It certainly sounds like a pancreatic attack.
If you look at the anatomy of the bile duct system you will see that bile is produced as a liver waste product and increasingly larger ducts finally reach a size that are typically illustrated with the gallbladder. Pain from the pancreas and pain from the gallbladder refer to the back, sometimes right between the shoulder blades. They call this referred pain because our pancreas and for that matter most of our organs that don't rely on conscious control, like the heart, lungs and the gut don't have direct pain nerves like a finger tip has.
During the development of an embryo/fetus, nerves, blood supply and such form buds that can become an arm, leg or a heart, liver, pancreas and such. In men the left arm bud and the heart bud both move out together, forming the heart and ultimately the left arm. When men have heart attacks, the left shoulder, arm and jaw demonstrate the pain felt by the heart. Women develop differently and the heart but pulls away from the spinal tube directly. When women have heart attacks, instead of the left arm going nuts with pain, the back hurts like somebody just drove a wedge between the vertebrae. A gallbladder attack and a pancreatic attack may be hard to distinguish just from the pain location.
A few months back I went to a Continuing Medical Education (CME) class on pain and pain management. The last presentation of the day was about four adolescents with serious problems that brought them to the trauma center. They weren't related although three were girls around 13-15 who had pancreatitis resulting from a stomach bug gotten in places like Virgin Islands or Bimini. All three of the cases of pancreatitis were so painful that doctors decided to induce comas in order to control the pain. Now that is a good description!
Doctors are famous for not volunteering information. They don't like to tell patients that there are levels of pain beyond giving birth to a baby or kidney stone. Considering the number of patients in crisis from pancreatitis that is beyond control, it is a good bet this is more pain than you believe possible to endure and not pass out. Pancreatitis can refer pain to the upper right quadrant of the abdomen, it can appear as the worst case of heart burn you have ever had and it can hurt right behind the belly button.
The "heartburn" pain is called epigastric pain and it will show up with a gallbladder attack very much in the same way. My last gallbladder attack was so intense that I followed the warning about heart attacks and rushed to the ER. I was fairly certain that I wasn't having a heart attack but it sure as hell wasn't heartburn either. I did have my gallbladder removed. When I talked with the surgeon after the operation he told me that I had multiple layers of scarring indicating I had been having gallbladder attacks for several years at least.
A gallstone passing through the bile duct could end up blocking the pancreas. This is so serious it isn't worth fooling around with. I had my gallbladder removed in the early 1990's via endoscopic surgery. My GP warned me that despite the three small bandaids on my abdomen not to be fooled, I had an organ removed and it would be the better part of a year before I would fully adjust. Since then, it has been learned that detaching the gallbladder from the wrong duct branch could cause problems. I believe most surgeons know this quite well but it is worth asking about it before he or she cuts on you. In some more recent posts, CF patients are being encouraged to have gallstones dissolved using Ursodiol or such. When I had mine removed, its use was reserved for children and people who are unable to go under anesthesia or can't otherwise be operated on. This is another item to discuss with your doctor.
Sorry for the diatribe on pain but it is a subject dear to my heart. The pancreas is impacted differently depending upon the CF presentation. Some lose the pancreas almost immediately or the pancreas may survive the lifetime of the patient. For those who have some vestige of a pancreas, they may produce some enzymes or they may be Pancreatic Insufficient, (PI) but not diabetic. In about 65% of people who have essentially dead pancreases, they have no pain. Many CFers go through a period when the pancreas slowly and painfully atrophies, possibly a year or decades, autodigestion of the pancreas is excruciating but it generally stops hurting when the atrophy is complete.
Autodigestion is the direct result of our thickened mucus. At the first stimulation the pancreas excretes enzymes, sodium bicarbonate and fluid to transport the digestive cocktail. The fluid is mucus in fact and a thick, slow moving mixture of enzymes, and a chemical designed to maximize them through a frequently undersized duct is a formula for disaster. A backup into the pancreas usually results in a pancreatic attack.
Now that you have had a couple of pancreatic attacks, possibly a gallbladder attack, what do you do? Removal of the gallbladder is relatively straight forward and many if not most CFers end up having it removed. If this is your option, don't waste time. Delay could result in another bout of pancreatitis. All removing the gallbladder accomplishes is the removal of a marble bag. Stones can form in the bile ducts but if you are going to produce stones, that bag acts like a stone maker that can produce stones as large as a chicken egg. Whenever fats are sensed at the top of the duodenum, the gallbladder contracts, sending bile acids, cholesterol and possibly a gallstone down the bile duct to meet the fat. Called the common bile duct, the pancreatic duct enters into the bile duct and through a hole (Sphincter of Odi) into the duodenum. Without a gallbladder, bile runs through the duct all the time, no extra juice with fat.
If you are entering a time where you are going to be suffering from chronic pancreatitis, find a very good pain management doctor. With luck it will burn out fast and not leave you diabetic or in pain. My pancreas has been locked in the worst of worst pain for decades and it sometimes drives me to distraction. The pain is impossible to fully control and I could have gone my entire life without being introduced to the brain dulling opioids I must take. Removal of the pancreas is possible but risky still. The Cleveland Clinic is one of the best places to start.
Best of Luck, please let us know how it goes,
LL
