jinavie:

(Learn more about the organs of the human bodies in other posts in the Viscera series here: http://jinavie.tumblr.com/tagged/viscera/chrono)

The pancreas is probably the most central organ in the human body. It is situated just under the liver and stomach, surrounded by the duodenum (first part of small intestine) and lies in front of the aorta. It is shaped like a fish and thus is divided into parts named the head, neck, body and tail. The head of the pancreas tucks into the loop of duodenum and drains its contents via the pancreatic duct, which joins with the common bile duct (from the liver and gallbladder).

The function of the pancreas is divided into two functions: exocrine and endocrine.

An exocrine gland is an organ that excretes its products out of the body (including the intestines), such as the salivary or tear glands. The exocrine function of the pancreas is the production and secretion of digestive enzymes that break down proteins, fats and carbohydrates in the small intestine. Because of this, injury to the pancreas often causes a leak of this digestive juice, causing the body to self-digest the pancreas (leading to pancreatitis) and surrounding organs. 

An endocrine gland is the opposite in that it secretes its contents into the bloodstream. These glands typically produce hormones, such as the thyroid, ovaries and adrenal glands. The pancreas’ endocrine function is related to an extremely common yet deadly disease: diabetes. Within the pancreas, there are millions of cells that cluster into groups called islets of Langerhans. There are various types of cells, but the most common are the alpha-islet cells that secrete glucagon and beta-islet cells that secrete insulin. Insulin acts to lower blood sugar (glucose) levels by promoting storage and use of glucose after a meal. Glucagon acts to increase blood glucose by promoting the breakdown of glucose storage units (glycogen) and the production of more glucose by the liver. Diabetes occurs when beta-islet cells fail to produce insulin because they are destroyed by the immune system (type 1 diabetes mellitus) or become desensitised by chronically elevated blood glucose levels (type 2 diabetes mellitus).

Another important disease concerning the pancreas is pancreatic cancer. Pancreatic cancer is notorious for its deadliness as it carries a 5-year mortality rate of over 95%. This is because it usually remains hidden - without any symptoms - until it as grown substantially and spread to other organs. However, this prognosis only applies to the most common type of pancreatic cancer involving exocrine cells (adenocarcinoma). There are far rarer cancers of the pancreas that involve the endocrine cells (e.g. insulinoma), which tend to have extremely good prognoses and are usually curable. 

Steve Jobs (founder of Apple Inc.) had this kind of pancreatic cancer - an islet cell neuroendocrine tumour. Despite his excellent chance of cure with chemotherapy and surgery, he refused treatment for nine months and instead relied on alternative medicine for cure. However, his disease worsened and he finally resorted to having surgery. By this stage, his disease had spread to the liver due to the nine-month delay in treatment. Spreading of cancer is called metastasis and is often an indication that the cancer is no longer curable. Jobs went against his doctors’ advice and opted for a liver transplant in the hopes of curing his cancer. Organ transplant involves suppressing the patient’s immune system (which also keeps cancers in check) to prevent rejection of the donor organ, which is why oncologists advise against transplants in cancer patients. Jobs’ condition deteriorated quickly after his liver transplant and his decisions ultimately led to his demise. 

I feel sad cause I feel like I’m neglecting all of you. But being preggo is a lot of work, and then working on top of being preggo is a lot of work. I’ll try and get the queue loaded up here shortly. Meanwhile, I hope everyone is staying healthy and everyone’s pancreas has been behaving!

madeofgoldx:

I NAMED HIM PANCRY. Got treat him nice, ya know? Maybe he’ll decide to work.

Alright, so I went in for an ERCP. My whole process has been a bit rushed and so I’m adding that to some of my confusion. I feel great now so I’m thankful, but for those who aren’t sure going in, here’s my walk through, along with a few links at the bottom that are pretty helpful. Some of this may be repeat for a few of my followers, but I figured one big summary is good!

