DUmmie FUnnies 05-13-05 (Pied Piper Pitt Hasn't Slept Since April!)

It looks like William Rivers (Pied Piper) Pitt is doing a lot of worrying that the scam perpetrated by Andy Stephenson is going to explode in his face. Pity Poor Pathetic Pied Piper Pitt (had to get in at least one allitertation) for he hasn’t slept since April as you can see in this Pitt authored DUmmie THREAD titled, “I could use a little help here.” Yeah, Pitt, you could actually use a LOT of help WHEN the AndyScam blows up in such a way that even the incredibly gullible DUmmies realize that Andy Stephenson has been scamming them just as cold-bloodedly as his former mentor, Bev Harris. A constant theme right now in DUmmieland is that they just KNOW that Andy is on the up and up BECAUSE Pied Piper Pitt told them so. I hate to tell you this DUmmies but Pied Piper Pitt has ALSO been having doubts about the DUmmies as have been documented in the Free Republic discussion forum of the previous DUFU edition titled, “’About the Andy Stephenson situation’---Skinner.” Oh, and speaking of Skinner, haven’t the DUmmies noticed that he has been MIA since issuing his doubts about Stephenson a few days ago? Skinner is less than an hour from Baltimore but he has yet to make the short trip over there to verify Andy’s fraudulent story. It is “The Silence of the Scams.” So let us now join Pied Piper Pitt in his state of complete sleeplessness. Somehow I think Pitt will be greeting the sun for many, many mornings to come. As usual the insomniac rantings of Pitt and his DUmmie followers are in Bolshevik Red while the commentary of your humble correspondent, who enjoyed a refreshing night of deep sleep, is in the [brackets]:

[You sure do, Pied Piper Pitt, especially after the DUmmies form a lynch mob to go after you when even those dopes realize FOR SURE that they have been scammed by Andy Stephenson, thanks in large part to you vouching for Andy’s honesty.]

I haven't been able to sleep for about two weeks. I start to drop off, and maybe actually sleep for about 20 minutes, before popping awake. Last night, for about the fifteenth day in a row, I saw the sun come up against my will. This has started to affect my stomach, which makes sleeping harder. I have tried exercise to wear myself out, and have managed to badly strain a muscle in my back.

[Your back will hurt even more after the DUmmies start angrily beating on it while cursing you for enabling the AndyScam.]

So, to recap: No sleep since April, rotten stomach, torn up back. I've reached that insomnia point where I am psyching myself out; I got no sleep the night before last, spent yesterday writing a PDA action alert and a 30-minute speech transcript, drove two hours to do the speech, gave the speech, did a three-hour Q&A, talked to people for another hour, drove two more hours to get home, and by the time I got back here I was literally quivering with exhaustion.

[So, to recap: You are worried sick about what will happen to you after Andy Stephenson is proven to be a complete FRAUD even to the satisfaction of the incredibly gullible DUmmie suckers.]

But I laid awake until 6:37am (I remember looking at the clock), popped awake an 8, 9, 10 before finally giving up and getting up at 11. I can barely see straight right now, my stomach feels like it has snakes in it, my back is killing me so I can't exercise...and I know for a stone fact that I won't be able to sleep again. Tried a nap an hour or so ago. Came thiiiiiiiis close to dropping of and then popped awake.

[3:11 AM: “Worried sick about the backlash when Andy’s scam is finally proven.”
3:12 AM: “Will they toss me out of Dummieland?”
3:13 AM: “Will my speaking engagements be cancelled?”
3:14 AM: “Maybe I could change my identity.”
3:15 AM: “DAMN YOU TO HELL, Andy, for suckering me into being your lousy cheerleader!!!”
3:16 AM: “Is it 3:17 AM yet?”]

Any ideas? I've already heard about taking mela-whatever, but that stuff gave my mother splitting headaches when she tried it. I have drastically cut back on caffiene. Any other suggestions would be appreciated. I've reached that violently, violently, violently frustrated stage of insomnia where sleep is a guaranteed impossibility, and if a routine like yesterday's (while on no sleep) can't get it done, I am at a total loss.

[Confession is good for the soul. And now let us read the hilarious advice on insomnia cures from your fellow DUmmies, Pitt.]

