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#1
Old 12-16-2014, 08:19 PM
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How can you die of pancreatitis?

Just heard of an acquaintance who went into hospital with pancreatitis and died.

Is it normally fatal? I thought it was just extremely painful and draining.
#2
Old 12-16-2014, 08:58 PM
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I'm so sorry.

Pancreatitis is one of those that can be mildly annoying or a very big deal indeed. The mortality rate for those who are hospitalized with pancreatitis is between 5-10%. If they have another infection or necrosis somewhere on their body, that goes up to 30%.
#3
Old 12-16-2014, 09:46 PM
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Sorry about your acquaintance. The pancreas secretes enzymes that digest food, and the body is, as far as those enzymes can tell, made up of the same stuff. So when the enzymes get where they are not supposed to be, they start digesting and breaking down the tissues they come in contact with. This sets off a systemic inflammatory response that affects the body as a whole, resulting, in the most severe cases, in multi organ system failure. It's that systemic inflammatory response that can cause death, not the pancreatitis per se (of course chicken-egg).
#4
Old 12-16-2014, 10:02 PM
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Pancreatitis as you've just been made so tragically aware, can be a lethal condition. I see a lot of it in my practice and have learned to respect it.

In terms of mechanisms of death (and major 'morbidity'), there are a number of them (often mutually reinforcing):

1. Sepsis (severe infection) - in and around the area of the pancreatic inflammation, there is, essentially, dead tissue and various products of inflammation (cellular debris, partially digested fat, old blood, etc.). It provides a nice medium for bacteria to grow and, by definition, is a 'deep infection' at the outset (i.e. not readily drainable).

But in addition to infection around the pancreas, other infections are also promoted, with pneumonia, in particular, always a risk (see below)

2. Lung Complications - the 'stress' of the pancreatitis itself, infection (around the pancreas or elsewhere), and the presence of fat digesting enzymes in the bloodstream (having been released from the destroyed pancreas), can singly or in concert cause what is called 'acute respiratory distress syndrome' or ARDS. The syndrome is characterized by the presence of fluid in the spaces where there should be air. In other words, it's almost a form of drowning. The mortality rate for ARDS is high, somewhere between 25 and 50 percent.

In addition to ARDS affecting the lungs, people with pancreatitis also tend to get collapse of their lungs (or parts thereof) since a) they tend not to take deep breathes since doing so causes pain in the area of the pancreatitis, and failure to take deep breathes predictably leads to collapse of parts of the lungs and b) the presence of inflammation around the pancreas almost always leads to fluid leakage and accumulation around the lungs (not in the airspaces) called pleural effusions. The effusions further compress the lungs thereby further promoting the latter's collapse.

Collapsed lung is, by itself, not a good thing. In addition, because collapsed lung tissue is 'just sitting there' not being aerated and cleared, the chance of developing pneumonia is high.

3. As mentioned by WhyNot, the inflammation in the pancreas can also eat through the blood vessels there, and that can lead to major, life-threatening hemorrhage.

4. Pancreatitis (for a number of reasons that I can elaborate if you wish), tends to cause kidney failure. And, once kidney failure occurs (even if only partial), everything else becomes more precarious. The risk of infection is also increased in the setting of kidney failure.

5. Metabolic derangements - blood sugar elevation and calcium problems are typical in severe pancreatitis. Details on request.

6. Protein calorie malnutriton - severe pancreatitis victims need lots of calories 'to heal' yet few are able to take them by mouth. Often, nutrition must be given by the IV route. That requires a large, so-called central line and is not infrequently a portal of entry for bacteria into the bloodstream. Even with nutritional support, people with pancreatitis can experience all the complications of depleted protein such as massive swelling and muscle breakdown. Both can lead to infection and other problems.

7. Blood clots - any severe, acute illness tends to activate the coagulation system. The tendency to clot formation is compounded by the immobility of pancreatitis patients, i.e. blood stagnates, and can clot, if you're not moving about. Blood clots can be fatal and are still grossly under-appreciated.