When my ERCP was scheduled it was through a long frustrating process. I’ve touched on my pancreatitis attack, and implied that I am not overly happy with my care received on my follow ups. (I only had 1 apt). I went for my physical to make sure I was “Healthy and ok to conceive and carry a baby”, and I was given the thumbs up. They didn’t even find the cyst until 2 months into my pregnancy, despite me voicing the discomfort, hardness, and growing of my tummy. After being told “The cyst isn’t really a big deal, they probably won’t even drain it after”, I finally listened to some friends and family and we asked for a closer look. After that, we were referred to a perenatal specialist as we were concerned for baby. He took one look at my ultrasound and told me he was calling “Colorado’s Pancreas guy”.

Long story short, this phone call was made the day before Thanksgiving, and my ERCP was scheduled for December 17th. Within that time, it was made clear to all parties that I was in big need of the procedure, and was pregnant.

I had been told by a friend who has unfortunately had to deal with this surgery multiple times, that this procedure would be a great deal of pain, that I would be out for a week or so, but that I was in good hands with my particular Dr. (we happened to have the same one now!), and that he was very informative. Unfortunately what I was reading on the internet/heard from the head nurse when scheduling my apt, was completely different! I’d read that I’d be out for weeks, that I’d be in agonizing pain for weeks! Some said I’d not feel a thing. Some said I’d only be moderately uncomfortable, but able to work the next day. The nurse in fact said I could go back to work the next day. I was told by my Dr. that I should not be in any pain following the procedure, and if I was we needed to stay. Well here is my personal experience. I hope someone walks away with this info and finds it useful!

I was not allowed to drink or eat past midnight. I arrived at the hospital at 6am, was in a group of 4 or 5 other patients being admitted for various other gastro-intestinal surgeries or procedures. Once I was checked in, I was taken back to the prep area.

My IV was started, at which point the nurses, anesthesiologist and their team came and spoke with me about the risks/entire process. Then the OB on call came and spoke to me about the risks/entire process, letting me know what they’d be doing to monitor baby. Then the Drs came to speak with me about the process, and what to expect.

I was told that after I was put under completely, they would use a mouth guard to protect my teeth and tongue, and would then slide the scope down my throat to my stomach. I was told a minimal amount of radiation for xrays would be used, along with ultrasounds and other means to gather information about the size and location of the cyst, but that those things using radiation in my case would be used at a minimum due to my fetus. I was informed about any minor ouchies I may acquire due to scopes, guards etc being put in my mouth…(none of which I experienced), and the general process from start to finish.

When I entered the OR, I was talked through the process as well as any learning Nurses/Drs (It is a university hospital) and when it came down to anesthesia time, I was told “Alright be ready for the unpleasant burning feeling in your hand.” That’s the anesthesia part. It’s very uncomfortable, it feels like a very hot wash over your arm, but it’s very very fast, only 5o 10 seconds, I felt it reach my head but was immediately under after that.

During my surgery they removed almost 3 liters of fluid from the cyst, and then placed 3 stents between the duodenum and the cyst so that any remaining fluid could drain on it’s own.

The next thing I remember vaguely is them removing the scopes/tubes from my throat. You have to be “sort of awake” for them to do this as they use your gag reflex to help expel the instruments. I was not awake enough to be really uncomfortable though, and it’s a very fast process. Once I was up and not so groggy, I started to throw up.

It’s not necessarily normal to throw up after this procedure, but because I had SO MUCH fluid in my stomach from the cyst, some of which had old blood in it from an internal damage or rupture of some sort, I was vomiting intermittently. The general consensus of nurses and drs involved was that I was nauseous and vomiting from the blood. So they chose to keep me overnight. Normally I would have been released a few hours after recovery.

I was a bit shaky on my feet afterwards, just from the anesthesia and recovery. But was was REALLy awesome was that my tummy was soft again. Not rock hard from the giant balloon in my gut. I felt pretty dang good immediately after my surgery. I was not in pain…I felt…awkwardly tender but did not hurt.

Please keep in mind I was only able to utilize Tylenol for pain relief, because I am pregnant any narcotics  (the good stuff!!) couldn’t be used! I was informed later by the attending nurse that when people come in for recovery from an ERCP, they’re pretty doped up. So you should have some good pain meds on board.

I did not get sore until later that evening. I really feel as though I am a bit of a different case, as my cyst was so big, that when it was removed all my guts relaxed back down and moved a WHOLE lot. All that soft and connecting tissue moved a whole lot. By day 2 I felt like my guts had been scrambled. I was not in excruciating pain, but I was very uncomfortable. Day 3 was as much pain, but in a different place, day 4 was much of the same.