Tried it. I managed to make myself unconscious, but that isn't sleep. Woke up worse off the next day. Tried it again a few days later, and all that happened was I was drunk and wide awake.

[Pied Piper Pitt---The wide awake drunk. That’s what happens when you fall such obvious scams that Andy perpetrates.]

Move the clock...for one thing. Looking at that thing with the blinking : all night can be horrifying.

[If Pitt moves his clock all it will mean is that he will have to keep walking over to it every 5 minutes to check to see if he got at least a half hour of sleep.]

yes, sex works remember, only in fundie land is a monogamous partner of the opposite gender who desires to become pregnant is a requirement for "sex."

[Only in DUmmieland does it not matter what gender or species your sex partner is.]

Will: see a doctor. Insomnia is a bitch, although I only get it maybe once or twice a month.

[Pitt needs to see a shrink doctor. See Pitt lying on the shrink’s couch? Let us see what the shrink is writing on his note pad: “Just plain NUTS!!!”]

This sounds like a case for sleeping pills though I ordinarily wouldn't recommend them.

[NOT a good idea. Pitt would be tempted to swallow the whole bottle after the AndyScam blows up in DUmmieland.]

Benadryl. But don't take it every night, as you can become addicted (as per my physician husband).

[Methinks Pitt would become addicted the first night after desperately popping pill after pill of those Benny’s.]

[And if that doesn’t work, have someone take a frozen turkey and slam it on Pitt’s head to knock him out.]

My problem is that I have bad physical reactions to anti-histamine stuff. I had raging bad allergies as a kid, and was always loaded up on the stuff. After a few years it just messed me up, and still does whenever I touch it.

[I can sympathize, Pitt. I’m allergic to wool so I’ve had to cross sheep off my date list. Such are the sacrifices I’ve had to make.]

[You’re going to do turkey in a tub filled with warm milk, Pitt? You really ARE kinky!]

[I once tried to commit suicide by taking a cyanide pill. Unfortunately some sick bastard tampered with the cyanide pill bottle and I took a Tylenol that he inserted instead. I’m suing!!!]

I don't really know any tricks to get to sleep but one thing I discovered is that it makes no sense to just lay there willing yourself to do it - the more you try, the less likely it is that it will happen. So when I couldn't sleep, I'd get up. I'd tidy the house, I'd do laundry, I'd go for a walk, I'd read, I'd write, I'd work. Eventually, I'd get very, very tired and I'd lay down again. If I didn't get to sleep within a reasonable time, I'd get up again.

[Good idea… Hey Pitt! My pad needs cleaning and after that you can do my laundry.]

The back thing is my own fault. I've been beating the shit out of myself on my weight bench, way overdoing it to try and get sleepy. A muscle in my shoulderblade area finally got tired of it and told me to f*ck myself.

[And after the AndyScam scandal explodes, Pitt, your fellow DUmmies will be telling you the same thing as your shoulderblade muscle told you.]

Definitely see a doctor...there might be a physiological reason you're having trouble sleeping.

Will, I'm not a doctor, but I am going to go ahead and give you medical advice anyway. Your body is telling you to take a break.

[Yes, good advice. Take a break, Pitt, on a Costa Rica getaway with Andy Stephenson. Don’t worry about expenses. Andy has $50,000 to blow.]

Otherwise, until you see an internist, a bit of turkey, milk and a warm bath. Then find something boring, yet educational, to read.

A friend of mine who went through a divorce said she would drop her jaw down as you would right before you fall asleep and then force herself to COUNT SHEEP. It actually worked for her.

White noise (I have a CD of very, very faint/distand thunderstorms and rain, and it's coma-inducing).

[White noise (I have a CD of very, very faint Pitt speeches, and it’s coma-inducing).]

Ambien is habit forming and every person is different. So telling someone to ignore legitimate and documented side effects and product warnings is not particularly sound advice, wouldn't you agree?

[WARNING: Side effects of Ambien may inlude nausea, diarrhea attacks, dizziness, urges to support left wing loony causes, and the total loss of any ability to discern obvious scams.]

dude...seriously...smoke up. If I need to be asleep, pot is my friend to a nice, happy, and deep sleep.