The above are just the shorter term complications. There is another set of long term complications, unfortunately.
#5
Old 12-16-2014, 10:10 PM
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I missed the edit window but had wanted to add:

As with any acute condition, the patient's baseline health status is important. A major cause of pancreatitis is alcohol use (not necessarily abuse). But, if there is prior alcohol-induced liver disease, for example, the person is not only that much more likely not to tolerate the pancreatitis, but can also develop a whole slew of other major problems each of which can be a threat to his/her survival (e.g. other forms of bleeding and kidney failure, a severe form of delirium called encephalopathy, . . .).
#6
Old 12-17-2014, 07:26 AM
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Wow, I had no idea it could be so serious. Thanks all for your comments.

The only previous time I'd heard of it was when our former Prime Minister, Brian Mulroney, had it a few years ago. He was under care for a month or two, but no suggestion it was life-threatening in his case.
#7
Old 12-17-2014, 12:59 PM
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Frightening. I had pancreatitis as a teen-ager (so over 60 years ago). I couldn't eat anything containing fat for a couple weeks and then I was fine. No complications and no long term effects. But Karl Gauss's post is real scary.
#8
Old 12-17-2014, 01:24 PM
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My pancreatitis was a prelude to my entire pancreas shriveling up and dying.
#9
Old 12-17-2014, 01:47 PM
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My spouse wound up diabetic as a result of pancreatitis, as it destroyed a sufficient amount of his pancreas that it had trouble producing sufficient insulin. There are also some sort of indications that he suffered a heart attack during it, but he doesn't remember crushing chest pain, or rather, if he did, he couldn't distinguish it from the rest of the pain he was feeling at the time.
#10
Old 12-17-2014, 02:01 PM
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Karl pretty much covered what I was going to say, but in much better detail than I could have given.

I want to point out that I lost my summer this year because of a gall bladder attack. By the time it came out, it was more than doubled in size, necrotic, and embedded in the underside of my liver. Another day or so would have it rupturing with a significant chance of fatality from peritonitis and blood loss.

Since they are adjacent, I'm surprised the gall bladder didn't take out my pancreas also. It did cause liver damage that I'm trying to deal with now.
#11
Old 12-18-2014, 10:37 AM
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My father was an M.D. who developed pancreatitis in his early 40s. He was not a drinker; the disease may have been related to a blocked duct after his gall bladder was removed. Anyway, he was in the hospital for months, and nearly died. He was on total parenteral nutrition (TPN) for months as well. He recovered, but the disease damaged his pancreas, kidneys, and other organs, including his digestive system, which led to malnutrition and muscle loss, and he ultimately died of these complications 20 years later. Even though he was debilitated, he was still seeing patients up until a week before he died. I miss him...
#12
Old 12-18-2014, 02:06 PM
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Originally Posted by KarlGauss View Post
Pancreatitis as you've just been made so tragically aware, can be a lethal condition. I see a lot of it in my practice and have learned to respect it.
I have a very close friend who suffered from pancreatitis repeatedly (and was made well aware that it's a dangerous, and potentially lethal, condition). Thank you for your detailled post, I'm going to bookmark it.
#13
Old 12-18-2014, 02:11 PM
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Originally Posted by KarlGauss View Post

The above are just the shorter term complications. There is another set of long term complications, unfortunately.
Could you elaborate about this?





FTR, the cause of my friend's pancreatitis is unknown. Some doctors have attributed it to an allergic issue, but "allergic pancreatitis" seems to be an Unidentified Medical Object (I found one medical article refering to it, though), so others dismiss this as not being a possibility.

