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Pancreas – Hermit of the Abdomen

Pancreas – Hermit of the Abdomen

Ashley Davidoff MD

O’ Dear pancreas

You have been called the hermit of the abdomen
By whom I do not know
But in your dark and hidden way, you have
spoken without a word
from the gurgling depths of the abdomen
Yes – you have earned this lonely title
and a coin should be tossed
to the person who coined the phrase


 

But it took a long time to understand who this hermit was – and what he was doing in the darkness of the abdomen

From the day of antiquity
You have been looked upon by many
Herophilus, the father of anatomy had the first incisive insights into you
As he was one of very few who had the guts to explore the guts in open fashion

Aristotle at the same time seemed to have known something about you
But then you lay unharmed and unexplored for almost 500 years
Until Rufus mistook you for a piece of meat –
You must have laughed at the “pan kreas” thing
How wrong he was – you evasive little trickster

And then the Talmud – always seeming to be right
Thought you were the finger of the liver –
Little did they know how independant you were

While Vesalius was up to your “hide and seek” game
The magical eyes of da Vinci missed you completely
Even though he saw the serpiginous splenic artery snake right above you

Your ducts seemed to have intrigued the next generation, Wharton, Wirsung, and de Graaf
As you sustained the pain of the quill penetrating your inner gut
(I forget you were already dead but it must of hurt just watching!)

A little later it was that man called Vater and the little Italian Santorini found your minor duct and your nipple
And so by this time we had a good understanding of you in your nakedness
But of course, as said – you were dead

And so young Bernard explored your factories, and got a sense of your canine workings,
But you were able to hold on to your sweet secret for just a little longer
Until the Langerhans found the family jewels in the famous 2% of your population-
The islets – those beautiful eyelits – governess of all things sweet in the body

Eberle Bernard Danilevsky, and Kuhne joined up across the world to expose your antacid and enigmatic enzymatic brew
And once again your wonderful workings for a better world were exposed –
And we knew then, that you were the quiet and effective type –
A hermit who did good
But did not want the limelight

To see you as you lived and breathed in the flesh
was the mission of Wilhelm the X-Ray man
who crusaded the path to visualise 40,000 Angstroms under the skin

 

abdomen, pancreas, liver, gallbladder, kidneys, CT scan, Art in Anatomy, Ashley Davidoff MD

 

And then there was a slew of heroes who learned to slew your sickened parts – including the famous Whipple who was able to Whipple you in an inimitable way

And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
Exposed the insular chemistry of you insulin that had given you the power over the sweet
Never mind – in the end it was for the good of all –
And a new era was borne

And so we try to understand your form as our scans explore you as you live and breathe
And we stare in awe at your odd shape – why oh why did you choose that shape?
What are you supposed to look like? – we have no clue
And we are happy – so happy for you that you are well nourished by a double blood supply
And we wonder why you have no skin – we thought all the organs had a skin
Except for your tail – almost a foreskin

And you are off axis on two planes – what is that all about? – kinda crooked

And your twin origins and the intimacy with the duodenum, of the ventral twin
And the strange fusion of the Wirsung guy excluding the little Italian Santorini
It seems to me that your matrimonial fusion with Wirsung and the bile duct has led to more problems than the merger was worth
It does not seem in the long run, to have been a marriage made in heaven
What was that all about? Is there a grand plan to come?

 

And so we try to understand your diseases
And in some way we understand that the guy glugging down the bottle
Could be punished by your reaction
But why Oh why are you so nasty to those whose misfortune it is to have stones roll down and get no satisfaction.. down the green vile bile route
Have you not learned to live with the green secretion by now
And did you not know that by reacting the way you do, that you are cutting off your nose to spite you head?

While type 2 seems remote from you
We don’t know about this Type 1 business
Why are you made to suffer so much at the hands of your own body on your own body?
We feel sorry for you – to have your own buddies reject you – must be awful
And then to see so many young ones suffer because you don’t work
And we once again see and understand what power you control from that deep dark hermit home of yours

And the cancer thing … so silently it creeps on you causing your collagen to counter
And only making things worse as it strangles nerve, blood vessel, and your spouse duct – the green one, – without regard

And then I think of you in your prime and in your happiness
When you are with you two buddies – the splenic vein and the renal vein
And you all look so much alike, and happy swimming in that deep ocean where you hide
And I wish this was forever

 

 

Copyright 2017 Revised from previous publication in The Common Vein

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The Common Vein: Anatomy of Structure – Units and Connections

Structure – The First Step

Structure is a material unit or object, composed of smaller parts that are connected and organized so that it can stand alone but also  be part of a larger and more complex whole

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The Units That Make the Whole – The Brick and the Brick Principle

The brick is the unit that is the basis of the brick building.

