For the past eight years, 48-year-old Robin Galbraith lived with a chronic stabbing in her mid-section that the mother of two says was "twice the pain of childbirth."
Galbraith, who lives in Tucson, couldn't travel. She stopped working. A walk around a grocery store was exhausting. Medications helped control the pain but slowed her down both mentally and physically.
She's hoping all that has come to an end. On Aug. 6, Galbraith had a rare type of cell transplant surgery that is expected to end the suffering she has endured from a debilitating condition called chronic pancreatitis.
Her surgeons at University Medical Center say Galbraith is the first person in the Southwest to have an auto-islet cell transplant to treat the condition. "Auto" refers to the use of the patient's own insulin-producing beta cells contained in clusters called islets. By using the patient's own cells, the chances of rejection are reduced.
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The cell transplant procedure involves removing the pancreas — the source of the patient's pain — and then putting the patient's insulin-producing pancreatic islet cells back into the patient's liver, where they lodge in small blood vessels and release insulin.
"There's a finite number of patients with chronic pancreatitis that are being treated in the country, and many institutions do not think it's worth the effort. There are about three or four in the country and we are now the first in the Southwest," said Dr. Rainer Gruessner, who is chairman of the University of Arizona's department of surgery and chief of surgery at UMC.
"Of course the easiest way to treat chronic pancreatitis is just by removing the pancreas. But then the patient will have to deal with brittle or labile diabetes for the rest of his or her life.
"It's estimated that up to 4 percent of patients with brittle diabetes die each year because of lack of control of glucose metabolism. Many of these patients are in their 20s, 30s and 40s and have another 40 or 50 years life expectancy. If you multiply the 4 percent with another 40 or 50 years, it's easy to understand then that these patients frequently die way before their time."
The islets, so named because they look like little islands floating in the pancreas, were removed from Galbraith's pancreas in a new, 1,200 square-foot $1 million "clean room" that the University of Arizona built in its medical research building. Eventually, UA officials hope their room will become a cellular transplantation institute.
The impetus for building the "clean room" came last year when Gruessner hired Dr. Horacio Rilo as the UA's new director of cellular transplantation. Rilo came to Tucson from the University of Cincinnati, where he was director of its clinical islet transplant program. Telemedicine technology was used to provide constant communication between the operating room and the laboratory.
Rilo built the Cincinnati program to a level where it became internationally known. While there, he performed 118 islet cell procedures to avert diabetes in patients who suffered from severe pancreatitis or to treat patients with extreme type 1 diabetes. He has performed close to 170 clinical islet procedures during his career.
Gruessner estimates between five and 20 islet cell transplants will occur at UMC every year.
After Galbraith's successful transplant, Gruessner and Rilo completed another successful transplant on a second chronic pancreatitis patient — 47-year-old Alisa Reece, who traveled to Tucson from her home in Franklin, Ohio, for the procedure. Reece had heard about Rilo's work when he was in Ohio, tracked him down in Tucson and persuaded her insurance company to cover the surgery.
Like Galbraith, Reece said she had been suffering for years.
"I'd be on my way to work and I'd have to turn around and go to the hospital," Reece in an interview in her hospital room Thursday, where she was still recovering from last week's surgery. "A lot of times it felt like someone was beating me across the back."
Like many patients with chronic pancreatitis, Reece spent a long time figuring out what was wrong and endured several misdiagnoses. One doctor advised her to see a psychiatrist, thinking her description of the pain was not believable.
Gruessner said the pain is intractable.
"The pain is just so severe and the quality of life is not good," Gruessner said. "The pain medications these patients are on could put a cow to sleep."
Without an islet cell transplant, both Galbraith and Reece said they likely would have ended up having a pancreatectomy — removal of the pancreas. While such surgery removes the diseased pancreas, it typically also causes the patient to become severely and permanently diabetic.
"If all the insulin producing cells are gone, then the patient ends up with what we call brittle diabetes in that he or she is not able to control their blood-sugar levels anymore," Gruessner said.
"Patients with brittle diabetes, or in this case what we call surgically-induced diabetes, are very much prone also to secondary complications of diabetes such as heart attacks, strokes, amputations, wound-healing complications, blindness — complications that have a true impact on the life."
Gruessner said he hopes to expand the transplant program to treat children with rare familial chronic pancreatitis and type 1 diabetes.
Though she's currently taking insulin as a postoperative precaution, Galbraith does not expect that to continue forever. She's looking forward to traveling again and to going back to work. Before her illness worsened, she'd been in hotel management.
Galbraith is also thankful that she and her husband live in Tucson. They moved here in 2007. Prior, they'd lived in Nevada and Alabama and could not afford the extra expense of traveling for the surgery. For years, Galbraith had been hoping to travel to Minnesota where she knew Gruessner was doing islet cell transplants at the University of Minnesota.
The same year she moved to Tucson, Gruessner did as well.
"It all worked out for us. It is sad so see some people who aren't able to do this because of insurance issues," said Galbraith, who has one grandchild and another on the way.
"I'm excited just to get back to real life."
Chronic pancreatitis facts
The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. It produces enzymes that help digestion and hormones that help regulate the way the body processes sugar (glucose).
Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which describes pancreatitis that occurs over many years.
Causes of chronic pancreatitis are varied and include genetics, gallstones, alcoholism, abdominal surgery, high calcium levels in the blood, ulcers and an injury to the abdomen.
A poorly functioning pancreas can cause digestion problems, kidney failure, malnutrition and diabetes.
For information about the University of Arizona's Comprehensive Center for Chronic Pancreatitis, go to: www.pancreatitiscenter.org
SOURCE: The Mayo Clinic
