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Doctor Nash
Doctor Nash, Professor of Medicine (MD)
Category: Health
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Experience:  I've been teaching and practicing medicine for more than 40 years.
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Is there a cure for Sphincter of Oddi Can someone who ...

Customer Question

Is there a cure for Sphincter of Oddi? Can someone who has been daignosed with this ever eat a normal diet and live a pain free healthy life again?
Submitted: 6 years ago.
Category: Health
Expert:  Doctor Nash replied 6 years ago.
drjones,

The spincter of Odi is an anatomical structure, not a disease or condition itself.

If you are having a problem related to it, is it spasm, scarring and blockage, tumor, or something else?

I see that you have had ERCPs and are still having problems. Please tell me more about the situation.

How old are you?

How is your general health?

Tell me all medicatios you take.

How long have you had problems?

How did they start?

When did you have the ERCPs?

Do you know if your liver function tests a reported as normal?

What are your current symptoms? Pain? Digestive? Other?

I'm sending this as an Information Request, so you can see it without paying; it is not an answer. Do not pay for it; you pay only for answers.


Customer: replied 6 years ago.
I'm a 40 year old female. I have no other health problems but it's hard to say that my overall heatlh is good when I have been in pain for two years.

I did have a cholecystectomy on Feb 18, 2004 because of polyp no stones. I was hospitalized for five days as I bleed internally and needed blood tranfusions.


The Dr.'s that I have seen have not told me that it was scarring or a tumor but that my pressures are high so my pancreatic shpincter's do not open as they should. I had an ERCP on Jan 10, 2007, this seemed to help a little as I was able to tolerate more foods but still low in fat and my second ERCP was on Aug 29, 2007. This last ERCP caused a pancreatic attack so I spent three days in the hospital. I have had constant discomfort since. I do not take pain meds I just tolerate it and eat a very low fat diet.

While I had some digestion problems since the cholecystectomy it was January 2, 2006 when I first started having URQ and spine pain and what I call attacks, pain and pressure in both the sternum and spine radiating into the ribs mostly on the right side. On this day I went to the ER and had blood work and catscan. My amylase was 115 and lipase was 334, only slightly elevated.

On Jan 19, 2006 I had an upper GI endoscopy, findings were normal. On Aug 24, 2006 I had a colonoscopy, findings were normal. On June 27, 2006 I had a MRCP, the finding were "The biliary system domonstrates normal appearance of the common bile duct, which taperes normally at the duodenum. The pancreatic duct is not enlarged or duplicated. There is a biliary trifurcation, a normal variant. Multiple cystic regions in the liver are domonstrated, some on close proximity to the biliary system, although several are separate and have signal characteristics of simple cysts. However, there are some at which the biliary system approaches very closely and communication cannot be excluded; alternatively, these could represent biliary hamartomas. There are no filling defects within the biliary system. The remainder of the visualized portions of the abdomen are unremarkable".

Through all of this I have had several blood tests most of which show slightly elevated Lypase and Amylase. You asked about my liver function, I just looked through my records and I beleive that you are looking for my AST and ALT, my ALT is 12, AST 18 on one lab report and on all other labs they are comparible. Almost everytime I have a really bad day pain level wise the next day my stools are always lighter and sometimes even pale yellow. I have learned that this means the bile is not flowing properly or at all. The hight my pain level the lighter the stools.

I currently take digestive enzymes, just started these three weeks ago. I take 37.5 mg of alprazolam at night to help with sleep, one multi vitamin a day.

I have URQ pain almost every day. It increase when I eat. Several times a week I also get sharp spine pain between the shoulder blades that radiate into the ribs with increase sternum pain. When I have the spine pain my teeth feel sore as well, this has happened since my first attack in Jan 2006. I believe that I have some level of malabsorbtion as I lose a lot of hair, my teeth hurt quite often and my nails have ridges that go from side to side not with the length of the nail.

