Re: TO VATS or NOT TO VATS

[Guest guest]

Margaret,

Welcome! I'm glad you found the group and I hope you find the support, information and friendship here that I have.

The biopsy question is one that most of us have faced and one for which there is no one size fits all answer. You will find the full range of opinions and experiences in this group. I had an open lung biopsy in June of 2006. I had a relatively good experience with the surgery and a horrible experience with the sedation and anesthesia. Once I got past the anesthesia induced complications my recovery from the biopsy was straitforward and uneventful. I did gain information from the biopsy that has helped me. Knowing what I know now, if I had it to do over again, I would.

Others will share their experiences and their opinions. Many would not do it again and there are those that regret doing it at all. Some have experienced a deterioration in the condition post biopsy.

Only you can say whether the possible benefits outweigh the potential risks. Identifying the specific type of fibrosis can be valuable. Have you had a high resolution ct scan? An awful lot can be identified with an hrct. I do understand your dilemma and unfortunately there are no easy answers.

Once again, welcome to the board!

Beth

Moderator

Fibrotic NSIP 06/06 Dermatomyositis 11/08

To: Breathe-Support Sent: Sunday, July 19, 2009 8:27:17 PMSubject: TO VATS or NOT TO VATS

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because

steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate

it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Margaret

I'm going to walk through the decision making process as I would see it.

First, the diagnosis to this point? Who made it and how? If it's not at

a major ILD center such as one of the Centers of Excellence, then I

wouldn't proceed to make any decision yet. I'd get to one of those

centers. One further question is have you been fully evaluated for all

the connective tissue diseases.

Then armed with all the possible information from the best experts, I'd

make the biopsy decision based on numerous combinations of criteria but

most importantly, what do you hope to learn and how will that

information be used. You talk about the prednisone issue so it becomes

would you use it with some diagnoses and not with others. Many choose to

use it regardless. Some choose to say no regardless. I did have a biopsy

for just the reason you mention. I did not have the smoothest of times

or the worst of them with it. I then chose based on it not to use

prednisone. If I had a form other than UIP or a confirmed connective

tissue disease, I probably would choose to try it.

Another consideration is your own personal need to know. One is the

possibility of clinical trials and the last is transplant listing.

As to basing this choice on whether the CT shows a marked decline or

not, I'm mixed on that thought. If you felt a marked decline today,

would you be more likely to try prednisone? I do understand not wanting

to upset the apple cart, but I also think being in the best health you

can be when you have the biopsy is advantageous. Furthermore, if you did

find through the biopsy you have NSIP for instance, would you want to

wait for it to get worse before trying an often effective treatment?

>

> HI all. I've been out here listening and watching your comments for

sometime. I find the site helpful, informative and interesting.

>

> I am a 58 year of woman with diabetes, acid reflux disease, High blood

pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not

confirmed.) I have been on O2 24/7 since 02/01/09. I am still working

and amazingly mobile ( with the help of my husband) and self reliant in

most things. Working is getting more difficult and I will probably give

it up this fall or winter.

>

> The Pulmonary Fibrosis DX has not been confirmed because I balked on

having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying

although there are some additional risks for me they are 90% sure they

can do the scope procedure and feel it is important to have it done so

they can determine weather I have the type of fibrosis that will respond

to steroid treatment. They will not start me on steroids without the

procedure because steroids will definitely push me into insulin

dependancy, and will wreck havoc with my sugar levels.

>

> At this time I am extremely happy with my progress on O2,and feel so

much better that I have in the past year that I am not inclined to rock

the boat.

>

> On my next visit to the surgeon if the 3 month followup catscan show I

am pretty much holding my own, I do not intend to have the biopsy. Not

because of the surgical risk, but because of previous experience with

steroid side effects. A bacterial infection treated with steroids in

2002 is the reason I am diabectic now. I want to put off the use of

insulin as long as possible. Of course if the catscan shows a rapid or

marked decline, I will have to reconsider.

>

> I do not know if this is a wise or foolish decision, but I am very

concerned about quality of life over quantity.

>

> If any of you are interested in commenting or relating your

experience, I would much appreciate it.

>

> Thanks,

>

> Margaret, Chandler, AZ

>

[Guest guest]

Hi Margaret- I had the VATS in May and am still not up to par. I had a very bad experience with it. After the surgery my lungs wouldn't work and I ended up in pulmonary ICU at ST. ph's in Phoenix FOR DAYS. I had to be intibated and then masked and it was a horrid experience and frankly if I had to do it again I would not do it. They learned nothing that they did not all ready kinow. they did rule out sclera Derma but had I not had it it would have ruled out itself in time. Some people have an easy time but I did not. I think that just continuing and having cat scans every so often would have proved as informative as my having the Vats. Joyce Eudy AZ birds By the way if you decide on the vats I do recommend St. ph's hospital. My treatment their was phenominal. If you'd like the name of my surgeon let me know because he was great too.

