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Old 12-02-2012, 12:53 PM   #1
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Elevated amylase, normal lipase. Seeking educated advice

I'm grasping at straws on how to approach a health issue I've been dealing with for the past 6-8 months or so. This board seems to be as good a forum as any but if there is somewhere online better suited to seek advice with these problems please feel free to direct me there. This post could have gone under a few different forums on this board alone, but when you're talking amylase/lipase the pancreas is the main concern. I honestly don't know if this is a pancreas problem though. This is going to be a lot to read, and I thank anyone in advance that takes the time to do so and share any feedback.

I'm a male in my early 30s generally in good health. I had a stretch of about 10 days earlier this year where my bowel movements increased from the normal once per day, to 3-5 times per day. I was very concerned and my doctor suspected IBS, but after some blood work she saw that my amylase was in the 500 level and sent me to get a CAT scan. She did not let me know that my lipase was normal though, and after reading online about elevated amylase I jumped to the conclusion I probably had pancreatitis. I do enjoy drinking alcohol on a regular basis and this period of irregular bowel movements did come around the time of a particularly bad weekend in terms of my alcohol consumption. I figured that a decade of drinking had probably done this to my pancreas.

When I went to the hospital for the CAT scan the technician thought it was strange that my script just with the barium milkshake prep and not with an imaging injection. She almost tried to convince me to go ahead and get the imaging anyway to eliminate the need to come back and do the scan again with it. I thought this was outside of the area of expertise of the technician to decide and told her so. She went and consulted with the doctor who was going to review the scan and he confirmed that I just needed the barium drink milkshakes and they had me chug even more to get the best scan possible (that stuff is less than pleasant).

From there I went to a GI specialist where I was seen by a nurse practitioner. She was also consulting with a doctor on staff (no appointments were available with a doctor in the immediate future at the time). By the time of this appointment my bowel movements had returned to normal. I should note that I had no other unusual symptoms during this time period, no pain, cramping, nausea or anything of that nature. When I explained this to the nurse practitioner, and she reviewed my blood work and the CAT scan, she basically told me there was no reason she could see why my amylase was so elevated. This was the first time I found out that my lipase levels were in fact normal so pancreatitis was unlikely (wish my doctor knew this because I had worked myself up that I definitely had it for the 2-3 weeks this was going on). The CAT scan results were completely normal, or "unremarkable" as the terminology goes. After examining my abdomen and reviewing with me the lack of other symptoms, the nurse practitioner said the other possible culprits, such as ulcers, liver problems, cancer, etc were unlikely. She spoke with the doctor and came back and let me know the most likely scenario was either that this was a one time anomaly, or that I had a condition called macroamylasemia which is benign and causes elevated amylase levels. Either way she did not think I had much cause for concern. She wrote a script for me to take a 24 hour urine sample to check for amylase levels there, and to get more blood work in a month or so. She also pointed out that if I have macroamylasemia my amylase levels have probably been elevated for a while and were most likely unrelated to the stretch of irregular bowel movements I had.

The urine test came back normal but the blood work had my amylase levels still in the 400 levels. At this point I was told to go back to the GI specialist but I didn't understand why. Maybe the nurse practitioner did not explain this well, but from what she told me there wasn't much more they could do for me in this situation. I don't believe there is a way to test for macroamylasemia, although as I said I may be mistaken. As my symptoms had subsided and I was at a point in my health insurance where I'd be paying 100% out of pocket up until October, I made the decision not to go back to the GI specialist. My logic being we were probably going to need to start a whole new batch of tests and in the end I was skeptical that they would provide any new information. I told myself if my symptoms returned I would address it then.

Now I have noticed as I've gotten older that the day after drinking I tend to have much high frequency of bowel movements. And since Thanksgiving I've had another stretch of time where my bowel movements have noticeably increased for the first time consistently since the first episode 6-8 months back. While I do think the most likely scenario is that I have macroamylasemia, I also don't doubt that the drinking I've done has taken its toll on my body and my bowel issues could be related. This period since Thanksgiving hasn't been a constant problem every day and hasn't been as bad as the previous stretch, so I'm not as concerned about it. But I do coincidentally have an appointment with my doctor coming up later this week just for a check up. I'm not sure how to approach these problems with her. Past another CAT scan with imaging, I don't know what else can be done to determine what's going on with me. And for the problems I'm having, I'm not certain what the imaging will show that the previous scan did not show? Maybe a more detailed look at my liver? With my insurance I'm back at a point where I can easily afford some expensive work, but I don't want to do it just for the sake of having it done and then hit that donut hole in my coverage again.

Once again I'm very thankful for anyone who takes the time to read all of that and give me any feedback. Half of me feels like I'm making too big deal out of this and that I'm probably just a normal male around this age who has indulged in a bachelor lifestyle and whose body can't handle the abuse I've put it through the same way I could in my 20s. But the other half of me is concerned I'm ignoring what could be a potentially very serious problem.