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The Brick – An Individual Unit That Needs to Connect In Order to Function and Be Valuable

The brick by itself has no function and no value to the world.  In order to have value it needs to connect with other bricks.  When the brick, a structural unit,  connects with other bricks and they organize, a wall is built. The wall as a structural unit, connects with other walls and they organize to form a room, and eventually a building is built.  Although the brick is nothing by itself – a weak brick can bring the whole wall and the whole building down.

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The Power of the Brick

It is Nothing by Itself  

However the Whole is Only as Strong as the Weakest Brick

The Units That Make the Body – The Cell and the Brick Principle

I am like a brick. Amrish Puri

The cell is the unit that is the basis of biology.

cell, cells, liver, process, physiology, function, receive, process, produce, export, principles, nucleus, cytoplasm, cytology, anatomy, art, the common vein, art in anatomy, Ashley Davidoff MD

The cell by itself has no function nor value, unless it is a unicellular organism.  In order to have value it needs to connect with other cells.  When the cell, a structural unit,  connects with other cells and they organize, a tissue is built. The tissue as a structural unit, connects with other tissues and they organize to form an organ, and eventually a body is built.  Although the cell is nothing by itself – a weak cell can bring the tissue and the whole body down.

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When the 37.2 trillion cells in the human body connect and organize, they create a spark of life housed in the body and gifted with a mind.

The difference between the brick building and the person is really the life that biology brings.  It is truly a miracle and the secret of how this happens still eludes human endeavour.  This secret may never be unlocked.

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Subtract The Bricks From the Cells.  What is the Result?

What is very clear, is that as human biologic units build, the  result is larger and more powerful than the individual parts.  At a critical number a spark of life emerges within the body, and a mind emerges from both of them.  When and how that happens remains a mystery.

Our first project is not to delve into the yet unanswerable “hows” of life, but rather into the “hows” of structure.  Structure is complex, but the pattern of units connecting and organizing is universal and permeates structure from the  subcellular level to the whole body and even beyond into our communities.

Some Quotes About the Brick Principle

 “A great building will never stand if you neglect the small bricks.”

Ifeanyi Enoch Onuoha

“Love is like a brick. You can build a house, or you can sink a dead body.” Lady Gaga

Brick and blood built Astapor, and brick and blood her people.”
George R R Martin – A Storm of Swords

14. “Genius too does nothing but learn first how to lay bricks then how to build, and continually seek for material and continually form itself around it.Every activity of man is amazingly complicated, not only that of the genius: but none is a ‘miracle.”
Friedrich Nietzsche

“I fear that in this thing many rich people deceive themselves. They go on accumulating the means but never using them; making bricks, but never building.”
George Eliot

“Faith. Trust. They don’t come naturally, but as we lay those first bricks, we notice that little by little, a foundation is forming. Eventually we can end up building the most beautiful things with faith and trust.”
José N. Harris

Bricks without straw are more easily made than imagination without memories.”
Author: Lord Dunsany

“It takes a thousand bricks to build a wall, but only one to tear it down.”
Markus W. Lunner

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The Common Vein: Clarity in Complexity

Introduction 

The Common Vein (TCV) is a learning process that clarifies the complexities of biology and medicine.

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Complexity is the prodigy of the world.

Simplicity is the sensation of the universe.

Behind complexity, there is always simplicity to be revealed.

Inside simplicity, there is always complexity to be discovered

                                                                                                                        Gang Yu

The Common Vein is a tree of knowledge that brings simplicity to the complexity of human biology and medicine.  Its arborized organization enables a stepwise, progressive approach to self learning.  Any student who can read, and who is motivated, will advance through this rich network of material. Most principles begin with a simple word or concept, within which resides encyclopedic complexity.  The root elements of that word can be explained in a sentence, which then progresses in volume and complexity to a paragraph, then a chapter, then a book, and beyond.

Imagine a library with all of its books strewn over the floor.  It would be nearly impossible to navigate the available information. Efficient organization of information is the key to understanding it. This concept holds true in any field of education.