TO VATS or NOT TO VATS

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Hi Margaret.... welcome to our board. The best place you can be as we fight our common disease.

Are you using O2 with a cpap at night for sleep apnea? Are you SOB (short of breath) during the day?

How was your PF dx?

I too opted out for a bio....too many other health problems, too old (71 next month) to chance not doing well after. And I opt out for prednisone except for short limited times.

Of course you know we are all different and react differently to every-med-and -other-thing.

It would seem you need all the info you can gather and know for sure what you want from a bio before having one.

......as for me....the results of bio wouldn't really matter, I still am negative about prednisone and if I were one to have serious complications (some of us do) I couldn't handle that well or my husband who has a bad heart.... so for me I opt out.

It's a big decision. Who do you have for support along with your husband? Gather all the info and then discuss and then decide.

Glad you are with us.

MamaSher; 70, IPF 3-06, OR. NasturtiumsDon't fret about tomorrow, God is already there!

TO VATS or NOT TO VATS

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Hi Margaret,

Is your hypertension, diabetes and acid reflux under control for now? I was very surprised to discover acid reflux as a possible contributor to IPF on the Mayo Clinic IPF web site. Also if you are able to control your blood pressure, and more importantly, your chances for pulmonary hypertension, your chances of living longer with IPF increase, as you may already know.

Consider asking both a gastrointerologist and indocrinologist if they and you can do anything further to maximize your health asside from IPF issues. If so, having the lung biopsy could be more worth your while.

In your shoes, I would most likely opt for a lung biopsy, especially if you will be having the less risky version via the trachea. Had I known the difficulty I would have following my wedge biopsy, I would have opted out and hopefully had had the less invasive biopsy. Like Joyce, I can say it was not easy in the least. Dr. Lasky mentioned that he had read a Japanese study which reported on such difficult recoveries. He said he had thrown the report away since he found the methodology lacking. That tells us though that there is always a risk of problems following wedge biopsies. I haven't found anything that would cause me not to have the less invasive proceedure your doctors are recommending. Even considering my own problems with biopsy, I would not discourage others from having it if doing so would bring about a different course of treatment. I dd come across a report suggesting that half of those receiving biopsies had changes in

treatment due to the biopsy. I find that finding significant.

If you are thinking about lung transplant or trial participation should your condition worsen, you may wish to talk to a pulmonologist assiciated with a research center near you.

What ever you decide, I know you can find understanding here. I wish you the very best and hope your life continues to bring you happiness.

Jerry/Mississippi/54/IPF/ April 05

Who believes that hard times help us appreciate the good times even more.

Subject: TO VATS or NOT TO VATSTo: Breathe-Support Date: Monday, July 20, 2009, 12:27 AM

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because

steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate

it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Jerry.... what is a 'wedge bio'?

MamaSher; 70, IPF 3-06, OR. NasturtiumsDon't fret about tomorrow, God is already there!

TO VATS or NOT TO VATSTo: Breathe-Support Date: Monday, July 20, 2009, 12:27 AM

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Sher,

The video assisted thorasic surgery (VATS) lung biopsy removed 2 small wedges from my left lung. However, I was told that chances were about one in three that something useful would be found that would make a difference in treatment. My first pulmonologist wanted to be "agressive" as he said.

Jerry/Mississippi/54/IPF/April 05Who believes that hard times help us appreciate the good times even more.

From: leigh.margaret <leigh.margaret@ yahoo.com>Subject: TO VATS or NOT TO VATSTo: Breathe-Support@ yahoogroups. comDate: Monday, July 20, 2009, 12:27 AM

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because

steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate

it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Just one word of caution about the biopsy done with a bronchoscope. It's very common to have the results from a transbronchial biopsy be inconclusive. They can't get the same types or quality of tissue samples that they can from the VATS or the open lung biopsy.

This biopsy method is not generally used for diagnosis of interstitial lung disease but more for cancer or other types of lung disease.