 
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Old 12-02-2012, 08:45 PM   #2
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Re: Elevated amylase, normal lipase. Seeking educated advice

Hi TB, I'm not a doctor, but an X-drinker. I didn't get into trouble till my mid 50s but I've been looking into what went wrong and I was surprised to learn drinking increases iron absorption from food, and over time, the resulting build up of iron can cause problems with the liver, which is what I believe happened to me.

Your case is interesting, as high iron is also notorious for inflaming the pancreas. The genetic iron overload condition hemochromatosis was originally called "bronze diabetes" as people with high iron tend to tan (bronze) easily, and the pancreas is the first organ that often goes haywire with iron overload.

Doctors rarely test iron levels in men, as men rarely have problems with anemia or iron overload, unless they drink for many years or have genetic hemochromatosis, which is relatively rare.

Do yourself a favor and get a full iron study done. It's a cheap and easy blood test. Be sure they include FERRITIN in the iron study, as this is sometimes left out and ferritin is the best measure of stored, built-up, total iron loading on the liver and pancreas.

Be sure and get a copy of your iron labs and take a good look at them... Serum iron and transferrin saturation should not be up near the high end of the normal range, but in the middle third of the range. The upper limit for ferrritin is often set outrageously high at 300 or even 400 for men, but the newer thinking is anything well into triple digits is simply not as healthy as ferritin of 100 or less, particularly if you regularly consume alcohol.

Alcohol consumption creates a lot of oxidative stress in the liver and pancreas, and iron is a very powerful pro-oxidant. Mix the two together and they can potentiate the negative effects of either high iron or alcohol alone. High iron isn't so bad if you don't drink, and drinking isn't so bad if your iron isn't high, but when combined they can and often do cause problems.

If your ferritin/stored iron is high, there's not a lot that can be done to lower it other than blood donation, which will fix this very quickly and effectively. My ferritin was only around 200 when I got sick, but I was drinking at the time. I lowered my iron through blood donation, and GOT BETTER!

Best of Luck to you!

Last edited by BillinSD; 12-02-2012 at 08:46 PM. Reason: edit

 
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Old 12-03-2012, 06:08 AM   #3
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Re: Elevated amylase, normal lipase. Seeking educated advice

Hi Bill, thanks for your feedback. I've never heard of the iron build up that can result from heavy drinking before and it's definitely something I'll look into. What about my case makes you think that may be the problem? Did you also suffer from an otherwise unexplainable increase in bowel movements? For the past 2 weeks I've been back up to 3 a day some days, although never more than that and sometimes back to my regular 1 or sometimes just 2.

I should point out that my pancreas was not inflamed in the CAT scan I had, which is why the GI specialist ruled out pancreatitis in combination with the normal lipase levels. Also in terms of "bronze diabetes," I certainly don't tan easily. Quite the opposite, when on vacation even with my best efforts I get the slightest of tans at best.

Either way I found your information interesting and like I said I will definitely read up on it more!

 
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Old 12-03-2012, 08:26 PM   #4
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Re: Elevated amylase, normal lipase. Seeking educated advice

You're actually still a bit young to have accumulated a lot of iron TB. I just thought of this as I developed high iron from drinking which led to trouble in my early 50s for me and the pancreas is very sensitive to high iron so this made me think you should have it checked.

My early symptoms were feeling overly full and queasy for hours (like 6 hours!) after eating big meals. I think I had a fatty liver as it was uncomfortable to sleep on my right side. Then, rather suddenly, inflammation kicked in and I was sick... I quit drinking and actually felt worse for several months before I started donating blood to get my iron down.

When I started feeling better after each donation, I had my iron checked and it was still elevated, even after 3 donations. Once I got my ferritin down below 50, I felt so good I wanted to drink again. Never want to go through detox again though. I've reached an age where I've had my fun, and want to stay healthy more than anything else now.

Again, I'm not a doctor... This was just my experience. Ruling out high iron is cheap and easy, and iron is often overlooked by doctors. Hope you get to the bottom of whatever is going on soon!

 
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Old 05-08-2013, 04:40 PM   #5
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Re: Elevated amylase, normal lipase. Seeking educated advice

Quote:
Originally Posted by TBu443 View Post
I'm grasping at straws on how to approach a health issue I've been dealing with for the past 6-8 months or so. This board seems to be as good a forum as any but if there is somewhere online better suited to seek advice with these problems please feel free to direct me there. This post could have gone under a few different forums on this board alone, but when you're talking amylase/lipase the pancreas is the main concern. I honestly don't know if this is a pancreas problem though. This is going to be a lot to read, and I thank anyone in advance that takes the time to do so and share any feedback.

