAM-e, St. John's wort, valerian, or others
imatinib, STI-571
kaolin; pectin
labetalol
levodopa and other medicines for movement problems like Parkinson's
disease
lithium
medicines for anxiety or sleeping problems
medicines for colds, flu and breathing difficulties, like
pseudoephedrine
medicines for hay fever or allergies (antihistamines)
medicines for weight loss or appetite control
medicines used to regulate abnormal heartbeat or to treat other
heart conditions (examples: amiodarone, bepridil, disopyramide,
dofetilide, encainide, flecainide, ibutilide, mibefradil,
procainamide, propafenone, quinidine, and others)
metoclopramide
muscle relaxants, like cyclobenzaprine
other medicines for mental or mood problems and psychotic
disturbances
prescription pain medications like morphine, codeine, tramadol and
others
procarbazine
seizure (convulsion) or epilepsy medicine such as carbamazepine or
phenytoin
stimulants like dexmethylphenidate or methylphenidate
some antibiotics (examples: erythromycin, gatifloxacin,
levofloxacin, linezolid, moxifloxacin, sotalol, sparfloxacin)
tacrine
thyroid hormones such as levothyroxine
Tell your prescriber or health care professional about all other
medicines you are taking, including non-prescription medicines,
nutritional supplements, or herbal products. Also tell your
prescriber or health care professional if you are a frequent user of
drinks with caffeine or alcohol, if you smoke, or if you use illegal
drugs. These may affect the way your medicine works. Check with your
health care professional before stopping or starting any of your
medicines.
What should I watch for while taking amitriptyline?
Visit your prescriber or health care professional for regular checks
on your progress. It can take several days before you feel the full
effect of amitriptyline.
If you have been taking amitriptyline regularly for some time, do not
suddenly stop taking it. You must gradually reduce the dose or you
may get severe side effects. Ask your prescriber or health care
professional for advice. Even after you stop taking amitriptyline it
can still affect your body for several days.
You may get drowsy or dizzy. Do not drive, use machinery, or do
anything that needs mental alertness until you know how amitriptyline
affects you. Do not stand or sit up quickly, especially if you are an
older patient. This reduces the risk of dizzy or fainting spells.
Alcohol may increase dizziness and drowsiness. Avoid alcoholic drinks.
Do not treat yourself for coughs, colds or allergies without asking
your prescriber or health care professional for advice. Some
ingredients can increase possible side effects.
Your mouth may get dry. Chewing sugarless gum or sucking hard candy,
and drinking plenty of water will help.
Amitripyline may cause dry eyes and blurred vision. If you wear
contact lenses you may feel some discomfort. Lubricating drops may
help. See your ophthalmologist if the problem does not go away or is
severe.
Amitriptyline may make your skin more sensitive to the sun. Keep out
of the sun, or wear protective clothing outdoors and use a sunscreen.
Do not use sun lamps or sun tanning beds or booths.
If you are diabetic, check your blood sugar more often than usual,
especially during the first few weeks of treatment with
amitriptyline. Amitriptyline can affect blood glucose (sugar) levels.
Call your prescriber or health care professional for advice if you
notice a change in the results of blood or urine glucose tests.
If you are going to have surgery or will need an x-ray procedure that
uses contrast agents, tell your prescriber or health care
professional that you are taking this medicine.
What side effects may I notice from taking amitriptyline?
Side effects that you should report to your prescriber or health care
professional as soon as possible:
abnormal production of milk in females
blurred vision or eye pain
breast enlargement in both males and females
confusion, hallucinations (seeing or hearing things that are not
really there)
difficulty breathing
fainting spells
fever with increased sweating
irregular or fast, pounding heartbeat, palpitations
muscle stiffness, or spasms
pain or difficulty passing urine, loss of bladder control
seizures (convulsions)
sexual difficulties (decreased sexual ability or desire, difficulty
ejaculating)
stomach pain
swelling of the testicles
tingling, pain, or numbness in the feet or hands
unusual weakness or tiredness
yellowing of the eyes or skin
Side effects that usually do not require medical attention (report to
your prescriber or health care professional if they continúe or are
bothersome):
anxiety
constipation, or diarrhea
drowsiness or dizziness
dry mouth
increased sensitivity of the skin to sun or ultraviolet light
loss of appetite
náusea, vomiting
skin rash or itching
weight gain or loss
Where can I keep my medicine?
Keep out of the reach of children in a container that small children
cannot open.
Store at room temperature between 15 and 30 degrees C (59 and 86
degrees F). Throw away any unused medicine after the expiration date.
NOTE: This information is not intended to cover all possible uses,
precautions, interactions, or adverse effects for this drug. If you
have questions about the drug(s) you are taking, check with your
health care professional