[After the DUmmies finally wake up to the AndyScam, they will be “shutting down” Pitt very rapidly.]

Try to figure out what caused this abnormal sleep cycle to begin in the first place and address that issue.

[I don’t believe that Pitt thinking about how he has become Andy Stephenson’s lead cheerleader in Dummieland is going to help him get any sleep.]

[Perhaps the acupuncturist can anesthetize those brain cells containing all memories about Andy.]

want something natural? try acupuncture- & I know where to get it cheap in the south end

[I don’t know about Pitt but Andy certainly would love to be acupunctured in the south end.]

You really should go to a doctor for a sleep evaluation. This may include keeping a diary for a week or so…

[May 13: “WHAT? WHAT? WHAT will I do when the DUmmies rise up against me when the AndyScam breaks?
May 15: “Need to leave the country. PRONTO!”
May 16: “Quick flight down to Costa Rica.”
May 20: “Slight gender preference modification but the honeymoon with Andy is just dreamy!”]

Cancel your appointments. Don't listen to TV or radio. Turn off your cell phone. Rent some funny movies.

Excuse the long post, this is snipped directly from the Swedish Hospital website. Swedish Hospital in Seattle, WA, where Undie "initially" went for treatment. Swedish Hospital, who couldn't perform the "Whipple procedure" so Undie HAD TO GO TO JOHN (sic) HOPKINS in Baltimore.

