tag:blogger.com,1999:blog-21091448686346933642024-03-05T02:32:24.345-08:00Gallant StridesA blog about anything and everything relating to humanity and the pursuit of making the world a better place, with a particular focus on chronic illness.Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-2109144868634693364.post-85605293258489450732012-12-09T16:32:00.000-08:002012-12-09T16:33:26.927-08:00I had brain surgery, what's your excuse? My Review<a href="http://www.goodreads.com/book/show/334546.I_Had_Brain_Surgery_What_s_Your_Excuse_" style="float: left; padding-right: 20px"><img alt="I Had Brain Surgery, What's Your Excuse?" border="0" src="http://d.gr-assets.com/books/1349072158m/334546.jpg" /></a><a href="http://www.goodreads.com/book/show/334546.I_Had_Brain_Surgery_What_s_Your_Excuse_">I Had Brain Surgery, What's Your Excuse?</a> by <a href="http://www.goodreads.com/author/show/43615.Suzy_Becker">Suzy Becker</a><br/>
My rating: <a href="http://www.goodreads.com/review/show/473972356">3 of 5 stars</a><br /><br />
I found the earlier parts of the book somewhat irksome and it took me a little while to identify with the author, who I initially viewed as a bit melodramatic. However, it is likely that each of us experience health concerns in our own unique ways, and I am one who prefers to remain positive instead of thinking that I’m going to drop down dead at any instant, despite the severity of a disorder. <br /><br />Another irritation was her lack of knowledge of pituitary disease, which resulted in her flippant rejection of pituitary tumors as being “real tumors” (page 67), simply because some of them can now be removed through the nose due to their location via improved technologies. Within the same calendar year, I underwent a transsphenoidal resection for a pituitary tumor AND a craniotomy for another separate lesion in my temporal lobe. Although neither operation is without risk, I admit that the latter surgery was more challenging in terms of both hospital recovery and surgical risk. Nevertheless, my pituitary disease has proved to be far more problematic and debilitating than the TL lesion, which merely necessitates anti-seizure medication at the present time. I understand that Becker was trying to affiliate with someone who has a tumor “with some odds of being malignant” but her dismissive attitude can be viewed as offensive to those with pituitary tumors. Another point to note is that all tumors have the potential to grow and to cause damage in the brain, and malignancy isn’t the only fact to consider. The location and type of tumor is also important due to the fact that different parts of the brain are used for higher cognitive functioning. Also, some pituitary tumors can grow as large as a plum before a diagnosis has been made, and some may secrete too much or too little of a critical hormone, which can cause a myriad of physical and psychological problems or even death (e.g. cortisol).<br /><br />That being said, as a whole, the book is very readable and the author deserves credit for portraying such a distressing personal journey with a great deal of frankness and entertainment value. I also appreciate the fact that Becker included a few useful tidbits throughout the narrative, such as information about a clinical paper (page 242) regarding mild brain damage. It is also good to know that by the end of the book she is recovering well and is able to resume her career and many of her other life passions. <br /><br />I’m not sure if I would recommend the book to anyone I know in particular, but I will certainly find a place on my bookshelf on which to keep it, if not only to remind me of the hilarious title!<br />
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<a href="http://www.goodreads.com/review/list/4616820-di">View all my reviews</a>
Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com1tag:blogger.com,1999:blog-2109144868634693364.post-47621895061609047852012-07-30T15:18:00.000-07:002012-07-30T15:18:10.471-07:00The DHEA Breakthrough: Look younger, live longer, feel better: My Review<a href="http://www.goodreads.com/book/show/1512845.The_DHEA_Breakthrough" style="float: left; padding-right: 20px"><img alt="The DHEA Breakthrough" border="0" src="http://photo.goodreads.com/books/1320434235m/1512845.jpg" /></a><a href="http://www.goodreads.com/book/show/1512845.The_DHEA_Breakthrough">The DHEA Breakthrough</a> by <a href="http://www.goodreads.com/author/show/706475.Stephen_A_Cherniske">Stephen A. Cherniske</a><br/>
My rating: <a href="http://www.goodreads.com/review/show/380477454">3 of 5 stars</a><br /><br />
Although somewhat outdated and a little oversimplified in parts, Stephen Cherniske, does provide some useful information about the therapeutic potential of DHEA when used in conjunction with a healthy lifestyle, such as good nutrition, stress reduction techniques, exercise and supplementation to increase energy and to protect bone and joint health. One must note, however, that many findings are not based on any long-term double blind clinical studies, which Cherniske does objectively declare throughout the book.<br /><br />It is incorrect that by the age of 50, growth hormone production in most individuals is too low to measure, as stated on page 57. Indeed, recent work demonstrates that some patients around this age actually suffer from adult growth hormone deficiency - due to pituitary gland damage - and thus require prescription supplementation via daily injections (obviously, not all people of this age are shown to be deficient via GH stimulation testing). <br /><br />I also wonder where the author draws his evidence for stating that women were the primary inventors up until recently. Although he may have used some ethnographic evidence, one cannot apply such a sweeping notion to the whole of the Paleolithic and Mesolithic periods. Indeed, the statement on p 107, “the first tools, it turns out, were not the weapons of men but the implements of women, which clothed, fed, and transported us through the ages.” is not backed up with any anthropological/archaeological credibility. Indeed, the first archaeological evidence we have for tools relate to those created by our predecessor Homo habilis, and not by modern humans at all. Additionally, many experiments and modern analyses conducted on Paleolithic stone tools have shown that many may have been used for butchering purposes. This would suggest a hunting or more male dominated role. Similarly, the subsequent Mesolithic period (following the last Ice Age) shows that modern humans invented a whole new stone tool tradition (called microliths), where tiny tools were adapted and utilized in order to hunt smaller woodland animals (e.g., deer). I could go on but I am veering off course. However, the author really needs to be more precise about what he is referring to. <br /><br />All that aside, Cherniske has provided some compelling arguments about why one should consider DHEA as an important facet of good health and longevity. I, for one, shall be discussing this issue with my endocrinologist at my next appointment.<br /><br />
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<a href="http://www.goodreads.com/review/list/4616820-di">View all my reviews</a>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com1tag:blogger.com,1999:blog-2109144868634693364.post-91623091356659788862012-04-10T00:26:00.001-07:002012-04-10T01:12:33.380-07:00Smoking & Health: Just the Facts!<br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><o:p><br /></o:p></span></div>
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><o:p> </o:p><b><span style="color: #660066; font-size: 12pt;">"Sometimes I just sit in front of a mirror
and watch myself inhaling that poison gas. If I was in a concentration camp and
someone tried to make me do that, I'd want to kill them."</span></b></span></div>
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<span class="apple-style-span"><i><span style="color: #404040; font-size: 8pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">http://smokeforwhat.com/no-smoking-quotes.php</span></span></i></span><span class="apple-style-span"><b><span style="color: #660066; font-size: 8pt;"><o:p></o:p></span></b></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">Everyone
knows that smoking is bad for one's health. The intention of this post is not to
get on my podium and rant about the contentious issues that have long been smoldering
between smokers and non-smokers, and I apologize in advance for any
unintentional conflict that may ensue. Instead, I merely aim to present some
basic facts about smoking in order to help those wishing to make informed decisions
about protecting their health from unsafe exposure.<o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><b>Is smoking
really as dangerous as <i>they</i> say?</b><o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">A preliminary
study in 1950 by epidemiologists Richard Doll and Austin Bradford Hill showed a
strong and real association between smoking and lung cancer. The study also
indicates that the more one smokes, the higher the risk of developing carcinoma
of the lung. Further, the act of smoking appears to cause the same amount of
harm whether the smoke is being inhaled or not!<o:p></o:p></span></span></div>
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<span class="apple-style-span"><b><span style="color: #281971; font-family: Arial;">Above the age of 45, the risk of
developing [lung cancer] increases in simple proportion with the amount
smoked, <o:p></o:p></span></b></span></div>
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<span class="apple-style-span"><b><span style="color: #281971; font-family: Arial;">and that it may be approximately 50
times as great among those who smoke 25 or more cigarettes a day as among
non-smokers.<o:p></o:p></span></b></span></div>
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<span class="apple-style-span"><i style="mso-bidi-font-style: normal;"><span style="color: #281971; font-family: Arial; font-size: 8pt;">~ Doll
& Hill, 1950, p747<o:p></o:p></span></i></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">In 1951,
the British doctors study began, which charted the smoking habits and health
conditions of about 40,000 physicians over a period of about 50 years. The first
report appeared in 1954, which confirmed an increase in mortality with the
amount smoked, with a significantly increased likelihood of lung cancer death
amongst those who smoked 25 or more cigarettes a day. The report also proved
that there was an increased risk of death from coronary thrombosis as the amount
of cigarettes smoked increased. <o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">The
results of many decades’ follow-up were published in a final paper in 2004,
which confirmed that the hazards of long term smoking had previously been
significantly underestimated. About a half of the people who continue to smoke
may ultimately die from their addiction. Typically, cigarette smokers shorten
their lives by about 10 years. The risks continue to be high with low tar
cigarettes.<o:p></o:p></span></span></div>
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<span class="Apple-style-span" style="color: navy;"><span class="Apple-style-span" style="font-size: 15px;"><b><u><br /></u></b></span></span></div>
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<span class="apple-style-span"><b><span style="font-family: Arial;"><span class="Apple-style-span" style="color: red;">On
average, cigarette smokers die about 10 years younger <o:p></o:p></span></span></b></span></div>
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<span class="apple-style-span"><b><span style="font-family: Arial;"><span class="Apple-style-span" style="color: red;">than
non-smokers</span><span class="Apple-style-span" style="color: grey;"><o:p></o:p></span></span></b></span></div>
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<span class="apple-style-span"><b><span style="font-family: Arial;"><span class="Apple-style-span" style="color: #351c75;">The
risk of being killed by tobacco is doubled with persistent smoking</span><span class="Apple-style-span" style="color: grey;"><o:p></o:p></span></span></b></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">Other
cancers that are linked to smoking are mouth, larynx, oesophagus, kidney,
pancreas, uterus and bladder. Studies also suggest that smoking causes heart
disease as well as numerous other diseases. The World Health Organisation (WHO)
estimate that in 2025 to 2030 there will be 7 million tobacco deaths. Half are
likely to die in middle age, between 35 and 69 years old. <o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><b>Secondhand smoke</b><o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">Secondhand
smoke (also known as passive smoking) can also have serious consequences on the
health of children and adults who do not smoke, as it contains many of the same
chemicals as the smoke that is breathed in by smokers. Secondhand smoke
involves the inhalation of the smoke released either directly from a burning
cigarette or from the smoke exhaled by the smoker. It holds a poisonous
cocktail of at least 4,000 chemicals (e.g., arsenic used in pesticides,
formaldehyde used to embalm dead bodies, and hydrogen cyanide used in chemical
weapons), many of which cause a variety of major medical disorders. In fact, because
it is created through different temperatures and conditions, the smoke that
comes off a cigarette between puffs may even contain more toxins than directly
inhaled smoke.<o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">Experts
agree that there is no safe level of exposure to secondhand smoke. Even brief contact
can increase the risk of heart attack and lung cancer. According the the U.S.
Surgeon General, a nonsmoker’s risk of getting heart disease is likely to be increased
by 25 to 30 percent by secondhand smoke, and the risk of developing lung cancer
in nonsmokers is increased by 20 to 30 percent. Endeavoring to smoke in a
separate area from family or ventilating the home are not successful methods at
removing these dangers. The only way to protect yourself and your loved ones to
is keep your environment smoke-free.</span></span><span style="font-family: Arial; font-size: 11pt;"><o:p></o:p></span></div>
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<span class="apple-style-span"><b><span style="color: #17365d; font-family: Arial;">Exposure
to secondhand smoke at home or at work increases a nonsmoker’s risk of
developing heart disease by 25 to 30 percent <o:p></o:p></span></b></span></div>
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<span class="apple-style-span"><b><span style="color: #17365d; font-family: Arial;">and
lung cancer by 20 to 30 percent<o:p></o:p></span></b></span></div>
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<span class="apple-style-span"><i style="mso-bidi-font-style: normal;"><span style="color: #17365d; font-family: Arial; font-size: 8pt;">~ U.S. Surgeon General’s Report 2006<o:p></o:p></span></i></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><b>No if’s, ands, or <i style="mso-bidi-font-style: normal;">butts</i>
- It’s never too late to burn that habit!</b><o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">Good
news! The follow-up 2004 Britsh doctors study showed that there is decreased
risk of dying prematurely when cigarette smoking is stopped… And the most benefit can be gained by
stopping sooner rather than later. If you need help in quitting, you may wish
to visit your general physician for appropriate advice and resources or you can
refer to some of the links below. <o:p></o:p></span></span></div>
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<span class="apple-style-span"><b><span style="color: #984806; font-family: Arial;">Cessation
at age 60, 50, 40, or 30 years gained, <o:p></o:p></span></b></span></div>
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<span class="apple-style-span"><b><span style="color: #984806; font-family: Arial;">respectively,
about 3, 6, 9, or 10 years of life expectancy.<o:p></o:p></span></b></span></div>
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<span class="apple-style-span"><i style="mso-bidi-font-style: normal;"><span style="color: #984806; font-family: Arial; font-size: 8pt;">~ Doll et. al., 2004, p1<o:p></o:p></span></i></span></div>
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<span style="font-family: Arial; font-size: 11pt;"><b>Sources/links</b><o:p></o:p></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2038856/pdf/brmedj03566-0003.pdf">Doll, R., and Hill, A. 1950. Smoking and carcinoma of the lung: Preliminary report. BMJ 1950;739-748:4682</a><o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2085438/pdf/brmedj03396-0011.pdf">Doll, R., and Hill, A. 1954. The mortality of doctors in relation to their smoking habits: A preliminary report. BMJ 1954, 1451-1455</a><o:p></o:p></span></span></div>
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<a href="http://www.blogger.com/goog_1600179314"><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">Doll, R., Peto, R., Boreham, J., Sutherland, I. 2004.
Mortality in relation to Smoking: 50 years’ observation on male British
doctors. </span></span><i><span style="font-family: Arial; font-size: 11pt;">BMJ</span></i></a><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.bmj.com/content/328/7455/1519.full"> 2004;328:1519</a><span style="color: #262626;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial; font-size: 11pt;"><a href="http://www.surgeongeneral.gov/library/secondhandsmoke/">The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 2006.</a><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;"><a href="http://healthmad.com/health/horrible-facts-about-smoking/">Horrible Facts About Smoking</a><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;"><a href="http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm">How to Quit: Government Resources</a><o:p></o:p></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><a href="https://www.quitnow.net/Program/About/">Quit For Life Program</a><o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><a href="http://QuitSmoking.com/">QuitSmoking.com</a><o:p></o:p></span></span></div>
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<span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.who.int/tobacco/en/atlas11.pdf">The World Health Organisation (WHO) Report</a><o:p></o:p></span></span></div>
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<br /></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com2tag:blogger.com,1999:blog-2109144868634693364.post-17570726879749270222012-03-15T16:26:00.000-07:002012-03-15T16:26:19.994-07:00The History of Medicine: A Very Short Introduction: My Review<a href="http://www.goodreads.com/book/show/5042035-the-history-of-medicine" style="float: left; padding-right: 20px"><img alt="The History of Medicine: A Very Short Introduction" border="0" src="http://photo.goodreads.com/books/1267271588m/5042035.jpg" /></a><a href="http://www.goodreads.com/book/show/5042035-the-history-of-medicine">The History of Medicine: A Very Short Introduction</a> by <a href="http://www.goodreads.com/author/show/1110783.W_F_Bynum">W.F. Bynum</a><br/>
My rating: <a href="http://www.goodreads.com/review/show/162565260">5 of 5 stars</a><br /><br />
This book was the recommended course textbook for the University of Oxford’s “History of Medicine” introductory program. Don’t be fooled by its tiny size – It’s jam-packed full of well-researched information pertaining to the history of Western medicine, beginning with the ancient Greeks of the fifth century BCE and continuing up to the present day. Bynum methodically breaks down the chronology by way of examining five kinds of medicine: Bedside, Library, Hospital Community and Laboratory, and his assessments are provided in a well-written and instructive manner. I highly recommend this book to anyone who has a starting interest in the subject.