Hello Everyone,
Tonight I attended an online chat on the Diabetes Station - Islet Cell
Regeneration with Michael German, MD. Here are the highlights of that chat.
For simplistic sake I have only included Dr. German intro and comments.
We are pleased to have as our guest tonight Michael German, MD , Clinical Chief
of the Diabetes Center at theUniversity of California in San Francisco who will
speak to us about Islet Cell Regeneration.
The work conducted in the lab of Dr. Michael German focuses on the pancreatic
beta cell, the cell that makes insulin. Dr. German and his colleagues are
interested in the cascade of gene activation underlying the development of beta
cells from less differentiated cells during embryogenesis and in how these genes
function in the mature beta cells. They also study where these processes break
down in diabetes, and how to translate their increasing knowledge of the beta
cell into novel strategies for curing diabetes.
Their general strategy is to identify the transcription factors that activate
cell-type-specific genes such as insulin in the beta cells. These factors and
their genes are then used as tools to understand the process of beta cell
development by studying both how they regulate gene expression and development,
and how they are regulated themselves.
While the short-term goal of Dr. German and his fellow researchers is the
creation of beta cells in the culture dish to be used in beta cell
transplantation (a discovery that would be exciting, but still require use of
immunosuppressive drugs), the long-term goal is much greater. It is that of
regeneration of new, working beta cells in the pancreas of people with Type 1
diabetes.
DR. MICHAEL GERMAN :
We know much more about islet cell generation (the original production of islet
cells in the developing embryo) than regeneration, but the evidence suggests
that the processes may be similar.
Once the beta-cells are destroyed in type 1 diabetes, there is no clear evidence
that they can spontaneously regenerate again... Although no one has ever looked
carefully enough to tell whether this may occur on a small scale.
On the other hand, we think that we can push the pancreas to regenerate new beta
cells by using particular genes or hormones.
There are at least two general ways to consider beta-cell regeneration: either
the production of beta-cells outside the body and then transplanting them back,
or generating them in the body itself. Both have promise, but the cells we would
use are very different.
If we do nothing to alter the cells or the immune system, then yes, the cells
would probably get destroyed by the same mechanisms.
But, there are ways to prevent that destruction, either by using drugs that
block or alter the immune system, or even by genetically changing the cells to
eveade the immune system.
Embryonic stem cells are one promising source of cells for producing islet cells
that could then be transplanted into a person with diabetes. We know that ES
cells have the capacity to form beta-cells, and have had some success producing
beta-cells from ES cells in the lab. In some cases these have been put into
diabetic mice and lowered blood sugars.
I should warn you, however, that there are serious doubts about some of the
published data on the use of ES cells to make beta-cells.
Many people in the field, myself included, beleive that the methods presently
used to make beta-cells from ES cells do not produce true beta-cells, and
instead make cells that contain insulin but do not secrete the insulin properly
in response to glucose.
Because ES cells can make all the different cell types in the body, I am
convinced that we can eventually use them to make normal beta-cells in
sufficient numbers to treat people with diabetes. It is going to take some more
work before we can do this in human, however.
As to your lifetime, I think there is a good probability, unless you are quite
old already. -- I expect a cure in my lifetime.
Other sources of cells, other than ES cells, show promise too, and might be a
shorter path to a cure. these include adult stem cells, the cells that reside in
most adult tissues and replenish cells as they die. Adult stem cells from liver
and pancreas are likely possibilities, and we have had some success with both.
We do not know whether the other islet cells will be neccessary. In animals,
pure beta-cells alone can cure diabetes, but the standard for a cure in a mouse
is different from a human. Mice do not eat three meals a day, and generally are
not very sensitive to hypoglycemia.
We have generated small numbers of islet cells in vivo, in rats, and lowered the
blood sugar in diabetic rats.
We did this using a gene therapy approach to stimulate cells in the pancreas to
generate new islet cells. We and others have also generated insulin-producing
cells in the liver as well. We do not know whether these cells function as tryue
beta-cells yet, however.
In the past we always said that immunosuppression was worse than diabetes for
most people, but that may be changing. There are new ways to "re-educate" the
immunsystem that require only one, or occasional treatments rather than
permanent immunosuppression. These methods are already being tested in humans,
including islet transplants.
Jane, that is a tough question, and most studies have not really addressed it.
Usually we are happy with just lowering the blood glucose. But if we generate
true beta-cells, in adequate numbers, the blood glucose should be remain normal
for good, and the diabetes would be considered cured.
Mary, immunosuppression has been used in the past to prevent diabetes, but it is
not used anymore because it never gave a permanent prevention. Newer approaches
are being tested in animals and humans, but no prevention strategy for human
type 1 diabetes is yet proven.
Jane, the cost of puchasing and caring for a chimpanzee is at least a 1000X that
of a mouse. The general strategy for diabetes, as for many other diseases, has
been to start with small animals like mice where you can afford to do lots of
experiments, even if 99.9% fail. Then the successful appraoches can be tested in
primates (usually monkeys), or other larger animals before going into humans.
Majorie, because I know from experience that any approach, no matter how
promising can hit unforeseen road blocks, I would never bet on a single
approach. the fact that we have several approaches being tested by many
researchers is promising. ES cells, adult stem cells, liver cells, nuclear
transfer, gene therapy, beta-cell replication.. these should all be pursued. For
my lab, we focus on the generation of beta-cells from stem cells, but that is
guided by my expertise as well as my belief that it is a promising approach.
Jane, the cost of puchasing and caring for a chimpanzee is at least a 1000X that
of a mouse. The general strategy for diabetes, as for many other diseases, has
been to start with small animals like mice where you can afford to do lots of
experiments, even if 99.9% fail. Then the successful appraoches can be tested in
primates (usually monkeys), or other larger animals before going into humans.
Majorie, because I know from experience that any approach, no matter how
promising can hit unforeseen road blocks, I would never bet on a single
approach. the fact that we have several approaches being tested by many
researchers is promising. ES cells, adult stem cells, liver cells, nuclear
transfer, gene therapy, beta-cell replication.. these should all be pursued. For
my lab, we focus on the generation of beta-cells from stem cells, but that is
guided by my expertise as well as my belief that it is a promising approach.
Reeann, Yes, islet transplantation is particularly promising for people with
pancreatitis, because you do not have to worry about autoimmune destruction of
islets. In fact, it was success in islet transplants into people with
pancreatitis that proved that this appraoch could work, even before the group in
Edmonton finally developed a immunosuppression regimen that works for people
with type 1 diabetes.
Marjorie, Yes, we worry about the possibility of legistative interference that
might prevent us from pursuing promising avenues to a cure. Fortunately, so far
therapeutic cloning has not been outlawed in the US.
Mary, Marjorie, Pancreatitis can be caused by a variety of problems -- toxins,
infections, genetic causes -- that have in common the general destruction of the
entire pancreas, often associated with sever pain and digestive problems. In
most cases the immune system is not the cause, soo if islets are transplanted
outside the pancreas, in the liver for example, they are fairly safe.
Marjorie, I would encourage you to cantact your legislators and explain what
stem cells and therapeutic could me for you and your family. Those who oppose
stem cell research often do not understand the human cost of the diseases that
stem cells could affect. The debate too often centers around issues of human
reproductive cloning (the cloning of a person, not just cells) and abortion,
issues that are really seperate.
Marjorie, I would encourage you to cantact your legislators and explain what
stem cells and therapeutic could me for you and your family. Those who oppose
stem cell research often do not understand the human cost of the diseases that
stem cells could affect. The debate too often centers around issues of human
reproductive cloning (the cloning of a person, not just cells) and abortion,
issues that are really seperate.
ReeAnn M. Betts-Morris - VA
Owner, ThePancreatitisPlace
434-409-7162

Dear Stacey,
I am sorry you had to seek us out but I am so glad we can help. Thank
you for your story. You seemed to have found the same doctor so many
have found, Dr. Dolittle. The one who does very little!!! Getting the
correct test run at the correct time is a big problem. When you go
into an attack (depending on how bad it is) timing is critical. Your
body tries to reset its self and return to normal. Hopefully you can
find a more experienced doc close by. Also all hospitals are not
equal. I was dx idopathic for 10 years until the right tests were
done and it came back with a history making result that tied mine to
Cystic Fibrosis. Sometimes it gets to the point that a gentic doctor
must be called in. I invite your husband to get involved as we have
great Caregivers support at TPP. I would enjoy speaking with you
during chat if you find the time. We also have started some other new
projects with TPP of which may help you in the future. I look forward
to hearing from you soon. What kinds of dogs do you have, I have a
chow that has been with us forever.
God Bless,
Robert
A Founding Member of TPP,
roberthammett@...

Hi Stacey!
I am also 30 years old and have Idiopathic Chronic Pancreatitis. I stopped
taking the pill 14 months ago or so and have never felt better! I also had
been on the pill for 10 years without stopping. My GI never said it could be
related but as far as I am concerned there had to be a connection. I have had a
few mild attacks and 2 or 3 bad ones, but nothing compared to how I was. I am
currently 4.5 months pregnant and amazingly enough I am even able to handle
more fatty foods lately. In the last 4 months I have only been on pain meds
for about 5 days which is really good. I was thinking that after the baby is
born I may try the pill again as an "experiment" but I don't know if I will or
not. It is kinda a risky choice just to see if it was coincidence or not.
Anyway, welcome to the group. You will find all the support and answers you
need
here.
Sending lots of happy thoughts your way.....
Marisa~San Diego, CA

Hi Stacey, Let me introduce myself..i am also 30 yrs old and i have CP Chronic
Pancreatitis. My first attack was 3 yrs ago on November 2000. I have two small
sons and working now...boy oh boy it's not easy. i have chronic pains everyday.
and i first noticed the problem when i was 15 yrs old..but wasnt diagnosed with
it. til the major attack came for a visit.
Yes u have to watch what you eat. even the smell of food can trigger an attack .
Staying a room with an IV no food when you're hungry isnt fun...That's just one
of the procedures...Lucky us...
I was really lost thought i was the only one with this disease but i was lucky
to find TPP my second family because everyone here understands what you are
going through, the sadness, the pain , or even when you want to just talk and
complain about your day.
So i am so happy you have joined us...and my prayers and thoughts are with
you...take care
Brenda

