Hi all,
Combining responses to a couple of recent posts. First, regarding
the
drug sandostatin. Karyn has never tried this treatment, though she
has considered it on a few occasions. I think the way it is supposed
to work is that it basically "shuts the pancreas down" so that it
stops producing its digestive enzymes (amylase, lipase, etc)
altogether. Insulin/glucagon production may not be affected, though
I'm not certain of that. They do say that if you are on a diabetic
taking insulin, you may actually wind up needing LESS insulin while
on
sandostatin, so either insulin production is stimulated, or your body
absorbs less carbohydrates, and thus NEEDS less insulin. Of course,
you need to take those missing enzymes orally (Creon, Viokase, etc).
Some patients report more problems with absorption (e.g. diarrehea)
until they figure out the right kind/dose of enzyme supplements.
Someone (TOri?) recently asked about familial links to pancreatitis
(hereditary factors). You may already be aware of the research going
on at the University of Iowa, but just in case, I'm including the
text
of an article about it I came across recently. It also mentions the
success of using sandostatin in the case of a young child stricken
with this condition.
Peg, had anyone ever suggested Brandon try sandostantin? Just
curious.
Cheers,
--Tull
*********************************************************************
Aggressive therapy benefits patients with pancreatitis
To Lynn Kartel and many of her relatives, familial pancreatitis
resembles an unwelcome guest who just won't leave.
Kartel's 3-year-old son, Jesse, has the disease, as does her father,
nephew, brother, and a niece. Lynn's oldest brother, who died from
complications of diabetes in 1988, had the disease as well.
"Yeah, it seems to go way back in the family," says Kartel, whose own
first pancreatitis attack occurred at age 11. "A lot of people in our
family died of various pancreas-related diseases over the years, but
it was never identified as 'pancreatitis' because nobody knew what it
was until more recently."
Lynn and Jesse both receive general health care from William Vaughn,
MD, a general practitioner in New London, Iowa who referred them to
the University of Iowa Hospitals and Clinics.
UIHC Hepatologist Frederick C. Johlin, MD, Associate Professor in the
Department of Internal Medicine, describes pancreatitis as a
devastating disease associated with high mortality among patients who
do not receive aggressive treatment. "In pancreatitis, the pancreas
essentially digests itself," he says.
"Pancreatitis can cause extreme pain in the abdomen and back, or even
in the lower part of the chest. Pancreatitis is frequently associated
with nausea and vomiting. When complications occur, it can be
associated with infections, bleeding, or abnormal fluid collections."
In these cases, Dr. Johlin says, patients can develop volume collapse
from pouring so many bodily fluids into the tissues injured by the
pancreatitis. This is when patients can become deathly ill.
Unfortunately, even the most knowledgeable physicians cannot always
prevent an attack of pancreatitis, but they can treat its
complications. "For instance, if the patient develops enough swelling
producing an obstruction of the pancreas or the
bile duct, we can effectively drain the system," Dr. Johlin says. "If
the pancreas becomes infected, we're very successful at detecting
that, treating it with antibiotics, and surgically debriding diseased
tissue from that area of the body."
Patients who fare best are those in whom the symptoms are immediately
recognized and, as a consequence, receive appropriate health care.
"The most effective treatment results from aggressive therapy
delivered by a specialist who understands the complexities of the
disease," Dr. Johlin says.
The causes of pancreatitis range from drug-induced damage to
gallstone
disease and alcoholism. In addition, the disease runs in certain
families, such as the Kartels.
"Familial pancreatitis is of special interest because we have ongoing
research trials," Dr. Johlin says. "We're very much committed to
identifying the gene that causes this disease in families."
Familial pancreatitis attacks children and young adults-many times
beginning a few months after birth. Last year as a 2-year-old, Jesse
Kartel was hospitalized once every six weeks with the disease. Dr.
Johlin drained Jesse's pancreas and started
him on home-administered injections of the drug, Sandostatin.
"When an attack occurs, we give him six injections, one every 12
hours," Kartel says. "It's really helped him a lot. Now we're only
getting attacks every three or four months, and they usually don't
last more than a couple of days.."
Mary Anne Berg, MD, a specialist in Clinical Genetics and genetics
research, and Dr. Johlin are initiating a research project at
University Hospitals and the UI College of Medicine to discern the
gene or genes responsible for familial pancreatitis. Identifying
these
genes may lead to a better understanding of the
cause of familial pancreatitis and guide further research toward
improving the treatment of this condition.
Anyone with questions about pancreatitis or the UIHC pancreatitis
study may call Dr. Johlin at (319) 356-4030 or Dr. Berg at (319)
353-7867.