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<a href="http://www.goodreads.com/review/list/4616820-di">View all my reviews</a>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-6500541298913759742011-10-26T10:38:00.000-07:002011-10-26T10:38:19.289-07:00After the Diagnosis: My Review<a href="http://www.goodreads.com/book/show/8520574-after-the-diagnosis" style="float: left; padding-right: 20px"><img alt="After the Diagnosis: Transcending Chronic Illness" border="0" src="http://photo.goodreads.com/books/1289347304m/8520574.jpg" /></a><a href="http://www.goodreads.com/book/show/8520574-after-the-diagnosis">After the Diagnosis: Transcending Chronic Illness</a> by <a href="http://www.goodreads.com/author/show/518834.Julian_Seifter">Julian Seifter</a><br/><br />
My rating: <a href="http://www.goodreads.com/review/show/227723461">5 of 5 stars</a><br /><br /><br />
I loved this book and found it difficult to put down! After the Diagnoses is written by a doctor battling with his own chronic condition (diabetes). He examines the challenges involved with chronic illness and includes thoroughly enjoyable stories pertaining to real life patient case histories. The book is packed with compassion, insight and humor and is a fascinating read. I would recommend this book to anyone who is concerned with chronic illness, including patients and their loved ones, physicians and medical students.<br />
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<a href="http://www.goodreads.com/review/list/4616820-di">View all my reviews</a>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com1tag:blogger.com,1999:blog-2109144868634693364.post-60944992907014347962011-10-01T17:01:00.000-07:002011-10-01T17:01:54.294-07:00Talking Back to Prozac: My Review<a href="http://www.goodreads.com/book/show/8283267-talking-back-to-prozac" style="float: left; padding-right: 20px"><img alt="Talking Back to Prozac" border="0" src="http://ecx.images-amazon.com/images/I/51ZCj8WZVuL._SX106_.jpg" /></a><a href="http://www.goodreads.com/book/show/8283267-talking-back-to-prozac">Talking Back to Prozac</a> by <a href="http://www.goodreads.com/author/show/941317.Peter_R_Breggin">Peter R. Breggin</a><br/><br />
My rating: <a href="http://www.goodreads.com/review/show/217745862">4 of 5 stars</a><br /><br /><br />
A thoroughly enjoyable read, rich with useful information. The book provides a helpful explanation about how antidepressants affect the brain and compares the dangers or “side effects” of these drugs to those of amphetamines. I found the data to be a real eye opener, especially when discussing the dubious protocols that were used for FDA approval, and the lack of pertinent facts that are accessible to medical providers to enable them to make reasonable judgments in their prescribing practices. The book contains many typographical errors though, which slightly spoils its credibility. <br />
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<a href="http://www.goodreads.com/review/list/4616820-di">View all my reviews</a>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-31603805849294201692011-06-16T12:33:00.000-07:002011-06-16T12:33:49.203-07:00PNA Webinar: Prolactinoma: A Patient's Perspective<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_ikr9bveNGnkDOljlSa2a4gVxEXPG-dVlxar3ZhPaINCpK-bnd9mUNag5hVB1KU7DdhbOwaF4eGHSk4aBZ-wnltcbW-HngQlLrd4tJzFjaKUhvqMfvadyV1tTtHj2VcHip7uTWr8Q6ec/s1600/GS+012+PNA+Webinar+Completed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_ikr9bveNGnkDOljlSa2a4gVxEXPG-dVlxar3ZhPaINCpK-bnd9mUNag5hVB1KU7DdhbOwaF4eGHSk4aBZ-wnltcbW-HngQlLrd4tJzFjaKUhvqMfvadyV1tTtHj2VcHip7uTWr8Q6ec/s320/GS+012+PNA+Webinar+Completed.jpg" width="320" /></a></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 16px;"><br />
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<span class="Apple-style-span" style="font-family: Arial; font-size: 16px;">The Pituitary Network Association (PNA) is offering a free webinar relating to prolactinomas. Further information about the event and registration details are as follows:</span><br />
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<tr> <td style="padding: 0in 5.4pt 0in 5.4pt; width: 476.05pt;" valign="top" width="635"><div class="MsoNormal"><span class="apple-style-span"><b><span style="color: black; font-family: Arial;">Title:</span></b></span><span class="apple-style-span"><span style="color: black; font-family: Arial;"> Prolactinoma: A Patient's Perspective</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><b><span style="color: black; font-family: Arial;">Date:</span></b></span><span class="apple-style-span"><span style="color: black; font-family: Arial;"> Thursday, June 23, 2011<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><b><span style="color: black; font-family: Arial;">Time:</span></b></span><span class="apple-style-span"><span style="color: black; font-family: Arial;"> 12:00 PM – 1:00 PM PDT<o:p></o:p></span></span></div><div class="yiv1909589285msonormal" style="margin-bottom: .0001pt; margin: 0in;"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><b><span style="color: black; font-family: Arial;">Details</span></b></span><span class="apple-style-span"><span style="color: black; font-family: Arial;"><o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><span style="color: black; font-family: Arial;">Many pituitary patients have had the frustrating, demoralizing experience of suffering physical and mental health issues - that are then dismissed or improperly treated by doctors who are supposed to show compassion and find the answers. Christina O'Neil-Bourne's story is unique, but it is also similar to that of many patients worldwide. Ms. Bourne is not only talented and beautiful (a former </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">Miss Nevada</span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">), she will also present a captivating story we all can learn from!<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><em><b><span style="font-family: Arial; font-style: normal;"><span class="Apple-style-span" style="color: white;">The Webinar Presenter</span><o:p></o:p></span></b></em></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><strong><span style="color: black; font-family: Arial;">Christina O'Neil-Bourne, M.M.E.</span></strong><span style="color: black; font-family: Arial;"><br />
<span class="apple-style-span">Music Teacher</span><br />
<span class="apple-style-span">PNA Board Member</span><br />
<span class="apple-style-span">Pituitary Patient</span></span><em><b><span style="color: black; font-family: Arial;"><o:p></o:p></span></b></em></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><span style="color: black; font-family: Arial;">Christina O'Neil-Bourne holds both a bachelor's and master's degree in Music Education. She teaches general music and band for the</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">Carson City School District</span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">. Christina was named</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">Carson City School District Teacher</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">of the Year 2009, and</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">Carson City</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">Rotary Teacher of the Year 2010. She was awarded the President’s Volunteer Service Award by </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">President George W. Bush</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">in 2003 for her efforts.<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><span style="color: black; font-family: Arial;">Christina is a former</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">Miss Nevada</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">and competed in the</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">Miss America Pageant</span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">. She volunteers her time for organizations aimed at bettering the lives of others through education.<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><span style="color: black; font-family: Arial;">In 2005, Christina was diagnosed with a</span></span><span class="apple-converted-space"><span style="color: black; font-family: Arial;"> </span></span><span class="yshortcuts"><span style="color: black; font-family: Arial;">pituitary tumor</span></span><span class="apple-style-span"><span style="color: black; font-family: Arial;">. For nearly two years, she struggled to find a doctor to help her. She found the PNA website and within months was able to get the medical attention she so desperately needed. Thanks to the PNA, she is now able to live an active and healthy life.<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><em><b><span style="font-family: Arial; font-style: normal;"><span class="Apple-style-span" style="color: white;">Presentation Description</span><o:p></o:p></span></b></em></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: Arial;">The webinar<span class="apple-converted-space"> </span><strong>Prolactinoma: A Patient’s Perspective</strong>, will be hosted by Christina O'Neil-Bourne, M.M.E. She will share the story of her struggle with a prolactinoma, and also provide information on how she has coped with the effects of<span class="apple-converted-space"> </span><span class="yshortcuts">pituitary disease</span><span class="apple-converted-space"> </span>on her physical appearance, mental health, and relationships.<br />
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• Introduction: Christina O'Neil-Bourne<br />
• Personal story<br />
• Discussion of physical, mental, and relationship changes<br />
• Discussion of how she coped with these changes<br />
• Life today<br />
• Advice for others</span><span style="color: black; font-family: Arial; font-size: 13.5pt;"><o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><strong><span style="color: black; font-family: Arial;">For those who have not registered,</span></strong><span style="color: black; font-family: Arial;"><br />
<span class="apple-style-span">please reserve your</span><span class="apple-converted-space"> </span><em>free</em><span class="apple-converted-space"> </span><span class="apple-style-span">webinar seat now at:</span></span></div><div class="MsoNormal"><span style="color: black; font-family: Arial;"><span class="apple-style-span"></span><span class="apple-style-span"><b><span style="color: black; font-family: Arial;"><a href="https://www3.gotomeeting.com/register/510361454" target="_blank"><span style="color: white;">https://www3.gotomeeting.com/register/510361454</span></a></span></b></span><b><br />
</b></span></div><div class="MsoNormal"><strong><span style="color: black; font-family: Arial;">Space is limited.</span></strong><span class="apple-style-span"><span style="color: black; font-family: Arial;"><o:p></o:p></span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #783f04;"><b><span class="apple-style-span"><b><span style="color: maroon; font-family: Arial;">After registering you will receive a confirmation email containing information about joining the webinar.</span></b></span></b></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="apple-style-span"><b><span style="color: black; font-family: Arial;">System Requirements:<o:p></o:p></span></b></span></div><div class="MsoNormal"><span class="apple-style-span"><span style="color: black; font-family: Arial;">PC-based attendees<o:p></o:p></span></span></div><div class="MsoNormal"><span class="apple-style-span"><span style="color: black; font-family: Arial;">Required: </span></span><span style="color: black; font-family: Arial;">Windows® 7, Vista, XP or 2003 Server<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="yshortcuts"><span style="color: black; font-family: Arial;">Macintosh</span></span><span style="color: black; font-family: Arial;">®-based attendees<o:p></o:p></span></div><div class="MsoNormal"><span style="color: black; font-family: Arial;">Required:<span class="apple-converted-space"> </span><span class="yshortcuts">Mac OS® X</span><span class="apple-converted-space"> </span>10.4.11 (Tiger®) or newer<o:p></o:p></span></div></td></tr>
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<div class="MsoNormal"><b><span style="font-family: Arial;">Sources/links</span></b></div><div class="MsoNormal"><span style="font-family: Arial;">Pituitary Network Association (PNA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial;"><a href="http://www.pituitary.org/intro.aspx">http://www.pituitary.org/intro.aspx</a></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial;"><br />
</span></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com1tag:blogger.com,1999:blog-2109144868634693364.post-21350409193223464972010-12-02T11:19:00.000-08:002010-12-02T11:19:09.503-08:00Diabetes Insipidus & Desmopressin Shortage<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU8Qoe55Ps02yvXOsjhK2EfR362sZ5GnbquZLQ0kxpG_cgRwQpaL3-90rIyMAwOeyRtQnCsBPk2ccYE5H5K05Pj92gg5Tfe0hAjJJKfqiTFN5Y_E-ZEjV0qabVdD2EsFrU-mgATa9xKbw/s1600/Desmopressin+Shortage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU8Qoe55Ps02yvXOsjhK2EfR362sZ5GnbquZLQ0kxpG_cgRwQpaL3-90rIyMAwOeyRtQnCsBPk2ccYE5H5K05Pj92gg5Tfe0hAjJJKfqiTFN5Y_E-ZEjV0qabVdD2EsFrU-mgATa9xKbw/s320/Desmopressin+Shortage.jpg" width="320" /></a></div><br />
<div style="text-align: center;"><span class="apple-style-span"><b style="mso-bidi-font-weight: normal;"><span style="color: #993366; font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 9.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Desmopressin: Two doses a day keeps the urine away!</span></b><span style="color: #333333; font-family: Arial; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 9.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"> </span></span></div><div style="text-align: center;"><span class="apple-style-span"><b style="mso-bidi-font-weight: normal;"><span style="color: #993366; font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 9.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br />
</span></b></span></div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">I was shocked and disappointed to recently discover that there was a national shortage of desmopressin acetate, a medication commonly used to treat <b>diabetes insipidus</b> (DI). After undergoing <b>transsphenoidal surgery</b> to remove a <b>pituitary tumor</b> this year, pathology revealed that the offending mass had damaged part of my <b>pituitary gland</b>. As a result, I was diagnosed with DI and prescribed desmopressin therapy to manage my symptoms. <o:p></o:p></span></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>What is diabetes insipidus?</b><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">Although there is more than one type of DI, for the purpose of this blog post, I am referring specifically to <b>CENTRAL diabetes insipidus</b>, which can result from a head injury, infection, <b>tumor</b> or neurosurgery. DI is a relatively uncommon condition where the patient’s body is unable to retain enough water. This can result in excessive thirst and frequent urination, which is very diluted and pale or colorless instead of being the usual yellow, and does not reduce in volume even if the patient decreases fluid intake. DI symptoms can also include nocturia (the need to get up from sleep at night in order to urinate). Indeed, before being given desmopressin therapy, I often visited the bathroom about three or four times every night…. Certainly not something that is conducive to a good night’s sleep, which is necessary to aid the recovery process. Another one of my symptoms included a strong craving for icy cold water and I literally drank liters of water faster than I could chill it (thank goodness for the bags of ice cubes kept in the freezer). Although the word “diabetes” generally refers to diabetes mellitus (“sugar diabetes”), <b>diabetes insipidus</b> is not specifically related, although both conditions are characterized by extreme thirst and polyuria (excretion of considerable quantities of urine). For this reason, it is sometimes called “water diabetes”.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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<tr><td style="padding: 0in 5.4pt 0in 5.4pt; width: 476.05pt;" valign="top" width="635"><div align="center" class="MsoNormal" style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCGf8QPNNJHV_c8yr6N6dewy5MECKv3wa_QLbujXym-GWFIJTxiQ4ToxG9pE49MZBXH3W9n7agn4kpRbkZ9wqAjrxBU_Ngt6KzYB1fjVPO_hJQ_fLHc8z12H9UkA1i8jrH1Rbm4HPHnzQ/s1600/GS+011+Science+small...jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCGf8QPNNJHV_c8yr6N6dewy5MECKv3wa_QLbujXym-GWFIJTxiQ4ToxG9pE49MZBXH3W9n7agn4kpRbkZ9wqAjrxBU_Ngt6KzYB1fjVPO_hJQ_fLHc8z12H9UkA1i8jrH1Rbm4HPHnzQ/s1600/GS+011+Science+small...jpg" /></a></div><div align="center" class="MsoNormal" style="text-align: center;"><b><u style="text-underline: #99CCFF;"><span style="color: navy; font-family: "Comic Sans MS"; font-size: 18.0pt; mso-bidi-font-family: Arial; mso-bidi-font-size: 12.0pt; text-shadow: auto;">Some science behind diabetes insipidus</span></u></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><u style="text-underline: #99CCFF;"><span style="color: navy; font-family: "Comic Sans MS"; font-size: 18.0pt; mso-bidi-font-family: Arial; mso-bidi-font-size: 12.0pt; text-shadow: auto;"><br />
</span></u></b></div><div class="MsoNormal" style="text-align: justify;"><b><span style="color: navy; font-family: Arial; text-shadow: auto;">DI generally occurs because of a deficiency of an important antidiuretic hormone called vasopressin (also known as ADH), which is responsible for controlling the release of urine from the kidneys. Vasopressin is made by the hypothalamus in the brain and is stored by the pituitary gland (the master gland of the endocrine system). When the amount of water in the body becomes too low, ADH is released from the pituitary gland – This helps to maintain water by instructing the kidneys to produce less urine (and to instead return water into the bloodstream). </span></b><b><span style="color: navy; font-family: Arial; text-shadow: auto;">When there is insufficient vasopressin, the kidneys are unable to properly conserve water whilst they carry out their function of filtering blood, and too much fluid gets passed from the body in the form of diluted urine. A shortage of vasopressin is usually caused from damage to the hypothalamus or the posterior (back part) of the pituitary gland.</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="color: navy; font-family: Arial; text-shadow: auto;"> </span></b> </div></td> </tr>
