chronic pancreatitis: 15 yo

[Guest guest]

Overall, I'm a bit confounded as to which direction to go and

acknowledge that I may be way off with my initial thoughts.

 

15 y o female NP. Med dx genetic chronic pancreatitis. Onset age 4

with epigastric/stomach pain, dx age 7. Genetic mutation of cystic

fibrosis, 2 younger paternal cousins now found to also have mutation.

 

Pain is supraumbilical area, dull, diffuse, extreme, occ radiates

around back. Worse with pressure, not with rebound, no change with

hot or cold application, but better with intake of cold during

attacks, eg popsicles. Desired hot pack to abdomen during tx but " NOT

because it would help pain, just that it felt good. "

 

History of approximately annual hospitalizations lasting 5-7 days for

px control. Is in pain mgmt program. Pancreas currently scarred and

shrinking. Since approximately at the onset puberty/menses age 13,

pain worse, more frequent attacks lasting longer, more difficult to

control, higher on pain scale. MDs said puberty/hormones will either

lessen or exacerbate. More frequent hospitalizations in last 2 years

with longer duration, missing a lot of school and has quit all

athletics and activities. Desires pain control and decrease in

frequency of attacks.

 

Appears quiet, well-mannered, well-spoken but not shy. Slightly pale,

freckled body. cold feet and hands, does not feel generally cold or

hot (but mother claims she seems cold and is frequently sweatered).

Catches colds easily and frequently. Fatigued most days, very

fatigued on days of pain, now occurring twice weekly, each with

additional day of residual pain. During attacks, can only get from

bed to couch but rarely complains. Reports generally happy and

outgoing (mother concurs) but quiet during attacks. Hypotensive.

 

Cycles unremarkable.

 

Poor appetite overall and worse with pain attacks, gets full quickly.

no bloating, no gas. BMs hard but long and formed QOD, q3 days,

probably due to meds, not particularly odorous. Dry skin, tends

towards eczema, dry hair. Thirst & ur nl. No vomiting, nausea occas

from meds. Belly warm to touch.

 

Sleep disturbed 2x nightly from px. Vivid dreams. Night sweats, but

she thinks that's because she enjoys the " comfort " of lots of

blankets (not because she's cold).

 

No known correlation of emotions or events that trigger episodes,

spontaneous.

 

Tongue wide, red, slight white coat towards rear, no coat anterior,

slightly redder tip. Very slightly scalloped and shiny edges.

Pulse deep, rapid, slippery, fuller than I expected to find, thin/sl

wiry in liver.

 

Complicated by daily meds: pancreatic enzymes, ultram for px, bentyl

anti-spasmodic, benadryl for itching from the meds, and a couple of

other pain meds she didn't bring with her when the pain worsens.

 

I have a couple of ideas for formulas, but I am a bit confounded by

exact diagnosis, possibly due to how meds are changing her diagnostic

signs. Seems to have a Lung-Spleen constitution (?) and yin is

damaged, but overall, pulse seems to indicate some damp/heat (or is

this the meds?), while tongue more yin xu heat. Is this liver-

gallbladder/stomach-spleen? I was considering a variation of Dan Shen

Yin or Qing Yi Tang or Chai Hu Shu Gan Tang as part of her formula.

Would a short-term of Long Dan Xie Gan T be worth considering despite

no extraordinary damp signs or is she not hot enough? Short term Da

Chai Hu Tang?

 

Vickii Gervais, LM, LAc

Wild Harmony Wellness Center

San Diego CA 92115

619.286.2888