I had asked for 3 days off from work, so I would in theory go back to work Thursday evening (surgery was monday morning). As of weds afternoon I had called to ask for thursday evening off. I also attempted to get up and be out and about starting weds. This was a terrible idea. I don’t consider myself to be a weenie by any stretch of the imagination, but getting up too soon was not a good idea. I tried to go out to just do some holiday shopping in my PJs, and after making one stop at the grocery store I was sweaty, panting, and in a ton of pain. I made the mistake AGAIN (glutton for punishment) Thursday, but managed to stay out a bit longer and get more done before needing a nap. It really takes it out of you!!

However, when I woke up Friday morning, the difference was huge. I still hurt, but not in a way that I couldn’t function. I ended up going back to work that evening, and was no worse for wear because of it.

So a total of 5ish days was about how long it took me to recover. I still “felt it” the weekend following the surgery, but I was not in any huge amount of pain.

So. 5 days, I slept in a recliner for about a week. (just easier to get in and out), and am now back in bed and doing just great!

If anyone has any questions for me, as always my ask is wide open. Anyway, here’s a few links for you!

National Digestive Diseases
Information Clearinghouse (NDDIC)

Post ERCP

Okay. lol, it seems like so much longer then 2 weeks since I posted last!

Anyway, here’s my update! (all really good!) It’s a little gross in places, so just be forewarned.

So I went in for my Surgery on December 17th. Went in at a bright and chirpy 6am!

I was almost immediately in surgery, after prepping me and speaking with me, I was probably in the ER room and ready for anesthesia by 830? The surgery itself was relatively fast. Only about an hour and 45 minutes. Here’s how things went!

My surgery took a smidge longer then normal, due to the size of my cyst. Once in, they ended up draining almost 3 liters of fluid. That is A LOT of fluid! From the time I was weighed before my surgery, to the time immediately following, I lost a total of 12 lbs. Since the surgery I lost another 4. They placed 3 stents (the normal going quantity is 1) between my duodenum and the cyst, and I continued to vomit almost another half liter of fluid following my procedure. Normally I would have been released from the hospital immediately, but because I couldn’t stop throwing up (understandably) they kept me until the following morning.

I want to go into detail a little bit about the surgery, because I was VERY confused and a bit misinformed about the whole process. I couldn’t get a straight answer from anyone…the internet gave me 5 different outcomes…my doctors/nurses words were different then that of people I’d spoken to regarding recovery. So I’m throwing this out there incase any of you have to go through the same procedure. I’m going to make a different post about it though, so the details don’t get all caught up!

But I just wanted to say…Everything else is great. I feel fantastic, for the first time in a really long time. I can eat a real sized meal without being uncomfortable or sick. I can SLEEP ON MY TUMMY!! I don’t have massive discomfort for no real good reason. It’s fabulous. Baby is doing really well, we’re almost 21 weeks now. We found out that we’re having a little girl. She’s so far healthy and happy and active!

Thanks to everyone for your well wishes and now that all is back to normal, I’ll be back on the hunt for more pancreas stuff for the blog!

Hope everyone had a safe, and alcohol free NYE!

Sorry guys! I’ve been preparing for a super busy December, so I apologize about the delay!

Anyway. The update!

So as I mentioned before, being preggo had me a smidge worried about the giant cyst in my tummy. But I’ll elaborate a bit.

So the timeline goes:

February 2012 - Went to ER with severe abdominal pain, stayed in the hospital for 2 weeks. Boy that was fun.

End of February 2012 -  I was in so much pain after my discharge, and I was running out of my pain meds. I was given 40 percocet for 10 days time. When I realized I was running out, I started making them stretch out, so I called to see if I could get something more…I was told that if I was in so much pain I needed to go back to the ER…otherwise I could try Ibuprophen, since tylenol wasn’t good for the pancreas. even though I’d been told it could be months before I started feeling normal again…so I resigned. And instead started taking 12+ ibuprophen a day.

