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Took accetane acne medication for a long. Suffering form recurrent episodes of acute pancreatitis. Cure?

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Practicing since : 2001
Answered : 492 Questions
In 2005/2006 my son XXXXXXX was on accetane acne medication and I believe he was on these tablets too long. Prior to that he has had an excellent health history. He was studying surveying at the time.
XXXXXXX is now 29. His first attack was two years after being on the accetane medication. Then he was fine until September 2011. In the last year he has suffered from constipation and he not not enzyme medication to balance things out because is he okay in that area. But if he does not eat he gets stomach discomfort.
Zanes Results listed below:
Procedure EUS 3 XXXXXXX 2013
Instrument loaner US scope
Medications Fentanyl-175mcg
Midazolam ā€“ 9mg
The pancreas was examined from the head to the tail. The pancreatic parenchyma had hyperechoic foci and mild lobularity which was more prominent in the tail, with a hypoechoic area measuring 17.5 by 43mm. This appearance in the tail may be in keeping with previous pancreatitis. The rest of the pancreas was normal with no focal masses. The main pancreatic duct was a normal size but had hyperechoic walls. The common bile duct was of normal size with no evidence of sludge or stones. The ampulla was normal. Glimpses of the gallbladder were obtained with no evidence of sludge or stones.
Left adrenal normal.
1.     3.9 EUS of chronic pancreatic, which may reflect previous episodes of acute pancreatitis. No cause for recurrent pancreatitis or abnominal pain identified.
2.     2. Hypoechoic area at pancreatic tail ā€“ differentials include residual changes from previous pancreatitis.

Thank you please let me know the bad news. I have to know what can be done. Thank you
Kind Regards
If he gets the tail taken off can he have a normal life please. Plus the hyperechoic walls can they heal with correct diet no sugar, fats gluten free etc. Is hyerechoic foci a fungus? If not what is it please. I forgot he had somalia food poisoning about 7 months before. In the last year his skin peels of his hands sometimes.
Is Zanes pancreatis dying?
What about di vinci surgury?
What about sugar diabetes. The specialists said, its on its way even though his ensymes/insulin is normal.
With the tail being taken off can he live a normal life pain free.
According to my research Zanes seems to have pancreatis that is digesting itself or a leakage what can be done?
His stomach has 3/10 to 5/10 pain status every day.
Doctors only offered oxytone pain killers? What is side effect please?
He suffers with constipation more than the other by far.
Accetane causes inflammation of bowel too.
Posted Wed, 24 Apr 2013 in Digestion and Bowels
Answered by Dr. Abhijit Deshmukh 19 hours later

I understand the problem your son is going through and also your justified concern regarding is.

Looks like your son is suffering form recurrent episodes of acute on an underlying chronic pancreatitis based on the information you have sent me. It means there is some irreversible changes and damage to the pancreas with an intermittent worsening of its swelling (acute exacerbation)

Let me answer your queries in the sequence you have asked them.

1) Getting the tail of pancreas off is no solution it will not help him
2) Diet changes do not help much in healing the pancreas or getting it back to is normal original state
3) Hyperechoic foci are areas of swelling/ inflammation no fungal infection
4) His pancreas are not dying but have some degree of loss of function with recurrent swelling in them.
5) Not much role of da vinci surgery or any other surgery based on eus report as of now since duct size is normal
6) Yes, he is more at risk of developing diabetes
7) Tail removal may not guarantee symptom relief and increases risk of diabetes
8) Avoid accetane look for other causes of exacerbation like alcohol, raised calcium etc
9) Oxytone to my knowledge is an anabolic steroid and may not help much and with side effects like nausea, vomiting, diarrhea, insomnia, headaches, abdominal pain and Hepatotoxicity. for long term pain relief an eus guided nerve block will help him
10 ) Constipation could be because of other medications for pain
11) Accetane is known to cause inflammatory bowel disease

Hope this answers your queries in detail. You can consult your gastroenterologist regarding same.

