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How Cycling Could Have Killed Me...aka the Most Bizarre Case of Acute Pancreatitis Ever

Wednesday, July 03, 2013



Although I still owe a story of Ghana, I am going to quickly catch you all up on what has happened in the past 2 weeks as it has been quite a difficult journey to where I am now, and will likely change my journey ahead.

In short, I have been very ill. I am finally home today, but still have a long way to go until I feel healthy again I suspect. I have severe acute pancreatitis and have recovered from shocked liver. Pancreatitis is usually caused by alcohol (I rarely drink) or gallstones (I had my gallbladder out in 2010, interesting blog about it back then if you are bored and looking for an interesting read about unexpected complications of gallbladder surgery...) Although they spent a week doing tests with 5 consulting teams (GI, Plastic Surgery, Orthopedic Surgery, Infectious Disease and Trauma Surgery) it is still not entirely clear what happened. Here is a brief version of my best guess:

I like to cycle - anyone who follows my page knows this. Hell, I *love* to cycle. I also like to take pictures of myself cycling.

This picture in particular was taken on one of my favorite country roads. Like an idiot I was cycling relatively fast (20-25 mph) while taking this picture and didn't realize how close to the road edge I had gotten. As the cycle wheel slipped over the edge, I corrected left, but too late. I tried to get out of my clipless pedals, but no luck - I was wearing brand new shoes with brand new (tight) cleats. Yup, because I have become complacent about safety, I rode my left knee into the ground, still clipped into my cycle (weak of stomach should skim over the next few photos):




I got unclipped once the bike stopped sliding and called for a ride. I grit my teeth and sprayed the wound on my knee with the two bottles of water to get some of the initial dirt, rocks, pebbles and grass out.



As an emergency physician I knew this laceration was deep enough to potentially go into the knee joint (an emergency that requires surgical washout) so I went to the Emergency Department to get a methylene blue injection (injected straight into the knee joint, you see if blue fluid comes out the laceration)



Yeah, that is just as fun as it looks - I cried during the injection - it was one of the most painful things I had experienced to that point...although compared to the rest of the week to come...it was a walk in the park

Got sutured and went home on antibiotics and some mild pain medications


The next day, I actually added a few sutures to an area that had opened a little deeper. I did this with no lidocaine or analgesic, so I know my pain tolerance is pretty good :-)


All day I had been feeling nauseated and having sharp stomach pains - I attributed it to the antibiotics and pain medications, but didn't make much of it.

The following day was when I became very ill. I was at the medical school lecturing when the pain became so intense it took my breath away. Like a sword going through my stomach and into my back. I started to black out, heart rate and blood pressure low. That's when I knew there was something really wrong.

The rest happened quickly. The Emergency Department is directly downstairs from where I was teaching. It did not take long to confirm my suspicion that I had acute pancreatitis and I was admitted to the hospital for classic treatment: IV morphine and zofran for pain and nausea, IVFs and nothing to eat for several days so that the pancreas can rest. The first day was a haze. Given the pain I remember that is probably a good thing.

The second day in the hospital I learned that I had a "shocked liver." This is one of the complications of severe pancreatitis and blood pressure being low. It may also have been from the trauma or from liver toxicity from various medications including the antibiotics I got. My hematocrit dropped 6 grams, my albumin and total protein bottomed out and my calcium dropped. Those of you who are medical know what that means. I was really ill. Multiple Cat/CT scans were done to find out if there was anything else like internal trauma causing these symptoms. Late that night I was in the MRI machine for more testing including an MRCP to look for an obstructing stone since my labs were so worrisome.



What they found was not a stone, but a "pancreatic divisum" - I know, silly big medical words. What it means is that when I was a fetus, my pancreas didn't fuse correctly leaving me with two ducts instead of one, which is a rare, but major risk factor for acute (and unfortunately recurrent) pancreatitis. So why now, at age 42? The GI and trauma specialists think that the trauma of the accident combined with high dose antibiotics shocked my system enough to create an inflammatory cascade causing my pancreas to start misbehaving. So there is the best guess - does it explain everything? - not perfectly, but I can live with that.

Luckily, my shocked liver healed (the liver is resilient and I am healthy). It is usually an all or nothing phenomena with acute hepatitis - it heals or it fails. Mine healed. After 4 days in the hospital with nothing to eat, frequent vomiting and excruciating pain I was allowed to try some fluids. Not very successful the first day (popsicles and jello luckily taste good going down or coming up) but after two days I was able to keep some fluids down. By the time I left the hospital I graduated to bland solids - crackers, toast with jam and soup.

