Hayden Edenfield

This is my Cousin Kristy's daughter. She is 15 years old and been suffering with Chronic pancreatitus since she was 3 years old.


Her blog can be found at:
http://chronicpancreatitis-isletcells4teens.blogspot.com/

She is doing well today and may not have to stay in ICU for the whole week. She is supposed to stay in the hospital for a month after the surgery.


There are two main types of pancreatitis: acute and chronic. About 90% of all cases of pancreatitis are acute; 10% are chronic.

Chronic Pancreatitis

Depending on the stage of the disease, chronic pancreatitis may be easy or difficult to diagnose. In general, the more advanced the chronic pancreatitis, the easier it is to diagnose. Chronic pancreatitis is very painful. It can occur after known episode(s) of acute pancreatitis or it may develop without an identifiable episode. The most common symptom is persistent abdominal pain, sometimes radiating into the back. Other symptoms include diarrhea, anorexia, malabsorption, and diabetes. Many people with chronic pancreatitis have experienced frequent hospitalizations or emergency room visits.

Chronic pancreatitis can be caused by a variety of things, including:

chronic alcoholism,
chronic obstruction of the pancreatic duct - the obstruction may be caused by pseudocysts, inflammation, tumors, cystic fibrosis,
traumatic injury to the pancreatic duct,
developmental variations in how the pancreas forms, or
no specific causes.
Intermittent attacks of acute pancreatitis may be called relapsing pancreatitis. Relapsing pancreatitis often leads to chronic pancreatitis in which the pancreas has become so scarred that amylase and lipase levels no longer elevate in the blood. In this case, the patient may also develop problems with intestinal absorption from a deficiency of the pancreas enzymes and have to take them in pill form.
Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption.

Patients with chronic pancreatitis usually present with persistent abdominal pain or steatorrhea resulting from malabsorption of the fats in food (typically very bad-smelling and equally hard on the patient), as well as severe nausea. Diabetes is a common complication due to the chronic pancreatic damage and may require treatment with insulin. Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.

Considerable weight loss, due to malabsorption, is evident in a high percentage of patients, and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein.
In up to one quarter of cases, no cause can be found. Autoimmune pancreatitis is increasingly recognized and may be associated with raised IgG4 levels, other autoimmune features and bile duct involvement.

The abdominal pain can be very severe and require high doses of analgesics.
Chronic pancreatitis is long-standing inflammation of the pancreas that results in irreversible deterioration of pancreatic structure and function.


Abdominal pain may be persistent or intermittent.
The diagnosis is usually based on the symptoms, but blood tests may be helpful.
Treatment involves allowing the pancreas to rest and taking drugs to relieve the pain.

In the United States, most chronic pancreatitis has no clear cause (idiopathic) or is due to alcohol abuse. Other less common causes include a hereditary predisposition, hyperparathyroidism, and an obstruction of the pancreatic duct caused by a narrowing of the duct, gallstones, or cancer. Rarely, an attack of severe acute pancreatitis makes the pancreatic duct so narrow that chronic pancreatitis results.

Symptoms

Symptoms of chronic pancreatitis may be identical to those of acute pancreatitis and generally fall into two patterns. In one pattern, a person has persistent midabdominal pain that varies in intensity. In this pattern, a complication of chronic pancreatitis, such as an inflammatory mass, a cyst, or even pancreatic cancer, is more likely. In the second pattern, a person has intermittent flare-ups (bouts or attacks) of pancreatitis with symptoms similar to those of mild to moderate acute pancreatitis. The pain sometimes is severe and lasts for many hours or several days. With either pattern, as chronic pancreatitis progresses, cells that secrete the digestive enzymes are slowly destroyed, so eventually the pain may stop.

As the number of digestive enzymes decreases (a condition called pancreatic insufficiency), food is inadequately broken down. Foot that is inadequately broken down is not absorbed properly (malabsorption), and the person may produce bulky, unusually foul-smelling, greasy stools (steatorrhea). Undigested muscle fibers may also be found in the feces. The inadequate absorption of food also leads to weight loss. Eventually, the insulin-secreting cells of the pancreas may be destroyed, gradually leading to diabetes.