Who Is Affected Pancreatic cancer is the fourth most common type of cancer in men, and the fifth most common type of cancer in women. Men are twice as likely as women to develop pancreatic cancer. It tends to strike people over the age of fifty (85%). Unfortunately, there are no methods of detecting pancreatic cancer at an early stage. Furthermore, pancreatic cancer usually progresses very rapidly; the average lifespan after diagnosis is four to eight months. The five-year survival rate is less than 1%. About 27,000 Americans are diagnosed yearly with pancreatic cancer; about 25,000 Americans die of the disease each year. Causes and Complications No one knows exactly what causes pancreatic cancer. It’s been proven that smokers have a greater risk of developing the disease, and some families seem to have an increased risk of pancreatic cancer. Because pancreatic cancer interferes with the body’s ability to utilize nutrients, unintended weight loss is a common symptom of the disease. Unfortunately, severe pain is eventually the norm with pancreatic cancer. As the pancreatic tumor grows and obstructs some of the liver and gall bladder ducts, jaundice (a yellow discoloration of the skin and the whites of the eyes) develops. Symptoms of Pancreatic Cancer by Rosalyn Carson-DeWitt, MD Unfortunately, pancreatic cancer does not cause symptoms in its earliest stages. By the time symptoms are noted, the disease has already been growing for some time. Furthermore, the initial symptoms of pancreatic cancer tend to be rather vague, so patients often ignore them for a certain length of time, allowing the disease to continue growing and spreading. By the time the symptoms are obvious enough to alert the patient and the doctor of a problem, the disease has often advanced and spread outside of the pancreas. If you experience any of these symptoms do not assume it is due to cancer. Most of these symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician. Decreased appetite – Most patients experience a greatly decreased appetite. This may be one of the first symptoms of pancreatic cancer, but because it may not be immediately noticed and because it can be a symptom of so many other conditions, it may be overlooked until other symptoms develop. Unintended weight loss – Over time, patients with pancreatic cancer tend to fall about 10% below their ideal body weight. This is due both to their decreased appetite, and to the inability of their body to process and utilize the nutrients in food. As cancer cells damage and destroy the cells of the pancreas, the pancreas loses the ability to aid in digestion. Pain – About 95% of all patients with pancreatic cancer have pain, often becoming quite severe as the disease advances. The pain is usually located in the abdomen and mid-back, and is often worse after eating, while lying down, and at night. Jaundice – Jaundice is the development of a yellowish discoloration of the whites of the eyes, the skin, and the lining of the mouth and eyes. When pancreatic cancer strikes the head of the pancreas, jaundice may occur earlier in the disease, because the tumor puts pressure on the common bile duct, the tube that connects the pancreas, liver, and gall bladder to the intestine. When the cancer is located in the body or tail of the pancreas, however, jaundice may occur later in the course of the disease. Fatigue – A progressive decrease in energy level is common. Nausea and vomiting – About 30% of patients with pancreatic cancer experience nausea and vomiting. Dark urine, light-colored stool – Like jaundice, these symptoms occur earlier in the disease when the tumor is located in the head of the pancreas, causing obstruction of the common bile duct. Depression, mood swings – Many individuals with pancreatic cancer notice changes in their general mood and emotions. True depression and mood swings occur in nearly 30% of patients. Blood clots – Some patients with pancreatic cancer develop blood clots, particularly in their legs Diagnosis and Prognosis of Pancreatic Cancer by Rosalyn Carson-DeWitt, MD The process of diagnosis includes the following: Review of your medical history Physical exam Diagnostic testing Cytology Staging Prognosis Review of Your Medical History Your doctor will ask you to describe your symptoms in detail. You’ll be asked about your smoking habits (past and present), history of exposure to chemicals, personal medical history, and family medical history; for example, have any close relatives had cancer? Physical Exam Your doctor will perform a complete physical examination, paying particular attention to the abdominal exam. Your doctor will feel for a mass in your abdomen, and ask if you have any pain or tenderness during the course of the exam. Diagnostic Testing The following tests may be done: Blood tests – A number of blood tests may be performed, although they cannot be used to definitively diagnose pancreatic cancer. They may show some of the changes that occur during pancreatic cancer, such as elevated levels of the enzymes amylase and lipase, increased bilirubin, elevated glucose, and changes in liver function tests. These changes can occur in other conditions as well. Imaging studies – Imaging studies are very important for diagnosing pancreatic cancer. A number of different types of imaging may be performed, such as: Computed tomography (CT) scan – a type of x-ray that uses a computer to produce cross-sectional images of the inside of the body. A CT can show the interior of the pancreas in detail, allowing a tumor to be diagnosed. CT is also very useful for diagnosing the spread of cancer beyond the pancreas. Ultrasound – the use of sound waves and the characteristic patterns they make bouncing off of various structures in the body to identify tumors and other conditions. Ultrasound studies can be performed by placing the transducer (the tool