Organizing Information

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From a Background of Complexity to an Organized Simplicity 

The above art-piece shows a background of extensive, pixellated, and seemingly inaccessible information. As it organizes into the central, conical figure, it begins to make sense. The word at the bottom of the cone becomes defined into its key elements (the 5 different colors of the circle).  A definition follows, which succinctly describes the essence of those principles. These elements advance to greater complexity at the next level: the paragraph.  Each elemental principle is further expanded in a chapter.  The ladder of organized information progresses, while remaining connected to its source. Roots and branches, origins and growth, are recurring themes in The Common Vein.

As we learn, we acquire new knowledge. At the same time, we modify and enhance preexisting knowledge. Education should therefore be viewed as a process, rather than a collection of facts (Learning Wikipedia). TCV’s cumulative approach reinforces previous knowledge as it advances existing knowledge. With the understanding that memory and its application are so key to the learning process, TCV encourages beginning with the roots (basics) and building to the branches (details) in a logical fashion.

The Tree of Knowledge

Below is a diagram of knowledge in its bare form. From the central trunk extends an arborising framework, from roots to branches, which represents advancement, or growth.

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Roots and Branches: Sources and Growth

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Roots and Branches: Sources and Growth – Advancing Complexity

The trunk reflects a single idea or concept (tree), which is part of a continuum belonging to something beyond it (branches) and something before it (roots).  The tree’s roots and branches again exemplify the concept of building upon previous knowledge.  The trunk’s extensions, in the form of roots and branches, are complex yet logical in their organization. A tree’s growth is multifaceted, yet progressive. The parts work together for the sake of the single element: the tree. In the tree, complexity and simplicity coexist.

Principles

A distinct focus on principles, especially as a starting point, provides a useful framework for learning. The Common Vein’s is founded upon principles that grow in complexity, which helps the student navigate the daunting mass of biological and medical information.

Principles of Human Biology

The image below diagrams human biology in its basic parts:

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This diagram of human biology is structurally identical to the diagram above. This diagram shows that the roots of human biology lie in both the structural and functional sciences. Combined, those two sciences enable the miracles of the working body and working mind. This simple diagram captures the entirety of human biology. Beyond these base elements lies magical complexity, which we can never fully grasp.

Principles of Medicine

This diagram, again identical in structure to the two above, explains that the roots of human disease originate in the disorder of the structural and functional sciences. The branches of diagnosis and treatment have evolved in response to the need for order and health of the body and mind.

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This tree illustrates The Common Vein’s central theme. Each biological part has both a structure and a function.  When they are in order and work cohesively, there is health.  With disorder, conversely, comes disease. The field of medicine attempts to bring order using two major disciplines: diagnosis and treatment.

Because roots and branches remain connected, a change in one element means a consequence in the others. The disciplines of diagnosis and treatment are founded upon the ability to identify and treat disordered structure and function. For example, an obstructed coronary artery causes a heart attack.  The clot in the artery causes a structural problem, with a the functional consequence (damaged heart muscle).   Coronary arteriography diagnoses the structural abnormality, and a cardiac echocardiogram diagnoses the functional consequence (decreased muscle contraction).  The treatment aims to reverse the structural abnormality by dissolving the clot, as it also aims to reverse the functional abnormality.

The Common Vein

The Common Vein finds clarity in complexity. It navigates the learner through complex information in order to understand, remember, and apply the knowledge.  Two major elements are used:

  1. Basic principles, which are connected and advanced through
  2. An arborised organization.

The “common” in the common vein refers to basic principles, while the “vein” represents the arborised connections creating a tree of knowledge.

Learning starts from the most basic element, and with careful progression, advances in detail.  Learning evolves over time, as it builds upon and enhances previous knowledge. The tree’s roots of knowledge reflect the learner’s existing knowledge. They are connected to the branches, which symbolize the paths of growth.

The Common Vein requires requires the ability to read, and passion for the subject material. With those, the whole field of biology and medicine opens up, and eventually, students learn to apply this network of knowledge as thoughtful thinkers and practitioners.

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Anatomy of the Caribbean Heavens

The heavens are rich with artistry  creativity, and lessons to teach us

When viewed from a ship at sea they are even richer – and vacation provides the time and opportunity to explore and express this beauty.  The art is biased of course by the perspective of the observer.  AiA finds the shapes and character of “things” related to the body, biology, art and culture of primary interest.  The Caribbean heavens explored from a boat contains  a wealth of material.

As we started our journey….