Hello Stacey,
Welcome to our Family at TPP (The Pancreatitis Place). I would like
to take a moment of your time to introduce myself. My name is Denise
Hammett and I live in South Carolina. TPP was created for those
suffering from Acute or Chronic Pancreatitis (or related conditions)
and their caregivers .If you have questions about this illness,
please feel free to jump right in and ask. Someone will answer you.
If you just need a shoulder to cry on. We are here for you. When
you're having a bad day and feel the need to vent about what is
happening in your life, let us know what going on. We are here to
share the good days as well as the bad days. We have members here
that have suffered for 15 or more years. This group is here to share
and learn all we can to deal with this illness on a day by day basis.
Feel free to check out the links section. We are always adding new
links to it. You can also check out our photo section and see who you
are posting to and maybe put a photo up of you. We also have Chat 2
times a week. One on Wednesday night and Sunday night at 7:00 Eastern
Standard Time. You can access the chat room with either AIM or AOL.
If you need help accessing the chat room, please feel free to contact
one of the mangament team.
Once again I want to give you the warmest welcome to our family here
at TPP You are not alone with this illness any more.You have joined a
family of caring people that are here to help in any way they can.
Our thoughts and Prayers are with you . Have a Blessed Day
Denise~S.C.
Caregivers Moderator
denise@...
http://www.thepancreatitisplace.org/

Howard Hughes Medical Institute
http://www.hhmi.org/news/melton5.html
Insulin-Producing Pancreatic Cells Are Replenished by Duplication
May 5, 2004 Howard Hughes Medical Institute (HHMI) researchers at
Harvard University have discovered that insulin-producing beta cells
in the pancreas that are attacked in type 1 diabetes are replenished
through duplication of existing cells rather than through
differentiation of adult stem cells.
Although the experiments, which were done using mice, do not rule out
the possibility that there are adult stem cells in the pancreas, the
researchers say that they do suggest strongly that embryonic stem
cells or mature beta cells may be the only way to generate beta cells
for use in cell replacement therapies to treat diabetes.
The research team, which was led by HHMI investigator Douglas A.
Melton at Harvard University, reported its findings in a research
article published in the May 6, 2004, issue of the journal Nature.
Melton's co-authors include Yuval Dor, Juliana Brown and Olga I.
Martinez, all of Harvard.
In cell culture, embryonic stem (ES) cells retain the properties of
undifferentiated embryonic cells. ES cells have the capacity to make
all cell types found in an adult organism. One of the most hotly
debated questions in biology is whether adult stem cells, which have
been isolated from blood, skin, brain and other organs, have the same
developmental capacity as ES cells.
Researchers have known for some time that ES cells can give rise to
pancreatic beta cells during development. "But the more interesting
question for us has been what happens in mature pancreatic tissue to
both maintain the pancreas and to regenerate it," said
Melton. "Previous studies have suggested that there are sources of
adult stem cells that might give rise to beta cells. However, those
studies had largely depended on histological `snapshots' of tissues."
Those snapshots can only suggest the "geographic" origin of new beta
cells and not the identity of the cells from which they arise, Melton
noted.
Melton and his colleagues knew that they could finally put such
questions to rest if they could tag beta cells in such a way that
that they could determine unequivocally whether the new cells were
made from existing beta cells or from a different reservoir of stem
cells. For these studies, they devised a "genetic lineage tracing"
technique that involved engineering a mouse whose beta cells
contained a telltale genetic marker that could be switched on by
administering the drug tamoxifen to the mice.
The logic behind the technique is relatively straightforward: When
the researchers administer tamoxifen to the adult mice, they can
easily follow the marker to determine whether it is inherited by
subsequent generations of beta cells. If it is inherited, then the
cells expressing the marker are the offspring of pre-existing beta
cells.
When the researchers applied their technique to the mice, they
discovered that all the new beta cells they examined whether
arising in the usual process of renewal or during regeneration
following partial removal of the pancreas - were generated from pre-
existing beta cells. According to Melton, the finding highlights a
largely unappreciated capability of beta cells.
No one has really paid much attention to the replicative capacity of
the beta cell," he said. "And this work shows the cells to have a
significant proliferative capacity that could be clinically useful."
According to Melton, the findings might have implications for
developing treatments for type 1 diabetes, a disease that destroys
beta cells. "If such people have residual beta cells, these findings
suggest that a useful clinical direction would be to find a way to
boost the proliferative capacity of those beta cells, to restore
insulin production in such patients.
On the other hand, if type 1 diabetics don't have any beta cells
left, then these findings suggest that the only source of new beta
cells is probably going to be embryonic stem cells, because there
don't appear to be adult stem cells involved in regeneration."
Melton emphasized that although the results by his group cannot rule
out the existence of beta-cell-producing adult stem cells, "they
raise the bar on trying to demonstrate their existence. In these
experiments, we find no evidence for the existence of adult
pancreatic stem cells," he said.
The genetic lineage tracing technique devised by Melton's group is a
tool that can now be used to trace the origin of cells involved in
the maintenance and repair of other types of tissue. Melton and his
colleagues are already using the technique to determine the origin of
new cells in lung tissue. And it should be possible to apply the
technique to understand the origin of cancer cells in tumors or to
understand the role of stem cells in such malignancies, Melton said.
With Warmest Regards
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

Hi! Rudy and Rhonda,
Thanks for replying to my post, its amazing that so many people
suffer from this and at so many different ages yet, some doctors
still tell people they are stress.
I happy to hear that you Rudy are doing well, and that Rhonda's
daughter Amanda is doing well also.
I do hate those days I get that feeling and pray they next morning I
don't wake up with a full blown attack!
One day at a time, i agree!
Stacey

Hi Stacy,
Welcome to TPP. You will find lots of support and informtion here.
I've been around for a few months and have made some new friends and
learned alot about this disease. My name is Rhonda and my daughter,
Amanda age 11, suffers from acute attacks. The pain you describe is
similar to her attacks. She also seems to have bad attacks about 2x
a year.
I am sorry you have gone through this and that it took so long to get
a diagnosis. I feel very fortunate that Amanda was diagnosed early by
a very observant ER doctor who ran the right kinds of tests.
I am glad to hear you have been pain free by watching your diet.
Denise from the board has tons of low fat receipes that you should
try, very yummy stuff. I hope you can avoid future attacks by
sticking with low fat food.
Rhonda
Tulsa, OK

Hey Stacey, welcome to TPP, a wonderful place with wonderful people.
I am only here since three weeks I think. I must say that I am in a
very mild periode also. Well, almost for the last two years. I had
the last severe attack end of May 2002. But I also have sometimes
that feeling in the stomach or surroundings. It gets you feeling
very unpleasant, because you don't know in fact if the real pain
will come through. But I live a day at a time and I am very grateful
for each pain free day. So Stacey, I hope that you also may have a
lot of those days, periods, months, years. With friendly greetings
from Ostend, Belgium. Rudy