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</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>The good news<o:p></o:p></b></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">The good news is that DI can usually be managed effectively with the synthetic antidiuretic hormone replacement therapy of vasopressin (desmopressin, DDAVP), which may be taken in nasal spray (</span><span style="font-family: Arial; font-size: 11pt;">intranasal)</span><span style="font-family: Arial; font-size: 11pt;">, tablet (pill), or intravenous (injection) form. The manufactured version of ADH works similarly to natural ADH in your body by preventing the kidneys from producing urine when the level of water in the body is low. When treated, DI does not cause any major problems or reduced life expectancy. However, if fluids aren’t replaced DI can cause severe dehydration and other serious conditions (especially in children, the elderly or in those who have other complicating health issues). It is therefore, important to have your electrolytes monitored to ensure that you are on the correct dose of medication and to carry an adequate supply with you when you are away from home. I have also read on many medical websites that it would be pertinent to wear a medical alert ID bracelet or necklace to inform caregivers of your condition in an emergency situation.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">I was prescribed the tablet form of DDAVP, although some patients prefer the nasal spray because it can be more quickly absorbed into the bloodstream. The spray, however, may not be suitable for some patients, such as those who have recently undergone <b>transsphenoidal</b> or sinus surgery, or for those who have a cold, as the nasal passages will likely be congested or blocked. In some cases, patients may switch to the intravenous method (e.g., those who have poor intranasal absorption or because they are undergoing surgery). Since taking desmopressin, my DI symptoms have improved dramatically and I no longer need to lug a large flask of water around with me, as if it were an oxygen tank. I am also able to enjoy a good night’s sleep and don’t seem to experience any significant or bothersome side effects (although I must admit that it is difficult to isolate some of the side effects from some other conditions and medications that I am currently encountering). <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>The bad news</b><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">The bad news is that there currently appears to be a national shortage of the drug desmopressin. The U.S.</span><span style="font-family: Arial; font-size: 11pt;"> Food and Drug Administration (FDA) recently announced that such a shortage </span><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">was due to increased demand and manufacturing delays (See <a href="http://www.hematology.org/News/2010/5782.aspx">here</a> for more information</span></span><span style="font-family: Arial; font-size: 11pt;">). Although this shortage is said to specifically relate to the intravenous (IV) form, a few patients also seem to be having trouble obtaining other types of the drug. </span><span style="font-family: Arial; font-size: 11pt;">I contacted my own pharmacy and the person I spoke to appeared oblivious to any shortages. However, I’m not overly confident in the information (or lack thereof) provided by this particular individual. Despite the fact that he had said he was a qualified pharmacist, he’d never actually heard of the medication desmopressin and was unresponsive when I asked if he would check with their supplier for availability of the drug. I did, however, directly contact Ferring </span><span style="font-family: Arial; font-size: 11pt;">Pharmaceuticals </span><span style="font-family: Arial; font-size: 11pt;">who said that desmopressin vials were indeed on back order, although the nasal spray was still available (Ferring do not have any dealings with the tablet form). <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>Summary</b><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>Diabetes insipidus</b> can be a serious medical condition and often needs to be treated with desmopressin therapy. It is important that you see your general physician if you think you may have DI. He or she will ask you about your symptoms and carry out the appropriate tests (which should include the water retention test) or refer you to an <b>endocrinologis</b>t for further examination. If you have already been diagnosed with DI and are having problems obtaining your medication, you may find it helpful to contact your own pharmacy for additional information. The Pituitary Network Association (PNA) are advocating on behalf of DI patients who are unable to obtain desmopressin and request that those in difficulty contact them accordingly (See PNA link below for more instructions). <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>Sources/links</b><o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial; font-size: 11pt;"><a href="http://emedicine.medscape.com/article/117648-overview">Cooperman, M. 2010. Diabetes Insipidus. EMedicine from WebMD</a><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.facebook.com/topic.php?uid=2210322960&topic=16266">Facebook Discussion Board “DDAVP tablet supply interruptions?”</a><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.fda.gov/drugs/drugsafety/drugshortages/ucm050792.htm">FDA Drug Shortage Website</a><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial; font-size: 11pt;"><a href="http://media.pituitary.org/newsletter/nov2010/whatsnew.htm#desmoshort">Pituitary Network Association (PNA) Newsletter November 2010</a></span><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.wolterskluwerhealth.com/pages/welcome.aspx">PPS Desmopressin Prescription Fact Sheet 2010. Wolters Kluwer Health, Inc.</a></span><span style="font-family: Arial;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial; font-size: 11pt;"><br />
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</span></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com19tag:blogger.com,1999:blog-2109144868634693364.post-37461353563361054792010-11-04T12:13:00.000-07:002010-11-04T12:13:16.531-07:00Pituitary Surgery & Sinus Infection: Why you may want to consult your ENT doctor prior to surgery<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAwBB1aJ0vV7JOqrjHdkchmv4KXGqQBxLnCRS8rDvu9XaZ1V_N2fao5HUNDd73BiTy6e3p3RJj9PTozVjQ0C33OU7hOTrnBewlxzkfeRO5YbEH_r7anJA5wRAhU2lBRrT-dQU3_cNg9vA/s1600/GS+010+Graphic+Sinusitis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAwBB1aJ0vV7JOqrjHdkchmv4KXGqQBxLnCRS8rDvu9XaZ1V_N2fao5HUNDd73BiTy6e3p3RJj9PTozVjQ0C33OU7hOTrnBewlxzkfeRO5YbEH_r7anJA5wRAhU2lBRrT-dQU3_cNg9vA/s400/GS+010+Graphic+Sinusitis.jpg" width="313" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><span class="apple-style-span"><span style="font-family: Arial;"><b><span class="Apple-style-span" style="color: #a64d79;">“</span></b></span></span><span style="font-family: Arial;"><b><span class="Apple-style-span" style="color: #a64d79;">The practice of medicine is a thinker’s art, the practice of surgery a plumber’s</span></b></span><span style="font-family: Arial;"><b><span class="Apple-style-span" style="color: #a64d79;">.”</span></b><span class="Apple-style-span" style="color: #a64d79;"> </span></span><span class="Apple-style-span" style="color: #a64d79; font-family: Arial;">~ Martin H. Fisher</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Arial; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br />
</span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt;">In my last post, I briefly mentioned some of the complications that may be associated with <b>transsphenoidal surgery</b> (see <a href="http://gallant-strides.blogspot.com/2010/10/prolactinoma-and-pituitary-surgery.html">here</a> for more information</span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt;">). Although not serious, one of the more common concerns involves a <b>sinus infection</b>, which may cause a number of bothersome symptoms such as: </span><span class="apple-style-span"><span style="font-family: Arial; font-size: 11.0pt;">facial pressure (in the eyes, nose and cheek area), stuffy nose, headache, fatigue, brain fog and thick nasal discharge</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt;">. <i>Transsphenoidal</i> means “through the sphenoid sinus” (one of the facial air spaces behind the nose), and so the neurosurgeon essentially inserts his surgical instruments (such as a microscope, endoscope, nasal speculum, and so on) through the nose and sphenoid bone, in order to access and remove the <b>pituitary tumor</b>. This procedure may lead to inflammation of the sinuses, which can ultimately block the nasal passage and inhibit the normal drainage of bacteria. These bacteria multiply and therefore frequently result in a <b>sinus infection</b>. <o:p></o:p></span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt;"><br />
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</b></span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt;"><b>Treating my sinus infection</b></span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><br />
</div><span style="font-family: Arial; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 9.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><div style="text-align: justify;">Prior to my <b>transsphenoidal surgery</b> this year, I was suitably advised of the risk of <b>sinus infection</b> and told that in such an event I should visit my general practitioner in order to get a prescription for <b>antibiotics</b>. In most cases, where the blockage is caused solely by post-op inflammation, this may be a sufficient means of relieving sinus congestion. I informed my neurosurgeon of the fact that I had already undergone three previous sinus surgeries (the last one only being carried out at the end of 2009) and he assured me that this would not pose any problems. So, when I discovered I had a sinus infection, I readily went to see my GP and completed ten days of Amoxicillin <b>antibiotics</b>, along with almost three boxes of over-the-counter Mucinex (it was only after I’d finished ingesting the second box that I discovered my GP had been remiss in establishing that Mucinex-*D* was the correct form). Unfortunately, I observed no noticeable changes in my symptoms and a follow-up appointment with my neurosurgeon reassured me that due to post-operative inflammation, it would likely take several months for the infection to clear up. My surgeon also recommended sinus rinses (such as the neti pot), and I ardently commenced with the <i>NeilMed</i> sinus rinses on a twice a day basis. For more than a month, I optimistically continued with the rinses, and although some improvement was shown, it seemed minimal.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><table bgcolor="#cc99ff" border="0" cellpadding="0" cellspacing="0" style="background: #CC99FF; border-collapse: collapse; mso-padding-alt: 0in 5.4pt 0in 5.4pt;"><tbody>
<tr> <td style="padding: 0in 5.4pt 0in 5.4pt; width: 476.05pt;" valign="top" width="635"> <div align="center" class="MsoNormal" style="text-align: center;"><b><span style="color: navy; font-family: Arial; text-shadow: auto;">If you have previously undergone sinus surgery, it may be worthwhile consulting your ENT doctor BEFORE undergoing transsphenoidal surgery.</span></b><b><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div></td> </tr>
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<div style="text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 9.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br />
</span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt; mso-bidi-font-weight: bold;"><b>The ENT doctor</b><o:p></o:p></span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt;">A fellow patient’s wife (and now friend) thoughtfully recommended an Ear, Nose and Throat (ENT) doctor who had experience in cleaning out the material from the sinus cavities following pituitary surgery. I eagerly made an appointment with him and underwent a <b>CT scan</b>, before regrettably discovering that all my previous sinus surgeries had been completely destroyed by my relatively recent <b>transsphenoidal surgery</b>. I was astounded. It seems that as my neurosurgeon entered my sinus cavity, he inadvertently crushed my septum and rearranged the superior <b>turbinate<span class="Apple-style-span" style="font-weight: normal;">s</span></b> via his speculum. Nasal <b>turbinate</b>s are bony prominences that structure the inside of the nose. My neurosurgeon had pushed them outwards, so that they ended up plugging up my sinuses. My ENT doctor therefore explained that I would need a fourth sinus surgery in order to reconstruct all the damage and alleviate my symptoms. Unfortunately, in my case it is likely that I shall need to undergo another <b>transsphenoidal surgery</b> at some point in the future (post-operative blood work suggests there is another microscopic <b>tumor</b> or residual <b>tumor</b>)…. Which will ultimately lead to yet ANOTHER sinus surgery. For now, therefore, my doctor recommended Prednisone steroids and 6 weeks of AMOX-CLAV. I am hoping that I will soon establish when my next <b>pituitary</b> surgery will likely be, so that I can make a suitable decision about when to undergo my next sinus surgery. Hopefully, both my ENT doctor and neurosurgeon can work together in taking care of both the brain and sinus issues associated with my next <b>transsphenoidal surgery</b>. I believe that such a situation should have indeed arisen with my last <b>transsphenoidal surgery</b>, and I am perturbed that my surgeon did not take extra measures to ensure that the structure of my nose facilitated normal function after undergoing such a rigorous procedure.<o:p></o:p></span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><br />
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</div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt; mso-bidi-font-weight: bold;"><b>Summary</b><o:p></o:p></span></div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><br />
</div><div class="yiv1909589285msonormal" style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 9.0pt;">This post is not intended to criticize my neurosurgeon. After all, his priorities are to remove the <b>pituitary tumor</b> safely and effectively, without causing any serious long-term damage. He is an excellent surgeon, and I am sufficiently confident in his work and hope that he will carry out my next <b>transsphenoidal surgery</b>. A family member used a clever analogy in order to describe his efforts: <b><span class="Apple-style-span" style="color: #a64d79;"><i>“He saved the house from burning in the fire, but broke down the front door in the process!” </i></span></b></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><br />
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</div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold;"><b>Further information</b><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><a href="http://gallant-strides.blogspot.com/p/glossary_15.html">Gallant Strides Glossary of Terms </a><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><a href="http://www.pituitary.org/intro.aspx">Pituitary Network Association (PNA)</a><span class="apple-style-span"><o:p></o:p></span></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><br />
</div><span style="font-family: Arial; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 9.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><a href="http://www.emedicinehealth.com/sinus_infection/article_em.htm">Sinus Infection Information from emedicinehealth</a></span><br />
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</span>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com19tag:blogger.com,1999:blog-2109144868634693364.post-63836124497771501452010-10-09T15:43:00.000-07:002010-10-19T14:52:48.124-07:00Prolactinoma and Pituitary Surgery<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-yQJd0rONA2asp13BEV7KdX2MdIG1QzHgW2uvFgtvXBiplTtB4bNvwFVKM-BNiHryDWWs7GAi6lid8dVqQtXOnrmSu8xSnLPOVGpOUJnJ0CNFiDp8rndPOg1LXrQBFNc9UivBcuLIT9w/s1600/009+Prolactinoma_Transsphenoidal+5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-yQJd0rONA2asp13BEV7KdX2MdIG1QzHgW2uvFgtvXBiplTtB4bNvwFVKM-BNiHryDWWs7GAi6lid8dVqQtXOnrmSu8xSnLPOVGpOUJnJ0CNFiDp8rndPOg1LXrQBFNc9UivBcuLIT9w/s320/009+Prolactinoma_Transsphenoidal+5.jpg" width="259" /></a></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><span class="Apple-style-span" style="color: #a64d79;"><i><b><br />
</b></i></span></span></span></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><span class="Apple-style-span" style="color: #a64d79;"><i><b>“Most of my prolactinoma patients suffer from poor health” </b></i></span></span></span></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"><span class="Apple-style-span" style="color: #a64d79;"><i><b></b>~ Nurse practitioner (undisclosed) from a specialist U.S. pituitary clinic.</i></span></span></span></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><br />
</span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">The treatment of <b>prolactin</b>-secreting <b>pituitary tumors</b> with <b>dopamine agonist</b> therapies is not always as straightforward as originally presumed. Indeed, many patients with <b>prolactinoma</b>s feel unwell, despite the fact that related symptoms such as profound fatigue, cognitive defects and malaise are often excluded from the majority of medical publications and websites. Additionally, a number of <b>prolactinoma</b> patients may be intolerant to drug therapy or are concerned about the long-term safety of <b>pharmacotherapy</b>. In fact, some specialists are even beginning to consider surgery as a feasible first line treatment for some <b>prolactinoma</b> patients.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
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</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>What is a prolactinoma?</b><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">A <b>prolactinoma</b> is a noncancerous or <b>benign pituitary tumor</b> (also called an <b>adenoma</b>) that secretes too much prolactin (also referred to as hyperprolactinemia). <span class="apple-style-span"><b>Prolactinoma</b>s are the most common type of <b>pituitary tumor</b>.</span> In women, common symptoms may include: breast milk production (lactation), irregular or total loss of menstrual periods not related to menopause, infertility, and decreased libido. Since men don’t have the full range of signs or symptoms as women and are often too embarrassed to tell their physician about symptoms such as impotence or enlargement of breast tissue, they are more likely to go undiagnosed until the tumor becomes large with higher prolactin levels. In such cases, symptoms can include headache and visual loss due to mass effect on the optic nerves or optic chiasm. For more detailed information about pituitary tumors in general, please refer to my previous posts <a href="http://gallant-strides.blogspot.com/2010/01/pituitary-disease-getting-word-out.html">here</a> and <a href="http://gallant-strides.blogspot.com/2010/05/third-annual-seattle-pituitary.html">here</a>.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
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</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>Traditional treatment for prolactinomas</b><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">When I was first diagnosed with a prolactin-secreting <b>tumor</b> in 2000 (via blood work and an MRI), my endocrinologist followed the usual protocol in prescribing <b>pharmacotherapy</b>. Surgery was never discussed as an option, and at that time I knew nothing about <b>pituitary</b> disease. Like many <b>prolactinoma</b> patients, I was initially prescribed the more cost-effective <b>dopamine agonist</b> called Parlodel® (also known as bromocriptine), but due to unbearable side effects, I soon switched to cabergoline (Dostinex®). Although I still suffered with some dizziness and nausea, I believed it in my best interest to continue with this treatment, so that the <b>tumor</b> would shrink in size and my prolactin levels would reduce. This worked reasonably well for several years until my health started to decline drastically, resulting in my inability to continue with everyday tasks, such as work, leisure activities or social events. Although I had discussed my <b>poor quality of life</b> with numerous medical professionals over the years, no one really seemed to put the pieces together - If your <b>endocrinologist</b> tells you that the <b>prolactinoma</b> is not the cause of your incapacitating symptoms, then this must surely be correct… Right? I was given a number of medications to help with chronic symptoms, such as overwhelming fatigue, post-exertional malaise and headaches, and thus began my frantic and desperate search to find the cause of my poor health situation. My eagerness to retrieve some sort of semblance of normal life led to innumerable highs and lows with various consultations and lab tests from infectious disease specialists, neurologists, sleep experts, ear nose and throat surgeons, and many more. All practically led to a dead end and I became increasingly disillusioned with the ability of the medical profession to help me get back on to the road to better health.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><br />