Last edited by clairobscur; 12-18-2014 at 02:12 PM.
#14
Old 12-18-2014, 05:43 PM
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IIRC, my mother-in-law (years ago) had a gallstone problem. The stones got into the ducts and blocked the duct hat also lead to the pancreas, thus producing blockage and inflammation of the gall bladder and pancreas as they filled up with fluid (bile?). Make all that stuff back up and increase in pressure, the organs become infected, the pressure threatens to burst them and spill bacteria into the tissues between the organs, thus causing even more infection, etc. (Same idea as a burst appendix, I assume).

At a certain point your body cannot handle the mess, and burst pieces of organs are not really likely to be getting the blood flow to help them fight infection. Plus if the other organs pick up that infection, they could shut down, causing a cascade of failures and eventual body failure.

It's never a good idea to have deep infections.

Last edited by md2000; 12-18-2014 at 05:43 PM.
#15
Old 12-18-2014, 05:58 PM
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Quote:
Originally Posted by clairobscur View Post
. . . long term complications . . .

Could you elaborate about this?
Most people do well after an episode of pancreatitis. In some cases, if an underlying cause was discovered, it will have been corrected thus lessening the chance of subsequent episodes.

By the way, by far the most common causes of pancreatitis are alcohol use and gall bladder disease (e.g. gallstones). Something like 90 percent of cases are attributable to one of those two risk factors. I should note, that with respect to the gall bladder, pancreatitis can still occur even if someone's had their gall bladder removed.

Other causes/risks of pancreatitis include:
- in association with ERCP (endoscopic retrograde cholangiopancreatography) which is a procedure where the bile ducts and pancreatic duct are
- VERY high levels of triglyceride (like 50 or 100 times normal, i.e. levels in the thousands (mg/dL) = levels of 20 to 100 (mmol/L))
- high levels of blood calcium
- certain drugs (e.g. 'gliptins' for diabetes, various anti-HIV agents, thiazide diuretics, and many more)
- previous episodes of pancreatitis
- trauma, especially to the abdomen (including surgery)
- infections (e.g. mumps, hepatitis)
- and more . . .

Now, in terms of the late, or longer term, complications of pancreatitis, I'd break it down into two major categories:

1. Local/mechanical
2. Impaired pancreas function

Late local or mechanical complications include:
- recurrent pancreatitis (sometimes one episode, a first episode, sets in motion a sequence of chronic and/or relapsing pancreatitis)
- cyst formation (more accurately termed pseudocyst formation) when a collection of 'junk' accumulates at the site of the pancreatitis. Pseudocysts contain dead tissue, white cells, digested fat, 'debris') and can cause severe pain, can bleed, can rupture, get infected, or compress nearby vital structures. Bleeding, rupture, and infection can be catastrophic, and compression of say, the bile duct (that should be draining the liver) is also a serious problem.

Impaired pancreatic function is in some sense predictable, since the pancreas is essential for both the production of digestive enzymes (for fat) and for the production of insulin. Especially after recurrent episodes of pancreatitis, the pancreas can become so damaged (and atrophied) that it can no longer make adequate fat digestive enzymes and/or insulin. The result is 'fat malabsorption' and diabetes, respectively. Often, this situation is referred to as pancreatic insufficiency, with the term exocrine pancreatic insufficiency used to denote loss of the fat digesting enzymes and endocrine pancreatic insufficiency to refer to the lack of insulin and the diabetes that results.

Fat malabsorption causes severe diarrhea and weight loss. When this occurs, and is left untreated, people can lose huge amounts of weight. Further, it's not just fat calories that won't be absorbed - fat soluble vitamins will also be poorly absorbed leading to a drop in their levels, and that leads to its own problems.

If the pancreatic insufficiency extends to cause inadequate insulin production, and thus diabetes, sugar levels tend to be erratic with periods of high sugar interrupted by periods of very low sugar. Part of the reason this happens is that a) people may be eating but not absorbing their calories as a result of fat digestive enzyme deficiency and b) in addition to making insulin, the pancreas also produces 'glucagon' which, in a way, is like an anti-insulin. It tends to do the opposite of insulin. Although people can inject insulin, the same is not true for glucagon (except in emergency situations). In the absence of glucagon, the blood sugar can fall to dangerously low levels and stay there. Living with diabetes that has arisen as a complication of pancreatic insufficiency can be extremely challenging to put it mildly.

