Patient Stories: 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.