Diagnosis

A doctor suspects chronic pancreatitis because of a person's symptoms or history of acute pancreatitis flare-ups or alcohol abuse. Blood tests are less useful in diagnosing chronic pancreatitis than in diagnosing acute pancreatitis, but they may indicate elevated levels of amylase and lipase. Also, blood tests can be used to check the level of sugar (glucose) in the blood, which may be elevated.

A computed tomography (CT) scan may be done to show changes of chronic pancreatitis. When available, many doctors now perform a special magnetic resonance imaging (MRI) test called magnetic resonance cholangiopancreatography (MRCP) instead of a CT scan. MRCP shows the bile and pancreatic ducts more clearly than CT scan.

Chronic Pancreatitis


People with chronic pancreatitis are at increased risk of pancreatic cancer. Worsening of symptoms, especially narrowing of the pancreatic duct, makes doctors suspect cancer. In such cases, a doctor is likely to order an MRI scan, CT scan, or endoscopic study.

Treatment

Treatment of repeated flare-ups of chronic pancreatitis is similar to that of acute pancreatitis. Avoiding all food and receiving only intravenous fluids can rest the pancreas and intestine and may relieve a painful flare-up. In addition, opioid analgesics are sometimes needed to relieve the pain. Too often, these measures do not relieve the pain, requiring increased amounts of opioids, which may put the person at risk of addiction. Medical treatment of chronic pancreatic pain is often unsatisfactory.

Later, eating four or five meals a day consisting of food low in fat may help reduce the frequency and intensity of the flare-ups. If pain continues, a doctor searches for complications, such as an inflammatory mass in the head of the pancreas or a pseudocyst (a collection of pancreatic enzymes, fluid, and tissue debris resembling a cyst). An inflammatory mass may require surgical treatment. A pancreatic pseudocyst that causes pain as it expands may have to be drained.

If the person has continuing pain and no complications, the doctor may recommend injecting a combination of the local anesthetic idocaine and corticosteroids into the nerves from the pancreas to block pain impulses from reaching the brain. If this procedure does not work, which is frequently the case, surgical treatment may be an option if the pancreatic ducts are dilated or if there is an inflammatory mass in one region of the pancreas. For instance, when the pancreatic duct is dilated, creating a bypass from the pancreas to the small intestine relieves the pain in about 70 to 80% of people. When the duct is not dilated, part of the pancreas may have to be removed. Removing part of the pancreas means that cells that produce insulin are removed as well, and diabetes may develop. Doctors reserve surgical treatment for people who have stopped using alcohol and who can manage any diabetes that develops. For people who no longer produce adequate digestive enzymes, taking tablets or capsules of pancreatic enzyme extracts with meals can make the stool less greasy and improve food absorption, but these problems are rarely eliminated. If necessary, a histamine-2 (H2) blocker or a proton pump inhibitor (drugs that reduce or prevent the production of stomach acid) may be taken with the pancreatic enzymes. With such treatment, the person usually gains some weight, has fewer daily bowel movements, has no more oil droplets in the stool, and generally feels better. If these measures are ineffective, the person can try decreasing fat intake. Supplements of the fat-soluble vitamins (A, D, E, and K) also may be needed.

Oral hypoglycemic drugs rarely can be used in the treatment of diabetes caused by chronic pancreatitis. Insulin is generally needed but can cause a problem, because affected people also have decreased levels of glucagon, which is a hormone that acts to balance the effects of insulin. An excess of insulin in the bloodstream causes low sugar levels in the blood, which can result in a hypoglycemic coma.