There, an overview of the late complications of pancreatitis. In conjunction with the acute complications (addressed in a previous post), they indicate what a nasty disease pancreatitis can be. I'll shut up now.

Last edited by KarlGauss; 12-18-2014 at 06:02 PM.
#16
Old 12-18-2014, 07:14 PM
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One of things that really annoyed me when my spouse had pancreatitis was the constant and unrelenting questions about his "drinking" habits. At the time, the spouse hadn't had an alcoholic drink in several years. But it was like no one believed us. I even had doctors pulling me into the hallway to say "no, really, how much alcohol does he drink in a day? Check the trash for bottles." No, really, he had had no alcohol for quite a long time prior to the episode. Give it a rest, people, not every case is connected to alcohol! Just because he looks like a redneck doesn't mean he drinks like one!

Finally, they mumbled something about maybe some sort of viral infection. In retrospect, it might have been elevated triglycerides, but maybe the elevated levels were a result and not a cause? His check-up prior to the pancreatitis did not show such elevated levels.

The real relief is that there hasn't been a repeat.
#17
Old 12-18-2014, 07:21 PM
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Originally Posted by Broomstick View Post
One of things that really annoyed me when my spouse had pancreatitis was the constant and unrelenting questions about his "drinking" habits.
Word. My husband just went through a bout of suspected pancreatitis. (They never did give it a definitive diagnosis; when he wasn't dead 3 days later, they sent him home.)

Constant harping on the drinking. No. He's a true social drinker, less than 2 drinks a week, many weeks none at all.

I get it. Patients lie. This is true. But I think part of the firm belief hospitalists have that pancreatitis is so strongly linked to drinking is because they don't believe those of us to tell them, truthfully, that no, he hasn't been drinking a lot. So they chart it as alcohol related, with maybe a note that the patient is a poor historian.
#18
Old 12-18-2014, 07:53 PM
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The worst part of that may be that spending so much time and energy on a wrong cause (alcohol) means they're excluding from their thoughts other causes, one of which, presumably, is the actual cause. I prefer to know the actual cause because then, just maybe, we can avoid going through all this again.
#19
Old 12-18-2014, 09:00 PM
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Originally Posted by Broomstick View Post
The worst part of that may be that spending so much time and energy on a wrong cause (alcohol) means they're excluding from their thoughts other causes, one of which, presumably, is the actual cause. I prefer to know the actual cause because then, just maybe, we can avoid going through all this again.
Exactly.
#20
Old 12-18-2014, 09:10 PM
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Originally Posted by Broomstick View Post
One of things that really annoyed me when my spouse had pancreatitis was the constant and unrelenting questions about his "drinking" habits.
Same with my friend (who is also an ex). She doesn't drink, either.
#21
Old 12-19-2014, 05:03 AM
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Found out a bit more about the situation.

Acquaintance had severe pains and went to hospital; diagnosed with a blocked gall bladder duct; things cascaded from there, with the pancreatitis, then kidneys, then a prior medical condition flaring up, leading to point where family decided to turn off the ventilator.

And, sounds like they did not have travellers' health insurance (they were on a trip to the US when this all happened), so now there are medical bills. US medical bills. Big, ugly ones.

What Canadians step foot anywhere near the 49th without getting travellers' health insurance?

Disaster all round.
#22
Old 12-19-2014, 05:52 PM
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Originally Posted by Northern Piper View Post
...
What Canadians step foot anywhere near the 49th without getting travelers' health insurance?...
Piper - sorry for you loss - it's always a bitch, but the ones that come out of nowhere...