Hi! My name is Stacey and I am from New Jersey, and I am 30 years
old. I've been reading some of the posts on the list and I feel so
lucky.
Heres my story:
I had my first attack 12 years ago, I remember calling my mom at work
to come home and take me to the doctor. I had the knife wrenching
pains in my stomach. So, she took me and of course you guess it,
your stressed and its gas, heres some pills for gastritis.
Well, for years I would get these pain about twice a year, the pain
so bad you can't move from the bed, try to eat cause you think its
hungry pain, until they get worse.
I would go to the doctor and again same thing nothing wrong, don't be
so stresses, see a shrink!
So, finally in 2002, I had a attack in May so bad that I was up
crying curled up in a ball all night. Of course went to the doctor
again the next day, and nothing. So, I told my husband it happens
again I'm going to the hospital. Then in July of 2002, it happened!
I called my husband from work to come get me and take me to the
hospital, I couldn't even drive.
When I got there they thought it was gall stones, ran some test,
meanwhile I'm in so much pain! Then the blood work came back and it
was pancreatitis, they gave me morphine but, it didn't help the
pain. So, more test, cat scan, the high tech image machine (forgot
the name?LOL) Nothing showing up that would of causes the
pancreatitis. I am not a alcoholic, and I guess they could tell that
cause they never even asked me. I spent 4 days in the hospital on
iv, and demoral, and left with idopathic pancreatitis.
So,now it get more interesting, my internal medicine dr. told me it
could be from birth control pills, I was on them since I was 16 and
never took a break from them. And she told me about the foods I can
not eat, and how much fat I should eat in a day.
Now, here it is 2 years later, no birth control pills, no fatty
foods, or gasy foods, no caffine. And I have not had a full attack!
Sometimes I get that feeling in my stomach, and I'm like oh no, here
we go and the next day its gone!?
What do you guys think about this?
Thank you for letting me share my story, I know I'm on the mild side
of this problem, and I feel for those who suffer everyday and thats
why I consider myself lucky!! I am thankful everyday for not having
a attack!
Sincerly,
Stacey
with my loving husband and two wonderful dogs!! in NJ

My wife is taking this one now and is slowing being wean off it, she
gets headace if she does't take it. hope this helps
http://www.mentalhealth.com/drug/p30-e01.html#Head_5
Amitriptyline should be used with caution in patients with a history
of seizures, impaired liver function, a history of hepatic damage or
blood dyscrasias and, because of its atropine-like action, in
patients with a history of urinary retention, or with narrow-angle
glaucoma or increased intraocular pressure. In patients with narrow-
angle glaucoma, even average doses may precipitate an attack.
There has been a report of fatal dysrhythmia occurring as late as 56
hours after amitriptyline overdose.
Patients with cardiovascular disorders should be watched closely.
Tricyclic antidepressant drugs, including amitriptyline, particularly
when given in high doses, have been reported to produce arrhythmias,
sinus tachycardia, and prolongation of the conduction time.
A few instances of unexpected deaths have been reported in patients
with cardiovascular disorders. Myocardial infarction and stroke have
also been reported with drugs of this class. Therefore, these drugs
should be used with caution in patients with a history of
cardiovascular disease, such as myocardial infarction and congestive
heart failure.
Concurrent administration of amitriptyline and electroshock therapy
may increase the hazards of therapy. Such treatment should be limited
to patients for whom it is essential.
Close supervision is required when amitriptyline is given to
hyperthyroid patients or those receiving thyroid medication.
Occupational Hazards:
May impair mental and/or physical abilities required for performance
of hazardous tasks, such as operating machinery or driving a motor
vehicle.
With Warmest Regards
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

USA TODAY
http://www.usatoday.com/news/world/iraq/2004-01-04-march-03-
glimpses_x.htm
Army Spc. William Jeffries: Jeffries had the kind of personality that
just attracted people all sorts of people. "Bill was liked by
everybody. Old people. Young people," said his mother, Marie
Jeffries. "He was an outgoing individual. He never met a stranger.
Everyone liked him, right on sight. He was big, and he was kind." A
specialist in the Indiana National Guard, the 39-year-old Jeffries
died March 31 at a hospital in Spain after becoming sick in Kuwait. A
military official told Jeffries' family that he suffered a blood clot
in his lung and acute pancreatitis. He had joined the National Guard
after serving 10 years in the Air Force, and lived in Evansville,
Ind., with his wife, B.J.
With Warmest Regards to all the troops, our prayer are with each and
every one of you
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

http://www.joplink.net/prev/200111/07.html
Is Secretin Magnetic Resonance Cholangio-Pancreatography an Effective
Guide for a Diagnostic and/or Therapeutic Flow-Chart in Acute
Recurrent Pancreatitis?
Alberto Mariani
Division of Gastroenterology and Gastrointestinal Endoscopy,
University Vita-Salute San Raffaele - IRCCS San Raffaele. Milan, Italy
There is increasing interest in magnetic resonance cholangio-
pancreatography (MRCP) - especially when performed with i.v. secretin
administration (MRCP-S) - as a procedure of first choice in the
diagnostic evaluation of bilio-pancreatic diseases. The high-
resolution projectional images of the bilio-pancreatic ductal system
obtained by MRCP are not achievable with other non-invasive
techniques such as ultrasound (US) and computed tomography (CT).
Moreover, MRCP performed in conjunction with abdominal magnetic
resonance (MR) imaging can be also useful in identifying pancreatic
parenchyma lesions. In particular, the evaluation of the outcome of
acute pancreatitis using non-enhanced MRCP can be as much accurate as
by contrast-enhanced MRCP and CT [1]. The diagnostic role of MRCP-S
can be an alternative to endoscopic retrograde cholangio-
pancreatography (ERCP) which is limited to therapeutic purposes. The
routine use of a non-invasive procedure such as MRCP-S is crucial
especially in patients with recurrent acute pancreatitis (RAP) who
are at high risk for developing post-ERCP pancreatitis.

Hi Chris,
Since we could not find any support groups for your friend and he
doesn't have a computer yet. I like to make a suggestion that will
help both you and him. Why not invite him over on chat night and both
of you join us on your computer Sir. He can ask the question that
he's concern about and you will pick up on what this illness is all
about. Which will give you clearer understand what your friend is
dealing with. So get on the phone and call him up and put on a pot
of coffee or tea and join us Chris. hope to hear form you soon.
With Warmest Regards
Gary Morris ~ Virginia
Customer Service Rep moderator.
Phone 434-490-7191
gary@...
http://www.thepancreatitisplace.org/

http://www.mri.tju.edu/MRCP.htm

http://www.elecjoncol.org/Archivage/PDF/135.pdf
Thanks,
Robert
A Founding Member of TPP,
roberthammett@...

http://intl-radiographics.rsnajnls.org/cgi/content/full/21/1/23
Magnetic resonance (MR) cholangiopancreatography (MRCP) is widely
used in the evaluation of pancreatobiliary disorders. However,
numerous related pitfalls may simulate or mask pancreatobiliary
disease. Maximum-intensity-projection (MIP) reconstructed images
completely obscure small filling defects and may demonstrate
respiratory motion artifacts. T2 weighting may vary with different MR
imaging sequences and influence MRCP findings. Incomplete imaging may
create confusion regarding ductal anatomy or disease. Furthermore,
MRCP yields only static images and thus may fail to depict various
anomalies. Limited spatial resolution makes differentiation between
benign and malignant strictures with MRCP alone extremely difficult.
Susceptibility artifacts may be caused by metallic foreign bodies or
gastric-duodenal gas. Fluid accumulation may produce a pseudolesion
or pseudostricture, although changing the imaging angle or section
thickness may be helpful. Pneumobilia may be misinterpreted as bile
duct stones, and true stones may be overlooked. Pulsatile vascular
compression can cause pseudo-obstruction of the bile duct. Use of
both source and MIP reconstructed images obtained from different
angles can help avoid cystic ductrelated pitfalls. Repeat MRCP or
conventional MR imaging can help avoid pitfalls related to the
periampullary region. Segmental collapse of the normal main
pancreatic duct may be misinterpreted as stenosis, but administration
of secretin is helpful. An awareness of these pitfalls and possible
solutions is crucial for avoiding misinterpretation of MRCP images.

