This seemed to be highly rated so I thought I’d give it a go. It’s not exactly a page turner and the story moves quite slowly. However, it is only as it wraps up towards the end that it goes from being just another rehash of a Shakespearan tragedy that I will forget quite quickly to something that genuinely moved me a little. Not the best novel I’ve ever read but not the worst either.
While the pancreas may not be one of the A-listers or showstoppers of the organ world (if there is such a thing), it is as important as any other cog in the system. For a long time, perhaps owing to its position behind the stomach, its true function was completely unknown. It is curious in appearance, shaped a bit like a leaf and rubbery in texture (apparently). This gave rise to a certain vagueness in its naming – it means ‘all flesh’ in Greek. Until the late nineteenth century, many thought its only function was as a shock absorber in the upper abdomen just below the ribs and the sternum.
The discovery of a sneaky duct that connects it with the first part of the small intestine was the first clue that it might have a deeper role. It was then discovered that the pancreas secretes a rich cocktail of juice and enzymes through this duct and into the intestine in order to help with our digestion. Specifically it helps in breaking down fats (with an enzyme called lipase), starches (with amylase) and proteins (with various different proteases). Basically, anything with ‘ase’ at the end generally means it is an enzyme of some form or other.
This is important because, without the ability to break these dietary components into smaller building blocks, we would not be able to absorb them from the intestines into our bloodstream. In addition, the pancreas produces lots of bicarbonate (an alkali) to neutralise all of the acids secreted in the stomach so that once your food gets into your intestine, it is at optimal pH for absorption.
That role alone is extremely useful you might say, but the pancreas is not finished there. While its function in digestion relates to what is known as the exocrine system (essentially ‘exo’ means outside and the digestive system is classed as ‘outside’ because it begins and ends outside!) the pancreas has a vital endocrine role. Endocrine relates to the travels of hormones throughout the closed circulatory system, i.e. the blood.
In those years where scientists considered the pancreas to be nothing more than a glorified cushion, hormones controlling the body’s sugar levels were thought to be pumped into the circulation from the brain. This idea persisted until a chap called Langerhans identified in 1869 an area of tissues in the pancreas different from the rest. When these areas were (rather cruelly) removed under anaesthetic from dogs, the animals went on to develop features of diabetes.
Through various means subsequent to this, it was proved that these ‘islets of Langerhans’ (useful to know for pub quizzes) secreted hormones, the first of which discovered was named insulin after the Latin term for ‘islands’. We now know that the pancreas also produces a second hormone called glucagon as well. As part of the endocrine system, these hormones are secreted from the pancreas into the bloodstream and it is here that they perform their vital work.
Insulin helps the cells around the body to take up sugar from the blood stream to use as fuel and also helps to store it in the liver. Glucagon performs the opposite role, mobilising energy stores in the liver and fatty tissue for those days when we’ve not had time for lunch or have decided to run a marathon.
In this way, to use a rather crude comparison, the pancreas is a bit like the national grid. When it receives certain signals that more energy than usual might be required, like going for a long run (just as TV coverage of a royal wedding, for example, might cause a surge in electricity uptake, to keep the national grid analogy alive), it prepares by secreting more glucagon to draw from the reserve of energy we keep stored in our livers and fatty tissue. If, on the other hand, we are providing more energy than we need by eating lots of sugar, the body switches to insulin to use up the sugar being eaten and store any spare energy left over.
So evidently the pancreas when it is working well is extremely important. When it is not, diabetes can result. But what else might go wrong?
Sometimes, the pancreas can become inflamed and this is known as pancreatitis. Every medical student will most likely know (or at least have heard of) the pneumonic GET SMASHED. Each letter represents a potential cause for pancreatitis, the two most common being Gallstones and ETOH or Excessive Alcohol. ‘S’ stands for Scorpion venom and, as there are not many scorpions running around Henley, I’ll not dwell on that too much.
Pancreatitis can range from the mild to the severe and can even be life threatening. Symptoms include severe upper abdominal pain going through to the back, nausea and vomiting. You may also sometimes get a fever and also diarrhoea. It often results in a stay in hospital where you can receive pain relief, fluids and oxygen if needed.
The other main condition affecting the pancreas is cancer. Pancreatic cancer is the UK’s 11th most common cancer and tends to affect those in older age groups more. Around 9,600 people in the UK develop pancreatic cancer each year.
The big issue with pancreatic cancer that gives it a high mortality rate is the difficulty in its detection. This means that it is often picked up only at later stages. Researchers are always looking for effective tests that might be used as a good screening tool, but as yet none has been found. The symptoms are often very vague but include…
-Weight loss
-Dull, boring pain or fullness in the upper abdomen which can go through to the back as well
-Jaundice, often without pain or any other symptoms (this occurs because of the pancreas’s proximity to the bile duct which, if pressed on, causes a back-up of the pigment bilirubin in the blood.)
One in ten cases may have a genetic element so, if a family member has had pancreatic cancer younger members may sometimes be screened.
If you are at all concerned about this, it is of course always worth coming to see your GP for a check.
As always, there is always more to learn. Even now, research is being done into other hormones produced by the pancreas which may perform roles as yet unknown, thereby, in the future, potentially opening up different possibilities for the treatment and understanding of various diseases, including diabetes. For that reason alone, I think the pancreas deserves a little more time in the limelight.
This was a bit of an impulse read. I needed something light and this one didn’t disappoint in that aspect. It begins with an intriguing conundrum and plays out like a traditional detective novel. The first half is therefore really good. Then it gets chilling, and after that, it just gets silly. I should have realised from the author that there would be a supernatural element, but setting it up in such detail had me thinking he had changed tack and tried his hand at something new – that there would be some clever explanation at the end of it. There wasn’t, it was just lazy supernatural humdrum. It was also a follow-up to one of his previous books which I hadn’t read. It was alright, but I’ve read far better.
This has been on my shelf for a while as I thought reading it might depress me a bit! One has to be in a certain mood for this sort of thing. While it was excellent and essentially had me completely entranced, it was still bloody depressing!
This is a well written and concise look into the development of US politics over the past century. It has implications for other nations as well, including the UK. It’s quite terrifying. It shows just how things are changing right under our noses. Such gradual change is only ever visible it seems in retrospect. If the people with the power to change things were as informed as those writing this book, perhaps things might turn out better!
Having read Any Human Heart, I was looking forward to this one. It doesn’t disappoint. While not as epic or profound as Any Human Heart, this is excellent in other ways. The plot is thrilling and intricate. The writing is exceptional. Great book. I can’t wait to read more of his stuff.
Interesting and thoughtful. By no means a comprehensive guide to the human body, this book tags on a rather more reflective outlook to selected aspects of our bodies, drawing upon his own experiences in practice.
Fantastic account of the exploits and operations of this interesting character. Also a chilling documentation of the nefarious individuals who existed all over the establishment and who were in a position to fuel dangerous propaganda during the 30s just prior to the war. Not dissimilar to our current situation.
