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Photograph taken by yours truly in eastern Washington state at sunrise, 2004

Monday, May 20, 2013

Gut Feelings: Revenge of the Pancreas


I have no idea if my many years of an unhealthy high-fat diet contributed to my current predicament, but they certainly couldn't have helped.  In the late evening of Monday, May 6, my pancreas decided to take revenge on me by attacking itself in what was a bout of acute pancreatitis.  The pain was beyond any that I had past experienced, mainly prior bowel obstructions.  It resulted in a four-day hospital stay and what will be a change in my diet for life.  I'm using this blog post to explain what the past couple weeks have been like for me, and while much of it might sound pessimistic, I will conclude this post with some personal points of optimism and hope.

The pancreas produces important hormones like insulin, but it also creates enzymes that break down food in your intestines.  During pancreatitis, the pancreas becomes inflamed.  Pancreatic enzymes begin to destroy the pancreas itself.  As one can imagine, this is not a healthy situation.  The two most common causes of pancreatitis are 1) excessive alcohol use and 2) gallstones blocking the path of the pancreatic enzymes.

When I began getting waves of minor abdominal pains in the early evening that Monday, I thought they might be indicators of a partial bowel obstruction, which I often get, but they tend to work themselves out pretty quickly on their own.  A couple hours later, the waves of pain got much stronger.  Within a short time, the pain became constant and unyielding.  I began infrequently vomiting while trying to find the most comfortable position.  It didn't matter if I was sitting, lying down, or standing up - the pain didn't let up.  I was sweating profusely and became very pale.  Finally, after about six hours I decided I needed to go to the emergency room.  At the time, I thought it likely I had a complete bowel obstruction.  I drove myself to the hospital around one in the morning, which took about 25-30 minutes.

The wait to be seen in the ER was only a few short minutes, but from that point on, it felt like an eternity until I saw a doctor.  When a bed opened up for me, I suddenly found myself in the pediatric section of the hospital (not quite sure why, but the pain blurred my memories at that time).  Hospital staff did an abdominal X-ray on me, and they initially did think it was a bowel obstruction.  They asked me if I'd accept the dreaded nasogastric tube, and I immediately said yes.  An NG tube goes through your nose into your stomach, while you're awake.  But I knew what was coming and I took it in stride, knowing the NG tube would likely relieve some of the pressure and pain by suctioning out anything in my digestive system.  I didn't even gag this time when they inserted the NG tube!  They then did a CT scan which along with blood work revealed I had pancreatitis.  They finally gave me the painkiller Dilaudid after being in the ER for about four hours.  The Dilaudid worked incredibly well; within ten seconds a certain wave of heat came over my entire body and stopped all of the pain.  It was such a relief that I immediately fell asleep.  Doctors and nurses woke me up every now and then with questions and syringes, and eventually they told me I'd be admitted to the hospital.

Thankfully, surgery wasn't necessary as the pancreatitis was caught very early.  The only treatment was the immediate cessation of any food or liquid other than a saline IV drip to keep me hydrated.  With the Dilaudid in my system, I didn't feel much pain at all.  One of my co-workers came in to see me that Tuesday afternoon, right about the same time they gave me an ultrasound.  No pregnancy!  They did the ultrasound to check my gall bladder which came up fine.  No gallstones... and I was adamant in my statements to the doctor that I don't drink much (I drink perhaps once every couple months, and it's usually just a glass of wine or a mudslide).  They did a lot of blood work, though the only immediate results they could get from that was that my triglyceride levels were high but not high enough to cause acute pancreatitis.  They did reveal a "fatty liver," which is exactly what it sounds like - an excess of fat in the liver, often caused by too much fat in one's diet.  Thankfully, that problem is reversible over time with a healthy diet.

After a couple days of the saline IV drip, they upgraded me to a liquid diet.  Jello and broth!  Actually, I really love Jello!  After another day, I was told I could try a diet of low-fat solid food.  I was getting occasional abdominal pains after eating, but it was tolerable.  By that time, I was declining the Dilaudid most of the time.  I don't like counting on narcotics if I don't have to (but they are wonderful when you do need them!).