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<tr> <td style="padding: 0in 5.4pt 0in 5.4pt; width: 476.05pt;" valign="top" width="635"><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="color: navy; font-family: Arial;">Dopamine agonists can sometimes be ineffective <o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="color: navy; font-family: Arial;">or not tolerated, and side effects to these drugs may be so severe that patients are unable to function.</span></b><b><span style="font-family: Arial; font-size: 11pt;"><o:p></o:p></span></b></div></td> </tr>
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</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">It wasn’t until I revisited my primary health issues and did some in-depth research on <b>pituitary</b> disease that I realized how uninformed many medical professionals were about <b>pituitary tumor</b>s. I recognized that I wasn’t the only one whose life had been hijacked by the seemingly inconspicuous <b>prolactinoma</b>. For example, several PNA (Pituitary Network Association) forum members responded to my question about microprolactinomas, cabergoline and debilitating fatigue, and stated that they or their family members had suffered from a <b>poor quality of life</b> (QOL) before embarking upon <b>transsphenoidal</b> surgery in order to remove the <b>prolactinoma</b>. Also, <b>dopamine agonists</b> can sometimes be ineffective or not tolerated by patients. In some patients, side effects to these drugs are so severe that they are hardly able to function. </span><span style="font-family: Arial; font-size: 11pt;">Major side effects of such drugs include: nausea, dizziness, headache, mental fogginess, fatigue, abdominal pain and more (see <a href="http://www.drugs.com/sfx/cabergoline-side-effects.html">here</a> for more information). Further, cabergoline has been associated with cardiac valve disease in people with Parkinson’s disease (see <a href="http://www.npr.org/templates/story/story.php?storyId=6718704">here</a> and <a href="http://www.eje-online.org/cgi/content/full/159/4/363">here</a> for further details relating to cabergoline and cardiac valve disease ).</span><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"> It is believed that the smaller doses used for </span></span><span style="font-family: Arial; font-size: 11pt;">hyperprolactinemia</span><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;"> are safer, although it is not really known whether the long-term use of such drugs would cause a similar outcome. As a precaution, some doctors follow patients who require long-term treatment with cabergoline with careful echocardiographic evaluation – But not all do. In my own situation, a Doppler study revealed that I already had ”slight and physiologic insufficiency of the mitral and tricuspid valves”. I may never know for sure whether cabergoline was the cause of my valvular heart disease, but it is a serious concern in the decision of whether or not to continue <b>pharmacotherapy</b>. Women who plan to become pregnant are also advised to discontinue <b>dopamine agonists</b> (due to unknown risk of birth defects). </span></span><span style="font-family: Arial; font-size: 11pt;">Without appropriate treatment, there is the potential for regrowth of the <b>pituitary</b> mass, leading to further problems, particularly due to <b>mass effect</b>. Contrary to what many medical professionals believe (except for <b>pituitary</b> specialists), the fact that the <b>tumor</b> is no longer visible on MRI due to shrinkage, does not mean that it has gone. If a patient still requires medication to treat elevated prolactin levels then the tumor must still be functioning. Some <b>prolactinoma</b> patients may, therefore, wish to consider surgical resection as an alternative treatment. <o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><br />
</span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"></span></div><table border="1" cellpadding="0" cellspacing="0" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt;"><tbody>
<tr> <td style="background: #FFCC00; border: none; padding: 0in 5.4pt 0in 5.4pt; width: 476.05pt;" valign="top" width="635"><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="color: #ff3300; font-family: Arial;">Several PNA forum members stated that they or their family members had suffered from a poor quality of life before embarking upon transsphenoidal surgery in order to remove the microprolactinoma.</span></b><b><span style="color: #ff3300; font-family: Arial;"><o:p></o:p></span></b></div></td> </tr>
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</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>Pituitary surgery </b><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">Due to recent developments in modern technology, <b>pituitary</b> surgery is becoming more straightforward (for microadenomas that are <1 cm in size) and increasingly safer. The surgery itself takes approximately an hour to complete, with the average hospital stay only lasting a day. Surgery is done with the intention of removing the <b>tumor</b>, whilst keeping the normal <b>pituitary gland</b> intact. Most <b>pituitary tumor</b>s can be removed by <b>transsphenoidal</b> resection. This entails going through the sphenoid sinus (one of the facial air spaces behind the nose), as opposed to opening the skull to reach the <b>adenoma</b> (craniotomy). The principal approach is the direct transnasal, which involves making an opening in the back wall of the nose so that the sphenoid sinus can be directly entered. In this case, there is no need for postoperative packing, as the surgeon can use the patient’s belly fat to prevent <b>spinal fluid leakage</b>. It is also feasible to make a cut along the front of the nasal septum (transseptal) or via an incision under the lip/upper gum (sublabial), although these procedures would necessitate postoperative packing and have a longer recovery time than the direct endonasal or endoscopic approach used for transnasal surgery. The success rate for patients with microprolactinoma is extremely high and many patients who decide to undergo <b>pituitary</b> surgery feel a great deal better as a consequence.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 3.75pt; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
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</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>Some complications associated with surgery</b><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><span class="apple-style-span"><span style="font-family: Arial; font-size: 11pt;">Although many patients have been shown to do well with <b>pituitary</b> resection, success is dependent upon the amount of experience the surgeon has at carrying out <b>pituitary</b> surgical procedures. A surgeon who is well versed in such matters will generally enable a better likelihood of complete <b>tumor </b>removal and minimal complications thereafter. It is important, however, to take some things into consideration, as like all surgical procedures, this operation carries some risks. Obviously, surgery would be more complicated for some <b>macroadenomas</b> that invade the cavernous sinus. The following list is not exhaustive but it provides some of the main points:<o:p></o:p></span></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Post-operative sinus infection</b>: After undergoing three separate sinus surgeries over the past ten years (for chronic sinusitis), I was perturbed to discover that many patients experience sinus infection after <b>pituitary</b> surgery. Common symptoms include: facial discomfort, stuffy nose, headache, fatigue, brain fog and dark nasal discharge. Although some medical professionals prefer to treat the infection with medications such as prescribed antibiotics and over-the-counter Mucinex-D, not all are in agreement. Antibiotics can be problematic, as they tend to destroy good bacteria along with the bad. In my case, I took Amoxicillin for 10 days, along with almost three whole boxes of Mucinex-D, but my infection hadn’t noticeably improved. My neurosurgeon explained that due to post-operative inflammation, it would likely take several months for the infection to completely clear up. He recommended using the neti pot twice a day in order to keep the area clean. Although I didn’t specifically have a neti pot, I immediately started using the NeilMed sinus rinses, which enabled more pressure and positive results. Although I still have an infection - which has persisted since July - my symptoms are gradually improving. If you really can’t bear the thought of nursing the infection for months on end, you may choose to visit a doctor that specializes in cleaning out the material from the sinus cavities after <b>pituitary</b> surgery. <o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Damage to the pituitary gland</b>: Although normally unanticipated, such a situation is more likely to occur with <b>macroadenoma</b>s than with <b>microadenoma</b>s. In my case, I was told that damage to the gland was most probably caused by the <b>tumor</b> itself (I assume that long-term growth and shrinkage of the <b>tumor</b> eventually led to the injury). In the event that damage to the <b>anterior</b> (or front portion) of the <b>pituitary</b> has occurred, new hormone replacements may be required, including: growth hormone, cortisol and thyroid hormone. Damage to the posterior (or back part) of the <b>pituitary gland</b> may lead to diabetes insipidus (see below).<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Diabetes insipidus (DI)</b>: Diabetes insipidus occurs when there is damage to the <b>posterior</b> part of the <b>pituitary gland</b>, and as a result the kidneys are no longer able to adequately conserve water. This causes the patient to frequently urinate large volumes, which in turn leads to excessive thirst in order to prevent dehydration. DI can be diagnosed through symptom history and laboratory testing, which may include the water retention test. This test can be quite a lengthy undertaking and can take a day or even longer before any conclusions can be made. So, make sure you take some good reading material with you (but no fluids or food!) My own recent experience involved sitting in a comfortable chair and being requested to produce a urine sample and to undergo lab work every hour. Although many post-operative patients experience DI initially after surgery, it is important to be aware of your symptoms during the whole recovery period. For instance, it wasn’t until about six weeks after surgery that I was diagnosed with DI. In most cases, DI is temporary after <b>pituitary</b> surgery, and can be treated with the oral medication, DDAVP (Desmopressin). Your electrolytes should also be monitored to make sure that you are on the right dose.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> <b> </b></span></span><span style="font-family: Arial; font-size: 11pt;"><b>Electrolyte imbalance</b>: The balance of electrolytes in the human body is necessary for normal function of our cells and organs. Electrolytes include: potassium, chloride, sodium, magnesium and bicarbonate. Common symptoms of electrolyte imbalance include: confusion, nausea and vomiting. Electrolyte imbalance can be diagnosed through blood testing and can be treated with electrolyte replacement.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Cerebral spinal fluid (CSF) leak</b>: A CSF leak is an abnormal drainage of the fluid that surrounds the brain and spinal cord. Common signs and symptoms include: a positional headache (that is worse when sitting up but better when laying down), a clear watery liquid or bloody discharge from the nose, or a dripping down the back of the throat that leaves a salty taste in the mouth. Depending on the severity of the CSF, it can be resolved with as little as bed rest and a substantial intake of fluids, or as much as repeat surgery. To prevent CSF leakage, a small piece of fat (about 2 cm) is taken from the abdomen and packed into the <b>pituitary</b> cavity. <o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Meningitis</b>: This is a rare complication from <b>pituitary</b> surgery. Common symptoms include: high fever, severe headache, stiff neck, nausea or vomiting, flu-like feeling, confusion and difficulty concentrating. Meningitis is usually a result of CSF leak and is normally treated with antibiotics.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Visual loss</b>: The optic chiasm may be damaged during surgery. Although rare, post-operative bleeding may flow into the area around the <b>pituitary gland</b> or into any <b>tumor</b> tissue that remains. This can put pressure on the optic nerves and cause vision loss. In such circumstances, an additional procedure may be needed to remove any blood clots. <o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Stroke</b>: There is a very small chance of damage being caused to the carotid arteries that are located close to the <b>pituitary gland</b>, in an area known as the cavernous sinus. This can cause and interruption of blood supply to the brain, potentially leading to stroke, severe blood loss or even death. Such a situation is, however, highly unlikely when surgery is performed by an experienced surgeon. <o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: 3.75pt; margin-top: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 3.75pt; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 11.5pt;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial; font-size: 11pt;"><b>Tumor regrowth</b>: Even after having surgery, there remains a chance that post-operative blood work may reveal another (microscopic) <b>tumor</b> or residual <b>tumor</b> that the neurosurgeon was unable to see during the procedure. In such cases, the patient may be required to receive further treatments, such as <b>pharmacotherapy</b>, an additional <b>pituitary surgery</b> or radiation therapy. For instance, my post-operative PRL level was above 10 mg/ml and it is continually rising, so with my next MRI we shall be looking out for another adenoma. I have become intolerant to medical therapy, so will inevitably have to undergo a second <b>transsphenoidal</b> surgery at some point in time.<o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
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<span style="font-family: Arial; font-size: 11pt;"><div style="text-align: justify;">While most medical professionals continue to prescribe <b>dopamine agonists</b> for the treatment of <b>prolactinoma</b>s, surgery may be a good option for some patients. The list of complications associated with <b>pituitary</b> surgery may seem daunting, but many of these are rare occurrences. As <b>pituitary</b> surgery has evolved technologically over the past few years, in the hands of a specialist it is a minimally invasive and low-risk procedure. Total surgical removal of the <b>tumor</b> results in complete “cure” (or what many doctors prefer to call remission), although this cannot be guaranteed. Success after surgery is based on an individual case, and it is important that you do your own research. Please talk to your <b>pituitary endocrinologist</b> and neurosurgeon for information about the likely outcome of you having surgery.</div><div style="text-align: justify;"><br />
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</div><div style="text-align: justify;"><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><b>Further information</b></span><span style="font-family: Arial; font-size: 11pt;"><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">Mediasite presentation: <a href="http://videomedia2.swedish.org/mediasite/SilverlightPlayer/Default.aspx?peid=ebb08f1d5a4e4f0e9b0cdf5036d7bcad">Advances in the surgical treatment of prolactin-producing pituitary adenomas</a> <br />
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</span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">Mediasite presentation: <a href="http://videomedia2.swedish.org/mediasite/SilverlightPlayer/Default.aspx?peid=38828263536841ebb2b5497b154d24e4">Potential complications including valvular heart disease associated with dopamine agonist therapy</a><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">Clinical study: <a href="http://www.eje-online.org/cgi/reprint/158/1/11.pdf">Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients </a><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;">Clinical study: <a href="http://www.eje-online.org/cgi/reprint/157/2/133.pdf">Quality of life is decreased in female patients treated for microprolactinoma</a><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.pituitary.org/intro.aspx">Pituitary Network Association (PNA)</a><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
</div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><span style="font-family: Arial; font-size: 11pt;"><a href="http://www.mdjunction.com/forums/prolactinoma-discussions">Prolactinoma support group</a><o:p></o:p></span></div><div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;"><br />
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</div></div></span>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com17tag:blogger.com,1999:blog-2109144868634693364.post-88586732808149406482010-07-19T12:41:00.000-07:002010-07-19T12:41:35.203-07:00Time out for Transsphenoidal Surgery<span style="font-family: Georgia; font-size: 11pt;">Just to let you know that I will be going for neurosurgery tomorrow and I may not be able to add any new blog posts for a while. I will, however, try to update this blog when I can. Thanks for your patience.</span><br />
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</span></span>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-10872777394017093782010-06-15T17:46:00.000-07:002010-06-15T17:46:23.420-07:00A Glossary of Selected Medical Terms (a work in progress)<span class="Apple-style-span" style="font-family: 'MS Shell Dlg'; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrbQMNB4uc1dvbiMqj597KL16xnqqO7o113NSd2Um1QrvmTdyYS95_dXhxFhlQkDZ2GeIgPUqeABY-NRUF-a_X6hRgbM9UL7F_VtKuYxUZl9YBEENLNoa2uaSw_8EALCHqhCBKSIDgX2Q/s1600/GS+Glossary+pic.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="78" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrbQMNB4uc1dvbiMqj597KL16xnqqO7o113NSd2Um1QrvmTdyYS95_dXhxFhlQkDZ2GeIgPUqeABY-NRUF-a_X6hRgbM9UL7F_VtKuYxUZl9YBEENLNoa2uaSw_8EALCHqhCBKSIDgX2Q/s400/GS+Glossary+pic.jpg" width="400" /></a></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Arial; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><br />