March 2012 - This was my one and only follow up apt. I was told at this apt that…well it would just be what it was. And that my diet should now be less fat, more vegan-y, and that alcohol was an obvious no no. I wasn’t scheduled for another apt, I was just told to call back if I had any other serious issues.

July 2012 - While I wasn’t feeling FABULOUS, my husband and I had been talking about kids. The whole ER trip sort of changes your priorities. So we went to get a physical. To check BP and cholesterol, and get a pelvic and do all those fun things. And so we went, and the doctor did all those thing, and direct quote “Everything looks great!” He asked me how my pancreatitis was…if I was drinking again…My answer was a little iffy sometimes still, and absolutely not…I told him about a tightness in my tummy, he said it was things still healing and being swollen etc. I didn’t ask further because hey…I was told it could be MONTHS, and after reading online about it, I was horrified to learn that there were people suffering for YEARS.

Sept 2012 - Yay! We’re preggo! We go in and get tests, everythigns good…they tell us come back in a month.

Oct 2012 - The doctor checks on everything and says things are good…oh you’re throwing up 10 times a day? Just keep an eye on it. She then asks to palpate my abdomen…to feel around. I say sure…there’s still this big mass in my tummy. She says OMG I THINK IT’S YOUR SPLEEN. So she schedules me for an abdominal ultrasound, along with a pelvic. Yay I get a two for one. Meanwhile I have a mini melt down, because everything I can find that says you have a hardened spleen says not good things about it.

End of October 2012 -  I go in for my ultrasound. The tech gets the surgeon after what she finds is NOT my spleen, and the surgeon says “well that is a large pseudocyst”. He also says that protocol on these is to let them drain themselves, and that in the event they do drain them, they are probably not going to do anything about it til after pregnancy is over. Okay…I guess.

Beginning of November 2012 - I go back to talk to the Dr about my ultrasound. She tells me it’s no big deal really…that while it’s uncomfortable all the Drs she’s talked to about it say that any surgeon probably isn’t going to want to remove it til after my pregnancy. We ask about the risks…she says room is not an issue “Mom’s have twins and triplets and just push things out of the way!” We voice our concerns again, asking if she’s sure..what if it breaks…what about all the discomfort I’ve already got…she says she’ll go talk to the Dr’s (she’s just a resident) and she’ll call me later. So she does, she calls me to tell me she got me a referral with a prenatal doctor. And that we’ll see what he has to say. Keep in mind, that any reading we’ve done on it has told us that any cyst larger then 6cm does NOT go away on it’s own, and DOES need to be removed or drained.

End of November 2012 -  I go in for my ultrasound with my new specialist. I’m laying there, and they do the ultrasound of baby first (who is very active and happy and healthy!) and then she looks at the cyst. Which has grown, btw. 3cm by 6cm more in a month. She says “Oh my goodness…this thing is huge…I’ll finish up and get the Doctor.” So she does. And he comes back. And the first words out of his mouth? “Oh no, that needs to come out asap. Like asap.” So the doctor tells me that he has to make some calls to some pancreas doctors, and he’ll call me later, but that this needs to come out the sooner the better. And that he hopes the following week,b ut it may take a few. The Doctor calls me that evening and begins the conversation with “well I spoke with the doctor and his words were “well that’s very impressive.” and tells me he’s forwarded my file onto the leading pseudocyst pancreas doctor in Colorado, and that I should have a call from him in the next day or two. This is, however, the day before thanksgiving, so I’m not planning on anything crazy.

After thanksgiving I called him, was informed that he was still out of town, so I called back the next day. They had all my information, and informed me that because I was pregnant, he would be doing the surgery himself, that they were going in through my stomach and suturing the cyst so it’d just drain into there from now on. And that my surgery is scheduled for the 17th.

So. There you have it. My crazy big cyst (three times larger then it should have been allowed to get) will be drained on the 17th. Still pregnant, currently at 15 weeks.

I won’t say that I’m not a little worried or scared. This could ruin the work week before Xmas for me, which is usually my more profitable time of year. But *shrugs* I’m really tired of being unable to sleep at night.

Anyway! Updates will probably be scarce the next few weeks. I’m really busy this time of year, but everyone take care, and I’ll give an update after my surgery!