Wish XXXXXXX a speedy recovery and healthy life ahead.
Above answer was peer-reviewed by
Follow-up: Took accetane acne medication for a long. Suffering form recurrent episodes of acute pancreatitis. Cure? 20 minutes later
Good Evening Dr XXXXXXX Deshmukh, XXXXXXX has bowel inflamation but accetane between 2004 and 2006 had a dose of retin ingredient as many got sick. Roche have decreased the volume of that ingredient. Alcohol is a no no he was a student and soccer coach in spare time, Alcohol is not in my family domain. I found out that you are only allowed to be on accetaine for 6months and XXXXXXX was on it for a year. But it could be something in the genes cause he is so thin.
If XXXXXXX has the nerve operation can the pancreas get better a bit and what areas will?
He seems to want to eat to get relieved, shy?
Are all those naturpaths a waste of time?
Are aspros safe for pain please.
Can you recommend a good specialist in Australia please.
Thank you very much I really appreciate it.
Kind Regards

Answered by Dr. Abhijit Deshmukh 4 hours later
Likely as per your description XXXXXXX has inflammatory bowel disease which can be induced by acctane. Good to know he does not consume alcohol. Anesthetic agents can be injected in nerve supplying the pancreas to reduce pain but does not affect course of pancreatitis.
Diet intake can continue as he wishes to except avoid excess fat if he has oily stools.
Well as an allopath, I do not trust in naturopathy since it is not evidence based but Iā€™m no sure.
If aspros contains aspirin then it has lot of side effects especially for bowel inflammation.
Also lot of drugs like steroids, azathioprine used for bowel inflammation can cause pancreatitis.
I regret I do not know a good specialist in Australia.
Hope this answers your query.
Wishing XXXXXXX a healthy life ahead.

Above answer was peer-reviewed by
Follow-up: Took accetane acne medication for a long. Suffering form recurrent episodes of acute pancreatitis. Cure? 21 hours later
Hello, Dr Deshmukh
I hope all is well whereever you live.
I have two more questions.
1. Zanes pain is mainly under the left arm pit which indicates that it is the tail side. Does that mean the tail is dying and what does mild lobularity which was more prominent in the tail indicate please.
2. Reading a information on the website chronic pancreatis patients only survive 10 to 15 years if lucky. Is that true please.
That is my final questions and I thank you and God bless.
Answered by Dr. Abhijit Deshmukh 12 hours later

The answers to your question are

1) Well, inflammation in tail of pancreas will cause pain in left upper quadrant of the abdomen, unlikely in the arm pit. To me the arm pit pain look unrelated and does not mean tail is dying.
Mild lobularity indicates changes of chronic pancreatitis (irreversible change in pancreatic tail)

2) Well I do not think his life span is affected. That is true if there is diabetes. We need to keep him in a good follow up and manage acute exacerbation well.

Hope that answers your queries.

Wishing XXXXXXX a happy and healthy life ahead.

You can remember me if you are concerned with Zane's problem again in future.

Thank you.
Above answer was peer-reviewed by
Follow-up: Took accetane acne medication for a long. Suffering form recurrent episodes of acute pancreatitis. Cure? 6 days later
Hello, Dr Deshmukh,
At the present moment XXXXXXX is eating a special diet of steamed fish and chicken only. This is topped with brown rice, broccali, celery, no beets or sweet potato.
He is having a gluten free, no sugar, no artificial flavouring, no frutose diet. This has helped his reflux and stomach buring sensation. The diet is for four months and it contains a number of health ingredients such as alfafa and a protein formula which helps his body absorb some nutients.
However, the pancreas pain is still there on the left latismas dorsi side of the body. He has a swollen lymph node on top of the head.
Why is the lymph node swollen on the head? I hope it is not cancer.
Also what is acute exacerbation?
Is Zanes scars likely to grow worse in time regardless of diet etc?
He was taking infodel something like that. Are there side effects.
Does morphine medication stablizers the growth of the disease? XXXXXXX would not go to hospital when having an attack. Does the hospitalization stop the pancreas from gaining more damage?
Since Zanes ensymes suppose to be normal but the pancreas is damaged can things stop there?
Thank you
Kind Regards
Answered by Dr. Abhijit Deshmukh 2 hours later