</span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Like any other profession,</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> the medical industry uses specific industry language that can sometimes be tricky to comprehend. Doctors and researchers use many technical terms and Latin nomenclature in order to describe specific diseases, bacteria, human anatomy, pharmaceutical drugs and so forth. I thought about explaining such terms at the end of each blog post, but after much consideration, I decided that it would be more beneficial for a Glossary to be added for better ease of reference. Everyone has to deal with some sort of medical issue at some point in their lives and so it is crucial that we all have access to information that may help us find our way to better health and recovery. As stated throughout this Weblog, I am not a medical or health professional, and the data provided is for informational purposes only and are not intended to replace medical information provided by licensed healthcare professionals. It is important, therefore, that you consult your own doctor for your own individual care. <o:p></o:p></span></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><b><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Using the Glossary</span></b></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">(a) Each term defined in this Glossary is shown alphabetically in</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><b><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">bold</span></b></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">font.</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">(b) Terms may be single words or longer phrases and may include domain-specific jargon or abbreviations.</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">(c) Within the text of definitions, supplementary terms defined elsewhere in the Glossary are shown in</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">italics</span></i></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">for ease of cross-referencing.</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">(d) Within the text of each new blog post, the terms available for access in this Glossary will be shown in</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><b><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">bold</span></b></span><span class="apple-converted-space"><b><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></b></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">font.</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">(e) Glossary entries are provided primarily in US English although UK English is also included where appropriate.</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Arial; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><b><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Scope of Glossary</span></b></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Please note that this Glossary does not provide an all-inclusive list, as the terminology specific to the discipline of</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">medicine</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">appears to be never-ending. Further, this Glossary is a work in progress and further entries may be added with new blog posts. The goal of this Glossary is to provide a quick and easy reference to the meanings of common terms used in the field of</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">medicine</span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">. For additional information about the terms defined, it is suggested that you refer to external sources such as those listed in the Bibliography below.</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Documents and publications of relevant sources used for the formation of this Glossary are included in the Bibliography. This Glossary is a work in progress and any errors found are my own (I am not a medical professional and I do not have an editor to check my work). </span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Arial; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><br />
</span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">I hope you will find this</span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><b><span style="color: windowtext; text-decoration: none; text-underline: none;"><a href="http://gallant-strides.blogspot.com/p/glossary_15.html">Glossary</a></span></b></span></span><span class="apple-converted-space"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"> </span></span><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">useful! </span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Arial; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><b><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Bibliography</span></b></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Parts of this Glossary were brought together with the help of several resources. Valued references include:<o:p></o:p></span></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Bottom Line. 2006. The World’s Greatest Treasury of Health Secrets. Bottom Line Publications. </span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal"><span class="apple-style-span0"><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-size: 12.0pt;">Pituitary Network Association. 2007 (4th ed.). It <i>Is</i> All In Your Head! The Pituitary Patient Resource Guide.</span></span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><br />
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</span></span></div></span></span>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-977177750899324632010-05-16T17:13:00.000-07:002011-07-18T20:53:31.997-07:00The Third Annual Seattle Pituitary Symposium: Some notes about the Patient Education Conference<div class="separator" style="clear: both; text-align: center;"></div><br />
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</b></span></span></div><div class="separator" style="clear: both; text-align: center;"><span class="apple-style-span"><b><span style="font-family: Georgia; font-size: 11pt;">“Facts Do Not Cease To Exist Because They Are Ignored.” ~ Aldous Huxley</span></b></span></div><div class="separator" style="clear: both; text-align: center;"><span class="Apple-style-span" style="font-family: Georgia; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><b><br />
</b></span></span></div><div style="text-align: justify;">On May 8, I was pleased to attend “The Third Annual Seattle Pituitary Symposium: A discussion with leaders in pituitary management”. The event was produced in order to educate and support pituitary patients and their families. I found it a worthwhile program, as patients were able to listen and talk to specialists, and to learn more about the different pituitary diseases and various treatments offered. In this way, patients are able to make informed decisions about their own disease management and to determine which therapies (such as medication, surgery or radiotherapy) may be suitable for their condition(s). Experts such as William H. Ludlam (Seattle Pituitary Center at Swedish), Roberto Salvatori (Johns Hopkins Pituitary Center), and Sylvia L. Asa (University of Toronto) were present, as well as a number of other creditable pituitary and tumor professionals (see complete list of presenters below). It must have been a difficult day for all of them, as they were required to share their time speaking at another concurrent symposium for physicians’ continuing education (called “Advances in Prolactinoma Management”). Although some presenters seemed a little hurried between auditorium sessions, they nevertheless endeavored to make room at the end of each talk to answer individual patient questions. It would have been nice if this time had been a bit longer in some cases, but answers to unique concerns are probably better achieved by scheduling a private appointment with the doctor. Another improvement I would suggest would be for the opportunity for presenters to sit in on each other’s talks so as to avoid the emergence of some seemingly conflicting information, especially when it came to making decisions about prolactinoma surgery.</div><div style="text-align: justify;"><br />
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</div><div style="text-align: justify;"><b>What this article entails</b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">It is not in the scope of this blog post to provide a comprehensive account of all that was discussed throughout the day, but I have attempted to supply some of the main points. This was nevertheless a sizeable task, and I often considered splitting the report into many smaller postings (i.e., Post #1: First Presentation, Post #2: Second Presentation, and so on). However, I feel that this would have affected the flow and cohesiveness of the various details that were presented at the symposium. While many of the themes and associated facts in this post were collected from the conference itself, I have also attempted to furnish the reader with some personal views about some of the challenging issues often encountered with pituitary disease. Nowadays, I hear a recurrent message from the medical community, for us as patients to be more proactive in our overall health and well-being. It is important to gain knowledge about our own condition(s), so that we can engage in well-versed dialogue with our physicians in the quest to resolve our poor states of health. It seems that the majority of information obtained from medical resources, such as peer-reviewed journals, Internet web sites and visits with the doctor, fail to include the more personal features of the disease (some of the more accommodating links are included below). For example, clinical symptoms frequently include the word “fatigue”, but don’t specifically address the significance of it or how it is likely to affect one’s prognosis in the long-term. A productive part of the symposium dealt with this issue by offering regular breaks, as well as a “Breakout” session where patients could interact and talk about their own specific challenges or triumphs.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Beginning with Breakfast</span></span></b></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia;"><b><br />
</b></span></div><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMRHNbjRZX5qXWDHG96BWgQTeKnapG4wVvGi-_Kb4dF4Em__YWa7Fh3ozBEs6IsACyEtE4BMAvLIYadhWcdVaerclPxhKN2L9lpfbD0te0uQuVQP7MptNmVShEoQEIXAAuVDMsGitHJpo/s1600/GS+007.03+Donut.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMRHNbjRZX5qXWDHG96BWgQTeKnapG4wVvGi-_Kb4dF4Em__YWa7Fh3ozBEs6IsACyEtE4BMAvLIYadhWcdVaerclPxhKN2L9lpfbD0te0uQuVQP7MptNmVShEoQEIXAAuVDMsGitHJpo/s320/GS+007.03+Donut.jpg" width="320" /></a></div><div style="text-align: center;"><span class="Apple-style-span" style="font-family: Georgia;"><b><br />
</b></span></div></div><div style="text-align: justify;">The event started early with a continental breakfast amongst other pituitary patients and their caregivers, and it didn’t take long for many to unite and spark up similar-themed conversations around the reception hall. Pituitary disease has always been viewed as a relatively rare condition, and so patients can sometimes feel isolated while going through the roller coaster of symptoms and diagnostic tests that are required for proper diagnosis. It is now becoming apparent, however, that one in five people around the globe may have a pituitary growth (see one of my previous posts <a href="http://gallant-strides.blogspot.com/2010/01/pituitary-disease-getting-word-out.html">here</a> for more information). Although many tumors (also called adenomas) are nonfunctioning and cause no apparent symptoms, some may be very serious and detrimental to one’s health. In fact, in some cases pituitary tumors can be fatal. This gathering was therefore particularly welcomed by those who wanted to compare their stories and to find affiliation with others who would understand. It was certainly an invigorating scene and I had already connected with two patients with Cushing’s disease and another with prolactinoma before the presentations even began. One tiny oddity regarding breakfast, however, was that the food provided mainly comprised sticky and sugary donut type treats, when so many with pituitary disease suffer from metabolic disorders, diabetes or considerable weight issues. Hopefully, we will see some healthy cereals or perhaps even a vegetable or two next year! </div><div style="text-align: justify;"><br />
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</div><div style="text-align: justify;"><b>Nonfunctioning pituitary tumors</b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Dr. Molitch presented the first topic, which was about nonfunctioning pituitary tumors. He explained the difference between the terms “micro” and “macro” that are used to convey tumor size. An arbitrary division is made at 1 cm, signifying that those less than 1 cm are microadenomas and those greater are considered macroadenomas. Another distinction can be made between tumors that produce either endocrine or mass effects. In some instances, the tumor can create over production of one or more hormones, such as prolactin, cortisol or growth hormone. For example, if a pituitary tumor causes excess amounts of prolactin, it is referred to as a prolactinoma. In the case where the tumor secretes too much cortisol, it is known as Cushing’s disease. Although not specifically mentioned by Dr. Molitch, it is now also understood that in some cases the tumor may be co-functioning (a plurihormonal adenoma), resulting in the secretion of more than one type of hormone (although this is less common). For example, it is possible for a patient to have both prolactinoma and Cushing’s disease. Despite the fact that some tumors may not produce excess hormone levels (nonfunctioning), its increasing size may put pressure on the pituitary gland and result in symptoms such as headache, visual field defects, diabetes insipidus (DI) or hypopituitarism (when the pituitary gland fails to produce the correct amount or number of hormones). In some instances, however, microadenomas produce no clinical symptoms (asymptomatic) and are often found as incidental findings. An example given was that of a person who would be sent to MRI following recent head trauma (such as a motorcycle accident), and the pituitary tumor was discovered as a secondary finding. In such cases, they are referred to as incidentalomas. In instances where a nonfunctioning macroadenoma is causing major symptoms due to its mass, however, it is necessary to consider suitable treatment options. </div><div style="text-align: justify;"><br />
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</div><div style="text-align: justify;"><b>An Overview of Acromegaly</b><br />
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</b></div></div><div style="text-align: justify;">Dr. Ludlam talked about one of the most conspicuous and serious forms of pituitary diseases, called acromegaly. Most of us have seen photographs of the Guinness Book of Records’ World’s tallest man or woman, or heard other remarkable stories about “giants” that just kept growing. Such a condition is not a new phenomenon, and it is even believed that some ancient rulers suffered from acromegaly or gigantism. The caption to this segment was taken in the auditorium during the symposium. If you look carefully, you will distinguish that the slide depicts portraits of Akhenaten, pharaoh of 18th dynasty in Egypt, and Roman Emperor Gaius Julius Versus Maximinus “Thrax” 235 AD. (“Acromegaly”, editors: van der Lely AJ. Et al, 2007, Informa Healthcare). On closer observation, you may notice that the facial features of both rulers are rather coarse. In around 10% of cases, pituitary tumors cause an excess production of growth hormone (GH), which causes a myriad of difficult physical and subjective signs and symptoms. A distinction is made between children and adults, as excess growth hormone in children results in taller stature because their bones haven’t yet fused (called pituitary gigantism). In respect of adults, where bones are fused, excessive growth hormone results in marked bony and soft tissue changes (referred to as acromegaly). This can lead to an altered facial appearance due to enlargement of the forehead (called frontal bossing) and jaw. Other symptoms of acromegaly include enlarged hands and feet, spreading of teeth, enlarged tongue, deepened voice, accelerated cardiovascular disease and more. The condition is also associated with other diseases such as sleep apnea, osteoarthritis and diabetes mellitus. Acromegaly affects both body and mind. Not only does the patient suffer from physical discomforts, such as joint pain and cognitive impairment, but also on a social level it can cause personality changes and disorders, depression, fatigue and decreased libido. Although acromegaly progresses gradually over the years, if not caught in its earliest stages, permanent disfigurement may result. While acromegaly is considered rare, it is believed that many patients are undiagnosed. The diagnosis of acromegaly can be confirmed by observing levels of insulin-like growth factor (IGF-1) and GH and applying a glucose tolerance test.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">There are many treatment methods for dealing with GH excess and tumor growth. The primary option for acromegaly is transsphenoidal pituitary surgery (further details are given below), which may be followed by irradiation and/or medical therapy. Pharmacotherapy includes the use of somatostatin analogs (octreotide LAR or lanreotide), dopamine agonists (cabergoline or bromocriptine), or a GH receptor blocker (pegvisomant). Tumor size and biochemical management of GH and IFG-1 levels affect long-term outcomes</div><div style="text-align: justify;"><br />
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</div><div style="text-align: justify;"><b>Advances in Pituitary Radiotherapy</b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Dr. Suh began this presentation by explaining that pituitary adenomas are very common, representing around 10-15% of all intracranial tumors (tumors within the skull). Around 3-25% are discovered as incidentals in autopsy reports. Some clinically evident cases can, however, cause severe morbidity. Around 70% of pituitary adenomas secrete hormones, such as prolactin (PRL), Growth Hormone (GH), Thyroid Stimulating Hormone (TSH), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). Also, mass effect from growing tumors can lead to visual defects, headaches, cranial nerve deficits and PRL secretion. There are many treatment options available for pituitary adenomas. A nonfunctioning incidental microadenoma may merely be observed with imaging studies over a period of time. In instances where the tumor is producing clinical symptoms, treatments may include medical therapy, surgery and/or radiotherapy (radiosurgery or radiation therapy).</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The medical therapies available for pituitary adenomas are varied, depending on the type of hormone that is being secreted. Excess PRL levels with a prolactinoma are treated with bromocriptine, quinagolide or cabergoline. Somatostatin, octreotide or pegvisomant are prescribed to patients with excess growth hormone levels. To suppress cortisol production associated with Cushing’s disease (CD), mitotane, ketoconazole or cyproheptadine may be recommended. Octreotide or somatostatin are shown to be effective for treating TSH-secreting adenomas. <br />
