Question concerning BMs and possible Creon connection.

I had a Whipple after rt and chemo 1 year ago. Taking creon 1 tab three times a day before eating stopped loose, fatty stools. Much better compared to before creon. The only complaint I have about creon is the cost and failure of Tufts Medicare to fully cover it.

Thank you

Based on the bowel movement symptoms you describe, it resembles pancreatic enzymes insufficiency. There is an on-line dosing calculator that makes optimization of Creon easy by calculating the amount of carbohydrates, fats and protein in each meal.

pertcalculator.org

The most knowledgeable member of the multidisciplinary team is the Registered Dietitian with the credential C.S.O. (Certification Specialist Oncology). That designation certifies thy have specific coursework and practical training to address the specific needs of GI cancers patients and those having a Whipple resection. They are the most knowledgeable I have found and who I rely on for dosing of pancrealipase. If you eat high fiber and legumes, you will need the enzyme alpha-d-galactosidase. it is available OTC as Beano. It will digest oligosaccharides found in peas, corn, broccoli, cauliflower, asparagus, Brussels sprouts, cabbage, skin of potatoes and all varieties of beans. Alpha-d-galactosidase is not an enzyme blended into Rx pancrealipase.

I also had the tail of the pancreas and spleen taken out and had the same problem you are having. Finally, my gastroenterologist told me a different way to take Creon. Take a few bites, then take one Creon, finish you meal and at the end take another Creon. I take a total of two 25,000 unit capsules with my main meals and so far, it’s been what has worked the best. If I see that I’m going to eat something very fatty, I take two instead of one at the end. Hope this helps.

@carlos322 have you tried buying through a Canadian pharmacy? I buy mine through Canadian Pharmacy Service and it’s the same brand and it’s a fraction of the cost.

Creon will help to slow the processing of food through your system and get more formed BM's. The usual dosage seems to be 2 pills at each meal but each person is different and there are dosing calculators out there but honestly it seems to me from what I hear and read that it is more trial and error. I take one at breakfast and 2 at dinner and 1 or 2 at lunch depending on what I'm eating. It's important not to take it too soon as it goes through your system in 20 minutes and is ineffective after that.

The key points from the manufacturer's guidance are:

Take Creon with every meal and snack, not just when symptoms occur.
For snacks, the dose is often about half of the meal dose, although your doctor may individualize it.
The dose is adjusted based on symptoms, stool quality, weight changes, and signs of malabsorption.
Creon should be taken with the first bite of food or immediately as you start eating.

The manufacturer's patient support site is:

CREON Complete Patient Support

The manufacturer also provides a dosing calculator (primarily designed for healthcare professionals but useful for understanding dosing concepts):

@cpblanco Hi, thanks for that suggestion. I messaged my oncologist to send me an Rx so I can start that process. Which pharmacy service do you use?

I recommend asking your oncologist if they have a cancer dietician you can be referred to. They are extremely helpful with this issue, how and how much Creon to take, what foods to eat, etc.

@carlos322 this is the pharmacy I use Canadianpharmacyservice .com I had to put a space after service because it won't let me post the link.