This has impacted my life in such a negative way. I can no longer travel because I'm just to affaid to go to far from home because I never know when the pain is going to flare up or worsen. I have slept in a recliner for almost two years as my pain increases when I lay flat and I cannot lay on my right side without causing a great deal of pain. I have given up golf and gardening as bending or swinging a club is to painful. Although I have lost weight I still wear the same size clothes. I cannot button my pants ever, and my bra causes pain. Any pressure on my stomach causes discomfort.

I am very fortunate to have an amazing and supportive husband but feel guilty because he does most everything around the house and want nothing more that for me to feel better. I get angry when anyone including Dr.'s imply that this maybe a mental issue. I know myself and I promise if I could do anything to correct this I would have done it long ago. I do not suffer from depression or any other mental illness as far as that goes. I do however sometimes have a hard time emotionally because of this, somedays I have a I'm going to figure this out and feel great again attitude and other days I feel like "will I ever get better". Currently I have pain in my sternum and URQ, it is increased because I have been sitting a little slouched when typing this, sitting up straight helped to releive some of the discmofort in the sternum.

Thank you for taking the time to read my story.

Sincerely,

drjones
Expert:  Doctor Nash replied 6 years ago.
What a great historian you are.

Are you a health care professional? Are you sand bagging me?

I will not for a moment dare to think you are a "head case." I have learned much about pain in the 49 years since finishing medical school. I would give you a fresh look in a team setting.

I still teach medicine, so I am not available at all times. I do check JA throughout the day. Please be patient; I will reply.

Please tell me where you have been getting your medical care, and we'll go from there.
Customer: replied 6 years ago.
I am not a healthcare professional just a pro at dealing with pain.

I had my cholecystectomy at Dartmouth Hitchcock of Keene NH by Dr. Pierre Hermans, both ERCP's done at Brigham & Womens Hospital in Boston MA by Dr. David Leslie Carr-Locke and catsans, MRCP, colonoscopy, endoscopy, regular gastro and emergency visits at Springfield Hospital in VT and Dartmouth Hitchcocke Medical Center in Lebanon NH. My gastro doc at Dartmouth Hitchcock Medical is Dr. D J Van Leeuwen.

I have recently read that Progesterone (and not estrogen, testosterone, thyroid or insulin)causes a relaxation of the sphincter, thus increasing bile flow. Therefore, people with estrogen dominance (relitive progesterone deficiency) are more likely to have a constricted Sphincter of Oddi. I have also read that when women who have estrogen dominance are treated with progesterone supplementation they see a great improvement in their digestion. What are your thoughts on this? Is it easy to test ones estrogen level?

Thanks again,

drjones
Expert:  Doctor Nash replied 6 years ago.
I see. Persistent pain → research. Hence, drjones.

My daughter has chronic pain → Doctor Jenn.

I was hoping that you had been treated locally and that I could send you to an academic edical center. No luch. You've had the best.

I'm not in a position to comment off hand on your suggestions. I'm a surgeon turned nephrologist in my later days; my research interest is kidney enzyme/hormones and hormones that act on the kidneys, mainly inregard to hypertension.

I'll do some reading myself and then talk with a pediatric GI guy who plays with gut hormones. This may not be until Tuesday, so please be patient.

We'll keep contract through this message thread. If it closes from disuse, just send a message to info@justanswer.com asking that it be reopened. I'll be notified.
Customer: replied 6 years ago.
While I appreciate your time I'm starting to feel like perhaps asking health related questions on internet sites such as this may not be as fuitful as I had hoped in finding answers about SOD and what my options might be if any given that I have already tried the most common approaches in treatment. I guess I thought because you asked several questions in your initial response to my original e-mail you were knowledgeable in the digestive/biliary field.

I wished the dr part of my username drjones meant that I was a Dr. as I'm sure it would be a benefit in finding answers and a solution to this most painful life debilitating illness. Not to mention that my colleagues would be those in the medical profession as apposed to the current financial/accounting professionals. Although they are a great team of people they're knowlege of the biliary system is ill at best.