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</div></div><div style="text-align: justify;">Where surgery has been unsuccessful (due to incomplete resection, recurrent tumors, or inoperable patients), pituitary radiotherapy may be used as an alternative treatment. It has also been utilized to reduce the requirement for long-term medical therapy. Because radiation therapy is administered in small doses, it can take many years for hormone regulation when offered for hormone-secreting tumors. Nevertheless, it is effective at preventing tumor growth within only a matter of months after commencing treatment, despite taking longer (sometimes years) to actually shrink the mass. Because medical and surgical therapies show a more immediate response when addressing pituitary tumors, radiotherapy is not often used as a first line of treatment. With recent technological advances, there has been an improvement in benefit and safety of radiotherapy, and although conventional (external beam) and stereotactic radiation therapy are used, most patients now opt for the stereotactic techniques, unless the tumor is particularly large. This method has the ability to match up to the shape of the tumor, thus reducing radiation exposure to proximate brain tissue. There are still, however, some concerns about damage caused to normal surrounding tissues and this can result in endocrine dysfunction, vascular injury, optic neuropathy (< 1%) and radiation necrosis (<1-2%). Recently, there are now single dose techniques, such as Gamma Knife® radiosurgery, which give out a more intense magnitude of beams to the pituitary tumor. Radiosurgery seems faster at reducing excess hormone production from sectretory adenomas than radiation treatments. Future work is required to refine the role of radiation in treating pituitary tumors.</div><div style="text-align: justify;"><br />
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</div><div style="text-align: justify;"><b>Medical Treatment Options in Cushing’s Disease</b><br />
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</div><div style="text-align: justify;">Dr. Heaney presented a talk about pharmacotherapy options for patients with Cushing’s disease (CD). I have also included some information obtained from Dr. Grossman’s presentation on medical therapy for pituitary tumors in general.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Despite the fact that most CD tumors are tiny (less than 5 mm in diameter), CD is the most serious and life-endangering condition caused by a pituitary tumor. It is also one of the most challenging pituitary diseases to treat. CD is caused due to pituitary adrenocorticotropic hormone (ACTH) hypersecretion, which results in excess cortisol production from the adrenal glands. Too much cortisol can cause many disabling and sometimes life-threatening symptoms, which can vary but include abnormal and rapid weight gain (upper body obesity), severe fatigue, high blood pressure, diabetes, osteoporosis, muscle weakness, coronary artery disease, psychological disturbances (irritability, anxiety and depression), fragile and thinning skin, poor sleep quality, hair loss, purplish stretch marks, and more.<br />
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</div><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: justify;"></div><table border="1" cellpadding="0" cellspacing="0" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt;"><tbody>
<tr> <td style="background: #FFFF99; border: none; padding: 0in 5.4pt 0in 5.4pt; width: 396.15pt;" valign="top" width="528"><div class="MsoNormal" style="text-align: justify;"><b><span style="color: #993300; font-family: 'Trebuchet MS'; font-size: 11pt;">Some patients may have a <u>cyclical</u> form of Cushing’s disease, which means that cortisol levels fluctuate between high and very low. In such instances, the patient may not experience the same patterns of weight gain as a classic Cushing’s patient (such as rounded face or the classic “buffalo hump”). Unfortunately, many physician’s fail to recognize this and misdiagnose patients with PCOS or attribute symptoms to other nonspecific illnesses such as Chronic Fatigue Syndrome (CFS). It is crucial that patients obtain a proper diagnosis as early as possible, as CD is linked to high morbidity and eventually mortality, if left untreated. <o:p></o:p></span></b></div></td> </tr>
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<div style="text-align: justify;">While many acromegaly and prolactinoma patients can be treated with medical therapy alone, there are no real effective drug therapies currently available for ACTH-secreting pituitary tumors. Drugs can be useful at controlling hypercortisolism (excess cortisol levels), but they do not prevent tumor growth. A medication commonly used for CD is called ketoconazole, which is an antifungal agent. It acts on the adrenal glands to reduce cortisol levels (and also lowers testosterone), but has shown to be less effective for long-term use. Ketoconazole is taken in pill form 2 or 3 times a day and is generally well tolerated by patients, although there are sometimes side effects associated with liver function (which can be monitored), edema and skin rash. Other oral medications that work upon the adrenal glands include metyrapone, aminoglutethimide, mitotane and etomidate, although these have a higher rate of side effects, such as dizziness, nausea, skin rash, edema and hirsutism (excessive hairiness in females). Other drug treatments used for CD patients include neuromodular therapies that act at the hypothalamic-pituitary level, such as serotonin antagonists (cyproheptadine, retanserin, ketanserin) and dopamine agonists (cabergoline and bromocriptine). </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">There are also GABA agonists (sodium valproate) and somatostatin receptor ligands (octreotide and lanreotide). For example, research has shown that peroxisome proliferator-activated receptor gamma (PPARy) agonists effectively suppress ACTH secretion in the mouse/rat cell line, but the few studies so far conducted with CD patients have produced inconsistent results. In one investigation, 14 patients were treated with rosiglitazone (8 mg-16 mg) for 1-7 months, resulting in normalization of urinary free cortisol (UFC) in 6 patients (42.9%) and mild improvement in clinical features. Other similar studies using rosiglitazone have also shown effective use in a subset of patients, but further work is required in order to identify the medicinal potential of PPARy agonists in CD patients. Some of the side effects include weight gain, edema, bruisability and hypertension (high blood pressure). Presently, many doctors believe that rosiglitazone is currently of little value in treating Cushing’s disease. </div><div style="text-align: justify;"><br />
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<tr> <td style="background: silver; border: none; padding: 0in 5.4pt 0in 5.4pt; width: 817.55pt;" valign="top" width="1090"><div class="MsoNormal" style="text-align: justify;"><span style="color: #003366; font-family: 'Trebuchet MS'; font-size: 11pt;">One thing that puzzles me is that cabergoline is generally effective at reducing both prolactin levels and tumor size in prolactinoma patients. I have also been advised by several MDs that cabergoline decreases cortisol levels in CD patients. It seems odd therefore that a medication would shrink tumors secreting excess prolactin but not those producing ACTH. In my own case, I am suspected of a co-functioning tumor due to both elevated prolactin and random cortisol levels. My prolactinoma has been managed with cabergoline therapy over the past 10 years, and the tumor has sometimes presented on MRIs but not on all </span><b style="mso-bidi-font-weight: normal;"><i><span style="color: #003366; font-family: 'Trebuchet MS'; font-size: 11pt;">(this does not mean that the tumor has disappeared, especially if the patient still requires medication to suppress excess hormone production. In fact ~ 30% of pituitary tumors do not present themselves on MRI due to issues such as tumor size, position, angle, or type of machine used).</span></i></b><span style="color: #003366; font-family: 'Trebuchet MS'; font-size: 11pt;"> I have been advised to discontinue cabergoline therapy whilst undergoing further testing for Cushing’s disease, as cabergoline suppresses cortisol and testing needs to be performed when cortisol levels are high. So, does this mean that my tumor would not have shrunk at all if it were not co-functioning with prolactinoma? Another oddity is that one of my previous MRIs has not only revealed a 5 mm adenoma, but also a smaller 2-3 mm lesion on my pituitary gland. This is thought to represent either a second pituitary tumor or a Rathke’s cleft cyst. I just wonder whether the larger tumor is the prolactinoma and the tiny one (more typical of Cushing’s) is responsible for my elevated cortisol levels. I suppose only time will tell and I will certainly update this information after I have consulted with my pituitary endocrinologist in June.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b style="mso-bidi-font-weight: normal;"><i><span style="color: #ff3300; font-family: 'Trebuchet MS'; font-size: 11pt;">*NB: Before testing for CD, make sure you check your current medications with your doctor. I went through a whole ICT test kit before realizing that I should have discontinued both cabergoline and estrogen. Whether you take estrogen in birth control form or as hormone replacement therapy (HRT) following a hysterectomy, it should be discontinued for 2-3 months prior to testing for CD so as not to skew lab results.</span></i></b><b style="mso-bidi-font-weight: normal;"><i><span style="color: #ff3300; font-family: Georgia; font-size: 11pt;"><o:p></o:p></span></i></b></div></td> </tr>
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<div style="text-align: justify;">Although octreotide and lanreotide are more effective at treating acromegaly than CD patients, the good news is that Dr. Heaney informed us about another somatostatin analogue drug-based therapy called pasireotide (SOM230), which is being developed to successfully target CD tumors. Somatostatin is a hormone made in the hypothalamus, which reduces the creation of several pituitary hormones. Pasireotide binds multiple somatostatin receptors (1, 2, 3, and 5) to mimic the action of natural somatostatin. Pasireotide requires injection once a day but is likely to develop into a once a month treatment. One analysis showed that after 15 days of pasireotide therapy 76% of patients had a reduction in UFC levels, and 17% of these had normal UFC levels. Although the drug has potential for lowering cortisol, it isn’t yet effective at reducing levels into the normal range. Pasireotide drug-therapy looks very promising and is currently awaiting approval from the FDA.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">So it seems that drug-based therapies can sometimes be helpful but are not generally effective as a sole treatment for CD at the current time. Pharmacotherapy, however, can be a suitable option for patients with severe cortisol levels that are awaiting surgery, are medically unfit for surgery, have poorly controlled diabetes and/or hypertension, or who decline pituitary surgery. The first line of treatment for Cushing’s disease for most patients therefore is pituitary surgery. Around 76% of microadenomas can be successfully resected via transsphenoidal pituitary surgery. The outcomes for macroadenomas are less successful (around only 30% of cases). It is not uncommon for CD patients to have several surgeries due to recurrent tumor growth.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Although CD patients are currently unable to rely on medical therapies as sole treatments, Dr. Heaney notified us of some preclinical drugs that have potential for use as treatments for hypercortisolism. For instance, mifepristone is a glucocorticoid receptor antagonist, which blocks the effects of cortisol. Its efficacy and safety for Cushing’s syndrome are currently under investigation. The trial involves giving subjects oral mifepristone for up to 24 weeks, and is suitable for those who have had failed or recurred pituitary surgery or radiation therapy. The study requires close monitoring for possible severe hypokalemia (low blood calcium), hypertension and clinical signs of adrenal insufficiency. <span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">More information can be found</span> <a href="http://med.stanford.edu/clinicaltrials/detail.do?studyId=4280">here</a>.<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> </span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">Another preclinical drug that both Drs. Heaney and Grossman mentioned was Retinoic acid (ligand for RXR/RAR nuclear receptor). Further details can be found</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> </span></span><a href="http://clinicaltrials.gov/ct2/show/NCT00845351"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">here</span></span></a><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">.</span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><br />
</span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><b>Breakout: Patient Small Group Discussions</b></span></span></div><br />
<div class="separator" style="clear: both; text-align: center;"></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVy7etQX1m3ukVojsu9HsFlT7x4zbxMvKYKDHXTgrpXRLHCnjriWmi33atRRnmvg28o1iyKz1-zpcZGZnrV65pTfbVeQchx04dnwihpz3cShFvgAlRU3EdjbSwHqZ-6hZ7hthRzP5P_pw/s1600/GS+007.09+Stacked+Hands.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVy7etQX1m3ukVojsu9HsFlT7x4zbxMvKYKDHXTgrpXRLHCnjriWmi33atRRnmvg28o1iyKz1-zpcZGZnrV65pTfbVeQchx04dnwihpz3cShFvgAlRU3EdjbSwHqZ-6hZ7hthRzP5P_pw/s320/GS+007.09+Stacked+Hands.jpg" width="218" /></a></div><div style="text-align: center;"><span class="Apple-style-span" style="font-family: Georgia; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><br />
</span></span></div></div><div><div style="text-align: justify;">After lunch, attendees were given the opportunity to separate into various groups, relating to type of pituitary disease they were interested in. Although I have a prolactinoma, I decided to join the Cushing’s crowd, as I am also suspected of Cushing’s disease. Patients present were at different stages of treatment: some undergoing testing for diagnosis, some planning surgery, and others who had undergone at least one surgery. This is the first time I had been in the company of fellow pituitary disease sufferers, and I confess that I felt quite emotional at times. It was a relief to know that I wasn’t the only one who felt discouraged by the inability to carry out simple daily tasks. Others had also occasionally questioned themselves and felt as though they were losing their minds. It’s amazing how well pituitary patients look despite how dreadfully ill they are inside, and it can sometimes take a long time to receive serious attention and proper diagnosis from the medical community. Sometimes it can even take years because physicians often fail to recognize the symptoms and put all the pieces together. In fact, I was surprised to discover that the failure of my GP to refer me to a pituitary specialist was not an isolated incident. I was fortunate in having PPO insurance, which enabled me to ditch this stubborn physician and find another who would provide that much needed referral. Others weren’t so fortunate and resorted to threatening to slap their GPs with lawsuits if they had to go elsewhere for diagnosis. This often had the desired effect, although personally I wouldn’t want to keep such a physician in my list of medical contacts. Another individual, however, put a positive spin on it by suggesting that a return to the offending physician could lead to better education within the medical community. In fact, some GPs have even been known to apologize. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><table border="1" cellpadding="0" cellspacing="0" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt;"><tbody>
<tr> <td style="background: #CC99FF; border: none; padding: 0in 5.4pt 0in 5.4pt; width: 392.9pt;" valign="top" width="524"><div align="center" class="MsoNormal" style="text-align: center;"><span class="apple-style-span"><b><span style="color: #333399; font-family: 'Trebuchet MS';">Unless someone has specifically gone through the same challenging set of circumstances as a pituitary patient, he or she would be unable to fully understand the disease in all its complexities</span></b></span><b><span style="color: #333399; font-family: 'Trebuchet MS';"><o:p></o:p></span></b></div></td> </tr>
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<div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Many patients disclosed that they found it difficult to stay in employment, drive a car, or deal with minor stressful events. Additionally, some struggled to get out of bed, at times spending days, or even weeks totally bedridden. Doing the housework or taking care of children seemed yet another milestone for many, and the general consensus was that it was easier to focus on the mere necessities in order to avoid living in complete filth! Some patients chose the option of seeking assistance from other sources. Although a number of patients suffered with mood swings and periods of anxiety, one individual in particular was concerned about the psychotic episodes she regularly experienced. Such occurrences had become so profound that she was unable to return to work, and her children had been taken away so that she wouldn’t harm them. She was totally aware of the serous nature of this state of affairs, but hadn’t really come any closer to resolving them. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">One of the biggest concerns for most patients relates to the lack of emotional support received from some family members and friends. Although relatives may be present during surgery and “recovery” periods, they were still unable to identify with the various battles encountered by someone with lifelong pituitary disease. I suppose the fact that patients present themselves as walking and talking individuals translates to many that they must be fine. Several at the meeting were in agreement with the fact that unless a person has specifically gone through the same challenging circumstances, they would be unable to fully understand the disease in all its complexities. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>Surgical Treatment Options for Pituitary Lesions</b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">This was an exciting presentation provided by Dr. Mayberg (specialist in microsurgery for pituitary tumors), who diverged from using the customary didactic graphs and diagrams but instead provided video footage of recent pituitary surgeries. I found this very helpful, as symposium attendees were able to observe pituitary surgeries on the screen, whilst Dr. Mayberg provided practical narration. He confidently assured us about recent advancements in modern technology, and said that pituitary surgery was becoming more straightforward (for microadenomas) and increasingly safer. He also stated that the success rate for patients with microprolactinoma was 100%. In fact, he basically said that if prolactinoma patients get tired of taking the [cabergoline] pill, then it’s easy enough to take the tumor out. It’s a personal choice. Obviously, surgery would be more complicated for some macroadenomas that invade the cavernous sinus. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Surgery should be carried out with the aim of removing the tumor, whilst keeping the normal pituitary gland intact. The most common type of pituitary surgery performed is the transsphenoidal resection. This involves going through the sphenoid sinus (an air space behind the nose), as opposed to opening the skull to reach the tumor (craniotomy). The primary approach is the direct transnasal, which involves making an incision in the back wall of the nose so that the sphenoid sinus can be entered directly. In this instance, no postoperative packing is required, as the surgeon can simply use fat taken from the belly to prevent spinal fluid leakage. It is also possible to make an incision along the front of the nasal septum (transseptal) or via an incision under the lip/upper gum (sublabial), although these methods would require postoperative packing and have a longer recovery time than the direct endonasal or endoscopic approach used for transnasal surgery. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>The Role of the Pathologist in Pituitary Patient Management</b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Dr. Asa provided some interesting data relating to the spectrum of pituitary disease, and detection (clinical, biochemical and radiologic). When the pituitary malfunctions it can cause mass effects, resulting in headaches, pressure on the optic nerve with loss of peripheral vision, and it can compromise normal function, resulting in an insufficient number or amount of hormones (hypopituitarism). A malfunctioning pituitary can also lead to hormone excess states, causing health problems such as sexual dysfunction/infertility, osteoporosis/arthritis, diabetes mellitus, mood disorders and accelerated heart disease. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">New results from a Meta-analysis study (Ezzat et al, Cancer 2004; 101(3):613-9) show that pituitary tumors are more common than once believed. The overall estimated prevalence is 16.7%, although this also includes nonfunctioning and asymptomatic lesions. Approximately one third to a quarter of tumors are believed to be prolactin secreting. The majority of tumors are micro (< 10 mm). Around 40% of patients with Cushing’s disease do not have detectable tumors on MRI. About a third of patients with infertility and elevated prolactin do not have observable tumors. It is thought that 4/100,000 lose pituitary function in the absence of a large pituitary growth (Clin Endocrinol (Oxf) 2001;55:735-740). Dr. Asa’s main theme was to increase awareness, in order that physicians consider pituitary disease as a likelihood when faced with a specific group of symptoms and/or laboratory results. In such cases, the patient may need to undergo testing for blood and urinary hormone levels and MRI.<br />
