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[IP] My dilemma

As most of you know, I have been very supportive of Kerry during her rough
periods of life.  I am currently in a very rough period of my own.  Kerry is
very supportive of me and will stand behind my decision.

During the last year, I have been tested, retested, operated on, retested
again, etc... Have given enough blood to keep Dracula happy for quite a

What has happened is I have been having periods of hypoglycemia.  With my
hypo events my bg usually run between 60-110.  Kerry contacted her nurse
educator who in turn contacted her endo.  He set up an office visit to get a
history, then he set up testing.  (August 1997)

The first test was a glucose tolerence  test.  Negative, but with an
abnormal result.  The next test was a CT.  (Sept 1997)  Again negative, but
an unexpected mass was found in my mesentary(?)  Now to the surgeon.  After
concidering(?) all options, it was decided that a biopsy of the mass would
be the next step.

(October 1997) The biopsy found the the mass was not solid like they
expected.  The cyst was drained and tested.  Thankfully it was benign.  The
following month a follow-up CT was performed.  The cyst was refilled and was
larger than before.  My surgery was within two seeks of this finding.
(December 1st)  Christmas was miserable.. Two hypos made me sleepy and
somewhat unsocialable.

In January, I was rehospitalized to undergo a 72 hour fasting test.  About
55 hours into the test I has a hypoglycemic event.  My bg was at 88 (yes
that is right).  The lab work showed that the insulin and proinsulin levels
had reacted normanlly until the hypo.  After the hypo my insulin level was
normal, but my proinsulin level had spiked up.  Results of the test
"hyperproinsulinemia" or an abnormal test result.

February 1998.  The endo and I decided that we should do an MRI.  Again
nothing, but two abnormal findings were detected.  There were no tests in

In April came a new test.  An octreotide.  This test is used to detect
tumors.  The suspicion is an insulinoma.  The results of the octreotide
indicated a small tumor IN the head of my pancreas.

May.  The next week I was back at the hospital for an endoscope with
ultrasound.  No tumor was seen with either test.

June.  Met with the surgeon to discuss options.  He was reluctant to go in
because he was not fully convinced of the presence of an insulinoma.  The
surgeon, the endo , and myself decided that a venous catherization should be
performed as a final test.  Sixteen samples were taken from various location
around the pancreas.

July.  Had an appointment with the endo on Thursday.  He informed me of the
results of the catherization.  The results showed elevated (high) levels of
insulin at all locations of the samples.  This proves the existance of an
insulinoma(s).  We immediately went to the surgeon's office to meet with
him.  (The dr's had talked earlier and the surgeon knew that I was in for an
appointment that day.)  The surgeon is still somewhat reluctant to operate,
but will do so if I say to.  We have agreed to do another CT.  He is still
expecting to have a lump jump out which would make the surgery "easier".

It appears that a large section of my pancreas is producing lots of extra
insulin.  This has not suprised me because none of the tests have come back
with "expected" results.  There are now 2 tests that confirm a pancreatic
problem.  I wish that there were some way that I could give Kerry some of
the extra insulin producing cells that my body appearantly has.

My dilemma is whether to have the surgery or not.  I understand the risks of
both results.  During the last three years this has been occuring the
frequency of the hypos has been increasing.

The surgery would be very complicated and last up to 8 hours.  Up to
approximately 30% of my pancreas would have to be removed.  Part of the
small bowel would then be used to connect the remaining part of the pancreas
to the rest of the tract for proper absorption.  Then everything else that
was removed to get access would have to be reattached.

The risk of not having the surgery is similiar to that of a diabetics.
Possible brain, organ, and nerve damage.  Even death.

The risk of having the surgery is the possible complications.  The least of
the worries would be the chance of becoming diabetic.  I say the least
because even though the idea of being diabetic scares the HELL out of me, it
is something that I can live with and can manage. Kerry and I have been
together for 14 years and this November we will be married for 10 of those
years, so I think I have some idea how to care for the diabetes.  Other
possible complications would include not getting the insulinoma removed,
internal bleeding, something not reattached correctly, etc.

This has me very scared and confused.  For one of the few times in my life I
do not know what to do.  I do know that in the near future I will HAVE to
make a very critical decision about this.  I am scared of making the wrong
decision.  I know that none of you will be able to make this decision for
me, but I would like to hear from you and get some outside thoughts to help
me.  I realize that this is a forum for insulin pumpers, but it has
developed into a very large family and I hope to get some support  while I
debate the options of yes or no.

Please feel free to e-mail me at email @ redacted .  Thank you for
your eyes and ears while I sit here confused pondering my options.

Brian Spitler

Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
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