One turn of events led to another, and so it was that Jim, and not his wife, took Jim’s 87-year-old father to his appointment with the dermatologist for the first time. And so it was that the dermatologist was not Jim’s father’s regular dermatologist, but Dr. Charlie Becknell, of Lexington, Ky., who was taking his place. And so it was that when Dr. Becknell greeted Jim’s father and then extended his hand to Jim, one of the most important turning points of Jim’s life spontaneously occurred.
As Jim recalls, “The guy just got fascinated with my look.”
Refusing to let go of Jim’s hand, Dr. Becknell began to ask questions. “Has your nose always been that big? Have your hands always been that big?”
Jim, somewhat flustered at becoming the focus of his father’s dermatology visit, parried each question with a plausible answer: “I work with my hands … My dad’s got a pretty good snout on him … Look at my dad’s hands – he’s a sight, and I’m getting there … I’ve gained weight over the years … The fat’s got to go somewhere.”
But the dermatologist was relentless. He asked whether Jim had skin tags, small, benign growths of hanging skin. “Yes, I have ‘em hanging all over me,” Jim said. He asked whether Jim had developed a space between his teeth. “Yes.” He asked whether Jim had numbness in his fingers. “Yes.” And then he asked Jim to remove his shoes and socks, which revealed feet that had grown from size 9 ½ to 12 since Jim’s wedding 30-plus years earlier.
“Every question he asked related to something I had,” Jim recalled.
On the spot, the dermatologist told Jim that he had acromegaly, a condition in which the body produces too much growth hormone and thereby causes tissues to enlarge. The culprit is usually a benign tumor on the pituitary gland. And while the tumor itself is not cancerous, the ultimate outcome can be deadly, as the heart and other internal organs continue to grow.
As Jim sat there processing all that he was hearing, Dr. Becknell pulled out his cell phone and called Jim’s family doctor. The next day Jim had blood tests, which revealed abnormalities consistent with acromegaly, and early the next week he had an MRI, which revealed a marble-sized tumor on his pituitary gland. His next stop, just a few days later, was the Brain Tumor Center at the University of Cincinnati Neuroscience Institute.
At the Brain Tumor Center, Jim and his wife, Jo, met a talented team of doctors: Lee Zimmer, MD, PhD, an ear, nose and throat surgeon (otolaryngologist) with UC Health, and a neurosurgeon with the Mayfield Clinic. These surgeons worked together to create a safe strategy for removing Jim’s tumor.“Jim had a classic case of acromegaly,” Dr. Zimmer said. “He had experienced multiple physical changes and distortions, including a change in head size (and hat size), an increase in nose size, an increase in jaw size and an increase in the gap between his teeth. His glasses had become too small, and he was forced to have his wedding ring resized several times. By the time we saw him, he was unable to wear his wedding ring at all.”
Dr. Zimmer noted that Jim did not have some major symptoms that are commonly associated with pituitary tumors, including loss of vision, double vision and headaches.
Within a week, Jim was scheduled to undergo a transsphenoidal pituitary tumor resection at the UC Medical Center. Dr. Zimmer began the procedure by inserting a long, tube-like instrument with a light and tiny camera into one of Jim’s nostrils and making an incision at the back of the nasal cavity. Dr. Zimmer continued toward the tumor through Jim’s “sphenoid sinus,” an air-filled bony cavity deep in the nose to reach the pituitary gland and tumor.
Once Dr. Zimmer had exposed the pituitary tumor, the neurosurgeon removed it with another long, slender instrument that he inserted into Jim’s other nostril.
The entire procedure took 45 minutes.
“Everything went like clockwork,” Jim said. “There were some positive effects immediately. I could tell the difference. One of the symptoms I had was sleep apnea. I still have sleep apnea, but it’s totally different.” Jo said she could tell that her husband was breathing more easily even before he left the hospital the next day, a Saturday. The surgeons, she said, “added 15 years to Jim’s life.”
Jim is continuing his recovery under the watchful eye of Michael Canos, MD, a UC Health endocrinologist. “Since his operation, his hand and finger size have decreased,” Dr. Canos said. “An MRI taken after his surgery shows that the tumor has been completely removed, and lab tests have shown a remission of tumor activity.”
Jim, a foreman who had never missed a day of work before his surgery, was back at the plant full-time within eight weeks.
And, in a story-book ending, he was able to slip on his wedding ring for the first time in years. Said Jo: “It was a big deal for both of us!”
– Cindy Starr
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Hope Story Disclaimer – This story describes an individual patient’s experience. Because every person is unique, individual patients may respond to treatment in different ways. Outcomes are influenced by many factors and may vary from patient to patient.