Georgia first-grader recovers from painful pancreatitis

ATLANTA - Cadence McAfee is back at Children's Healthcare of Atlanta with her parents, 7 months after the Peachtree City, Georgia, first-grader's and twin's life was suddenly thrown off track by a wave of pain in her abdomen.

"And as we're driving along, she just starts screaming in pain," Liz McAfee, Cadence's mother, remembers "I pull over, and she is just writhing in pain in the back seat, and she starts vomiting."

Liz McAfee has four kids, so she's seen her share of stomach bugs.

"But the more she started vomiting, the more blood became present," she remembers. "When the blood showed up, I went, 'Oh, this isn't normal.'"

McAfee drove Cadence to their local emergency room, where the kindergartener was stabilized with medication and diagnosed her with a torn esophagus. But a few days later, the stomach pain returned.This time, the McAfee family rushed Cadence to Children's Healthcare of Atlanta at Egleston.
Cadence was diagnosed with had acute pancreatitis, an intensely painful condition in which the pancreas becomes inflamed.

Dr. Jay Freeman, Director of the new Advanced Pancreatic Care program at Children's, says you typically see in pancreatitis in adults, not children.

"It's very rare, actually," Dr. Freeman says. "Acute pancreatitis only occurs in about 1% of children in general. Only about a third of those will go on to have acute, recurring pancreatitis such as Cadence has."

Tests showed Cadence has a gene mutation that predisposes her to pancreatitis.
She had blocked pancreatic duct, causing digestive enzymes produced by her pancreas to back up and create a painful pocket of fluid, on her pancreas. Most children with acute pancreatitis get better in 4 or 5 days, with IV fluids, rest and medication to treat their pain.
But, unable to eat, facing bouts of crippling pain, Cadence was losing weight quickly.

"She lost 10 pounds in the first week," Travis McAfee, Cadence's father, remembers. "She's already our little pixie, and to see her really dropping weight that quickly was definitely a scary experience."

That's when Dr. Field Willingham, the Medical Director of Therapeutic Endoscopy at Children's Healthcare, knew they needed to do something.

"Dr. Willingham said, 'We need to do this now because if she loses any more weight, I probably won't be able to do this surgery," Liz McAfee remembers.
Cadence was brought across the street to Emory University Hospital
for a procedure known as an ERCP. Dr. Willingham used a scope to place a stent into the blocked duct to reopen it. A few days later, he repeated the procedure, placing a larger stent into the same duct.

"Pretty much the minute the stent went in, she was resolved clinically," Dr. Willingham says. "And she was able to resume eating a regular diet and the pain went away. It was amazing. It was the sort of thing you go into medicine to do.Her pain went from a 10 down to a 4, and she was doing just so well," says Liz McAfee.

As Cadence stabilized back at Children's, Dr. Willingham's team performed a first-of-its-kind procedure at the hospital to remove the stent.

"It was like we had our girl back," Cadence's mother says. "She was happy, smiling and had energy, and her color was back.

Because of her mutation, Cadence McAfee may face other bouts of pancreatitis down the road.
But, for now, she's healthy again.

"She's doing great," Liz McAfee says. "She has zero pain. She hasn't had a single pancreas episode since March."