http://www.radiology.vcu.edu/mrcp.htm
Magnetic Resonance Cholangiopancreatography represents a relatively
new development in MR technology that allows for rapid evaluation of
the biliary tract, pancreatic duct and gallbladder without contrast
material administration, instrumentation or radiation. To date, over
2000 MRCPs have been performed at the Medical College of Virginia
Hospitals. Special imaging sequences that are heavily-T2-weighted are
utilized to depict the biliary tract, pancreatic duct and gallbladder
as high signal intensity or bright structures owing to the fluid
within them. Studies performed at the Medical College of Virginia
Hospitals as well as at other institutions have shown that the
accuracy of MRCP is comparable to that known as ERCP (endoscopic
retrograde cholangiopancreatography, the traditional but invasive
means of imaging the pancreaticobiliary system) in the evaluation of
choledocholithiasis, malignant obstruction, anatomic variants and
chronic pancreatitis. In most instances, MRCP can be completed in 10
minutes and is easily performed as an outpatient examination.
Since its introduction in 1991, the role of MRCP in evaluating
pancreaticobiliary disease has continued to evolve. MRCP is assuming
a larger role as a rapid, accurate and non-invasive alternative to
diagnostic ERCP. During the past several years, radiologists and
nonradiologists alike have shown a keen interest in MRCP and its
clinical applications. Technical refinements such as fast MR
sequences that allow for imaging of the entire biliary tract and
pancreatic duct in a single breathhold have resulted in marked
improvement in the quality and diagnostic yield of MRCPs. As the
quality of MRCPs has improved, the clinical applications of this
technique have expanded such that MRCP is now replacing diagnostic
ERCP in many instances.
Current techniques allow for depiction of obstructed or dilated bile
and pancreatic ducts in essentially all patients. Normal caliber
extrahepatic bile ducts and central intrahepatic ducts are routinely
depicted in as many as 100% of patients. Although the normal caliber
pancreatic duct may be more difficult to visualize than the bile
duct, the normal pancreatic duct can be visualized in 80-95% of
cases. Dilated ducts proximal to an obstruction are well visualized,
usually better than with ERCP where there can be difficulty in
opacifying ducts proximal to a high-grade obstruction.
MRCP avoids the complications of ERCP such as pancreatitis (3-5%),
sepsis, perforation and hemorrhage. The main disadvantage of MRCP is
that it is purely diagnostic and does not provide access for
therapeutic intervention.

