- Dr L

[Guest guest]

Hi ,

I am sorry that I was so negative yesterday about Dr L. I really

think he is a good guy - better than most. In my case, I think he

was just having a bad day as what I experienced didn't jibe with

the majority of people's experiences. In addition, I have issues

concerning bad treatment in the past and it is hard for me to give

new physicians the benefit of the doubt. I also have, most likely,

too high expectations from physicians and am overly sensitive if I

feel they are patronizing me.

I don't NOT recommend him. Especially if you are looking for a

definitive answer. I think his expertise and protocol for

diagnosing and treating pancreas diseases is probably one of

the best in the country.

That being said, it may be unreasonable to expect any kind of

clear cut answer for a diagnosis and treatment. Most pancreas

problems are not well understood and the art and science of

diagnosing and treating benign pancreas diseases are still in

the dark ages, to some extent. Basically, the medicine of

pancreas diseases is at the level of heart disease in the 1920s

or so. That is, in the early 20th century it was a paradigm that no

doctor in his right mind would ever, ever consider touching the

heart in any way, let alone do surgery to correct deformities. This

is basically the case with pancreas diseases in the 2st century.

The paradigm is that a doctor, never, ever messes with the

pancreas (unless there is a malignancy or otherwise life

threatening) because it is thought by most that you will do more

harm messing with it, than good.

You also have to remember that there are many etiologies to the

disease and most of them are not well understood so getting the

best treatment is basically an exercise in futility if the patient is

looking for hard and fast answers. Again, compare it with heart

disease. Nowadays, we take it for granted that pain and disability

of the heart has angina as a symptom (one symptom that is

clearly recognized) and that there are many blood tests that are

known that can diagnose heart problems. And the treatment -

bypass surgery, angioplasty and stenting - are all recognized as

a relatively safe, effective and almost routine treatment for certain

types of heart disease. But in the same token, when it comes to

pancreas disease the pain, lab work, diagnoses and treatment

are all still considered " controversial " , or speculative, and open

to very heated and diverse opinions.

So, considering the state of the art with pancreas disease, the

patient has to make decisions based on what he is experiencing

today. If your husband is pain free and is living a relatively normal

life, the risk of causing more damage by doing some type of

intervention with the hope of preventing problems later on may

not be a reasonable approach at this time. Each time a doctor

messes with the pancreas you are risking huge problems - in

effect, you may actually end up causing the disease that you are

hoping to " cure " or prevent. Many physicians, and Dr Lehman

included - based on what he told me - think that if you are able to

function relatively normal at the stage that you are at, you should

just accept it and live your life as best you can and only start

messing with the pancreas when an emergency occurs or the

pain and disability becomes so great that you can no longer live

a life out of bed.

Obviously, your decision is very personal and only you two know

what is right for your family.....but the sad news is with this

disease is that if there is no obvious problem to treat (like an

obvious mass in the pancreas, an obvious blockage of the duct,

etc) then there really is nothing that medicine has to offer to treat

the disease. If you are looking for a second opinion about the

diagnosis and treatment options available to your husband, then

I recommend Dr L If you are looking for that miracle " cure " than I

fear you may be disappointed. The " let's wait and see " approach

may be the best option available to your husband at this time.

Once damage to the pancreas occurs and becomes chronic,

there is no cure....only treating of symptoms as they occur - and

if your husbands symptoms are relatively stable then there really

may be no treatment out there at this time.

Laurie