The Pancreas: Don’t Mess With It?

In medical school I learned the first rule of surgery: "Eat when you can, sleep when you can, and don't mess with the pancreas."

It may seem funny that the pancreas, of all organs, is held in such high regard by surgeons. What would make it as notable to them as eating and sleeping? As it turns out, 95% of the cells in the pancreas manufacture enzymes that help to break down food (protein, fat, and carbohydrates), and these enzymes are so powerful that if they are released into the abdominal cavity, they can create massive damage to our own tissues. So a healthy respect for the pancreas is certainly in order, especially if you have a scalpel in your hand.

The pancreas is about 4 inches long and is located just behind the stomach. It contains a collecting system for enzymes that empty into the small intestine (along with bile from the gallbladder) when the presence of food is detected. This is how we turn tough food like steak into absorbable protein. The intestines have special protective coatings, including a mucous barrier, that prevent the pancreatic enzymes from harming them.

Most people associate the pancreas with insulin, its number one hormone product. Insulin is produced by the other 5% of cells inside the organ. Insulin triggers the body to remove sugar from the blood and use or store it for energy. Without insulin, sugar (contained in the carbohydrate-rich food we eat) remains in the blood, causing it to be sticky and thick. High levels of blood sugar (over time) can cause damage to small blood vessels that supply our eyes, toes, kidneys, and nerves. This is why people with diabetes (who either have too little insulin, or make no insulin) can develop eye damage, foot ulcers, nerve pain, and kidney failure over time. Of note, the pancreas also makes the hormonal antidote to insulin, called glucagon, which triggers the body to release sugar into the bloodstream when levels are low.

What can go wrong with the pancreas?

1. Pancreatitis – inflammation of the pancreas occurs when its digestive enzymes build up to high levels and begin to irritate its own tissue. Pancreatitis can be very painful, and is diagnosed with lab tests that check for high levels of pancreatic enzymes in the blood stream.
2. Pancreatic cysts – because the pancreas is very glandular and is constantly producing enzymes and hormones, it can develop fluid filled sacs, or cysts, that can cause structural problems.
3. Pancreatic Cancer – though rare, cancer of the pancreas is very dangerous. There are several sub-types of cancer, depending on which cells are affected. More information about pancreatic cancer is available here: http://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/home/ovc-20268502
4. Insulin Insufficiency – some people do not produce enough insulin to meet their body's needs. Being overweight or obese can cause resistance to insulin and a higher insulin requirement. If the pancreas doesn't keep up with the needs, "Type 2" diabetes develops.
5. Autoimmune destruction of insulin-producing cells – in some cases, our body's immune system mistakes insulin cells for foreign invaders and attacks them. When these cells are destroyed, the body produces no more insulin, and "Type 1" diabetes results. People with type 1 diabetes cannot survive without insulin injections to replace their lost insulin production.

How to keep your pancreas healthy:

1. Avoid excessive use of alcohol – chronic alcohol consumption is the number one cause of pancreatitis.
2. Maintain a healthy weight – gallstones can hurt the pancreas by plugging up the common passageway that they, along with pancreatic enzymes, flow through to get to the intestine. Gallstones are more likely to form in people who are overweight or obese, or eat high fat diets.
3. Don't smoke – cigarette smoking increases the risk of pancreatitis and pancreatic cancer.
4. Limit your consumption of sugary food and drinks and high fat and processed foods. They can increase the fat content of your blood, which can lead to pancreatitis.

The bottom line for pancreas health: eat healthfully (such as the Mediterranean diet), maintain a healthy weight, exercise regularly, and avoid drinking and smoking. I suppose you could say that "clean living" is the best way to avoid "messing with the pancreas."

References
http://columbiasurgery.org/pancreas
http://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/home/ovc-20268502
https://authoritynutrition.com/mediterranean-diet-meal-plan/

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The Spleen: Least Useful Organ In The Human Body?

The spleen has been the target of much ridicule, made fun of by medical students and dismissed as nothing more than a "graveyard for red blood cells." In the Middle Ages, the spleen was associated with melancholy, and in more modern times, anger (perhaps you've heard the expression "vent your spleen" – which means to let your anger out).

If you were a spleen, you'd probably have some serious self-esteem issues.

While it's true that we can live without our spleens, they do have an important health contribution to make. The spleen is a soft, squishy organ, normally about the size of a fist and it sits just behind the stomach and under the left rib cage. It is a blood filter and storage system, recycling red blood cells and storing clotting components called platelets.

Most importantly, the spleen produces white blood cells, which form the foundation of our immune systems (to fight flu and pneumonia for example). In a sense, the spleen is like a blood transfusion center – an emergency back up organ for blood products.

The spleen is more famous for the trouble it can cause than the contributions it makes. There are some diseases that cause massive enlargement of the spleen, putt
ing it at risk for rupture. When the spleen breaks, it bleeds very heavily and can cause a life-threatening surgical emergency.

What can harm the spleen?