I was labeled an "independent" at the hospital, which I took as a joke but it seemed it was actually their way of saying I could get out of bed on my own and didn't need much assistance.  Independent is a good life description for me, though... I dislike depending on others for my needs, a lifestyle which I should probably shed a little bit.  I enjoy helping others but have a very hard time accepting it for myself.  Hence, I drove myself to the hospital instead of calling someone else... and I definitely wasn't going to pay for an ambulance!  But again... I know I do need to learn to ask for help.

Funny story.  During my last night in the hospital (Thursday night), for some reason the nursing staff turned on my bed alarm.  So when I got up around 3am for an urgent trip to the bathroom, my bed let out this high-pitch ear-piercing sound.  As I hastily walked to the bathroom, a nursing assistant came in and let out a gasp because she didn't expect to see anyone walking around in the room so quickly.  The whole scene was awful at the time, but kind of hilarious looking back.

Friday I was told I could leave the hospital.  The gastroenterologist who had been popping in to see me daily told me he'd schedule an appointment with me for a couple weeks later.  An MRCP (advanced form of MRI) will eventually be scheduled to check for any possible physical causes of the pancreatitis.  Some specialized blood work results are pending (at least one test I know is to check for an autoimmune disorder).  In the mean time, I'm left wondering what the heck caused the pancreatitis in the first place.

When I was discharged, I asked the nurse how long I'd be on a low-fat diet. "For life," she told me, in a way that also said, "Didn't you know that, silly?"  My primary care doctor who I saw the following Monday confirmed the low-fat diet would be for life.  I'm also not allowed to have alcohol again.  I can deal with the absence of alcohol... but it has certainly been an eye-opening struggle and adjustment as I've been researching how to go about having a low-fat diet.  It's not going to be easy, but I'm gradually learning what I can and cannot eat.

For the first three days after being released from the hospital, I had almost no appetite.  I'd get hungry, but whenever I'd eat, I felt full after just a few bites.  Since being admitted to the hospital, I've lost almost ten pounds - not a great way to lose weight, but hey, I'll take it!  Thankfully, my appetite is back now, though I'm still not eating enough to simply maintain weight.  That will come with time soon, I know.

I am going to miss pizza.  And hamburgers.  And anything fried.  And pretty much all kinds of foods that I love to eat that are high in fat.  Instead, I'm having fruits, vegetables, lean turkey burgers, baked fish, and chicken vegetable stir fries with brown rice (without the cooking oil, which is high in fat), and lean turkey sandwiches.  I do love fat-free Fig Newtons and fat-free yogurt.  Those are my treats for the time being.  I have a steep learning curve ahead but I know that this is for the best.  I do think that my life-long high-fat diet did contribute somehow to the pancreatitis.  Even if it didn't contribute to it, switching to a low-fat diet will be good for my heart, my pancreas, and the rest of my body.

For now I also can't have caffeine, but I'm hoping when I see the gastroenterologist next week, he'll give me his blessing to have coffee every now and then.  Let me keep something I enjoy, like mochas!  Crossing my fingers about that.  If you know me well, you know mochas are a daily staple for me.

I don't know what my journey will be ahead.  I haven't dealt well with not knowing why this happened, but I hope to know in the coming weeks.  I also don't know if this will happen again, and that's a seed of fear that has unfortunately been planted.  Some weird things have been happening, too.  I'm getting night sweats even though it's cool in my bedroom with the air conditioner.  Also, my shin splints are back with a vengeance since the pancreatitis hit me (and they clearly weren't caused by running!).

But here's what I do know.  I know that I appreciated the visits at the hospital from my co-workers and staff members, as well as the phone calls, texts, and posts on social media wishing me well.  Support from others goes a long way.  I appreciated the cards and small gifts I received.  This whole experience has also re-kindled my spiritual reflections and beliefs.  Life is so fragile and precious.  On the morning after being discharged from the hospital, I stepped out of my apartment and observed an overcast sky with a subtle drizzle of rain.  The trees and plant life were especially lush with green.  I was briefly overcome with emotion at the beauty of it all and cried a few happy tears. Sometimes we need experiences of high stress and uncertainty to remind us just how amazing life really is.

Thanks to everyone for these measures of support!