Anatomical adventures

Do you know what the pancreas is?
Do you know what it does?
Or where exactly it's located?

A month ago, my answers to those questions would have been along the lines of:

Well, um, it's an internal organ, well, obviously it's an internal organ, you already knew that, but you know, isn't it something to do with the liver, or with the kidneys, or maybe both, isn't it? Maybe attached to one of them, possibly? Kind of small? I'm picturing it as red. Or possibly pink. An organy kind of colour. Possibly not that important, like, you could have it taken out, but also, possibly, vital, like you can't live without it, but, you know, I'm not actually sure about the quite important difference between those two options.

It's maybe something to do with processing blood? Or with the digestive system? Maybe? Enzymes, enzymes is coming to mind, not entirely sure why, maybe it does something with enzymes?

It's in the torso, that much I know, well, ok, that's pretty obvious too, no bonus points there. I'm thinking it's in the abdomen, lower part of the torso anyway. Again, thinking it's fairly small and sort of there (cue waving of hand around general tummy region). Ish.

That was pretty much the sum total of my knowledge of the pancreas a little over one month ago. Anatomy was never my strong suit, despite two years of Leaving Cert biology. Now, one month later, I know more than I probably ever would have wanted to.

Now I know that the pancreas is indeed an internal organ, and that it produces enzymes and hormones, particularly insulin. The enzymes go into the stomach to be used in digesting food. The insulin regulates blood sugar. The pancreas is in fact pretty large, seeming to be somewhere between 10 cm and 25cm (6 and 10 inches) long, and it kind of looks like a leaf, or at least is sometimes referred to as 'leaf-shaped', and it's sort of flattish. It is pretty much a vital organ. It is very much part of the digestive system, it is not in fact really much to do with the kidneys or the liver, and it has nothing at all to do with cleaning the blood. In terms of size, though not function, I was imagining something more akin to the gallbladder, which is very small, so I was totally off there. It's attached to the stomach via the bile duct and the enzymes go (well, are meant to go) straight from the pancreas into the stomach where they do their digestive work. It sits directly behind the stomach, on the left of the lower torso, and being quite large goes from the centre of the body out towards the left side, all the way behind the stomach. And probably, it is kind of red. Or maybe pink. That last bit, about the colour, I still don't know.



The reason for this rapid if still slightly vague increase in knowledge is that The Unfortunately Loyal Boyfriend (yes, he has approved this name, in fact, co-suggested and heartily endorsed it) has pancreatitis. Or more specifically, he has moderately severe acute pancreatitis. Pancreatitis is (because I didn't know this either a month ago, and probably neither did you) inflammation of the pancreas. Also, pancreatitis is not a good thing. And also, it's very, very sore. And also, pancreatitis is quite serious, and it can be very serious, but in this case it is only a bit serious. That last, at least, is a good thing.

So I also know quite a bit about pancreatitis. About 20% of the time they never discover what has caused it, and The Unfortunately Loyal Boyfriend is currently falling into that category. Most often pancreatitis is caused by severe alcohol 'misuse', which is in itself the severe misuse of a euphemism, as this is referring to, say, someone drinking ten drinks a day for a few years, very-probably-an-alcoholic type of misuse. Obviously that's not the cause in this case, as he drinks very little indeed, and has pretty much the opposite of, as he put it, "a life of bacchanalian excess." Another major cause is gallstones, which CT scans have revealed he also doesn't have. There are some other rare causes such as a couple of genetic disorders or reactions to particular medications, again these are not part of the picture here. So that currently leaves two main options: that a more detailed scan will reveal 'grit' or very tiny gallstones that are too small to show up on the CT scan, and that these are the cause of the inflammation; or that he is in the 20% of cases where they never find out the cause, and his pancreatitis will ultimately be termed 'idiopathic'. We're not holding out a lot of expectation for a cause or a cure, but we'll wait and see. Essentially we have an illness that appears suddenly, produces a lot of pain and requires hospitalisation, and no cause is likely to be found. Yay.

In terms of what has happened and is happening, he woke up one morning more than five weeks ago with severe pain in his stomach. Doctor thought it was duodenitis or gastritis, i.e. inflammation of the stomach or upper part of the small intestine, and prescribed medication accordingly. He wasn't able to eat and was generally very sick. When the pain got worse and then only a little better over the next couple of days, we went back to the doctor and then directly to hospital, where a CT scan showed inflammation of the pancreas.

Cue admission to hospital, intravenous (IV) fluids, IV pain medication and IV antibiotics. Also no food or water. The treatment for pancreatitis, it turns out, always involves admission to hospital, IV fluids, pain meds and usually antibiotics as prophylactic against infection, as well as giving the pancreas and digestive system a rest by not eating, so this was pretty textbook. He rapidly began getting better, the pain went away, and he was able to eat small amounts. After six days the inflammation was gone, he had no pain and he was off all the medications. He was in reasonably good shape, the doctors (and we) were happy (well, as happy as we could be), and he was discharged from the hospital. They said when he was discharged that there was a 20% chance of readmission within a week, that is just the way pancreatitis goes. Yay again.

So, he took it very easy at home, generally feeling okay and without any pain. It looked like he had had a fairly mild bout of acute pancreatitis and was recovering well, with maybe a couple of weeks ahead of slowly recovering to full strength. Actual yay.

Alas, five days after coming out of hospital the pain suddenly and dramatically returned. He had fallen into a second 20% category. He was back in hospital within a couple of hours and has remained there since, now 25 days. The pancreatitis was now being described as 'moderately severe', though it's important to realise that this is still in a very different category than severe or chronic pancreatitis, which involves hospitalisation in an Intensive Care Unit (which he has not needed) and which can be much more serious. Sometimes acute pancreatitis episodes resolve within a week to two or three weeks, sometimes they drag on for months, so he is currently somewhere in the middle of that spectrum. He has needed IV antibiotics, pain meds, fluids and drugs as before, but this time also some procedures to allow him to get IV nutrition, among other things. He didn't get to eat solid foods or drink water for days. Some of the time he was still in a great deal of pain, despite all the pain medication. One doctor told us that pancreatitis is one of the most painful things you can experience. And it usually takes a long time to get better. Really not so much yay.

Everything that was being done in hospital was helping him, and now he is much, much recovered. He has no pain, he's eating and drinking and most of the tubes are gone. He has even gotten to leave the hospital on a couple of days for a few hours at a time and finally they are talking about a discharge date in the very near future that seems likely to happen and not be delayed, as has already occurred. It seems like we are nearing the end of this acute phase, which is great, and we'll get through the next phases too, whatever they entail.

Writing here is to begin to explain some of this experience. Mainly to explain the facts of pancreatitis, the actualities of what's happened, to help make it clearer to others what it is about, at least the much greater though still limited understanding of it that I have gained. It will take me longer to write about how I feel, about how this has affected and will change our lives, about the many strangenesses and sadnesses and joys of going through this. Of going back and forth to the hospital every day, except today, of being there with him, and being home, without him. Of trying to understand what is happening and what it means, when we get new information from doctors and sometimes different predictions or explanations every day or couple of days. Of not knowing or half-knowing what the immediate term and longer term implications might be, and at the same time trying to ignore that quasi-knowledge and live only day to day. Of what it's like to see him get worse at times and now, thankfully, to get much better.

As he would say, this is now Day 40 of the Big Fat Pancreas Adventure, including 25 consecutive nights in hospital so far this time and 31 nights in hospital in total. As I would say, do what you can. As we would say, it is what it is.

And life, it's definitely an adventure.