1. Mononucleosis (also known as "mono") is a fairly common viral infection that attacks one of our white blood cell lines, the monocytes. It is caused by the Epstein-Barr virus, and usually produces a very sore throat and severe fatigue which can last for weeks or months. The spleen filters and captures the sick monocytes and they build up to the point of sometimes enlarging the organ from a fist to a football!
2. Cancer – it is not uncommon for some cancers to spread to the spleen, and some blood cancers directly enlarge the spleen (lymphoma and leukemia).
3. Traumatic Injury - Sometimes spleens are damaged in traumatic injuries, such as car accidents or falls, and they need to be surgically removed due to bleeding.
4. Malaria or Parasitic Infections – while this is rare in the United States, travelers should be aware that there is a risk of splenic enlargement from such diseases.
5. Sickle Cell Disease – this is a genetic disease that causes red blood cells to develop abnormal shapes. The spleen will hoard these deformed cells, and can become very enlarged from them.
6. Liver Cirrhosis – an enlarged liver can cause back up of blood to the spleen and increase its size as well.

When the spleen is bloated from any condition, it can inadvertently store and hoard too many blood products, especially platelets. People with enlarged spleens may have a low circulating platelet count, which predisposes them to bleeding problems. This spells double trouble if the spleen ever breaks apart from its large size.

What can you do if your spleen is enlarged? First of all, contact sports should be avoided at all costs. Any person who has been diagnosed with mononucleosis, for example, should be very careful not to risk bumps and impact to the left side of their chest and abdomen. It is fairly easy for physicians to determine if a spleen is larger than normal – ultrasounds, CTs and MRIs can determine the size of the organ. Since mono has no treatment or cure, it takes time for it to resolve on its own.

In some cases, enlarged spleens cause enough trouble with their cell-hoarding and bleeding risk to require removal. This is a fairly simple procedure, with few long term consequences (other than not being able to "vent your spleen" anymore).

If you do have your spleen removed, it is important to get annual flu vaccines, and the pneumonia vaccine every five to ten years to boost your immunity to these potential infections.

Although the spleen may be one of the least vital organs, it can create serious problems if it bleeds, so a healthy respect for the spleen is essential. I'm sure your spleen would appreciate a little self-esteem boost from you! You can sing the R-E-S-P-E-C-T song to it, I won't tell.

References:
http://www.mayoclinic.org/diseases-conditions/enlarged-spleen/home/ovc-20212739
http://www.hopkinsmedicine.org/gec/series/pneumococcal_vaccination.html

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Kidneys: What Do They Do and How Can You Keep Them Healthy?

Do you remember the scene in Finding Nemo where the fish jam up their aquarium filter to get their dentist owner to clean the tank? That scene always makes me think of kidneys – because without them, our bodies would become rapidly overloaded with waste products, just like that dirty aquarium water!

Most of us don't spend much time thinking about our kidneys, and yet they are vital little organs. Not only do they filter our blood by producing urine, but they help to control our blood pressure and produce hormones that keep us from becoming anemic or weak-boned.

Kidneys are so efficient at filtering blood, that you only really need one to do the job. That's why kidney transplants are so popular – living donors can survive quite nicely with just one.  Unfortunately, most other organs can only be transplanted if the donor is deceased.

Your kidneys are about the size of your fist and are located on either side of the low back, just below the rib cage. Large arteries supply them with about 200 quarts of blood per day, out of which 2 quarts of waste (i.e. urine) is created. Urine travels to the bladder from the kidneys through tubes called ureters. Urine is stored in the bladder until enough of it builds up to trigger an urge to go to the bathroom.

Your kidneys go about their business without much fuss, unless they are put at risk by the following:

1. Dehydration – when people get dehydrated from insufficient fluid intake, this can actually harm the kidneys. They need a certain amount of fluid to pass through them to maintain their normal function. Sometimes people become dehydrated from summer heat or intense exercise, but accidental dehydration can also be triggered by blood pressure medicines or "water pills."
2. Infection – urinary tract infections are quite common, especially in women. When these infections are left untreated, bacteria can crawl up through the bladder and into the ureters that reach the kidneys, and cause dangerous infections.
3. Drugs– drugs are removed from the body by one of two major pathways: the liver and the kidney. If you take too much of a drug that is removed by the kidney, the concentration of the drug in the kidney can cause damage. Ibuprofen, aspirin, and naproxen are probably the most common medications that can hurt kidneys. But some people have more sensitive kidneys than others, and there are many possible drugs that can cause damage. This problem is so common that 66% of seniors will have signs of kidney injury (at some point) from the medicines they take! *
4. High blood pressure – as you can imagine, the pressure of the blood going into the kidneys can itself cause damage if it's too high. The kidneys try to protect themselves from high incoming pressure with a complex hormonal messaging system that affects salt and artery elasticity. However, over time high blood pressure can overcome the kidney's defenses and injure their delicate tissue.
5. Diabetes (or too much sugar in the blood) – when too much sugar remains in the bloodstream, it can "gum up" small blood vessels and tubes. The kidneys are full of tiny filtering tubes, and high sugar concentrations can injure them.
6. Cysts – some people are prone to cyst formation (cysts are fluid-filled sacks that develop in the kidneys for unknown or genetic reasons). When there are many cysts present, they push on the normal kidney tissue and can prevent them from being able to filter properly.
7. Cancer – kidney cancer is quite rare (we have about a 1.5% lifetime risk of developing it) but our risk for it increases if we smoke, have high blood pressure, or are obese.