that produces the sound waves and generates a picture onto a monitor) on the outside of the abdomen. Endoscopic ultrasound – this is a more detailed form of ultrasound. A thin, lighted tube (endoscope) is passed down your throat, through your stomach, and into your intestine. The endoscope has a tiny ultrasound transducer within it. This allows the pancreas and surrounding organs to be viewed on the ultrasound monitor. Endoscopic ultrasound can help identify the presence of a tumor in or around some of the major vessels surrounding the pancreas, invasion by the tumor into the surrounding organs, and in lymph nodes surrounding the pancreas. Magnetic resonance imaging (MRI) scan – a test that uses magnetic waves to produce images of the inside of the body. Using a large magnet, radio waves, and a computer, an MRI produces two-dimensional and three-dimensional pictures. An MRI can identify a tumor within the pancreas, as well as determine if the tumor has spread outside of the pancreas. For example, MRI is particularly good at showing the major blood vessels outside of the pancreas, in order to see if they are being compressed or invaded by pancreatic cancer. Endoscopic retrograde cholangiopancreatography (ERCP) – a thin, lighted tube (endoscope) is passed down your throat, through your stomach, into your intestine, and to the location of the common bile duct. Dye is squirted through the endoscope and into the common bile duct. X-ray pictures are taken. The dye outlines the common bile duct and the pancreatic duct, so that any abnormal areas stand out more clearly on the x-rays. Biopsy samples and fluid can also be taken through the endoscope. Angiography – a dye is injected into an artery and a series of x-rays are taken. The dye coats the blood vessels and the pancreas, making it easier to see on the x-ray images if a tumor has invaded, compressed, or otherwise interfered with the normal functioning of blood vessels. Due to the high quality images of current CT scans, angiography is rarely necessary. Laparoscopy – tiny incisions are made in the abdomen, and a small fiberoptic tube with a lighted tip (a laparoscope) is inserted. The scope can be used to look at the pancreas, the surrounding tissues, the liver, and the wall of the abdomen for the presence of tumor. Miniature surgical tools can also be inserted into the abdomen to remove tissue samples (biopsies). The tissue samples will be checked for cancer cells. Laparoscopy is useful for both diagnosing pancreatic cancer, and determining whether the cancer has spread outside of the pancreas. This can be done as an outpatient procedure. Biopsy – the removal of a small sample of pancreatic tissue and examination under a microscope to check for the presence and type of cancer cells. This is an important part of diagnosing pancreatic cancer. The tissue sample may be obtained during the course of an endoscopic retrograde cholangiopancreatography exam, during laparoscopy, or through fine needle aspiration (FNA). During fine needle aspiration, a tiny needle is inserted directly through the skin of the abdomen and into the pancreas in order to withdraw a sample of pancreatic tissue. Some researchers believe that FNA should not be performed unless the tumor is inoperable, because the cancer cells may accidentally be spread along the track of the needle. If an abnormality is seen in another organ (such as the liver), a biopsy of that abnormality may be done instead. Cytology Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer. The first thing that cytology studies will do is determine what type of pancreatic cell the cancer involves. Exocrine cells are much more commonly involved in pancreatic cancer than endocrine cells. Cytology will also try to determine the degree of abnormality and aggressiveness of the cancer cells. Staging Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (e.g., surgery vs. chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0 – 1) imply a favorable prognosis, whereas high staging classifications (4 – 5) imply an unfavorable prognosis. Information to aid in staging pancreatic cancer can come from the results of imaging studies (CT scans, MRI, ultrasound, angiography, endoscopic retrograde cholangiopancreatography) and laparoscopy. These studies help detail whether the pancreatic cancer is contained within the pancreas, or whether it has begun to invade blood vessels, lymph nodes, or other organs and tissues surrounding the pancreas. If your doctor is suspicious that the cancer has spread to distant areas of your body (such as the liver, lungs, bone or brain), then other tests may be done to study those organs. Once all the information has been collected, your doctor will put it all together to determine the stage of your cancer. A common system used for staging is called the TNM system. This system characterizes three aspects of pancreatic cancer: information about the tumor (T), the lymph nodes (N), and the presence of distant metastasis (M). As with grading, the higher numbers reflect a greater degree of abnormality and spread. Pancreatic Tumor (T) The T stages are as follows: TX: Tumor cannot be evaluated. T0: There is no evidence of tumor. Tis: There is minimal tumor without invasion (in situ). T1: Pancreatic tumor measures 2 centimeters (cm) or less, and has not spread outside of the pancreas. T2: Pancreatic tumor is greater than 2 cm, but has not spread outside of the pancreas. T3: The pancreatic tumor extends beyond the pancreas but does not involve the superior mesenteric artery or the vessels of the celiac axis, both of which are located in the abdomen. T4: The pancreatic tumor extends beyond the pancreas and involves the superior mesenteric artery or vessels of the celiac axis. Lymph Nodes (N) The N stages are as follows: NX: Nodes cannot be evaluated. N0: There are no cancer cells in the regional lymph