So here I am at home. Still having pain but lucky to be doing so well and a little better every day. No exercise for awhile unfortunately. Pancreatitis is a catabolic state (body breaks down) and I am exhausted and amazingly deconditioned for only 9 days. Plus, there is my knee. Debrided by plastic surgery, with possible patella (knee cap) fracture followed by orthopedic surgery, I can limp but cycling, elliptical etc (even the pool) is out of the question until this heals, and that may be awhile.

So patience...
Patience will be key this month, and logging and being accountable for every calorie.
I will try to balance being a bit more active every day with putting my health first and not overdoing it.
No alcohol. None - it's not worth risking a recurrence and a 100% low fat diet (not just most of the time, like what I usually do).

I am grateful for my health, and that I am healing quickly - likely because I was so fit and in shape
I am grateful that pain is all that I have now - I can deal with pain
I am grateful for my friends and family who sat with me while I writhed in pain and vomited more times than I can count. I think it was harder for them than for me some days.

(Pain controlled for a moment by lots of morphine - happy for the flowers, balloons and love of good friends)

Finally, I am grateful that somehow I managed to be cheerful through most of it - one of my friends said severe pain brings out our true character- I hope that is true.



If you have made it this far, thank you for listening. It was a long, painful and at times scary week.
I am happy to be home and yes, I will be back on my cycle in no time -stronger mentally while I become stronger physically.


Leaving the hospital...


Thank you to everyone who has or will support me - love you all!
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  Member Comments About This Blog Post:

KG4PVOWIFE 7/22/2013 3:00PM

    So scary! I am just getting caught up and this made me cringe. So glad you are on the mend.

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HIPPICHICK1 7/9/2013 4:07PM

    I haven't had a chance to read your blogs lately, but am glad I came around today to catch up with you. So sorry to hear that you went through so much pain, but life is like that and we go on. Get well soon!

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SBHPATRICK 7/7/2013 5:13PM

    SO happy you are doing well now and are on the mend. Thank you for sharing your story with us - thinking healthy thoughts for you!

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SMOKINGUN 7/5/2013 8:33AM

    You are now and have always been an inspiration to me. To say you went through a lot is saying the least. I saw you when you could tolerate company for a short time and was grateful to be with you just wishing to be able to take your pain away. It was obvious, you were in great pain, yet worried about the effects it had on me, your dad. You showed tremendous strength and stamina to maintain the "look" of recuperation while in the throngs of some extremely intense pain. So glad you are on the road to recovery albeit slower then I would pray for. Continue to educate all of us as you progress on your path to being a healthy you. Love you Dad
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KONRAD695 7/5/2013 2:11AM

    It's funny the weird stuff you find out when you're sick/injured. You have a double ducted pancreas and I have three mini spleens. It's quite a few days later now. I'm glad you're out of harms way. I will be thinking of you daily. Keep well my friend.

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JUST_BRENDA 7/4/2013 7:15AM

    What a nasty fall. Get well soon.

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NIELSENSLADY 7/4/2013 2:15AM

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GETFIT2LIVE 7/3/2013 4:33PM

    So glad you're home and healing--that could have gone so much worse! Take good care of yourself and be wise about what you do to be active during this recovery time.

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SUNNIE00 7/3/2013 1:47PM

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JSTCHLIN 7/3/2013 12:59PM

    So happy you are home and starting to feel better. I'm glad to hear throwing up Jello tastes decent. LOL. Great pics, for those who can stomach it. Safety first is your motto and you're taking pics at 20-25mph.... Way to go! But seriously, my thoughts and prayers are with you and a speedy recovery.

Take care and stay healthy

Mike
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MANLEYSANDY 7/3/2013 12:36PM

    Holy Moly! You are one tough cookie! I am glad you are on the mend. You look great...

Keep us updated on your progress!

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JAMIELOGICAL 7/3/2013 12:09PM

    Between your husband's accident and yours, followed by this stint in the hospital, it must be very rough on you right now. But it sounds like you are fairing remarkably well and staying fairly positive, while remaining realistic. I know how tough it can be facing a long recovery and the trick will definitely be to keep your spirits and motivation up. I wish you the best of luck and I hope you feel better soon!