Just wanted to thank you for summing up the US medical system so succinctly.

This GQ, so I'll stop here.
#23
Old 12-19-2014, 06:52 PM
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My Sister just had Pancreatitis a month ago. It was as mentioned in previous anecdotes above Gall stone related. Ironically, and annoyingly, she had the Gall Stones block the duct on the Monday, she was scheduled to have the Op to remove the Gall bladder on that Friday.

She was seriously ill for a fortnight, I'm actually quite glad I didn't know there was an almost 10% death rate until now. Fortunatly she's recovering well, and the op has been rescheduled for January.
#24
Old 12-19-2014, 08:35 PM
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Originally Posted by Broomstick View Post
One of things that really annoyed me when my spouse had pancreatitis was the constant and unrelenting questions about his "drinking" habits. . . . Finally, they mumbled something about maybe some sort of viral infection. . . .The real relief is that there hasn't been a repeat.
Glad that there was no repeat. My son had pancreatitis and his wife got annoyed with those questions and with questions along the line of "he's not really in that much pain, is he?" as if he was looking for drugs.

They x-rayed for gallstones and there weren't any. So they figured either it was alcohol related or the stone passed. When he had a second attach, they got more invasive and found out that he had two ducts. The story, which I got second hand, is:

1 - before we are born we, as fetuses, have two pancreases, each with its own duct.

2 - typically, the two pancreases and the two ducts migrate and fuse before birth.

3 - in some people, the pancreases fuse, but the ducts do not - one duct empties the front of the pancreas and the other empties the back.

4 - when we are young, most of the flow comes from (IIRC) the front - if the front duct is large enough, a person with two ducts won't know that they have two.

5 - when we get older, more of the flow comes from the back (or the other way around, if I'm getting them reversed) - if the back duct isn't big enough to handle the increase: pancreatitis.

The son got a stent to stretch the duct that was too small. After the excitement was over, I told him that I should have suspected that he was a mutant. He replied that it probably wasn't his genes so much as a hostile uterine environment. That's my boy.

In his case, once they found the structural anomaly they stopped asking about drinking. It was a nice, physical explanation. They stopped asking if he was exaggerating the pain back when his first blood test results came in. I can't remember what they measured, but he holds a record for that hospital.

I hope that your husband has no recurrance, but if he does, it's possible for them to find a reason besides 'maybe it's alcohol' or 'I don't know.'

Last edited by Yllaria; 12-19-2014 at 08:39 PM.
#25
Old 12-20-2014, 09:26 AM
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Originally Posted by Northern Piper View Post
Found out a bit more about the situation.

Acquaintance had severe pains and went to hospital; diagnosed with a blocked gall bladder duct; things cascaded from there, with the pancreatitis, then kidneys, then a prior medical condition flaring up, leading to point where family decided to turn off the ventilator.

And, sounds like they did not have travellers' health insurance (they were on a trip to the US when this all happened), so now there are medical bills. US medical bills. Big, ugly ones.

What Canadians step foot anywhere near the 49th without getting travellers' health insurance?

Disaster all round.
I'm also sorry to hear about that. These things can come out of nowhere, with no warning, and escalate quickly to a life-threatening level. IIRC, my mother-in-law said in her case it was too risky to operate on a severely inflamed gall bladder; all they could do is feed her antibiotics and wait for the inflammation to ease first. It seems that it's like a heart attack - can hit you any time with no warning.

(side note - my father, while living in the USA years ago, had to have his gall bladder removed. Initially Blue Cross tried to deny the coverage, saying it was a pre-existing condition... since gallstones take decades to develop.

What happens to those medical bills? I assume they become part of the estate settlement and any outstanding are cancelled with his death?)

But yes, I today marvel at my stupidity of driving across the USA on several vacations, while much younger, with no coverage, on a motorcycle. I can't imagine today going across the border without coverage.
#26
Old 01-31-2015, 10:19 AM
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an update: we were watching Mary Poppins over the Christmas holidays, and I started doing a "where are they now" search for the different actors on wiki/imdb.