nodes. N1: There are cancer cells in lymph nodes surrounding the pancreas. Distant Metastasis (M) The M stages are as follows: MX: Presence of metastasis cannot be evaluated. M0: There are no distant metastasis. M1: There are distant metastasis, such as to distant lymph nodes, liver, lungs, and/or brain. Determining the Stage Once the T, N, and M categories have been determined, the information is grouped together to determine your stage. The groupings are as follows: Stage T, N, and M Classifications Stage IA T1, N0, M0 Stage IB T2, N0, M0 Stage IIA T3, N0, M0 Stage IIB T1, T2, or T3; N1; M0 Stage III T4; N0 or N1; MO Stage IV T1, T2, T3, or T4; N0 or N1; M1 An Alternate Method of Staging Another method of staging addresses whether the original pancreatic tumor can be surgically removed or not. Most physicians believe that tumors that have invaded major blood vessels (T4 or Stage III) cannot be removed. Therefore, this method of staging utilizes information about blood vessel invasion. This system has three designations: Resectable pancreatic cancer – visible tumors can be removed. Locally advanced or unresectable pancreatic cancer – the cancer has spread to neighboring tissues or invaded into blood vessels, therefore the cancer cannot be removed through surgery. However, no distant spread has been diagnosed. Metastatic – the cancer has been found in distant sites; it has spread well beyond the pancreas. Prognosis Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available. Prognoses provided in this monograph and elsewhere should always be interpreted with this limitation in mind. They may or may not reflect your unique situation. Unfortunately, pancreatic cancer is often relatively advanced at the time that it is diagnosed. As a result, the number of patients who survive for five years or more after diagnosis is very small; perhaps as low as 5%. About 21% of all patients diagnosed with pancreatic cancer survive for a year after diagnosis. Treatments for Pancreatic Cancer by Rosalyn Carson-DeWitt, MD While standard protocols have been established for the treatment of virtually all cancers, physicians will often modify them for their individual patients. These modifications are based on many factors including the patient’s age, general health, desired results, and the specific characteristics of his or her cancer. Since the treatments described in this report represent the standard therapeutic approaches, your physician may not strictly adhere to them. Pancreatic cancer is difficult to treat. Several types of treatments (modalities) are in use, and more than one type of treatment may be used. However, the overall effectiveness at prolonging life after diagnosis is minimal. Some treatments are performed not with the hope of cure or prolonging survival time, but in the hope of relieving symptoms. When considering treatments for pancreatic carcinoma, you and your doctor will want to weigh the chance of lengthening your life span versus the disruption to your quality of life due to the rigors of a particular treatment. If the disruption is considerable, and the expected lifespan based on the stage of cancer is relatively short, you and your doctor may decide that using a significant percentage of your remaining time struggling with the side effects of treatment is not a good option. Treatment may involve any combination of the following: Surgery Chemotherapy Radiation therapy Lifestyle changes Managing the side effects of cancer and cancer treatment Existing treatment protocols have been established and continue to be modified through clinical trials. These research studies are essential to determine whether or not new treatments are both safe and effective. Since highly effective treatments for many cancers remain unknown, numerous clinical trials are always underway around the world. You may wish to ask your doctor if you should consider participating in a clinical trial. You can find out about clinical trials at the government website ClinicalTrials.gov. Surgical Procedures for Pancreatic Cancer by Rosalyn Carson-DeWitt, MD This page discusses the use of surgery for the treatment of pancreatic cancer. For a thorough review of surgery, please see the surgery treatment monograph. Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues. Two basic categories of surgery may be used to treat pancreatic cancer: curative and palliative. Curative Surgery Curative surgery aims to remove as much tumor as possible, in the hopes of actually curing the cancer. Prior to any attempts at curative surgery, it is important that detailed imaging studies are performed. Curative surgeries should only be done if the studies show that the cancer is contained within the pancreas, and is therefore considered resectable (capable of being removed). Potentially curative surgeries include the following: Distal pancreatectomy Total pancreatectomy Pancreaticoduodenectomy (Whipple procedure) Palliative Surgery Palliative surgery does not hope to cure the cancer, but is done in an effort to relieve some of the complications of pancreatic cancer, and improve quality of life. Common palliative surgeries involve decompressing a blocked common bile duct, either by creating a new opening between the gall bladder and part of the intestine (cholecystojejunostomy or choledochojejunostomy) or by placing a stent (a bit of tubing) into the common bile duct, in order to keep it open. These procedures help relieve some of the pain associated with an obstruction. Pancreatectomy The surgery for a distal pancreatectomy and a total pancreatectomy are very similar. The major difference is the amount of tissues and organs that are removed. In a distal pancreatectomy, only the tail of the pancreas is removed. It is important that careful imaging studies are done before this surgery; the surgery is only undertaken if these studies show that