Sunday, August 09, 2009

Pancreatitis

'Is there any way we could be forewarned of this dreaded disease? Can this be avoided?' I asked Dr. Udwadia, whose skills in combating complicated physical disorders that require intensive care are legendary. ‘There is no solution that one can do that, Even if one discovers gall stones in gall bladder, they are harmless. Generally, no one would advice to have them removed'. He continued. ' It is only in rarity that these stones may pop out from the bottom of the bag , come to bile duct and block the mouth of the pancreas thereby beginning a rapid chain of events that would bring a human being on the threshold of life and death'.

I was witness to two incidents of Pancreatitis that turned horribly fatal. Usually Pancreatitis (chronic) is associated with alcohol abuse but in these two cases, both became victim of 'gall stones' leading to 'acute pancreatitis'. I think one should be lucky to have it quickly diagnosed. I felt, most general physicians don’t always detect the symptoms quickly and often try to cope up with other possibilities. I wonder why routine abdominal ultrasound screening is not part of medical check up. I guess it doesn't justify the cost and like Dr Udwadia said, there is no remedy unless symptoms show up.

Losing one's appetite (anorexia) and in turn weight, Vomiting are of one of the definite indicators of the onset of pancreatitis. But often we neglect this attributing to various other reasons. When acute abdominal pain begins, we rush to clinic or hospital that first alleviates the pain (rightly so), order X ray, routine laboratory tests and by the time the results come in, another day is lost. By then patient's condition worsens. A CT scan is ordered. Again possibility of in-house CT scanner is one such factor that is consuming a vital time. Getting appointment for immediate CT, transporting a sick patient, getting immediate radiologist's diagnosis, all this takes one more day. Meanwhile, physician is restless about the patient’s worsening condition and asks for surgical intervention to look at the possibility of intestinal entanglement or any other reason. Meanwhile, laboratory tests arrive. They confirm the onset of Jaundice. But CT scan can only confirm the final diagnosis. When radiologist confirms the onset of Pancreatitis, an intensive care battle begins. Is hospital ready to handle such emergency? Do they have intensivists with high end medical gadgetry like sophisticated ventilators, syringe infusion pumps, nursing staff with expertise of such acute care? Does the hospital have endoscopy unit in case they need to attempt? Can they provide acute dialysis facility? If this hospital doesn't have it all that, Can ICU bed be secured at the hospital who has this facility? Acute Pancreatitis has 50 % mortality but that's after patient has a chance to get treatment. A decision has to be made and time is ticking away. A factor of 'luck' decides if one has a fair chance to battle with Pancreatitis or give it up before the battle starts.

Both my father and a dear friend were lucky. They managed to get an intensive care bed in a hospital that had efficient and expert clinical team that had experience in managing this situation. Next few days, it's roller coaster ride. Vital physical parameters do get taken care but after few days fortunes fluctuate every now and then. Success on one front opens up another two new battle fronts. A clinician warns, ' A recovery if at all happens, will be long drawn slow affair but any time a situation may worsen so rapidly that only few days would all be there to say goodbye to dear life'. At that point onwards, my father and friend took two different paths. One towards the progress of slow recovery while the other towards the ravine of death.

My friend was younger (in mid 30's) was in fitter physical condition than my father in late 60's with accompanying diabetes. But this long recovery too makes one so vulnerable. A pancreas that's corroded by its own juice leaves remnants of dead tissues that need cleaning through surgeries. A little or no Pancreas left means patient is lifelong insulin dependent and prone to every infection. How can we control our surroundings like Air, water, food and people around us? Can one live in sterile environment all one's life? Is this possible in an Asian environment? The answer was and is sadly 'no'. My friend too after spectacular and miraculous recovery landed up again in the intensive care to battle the infection. Body already weakened by antibiotic bombardment, crippled with diabetes (having pancreas removed) made it difficult for another repeat of previous success. He too succumbed.

Four ' F' make one prone for Gall stones. Forty age, Female, Fertile woman and Fat. So all factors are associated with woman! I am curious to know the percentage of acute pancreatitis with woman.

Two bitter incidents were also coupled with knowledge of one happy incident. A female cousin, plump, mother of two but not yet in forties had to undergo emergency surgery for acute appendicitis and surgeon discovered gall stones. He took them out as he repaired her appendix. A smart move indeed.

August 8th is the day when my father succumbed. It brought the memories linked with Pancreatitis. During my annual check up, I asked if I could include a check on the presence of my gall stones. The answer was negative.

Today is Singapore's 44th B'day. Happy B'day Singapore. I read the news that Singapore's ruling party is looking for a person in 30's to lead them in the next general election. A bold and pragmatic move that has caught up with the rest of the world, after Obama became president of US.

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1 Comments:

Anonymous Dr Sajiv said...

Hello

gone thrugh ur blog and like to share this page about the acute pancreatitis.

I appreciate ur knowledgeble presentation in your blog!all the best!

Medical Encyclopedia: Acute pancreatitis
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000287.htm

10:33 AM  

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