Little Michael Banks (Matthew Garber) died of pancreatitis in real life, aged 21, as a complication of hepatitis contracted while travelling in India.
#27
Old 02-01-2017, 10:29 PM
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What next?

I had no history of gall bladder problems and I do not drink except a glass of wine maybe 3x year. For several years I had borderline type 2 diabetes which I controlled with diet and exercise. I lived a healthy lifestyle and am not overweight. Then I had a stroke and everything changed. I crossed over into type 2 diabetes. Then a year ago I landed in the ER with abdominal pain and recurrent vomiting. That was the first time I heard of pancreatitis. It was labeled idiopathic since I didn't fit the usual causes. I was in the hospital for 6 weeks including time with an NG tube while my pancreas rested and my enzyme levels went back to acceptable numbers.
In the last several months I've had several more bouts of pancreatis, each lasting 3-5 days. Along the way I added an ulcer, now healing, a persistent bladder infection, and now fatty liver. Again, all idiopathic. I'm wondering, of course, if any of these are connected, as well as what next.
#28
Old 02-02-2017, 08:59 AM
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Let me point out that an American getting ill in Canada will also be fully billed for his service, so universal medicare does not generally cover foreigners.

I continue to keep my supplementary health insurance even though I pay much more than I get in benefits just because it also covers me abroad and will even arrange a medevac if needed. They paid $25,000 to bring a neighbor back from Texas after he had a heart attack there.

Incidentally, when I had pancreatitis as a teen-ager, I doubt I had ever drunk alcohol and teen-agers had no access to drugs 65 years ago. Also I've never had gall-bladder problems. So must be one of the 10% sporadic cases.
#29
Old 02-02-2017, 10:18 AM
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Originally Posted by Suzyg View Post
I had no history of gall bladder problems and I do not drink except a glass of wine maybe 3x year. For several years I had borderline type 2 diabetes which I controlled with diet and exercise. I lived a healthy lifestyle and am not overweight. Then I had a stroke and everything changed. I crossed over into type 2 diabetes. Then a year ago I landed in the ER with abdominal pain and recurrent vomiting. That was the first time I heard of pancreatitis. It was labeled idiopathic since I didn't fit the usual causes. I was in the hospital for 6 weeks including time with an NG tube while my pancreas rested and my enzyme levels went back to acceptable numbers.
In the last several months I've had several more bouts of pancreatis, each lasting 3-5 days. Along the way I added an ulcer, now healing, a persistent bladder infection, and now fatty liver. Again, all idiopathic. I'm wondering, of course, if any of these are connected, as well as what next.
You should discuss this with a doctor, not an online forum, and everyone else should note that this is a zombie thread.
#30
Old 02-02-2017, 11:15 AM
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I'm glad the thread was bumped up, I learned some things.
#31
Old 02-02-2017, 11:34 AM
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Originally Posted by Suzyg View Post
In the last several months I've had several more bouts of pancreatis, each lasting 3-5 days. Along the way I added an ulcer, now healing, a persistent bladder infection, and now fatty liver. Again, all idiopathic. I'm wondering, of course, if any of these are connected, as well as what next.
Speaking as a physician, you should be asking your gastro-enterologist these questions.
#32
Old 02-02-2017, 05:16 PM
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The pancreas is a special, touchy, and largely ignored organ.

But the whole discussion serves to demonstrate how we all "hang by slender threads". While the human body is quite resilient and can handle lots of abuse, one unexpected sideways hit or one puff of an "ill wind" can seriously mess you up or kill you, if you are unlucky.

There's all kinds of stuff that can go wrong with all different parts of you. Really, when you think about it, Life is (mostly) a huge counter-argument to Murphy's Law. Mostly we just keep going and going. Except when Murphy gets an upper hand, and then we don't.
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