Medical Bio Hamilton, Cl

8977594.doc

10/16/2008

1

CHARLES L HAMILTON DOB: 10/2/43 MDA: 124197 VA: 465-66-9066 H9066 [email protected] 1.11.05

Medical Biography. Diagnosis: At age 33 -January, 1977 - surgery in MD Anderson Hosp, Houston, TX Pathology diagnosed Histiocytic lymphoma diffuse and a Carcinoid tumor in the small intestine which had pushed though the ileocecal valve and caused intussusception or blockage of the intestine. Surgery: right hemicolectomy Chemo: CHOP double treatments (3) of 9 scheduled I quit when the Brazilian doctor told me that I would have full raging lymphoma in 2 yrs whether I completed all 9 doses of chemo or not. Remember - these were DOUBLE treatments!! Carcinoid was totally ignored. Followed with periodic chest x rays and blood work and occasional urine tests - NED on all tests although 5HIAA kept increasing. Recurrence: In 1993 as a result of a complaint of shoulder pain, I was undergoing a chest CT and radiologists found a large spherical tumor in my liver. Total of 5 tumors of differing diffusion and size were spread across the liver descending in size from right to left. In 1994, 3 microembolizations using cisplatin in the lactate "sand" Result being stasis and some slight shrinkage. Within a year, the largest tumor was larger than it was in 1993. It was greater than 4.5cm In 2001, RFA of right lobe of liver concentrating on 3 tumors. Excised gall bladder Surgery by Daniel J Frey, MD, Chief, Section of Transplantation, Professor of Surgery Transplant Institute of New Orleans 3535 Bienville, Suite 225 New Orleans, LA 70119 Phone: (504) 488-8121 Fax: (504) 488-9672 [email protected] In 2002, intestinal torsion. Caused acute sepsis, 12 days in SICU, etc Spring Branch Hospital, Dr Talieh 2003- 2004 MDACC Core biopsy showed that liver is 85% fat by volume… NASH Tumors are 35% of volume.

8977594.doc

10/16/2008

Projected procedures at MDACC

2

CY 2005

Angiogram of liver to be done on 1.19.05 SirSpheres chemoembolization to be done on 2.9.05? By Dr Murthy, Interventional Radiology, MDACC

Current Physicians Oncologist, (Carcinoid Specialist) YAO, James C, MD assigned by MDA Hospital, Houston, TX as lead physician Asst Prof, GI Medical Oncology, UTMDACC 1515 Holcombe Blvd Box 0426, Houston, Tx 77030 [email protected] Oncologist, (Carcinoid Specialist) Eugene A Woltering, MD, FACS The James D Rives professor of Surgery and Neuroscience Chief, Section of Surgical Endocrinology Director of Surgical Research Louisiana State University Health Sciences Center 1542 Tulane Ave Dept of Surgery, 7th Floor New Orleans, LA 70112 Telephone: 504-568-2344 Fax 504-568-4633 Pager 504-679-7977 Cell 504-884-3555 Also Staff Physician, VA Rgn, NOLA [email protected] Have seen Dr Woltering and fellow staff in New Orleans in Sep 1999 and again for RFA of liver in Dec 2001, last consult was Oct 2004

HMO, PCP Suresh K Babu, MD,. PA Internal Medicine 350 Business 290 East, Ste 5 Hempstead, TX 77445 979-826-8833

8977594.doc

10/16/2008

3

VA, PCP Dr V Krishnan VA, Regional Hospital 2003 Holcomb Houston, TX 77004 713-791-7838 (fax)

Carcinoid Syndrome (is the result of an excess of serotonin…) Reactions can escalate into a Carcinoid Crisis. Side effects of the syndrome: Flushing, diarrhea, occasional palpitations/fluttering and shortness of breath (stress effects or exercise?). hot flashes and also some dizziness from orthostatic hypotension or ??? and the never ending fatigue. My crises are brought on with consumption of peanut oil or toasted peanuts - a handful will do it. Cannot tolerate any papain, ketsup or similar concentrated tomatoes, grease or spicy foods. Cannot tolerate raw fruit as in grapes, plums, watermelon. Causes out of control diarrhea. Also, iodine contrast, epinephrine, prednisone…= Carcinoid crisis

Medications: Lomotil to assist in controlling major attacks of diarrhea 2.5mg, #3 tid prn MS Contin - timed release morphine for pain and partial control of diarrhea and flushing. 15mg, qid prn Sandostatin - 1500mcg per day up until Oct 2000, then discontinued Levbid rarely for quieting spasmodic stomach or out of control diarrhea. Dilaudid for break thru pain or Crisis. Lasix - peripheral edema 40mg bid Micro K - muscle cramping, blurred vision qd prn Uroxatral – prostatitis 10mg qd Avapro - blood pressure 150mg qd Ranitidine - 150mg bid gerd (works!!) Loratadine – 10mg qd prn

Present Complaints -1. Constant or Frequent Complaint: FATIGUE! Inappropriate sleeping (almost narcolepsy) Lethargy especially preceding diarrhea “attack” Zero libido Frequent but sloooow urination Skin disorders, growths Hot flashes (flushing) Prickling, itching, dry skin while flushing Diarrhea - treat with Lomotil then Hyoscamine as it worsens. Hemorrhoids – of course Tinnitis and Peripheral edema

8977594.doc

10/16/2008

2. Occasional or Infrequent: Difficulty Swallowing (hiatal hernia?) Dizziness upon or while standing. (Alpha Blocker?) Pedal contracture (Micro K, one daily) Burning eyes (eyeritis?), blurred vision dry eyes, etc

Usual Exams (quarterly to annually) 5-HIAA 24 hr urine collection Serotonin Serum Serotonin Whole Blood Chromogranin-A (which really tells us more about the Carcinoid than the 5HIAA) Tryptophane Substance P Octreascan MRI abdominal with/without contrast Heart to rule out damage to valves from the serotonin = stress test and EKG plus the usual CBC, lipids and other tests for other reasons.

Resources [email protected] List guru is Dr Woltering Carcinoid discussion list for patients, doctors, etc 580+ members Subscribe by sending empty email to [email protected] Has 4 MDs, numerous P.A.s, and other medical professionals, this is NOT a support list. www.carcinoid.org (Carcinoid Cancer Foundation) THE source on the internet. Maintained by Dr Warner’s wife Monica who is a certified dietitian specializing in Carcinoid patients. http://www.netumoradvisor.org/index.asp Physician resource to ask questions about neuroendocrine tumors Dr Woltering is one of the advisors ...

4

8977594.doc

10/16/2008

5