I will be patient while you check in with your GI guy and look forward to hearing back from you on Tuesday.

drjones
Expert:  Doctor Nash replied 6 years ago.
My last message may have misled you. The questions I asked are those any competent physician should ask. I may have some advantage since I have in the past done quite a bit of biliary surgery.

As a former surgeon, I am more than familiar with GI issues. And as a professor of medicine, I have to know a lot more, or I cannot teach about the wide field. When I am an attending, we cover patients with a variety of problems. I am professor of physiology and biophysics (and instructor in orthopedic surgery) as well, and have taught GI physiology to medical students. I have an exensive knowledge base.

Unfortunately, you have exhausted my knowledge as well as that of your own doctors at the finest of academic medical centers. (I trained in nephrology with a former chairman of the department of medicine and later dean at Dartmouth and have in the far past been visiting professor at both Darthmouth and Harvard).

The problem here is that we have to go beyond the expertise of the GI specialist. The woman with whom I will speak is doing cutting-edge research in a rather esoteric sub-, sub-specialty of gastroenterology.

I'm not certain that my visit with her will be fruitful for you; I am hoping that she will suggest some area of investigation that your people might follow.


I am not a quitter, and since you are not either, let's continue to work on this. Neither of us has anything to lose. I don't come to JA for income; I come here because in everything that I still do (at age 75), I hope to make a difference. This is why I don't give short answers and jump from one client to another, why I am willing to continue with each one I accept (usually the difficult problems that other JA experts refer to me) until I have done all I can do. If I can improve your quality of life, mine is also improved.
Customer: replied 6 years ago.
I appreciate that you asked quesitons in your previous messages they were good valid questions. I guess I'm just feeling the same frustration that I have felt all along. It was unfair of me to to expect that you could give me the magic answer in a few short e-mails when the very capable professionals that I have seen to date have not been able to provide me with answers and or a solution to this illness.

I'm still very curios and want to learn more about the estrogen dominence/progesterone theory. One of the few reasons that this interest me is becuase I had started an estrogen based birth control two weeks prior to my first attack on Jan 2n 2006. I was not on birth control to prevent pregnancy as I have had a tubal but to regulate and slow my mentrual cycle. I stayed on the birth control another month before I stopped taking it. I will let you know if I find any articles or documentiatin that would validate this theory.

Thank you for taking the time to discuss my case with your colleagues and I hope that I'm one more of those whos quality of life you will have improved as I'm sure there are many.

Sincerely,

drjones
Expert:  Doctor Nash replied 6 years ago.
I hope you didn't take my last message as remonstrative. As I reread it, it does have that tone.

Part of what drives me is curiosity, probably the driving force in the research part of my career. So, I try to learn enough to help you. I have said for years that if a day goes by in which I have not learned someting new, it was a wasted day.

Another is simply payback. This is related to the fact that what I earned to pay for my education was only a small part of its cost. The remainder, and my income thereafter, was derived in large part from taxpayers like you, be it from grants and contracts or from governmental support of my institution.

There is another factor in your case. You show me strong intellect, sense of self, and communications skills. It's a pleasure to "talk" with you.
Customer: replied 6 years ago.
I enjoy learning as well but to be honest with you I wish that I could have spent the last few years learning about something other than Sphincter of Oddi.

More people need to give back, unfortunately the majority of our society is to busy tryng to see how much they can get and how much better it is than that of their neighbors. I'm not able to give as much time to my community as I once did because it takes all of my energy to make it through the work day due to the disomfort and pain and low energy level. A few things that I enjoyed before I became sick were to serve on the school board for a small private school that my daughter attended prior to college and volunteering as a cheerleading coach the young children in our community Pee Wee football league. My daughter and I have also spent Thanksgiving day serving dinner at the area drop in center, this was the most rewarding.

Thank you for your kind words, the pleasure is mine.

Sincerely,

drjones
Expert:  Doctor Nash replied 6 years ago.

