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they work for a little while for some people and they are not

permanent.....hope this helps Mark

Question About Stents

> Hi all,

>

> Do stents work or not? Are they permanent or is it a temporary fix for

> temporary relief??

>

> Thank you,

> Eileen

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Hi Mark and thank you.

Thi squestion may sound silly,but from what I have read, if they

only are temporary and the placing of them can cause scarring, why

is it done?

Eileen

>

> they work for a little while for some people and they are not

> permanent.....hope this helps Mark

> Question About Stents

>

>

> > Hi all,

> >

> > Do stents work or not? Are they permanent or is it a temporary

fix for

> > temporary relief??

> >

> > Thank you,

> > Eileen

> >

> >

> >

> >

> >

> >

> >

> >

> >

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Hi Eileen,

Actually your question gets to the heart of the matter when it

comes to stents. It is one of the more controversial treatment for

non-malignant pancreas disease. Especially if it is done soley

for pain control - that is, based on symptoms of the disease and

no signs. If there is a clear indication of an obstruction seen on

ERCP for example...like a tight constriction to the duct or a very

gross dilation or a mass impinging on the duct or even a

pseudocyst.... then stenting is not all that controversial. They will

put it in for different time-frames. The improvement of the duct is

then monitored.

But when you suggest that the pain is coming from an

obstruction to the flow of juice and there are no signs of

that....then you get a very opposite extreme outlook. Some

doctors are very adamant that you never stent in these cases,

others say that it is worth at least one try. And both sides are

right, that is, their opinions are based on very sound, scientific

reasoning.

The downfall comes in the way that pointed out....that

is, when doctors treat each patient with pancreas / biliary pain in

exactly the same way...not looking at the unique presentation

and medical history. For some people, even messing with the

pancreas once to try stenting may be very dangerous, for other

people it may be a reasonable risk to take. I think, again just a

humble opinion, that the best endoscopists / pancreatologists

are those that are willing to put in the time to know their patients

and are not ready to dismiss a procedure out of hand. I know that

this sounds self-evident, that is, that ALL doctors should or do do

this, but in my experience as a patient (and even as a health care

worker) this is not so. It is relatively common, and easy, for

doctors to see things in black and white, if / then scenarios....

and are not willing to taylor the treatment and diagnostics to the

patient.

I have to say, to me, thai is a characteristic that I most value in a

doctor...even more so than his / her techniques or credentials I

think.

The one reason I got on so well with my good surgeon is that he

understood my odd requests and why I made them. That is why I

really disliked his PA - she was always telling me " well everyone

else wants it this way " . Dr S realized that I do not go " blind " into

an OR. That I need to see him before I go under to know (as I

teased him) that it is really HIM in the mask and not some

imposter or lacky. He understood too, that there was no way in

heck I was going to go to a pre-op or post-op appointment with

ANY doctor in the gyn field. So he always called for a surgical

consult without my knowledge -which was our arrangement. I

agree that most people wouldn't do that, I do not recommend

anyone else doing it, but that is just me, and the way it will

always be. Now he has the right to not comply....but if it doesn't

cause any harm, then he is open to the idea.

That is why I am VERY alarmed at the survey that I saw in a

newspaper a few days ago....the one that said if a patient doesn't

comply with recommended advice for medical care, the doctor

" most likely " will drop the patient. In certain circumstances, I may

agree with that statement....but in most I don't. Think about it....if

a doctor says that the only way he will treat our pain is if we

undergo surgery.....and we refuse....then he has the right to deny

us any treatment at all? I know most people would say, go to

another doctor....but it isn't always as easy as that (insuance

coverage, distance, and even number of doctors in your rural

area). We were always taught in school that if a patient doesn't

wish to be treated in a 'standard " way, that you were still morally,

legally and ethically obligated to see that he / she received care

from you until the patient terminated that care. And if the

physician terminates care because the patient's attitude really is

unacceptable to the physician.....then he / she has to arrange for

someone else to assume it.

Now, I realize that this principle is no longer is practiced for the

most part by physicians but I bring this up as an example of how

far things have changed even in my short career (almost 25

years).

Anyways, off on a blubbering tangent again. This is the first time

in weeks that I have had the time and energy to wax

philosophical on this board. Sorry that you are the recipient of my

dancing keyboard!

laurie

Oh - stenting can also be used as a diagnostic tool...that is, if the

pain goes away, then it can be assumed that an obstruction was

the cause.

And there are ways that doctors can reduce the chance of

scarring. For instance, if you undergo multiple stents..it is

recommended that each stent be a different length. So if the first

stent is 5 cm long, the next one may be 7, the third 6. the fourth, 3

etc....It is thought that the scarring occurs at the tip, (the one

furthest into the duct) so that by varying the length, the duct isn't

exposed to as much inflammation, etc. Also, although changes

are seen in stented ducts, most literature speculate that it may

not be significant. It is thought that these are temporary changes

for the most part and that within months (?) these abnormalities

are gone. They are not sure yet how long term or injurious these

changes are.

From what i understand, there is a lot of research work going on

too, to come up with a more friendlier stent. I heard of a group in

Australia I think that is working on a stent that decomposes in

the body after a while....kind of like the dissolving stitches (in

prinicple).

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