Sweet Rewards

The following is from the August 21, 2007 edition of “The Daily Journal“:

By David Iams: Special to The Daily Journal

Any lifelong diabetic freed by a pancreas transplant from the prospect of endless years of insulin injections and harsh rules on sugar intake could be forgiven and forgotten for planning to celebrate that freedom with a a sticky sweet banana split with all the trimmings.

What was memorable about the split Kitty Castellini created Sunday at General Custard’s in Vineland to celebrate the third anniversary of her transplant was that on top of the banana, vanilla custard, chocolate syrup, wet nuts, whipped cream and maraschino cherries were two Reese’s peanut butter cups.

Reese’s are symbolic for the Vineland woman because they were the first sweets she was allowed to eat after her transplant on Aug. 13 2004 at the University of Maryland Medical center in Baltimore.

They also symbolize the bond that developed between Castellini and her endocrinologist, Dr. Joseph J. Fallon Jr. of Woodbury, like her a Type 1 diabetic, between the time he told her she was a prime candidate for the procedure and the day in November 2004 when she went to Dr. Fallon with a packet of Reese’s pieces to see if he thought her well enough to consume them.

He opened the packet for her.

“My own signature,” she said about the topping on Monday, the official anniversary, back at General’s Custard for lunch with her husband, Gary, and for a review of the “third birthday” celebration the day before that drew 70 family members and friends, including Dr. Fallon and state Sen. Nick Asselta.

She had waited three years for the treat. Last year, she marked second birthday by going to Walt Disney World Resort in Florida for a rose ceremony, honoring her transplant donor and diabetics in general.

On the first birthday, she was still in recovery.

“It took 1 1/2 years, longer than normal,” she recalled.

Pancreatic transplants as an answer to diabetes go back to the late 1960s, but the number only began increasing about 20 years ago.

A total of more than 13,300 pancreas transplants have now been performed, according to statistics at the International Pancreas Transplant Registry at the University of Minnesota School of Medicine.

They are effective only against Type 1 diabetes, once known as Juvenile Diabetes, which developed at age 7.

In Type 1, the pancreas produces little or no insulin. In Type 2, which develops later in life, the pancreas produces insulin but the body doesn’t use it efficiently.

There also is so-called gestational diabetes, a temporary condition associated with pregnancy.

In most transplants, more than 75 percent, the patient’skidneys also are replaced simultaneously with the pancreas, usually from teh same donor.

Kidney failure, along with many other neurological and visual disorders are commonly associated with Type 1 diabetes.

A dual transplant appears to contribute to better survival rates for both organs, according to figures from the Mayo Clinic.

After five years, the survival rate for the pancreas in a simultaneous transplant is 70 percent, while the organ survival rate for other pancreas transplants is 52 percent.

But Castellini underwent a so-called PTA, a pancreas transplant alone. The reason was a combination of bureaucratic and logistical issues, according to Dr. Fallon.

Castellini had initially decided on a transplant because at the age of 43, her condition was worsening.

In addition to eye problems she was suffering a loss of short-term memory and earlier at the age of 41 had suffered a heart attack.

The PTA seemed reasonable to a transplant specialist at Our Lady of Lourdes Hospital in Camden, Dr. Nasser I. Youssef, who said her small frame and lack of diabetic complications to her kidneys made the PTA feasible.

In addition, her health insurance company, instead of having the procedure done locally, insisted she go to the University of Maryland.

It was a good move in more ways than one.

Not only is the center a nationally known pancreas transplant facility, a donor organ became available “comparatively quickly,” according to Dr. Fallon.

“The stars were looking out for her,” he said.

Her health insurance covered the cost of the procedure, including doctors, organ procurement and follow-up care, including immuno-suppressants to prevent organ rejection.

Organ rejection is one reason a transplant is not a treatment option for pancreatic cancer, no matter how unfair it might seem to replace the pancreas of a diabetic whose condition, while chronic, is not necessarily fatal.

Cancer itself is a disease of the immune system, Dr. Fallon said.

A pancreatic transplant normally is accompanied by the use of three immune-suppressive drugs, added Dr. Youssif, who has performed about 80 tranplants at Lourdes since 1995 and who trained at the University of Minnesota.

The result is that the drugs that keep the body from rejectiong the transplant keep the body from attacking the cancer cells.

A patient with pancreatic cancer is far likelier to reject the transplant than a diabetic.

Ironically, people at high pancreatic cancer risk, those with one or more family members who died of it, are starting to turn to preventive removal of the pancreas, according to a report this month in the New York Times.

So far, 20 people have had all or part of their pancreas removed even though it means they will have to contend with severe diabetes the rest of their days.

Castellini still has to take anti-rejection medication. She consults twice a week with a nurse and tests her blood sugar once or twice a day – down from the 15 to 20 times daily at the outset.

And on her own she is championing the cause of the war on Type 1 diabetes across the nation.

She has met with Dr. Aaron I. Vinik, a prominent diabetes researcher who did gene research on the pancreas in 1983 by wrapping the pancreas of hamsters in cellophane in the search for the organ’s insulin-producing islet cells, and Dr. Camillo Ricordig, who is working on islet cell transplants and locally Dr. Thomas I. Margolis, a retinal specialist on diabetic eye disease.

She is also writing a book about fighting diabetes.

No publishing date has been set, but the tentative title is “A Doctor’s Wish, A Patient’s Dream.”

The book’s subtitle?

“I’ve been Cured: Pass the Reese’s.”