Saturday, June 20, 2009

Steve's hormone imbalance

From a Jan. 5 Apple press release containing an open letter from Steve Jobs:

As many of you know, I have been losing weight throughout 2008. The reason has been a mystery to me and my doctors. A few weeks ago, I decided that getting to the root cause of this and reversing it needed to become my #1 priority.

Fortunately, after further testing, my doctors think they have found the cause—a hormone imbalance that has been “robbing” me of the proteins my body needs to be healthy. Sophisticated blood tests have confirmed this diagnosis.

The remedy for this nutritional problem is relatively simple and straightforward, and I’ve already begun treatment. But, just like I didn’t lose this much weight and body mass in a week or a month, my doctors expect it will take me until late this Spring to regain it. I will continue as Apple’s CEO during my recovery.
From an exclusive story in Saturday’s Wall Street Journal:
Steve Jobs, who has been on medical leave from Apple Inc. since January to treat an undisclosed medical condition, received a liver transplant in Tennessee about two months ago. The chief executive has been recovering well and is expected to return to work on schedule later this month, though he may work part-time initially.

Mr. Jobs didn't respond to an email requesting comment. "Steve continues to look forward to returning at the end of June, and there's nothing further to say," said Apple spokeswoman Katie Cotton.

When he does return, Mr. Jobs may be encouraged by his physicians to initially "work part-time for a month or two," a person familiar with the thinking at Apple said. That may lead Tim Cook, Apple's chief operating officer, to take "a more encompassing role," this person said. The person added that Mr. Cook may be appointed to Apple's board in the not-too-distant future.

At least some Apple directors were aware of the CEO's surgery. As part of an agreement with Mr. Jobs in place before he went on leave, some board members have been briefed weekly on the CEO's condition by his physician.
From an earlier Bloomberg exclusive, January 16:
Apple’s Jobs Said to Be Considering Liver Transplant
By Connie Guglielmo, John Lauerman and Dina Bass

Jan. 16 (Bloomberg) -- Apple Inc. Chief Executive Officer Steve Jobs is considering a liver transplant as a result of complications after treatment for pancreatic cancer in 2004, according to people who are monitoring his illness.

Patients with Jobs’s condition can survive for 20 years or more from the time of their original cancer diagnosis, and the surgery often gives good results, said Steven Brower, professor and chairman of surgery at Mercer University School of Medicine in Savannah, Georgia. Brower hasn’t treated Jobs and doesn’t know details of his condition.

Jobs, who appeared increasingly thin and frail throughout 2008, hasn’t provided details about his condition. In a statement released Jan. 5, Jobs said he was suffering from a “hormone imbalance” and that the remedy for his weight loss was “relatively simple.” On Jan. 14, he announced that he was taking a five-month medical leave because his health issues were “more complex” than he originally thought.

In a telephone interview today, Jobs said he won’t comment further on his health.

“Why don’t you guys leave me alone -- why is this important?” Jobs said.

Apple spokesman Steve Dowling declined to comment. The company’s board members -- including Intuit Inc. Chairman Bill Campbell, former U.S. Vice President Al Gore and Google Inc. CEO Eric Schmidt -- either couldn’t be reached or declined to comment.


Jobs said in 2004 that he underwent surgery to remove a neuroendocrine islet cell tumor, a rare, slow-growing type of cancer that affects as many as 3,000 people in the U.S. annually. These tumors are distinguished by their tendency to overproduce hormones such as insulin. Excess hormones can lead to low blood sugar, low blood pressure or other symptoms.

Neuroendocrine tumors that originate in the pancreas, as Jobs’s did, often spread to the liver. One option doctors have in these cases is to perform a liver transplant, Brower said.

“It’s one of the tumors for which transplantation can be considered,” said Brower, who is a member of the American Society of Clinical Oncology. “It’s rare, but it’s sometimes done.”

Jobs underwent extensive abdominal surgery when his tumor first appeared. He may have undergone a Whipple procedure, in which parts of his pancreas, small intestine, stomach and bile duct would have been removed, to try to rid his body of all cancerous tissue. The pancreas often ceases functioning after such surgery and needs to be removed.

Treatment Outcome

Brower said the transplant might work out well in a patient whose neuroendocrine cancer began in the pancreas, in part because this tumor type often spreads only to the liver and grows so slowly. Even after having had a Whipple procedure, a patient might expect to have good quality of life, he said.

“The outcome can be quite good,” he said. “With immunosuppressive drugs, the patient can expect to have a significant, durable life expectancy.”

Some liver transplant patients get part of an organ from a living donor. After the operation, the livers of the donor and recipient grow back to normal size.

A patient getting a liver transplant for a neuroendocrine tumor that has spread from the pancreas might get a partial organ, Brower said. Complete organs that come from cadavers are in short supply, and are generally reserved for patients with liver failure, cirrhosis or certain kinds of liver cancer, he said.
From USA Today, January 26, 2006:
Doctors have found ways to extend the lives of patients who have liver and pancreatic tumors, two of the most difficult cancers to treat.

At a meeting Friday in San Francisco of four leading medical societies, researchers noted that liver transplants can be lifesaving for some liver cancer patients.
Yet few patients — only 21% — are lucky enough to receive liver transplants ...

Liver transplants are rare partly because not enough organs are available. There were 6,169 liver transplants in the USA in 2004, according to the United Network for Organ Sharing. Nearly 2,000 people await transplants every year, says Robert Merion, a University of Michigan professor and transplant surgeon who was not part of the study.
Doctors from Germany also announced at the San Francisco meeting that certain drugs can help pancreatic patients live slightly longer. Pancreatic cancer afflicts 32,180 people a year and kills 31,800, the cancer society says.
From the University of Maryland Medical Center:
Transplant Center
Liver Transplant Program

Patients with end stage liver disease who have failed standard medical and surgical therapy can be considered for liver transplantation. Signs and symptoms of end stage liver disease include jaundice, ascites, edema, variceal bleeding, low platelet count, fatigue, severe itching and worsening mental confusion. A number of acute and chronic diseases of the liver can result in end stage liver disease. Appropriate patient selection is paramount to the overall success of liver transplantation.

Due to limited availability of donor livers, the procedure is contraindicated for patients who are unlikely to survive the procedure or receive long-term benefit. Patients are considered individually and their candidacy is assessed by a formal multidisciplinary evaluation process.
I’ve tried to give Apple and Jobs the benefit of the doubt, but it appears that Apple and/or Jobs released intentionally misleading information up through his January 14 announcement of a 5½ month medical leave.

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