Before I get to the smoothest part of my story, the Whipple Procedure, I first have to bore you with what led up to it.  I am writing this mostly for the folks that are still considering the surgery.

My Whipple came after a year and a half of attempts to avoid it.  It took 3 ERCP's to find out the cause, 1 more for an accurate diagnosis and 3 more to unsuccessfully try to stop the carnage.  This all occurred after 3 years of trying to diagnose my problem which began with an attack of Severe Acute Pancreatitis that almost killed me 12 years before the final assault.  Even knowing that I had damaged my pancreas with the major acute attack the quack GI I was going to kept insisting, and this is a direct quote, "Diarrhea cannot be caused by the upper GI tract.  You must have a lower GI problem."  He probably added two years to the search and delayed the ultimate diagnosis until there was nothing that could be done except the Whipple.  He was just the last in a long line of failures as far as I was concerned.  I had misdiagnosed digestive problems from the time I was 19.  They finally discovered that I had Pancreas Divisum and had been suffering subclinical and clinical attacks all my life when I was 46.  

The massive attack I had when I was 34 was probably the last big warning.  Since I did not have much knowledge then I let the docs get away with just putting a "?" down as to cause.  They let it drop and I was too ignorant to know better.  After dumping the quack because he refused to search any further for the cause of my upper left abdominal pain, recurring nausea, excessive sweating for no physical reason and persistent diarrhea (yeah, I know, DUH!) I switched GI docs (no small feat thanks to the ins. co.).  This doc took three failed shots at an ERCP before he figured out he wasn't doing anything wrong and I indeed had Pancreas Divisum that was blocking his entry into my pancreas through the Sphincter of Oddi.  He told me that there was only one Doctor in town that he trusted to cannulate the Ampulla of Vater into the secondary pancreatic duct.  I was incredibly lucky that he was able to talk Dr. Atilla Ertan into accepting me as a patient.  He was the Doc who certified most of the other doctors in the area on ERCP equipment and procedures and at the time he took very few patients that were not already in a clinical research program.

Dr. Ertan had me on the radiology table within days and had completed the implantation of the first stent.  By the time I came back to see him the next time I had done my homework.  I had studied up on everything.  I asked intelligent questions and was talking with him in ways that left his med student's head spinning.  From that point on Dr. Ertan treated me as an equal.  He fed me research papers and pointed out significant research for me to look at.  He talked to me in Medical terms.  I took it upon myself to learn that terminology.  I took copious notes every time we go together.

When it became painfully obvious that we were not going to be successful at staving off Severe Chronic Pancreatitis we started discussing all of the alternatives.  We ended up opting for Puestow's Procedure rather than a Whipple.  The Puestow was major surgery but was by far the easier surgery from which to recover.  This decision was based upon a variable assumption that the stenosed and malformed ductwork was the cause of my pain.  We also discussed the very real possibility that the dilated ductwork was just a symptom of severe structural deterioration of the pancreas.  If that were the case then the odds became very slim that a Puestow would be even marginally successful.  Given that it would be very difficult if not impossible to perform a Whipple once a Puestow was done I was made aware that there was a certain degree of probability that a Whipple would actually be the proper procedure for me.  The real difficulty came in that very few surgeons are highly proficient with both and Dr. Ertan by now had built some kind of a kinship with me.  He was not going to send me out in search of just any insurance plan surgeon.

Dr. Ertan was the Chief Professor of Gastroenterology at Baylor College of Medicine at the time.  He was able to convince Dr. Chuck (F. Charles actually) Brunicardi to take me on as a patient.  Dr. Brunicardi had recently been recruited in to take over for Dr. Micheal DeBakey as the Head of Surgery at Methodist Hospital and as Chairman and Chief Professor of Surgery at Baylor College of Medicine.  Dr. Brunicardi came to Baylor CofM from UCLA Medical where he was the Assistant Head of Surgery.  In addition to heading up the Islet Cell Transplant Program at UCLA he also helped redefine the Whipple Procedure.  He had done hundreds of both procedures and was the most admired alimentary surgeon still cutting in the Southwest.

At UCLA, among other research sites they revised the procedure so that in many cases they were able to preserve the pylorus and or the duodenum.  Subsequent research has proven that when this variation of the procedure is done properly it nearly eliminates morbidity and mortality from the surgery.  Since there were fewer complications to be concerned about the surgeon can spend his time, effort and concentration on the steps that mean the difference to success or failure in the operation, isolating the blood supply, creating new insertion points for the bile duct and pancreatic ducts and suturing the viscous organs together so there is the least amount of fistula (leakage) possible.  Now if there was a death from the procedure it was more than likely due to the actions of the surgeon and not the procedure itself.  The Whipple became a mainstream procedure for non-cancer patients and stepped out of the realms of research.