the tumor is only in the pancreatic tail. In a total pancreatectomy, the entire pancreas (head, body, and tail) and the spleen are removed. Description of the Procedure You’ll be given a general anesthetic for this operation. An incision is made in your abdomen, and the appropriate portions of the pancreas, and in some cases, the spleen, are carefully removed. Because the pancreas makes digestive juices, this operation must be performed with great care so that pancreatic juices don’t leak into your abdomen, where they can destroy tissue. Surgery on the pancreas has a high complication rate, and patients often need a reasonably long hospitalization to ensure a good recovery. A one to two-week hospital stay is not unusual. If serious complications ensue, the hospital stay will be longer. Effectiveness Pancreatic cancer is a very difficult disease to treat. Even with potentially curative surgeries, the five-year survival rate is terribly low; about 20% of people with resected (removed) tumors are alive five years after diagnosis. Possible Complications Distal pancreatectomy has a very high complication rate—about 41% or more of all patients experience some type of complication. In order of importance, the potential complications after pancreatectomy include: Bleeding – can be massive, requiring a return trip to the operating room to locate the source of bleeding and stop it. Delayed stomach emptying – about 19% of patients who have had pancreatectomy will experience this complication. This involves liquids and solids remaining in the stomach for an abnormally long period of time after eating or drinking. Patients with this complication may need to be fed using alternative methods (such as through a tube directly into their intestines) until their stomach heals. Pancreatic anastomotic leak – this complication occurs when pancreatic juices leak into the abdomen. Most surgeons try to avoid this complication by leaving drains in place, so that any fluids that accumulate around the area where the pancreas was removed are drained out of the abdomen through tubes. Other possible complications include the following: Infection Walled-off areas of infection within the abdomen (abscesses) Diabetes Heart failure Kidney failure Liver failure Blood clots Postoperative Care You’ll wake up with a catheter in your bladder; if things go well, this will be removed within a few days. You’re likely to wake up with a nasogastric tube. This is a tube that enters through your nose and reaches into your stomach to drain accumulating digestive juices. You may also have several surgical drains, which are tubes that drain fluids out of your abdomen. Until your intestine begins functioning again, you’ll be given nutrition through a tube directly into your intestine, or through your veins. When nutrition is delivered directly into your veins it is called total parenteral nutrition (TPN). Because you no longer have all of your pancreas, you may become diabetic after surgery. This means that you’ll need to check your blood sugar several times a day, and you will probably need to take insulin. You may need to take enzyme pills to help you digest your food. You may require antibiotics. You may be given medications to prevent blood clots (blood thinners) You’ll require regular pain medications. Pancreaticoduodenectomy (Whipple procedure) This operation is an attempt at curing pancreatic cancer. Before having this surgery, it is important that detailed imaging studies be done to determine that your cancer is indeed considered resectable (capable of being surgically removed). Pancreaticoduodenectomy is an extremely extensive operation. The head and body of the pancreas, either all of the stomach or the lower part of the stomach, the first and second sections of the small intestine (duodenum and jejunum), surrounding lymph nodes, and the gall bladder and common bile duct are all removed. This is a very complex surgery, requiring great expertise on the part of the surgeon. There is a very high complication and death rate from this surgery. It is important to have this operation done at a medical center where many are performed. In these settings, the death rate due to this surgery is about 2% to 5%; at smaller, less experienced hospitals, the death rate may be as high as 10%. Description of the Procedure If you are very weak prior to surgery, you may be given liquid nutrition through a tube directly into your small intestine, to help build your strength and improve your chances of a good recovery. This may be done for a week or so prior to surgery. You’ll be given a general anesthetic for the operation. A large abdominal incision will be made, since your surgeon will need to access many organs during the operation. Your surgeon will remove the necessary organs, and then spend some time reconstructing your digestive tract. Your intestine needs time to recover and begin functioning again; you’ll have to stay in the hospital until this occurs, typically up to two weeks. If you have any complications after your surgery, your stay will be longer. Effectiveness Pancreatic cancer is a very difficult disease to treat. Even with potentially curative surgeries, the five-year survival rate is terribly low; only about 20% of people who undergo resection (removal of tumor) are alive five years after diagnosis. Possible Complications and Postoperative Care About half of all patients who undergo pancreaticoduodenectomy experience complications after surgery. The death rate after operation may be as high as 15%. The possible complications are the same as those for a pancreatectomy. The post-operative care is the same as well. This page discussed the use of surgery specific to the treatment of pancreatic cancer. For a thorough review of surgery, please see the surgery treatment monograph.

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