What can you do to promote healthy kidneys?

1. Drink plenty of water – How much is enough? Your kidneys will actually tell you if you've had enough. Check your urine color: if it's light yellow to clear, you are well-hydrated. Dark yellow or orange urine means you are dehydrated and need to drink more.
2. Get tested (and treated) for high blood pressure. Most people cant "feel" high blood pressure so they don't always take treatment seriously. It is very important to take blood pressure medicine if you cannot control it with diet and lifestyle changes.
3. Get tested (and treated) for diabetes. Again, people can't "feel" diabetes until damage is already done. Tight control of your blood sugar will reduce your risk of "gumming up" your kidneys and blood vessels.
4. Take as few medications as necessary, and do not exceed recommended doses of over-the-counter or prescription medications.
5. Do not smoke.
6. Maintain a healthy body weight. Obesity is associated with high blood pressure, diabetes, and kidney disease.
7. Make sure you treat urinary tract infections quickly. If you have a burning sensation or pain with urination, or are urinating more frequently than usual, check with your doctor right away. If you wait until you have a fever or back pain (that's what kidney pain feels like), you may have a serious or life-threatening infection. Your doctor may order a urine test to see if you have an infection, and then recommend specific antibiotics that will kill the type of bacteria that are causing the problem.

Just as Nemo and friends didn't like living in a dirty fish tank, we should take care of our kidneys so we don't end up in a similar situation! In most cases, kidney disease can be avoided by following the 7 tips listed above.

References
*Drugs that can hurt kidneys: http://www.aafp.org/afp/2008/0915/p743.html
Prevalence of kidney cancer: https://seer.cancer.gov/statfacts/html/kidrp.html
Risk of kidney cancer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012455/

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Dr. Val Jones MD - Health Tip Content Editor

Introducing...Doctor Val Jones!

Greetings, Health Tips readers! I'm sure you were all very sad to see Dr. D complete his final tip last week. After 12 years, and over 600 tips, he's probably become like a little medical voice in your head. Well, that voice may be slightly higher in pitch now that I'm here, but it shares almost all of the same views and opinions. I'm Dr. Val Jones (Dr. V - it rhymes with Dr. D!) and I'm looking forward to writing to you on a weekly basis.

A little bit about me – I've been answering online health questions for almost 10 years, and I guess the administrators felt I had finally proven myself worthy of a broader audience. They are very careful about whom they permit to write health tips, you know! I am a board-certified physiatrist (my specialty is known as physical medicine and rehabilitation or "PM&R") who went to medical school at Columbia University, and then finished my training in New York City. I traveled across the United States for 6 years, filling in for doctors at various rehab hospitals in 10 different states (AR, NY, CA, FL, VT, SD, NE, VA, DC, WA). Then I took a full time position as the Medical Director of Admissions at Saint Luke's Rehabilitation Institute in Spokane, Washington.

A little bit about my specialty -- I believe that PM&R is one of the best-kept secrets in healthcare. Although physiatry dates back to America's Civil War, few people are familiar with its history and purpose. Born out of compassion for wounded soldiers in desperate need of societal re-entry and meaningful employment, "physical reconstruction" programs were developed to provide everything from adaptive equipment to family training, labor alternatives and psychological support for veterans.

PM&R then expanded to meet the needs of those injured in World Wars I & II, followed closely by children disabled by the polio epidemic. In time, people recognized that a broad swath of diseases and traumatic injuries required focused medical and physical therapy to achieve optimal long term function.

One thing we rehab physicians focus on is using exercise and healthy lifestyle choices to improve our health and avoid disease. In many cases, physical therapy is as important as medications or surgery to combat disability. The health benefits of regular exercise and good nutrition should not be underestimated so we physiatrists try to combine them with our deep knowledge of medicine, pharmacology, neurology and surgery. You'll find that we are just as likely to prescribe exercise as we are medications, tests, or procedures. PM&R docs care more about what you can (and want) to DO, than about what your lab tests look like.

Going forward, I want to help you add life to years. To enjoy all the things you CAN do, and make changes that will help you achieve your goals. To that end, I thought we'd start with a little tour of the human body, to remind ourselves about how it works, so that we fully understand how to avoid (whenever possible) the things that can go wrong with it.

I'd like to begin with a review of the kidneys - two fantastic little filter organs that are tucked away in your lower back.  Check in next week for the scoop on kidney health!

Reference: http://www.nhs.uk/Livewell/fitness/Pages/whybeactive.aspx

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