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</div><div style="text-align: justify;"></div><table border="1" cellpadding="0" cellspacing="0" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt;"><tbody>
<tr> <td style="background: #FFCC00; border: none; padding: 0in 5.4pt 0in 5.4pt; width: 476.05pt;" valign="top" width="635"><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="color: red; font-family: Georgia; text-transform: uppercase;">Around 40% of patients with Cushing’s disease do not have detectable tumors on MRI.<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="color: red; font-family: Georgia; text-transform: uppercase;">About a third of patients with infertility and elevated prolactin do not have visible tumors on mri</span></b><b><span style="font-family: Georgia;"><o:p></o:p></span></b></div></td> </tr>
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<div style="text-align: justify;">The role of the pathologist is to manage the clinical laboratory and to offer clinically related and accurate diagnostic tests for pituitary function and assessment. One fascinating revelation for me was that it is possible for pathologists to use a practical approach in diagnosing pituitary specimens taken from surgery. Pituitary adenomas can be assessed using several special stains and “immunohistochemical” markers in order to classify the pathologies. In this way, it is possible for the pathologist to distinguish certain clinical characteristics and to predict targeted therapies for patients with pituitary tumors. It is important, therefore, that the neurosurgeon endeavors to send the surgically removed tumor to the pathologist for evaluation (apparently, this doesn’t always happen). </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>Medical Management of Prolactin Secreting Pituitary Tumors</b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Dr. Salvatori provided the final presentation of the day by discussing one of the most common types of pituitary tumor, the prolactinoma. This is also one of the less serious types of pituitary adenomas as it can generally be easily treated with pharmacotherapy. This tumor secretes too much prolactin (also called hyperprolactinemia). Symptoms in females include breast milk discharge from the nipples, irregular or complete loss of menstrual periods, infertility, and low libido. Men may have enlarged breasts and loss of libido. Because men don’t have the full range of signs or symptoms as women, they often go undiagnosed until the tumor becomes large with higher prolactin levels. In such cases, symptoms include headache and visual loss from mass effect on the optic nerves or optic chiasm. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><table bgcolor="#ccffff" border="0" cellpadding="0" cellspacing="0" style="background: #CCFFFF; border-collapse: collapse; mso-padding-alt: 0in 5.4pt 0in 5.4pt;"><tbody>
<tr> <td style="padding: 0in 5.4pt 0in 5.4pt; width: 392.9pt;" valign="top" width="524"><div align="center" class="MsoNormal" style="text-align: center;"><span class="apple-style-span"><b><span style="color: #ff6600; font-family: 'Trebuchet MS';">“Patients exposed to BRC for at least one month are more likely to have tumor, and possibly less likely to be cured by surgery” ~ Roberto Salvatori, MD</span></b></span><b><span style="color: #ff6600; font-family: 'Trebuchet MS';"><o:p></o:p></span></b></div></td> </tr>
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<div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The treatment goals associated with prolactinoma include shrinkage of the mass, preservation or recovery of pituitary function, and prevention of recurrences. It is also important to prevent long-term complications of hypogonadism (low levels or impaired production of sex hormones), which can lead to osteoporosis. Dopamine agonists such as bromocriptine (Parlodel®) or cabergoline (Dostinex®) are generally effective at reducing tumor size and prolactin levels. Personally, I found cabergoline more tolerable than bromocriptine, and it is certainly the drug of choice if surgery might be considered as a future option. Pituitary tumors are generally soft in nature but prolonged use of bromocriptine can increase the consistency, making them hard and thus more difficult to remove.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Physicians often work with the patient by recommending a withdrawal protocol. If the drug has been successful at managing prolactin levels for at least a year, and the tumor is no longer evident on MRI, the patient is able to gradually discontinue the medication. Some patients may stay in long-term remission after a period of several years of dopamine agonist therapy. However, this is not always the case. In my own situation, I have attempted to taper off cabergoline numerous times over the past ten years, but a three-month follow up has always demonstrated elevated prolactin levels. I was always told that I would need to continue cabergoline therapy until I reached 52 (the natural age of menopause). Since undergoing a premature hysterectomy last year, however, I realized that this was incorrect. Medical therapy needs to be continued (with breaks if possible) for life, or the tumor will likely grow larger and increase prolactin levels. Just because the tumor no longer presents itself on MRI due to shrinkage, it doesn’t mean it is no longer there. Indeed, if a patient still requires medication to treat elevated prolactin levels then the tumor must still be functioning. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">One thing to consider is the fact that dopamine agonists such as cabergoline carry the serious risk of cardiac valve disease. It is important to note here, however, that the research conducted included Parkinson’s disease patients who were generally on far higher doses than those with prolactinoma. Further, the patients treated for Parkinson’s disease differ in age (are generally older). It is believed that the smaller doses used for prolactinoma are safer, although it is not really known whether the long-term use of such drugs (say in 20, 30 or 40 years) would cause a similar outcome. For those patients requiring long-term treatment with cabergoline, it is recommended that regular echocardiographic evaluation should be carried out. Hopefully, larger studies will be conducted in the foreseeable future. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Although medication is the first line of treatment for prolactinoma patients, surgery may be performed when medication is ineffective at reducing tumor growth and/or prolactin levels. In such instances, the tumor has grown into a macroadenoma prior to undergoing surgery. However, surgery may also be preferred as treatment for microadenomas where the patient no longer wishes to continue long-term drug therapy. For instance, the patient may not be able to tolerate the medication or perhaps is unable to afford the high cost of the drug due to lack of medical insurance.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Although I hear physicians state repeatedly that patients with prolactinoma shouldn’t suffer with poor quality of life when treated with medical therapy, I have come across a number of patients (both online and now in person) that actually do. For example, several members of the Pituitary Network Association (PNA) responded to my question on the forum about microprolactinoma, cabergoline and debilitating fatigue. In fact, due to their poor QOL some of them decided to undergo surgery and are now feeling a great deal better. I also came across one of the few peer-reviewed journals relating to QOL for patients treated for microprolactinoma. The study can be found <a href="http://www.eje-online.org/cgi/content/full/157/2/133">here</a>.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>Final Comments</b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Although this article is not intended as an all-inclusive review of pituitary disease, I hope you will find my notes from the Seattle pituitary symposium informative. However, I am not a medical professional and I may have misunderstood some of the information offered. Please consult a trained physician for your own individual care. Should you find any errors or wish to add any pertinent information, please let me know. Wishing you and your family well in your road to recovery and good health. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>Useful Links</b></div><br />
<a href="http://www.swedish.org/body.cfm?id=2261"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Dr. William Ludlam talking about Pituitary Disease</span></span></a><br />
<a href="http://www.pituitary.org/intro.aspx"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">The Pituitary Network Association (PNA)</span></span></a><br />
<span class="Apple-style-span"><a href="http://www.cushings-help.com/intro.htm"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Cushing’s Help and Support</span></span></a></span><br />
<span class="Apple-style-span"><a href="http://cushings-help.org/"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Cushing’s Help Organization</span></span></a></span><br />
<span class="Apple-style-span"><a href="http://www.magicfoundation.org/"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">The Magic Foundation</span></span></a></span><br />
<span class="Apple-style-span"><a href="http://www.eje-online.org/cgi/content/full/159/4/363"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Cabergoline heart valve long-term use</span></span></a></span><br />
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</div></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com1tag:blogger.com,1999:blog-2109144868634693364.post-77948747806672091572010-03-30T18:17:00.000-07:002010-03-30T18:17:46.135-07:00Technorati Claim Token: V4X6ZX273HJRTechnorati Claim Token: V4X6ZX273HJRDilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-46753280987200102952010-03-27T15:12:00.000-07:002011-07-18T21:00:02.685-07:00How to avoid slaying your PC: Backing up your data before something inevitably goes wrong<div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioZg6gdEdP4Bq-kjYSNmKqqQB4lExnla6uy0BDTugn2toU8xz80NRrFBuvOV47SDJm9LSmhSmXgX63uTOKx2la9wd4L5rDL9GVi0oCtrNNjCZSeh3fZ19vYBflDh6YG7TUKEd3lrfEEnI/s1600/GS+Post+005.1+Slaying+PC.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioZg6gdEdP4Bq-kjYSNmKqqQB4lExnla6uy0BDTugn2toU8xz80NRrFBuvOV47SDJm9LSmhSmXgX63uTOKx2la9wd4L5rDL9GVi0oCtrNNjCZSeh3fZ19vYBflDh6YG7TUKEd3lrfEEnI/s320/GS+Post+005.1+Slaying+PC.jpg" /></a></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #333333; font-family: Georgia, 'Times New Roman', serif; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><b><br />
</b></span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="apple-style-span"><b><span style="font-family: Georgia; font-size: 11pt;"><span class="Apple-style-span" style="color: #b4a7d6;">Back up my hard drive? How do I put it in reverse? ~ Compurt Quotes</span></span></b></span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #333333; font-family: Georgia, 'Times New Roman', serif; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px;"><b><br />
</b></span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">According to the Boston Computing Network (BCN), almost a third of PC users have lost all of their computer files due to occurrences outside of their control. Important items such as office documents, photographs, music and videos can instantly disappear, simply because of a technical problem: viruses, failing hard drives, and computer hackers can all take their toll on our PCs, but backup devices also share their own slice of “packed up” pie. A few weeks ago, I personally experienced some loss of data, and thought it may be useful to write a post here about what I have since discovered. Although I’m not an IT professional, I hope that this extended article will at least give you some idea of how to protect your own digital data from unforeseen circumstances. This piece of writing does not relate to any specific health issue, as many of my other posts do, but I’m sure that the stress caused by such computer glitches would likely exacerbate a condition. So, let’s hope that in the process of building and protecting our data “libraries”, we will also be able to protect ourselves from any undue breakdown or indeed the loss of our own sanity! </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">One of the main causes of so much loss of information is because huge quantities of electronic data are now being stored in smaller spaces. Most of us have confidence in backup tools and methods, but even these have been shown to be unreliable at times. In fact any type of digital storage is susceptible to failure. A staff member from Ontrack recently confirmed to me that 80 percent of PC users who have lost their data had regularly backed up their work beforehand. This was also my own experience. I have been methodically backing up my work for years. However, when returning to some old media to support some of my new writing projects, I was unable to access a number of my documents. This was very frustrating to say the least. It is crucial, therefore, to make sure that at least two different copies are made, as no single method of storage is completely safe. And even if those storage media do endure the test of time, the constant progression in technology means that it will likely suffer from hardware obsolescence in the future. It would be a bit like having a record but no record player! I recall finding a Travan 5GB minicartridge that had been held in a museum’s safety deposit box for quite some time. Because a specific (and expensive) drive was required to retrieve the information within it, I decided to implement a completely new database system to house collection information (via PastPerfect). In fact, I know of other non-profit organizations that have resorted to merely storing devices in climate-controlled piles, still hoping for some type of universal guidelines to miraculously appear. Although there is no perfect solution at this time of writing, backing up multiple copies of the same data regularly using several forms of media should at least preserve your data for the time being, and then when necessary, the contents will be available for transfer to future storage systems.</span></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Compact Disc</span></b><br />
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</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvm8_D4ZTsB1D6fpD0qutbnywsSCLtte1mDBImsOzczzAWvXHg3b2Py3AQjbnEd7PZYFxJDBdAAUikLkTq0Aj49le0tI5qWi5oBvY_WbBaL8E42PgoC_FLeBJzKqkV0ti58QmTI_rYjyw/s1600/GS+Post+005.2+Compact+Disc.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvm8_D4ZTsB1D6fpD0qutbnywsSCLtte1mDBImsOzczzAWvXHg3b2Py3AQjbnEd7PZYFxJDBdAAUikLkTq0Aj49le0tI5qWi5oBvY_WbBaL8E42PgoC_FLeBJzKqkV0ti58QmTI_rYjyw/s320/GS+Post+005.2+Compact+Disc.jpg" /></a></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Gone are the days when we simply backed up our files with a floppy disk (</span><span class="apple-style-span"><span style="color: white;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">5¼-inch floppies)</span></span></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">, as these have now generally been replaced with the newer Compact Disc (CD). There was little choice to continue with the floppy, as these were continually being phased out when PCs became outfitted with a CD burner instead of a floppy drive. Personally, I was sad to see the floppy go as it actually appeared to be reliable as well as durable. However, CDs became more popular, probably due to the fact that they offered more storage space than their predecessor and were relatively inexpensive to buy. CDs are a convenient way to back up your files, but it is important to note that they have a high susceptibility to damage and should not be utilized as a sole method of storage. My first encounter with the fragility of the CD occurred a number of years ago, when I was looking for an effective way to both archive data as well as back up general office work for a small museum. Like most small museums, we had a limited budget. I didn’t know that much about CDs at that time and had started out with the rewrite version (CD-RW). My purpose was to have a CD that I could update on a regular basis, by both adding new content as well as deleting the old. However, since these CDs became corrupted more often than not, I decided to abandon them completely. I then switched to the write-once version (CD-R), where data could only be added but not changed. This meant that I had to add dates to the document name, in order to distinguish the old from the amended version (The CD would not copy two files with the same name). The CD-R did prove to be a better choice, although it still became corrupted at times. It also seemed to take a long time to copy the data to the CD and to access the material thereafter. Another problem I encountered with CDs (although DVDs are better) was their limited data capacity. It took many CDs to hold my backup, and it became increasingly difficult to keep track of them all. </span></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">More importantly, what most people don’t realize is that the quality of commercial CDs is far superior to those offered for sale in general retail stores. Commercially produced CDs are not burned, but the dips and bumps (representing the digital data) are molded or “pressed” directly into the plastic bottom layer. If handled and stored correctly, these discs are said to last for decades. The domestic CD-R, however, uses a cheap but highly reflective dye, which when burned via your CD-R drive, eventually degrades the data within a few years. When coupled with CD rot (caused by oxidation and fading), it can corrode your data much faster than plain old-fashioned acid-free paper. The CD-R will last longer if cared for properly. Avoid high temperatures, humidity and direct sunlight as these can cause damage such as warping. It is important to store them in a clean, dark and stable environment that doesn’t get too hot and that has an even relative humidity. Handle the CDs by the edges, as scratches and fingerprints can render it unreadable, and constant bending can also lead to deterioration. Store them vertically in a quality protective holder, with soft vinyl inserts or Tyvek sleeves, although a standard jewel case may also be adequate. Many experts advise not to affix a label to the CD, although others say that it adds more protection. Some state that only water-based marker pens designed for CD use should be applied for labeling, as solvent-based markers can seep through the layers and destroy the disc. I have been unable to find any specific long-term lab tests that would either confirm or disprove this theory, however.</span><span class="apple-style-span"><span style="color: black;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></span></span></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">There are said to be a number of remedies that can help clean CDs if they do become unreadable (such as gently rubbing with soapy water, Isopropyl Alcohol, toothpaste or car polish, or even investing in rescue software). I have tried using a commercial brand liquid, which cautioned that the product could be harmful or fatal if swallowed! I’m not sure that I want to be in contact with such a product on a regular basis, even if it did prove to be useful. The best remedy that I would suggest would be to not rely on CDs for archiving irreplaceable data. If you do decide to use CDs for routine backups, however, make sure that you don’t skimp on the price – Use good-quality brand name discs. The saying, “You get what you pay for” certainly applies to the situation when buying CDs.</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></div><div class="MsoBodyText2" style="text-align: justify;"><br />
