Pancreatitis is still a disease that most people don’t know about. I just know that what I went through others are going through as well. Anything I can do to let people know that amazing things are happening here in this field is the least I can do to give back.
By chance, Chris Marshak, 46, is married to a nurse who not long ago, before they moved to Long Island to raise their two children, worked for NewYork-Presbyterian/Weill Cornell Medical Center. His son was also born there. And then, in another connection of good fortune, his local physician happened to go to medical school with a gastroenterologist at Weill Cornell who is a leading specialist in endoscopic retrograde cholangiopancreatography (ERCP) — a treatment that would help save Chris’ life.
“I actually hit the lottery, when it came to pancreatitis,” Chris says, “I had it as bad as you can have it.” It is believed that acute pancreatitis begins when gallstones form a blockage at the point where the common bile duct, next to the main pancreatic duct, joins the small intestine. There, the swelling common bile duct pushes against and blocks the main pancreatic duct, obstructing the flow of pancreatic fluids, causing severe damage, danger, and pain. In Chris’ case, the gallstones were unformed and the sludge was restricting the pancreatic duct; the resulting infection was profound. As he was being treated in a local hospital, a pancreatic pseudocyst, caused by pancreatic destruction, was developing, with a fluid volume at a frightening two liters, threatening lethal sepsis.
“Just after dinner on December 12, 2013, I started to feel a little discomfort in my side,” Chris recalls. “Within an hour it became the most excruciating pain I’ve ever felt.” The emergency room at the local hospital correctly diagnosed acute pancreatitis. Visualization of the pancreas under normal circumstances at most hospitals is very difficult. To see the disease process, without advanced imaging, requires open surgery.
During the “wait and see” phase — the standard protocol — Chris’ white cell count rose dramatically, along with his discomfort. His amylase and lipase numbers went through the roof – 1,783 for the amylase, which has a normal range of 28 to 100, and 3,300 for the lipase, which has a normal range of 11 to 73. The ER doctor told his wife that in his 20-plus years in the ED he had never seen numbers that high. Initial optimism disappeared when Chris did not respond to any treatment. He had been growing steadily worse for seven days, and surgeons came in to discuss complex surgical procedures, which carried high mortality rates, as the next step.
Chris’ wife, Laura, and his personal physician knew they needed to find another way, which they did at NewYork-Presbyterian/Weill Cornell Medical Center, where numerous gastroenterology faculty are highly experienced in ERCP, an advanced technique for visualizing the pancreas and the treatment of severe pancreatitis. Sight unseen, the Weill Cornell team sent an EMS team to the local hospital to transfer Chris and, notes Chris, “everything was orchestrated from that point on. It was at that point that I began to feel comfortable. It was immediate. I saw a kind of energy with the EMTs in the way they dealt with me throughout the transport. Even at that early stage, I saw that level of expertise. I had a sense they were operating at a higher level.”
ERCP is performed through the mouth and allows the doctor to visualize the pancreas and ducts, or place stents to create methods for drainage, without any incision.
The team at Weill Cornell helped guide and support Chris through an arduous process with many setbacks and more than a year of treatment that included 10 ERCP procedures and the removal of his gallbladder by Dr. Michael D. Lieberman, Director of Surgical Oncology at Weill Cornell and an expert in pancreatic disorders. Not permitted to eat so the pancreas could rest, Chris had to bear a feeding tube for almost four months, during which time he lost more than 40 pounds.
Chris has since returned to his career as a drummer and in his spare time helps to create awareness about pancreatic disease.