I'm a male in my early 30s generally in good health. I had a stretch of about 10 days earlier this year where my bowel movements increased from the normal once per day, to 3-5 times per day. I was very concerned and my doctor suspected IBS, but after some blood work she saw that my amylase was in the 500 level and sent me to get a CAT scan. She did not let me know that my lipase was normal though, and after reading online about elevated amylase I jumped to the conclusion I probably had pancreatitis. I do enjoy drinking alcohol on a regular basis and this period of irregular bowel movements did come around the time of a particularly bad weekend in terms of my alcohol consumption. I figured that a decade of drinking had probably done this to my pancreas.

When I went to the hospital for the CAT scan the technician thought it was strange that my script just with the barium milkshake prep and not with an imaging injection. She almost tried to convince me to go ahead and get the imaging anyway to eliminate the need to come back and do the scan again with it. I thought this was outside of the area of expertise of the technician to decide and told her so. She went and consulted with the doctor who was going to review the scan and he confirmed that I just needed the barium drink milkshakes and they had me chug even more to get the best scan possible (that stuff is less than pleasant).

From there I went to a GI specialist where I was seen by a nurse practitioner. She was also consulting with a doctor on staff (no appointments were available with a doctor in the immediate future at the time). By the time of this appointment my bowel movements had returned to normal. I should note that I had no other unusual symptoms during this time period, no pain, cramping, nausea or anything of that nature. When I explained this to the nurse practitioner, and she reviewed my blood work and the CAT scan, she basically told me there was no reason she could see why my amylase was so elevated. This was the first time I found out that my lipase levels were in fact normal so pancreatitis was unlikely (wish my doctor knew this because I had worked myself up that I definitely had it for the 2-3 weeks this was going on). The CAT scan results were completely normal, or "unremarkable" as the terminology goes. After examining my abdomen and reviewing with me the lack of other symptoms, the nurse practitioner said the other possible culprits, such as ulcers, liver problems, cancer, etc were unlikely. She spoke with the doctor and came back and let me know the most likely scenario was either that this was a one time anomaly, or that I had a condition called macroamylasemia which is benign and causes elevated amylase levels. Either way she did not think I had much cause for concern. She wrote a script for me to take a 24 hour urine sample to check for amylase levels there, and to get more blood work in a month or so. She also pointed out that if I have macroamylasemia my amylase levels have probably been elevated for a while and were most likely unrelated to the stretch of irregular bowel movements I had.

The urine test came back normal but the blood work had my amylase levels still in the 400 levels. At this point I was told to go back to the GI specialist but I didn't understand why. Maybe the nurse practitioner did not explain this well, but from what she told me there wasn't much more they could do for me in this situation. I don't believe there is a way to test for macroamylasemia, although as I said I may be mistaken. As my symptoms had subsided and I was at a point in my health insurance where I'd be paying 100% out of pocket up until October, I made the decision not to go back to the GI specialist. My logic being we were probably going to need to start a whole new batch of tests and in the end I was skeptical that they would provide any new information. I told myself if my symptoms returned I would address it then.

Now I have noticed as I've gotten older that the day after drinking I tend to have much high frequency of bowel movements. And since Thanksgiving I've had another stretch of time where my bowel movements have noticeably increased for the first time consistently since the first episode 6-8 months back. While I do think the most likely scenario is that I have macroamylasemia, I also don't doubt that the drinking I've done has taken its toll on my body and my bowel issues could be related. This period since Thanksgiving hasn't been a constant problem every day and hasn't been as bad as the previous stretch, so I'm not as concerned about it. But I do coincidentally have an appointment with my doctor coming up later this week just for a check up. I'm not sure how to approach these problems with her. Past another CAT scan with imaging, I don't know what else can be done to determine what's going on with me. And for the problems I'm having, I'm not certain what the imaging will show that the previous scan did not show? Maybe a more detailed look at my liver? With my insurance I'm back at a point where I can easily afford some expensive work, but I don't want to do it just for the sake of having it done and then hit that donut hole in my coverage again.

Once again I'm very thankful for anyone who takes the time to read all of that and give me any feedback. Half of me feels like I'm making too big deal out of this and that I'm probably just a normal male around this age who has indulged in a bachelor lifestyle and whose body can't handle the abuse I've put it through the same way I could in my 20s. But the other half of me is concerned I'm ignoring what could be a potentially very serious problem.
Hello,

I am interested in your situation (though sorry you are stressed over it). I am in my mid 40's though, and female. I am a healthy weight and eat a healthy vegetarian diet. My "bachelorette" days are behind me so for me it's little or no alcohol.

Regardless of our differences though, we seem to be in the same (or a similar boat). About 3 yrs ago I went to a new dr who is the first to test for amylase. Mine was high, around 245 although lipase was normal. Like you, I went for a barrage of scary tests (including an MRI) of the pancreas, etc. All were normal.