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MEEBELO 7/3/2013 11:11AM

    I'm so glad you are on the mend. I don't know that I would be as positive as you are about what you're dealing with. Take care of yourself.

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RENZRYD 7/3/2013 10:51AM

    I am so glad to hear you are ok...I was almost thinking your got ran over by a car or something. Wow your story is amazing and I am glad you are getting better. BTW, you are looking really good in the bed photo, so you are still on track to get to your goal emoticon , sorry that may have been out of line but you are being so successful right now I am happy for you even with your trials. HUGS!
-Renee

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RUNNING-TURTLE 7/3/2013 9:47AM

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ROCKMAN6797 7/3/2013 9:01AM

    Holy Moley! That injury looked absolutely gnarly! So glad that too all the action you did and here to you recovering quickly and completely Hollynn. Take it slow and easy and soon you will be back doing what you love to do...cycling like a mad woman!

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KATRINAKAT23 7/3/2013 8:49AM

  Wow, you are brave. I have very low tolerance for pain. I hate when Drs. won't give strong meds for pain, I will deal with the after affects later, just take my pain away NOW, I say. lol

I am so happy you are better, sounds like you had a very rough go of it. emoticon

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FITMARY 7/3/2013 8:42AM

    I'm so sorry you've been ill, but it's GREAT to see you getting healthy!!! Beautiful flowers too! You must have LOTS of people who love you. Take it easy and get well!!!
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FABAT402009 7/3/2013 8:40AM

    Wow!! So happy you are on the mend and talk about scary times. I can only imagine how worried your hubb, family and friends were. Please keep us updated on your progress.

Guess this will be a great time to start working on a TBR list of books or catch up on some movies you've missed.

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OPTIMIST1948 7/3/2013 6:13AM

    Ummm....Girl, you crazy. You funny crazy takin' pictures of yo self all banged up and doin minor surgery on yo self. I've heard of people taking their own stitches OUT but seriously. (reverting to normal voice) Seriously tho, I'm glad everything came out ok.

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RASPBERRY56 7/3/2013 5:15AM

    Yikes! Incredible what you've gone through!

I know of a social acquaintance who was almost lost to pancreatitis - and was NOT a drinker to any significant extent.......I've also heard of other cases involving *non-drinkers* so I don't quite buy into alcohol being an *absolute* contributing factor.......

Biking - yeah, that can be quite dangerous, especially in highly populated areas such as mine........I've seen WAY too many close calls between car and bike that I've TOTALLY stopped biking (and I have a nice, clean, rarely used bike).........at least I can work out by other methods!

The most important thing is that you survived and are thriving! You have *truly* earned the "spunky" part of your name!

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AROCHFORD 7/3/2013 4:33AM

    Healing vibes sent to you! Glad to hear you are improving!

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NUOVAELLE 7/3/2013 4:15AM

    I have to admit, the title of your blog really scared me - and the pictures even more! I am a beginner cyclist - at the age of 37 - and I think I'll love it, so I was kind of worried.
I'm sorry you had to go through all this pain and all these scary things but I'm glad you're back home and healing.
You have my prayers for a speedy full recovery.
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SEPTEMBERSPIRIT 7/3/2013 3:43AM

    You are an incredible woman! Those pics were well ummm - OUCH!

I'm happy you're on the mend and I have no doubt you will be back at it in no time. emoticon

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MESEATURTLE 7/3/2013 1:41AM

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FENWAYGIRL18 7/3/2013 1:38AM

    I hope you'll soon be feeling better it sounds scary what you went through and I hope when you are able to go back on that bike you don't use the phone while driving, just like a car we need our attention focused on the road.
I live with chronic pain on a daily basis, so my heart goes out to you for having to endure that much pain, god bless!

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MATER88 7/3/2013 1:07AM

    WOW! That was quite a time for you there. I'm so glad that everything seems to be heading the the right way.

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KPETSCHE 7/3/2013 12:54AM

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Wow! Thanks for the little horror story before bedtime! Glad that you have a good outlook because it sounded pretty awful!
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DALID414 7/3/2013 12:52AM

    Oh my goodness!!
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PENGUITO 7/3/2013 12:44AM

    Scary stuff! I'm so glad to have you home!
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TADTURC 7/3/2013 12:44AM

    Wow, best of health sent to you!

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