Hayden had to have the puestow procedure at the age of 4:

Puestow procedure
The operation involves creating a longitudinal incision along the pancreas while the main pancreatic duct is filleted open longitudinally from the head of the organ to its tail. The duct and pancreas are then attached to a loop of the small intestine (pancreaticojejunostomy), which is oversewn to the exposed pancreatic duct in order to allow its drainage. When used in the appropriate setting, pain from chronic pancreatitis can improve. One advantage of this procedure compared to a Frey's procedure is that pancreatic tissue is preserved, which may be of critical importance in patients with exocrine or endocrine insufficiency from their chronic pancreatitis. A Puestow procedure is indicated for the treatment of symptomatic chronic pancreatitis patients with pancreatic ductal obstruction and a dilated main pancreatic duct. One of the problems that can lead to failure of the Puestow procedure is that pain can persist due to failure to drain the pancreatic duct on the head of the pancreas. A Frey's procedure is an alternative surgical procedure to the Puestow that allows for better drainage of the head, but pancreatic tissue is removed.

Her Doctor now is at the University of Minnesota:
Dr. Sutherland graduated from the University of Minnesota Medical School in 1966, completed his Surgical Residency in 1975, and a Transplant Fellowship in 1976. He has been on the faculty at the University of Minnesota since 1976, Professor of Surgery since 1984, and Head of the Division of Transplantation since 1994. He is also Director of the Diabetes Institute for Immunology and Transplantation at the University of Minnesota. Since 1980, he has been Director of the International Pancreas Transplant Registry. He was recently (2002-2004) President of The Transplantation Society, the Past President of the American Society of Transplant Surgeons (1990-91), the Cell Transplantation Society (1996), and the International Pancreas and Islet Transplantation Society (1997). His major academic interests include an array of transplantation topics with special emphasis in clinical and experimental pancreas and islet transplantation. He is author or co-author on well over 1000 publications.

Hayden is not a type 1 Diabetic, those are the people who this surgery is usually for. Here is an explannation of the surgery:

Islet Transplantation for People with Type 1 Diabetes

The purpose of an islet transplant is safe and effective treatment of Type 1 diabetes. Although islet transplants have been performed in clinical trials for years they are not yet considered standard medical care. What is exciting is that the outcomes of islet transplant clinical trials have significantly improved over the years. Continuing clinical trials are needed to further improve the success rate of islet transplantation.

Insulin therapy, whether by injection or insulin pump, is life-saving, however, insulin therapy is not perfect. Most people with type 1 diabetes still have blood glucose levels that are above normal, putting them at risk for long-term complications of diabetes. Patients able to keep their blood glucose levels near normal often have trouble with low blood glucose (hypoglycemia). After a number of years with type 1 diabetes some people lose the early symptoms such as sweating, dizziness, extreme hunger that warn them that their blood glucose level is at a low level. The inability to sense a low blood glucose is called hypoglycemia unawareness and raises the risk of severe hypoglycemia. Severe hypoglycemia is defined as needing help from someone else to raise the blood glucose such as giving juice, soda pop, or glucagon. The possible advantage of islet transplantation over giving insulin via injections or pump is that the transplanted islets would maintain normal blood sugar under all conditions, and would not produce excess insulin resulting in hypoglycemia.
How is an Islet Transplant Performed?

Islets transplanted into people with diabetes come from the pancreas of a deceased organ donor. An overview of the process is shown below. The islets are isolated from a decreased donor’s pancreas and infused into the recipient’s liver via the portal vein. The transplanted islets then produce insulin in response to sugars found in the blood as it flows through the liver.
A number of critical steps must be taken in a timely fashion to complete an islet transplant.

1. The donor pancreas is obtained by a highly skilled group of physicians. The University of Minnesota has a dedicated team on call to obtain pancreases.

2. The pancreas is brought to a facility the University of Minnesota whose purpose is to make biological products such as human islets. At this facility, staff members isolate and purify the islets. This process takes more than six hours.

3. The pancreas is cut into small pieces and put in a special container with steel marbles. The container is shaken, and enzymes are added to break down the tissue so the islets are freed from the rest of the tissue.

