Somewhere around
1993, I began to experience flushing after eating. At first they lasted less than a minute and were
several months apart. I wondered about them but really did not pay much attention to them.
By 1996 or 1997 the flushes were happening more frequently. Typically they would occur at
work after eating a light lunch and might last for several minutes. I had someone take my blood
pressure immediately before eating and then again during a flush. There was no indication of a
problem here because there was little if any change in BP; if anything it may have been slightly
lower during a flush. During the same period, I also began to have what can best be described as
bowel disturbances. I would be constipated for a couple of days, then have diarrhea for a few
hours, no movement for a day and then back to normal for a week or so before the cycle repeated
itself again. I was a little concerned about this but this was a high stress period in my work life
and I guessed that to be the cause. I had also noticed a lot of hair growing in and on my ears -
another sign of age perhaps. I have now learned that this may be caused by the same chemical
that causes flushing and sometimes heart damage.
In 1998, the flushes and bowel disturbances were becoming much more frequent and severe
and I finally mentioned them to my family Doctor. The first thought was stress as the company
that I was working for was in the process of shutting down manufacturing operations, which
would ultimately leave me with no job. He put me on several stress medications, which helped
the stress but did nothing to alleviate the flushing or bowel disturbances.
In 1999 the factory shutdown was complete and I had secured and was comfortable with new
employment; the stress factor was gone. The flushing had gotten much worse, occured after
every meal and lasted as much as an hour. Typically, I also had stomach and intestinal gas at the
same time and occasionally sneezing and temporary hearing reduction. A large meal of "good"
food usually caused a far worse attack than did "fast" food. I tracked what I ate and we looked
for a food allergy with no success.
My Doctor ran all sorts of blood and other tests again with no useful results until we tried a
glucose tolerance test. We found that my blood sugar went very high about 30 minutes into the
test and then dropped below normal and finally returned to right smack in the middle of the
normal range after 2 hours. Because of the timing, he and I both agreed that this was probably
the source of the flushing and other problems. He suggested that I try eating smaller meals more
often. This was a huge nuisance and did not help either. The next step was to suggest that there
may be something to "male menopause". Testosterone level was checked and found normal.
In January of 2000 the flushing continued to get worse and was becoming almost debilitating
so I was back to the Doctor again. He had no idea what else to try and sent me to an
Endocrinologist. The Endocrinologist ran thyroid and other tests and found nothing amiss.
Because of the known Glucose Tolerance problem he decided to have me try Glucophage to see
if it would control the blood sugar swings and stop the flushing.
After one month I went back to see him with the report that Glucophage had no effect at all.
This time I ate my lunch in the car just before arriving at the Endocrinologists office so
that he would get to see a flush. He was surprised at what he saw and I do not think that he had
actually visualized what I was trying to tell him. The Doctor and his PA put their heads together
and suggested a 5-HIAA test. The PA said that it was a long shot and would probably come back
negative but that what I was experiencing was one of the symptoms of Carcinoid Cancer. This
was
the first time that anyone had used the big "C" word and I was very frightened.
The 5-HIAA test came back VERY positive and the PA said that there was really no doubt as
to the source of the problem. I immediately went to the Internet to learn about Carcinoid Cancer
and the Doc scheduled me for a series of CT scans.
By March 16, 2000 the results were in and I found that I had multiple cystic and solid lesions
on my liver the largest of which was 5 cm. On March 22, 2000 a needle biopsy was done on the
largest tumor and it was identified positively as a Carcinoid tumor. Chest CTs and
Echocardiograms of my heart showed all was OK. Thankfully, I had suffered no heart damage
from the tumor secretions.
On March 31, 2000 I had an Octreoscan which showed the same liver tumors shown by the
CTs and also a 3 cm tumor at the "root of the mesentery midline". This is probably the primary
tumor. My Oncologist and I discussed various treatment options and decided that for the time
being we should treat the symptoms with Sandostatin and monitor the tumors to see what they
are going to do. I began self-administration of Sandostatin SubQ in three 50mcg injections per
day. After about 10 days, I ramped the level gradually up to 300 mcg per day in three
injections.
There were some nasty side effects (headache, diarrhea, cramping, gas pains and difficulty
urinating) for the first few days but that quickly cleared as I became adjusted to the Sandostatin.
Blood tests also indicated that the Sandostatin was having no adverse effect on my Gall Bladder.
The flushing subsided almost immediately and the bowel disturbances that I had been having
were reduced to a tolerable level. I felt better than I had in a long time.
Shortly after this my Oncologist referred me to a Cancer Surgeon who had some experience
with Carcinoid. He ordered a Small Bowel Study which revealed no tumors inside of my
intestines and hence no blockages present or even imminent. He indicated that although he could
debulk the largest tumors surgically, he could not cure me with surgery. His recommendation
was that we do nothing surgically now but just be watchful.
After awhile I found that the flushing and difficulties after lunch had not quite cleared up. I
reasoned that perhaps during an active workday more Sando was required. I altered my shot
schedule so that during the day the time between shots was 6 hours and at night was 10 hours; the
evening time remained at 8 hours. This worked and I continued this schedule until Sept 2000
when, at the recommendation of Dr. Richard Warner of the The Carcinoid Cancer Foundation, I switched to 20mg
LAR.
In Feb of 2001 I switched to the LAR 30mg - mostly for the possible additional therapeutic
effect. At first we did the LAR shots at home, but my wife was never comfortable giving them to
me and when we had a complete failure due to clogging of the needle that we could not unclog
she flat refused to do it again. I finally agreed to have them done by the nurse at my Docs office.
A pleasent epilog to the clogging incident is that Novartis graciously replaced the dose at no
charge. Their rep gave me further and very important instructions over the telephone. This
additional instruction mostly involved making sure that the Sando is fully at room temperature
before mixing and also involved agitation methods. An updated procedure may be found on my
personal website Procedures
page.
I have continued with the LAR 30mg and periodic CT scans. The
last set done on August 20, 2007 shows my largest liver metasteses slightly larger by 1/2 cm and root of the mesentary primary unchanged from the last CT in Jan. 2007, however we have seen the slight increase before and the next time it was back to the original 5cm and so I will not worry about it unless the increases continue. They are both maintaining the same average of 5cm and 3cm respectively that they have since my diagnosis in early 2000. Since I have had no treatments of any kind other than Sandostatin, I have to credit it with keeping the tumors supressed and dormant as far as growth or further metastizing are concerned.
I continue to have almost constant problems with gas, diarhea and constipation but the
flushing and it's associated other symptoms are a thing of the past. I have tried various things to
control the digestive distubances including walking after eating, diet modification, a couple of
prescribed medications and various over-the-counter products but none has really provided a
solution. I do go easy on things which produce gas for me such as carbonation, highly spiced
foods, beans and several other foods that have always given me indigestion. This helps but has
not solved the problem. It is my opinion that some of this difficulty may be Sandostatin related
but if so it is a small price to pay for the apparent tumor growth control that I am getting from it.
So for now, I continue to work, play and do most of the things that I have always done.
Hopefully before the tumors start to move again someone is going to find a cure for this disease.
For more detail on my Carcinoid journey, you may wish to go to the Progress
page on my
personal website. Please feel free to send me Email at