The last stent had come out and the Chronic Pancreatitis pain had returned at an almost intolerable level.  Since I was convinced now that I had the best team I could ever hope for  it was time to just schedule it up and trust in the professionals that I truly believed in.  It was an almost intolerable wait of 6 weeks to get an entire day of both his time and an OR.  I went on Short Term Disability swallowed a heavy dose of pain meds and watched the hours tick away until the day I could begin to see the pain end.  I spent my time signing all the legal papers such as wills, civil and medical Powers of Attorney, Living Will, etc., and getting all the finances in a transferrable condition.  I had the long difficult talks with my kids (they were both in College then....gosh, I'm tearing up just thinking about that again).  In differing ways it took forever for the day to arrive and yet it came so painfully quick.

Dr. B. was so incredibly supportive to both Nancy and I.  I do not think there is a finer human being on the face of this Earth than Chuck Brunicardi.  Anyone who thinks all surgeons are arrogant Prima Dona's needs to meet this man.  Even though he had just spent more than 9 hours working on me with more than 5 of it just freeing the Mesenteric artery he sat down with Nancy and talked with her, calmed and reassured her and waited with her until I woke up.  As soon as I woke up in Surgical ICU he was there to introduce the nurse that would be in charge of watching over me and tell me the initial details about the surgery.  Since they had opted for the Whipple because of the extensive damage to the pancreas he told me they had taken the head and most of the body of the pancreas.  He reassured me that there was no sign of cancer but that they had removed several precancers in the process.  He then told me what to expect for the next 2 days in SICU.  He told me if I chose to stay in SICU for a 3rd day (which I ultimately did basically because I was afraid and in pain) he would make sure the insurance company would accept it.

I had chosen the epidural blocks instead of the heavy narcotic load because I wanted to retain some level of alertness.  Maybe there is a compromise.  The drip epidural kept me out of pain until I moved.  Then I had to wait for it to subside before I could breathe easy again.  While I was in SICU they kept giving me pain injections whenever I wanted them.  When I was back on the Surgical Floor it wasn't the same.  When they switched me over to the PCA pump with Fentanyl I had to learn how to deal with the searing pain every time I moved.  I learned I had to anticipate my movements by hitting the PCA pump a few times in advance of the movement.  I found it took too long to catch up if I didn't get some going beforehand.  

I also was taught a trick by my favorite nurse.  She snatched the pillow from my roomie when he checked out and gave it to me as a "clutch" pillow.  When you want to move or cough you clutch the pillow to you incision before you do it.  It gives you support with no hard edges or heavy pressure.  It reduces the pain you feel when you have to use your stomach muscles to sit up.  You also learn to run the legs and back of your bed up as far as they will go when you want to get out of bed or just sit up over the edge.  This allows you to roll to your side to sit up thereby using you back muscles instead of your stomach muscles.

The first 3-4 days are the worst.  Once you are past that you begin to adapt to the condition.  I won't say the pain becomes your friend but it becomes familiar.  You begin to test your limits.  Every day the limits change.  Sometimes you can do more.  Sometimes you can do less.  You just have to keep pressing.  It's OK to lie back and cry and say you can't do it as long as an hour or two or three later you're pushing the envelope again.  

After the 3rd or 4th day you have to take control and start the reclamation project.  You start with the breathing exercises and move on to raising the back of your bed up.  You can then move on to sitting with you legs over the edge of the bed.  Before you know it you're rolling over on your side and pushing yourself up.  The progress is small and each small step comes at the expense of more pain but if you can task yourself with these small steps and take plenty of time to rest in between then you get stronger and more pain free.

They ended up taking 1/2 my stomach (why did they leave the fat half?), all my gall bladder, a significant section of my small intestine and 3/4 of my pancreas.  They basically gave me a new digestive system.  I pretty much had resigned myself to be on Viokase the rest of my life anyway so the head and body of my pancreas was superfluous as far as I was concerned.  They were able to save nearly the entire tail of my pancreas at the time so I have yet to require insulin.  I am somewhat hypoglycemic so it appears I am producing more insulin than glucagon now.  The Alpha cells are loosing the race to the beta cells so far.

DON'T READ THE NEXT PARAGRAPH WHILE EATING OR ON A QUEASY STOMACH
I did have some trouble adapting to my newly reconfigured stomach.  I tend to clot very quickly so my stomach ended up with a large amount of coagulated blood in it.  They were keeping my pancreas shut down with somatostatin so nothing was passing though into my small intestine.  The blood clots ended up clogging up my NG tube.  They could not keep it clear.  They ended up pulling it 2 days early.  It felt WONDERFUL to get it out.  I had visitors come in that evening.  The chapter director (I was Assistant CD for him) of our motorcycle club came up to visit for the first time.  He is a bit queazy about hospitals.  They walked in just 30 minutes after I had finished my first bowl of cherry jello and just in time to see it come out again at incredible velocity along with all of the coagulated blood the NG tube couldn't extract that had been in my stomach for nine days.  Forget the little kidney shaped spit basins, I almost overflowed the wash basin.  For some strange reason Lloyd and Wanda didn't stay long that night and all their visits after that were by telephone.

After clearing my stomach everything started working rather smoothly with the exception of the standard hospital constipation.  That kept me in the hospital an extra day or two.  Dr. Ertan is notorious for sneaking a stool softener into my 2 AM pills and he must have taught that trick to Dr. Brunicardi.

