Easing the Pain of Chronic Pancreatitis
May 15, 2014
By Beth Carroll (photography by Jeff Woodward)
Patients with chronic pancreatitis often face severe, unrelenting pain with little or no relief. There is no cure for this progressive disease; and for many, there’s no effective medical treatment beyond high doses of narcotics. But, a new surgical treatment offered at Dartmouth-Hitchcock offers hope to patients like Jennifer Bowen, who once thought a normal life would never be possible. In this emerging field of study, preliminary results are showing real promise in the treatment of chronic pancreatitis and in easing the pain.
Jennifer Bowen’s Story: Auto Islet Transplantation
Jennifer Bowen: I’m eating a pastry, chocolate and butter. It’s so good, it’s so good.
Narrator: A year ago a high fat meal like this might have landed Jennifer Bowen in the hospital suffering from pancreatitis –a disease in which the pancreas becomes inflamed causing severe pain.
Jennifer Bowen: It’s as if you’ve been punched in the stomach, and it’s absolutely relentless.
Narrator: Bowen’s first attack happened at the age of 31.
Jennifer Bowen: You don’t recover from recurring pancreatitis.
Timothy Gardner, MD, director, pancreatic disorders: Pancreatitis is caused by a lot of different reasons, toxins, gallstones, medications, genetics, but in many instances we don’t know.
Narrator: An elementary school teacher and mother of two, Bowen continued to work but quickly exhausted all her sick days.
Jennifer Bowen: I’m going to say I would have lost my job if I hadn’t gotten better.
Narrator: When Bowen heard about a new surgical treatment at Dartmouth-Hitchcock that might offer a potential cure, she didn’t hesitate –even though it meant removing her pancreas and carried the risk of diabetes.
Dr Timothy Gardner: Essentially what we’re telling Jen is we’re going to potentially trade one disease which is pancreatitis, a horrible painful debilitating disease, for another disease, diabetes.
Jennifer Bowen: Just the idea the pain would be gone outweighed the risk of having diabetes.
Narrator: The procedure, called auto islet cell transplantation, has been performed at Dartmouth-Hitchcock since 2012. It involves removing the pancreas, extracting insulin producing islet cells and transplanting them to the liver. In the past, a pancreatectomy meant lifelong diabetes. This procedure offers the opportunity for pain relief and blood sugar control.
David Axelrod, MD, section chief, transplantation surgery: I think it’s certainly innovative and truly the state of the art for taking care of these patients and is something that is uniquely offered at Dartmouth-Hitchcock in the New England region.
Narrator: And, Bowen’s surgery also marked a first.
Dr Timothy Gardner: As far as we know that’s the first time that’s ever been done worldwide laparoscopically.
Narration: That means a faster recovery and less time in the hospital.
Dr David Axelrod: The total pancreatectomy part of the procedure involves removing the entirety of the pancreas and the spleen. We package the pancreas in a preservation solution and put it on ice and it’s taken down by courier down to our partners at Massachusetts General Hospital.
Narrator: After the islet cells are processed they’re driven back to the hospital where surgeons then infuse the islets into the liver. Kerrington Smith, MD, pancreas surgeon: You can actually see the little islets; they’re not really cells but clumps of the islet, in tubing and infusing into the liver. There’s a little bag of yellow fluid and it goes in over twenty minutes.
Jennifer Bowen: So, the islets on my liver, my livereas as I like to call it, is functioning very well.
Dr Timothy Gardner: Jen is doing spectacularly well.
Dr Kerrington Smith: A lot of these patients literally wake up for the first time in years with no pancreatitis pain.
Narrator: There is a tradeoff; without a pancreas, patients need to take daily enzyme replacement pills to digest food.
Dr Timothy Gardner: Every single patient we’ve done this for has said I would repeat it. I would do it again if I had the opportunity.
Narrator: Now, more than a year after surgery, Bowen continues to be monitored and tested.
Jennifer Bowen: In the beginning I was checking my blood sugar three times a day, and I don’t anymore and I’m not diabetic.
Dr Timothy Gardner: The chance to not be in pain, the chance to not be a diabetic that’s our goal for everyone.
(Dr Gardner to Jennifer) So, I got your labs back and they look perfect. Liver? Liver is perfect. Blood counts look good so those islet cells are working just perfectly. Dr Timothy Gardner: I think anybody who has chronic pancreatitis or recurrent, acute pancreatitis they should at least be evaluated to see if this would be an appropriate procedure for them.
Jennifer Bowen: My life today is so wonderful.
Dr Timothy Gardner: This is a procedure that is life changing and lifesaving in many instances.
Jennifer Bowen: After 11 years of not being able to eat and going to bed every night in fear of waking up with this horrible pain –it’s the most wonderful thing in the world. (Jennifer looking at photos) Look I’m eating a chocolate milk shake with whipped cream on it.