Sam Greenberg (Host): This is Healthy with VCU Health. I'm Sam Greenberg. Today, we're discussing chronic pancreatitis, what it is, how it can impact daily life, and the treatment options available for people living with chronic pain. One specialized treatment we'll be discussing is total pancreatectomy with islet cell autotransplantation, or TPIAT, a procedure that may be an option for some patients with severe chronic pancreatitis.

Joining us is Dr. Aamir Khan, Director of the TPIAT program at VCU Health. The program is recognized as a National Pancreas Foundation Center of Excellence, reflecting the highest standards of expertise and multidisciplinary patient care. He'll explain how TPIAT works, who may be a candidate for the procedure, and what patients can expect when considering this treatment option. Dr. Khan, thank you so much for joining me today.

Dr. Aamir Khan: Thank you, Sam. Thanks for having me.

Host: Of course. It's my pleasure. So, Dr. Khan, to start us off, can you tell us a little bit about your background and what led you to focusing on treating chronic pancreatitis?

Dr. Aamir Khan: Yeah. So, I'm an abdominal transplant surgeon who also focuses on the diseases of the pancreas, and I have spent much of my career caring for the people with chronic pancreatitis. So, what drives me is seeing how much pain this disease can cause and knowing that, with the right care, we can offer answers and help you get your life back.

At VCU Health, we work as a team to offer both medical and surgical treatment options, including advanced treatments like the TPIAT.

Host: Doctor, for someone like myself who maybe is a little bit shy of a medical degree, let's zoom out a little bit. What is your pancreas and what does it do?

Dr. Aamir Khan: So, to put it in more simple words, your pancreas is a large tadpole-shaped gland which is located deep in your belly. It's very central in your abdomen. It plays two very important roles. It helps your body to digest food and also helps to regulate blood sugar levels by producing these chemicals or hormones like insulin. When the pancreas isn't working properly, it can cause a major impact on overall health.

Host: So staying zoomed out a little bit, what exactly is chronic pancreatitis?

Dr. Aamir Khan: Chronic pancreatitis is a very debilitating condition where the pancreas becomes inflamed over a long period of time. And instead of healing, the pancreas slowly keeps getting damaged in most of the cases. This can lead to the development of, you know, ongoing pain, trouble digesting food, and sometimes even diabetes in later cases. Unlike a one-time flare-up, this is something that doesn't necessarily go away on its own always and can sometimes get worse over time.

Host: Sure. And what do those flare-ups look like? What symptoms should people look out for? And is there a certain population who is most at risk?

Dr. Aamir Khan: The most common symptoms patients tend to have is ongoing abdominal pain that can be very severe, and it really can disrupt your daily routine. You may also have nausea, you may have weight loss, diarrhea, and sometimes greasy stools, mainly because your body isn't absorbing food well.

Alcohol and gallstones seem to be very common causes for this disease, but certain lifestyle factors like drug use and tobacco use can also increase the risk of chronic pancreatitis. Most of the times adults are affected, but children can also develop it, especially when children have those genetic mutations and autoimmune conditions.

Host: Okay. So, someone thinks they have chronic pancreatitis. They're afraid to go to the doctor. They don't know about the experts at VCU Health. What can happen if chronic pancreatitis isn't treated properly?

Dr. Aamir Khan: If it goes untreated, the patients, often their symptoms can often get worse and harder to control. Over time, you know, you may lose your ability to digest food properly and, as a result, can develop weight loss and may even, in advanced cases, develop diabetes. Many people find that they can't work, sleep, or even enjoy daily routine. That's why getting the right care early on is so important, and we want to stop the disease from taking over your life. If you've had pancreas pain for a long time and it's affecting how you live, that's a sign to talk to your specialist.

Host: Pick up the phone, get it treated. The good news is there is the expert care available at VCU Health. And going right along with that, Dr. Khan, can you tell us more about that care? What are some of the treatment options for patients dealing with chronic pancreatitis?

Dr. Aamir Khan: Most patients with chronic pancreatitis, they're first managed with medications, sometimes lifestyle modifications, some nutritional support. And sometimes, when those medical managements do not control, then they can also need advanced endoscopic care. Only when all of these treatments fail to control their symptoms, then we evaluate them for this procedure called TPIAT.

Host: All right. You mentioned TPIAT right there. Let's stick right with that. What is the procedure and who is a good candidate who might benefit from it?

Dr. Aamir Khan: So, TPIAT stands for total pancreatectomy with islet cell autotransplantation, and it's a treatment for people with severe chronic pancreatitis who haven't found relief from other treatment modalities. During surgery, we remove the entire diseased pancreas to eliminate the source of pain. Once the pancreas is removed, it's taken to our nationally recognized islet cell lab, where we carefully isolate the patient's own islet cells.

Once purified, then we transplant these islet cells into the patient's liver, where they continue to function and produce insulin which helps to regulate their blood sugar while simultaneously removing the source of chronic pain. So, the goal is twofold in this situation. It's mainly to relieve their pain and help their body keep making insulin so that they are less likely to become diabetic.

Host: And you mentioned that children can get chronic pancreatitis. Can children receive TPIAT to treat the disease as well?

Dr. Aamir Khan: Yes, absolutely. It's relatively less frequent in children, but through our partnership with Children's Hospital of Richmond at VCU, we're able to offer the same level of expertise and seamless coordinated care for our pediatric population as well.

Host: Are there risks involved with TPIAT, and what does the recovery period look like?

Dr. Aamir Khan: So, like any major surgery, there are risks and it's not the right option for everyone. Recovery can take time and you'll need close follow-up care. Sometimes people still need insulin afterwards, but many can avoid it or at least were able to reduce it afterwards.

TPIAT can certainly be a life-changing operation. It's a highly unique and specialized procedure that's performed only at a very few centers in the country. What is most important is that we have an amazing and dedicated team to walk you through every step, so you understand what to expect and feel supported the entire way.

Host: Dr. Khan, as we wrap up, why should someone consider coming to VCU Health for that TPIAT procedure? And what are a few things that you would like people to take away and that you would like people to know?

Dr. Aamir Khan: You know, we have different treatment options available and expert care here at VCU Health. TPIAT is a very highly specialized procedure, and only about 15 to 20 centers in the entire country offer it. At VCU Health, we have performed more than 100 of these procedures, which speaks to the breadth of the experience we have and the rarity of our program.

We're also recognized by the National Pancreas Foundation as one of the Centers of Excellence, which, you know, means our program meets the highest standards for patient care, experience, and outcomes. That experience really matters. At VCU Health, we have a dedicated team that focuses on chronic pancreatitis and TPIAT care from evaluation through surgery and long-term follow-up as well. You're cared for by a team that specializes in this disease and understands how complex it can be. If you're living with chronic pancreatitis pain, know this: you're not out of options, and you don't have to live like this forever. There's always hope, and starting a conversation is the first step towards feeling better.

Host: Pick up the phone, make the call, and call the National Pancreas Foundation Center of Excellence at VCU Health. Dr. Khan, thank you very much. This has been fantastic wealth of information. Again, thank you for your time today. I really appreciate it.

Dr. Aamir Khan: Thank you so much for allowing me the opportunity to talk.

Host: Of course. To schedule a TPIAT evaluation, call 804-828-6705 or visit vcuhealth.org/tpiat to learn more about VCU Health's TPIAT program. And to listen to other podcasts from VCU Health, visit vcuhealth.org/podcast. This is Healthy with VCU Health. I'm Sam Greenberg.