Well I do not understand why is he on so much diet restriction for colitis and pancreatitis. If he does not have coeliac disease he need not be on coeliac diet.
- Lymphnode needs to be ascertained for its size, pain and number. If more than 1 cm sized, painful and if multiple nodes need to be evaluated. An needle FNAC should give the diagnosis.
- Acute exacerbation is worsening of pancreatitis symptoms on an underlying chronic disease.
- Not necessarily does the scar increase. It is difficult to predict the worsening of scars with age. Only time will tell. We need to find cause for these scars and prevent acute pancreatitis episodes and treat them aggressively once they occur.
- I am not sure what is infodel. Tried searching but not fruitful.
- No, morphine does nothing to disease process. It is a strong analgesic and has a strong addiction liability. Need to take it only when absolutely necessary.
- Possibly yes, if pain is severe hospitalization helps. It may prevent the complications too.
- Well, if he has underlying chronic pancreatitis, then it may very slowly go on even in absence of pain.

Hope this answers your query.
Wish him a speedy recovery.
Above answer was peer-reviewed by
Follow-up: Took accetane acne medication for a long. Suffering form recurrent episodes of acute pancreatitis. Cure? 23 hours later
Hi Dr,
The specialist thinks XXXXXXX has autoimmune pancreatis, as he started with inflammatory bowel disease, had fatty liver, a gallbladder only working 67% and really bad consitipation. He had to go to hospital with that as his bowels weer ready to burst. Also autoimmune makes the lymph node on the head swell.
Apparently it is not alcohol disorder of pancreatis. The blame of alcohol drove me crazy. My mum died alvoa nervosa which is related to cystic fibrosis. My father in law died of Parkinsons disease. I suffer from Hashimotos disease. Apparently XXXXXXX has approx six months left if he turns into a diabetic. So he has to get on this medication with this reference. WWW.WWWW.WW Japanese doctors found the treatment.
Prior to my last email the medicine they gave him was ibuprofen.
You just have to excuse my spelling as XXXXXXX wont show me want medication they prescribed. He just told me.
On the diet given his skin stopped peeling and they turned yellow for a few days.
It has gone away now.
Sorry Dr, I forgot to say his body is not absorbing many nutients. I hope it is not too late as the time frame for diabetes is 2 years so his GP said. Is that true? According to thyroid autoimmune disorder it can run in the family especially if you come from countries like XXXXXXX (potato famine), India and African nations where starvation is a problem and that disorder can damage ones immune system. I do heaps of research to enhance the epistemologil factors out the theory.
Kind Regards
Answered by Dr. Abhijit Deshmukh 12 hours later

I appreciate your efforts in terms of the research you have done.

Well if he is feeling better with the prescribed diet then you can continue with the same. Adding a multivitamin supplement to his diet / medications will definitely help him.

Auto immune thyroid disorders can run in family; but it does not really damage once immune system. It just alters it a bit and usually not a concern if properly evaluated, followed up and treated.

Wish XXXXXXX an healthy life ahead.

Above answer was peer-reviewed by
Follow-up: Took accetane acne medication for a long. Suffering form recurrent episodes of acute pancreatitis. Cure? 29 hours later
Dear DR Deshmukh
XXXXXXX is only feeling better in some areas reflux and stomach but not the pancreas with the diet. The pancreatitis is still there.
What is immune pancretis the results come out next Tuesday. I know it is similar to cancer testing and results can often be confused with cancer. Apparently the Japanese have treatment for it. Do you know about the success rate please.
Do people have short lives with that too Dr I cant stop crying.
Thank you very much.
Kind Regards
Answered by Dr. Abhijit Deshmukh 20 hours later
Well autoimmune pancreatitis is a relatively treatable disease with steroids. It helps in controlling the symptoms and initial response to treatment is good > 70 %. The long-term data with this disease is yet to come.
Yes, it can be confused with cancer, but that seems to be unlikely in XXXXXXX
Well only if complications like severe exacerbation or diabetes develops then yes the survival can get reduced otherwise that not much to worry.
I think you should stop worrying too much and face it the way it comes.
Best wishes.

Above answer was peer-reviewed by
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