Over the last 3 years I've had it tested regularly and while it fluctuates slightly up and down, it never is anywhere near normal.

My doctor is perplexed but unworried. At first he thought it was linked to cholesterol, but when my cholesterol goes down, the amylase goes up! My cholesterol is normal.

I have no other health issues that I know of besides hay fever. The doctor wonders if perhaps I eat a bit too much carbs because the amylase is utilized in carb digestion. He thinks I might eat less of them and see what happens.

I am also gluten free (!) for several years and although I eat some carbs I definitely don't overdo and maintain a fit weight. I work out too so I feel a bit "entitled" to the limited carbs I do consume. Basically, I'm not up for a carb free life so I don't think we'll do that experiment.

Today I got results from my latest blood tests. Everything in normal range but amylase had gone up from 195 at my last visit to 245.

I hope it simply comforts you to know someone else is concerned about it as well, and has been for 3 years! It's weird knowing something is "way off" and not being able to know why. I'm very big on knowing why and taking action, so this is frustrating! But if there are no associated problems, I guess we just live with it and try not to worry.

I'd be curious to know if several months later you still have elevated amylase?

Good luck and best wishes!

 
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Old 05-12-2013, 08:04 PM   #6
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Re: Elevated amylase, normal lipase. Seeking educated advice

I likely have chronic pancreatits and have just mildly elevated lipase when in a flare but all my imaging for 4.5 yrs is clear. However I have pain that goes w it. I believe I've had it for 7 yrs with my esrly symptoms being acid reflux. Many people with cp do not have pain at first but its a progressive disease so it comes down the road. It's a complex disease.

Sometimes people naturally have a bit elevated enzymes but not too high.

Last edited by moderator2; 07-10-2013 at 08:05 PM. Reason: posted disallowed website

 
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Old 07-10-2013, 07:57 PM   #7
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Re: Elevated amylase, normal lipase. Seeking educated advice

This is not consistent with what any doctors/specialists I've spoken with have told me during the problems I described above. I was given the impression that the pain that you would be experiencing if there are issues with your pancreas would be apparent very early on in the process, which is why it was ruled out for me repeatedly. I also find it suspect that you use the phrase "I likely have chronic pancreatits [sic]," it does not sound like you have been diagnosed or have strong medical advice in this area. Especially if your imaging is clear. It sounds to me like you may want to seek a second opinion.

Also in response to WackyJacky1, I have not had problems with the symptoms I posted about originally in the past 7 months, and after consulting my doctor again and reviewing the fact that my amylase is elevated while my lipase has remained normal, and all the tests I've had etc, she felt that macroamylasemia was the most likely scenario and didn't feel it was necessary to continue with testing unless I had more unusual symptoms. Since then my body has returned to a very normal daily cycle and I have not thought about all the problems I went through last year all that much.

I do still get e-mails about this post from time to time though so I'm just checking in.

Last edited by moderator2; 07-10-2013 at 08:05 PM.

 
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Old 07-10-2013, 08:32 PM   #8
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Re: Elevated amylase, normal lipase. Seeking educated advice

Actually if you do a simple google search on chronic pancreatits it is a very hard disease to diagnose. First off, often times enzymes are just mildly elevated if at all, also early stage/minimal change often is not viewable on scans as its a hard organ to view. With that, you have to put pieces of the puzzle together and in my case it's elevated enzymes when I have pain, malabsorption, and a tumor marker that elevates with either PC, CP or gallstones (ruled out).

CP on average can take 7 yrs to dx


Quote:
Originally Posted by TBu443 View Post
This is not consistent with what any doctors/specialists I've spoken with have told me during the problems I described above. I was given the impression that the pain that you would be experiencing if there are issues with your pancreas would be apparent very early on in the process, which is why it was ruled out for me repeatedly. I also find it suspect that you use the phrase "I likely have chronic pancreatits [sic]," it does not sound like you have been diagnosed or have strong medical advice in this area. Especially if your imaging is clear. It sounds to me like you may want to seek a second opinion.

Also in response to WackyJacky1, I have not had problems with the symptoms I posted about originally in the past 7 months, and after consulting my doctor again and reviewing the fact that my amylase is elevated while my lipase has remained normal, and all the tests I've had etc, she felt that macroamylasemia was the most likely scenario and didn't feel it was necessary to continue with testing unless I had more unusual symptoms. Since then my body has returned to a very normal daily cycle and I have not thought about all the problems I went through last year all that much.

I do still get e-mails about this post from time to time though so I'm just checking in.
__________________
Upper left sided stabbing pains in episodes since 09. Slight increased lipase and tumor markers, 5 EUS, 2 MRCP show zero damage. Low ejection on Hida, but no stones.

 
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