I was out of the hospital is 13 days. There was a road construction project in between the parking garage and the hospital so the lines to get in and out of the Hospital were horrendous.  I actually stood up out of my wheelchair and walked out the driveway to get in the car at the street, carrying my historic wash basin with me.

I immediately laid claim to the recliner when I got home and stayed there for a couple of days zonked out on the pain pills I had gotten.  It took a couple of days to readapt to the pain meds and I started getting more active.  I was feeling at 3 weeks post surgery like I was behind the curve but by week 4 I was completely off the pain meds and starting to get active.  By week 6 I was driving again and had started eating real meals.  By week 8 I was back at work.  

I have to say I worked for the most incredible company, Forte Software.  During the time I was off my department was dissolved.  Not only was I not furloughed as soon as I returned but they had created a new job for me at the same rank and a slight raise in pay.  My new boss and his wife came to visit me twice while I was in the hospital and kept bringing little low fat treats by the house until I got back to work even though I lived 15 miles from the office and 40 miles from their home.  When I started back to work Steve, my new boss, put himself on a plane to catch the meetings that I should have covered for the first month just to give me a little additional recovery time at full pay.  There aren't many employers like that anymore.  Forte Software was gobbled up by Sun Microsystems and all of those executives and managers that made Forte such a great acquisition (not to mention such a wonderful employer) were discarded by way of demotions, terrible assignments or just packaging out.  Such a shame.  I felt I owed true loyalty to an employer for the first time since the early '70's, all for naught.

But I digress.  Dr. Brunicardi's incredible skill and my own ability to heal rapidly (I once had a disk removed from my back at 1pm and I was walking the hospital hallways at 6pm the same day.)  made me recover in record time.  I have heard of no one else back to work in 8 weeks post Whipple.  Dr. B. used a technique that made a vertical incision from just above the bottom of the sternum to just below the navel right on the midline.  This technique while the muscles are bruised from being stretched by clamps does not crosscut any muscle fibers.  That radically reduces the recovery time from other doctors techniques.  He also chose to use a single Jackson-Pratt (J-P) drain.  The human body has no way to deal with fluids in places where there are not supposed to be fluids.  When there is leakage (fistula) the body hasn't a clue what to do with it and it usually causes problems.  The drain is put in place to take away that fistula.  The more drains used the greater the amount of fluid that can be drained but it also increases radically the chances for complications such as rupture, breakage and infection.  He took a calculated risk that a single, properly placed drain would be sufficient.  He taught me how to properly care and dress it and prayed he was right.  There was a little concern when it was still oozing after 3 weeks but it had completely stopped draining by 3 weeks and was removed just 8 days after discharge from the hospital.

I went along fantastically until the middle of September (12 weeks) when I felt so good I decided to start running again instead of just walking.  That night I was back in the hospital with an attack of Acute Pancreatitis.  I was actually in the hospital longer with that attack than I was with the surgery.  

I was terribly disappointed and fell into a pretty deep depression when I discovered that the surgery did not stop the deterioration of my pancreas.  Dr. Ertan stepped in with my "Emergency Kit".  The kit consisted of a wonder drug called Sandostatin (a somatostatin octreotide that shuts down the exocrine pancreas), Phenergan suppositories and a large supply of Vicodin.  I simply inject myself with the Sandostatin every 4-6 hours upon the arrival of the attack and take the Vicodin and Phenergan as needed.  If the attack has not subsided within 24-48 hours I call his office on the way to the ER.  He'll have them jumping through hoops when I arrive.

This regimen has stopped 16 of 19 attacks within 48 hours over the last 3 1/2 years.  Unfortunately all 19 attacks have taken their toll on the remaining 1/4 of my pancreas.  I am once again disabled by Chronic Pancreatitis.  Whatever was causing the pancreas to degenerate was not resolved by the Whipple.  However I refuse to consider the surgery a failure.  I thank my surgeon each and every day for my Whipple. 

Three years ago I was crippled by pain from CP.   Because of Dr. Brunicardi's skill I got all of my kids through school and well started in their adult lives. I had a record income year and ended up with the job I had always dreamed of and excelled at it. My wife and I became closer than we had ever hoped to be and we found and bought our dream farm on which to retire. 

None of this would have been possible without the Whipple. 

I am realistic. I know from my research what the end result of CP is. I know that someday I will end up with out a pancreas. I have only had hope to be pain free and insulin independent. The Whipple got me more than two years of that goal after I was already disabled by Chronic Pancreatitis.  What would you give for two years?

The Whipple Procedure is a radical surgery.  It is not one to be entered into blindly.  You really have to ask your prospective surgeon if he or she is going to use the pylorus preserving technique.  Is he/she going to save the duodenum?  Will the vertical midline incision be used?  How many of this type of procedure has he or she done?  Where did they learn it?  Can the reference be verified?

You really shouldn't proceed with the surgery until you have answered the questions to your complete satisfaction.

I hope I haven't put anyone to sleep.  I know this is extremely long but it is all part and parcel to the reasons for and results of my Whipple.

Thanks for indulging me.

Chuck