I swear I saw  Prometheus running down from the heavens !

body, sky, heavens,clouds, athlete, running

and then I looked a little closer …

body, sky, heavens,clouds, athlete, running

and then put on my shades… and yes twas  a powerful athlete running down to earth from the skies and he was carrying something!  body, sky, heavens,clouds, athlete, running

 

Prometheus is a Greek mythological figure who brought fire to the earth that he stole from Mount Olympus.  He was punished by Zeus who chained him to the rocks of Mount Caucasus.  In addition an eagle (Zeus himself) punished Prometheus by daily feeds on his liver.  The ancients knew of the magical regenerative properties of the liver and the antiseptic qualities of bile.  The eagle (Zeus) is later slain by Heracles and Prometheus is given his freedom.  He gains strength due the the regenerative powers of the liver (also known by contemporary physicians in the world of hepatology and hepatic surgery).

Talking of animals of the sky?  And what about the Scottie dog?  What lessons does he have to teach us?

body, sky, heavens,clouds, dog, Scottie, shape, running

Scottie of the Skye in the Sky

In this image a Scottie dog was found romping in the heavens.  The Scottie is an endearing name for the Scottish terrier – aka Aberdeen terrier.  It is part of the group of Skye terriers and therefore is fittingly suited for the theme of the wonderful sightings in the sky.   The Scottie is one of the terrier breeds that come from Scotland.  Other terriers in this group include the Skye, West Highland Terrier, Dandie Dinmont and the Cairn .  The Scottie has a characteristic compact and powerful body.  The torso and head are rectangular, ears are pointed , eyes are almond shaped, and the beard has  long and soft hair.  The legs are short but powerful allowing for agility and quick movement. The breed exemplifies “power in a small package” . The confident and independent nature has earned them the nickname “Diehard”.  It is extremely territorial.  Both President Franklin D Roosevelt and George W Bush owned Scotties. George, the fourth Earl of Dumbarton owned a pack of brave Scottish Terriers, that were named “Diehards”.  Dumbartons regiment in the The Royal Scots were fittingly named the “Dumbarton Diehards”  Scotty Cramp is a disease in Scottish Terriers that causes muscle spasms resulting in hyperflexion and hyperextension of the legs. It is an inherited recessive trait of the breed.  It is  caused by a deficiency in serotonin.

sky, dog, Scottie, shapes, heavens, bones, anatomy, knees, X-ray. spine, lumbar spine, pars interarticularis, back, spondylolysis, diehard

1 Real Scottie, 1 in the Sky, and 2 in Dem Bones

In Radiology we look at the neck of the Scottie dog in a condition of the lumbar spine that causes back pain in athletes called spondylolysis.  The neck of the Scottie is overlaid in maroon in the image on  the right and represents the pars interarticularis which may undergo stress fracture in young athletes (spondylolysis) resulting in one lumbar vertebral body slipping forward on the other (spondylolisthesis).  It is one of the causes of back pain in young athletes. 

Rain – Good or Bad? –  

sky, heavens,clouds, rain, sun, sky

“Anatomy of Rain in the Sky at Sunrise” 

In this image sunrise brings a shower of rain in the east.  The sun shining through the dark clouds illuminates other clouds and brings some hope.  In the context of the vacationer the rain is a disappointment and means an undesirable day indoors.   For the farmer and for mother earth it is a blessing!

The art piece is dominated by falling rain and a rising sun that shines through and illuminates the vista.

and what does that teach us – It all depends on context

Some quotes:

Predicting rain doesn’t count. Building arks does.  Warren Buffett

Let the rain kiss you. Let the rain beat upon your head with silver liquid drops. Let the rain sing you a lullaby.  Langston Hughes

 As the day continued – it got grayer and grayer

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Anatomy of Rain in the Sky

In this instance the gray skies of rain bring a gloom for some and yes … also a bloom .. of life for others.  It is an essential to all biology.  

The image shows rain romping  from the heavens.  

Some Quotes

The best thing one can do when it’s raining is to let it rain.  Henry Wadsworth Longfellow

Gray skies are just clouds passing over. Duke Ellington

The rain began again. It fell heavily, easily, with no meaning or intention but the fulfilment of its own nature, which was to fall and fall.  Helen Garner

but things change..time moves on..and 

“Time and Tide Wait for No Man”

And the following day – all had changed – the rain had passed and bright orange heavens illuminated the sky a moment before sunrise

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Anatomy of the Sky Before Sunrise

Moments before sunrise brings light to the darkness, just before the sun pokes its head from the blanket of the ocean.  The sun shining illuminates the sky with an orange optimism in the cloudless sky.