http://www.borland-groover.com/MRCPvs.ERCP.htm
MRCP Vs. ERCP
Concept: What's New Might Be Good?
As with all in medicine, and especially in fields such as
gastroenterology and hepatology, advances in both technology and
pharmacology are ever changing. With these new advances comes the
process of deciding what is truly added value with respect to both
diagnosis and therapeutics, and what is just a mere blip on the radar
field in the advances of medicine.
What follows is an instance of a reported new diagnostic techniques,
which may have an impact on what we do both in a diagnostic and
therapeutic approach to GI disease of the hepato - biliary system
MRCP: Magnetic Radiologic Cholangiogram
MRCP is a new application of a know form of body imaging known as
MRI. With this technique, a patient's Hepato-Biliary & Pancreatic
system is imaged using a MRI unit, and utilizing special software, an
image similar to a cholangiogram and / or a pancreatogram is
obtained. This type of imaging can reproduce images very similar as
those obtained from the more invasive approach with ERCP (Endoscopic
Retrograde Cholanigiopancreatography) without the added risk of
pancreatitis, sedation, and perforation.
The downside at present is physician interpretation of the films, and
the relative new application of this software in institutions not
familiar with it.
In addition, all that MRCP allows is an image, not a curative
possibility, and hence the problem that faces the consultant
gastroenterologist/hepatologist.
When and whom to use this new imaging technique?
In patients with highly suspected pathology in which therapeutic ERCP
may have value, there is little value in obtaining an MRCP. Such
patients that would benefited from ERCP would include:
Patients with obstructive jaundice in which ultrasound or CT scan
suggests biliary dilatation from either a stone or a mass, where
therapeutic remedies such as stone removal or stent placement with
cytology aspiration could aid in diagnosis and in improvements in
symptoms.
Biliary dyskensia in which patients with post cholecystectomy pain
syndromes are being considered for sphincter of oddi manometry
Recurrent idiopathic pancreatitis in which patients are being
considered for pancreatic/common bile duct manometry
Patients with Pseudocysts in which attempts at endoscopic drainage
with either stents or trans-gastric cyst-gastosotomy are considered
Post-Cholecystectomy bile leaks or surgical bile duct injuries, in
which stenting of the bile duct or dilatation of strictures can occur
with ERCP
Examples where MRCP may have added value are in patients with a low
probability of correctable pathology as provided with therapeutic
ERCP such as:
Patients with elevated Liver Function test which have no evidence of
hepato-biliary ductal dilatation on abdominal ultrasound nor CT in
which the risks of ERCP are especially high. These patients would
include those with compromised cardiopulmonary function, patients
with known problems with conscious sedation.
Patients with unexplained abdominal pain in whom a low probability
of hepato-biliary pathology such as retained common bile duct
stones, cancer, biliary dyskensia, or idiopathic pancreatitis is
suspected by both clinical presentation and previous imaging such as
CT and ultrasound.
Patients with jaundice where there is no evidence of ductal
dilatation by US nor CT but CBD dilatation needs to be ruled out.
As with all new technology, the role of MRCP is still to be defined.
Within Jacksonville, MRCP is available, but at present, its use is
best with those of its attributes and pitfalls when ordering it.
Article By: Kyle Peter Etzkorn, M.D., F.A.C.P.
Current Medical Literature:
The value of magnetic resonance tomography (MRT), magnetic resonance
cholangiopancreatography (MRCP) and endoscopic retrograde
cholangiopancreatography (ERCP) in the diagnosis of pancreatic tumors
Diehl SJ , Lehmann KJ , Gaa J , Meier-Willersen HJ , Wendl K , Georgi
M
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1999 May;170
(5):463-9
To prospectively evaluate the role of MRI including MR
cholangiopancreatography (MRCP) compared to endoscopic retrograde
cholangiopancreatography (ERCP) in the diagnosis of pancreatic
cancer. MATERIAL AND METHODS: ERCP and MRI including MRCP were
performed in 52 patients with suspected pancreatic cancer. MRCP was
obtained using a single-shot RARE technique. The results of axial
images and MRCP were compared to concurrently performed ERCP
examinations. The standards of reference were the surgical and
pathological findings, respectively. Image quality of MRCP was
assessed using a three-step-score (1 = good, 2 = fair, 3 =
nondiagnostic). RESULTS: In 88% of the cases the MRCP was of good
quality. Only in 4% was MRCP non-diagnostic. The combination of MRI
and MRCP showed an overall accuracy of 88%, whereas the overall
accuracies of MRCP alone and ERCP were 80%, and 85%, respectively.
The positive predictive values of MRI/MRCP, MRCP alone, and ERCP were
91%, 85%, and 88%, respectively. CONCLUSION: For the detection of
pancreatic cancer MRI including MRCP is comparable to ERCP and can be
regarded as the method of choice in patients with suspected
pancreatic cancer. ERCP is the procedure of choice in patients with
contraindications to MRI and in patients in whom additional
therapeutic procedures are performed.
Diagnostic usefulness of magnetic resonance cholangiopancreatography
(MRCP) in comparison with retrograde cholangiopancreatography (ERCP)
for Cholelithiasis Ahn T , Matsumoto M , Ueda S , Fukui H
Nippon Rinsho 1998 Nov;56(11):2923-7
To elucidate MRCP diagnostic usefulness compared to ERCP. PATIENTS,
METHODS: 29 MRCP performed patients diagnosed by ERCP were studied.
RESULTS: MRCP showed 92%, 67% sensitivity and 73%, 100% specificity
in choledocholithiasis (CBD) and cholecystolithiasis (GB),
respectively. MRCP revealed 4.0 false positive and 1.5 false negative
in CBD and GB, respectively. MRCP could detect 22 stones out of 33 in
CBD and 13 out of 42 in GB. As for the maximal diameter, MRCP
depicted 31% for less than 5 mm and 100% for over 6 mm in CBD. In GB,
7% for less than 5 mm, 83% for 6-10 mm and 100% for over 11 mm.
CONCLUSION: Although the depiction of tiny stone is limited, MRCP is
a useful diagnostic tool for cholelithiasis, especially
choledocholithiasis.
Can MRCP replace ERCP?
Takehara Y Department of Radiology, J Magn Reson Imaging 1998 May-
Jun;8(3):517-34
Magnetic resonance cholangiopancreatography (MRCP) has replaced
direct cholangiography and pancreatography in many instances. Its
complete noninvasiveness and flexibility are less onerous for
patients. For the use of screening as well as scrutiny, MRCP has
played an important role in diagnosing various pathologies in this
field. The usefulness of MRCP is not limited to anatomical
evaluations; it can also yield physiologic and functional
information. From a cost-performance basis, MRCP is undoubtedly
superior to direct methods. Coupled with a cutting-edge MR system,
MRCP has the potential to limit the use of invasive transpapillary
and percutaneous methods merely to interventional purposes. In the
near future, the emergence of interventional MR scanners will make
MRCP even more competitive, and the replacement will be accelerated.
Comparison of endoscopic retrograde cholangiopancreatography with MR
cholangiopancreatography in patients with pancreatitis. Sica GT ,
Braver J , Cooney MJ , Miller FH , Chai JL , Radiology 1999 Mar;210
(3):605-10To assess the usefulness of magnetic resonance (MR)
cholangiopancreatography (MRCP) in the evaluation of disease in
patients with acute or chronic pancreatitis. MATERIALS AND METHODS:
MR imaging was performed at 1.5 T in 39 patients with chronic (n =
30) or acute (n = 9) pancreatitis. The patients underwent a pancreas
MR imaging protocol that included an MRCP sequence. Comparison was
made with findings at endoscopic retrograde cholangiopancreatography
(ERCP), performed within 30 days. Three blinded readers used a
scoring system to evaluate nine segments of the pancreatic and
biliary ducts as depicted on the ERCP and MRCP images. MRCP image
quality was also evaluated. RESULTS: Of 196 segments analyzed, 17
were not seen at MRCP (sensitivity, 91%). Of the segments visualized
at MRCP, 14 were incorrectly characterized (accuracy, 92%). At MRCP,
segments not detected or mischaracterized were either normal,
slightly dilated, or narrowed. At ERCP, 42 segments in 19 patients
were not visualized. MRCP findings were considered useful in all
those cases. MRCP image quality was not interpretable in two cases
due to artifacts. CONCLUSION: Very good correlation between ERCP and
MRCP findings was demonstrated. Both modalities failed to depict
pathologic conditions depicted by the alternative method. MRCP may
obviate ERCP, particularly in patients who cannot undergo ERCP or in
whom ERCP has been unsuccessful.
Comparison of endoscopic retrograde and magnetic resonance
cholangiopancreatography in the surgical diagnosis of pancreatic
diseases. Yamaguchi K , Chijiwa K , Shimizu S , Yokohata K , Morisaki
T ,
Am J Surg 1998 Mar;175(3):203-8 Magnetic resonance
cholangiopancreatography (MRCP) is a newly developing noninvasive
examination of the biliopancreatic trees. Roles of MRCP in the
diagnosis of pancreatic diseases have not been scrutinized. METHODS:
Endoscopic retrograde cholangiopancreatography (ERCP) and MRCP were
reviewed in 52 Japanese patients with various pancreatic diseases and
6 patients with normal pancreas to compare their diagnostic
usefulness and limitation. RESULTS: In those with normal pancreas,
only the main pancreatic duct was visualized by MRCP, while both the
main pancreatic and branch ducts were clearly delineated by ERCP. In
3 patients with serous cystadenoma, the tumor was not visualized by
ERCP, whereas it was visible as a high-intensity mass on MRCP. Of 18
patients with a "mucin hypersecreting" tumor of the branch type, MRCP
demonstrated cystically dilated branch ducts in all, while ERCP
failed to visualize the dilated ducts in 6 patients. However, the
details of the cystic lesions (mural nodule, communication with the
main pancreatic duct) were more exactly demonstrated by ERCP than
MRCP. In 5 patients with a mucin hypersecreting tumor of the main
pancreatic duct type, the dilated main pancreatic duct and the
presence of mural nodules were similarly demonstrated both by ERCP
and MRCP. In 12 patients with pancreatic adenocarcinoma, indirect
findings were similarly demonstrated both by ERCP and MRCP, ie,
stenosis (4 patients) and obstruction (8) together with dilation of
the main pancreatic duct (9). In 3 patients, the center of the mass
showed high intensity on MRCP, suggesting the secondary change of
pancreatic carcinoma. In 8 patients with obstruction of the main
pancreatic duct due to carcinoma, the distal pancreatic duct was
visualized by MRCP but not by ERCP. In 9 patients who had undergone
pylorus-preserving or standard pancreatoduodenectomy, follow-up MRCP
was obtainable in all examined and displayed the main pancreatic
duct. CONCLUSIONS: MRCP plays a complementary role in the surgical
diagnosis of pancreatic disorders and is especially useful to examine
the pancreatic duct after pancreatoduodenectomy.
Magnetic resonance cholangiopancreatography accurately predicts the
presence or absence of choledocholithiasis. Hochwalk SN , Dobryansky
M BA , Rofsky NM , Naik KS , Shamamian P , Coppa G , Marcus SG J
Gastrointest Surg 1998 Nov-Dec;2(6):573-9
Accurate common bile duct (CBD) imaging in patients with biliary
calculi is an important determinant of specific therapy. Noninvasive
methods to evaluate calculi in the CBD have limited accuracy and rely
mainly on ultrasonography and computed tomography. Magnetic resonance
cholangiopancreatography (MRCP) is a new noninvasive modality
available to evaluate the biliary system. This study was undertaken
to assess the accuracy of MRCP in predicting the presence or absence
of CBD stones in patients at increased risk for choledocholithiasis.
The medical records of 48 patients with a final diagnosis of biliary
calculous disease undergoing MRCP between November 1995 and April
1997 were retrospectively reviewed. Three groups were identified:
choledocholithiasis (n = 19), gallstone pancreatitis (n 5 11), and
uncomplicated cholelithiasis (n = 18). In all patients the presence
or absence of CBD calculi, as determined by MRCP, was correlated with
the final diagnosis obtained from endoscopic retrograde
cholangiopancreatography (ERCP) (n = 19), intraoperative
cholangiography (n = 6), CBD exploration (n = 13), or clinical follow-
up (n = 10). Sensitivity, specificity, and accuracy of MRCP were
determined. The major clinical indications for MRCP in the 48
patients ware abnormal liver function tests followed by
hyperamylasemia. Twenty patients were diagnosed with CBD stones and
28 were not. MRCP correctly predicted the presence of CBD stones in
19 of 20 patients and failed to detect CBD stones in one patient with
gallstone pancreatitis. MRCP incorrectly predicted the presence of
CBD stones in 3 of 28 patients ultimately found to have gallstones
and no CBD stones. MRCP correctly predicted the absence of CBD stones
in the other 25 patients including 10 patients with gallstone
pancreatitis. Overall, MRCP had a sensitivity of 95%, a specificity
of 89%, and an accuracy of 92%. MRCP is an accurate, noninvasive test
for evaluating the CBD duct for the presence or absence of calculi in
patients suspected of having CBD stones. Our data support the use of
MRCP in the preoperative evaluation of these patients as findings may
influence therapeutic decisions.
A prospective evaluation of magnetic resonance
cholangiopancreatography in patients with suspected bile duct
obstruction Adamek HE , Albert J , Weitz M , Breer H , Schilling D ,
Riemann JF. Gut 1998 Nov;43(5):680-3 The value of magnetic resonance
cholangiopancreatography (MRCP) is under debate. AIMS: To assess the
diagnostic accuracy of MRCP and endoscopic retrograde
cholangiopancreatography (ERCP) and to determine whether MRCP may
help to prevent unnecessary interventional procedures. METHODS:
Eighty six patients with suspected common bile duct obstruction who
presented between January and December 1996 were enrolled. Twenty six
were excluded due to anatomical reasons or because MRCP or ERCP could
not be performed successfully. Results of MRCP were interpreted by
two radiologists and a gastroenterologist unaware of clinical
diagnosis. Final diagnosis was determined by ERCP and
histopathological findings or a follow up of at least 12 months.
RESULTS: MRCP images of diagnostic quality were obtained in all 60
patients. Thirteen patients had a clear bile duct. Sensitivity and
specificity for the detection of any abnormality (n=47) were 89% and
92%, and for the detection of malignancy (n=27) 81% and 100%,
respectively. These results were equivalent to the respective figures
of ERCP (91% and 92% for any abnormality, and 93% and 94% for
malignant diseases). CONCLUSIONS: MRCP is as sensitive as ERCP in the
evaluation of biliary tract diseases. As the specificity of this non-
invasive technique is close to 100%, MRCP may prevent inappropriate
invasive explorations of the common bile duct and pancreatic duct.
Value of magnetic resonance cholangiopancreatography in demonstrating
major bile duct injuries following laparoscopic cholecystectomy. Yeh
TS , Jan YY , Tseng JH , Hwang TL , Jeng LB ,Chen MF
Br J Surg 1999 Feb;86(2):181-4 Conventionally, recognition of bile
duct injuries after laparoscopic cholecystectomy largely relies on
endoscopic retrograde cholangiopancreatography (ERCP) and
percutaneous transhepatic cholangiography (PTC). However, these
invasive procedures are not without risk. Preliminary experience with
use of magnetic resonance cholangiopancreatography (MRCP) to identify
these injuries is reported. METHODS: The medical records of five
patients who had undergone laparoscopic cholecystectomy and had
suspected major bile duct injuries were reviewed. All five patients
underwent MRCP, followed by conventional cholangiography: either ERCP
or PTC, or both. The findings of MRCP and conventional
cholangiography were compared. RESULTS: Four patients had proven bile
duct injuries. The remaining patient had gallstones dislodged into
the common bile duct (CBD) during laparoscopic cholecystectomy, which
presented as transient jaundice mimicking a bile duct injury. The
MRCP images were of higher diagnostic value than conventional
cholangiographic images in four patients with frank bile duct injury.
For these patients, ERCP showed only the cut-off sign of the CBD, and
PTC was needed to visualize the upper biliary system. MRCP, however,
demonstrated the entire biliary system proximal and distal to the
amputated or stenotic sites simultaneously. In the remaining patient
with dislodged gallstones, the two techniques yielded similar
diagnostic information. CONCLUSION: This preliminary study suggests
that MRCP is an ideal diagnostic test whenever bile duct injury
following laparoscopic cholecystectomy is suspected.
MR cholangiography: techniques and clinical applications. Pavone P ,
Laghi A , Panebianco V , Catalano C Eur Radiol 1998;8(6):901-10
Magnetic resonance cholangiography (MRCP) is a new non-invasive
imaging technique for the evaluation of bilio-pancreatic disorders.
Different sequences, using both breathhold and non-breathhold
techniques, have been employed in order to obtain MRCP images. The
authors discuss the technical aspects, particularly focusing their
attention on a non-breathhold, three-dimensional, fat-suppressed
turbo-spin-echo sequence, optimized on a 0.5-T magnet with 15 mT/m
gradients. Clinical applications of MRCP are evaluated, presenting
data from both the literature and personal experience. The main
indication for MRCP study is represented by the evaluation of common
bile duct obstruction, with the aim of assessing the presence of the
obstruction (accuracy 85-100 %) and, subsequently, its level
(accuracy 91-100 %) and its cause. The utility of associating
conventional MR images to MRCP in malignant strictures in order to
characterize and stage the malignant lesions is also discussed.
Finally, data are presented regarding the indications and utility of
MR pancreatography in the evaluation of patients with chronic
pancreatitis.
Comparison of magnetic resonance and endoscopic retrograde
cholangiopancreatography in malignant pancreaticobiliary obstruction.
Georgopoulos SK , Schwartz LH , Jarnagin WR , Gerdes H , Breite I
Arch Surg 1999 Sep;134(9):1002-7 We hypothesize that magnetic
resonance cholangiopancreatography (MRCP) is comparable to endoscopic
retrograde cholangiopancreatographic (ERCP) as a diagnostic tool in
patients with malignant biliary obstruction. DESIGN: Eighteen
patients with suspected pancreaticobiliary malignancy were evaluated
by ERCP and MRCP in 8 months (March 1, 1996, to October 31, 1996).
Magnetic resonance cholangiopancreatography was performed with a 1.5-
T scanner using 4-mm slices. Images were obtained in a 14- to 28-
second breath-hold. Images from MRCP were retrospectively evaluated
by a radiologist for image quality, ductal dilation, level of
obstruction, and overall diagnostic impression. Images from ERCP were
retrospectively evaluated by a biliary endoscopist (L.H.S.) and
served as the standard for calculating sensitivity, specificity, and
positive predictive values. In addition, intraoperative findings were
compared with MRCP results in all patients explored. RESULTS:
Diagnostic-quality MR images were obtained in 18 patients (100%).
Diagnostic-quality endoscopic images were obtained in 16 (89%) of 18
attempted biliary cannulations and 11 (78%) of 14 attempted
pancreatic cannulations. Magnetic resonance CP accurately delineated
the level of extrahepatic biliary ductal obstruction in 13 (87%) of
15 patients. More important, MRCP provided valuable staging
information in most patients. Findings from MRCP correlated with
operative findings (size and location of tumor and mesenteric
vascular involvement) in 8 (80%) of 10 patients who underwent
surgery, while failing in 2 patients (20%) with carcinomatosis.
CONCLUSIONS: Magnetic resonance CP is a sensitive study for detecting
the presence and level of biliary ductal obstruction in patients with
cancer. The results are comparable to those of ERCP; however, MRCP
provides additional data regarding extent of disease that is not
available from ERCP alone.
A prospective comparison of magnetic resonance
cholangiopancreatography with endoscopic retrograde
cholangiopancreatography in the evaluation of patients with suspected
biliary tract disease.
Varghese JC , Farrell MA , Courtney G , Osborne H , Murray FE
Clin Radiol 1999 Aug;54(8):513-20 To determine the diagnostic
accuracy of magnetic resonance cholangiopancreatography (MRCP)
compared with direct cholangiography in the detection of biliary
tract disease. PATIENTS AND METHODS: MRCP was performed in 100
patients in whom direct cholangiographic correlation (ERCP, n = 98;
PTC, n = 9; intraoperative cholangiography, n = 3) was available for
comparison. The MRCP examinations were performed using a two-
dimensional multi-slice, fast spin echo (FSE) technique and a local
surface coil. The diagnoses at direct cholangiography were
choledocholithiasis in 30 patients, benign and malignant strictures
in 28 patients and normal bile ducts in 42 patients. The nature of
the strictures (benign, n = 2; tumor, n = 18; lymphnode recurrence, n
= 3; unknown histology, n = 5) was determined by one or more of the
following procedures: surgery (n = 8), biopsy (n = 15), cytology (n =
6) and cross-sectional imaging/follow-up findings (n = 3). RESULTS:
MRCP diagnosed choledocholithiasis with a sensitivity of 93%,
specificity of 99% and accuracy of 97 %. It resulted in two false-
negative and one false-positive findings when compared with direct
cholangiography. MRCP accurately diagnosed the presence and level of
strictures in all patients. The overall sensitivity, specificity and
accuracy of MRCP in the detection of bile duct lesions were 97%, 98%
and 97%, respectively. CONCLUSION: MRCP has a high diagnostic
accuracy when compared with direct cholangiography in the detection
of bile duct disease.

