A Patient’s
Story …………Delbert R. Holser
May 7, 2004
Let me tell you a story about some very good Doctors. In 1996 I
was under the care of Michael R. Harbut MD, an Occupational and
Environmental Specialist. I started seeing him in May 1996. He sent
me to several other Doctors to rule out what was causing my problems.
I was getting sick at work a lot. Jeffrey Leflein MD finally diagnosed
me as having the disease called “Behcet’s Disease”.
Behcet’s Disease is an autoimmune disease causing inflammation
of the small blood vessels throughout the body. My main symptom
and one of the rarest ones is ulcerative colitis. I had apthous
ulcers in my mouth and throat.
In February 1996, I had a glucose tolerance test and was diagnosed
as a borderline type two diabetic. I controlled my blood sugar with
diet. On November 6, 1996 I was at Dr. Harbut’s office and
I asked him to check my blood sugar. It was over 300. He called
an endocrinologist, Yau-Liang Su, MD and arranged for me to see
him within a half-hour. Dr. Su did a complete endocrinology exam;
he asked many questions and checked me over thoroughly, even asking
his associate Dr. Ahmad to see me. He decided to take several vials
of blood for a series of hormone blood tests. Apparently when speaking
to Dr. Harbut he was somewhat suspicious of what was wrong. Two
of the tests were IGF-1 and growth hormone. He prescribed glucotrol
XL 5 mg to begin with. I went deer hunting on the 14th and was gone
until the 20th.
From the time I left Dr. Su’s office, and arrived home on
the 20th, I lost 13 lbs. I was dehydrated and feeling quite ill.
On my answering machine was a message from Dr. Su stating my IGF-1
was 1535 and my growth hormone was 48. [Normal < 390 and <
5 respectively] He wanted me to have a MRI of my Brain -- specifically
the pituitary gland. He made arrangements with Providence Hospital
in Southfield so all I had to do was call for an appointment.
On the 22nd, I went to see Dr Harbut on a scheduled visit. He took
one look at me, asked a couple of questions and put me in the hospital.
So while in the hospital [Providence of Southfield] I had the MRI.
I had a golf ball sized tumor on the anterior side of my pituitary
gland. My ulcerative colitis had been so bad since the beginning
of November, I was reduced to wearing adult size diapers. I was
miserable and dehydrated. My electrolytes were very low. That is
why Dr. Harbut put me in the hospital. He ordered ringers of lactate.
Dr. Su consulted Dr. Harbut and they contacted Blaise Audet MD,
a Neurosurgeon who contacted Dr. David Davis MD, an Ear, Nose and
Throat Specialist [ENT]. Both surgeons came to see me and explained
that I needed surgery soon.
Dr Davis and Dr Audet told me how the procedure would be done.
I was sent to see an Ophthalmologist for a complete eye exam to
determine if any eye damage had occurred. The tumor was pushing
on my optic chiasm. My surgery was to happen Saturday November 30th.
Dr Audet was to go out of town on December 2nd. If he waited he
would not be able to schedule with Dr Davis to do the surgery until
after January 1st. He was afraid I would go blind if he waited.
So he scheduled a rare Saturday surgery.
They went up my nose with a fiber optic scope, entered the brain
cavity, and removed the tumor. The surgery went well. The first
thing I remember was being wheeled into ICU, a standard procedure
for this type of surgery. They took real good care of me in ICU.
I had three IVs, with one in an artery. That is where they drew
blood throughout the first 12 hours after surgery. My nose was packed
and I had black string taped to my face that was attached to the
packing. I had no idea what I looked like for the first couple of
days. I had a foley [catheter] for urination. They needed to monitor
my urine output since a possible complication with this surgery
is diabetes insipidus. I really wanted it removed by the third day.
I was put on Vitamin C 500 mg twice a day for healing the small
blood vessels and nerves. I was given shots of a steroid, which
name I cannot remember. It started with an “S” and made
me gag as though I were going to vomit. I never vomited though.
The nurse checked the PDR after I explained the reaction I was having
and sure enough, the feeling like vomiting was a side affect. The
steroids were to help prevent swelling on the brain. My Behcet’s
Disease improved a lot while taking the steroids. I was put on oxygen
using a triangle facemask with lots of moisture. It helped me heal
as well as breath through my mouth. The moisture prevented a dry
throat.
Monday December 2nd Dr. Davis pulled out the packing. Boy did that
feel good. I had seen Dr. Davis previous to all this and he knew
I had a deviated septum in my nose. The first thing I said to him
when he came to see me about doing the surgery I said, Can you fix
my nose? Then I asked about the procedure. He fixed my nose. The
next few days after returning home my blood sugar took a real dive.
I was actually hypoglycemic. I quit taking the glucotrol and my
blood sugar returned to normal. Growth hormone suppresses insulin.
That is why my blood sugar was high. It also suppresses testosterone.
My testosterone level was low and I had been impotent for several
years previously. I am not impotent now. I had developed carpal
tunnel syndrome and had surgery on my right wrist in May 1996. My
left wrist was equally as bad. I never had surgery on my left wrist.
It is perfectly normal now. The surgery on my right wrist was probably
unnecessary. Excessive growth hormone causes carpal tunnel syndrome.
My feet grew a couple of sizes as an adult and my hands got wider.
The bridge of my nose got wider and reduced several months after
the surgery.
My diagnosis is Acromegaly. Excessive growth hormone can also aggravate
diarrhea. That is why I was so sick in the beginning of November.
I saw Dr Audet several times for one year. I saw Dr Su regularly.
In February 1997, I had a post-surgical MRI. Everything looked good.
In April 1997, I started radiation therapy every day for five weeks.
The process includes a CT Scan, some x-rays, and the molding of
a face mask/brace. I was fastened down to the table to keep my head
still. I was producing too much growth hormone still and I was injecting
myself with sandostatin. The radiation was to kill off more of the
cells that produce growth hormone. It kills off other cells on the
pituitary gland also. Later I started taking thyroid medication,
testosterone patches, and cortisol.
Now I receive a once a month shot of sandostatin LAR. In 1999,
I started gaining weight. Even when I hardly ate I gained. This
is partially attributed to the growth hormone. Growth hormone deficiency
symptoms include in vessel fat storage and weight gain, especially
around the organs of the abdomen. My body had been used to very
high growth hormone, and the absence of the hormone made my body
think I had a deficiency. Today my Acromegaly is well under control
and being monitored by Dr. Su. I only wish I could say the same
thing for the Behcet’s Disease, especially the ulcerative
colitis.
The pituitary disorder, its discovery, my surgery and treatment
are very remarkable. I would have the surgery again if I had to.
The medical care I received was the best care in the world. My doctors
are the best. They understand the limits of their specialties, know
who to refer to, and talk to each other about my case. I could not
ask for any more.
Sincerely,
Del
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