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Procedure Invented by Stanford Oncologist Featured on TV Show "House"

By Mignon Fogarty

Jeff Norton, MD
Dr. Jeff Norton, Chief of Surgical Oncology at Stanford


By the time Christine Orr heard Dr. Norton say the words, “You're going to be fine,” she was hardly in a state to believe him. Having been through two years of hell and at least four dismissive misdiagnoses, the Bay Area elementary school teacher and mother of five was still scared she was going to die.

Orr was suffering from an extremely rare form of pancreatic tumor called an insulinoma, which only strikes about one in four million people. As the inventor of two methods for localizing these tiny tumors (which usually don't show up on normal imaging scans), Dr. Jeff Norton, the Chief of Surgical Oncology at Stanford, is considered the world expert on insulinoma, and even he still only operates on about 5 to 10 patients with the disease each year.

Strange Symptoms

Although insulinomas do not metastasize and spread like more common forms of pancreatic cancer, they secrete dangerous levels of insulin into patients' blood, causing extremely low blood sugar and a confusing array of symptoms. “[Before they are diagnosed] the patients usually understand that they have to eat a lot of food, but they don't know why,” says Norton. (The food keeps their blood sugar high enough so that they can function.)

Orr's life had become just such a nightmare. “I was so sick, I would wake up every morning and wonder that I was still alive,” she says. Faced with extreme and unexplained weakness, dizziness, and difficulty thinking, she eventually discovered the only way to keep going was to consume almost unfathomable amounts of sugar. “I was like a crazy woman craving sugar,” she says. “A healthy breakfast would consist of eggs and three cartons of orange juice. At the end I was also eating three quarters of a pound of M&Ms a day; and if I didn't get them I could hardly keep my head up.”

Finally, A Diagnosis

Although this overload of sugar sounds unhealthy, for someone with as much insulin in her blood as Orr, it was essential. In fact, it was when she attempted to give up sugar and eat a healthy diet of turkey and rice that she became so ill she ended up in the emergency room and got on a path that finally led to an accurate diagnosis.

The emergency room doctor couldn't find what was wrong with Orr, but knew intuitively that it was something serious. “He told me that the next time this happened – and he was pretty sure it was going to happen again – that my husband should take me straight to Stanford,” says Orr.

But her next emergency room visit took her to the Palo Alto Medical Foundation, where a fortunately spitfire endocrinologist named Carol Clewans finally made the diagnosis of insulinoma.

Finding Dr. Norton

Yet now Orr faced a new dilemma: Dr. Clewans didn't know of any doctor who could treat an insulinoma. The family feared they would have to sell their house to cover the costs of out-of-town treatment. But then Dr. Clewans discovered that Dr. Norton had just transferred to Stanford a week earlier, and said, “If he's as great as everybody says he is, then I think you are in good hands.”

Meanwhile, Orr's husband was hitting the Internet heavy, checking out the treatments and doctors. “Sure enough, Dr. Norton's name came up on every site and every book that he checked out about insulinoma,” says Orr. Still it was terrifying. “People kept saying, you have a tumor in your pancreas, but we think you're going to be fine. And I kept asking the nurses, 'Where's my pancreas?'”

Who Better Than the Inventor?

Orr remembers meeting Dr. Norton for the first time, and hearing that he had invented a procedure called the calcium angiogram that is used to localize the nearly invisible tumor before surgery, as well as a procedure that uses ultrasound during surgery to precisely zero in on the region that needs to be removed. “He was the only hope I had,” she says.

She felt confident she was in good hands. “I know he has seen people from all over the world...but he really listens to his patients, and that is what really impressed me about him,” she says.

Encouragement in a Time of Trouble

After her surgery, Orr spent about five weeks at Stanford recovering, and gushes with praise for the nursing staff at the hospital. She had terrible vomiting and remembers, “There was an amazing nurse who would just hold my head [while I was sick].” She also recalls that as she walked through the halls, 115 pounds in her 5' 7” frame and trying to regain her strength, the nurses would speak warm words of encouragement whenever they saw her.

Although she didn't feel like it, Dr. Norton also repeatedly told her she was going to be 100% fine during his visits, and offered words of encouragement. “He's a kind, brilliant man,” she says.

Vindication From Misdiagnoses

After the surgery, and her eventual recovery, Orr savored in the satisfaction of calling the other doctors who had misdiagnosed her, and telling them that Dr. Norton had found and removed her tumor.

In fact, insulinomas present such a diagnostic challenge that the disease – and Dr. Norton's calcium angiogram – were recently featured on the television medical drama “House.”  In that show, the patient was misdiagnosed with tuberculosis.

For Orr, some doctors had believed her problems were caused by stress (and prescribed antidepressants), while others initially thought that either she had a condition called Munchausen's Syndrome (where patients harm themselves for attention), or that her husband was trying to kill her by somehow secretly injecting her with insulin.

Real-Life vs. House

Dr. David Foster, a physician who is also a writer for the show "House", based the insulinoma episode on one case he remembered from long ago from when he was training. Orr was moved to tears when she saw the episode, because it reminded her so much of her experiences, and her husband wrote to Dr. Norton to let him know that the calcium angiogram had been featured in the story.

Orr thought the show made the diagnosis and treatment seem a lot easier than it really was, and Foster concedes that it is a common challenge they face in squeezing complex medical situations into a one-hour TV show. Yet her biggest complaint is that she thinks the show doesn't do justice to real-life doctors.

“It really doesn't show the hard work that Dr. Norton went through. It showed House being the jerk that he is, but it didn't show him putting his heart into it, and doing what Dr. Norton does you have to have heart,” she says.

Posted: 05/15/06

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