Suspicious and Sinister Polar Bears

I have met many types of doctors over the last couple of years, and the only thing they seem to universally hold in common is their credentials as graduates of medical school somewhere in the world.  Some I have met are very open and engaging, some are quiet but authoritative, and others can stun you with a look that says “I like you better when you’re under general anesthesia and I’m playing with your insides.”  As I have alluded to elsewhere in this blog, I pretty much have a team of doctors, so I get to experience these myriad personalities on a rotational basis. My two big ‘uns right now are Dr. MacRae and Dr. Hirschfield (see side bar “The Cast of Ang’s Anatomy.) Dr. MacRae is a little (okay, a LOT) scary but she has a phenomenal reputation as a surgeon and, if I’m honest, I’d prefer that she was excellent with her scalpel and mediocre at bedside manner rather than the other way around. Dr. Hirschfield is my newest specialist and he had my trust right off the bat because his first name is Gideon and he’s ginger. (And all who know me understand my affinity for gingers: one of my favourite cousins, one of my favourite aunts, my future husband and Ronald Weasley all have in common this noble hair pigment). Equally scientifically, my father trusts him because he’s British and was educated at Cambridge, which apparently imbues him with additional medical powers that graduates of North American schools are lacking.

To be honest, though, Dr. Hirschfield has always scared me a bit because of what he symbolizes. For the most part (FINGERS TIGHTLY CROSSED), despite my next surgery being IBD-related and very close on the horizon, my GI problems and Colitis battles are largely behind me. The liver stuff with the PSC is this looming specter on my horizon that I don’t really understand but know enough about to fear. This means that whenever I go to see him, I dread several of the following words coming from his mouth: “The PSC has accelerated and we need to talk about transplantation.” (That’s the big one). “Your liver is overworked; stop drinking alcohol entirely.” [Granted, not a catastrophe, but I think it’s unfair to deny me the entirety of my holy trinity: Diet Coke, Smartfood and Pinot Grigio or Sangria. As I have already been forced (relatively) to give up Diet Coke and Smartfood, I am clinging to the last of my “make-ang-happy-material-goods.”] “You’re going to need another stent procedure.” (Again, not horrible, but definitely unpleasant. See the “I am Jack’s Raging Bile Duct” page and examine ERCP’s for further information.) Or “We got it wrong; it’s not PSC but a bile duct tumor.” (Granted, at this point, with numerous MRIs and CT Scans behind me, this is highly unlikely, but I cannot shake the idea entirely.*)

But, the Hirsch has said none of those things. He’s one of those really positive people that says bumper-sticker phrases like “you can do anything!”, “liver disease doesn’t mean an end to your life. People live with this disease every day”, and “if you want to travel, travel. See it all!” (As I said, he is the optimist to my pessimist and sometimes I want to snipe back at him with: “yeah, I can do anything. But, when my pancreatitis really gets going, and I take pills and stop solid foods and then don’t have the energy to turn myself over on the bed…is that when I’m supposed to be all I can be? When I’m supposed to call my travel agent and book my adventures?” But, as my friends and family can attest, these bouts of bitchitis pass and fade and I find myself encouraged by the little things again, like peanut butter, really good pickles and sour gummy hamburgers. mmm gummy hamburgers...) 

But, I digress. I know I’ve linked to a medical definition of PSC, but from my limited understanding, this is what’s going on in layman’s terms:  PSC is a disease that damages and blocks bile ducts inside and outside the liver. Bile is a liquid made in the liver and, therefore, bile ducts are tubes that carry bile out of the liver to the gallbladder and small intestine. In the intestine, bile helps break down fat in food.  Over time, PSC patients get inflammation of their bile ducts as a result of scar formation and narrowing of the duct. As such, bile builds up in the liver and damages liver cells. Eventually, scar tissue can spread throughout the liver, causing cirrhosis and liver failure. (Awesome.)

Anyway, today I learned from the Hirsch that these strictures (the narrowing and/or scarring) are classified as either Sinister or Suspicious, which I think is pretty wicked. From my latest MRI, he could see the stricture that I had back in 2008 which eventually prompted my diagnosis. In the image he could see that the scarring had healed and that the duct is now significantly narrowed, but that bile can still pass in and out of the liver as needed.** He also showed me my new stricture – my suspicious stricture – that has begun to form in the common bile duct. Apparently, suspicious is the type you want because it means they are merely looking at it and watching to see what it does. A sinister stricture, on the other hand, is bad news bears and pretty much means that full blockage of the duct is imminent. And, from my limited medical knowledge, once the common bile duct gets shut down, it is only a matter of time before the liver becomes cirrhotic and begins to fail. So, for the time being, Suspicious is winning the day and Sinister is on the Ropes. Stay tuned…      

* This fear is probably due in large part to a careless remark made by a nurse when I was undergoing diagnostic tests to try and figure out if I did have PSC. I was at Princess Margaret and the doctor who had referred me specialized in the area of liver oncology (at the time my doctor’s told me that the mass they found on the ultrasound could be a PSC stricture or a tumor known as cholangiocarcinoma). Anyway, as she was setting me up in the CT machine she asked how long I had had cancer. I freaked. I admit it.  Not then, of course, because that would betray my bitter and cool persona. However, once home I called friends and family and fretted to them about what this meant. Although they assured me then, and doctors have assured me since, that there is no evidence of a tumor, I am still struck by how quickly it can go the other way and can’t seem to entirely dismiss it.


**I wanted to take this opportunity to do a “shout out” to the mighty polar bear. While there is no cure for PSC, there have been studies that have linked the ingestion of a drug called Ursodiol to an improvement in the progression of the disease (I take this to mean that there is no causal link between Urso and PSC improvement, but it seems to work and they don’t know why).  The drug is basically a synthetic form of polar bear bile, which is more viscous (wateryish) and can navigate through the narrowed bile ducts more easily than a normal, healthy person’s bile. So, I take these pills twice a day and give a nod to the majestic polar bear that is, for the moment, apparently helping to save my liver… And, as thankful as I am for this medical advancement, I am horrified by this and want to make it clear that that Urso pills I am taking are entirely synthetic and have nothing to do with this barbaric practice. And because the previous link really made me sad, I give you this.