Please go here for complete details
http://www.gehealthcare.com/rad/mri/applications/body_current_mrcp.htm
l
MR Body Applications ~ Current Capabilities
MRCP
Figure 1: MRCP for a case of bile duct cancer
The use of MRI for imaging the biliary system and pancreatic duct has
generated interest as an attractive alternative to more traditional
imaging techniques such as Endoscopic Retrograde Pancreatography
(ERCP) and Transhepatic Cholangiography because it is non-invasive,
and does not require the injection of a contrast agent. While the
optimal method for obtaining Magnetic Resonance
Cholangiopancreatography (MRCP) images is still under investigation,
the Single-Shot Fast Spin Echo (SSFSE) technique has emerged as a
promising pulse sequence for visualizing both the biliary system and
the surrounding structures.
SSFSE is an ultra-fast, T2-weighted sequence, with sub-second single
slice data acquisition. The ability to acquire an image in less than
one second overcomes most of the motion artifact problems associated
with older MRCP techniques such as conventional FSE- or GRE-based
techniques. Both respiratory and bowel motion are "frozen" by using a
snapshot acquisition technique, and motion artifacts are virtually
eliminated from the image. An additional benefit of using such a
rapid technique is the ability to acquire multiple slices in a single
breath-hold. This eliminates misregistration from patient motion
between image acquisitions.

