Question about burnout

[Guest guest]

Hi all, I was just wondering if anyone could tell me

what it means to have your panc burn out? And what

are the effects of it? Do you still have the pain, is

it a matter of not producing the enzymes and insulin?

I'm curious because I've been told that I should

either have a surgery to reopen my duct that has

closed after my whipple, or to have the TP ICT. I was

trying to decide which open surgery I should have.

And after doing my research on the TP-ICT with my

insurance and with minnesota, I have come to the

deduction that we can't afford to do the tp ict due to

the fact that insurance only pays 60% out of network

and I just don't have 30,000 lying around. I'm

wishing at this point that burnout means the pain is

gone!!! Then maybe I could wait for that to happen.

Thanks, and here's to a painfree night!!!

sandy

reno

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[Guest guest]

Hi Sandy,

I am not sure if anyone answered this already but I didn't want

you to think that this got ignored if no one else hasn't....so here is

my attempt to answer your question about burnout.

From what I have learned, it seems that burn-out may be another

one of those myths that is connected to benign pancreatic

disease. My understanding is that yes it happens, maybe more

often in alcoholic pancreatitis than the other kinds, but that there

is no hard and fast rules about it....that is, not all people go on to

burn-out and if they do, this doesn't necessarily mean that the

pain goes away. For some it does, for other's it doesn't.

Burn-out can occur after many, many years (even decades) or

sooner or not at all.

I think that burnout refers to the total shut down of the

pancreas.The pancreas is so shriveled and / or atrophied that it

is basically a dead organ (think of post-menopausal ovaries;

they are still there in the body but very small and not producing

any significant hormones). So it is not producing either the

endocrine hormones (insulin etc) and the exocrine enzymes

(amlyase, lipase, etc).

Basically, depending on burn-out as a way to alleviate pain is not

a sure thing.....and because your pancreas is virtually dead at

this point, it is not something that you really want to look forward

to, although I can understand wanting to, especially if it would

mean that there will be no more pain. As far as the

surgeries.......there are many thoughts about when and why to do

those types of surgeries. Intuitively, the easy answer seems to

be to do the less invasive, less risky, more organ conserving

surgery (like the whipple) so that you have more options later on.

And it is always hoped that the " simpler " surgery will be the

" cure " so to say. However, if the TP / ICT is very likely to be in the

patient's future, there is some evidence that suggests that the

patient doesn't want to wait too long. The longer he / she waits

and the more damage to the organ that is occuring, the less

likely the surgeon will be able to harvest viable islet cells. So the

chances for successfully re-implanting enough so that insulin

dependence can be avoided (or attenuated) can be

compromised. Also, if the patient is losing ground by waiting -

that is,getting less healthy - then you add a bigger risk of having

complications from the surgery itself. Harder surgery, harder

recovery, harder adjusting, bigger chance that there are not

enough functioning islet cells are the risks if a person waits too

long for the TP / ICT.

It is a very hard call to make, one that needs to be done with

much thought and careful questioning of the appropriate

surgeons, GIs and patients that have gone through the

procedure.

Laurie