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Anatomy of the Sky at the Moment of Sunrise

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Anatomy of the Sky 1 Minute after Sunrise

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Anatomy of the Sky 3 minutes After Sunrise

Time passes quickly

Quotes

“You can’t stop the future, You can’t rewind the past, The only way to learn the secret…is to press play.” – Jay Asher

“Life is a series of natural and spontaneous changes. Don’t resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” ― Lao Tzu

As the day progressed – Nirvana – a blue blue sky , and a blue blue ocean  – interrupted only by a ruffle of waving white

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Blue Sky, Blue Water, and A Ruffle of Waving White

and this also was not for long .. as time passed and ever changing cloud pattern passed before our eyes – containing all sorts of people

… and a surprise artist made his appearance –

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Chagall Blessing the Sky

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  Blessing in the Sky with Overlay

The artist spotted Chagall flying in typical fashion through the heavens of the Caribbean.  he had his arms outstretched as if to bless the sky

And by the end of the first day… the clouds rolled in to compete for kingdom of the earthly sky

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Anatomy of the Sky as the Sun Starts to Set

The kingdom of the earthly sky is shared by the sun with the clouds as each seeks to dominate.  For the sun this is a small battle since its kingdom stretches over the entire solar system.  For the clouds this is a major battle since they only rule over the earth.  They both play an essential role in preserving life on earth.  The sun is constant and dependable.  The clouds are transient and fickle. The setting sun descends through the blanket of the clouds, and gives the sky a mysterious, and magical  feel.

And the next day… the clouds and the sun shared the spotlight at sunrise

I took a nice cuppa tea, and sat on a chaise – longue to watch the spectacle.  To my surprise I saw my knee caps…

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Sunrise View of the Knee Caps

The art piece expresses a joint experience of my knees and the sun. As I sit on the chaise-longue sipping tea and watching the sunrise with X-ray vision, I share a gaze with the sun.  The sun looks at the sunrise view of my knees and I look at its sunrise in the sky.  In radiology we use the ‘sunrise view” to evaluate the joint space between the patella and the femur.

As the day progressed the clouds disappeared, and a day moon appeared.

 

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Day Moon

And nighttime came – not a cloud in the sky … blackness descended revealing the light of a crescent moon and its neighbour  Venus.

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The Moon and Venus in Conversation

and the heavens turned black – and I saw the overshadowed crescent moon talking to Venus… “What are people thinking?- Do they not realise life rules over death? Peace over terror? Why do the leaders of the people not declare this universal truth? It is so clear from where we stand, that there is something going wrong down there….Leaders must not remain silent! “

And after the moon rose my hand rose to tell the moon something…

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I Have a Bone to Pick with You .. I said

In this art piece the larger than life bones of the hand reach out into the sky in conversation. Tongue in cheek it wants to share the idea that it has a bone in its wrist that shares a common feature with the moon.  The lunate bone is is found in the  proximal row of metacarpal bones in the wrist, so named because of its shape. “Luna” is the Latin name for the moon.

and then two more hands with their scaphoids appeared to teach us the last lessons from the Caribbean

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Scaphoids That Pass Under the Lunar Night

The art piece shows a night time sky with the X-ray of three hands.  The hand on the left and right side of the image have the scaphoid bone of the wrist outlined in color.  The scaphoid is so named because of its ship like shape. “Skaphos” means  ship in Greek.  The middle hand dominates the trio of hands and unrealistically dominates the skyline.  The lunate bone is highlighted in the middle hand.  It is so named because it is moon shaped.   Artistically the scaphoid bone on the right is colored in Irish green since the ring finger carries a claddagh ring -an Irish ring that represents love, loyalty, and friendship.  The larger than life delicate  fingers of the middle hand reach out to the moon and  talks with the moon about their common shapes… small talk in the big picture

From a literary point of view the title “Scaphoids that Pass Under the Lunar Night” infers and  invokes the sentiment of Longfellow in “Tales of a Wayside Inn” about the “ships that pass in the night”

“Ships that pass in the night, and speak each other in passing,
Only a signal shown and a distant voice in the darkness;
So on the ocean of life we pass and speak one another,
Only a look and a voice, then darkness again and a silence.”

“Ships that pass in the night” speaks of chance meetings that are transitory that come and go and are just part of life that do not result  in a meaningful relationship – and in other contexts of two people who almost encounter each other – but do not.  In both cases, with a little effort of either party, a connection may have been life changing.

… and  these were just a few lessons taught by the Caribbean sky!