Beth

Moderator

Fibrotic NSIP 06/06 Dermatomyositis 11/08

To: Breathe-Support Sent: Monday, July 20, 2009 3:12:33 PMSubject: Re: TO VATS or NOT TO VATS

Hi Margaret,

Is your hypertension, diabetes and acid reflux under control for now? I was very surprised to discover acid reflux as a possible contributor to IPF on the Mayo Clinic IPF web site. Also if you are able to control your blood pressure, and more importantly, your chances for pulmonary hypertension, your chances of living longer with IPF increase, as you may already know.

Consider asking both a gastrointerologist and indocrinologist if they and you can do anything further to maximize your health asside from IPF issues. If so, having the lung biopsy could be more worth your while.

In your shoes, I would most likely opt for a lung biopsy, especially if you will be having the less risky version via the trachea. Had I known the difficulty I would have following my wedge biopsy, I would have opted out and hopefully had had the less invasive biopsy. Like Joyce, I can say it was not easy in the least. Dr. Lasky mentioned that he had read a Japanese study which reported on such difficult recoveries. He said he had thrown the report away since he found the methodology lacking. That tells us though that there is always a risk of problems following wedge biopsies. I haven't found anything that would cause me not to have the less invasive proceedure your doctors are recommending. Even considering my own problems with biopsy, I would not discourage others from having it if doing so would bring about a different course of treatment. I dd come across a report suggesting that half of those receiving biopsies had changes in

treatment due to the biopsy. I find that finding significant.

If you are thinking about lung transplant or trial participation should your condition worsen, you may wish to talk to a pulmonologist assiciated with a research center near you.

What ever you decide, I know you can find understanding here. I wish you the very best and hope your life continues to bring you happiness.

Jerry/Mississippi/ 54/IPF/ April 05

Who believes that hard times help us appreciate the good times even more.

From: leigh.margaret <leigh.margaret@ yahoo.com>Subject: TO VATS or NOT TO VATSTo: Breathe-Support@ yahoogroups. comDate: Monday, July 20, 2009, 12:27 AM

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because

steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate

it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Jerry ... I did'nt (don't) want to go through that and then perhaps not know anything... I like better odds than that.

MamaSher; 70, IPF 3-06, OR. NasturtiumsDon't fret about tomorrow, God is already there!

TO VATS or NOT TO VATSTo: Breathe-Support@ yahoogroups. comDate: Monday, July 20, 2009, 12:27 AM

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate it.Thanks,Margaret, Chandler, AZ

[Guest guest]

Sher,

I understand. At that time, I felt my chances for living very long at all were virtually nil. I had a more despirate feeling then than I do now. So many changes were going on in my life due to my lung problems. In my more relaxed life now, I look back and I can easily see your point. Probably the biopsy hasn't changed much about my IPF treatment so far. But I feel that I can calmly look forward to possible trials if my condition worsens. As I get older, I expect my perspective to change also.

Jerry/Mississippi/54/IPF/April 05Who believes that hard times help us appreciate the good times even more.

From: leigh.margaret <leigh.margaret@ yahoo.com>Subject: TO VATS or NOT TO VATSTo: Breathe-Support@ yahoogroups. comDate: Monday, July 20, 2009, 12:27 AM

HI all. I've been out here listening and watching your comments for sometime. I find the site helpful, informative and interesting.I am a 58 year of woman with diabetes, acid reflux disease, High blood pressure, sleep apnea, obesity and pulmonary fibrosis ( DX not confirmed.) I have been on O2 24/7 since 02/01/09. I am still working and amazingly mobile ( with the help of my husband) and self reliant in most things. Working is getting more difficult and I will probably give it up this fall or winter.The Pulmonary Fibrosis DX has not been confirmed because I balked on having a lung biopsy. I now have 2 pulmonary guys and 1 surgeon saying although there are some additional risks for me they are 90% sure they can do the scope procedure and feel it is important to have it done so they can determine weather I have the type of fibrosis that will respond to steroid treatment. They will not start me on steroids without the procedure because

steroids will definitely push me into insulin dependancy, and will wreck havoc with my sugar levels. At this time I am extremely happy with my progress on O2,and feel so much better that I have in the past year that I am not inclined to rock the boat.On my next visit to the surgeon if the 3 month followup catscan show I am pretty much holding my own, I do not intend to have the biopsy. Not because of the surgical risk, but because of previous experience with steroid side effects. A bacterial infection treated with steroids in 2002 is the reason I am diabectic now. I want to put off the use of insulin as long as possible. Of course if the catscan shows a rapid or marked decline, I will have to reconsider. I do not know if this is a wise or foolish decision, but I am very concerned about quality of life over quantity. If any of you are interested in commenting or relating your experience, I would much appreciate

it.Thanks,Margaret, Chandler, AZ