Inside Tract - For Baffling Pain, an Answer
Issue No. 1
For Baffling Pain, an Answer
Date: March 1, 2010
Looking back, says Mary Szuchnick, the pain had first started when her gallbladder was removed after a physician discovered it was full of gallstones. Until that point, she’d had some discomfort and digestive issues. But it was nothing like what developed in the year following her surgery.
“This pain was completely different,” she says. “Things got progressively worse.”
That’s because the source of the problem was not her gallbladder, but the obscure, rarely mentioned sphincter of Oddi, the valve responsible for controlling the flow of digestive juices into the duodenum. In patients like Szuchnicki, that valve becomes spastic, causing pain from increased pressure in the biliary tree or in the pancreatic ductal system. Known as sphincter of Oddi dysfunction (SOD), the condition receives little attention even in medical circles and is often confused with other illnesses, such as IBS.
But Szuchnicki—along with her gastroenterologist and her primary care physician—did not know that. What she did know was that no amount of medication or time was helping her problem.
“It got to the point where I couldn’t sleep and was consuming just liquids,” she recalls. “I didn’t want to believe that the rest of my life would be like that.”
When she told her primary doctor that she would no longer return to her gastroenterologist, he referred her to The Johns Hopkins Hospital, where she met endoscopy chief Patrick Okolo and nurse Laurie McClelland, who sees the majority of Hopkins’ SOD patients like Szuchnicki.
“Mary is a very positive individual, and she didn’t let this get her down or incapacitate her,” McClelland says. That outlook explains how Szuchnicki coped for so long with the pain. “She’s very strong-willed and has a good attitude, so she just kept trudging along.”
Soon began a series of exams and tests, as Okolo and his staff narrowed down the possibilities using a process of elimination. A manometry study revealed that Szuchnicki’s sphincter of Oddi had significantly elevated pressure—a classic sign of SOD. Okolo performed a sphincterotomy to repair the dysfunctional valve.
When Szuchnicki woke up after the procedure, the pain was gone.“I thought, Are you kidding me?” she remembers. “This is awesome.”