I keep telling myself that some day I will publish a bumper sticker that says, "Teach ethics, then religion."

Frank Nash

Customer: replied 6 years ago.
Please let me know when you publish this bumper sticker as I'd like to purchase several and hand them out, oddly enough I know plenty of people I would like to share them with.

I can see it now, from my rearview mirror lightbulbs going off as people lightly thump themsleves up side their heads and say (outloud) "what a concept".

drjones
Customer: replied 6 years ago.
Hi have you had a chance to discuss my case with your colleuge? I look forward to hearing what you might have learned.

drjones
Expert:  Doctor Nash replied 6 years ago.
Sorry to say, I've been ill and have had to put all things aside for a few days.

I am five years post kidney transplant and the anti-rejection meds have me walking a fine line between rejection and infection. I catch everything (from my gradndkids?), and it lasts and lasts and lasts ....

I always recover, so I will be talking with my GI guy.

Please be patient.

Frank Nash
Customer: replied 6 years ago.
I'm sorry to hear that you are not well. It sounds as though you have had your own serious health issuse to deal with.

Please take care and get well. I look forward to hearing from you in the future.

Sending positive energy your way,

drjones
Expert:  Doctor Nash replied 6 years ago.
The fact is that I have not been to the medical center for a while. Frankly, I haven't been very active at all. It's hard for me to motivate myself when I'm not feeling well.

I've just made a note to call Sandra on Monday and e-mail the URL for this thread to her.

I do feel quite guilty about this because you have been more helpful to me in my consideratons than 99+% of the poor people who send us questions.
Customer: replied 6 years ago.
Reply to Doctor Nash's Post: Sorry to hear that you are still not feeling well. Unfortunatley I know all to well how you feel. I have just had three very hard days of pancreatic and biliary pain, living on toast and water. Things seem to be a little better today, thankfully.

Thank you for forwarding this to Sandra, I look forward to hearing from either of you in the near future.

Sending positive energy your way,

drjones
Expert:  Doctor Nash replied 6 years ago.
Sandra sends her regrets; she is a baffled as I and the rest of your docs.

In my surgical days, sometimes we did something questionable because everything else had failed. This is far less common now because of the beautiful imaging technology. Forty years ago, my best imaging tool was a scalpel.

Now, however, I wonder whether the imaging methods may not on occasion get in the way of an aggressive and beneficial procedure. The contrast between white (or clay-colored) stools and a presumably functioning sphincter (in the face of normal hepatic function) raises questions for me.

So, has anyone suggested directly attacking the sphincter of Odi?

With endoscopic techniques, this is minimally invasive, and I would look at it as a therapeutic trial. The risk-benefit ratio could be highly favorable.
Customer: replied 6 years ago.
Reply to Doctor Nash's Post: Thanks for getting back to me. You ask if "anyone has suggested directly attacking the sphincter of oddi", by that do you mean; have I had my sphincter cut? I have had two ERCP's with sphincterotomy. I had favorable improvement after the first one but the second one that I had on Aug 29th has caused more pain and made things worse in general.
Expert:  Doctor Nash replied 6 years ago.
I must wonder if the area of the sphincter has actually scarred. Another possibility is that the some of the sphincter muscle fibers are intact but are not responding to the hormone cholecystokinin (CCK).

The presence of fats or protein in the first portion of the duodenum causes release of CCK, which stimulates production and release of pancreatic juice and bile, contraction of the gall bladder, and relaxation of the sphincter of Odi. Recent developments show that it plays many roles in distant parts of the body, including the brain.

When you first questioned hormones, I went beyond CCK because it has been known since before I entered took my first medical physiology course in 1952, and I have taught about it in every physiology course I have given, from the P105 (freshman) to the F550 (graduate). It is basic and fundamental. It is so basic, that both Sandra and I were looking for something far more complex.

Perhaps you should have another HIDA scan, fasting and after administration of CCK. I discussed this with Sandra this morning, and she questions why this has not been done.

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