4. The islet tissue cells are removed, washed, counted and checked to be sure they are not damaged. On average, approximately 500,000 of the 1 million islets in a pancreas can be retrieved. This number of islets can usually maintain normal blood sugar levels. If the number or quality of islets is not satisfactory, the transplant must be cancelled.

5. If the number or quality of islets is satisfactory, the islets are cultured for two days before transplant.

Islet transplantation is a usually done in the radiology (X-ray) department and it takes 30 minutes to 2 hours. The recipient receives some sedation but remains awake. Islets are put into the body through a catheter (tube) in a vein of the liver. This vein is called the portal vein. The catheter can be placed in two different ways. The study doctors will decide which way would be safest for you. The two possible ways are:

1. Placement of islets through a needle going through the skin into the liver. If you have this procedure it will be done in an x-ray room. You will receive medication to sedate you and medication to numb an area on your right side between two ribs. The doctor will insert a needle into your liver. A computed tomography (CT) scan or an ultrasound will be used to help the doctor get the needle into the portal vein. A kind of dye will be injected to make sure that the catheter is in this vein.

2. Placement of the islets through a small cut in the skin. If you have this small operation, you will receive a medication to sedate you and a local anesthetic (numbing medicine) will be injected into your upper abdomen. A cut (no longer than two inches) will be made and the catheter will be inserted into a branch of the portal vein. If you receive your islets in this way, after all the islets have been given, the catheter will be removed and the cut will be closed with stitches that will dissolve when the cut is healed.

Recipients recover quickly from the procedure and are typically discharged from the hospital 2-3 days after the infusion. To monitor the patient’s health status and to determine how the islets are functioning, the islet transplant recipient will have to visit the University of Minnesota numerous times in the first year post-transplant as an outpatient. A second or third islet transplant is considered if the first does not stop the need for insulin injections or if blood glucose control is not well managed.




What are the Risks Associated with an Islet Transplant?

Although islet cell transplantation is being developed as a safe alternative to pancreas transplantation, people who participate in islet transplant trials may have more problems resulting from study participation than if they continued insulin treatment alone. Islet cell transplantation is an experimental treatment. As with any experimental treatment, there is a risk that rare or previously unknown complications can occur.

There are two main types of risks associated with islet cell transplantation:

First, the risks associated with the transplant procedure itself. These risks include slowed breathing from the anesthesia, severe bleeding, blood clots, abnormal liver function, accidental injury to organs, infection, decrease in blood pressure, pain, extra exposure to x-rays, allergic reaction to contrast dye, and very rarely, death.

Second, there are risks associated with the use of anti-rejection drugs, also known as immunosuppressive drugs or immunosuppressants. These drugs are needed for all transplants. Immunosuppressive drugs must be taken to prevent the body from rejecting a transplanted organ. Anti-rejection drugs may weaken the recipient’s immune system, which can lead to serious infections and even cancer.

What are the Benefits Associated with an Islet Transplant?

If successful, the transplanted islets will produce enough insulin so that the transplant recipient will no longer need to take insulin shots or use an insulin pump. A successful transplant will also control blood sugar levels in a normal or close to normal range and therefore will prevent low blood sugars. If the transplant is partially successful, the recipient may benefit from more stable blood sugar control, needing less insulin, with fewer low blood sugars. Because improved control of blood sugar has been shown to slow the complications of diabetes, islet transplant recipients may benefit whether their transplant is fully successful or partially successful. Preliminary studies suggest that islet transplants also improve quality of life. At this time larger studies monitoring development and progression of diabetes complications and quality of life in more transplant recipients for longer durations are needed to assess the true benefits of islet transplantation.

I want to thank all of you for praying for Hayden and you can keep updated through her blog or www.caringbridge.org
type in the name: Haydenedenfield

Here is an encouraging word from scripture, by way of KLOVE:
Encouraging Word
Friday 2/20/2009

If you confess with your mouth that Jesus is Lord and believe in your heart that God raised Him from the dead, you will be saved.