http://www.duke.edu/~philrad/mrcp.htm
Thanks,
Robert
A Founding Member of TPP,
roberthammett@...

Hi Robert
Could you or anyone else tell me what a MRCP is. They (DOCS)
want to do one me.
I think ive had every test there is except this one,, I guess I just want to
know how it is done.
Thanks , Dave

Hi Dave,
I wil get you some information on MRCPs
Here is a link that showes images:
http://www.med.umich.edu/rad/mribody/portal/series6.html
Thanks,
Robert
A Founding Member of TPP,
roberthammett@...

Hi Shelly,
It has been very long time since wwe heard from you!!! Can't leave us
hanging like that girl!!!! I hope this patch works well for you. It
can do good for baseline pain most of the time but you still should
continue with your oral meds just in case. Also watch for a rash
developing as these patches do BURN!!!!
Thoughts ands Prayers,
Robert
A Founding Member of TPP,
roberthammett@...

Hi Everyone,
It's been a long time since I last posted and I thought it was about
time I popped in and said Hi!
I try and read all the posts although some days it is difficult to
even get out of bed let alone sitting at a computer, as most of you
know!
I have been going to the hospital in London for a few months now.
Had an MRCP which I should find out the results of tomorrow, and
also being tested for Hereditary Panc but they have yet to recieve
the pack from Europac. One man has been waiting about 8 months for
the pack to arrive so that test may be in the future! They also said
that my pancreatic duct may not be working as it should. A bit like
SOD but the other duct! They have decided to save the ERCP until
there is nothing more to try unless I have a pancreatitis attack,
then it wouldn't matter because I would already have it! I may also
be getting a pain relief patch tomorrow which would be a great
relief, even if I was pain free for just a day!
You are all in my thoughts and I hope you all have some good days.
Lots of Hugs,
Shelley
x
P.S I haven't seen any posts from Pat in Ireland recently, does
anyone ever hear from him?

Hello,
Had my f/u visit with my GI, was told my endoscopic u/s was normal,
no stones and all biopsies were normal too.. my Dr has decided to
try and manage my pain with Amitriptyline, 10 mgs to start. I know
this med is used for depression and many other things including pain.
What I would like to know is how this works for others and any side
effects..
Thank you all
Liz

Hey Polly,
I am glad to see you up and posting. Sorry you had so much trouble
with the ERCP. Robert was awake thru his too. Horrible Thing to go
thru. But I am glad for you that it is over. I am glad that your Dad
and Jon came to see you and to get you out of the hospital for your
birthday. Jon told me about the flower garden he made you for your
birthday. That was so sweet :) Hope you are doing fine tonight. Out
thoughts and prayers are with you.
God Bless
~*~Denise~*~S.C.
Caregivers Moderator
denise@...
http://www.thepancreatitisplace.org/

-
HI Chris
My name is BruceI live out in suffolk county NY. there are no groups
that come from New York. I have had CP for 6 years now and have found
several groups for pancreatitis. I have become a member of the TPP
and have found it the best best group from all that I have been on. I
have become active withe the TPP and became membership moderator for
the group. There is a weekly chat that meets twice a week sun and wed
at 7.00 pm EST. There is also a board to post any question you might
have or just to vent So come and visit us in the chat room one night
you will see this is one big happy family.
Wishing you well
Bruce
Bruce Long Island NY
Membership Moderator

http://www.healthology.com/printer_friendlyAR.aspb=hairlosscentral&f=d
ental_health&c=dental_badbreath
Fresh-Mouthed Answers to Bad Breath
Published on: April 30, 2004
By Christine Haran
Bad breath is a common but embarrassing social problem that is likely
to have plagued anyone who eats onion and garlic. But some
unfortunate souls seem to have bad breath more often than others.
This might explain why Americans are doling out over $3 billion to
buy gum, mints and other industry remedies in pursuit of fresh
breath. Chronic bad breath, a condition known as halitosis, can stem
from poor oral hygiene, dry mouth and even the Atkins diet.
Below, Richard H. Price, DMD, a consumer advisor for the American
Dental Association who practiced dentistry in Newton, Massachusetts,
explains the best ways to combat bad breath, and not just disguise
it.
What causes bad breath?
Ninety percent of bad breath problems are caused by unique bacteria
in the mouth. They are anaerobic bacteria that produce volatile
sulfur compounds that consist of hydrogen sulfides and mercaptans.
These compounds are what gives bad breath its distinctive odor, that
rotten egg odor.
How does what you eat affect your breath?
There's food and there's diet, and both can influence your breath.
There's onion breath, garlic breath, tobacco breath. The odor-causing
chemicals that give onion, for example, its distinctive odor are
digested and the digested products go into the bloodstream. The blood
is brought back to the lungs to get fresh oxygen, so you breathe in
and out the onion breath (or garlic breath, or tobacco breath).
There's also bad breath that is associated with certain diets, such
as the Atkins diet. In order to efficiently burn fat, you need a
certain amount of carbohydrate, and the Atkins diet is a low
carbohydrate diet. So if you don't have enough carbohydrate, the body
has to modify the way it deals with fat and it produces a chemical
substance known as ketones. Ketones give the breath a different odor.
How does poor dental hygiene contribute to bad breath?
Even somebody whose mouth is meticulously scraped, cleaned and
flossed can still have bad breath, but if you don't have good