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</div><div class="MsoBodyText2" style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">External/portable hard-drive </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></b><br />
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</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4234IRZ-p0QKtA05QjCqYDXCifRZfaGJYkCoEK5Qt7fUKDUg71hNZhPmFhkOjbdj_fhhlRflDId93fJtAsQ5Qj1E_YXraNZsTsZ18wSc7rk4UX7KdIdU2K0C6GZHnr-Sh4yAPb4EYXng/s1600/GS+Post+005.3+Seagate+PHD.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4234IRZ-p0QKtA05QjCqYDXCifRZfaGJYkCoEK5Qt7fUKDUg71hNZhPmFhkOjbdj_fhhlRflDId93fJtAsQ5Qj1E_YXraNZsTsZ18wSc7rk4UX7KdIdU2K0C6GZHnr-Sh4yAPb4EYXng/s320/GS+Post+005.3+Seagate+PHD.jpg" /></a></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The portable external hard-drive (PHD) is one of the easiest and quickest ways to store your data, and the device can be easily found for purchase in many retail stores. It is wise to do your homework before purchasing one, however, as they can differ greatly. I’d read several reviews about one particular model that suddenly broke down with all data becoming instantly unrecoverable. So, it is important to research feedback to see how devices fair among customers. PHDs can vary in price, depending on the size and the speed. I decided to purchase one that had sufficient capacity, so that I wouldn’t have to buy another one for quite some time. The device can be set up to provide regular automatic backup of files, although it needs to be plugged into your computer and available when a backup is scheduled to take place. So, if you store your PHD somewhere else (such as a fireproof safe) for protection, you will need to remember to retrieve it before your backup occurs. Like anything mechanical, though, PHDs suffer from wear and tear (or the fate of becoming obsolete) and it is likely that it would need replacing within a 3-5 year period. The good news is that it copies much faster than CDs, so it may be convenient to just let it copy to another device overnight. One of the issues I’ve encountered so far is that on a couple of occasions, some added data failed to write to the device. On the whole, however, I have found the tool to be both convenient and reliable. The PHD pictured here is the Seagate FreeAgentGo (320 GB). Although it was recently priced at $149.99 at Best Buy, it has come down in price considerably and is now only $79.99. FYI, Best Buy has a policy that if you find an item cheaper elsewhere, they will match the price. <i>(Note: I am in no way affiliated with Best Buy or its products)</i>.</span></div><div class="MsoBodyText2" style="text-align: justify;"><br />
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</div><div class="MsoBodyText2" style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">USB flash drive</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></b><br />
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</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOIbqAD8z3Bg79MpWMnthhmr0z4va7CtE8etMUWwnGQGGUJ8sxZhN7LCP-qwyRMrvdHb5IKhe-wFzMOQ9-VkUOBRvc2n7OcBr2u5N7zJftf30zWj1zIHfD7CBtyPqJttB_TjOuuYDYLQQ/s1600/GS+Post+005.4+USB+Flash+Drive.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOIbqAD8z3Bg79MpWMnthhmr0z4va7CtE8etMUWwnGQGGUJ8sxZhN7LCP-qwyRMrvdHb5IKhe-wFzMOQ9-VkUOBRvc2n7OcBr2u5N7zJftf30zWj1zIHfD7CBtyPqJttB_TjOuuYDYLQQ/s320/GS+Post+005.4+USB+Flash+Drive.jpg" /></a></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">There is now a growing trend to use USB flash drives (also referred to as memory sticks, pen, thumb, jump or keychain drives) as a form of portable storage. These compact, removable devices are wonderful for carrying around your data to use at another venue (such as a PowerPoint presentation), and can hold fairly large amounts of data. They are also not as easily damaged as CDs and can be conveniently plugged into a computer for straightforward and speedy transferal of data. Due to the construction of the device (a circuit board covered with transistors), it is able to stay in a given electrical charge state for many years. In fact, if you store it away safely, its memory will most likely outlive your own! Despite the longevity of the device when not in use, there is a limit to the number of times data can be written to it before it gets worn out (although the allowable number of writes is large, being typically 10,000 or 100,000). For this reason, it would not be unreasonable to move the data to a newer device every few years. Flash drives come in many sizes and speeds, and are a relatively inexpensive way to store data. Again, do your homework before settling on a purchase, as substandard flash drives that have previously been discarded by manufacturers, often find their way back onto the market at cheap prices. The one pictured here is the Sandisk Cruzer (32GB), which I purchased for $89.99 from Best Buy. <i>(Note: I am in no way affiliated with Best Buy or its products).</i></span><i><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></i></div><div class="MsoBodyText2" style="text-align: justify;"><br />
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</div><div class="MsoBodyText2" style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Cloud storage</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></b><br />
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</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPUxZMVw3JltMkWdm_KrSERMChkZuYTuuuETtRtgZ_1JG9adcOIXUcwZPWgtTslpzKOmZxexmmv1MyrQL6nQ27qua6sRxoM7XqXYdl11Oyu57YkGqRNYUaaTSEUqAZBl_FGfqickR6vzE/s1600/GS+Post+005.5+Cloud.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPUxZMVw3JltMkWdm_KrSERMChkZuYTuuuETtRtgZ_1JG9adcOIXUcwZPWgtTslpzKOmZxexmmv1MyrQL6nQ27qua6sRxoM7XqXYdl11Oyu57YkGqRNYUaaTSEUqAZBl_FGfqickR6vzE/s320/GS+Post+005.5+Cloud.jpg" /></a></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Many Internet companies are now offering online backup services (also called remote, 0ff-site or cloud storage), which means that they permit you to keep your personal files on their servers. Such services are becoming ever more popular and are a great choice if you want to share files between several computers. Some of these facilities can be utilized at no cost, although they do have a limit on how much you can store. Others may charge money, but in return they enable you to store considerably more data. If you store your data on a cloud storage system, you will be able to access your files remotely from any computer in the world, by logging on to your account with your registration password. Some automatically sync your data to the web while you are still able to work on your documents. The advantage of using an off-site method for backing up your work is that you don’t need to carry around a physical storage device to retrieve your information. Also, even if your home gets totally destroyed by some major natural catastrophe (such as an earthquake, tornado, fire or flood), your work will be kept safe. However, nothing is ever foolproof and the company offering the service may suffer some disaster of their own: Their servers could crash, hackers could get into their servers, or the Internet company could even go out of business. In fact I recently received a message from one individual who had suffered such a fate, stating that the hosting company had wiped </span><span style="color: black;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b><span class="Apple-style-span" style="color: #eeeeee;">"5 days worth of posts and articles from my databases... 'by mistake' and then went on to go under without warning.”</span></b> </span></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> This is surely a horrifying way to realize why it is so important to back up your data via various means. Although off-site backups are an essential part of any disaster recovery plan, for reasons just stated, it should not be your only method of backup. </span></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">When deciding which service to use, it is a good idea to find out how secure your data will be. Most companies include a method of encryption, which means that they use a complex algorithm to encode information, making it more difficult for hackers to access. However, some companies merely use the authentication process, which simply requires a user name and password. This is obviously far less secure when used in isolation. Authorization practices also exist, which enable the client to list people who are authorized to access the information stored in the cloud. Some examples of cloud storage services include Google Docs, YouTube, Facebook, Picassa, MobileMe, Carbonite or Mozy, although there are countless more. One of the problems I’ve found when using cloud storage is that large compressed folders can sometimes take considerable time to upload to the cloud.</span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Network attached storage (NAS)</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></b><br />
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</span></b></div><div class="separator" style="clear: both; text-align: center;"></div><div class="MsoNormal" style="text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3fo5_x1THL5K4L8WsXG5o0rjM3n3gDH1FkFTSoDBBMt8MaXsH3NaYA1vOdT3xFAhbofHGNTtZR1geRpA_X7OSEkS3b513zLddCuExkC44YchyM64fAACCrYgHZRTaJGyTxUInQFFofZc/s1600/GS+Post+005.5+NAS.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3fo5_x1THL5K4L8WsXG5o0rjM3n3gDH1FkFTSoDBBMt8MaXsH3NaYA1vOdT3xFAhbofHGNTtZR1geRpA_X7OSEkS3b513zLddCuExkC44YchyM64fAACCrYgHZRTaJGyTxUInQFFofZc/s320/GS+Post+005.5+NAS.jpg" width="273" /></a></div><div style="text-align: center;"><br />
</div></div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">This method is something that I am seriously considering investing in this year, as it is believed to be one of the best and most versatile ways for data storage and backups. NAS are independent storage devices that connect to your home network via your home Wi-Fi or wired network. It enables multiple computers to access the stored files at the same time and was primarily used for business purposes, although it is now becoming increasingly popular within general households. The discreet sized box enables an unlimited amount of storage capacity (by adding extra drives as needed) and falls within a similar price range to the PHD. Despite not being directly attached to a PC, files may be accessed as conveniently as any other drive (under “My Computer”). NAS also has the ability to routinely back up your data and to access your files remotely over the Internet. The good news is that even if your computer gets damaged, your data remains safe, as it is stored on a separate network. One thing that I’ve heard about NAS, however, is that they may be a bit more complicated to set up than a USB hard drive. </span></div><div class="MsoBodyText2" style="text-align: justify;"><br />
</div><div class="MsoBodyText2" style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Windows/Vista backup</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></b><br />
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</span></b></div><div class="separator" style="clear: both; text-align: center;"></div><div class="MsoBodyText2" style="text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpAPOx0wdsQ5JhBv0ExT97tjrbB3ci_kZkPIdoEURrOcrsVndTw2Ib7nqmgD_GZpFhP4gb2R7ew5W-lpvx85TWadJDnglBDdhpCXneZ4deFjM7hc4IwgS_2TLzu85qmLn1RxANiq76QOw/s1600/GS+Post+005.6.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpAPOx0wdsQ5JhBv0ExT97tjrbB3ci_kZkPIdoEURrOcrsVndTw2Ib7nqmgD_GZpFhP4gb2R7ew5W-lpvx85TWadJDnglBDdhpCXneZ4deFjM7hc4IwgS_2TLzu85qmLn1RxANiq76QOw/s320/GS+Post+005.6.jpg" width="320" /></a></div><div style="text-align: center;"><br />
</div></div><div class="MsoBodyText2" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> <a href="http://www.microsoft.com/windowsxp/using/setup/learnmore/bott_03july14.mspx">Windows XP</a> includes a built-in mechanism that enables you to back up (or restore) large amounts of data in an in a straightforward and swift manner. All you need to do is to make sure that your files are organized well in a convenient location, and then to follow instructions provided by the default Windows wizard. Backup is located in the Start menu - All <b>Programs</b> - <b>Accessories</b> - <b>System Tools</b>. Windows XP backups can be run manually on a regular basis, or scheduled for automatic backup by altering the Advanced settings. <a href="http://www.microsoft.com/windows/windows-7/features/backup-and-restore.aspx">Windows 7</a> and <a href="http://technet.microsoft.com/en-us/magazine/2007.09.backup.aspx">Vista</a> (accessible from the Backup and Restore Center in the Control Panel) also offer similar backup software. Windows can be used to create backups on NAS devices, external drives, or even on your primary hard drive. The advantage of using this backup method is that it requires no additional financial cost if you already own a copy of the operating system. However, it has been criticized for not having many of the advanced features that come with the commercial packages, and is thus considered an inferior backup solution</span><span class="apple-style-span"><span style="color: black;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">.</span></span></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> </span><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></b></div><div class="MsoBodyText3" style="text-align: justify;"><br />
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</div><div class="MsoBodyText3" style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Summary</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></b></div><div class="MsoBodyText3" style="text-align: justify;"><br />
</div><div class="MsoBodyText3" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">If you regularly use a computer, then backup should be an essential part of your computing practice. There are far too many horror stories about individuals or organizations that have totally lost their data due to issues such as system failure, computer viruses, human error, theft or inadequate backup, and it is inevitable that something will go wrong at some point in time. You can never totally prevent data loss, but by backing up your work, you can reduce the chances significantly. If your computer fails, it could cost you hundreds or even thousands of dollars to pay a data recovery specialist. Regular backup of your data via several cost-effective devices as described above, however, will not only likely save you pennies, but it will also save you peace of mind.</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></div><div class="MsoBodyText3" style="text-align: justify;"><br />
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<span class="apple-style-span"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b>Resources</b></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b><br />
</b></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b><b><span style="font-family: Georgia; font-size: 11pt;"><a href="http://www.bostoncomputing.net/consultation/databackup/statistics/">Boston Computing Network</a></span></b></b></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px; font-weight: 800;"><br />
</span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px; font-weight: 800;"><span class="apple-style-span"><b><span style="color: black; font-family: Georgia; font-size: 11pt;"><a href="http://www.ontrackdatarecovery.co.uk/data-recovery-articles/">Ontrack Data Recovery Articles </a></span></b></span></span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: medium;"><span class="Apple-style-span" style="font-size: 15px; font-weight: 900;"><br />
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</span></span></div></span>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-65170474145354530512010-01-29T19:20:00.000-08:002011-07-18T21:02:49.407-07:00Pituitary disease: Getting the word out<span class="Apple-style-span" style="font-family: 'MS Shell Dlg'; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><span class="Apple-style-span" style="color: #4b5d67; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 11px; line-height: 15px;"></span></span></span><br />
<span class="Apple-style-span" style="font-family: 'MS Shell Dlg'; font-size: small;"><div class="separator" style="clear: both; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglHm8f5g0fQWbn6vlhzdqp-e88PlyPh_53ek4mG1UeO_SDvsNZzRIAN2TN2JbcOyuCRouUaHsbASj9dTVn9uJfHpe2F_7Cjy0IGw4iRQZ4IkMc_eNgAKCx-LMXnOVPMbPq4Zh4FiSS2Yg/s1600-h/GS+-+Graphic+Pituitary.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglHm8f5g0fQWbn6vlhzdqp-e88PlyPh_53ek4mG1UeO_SDvsNZzRIAN2TN2JbcOyuCRouUaHsbASj9dTVn9uJfHpe2F_7Cjy0IGw4iRQZ4IkMc_eNgAKCx-LMXnOVPMbPq4Zh4FiSS2Yg/s320/GS+-+Graphic+Pituitary.jpg" /></a></span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">According to the Pituitary Network Association, one in five people throughout the globe may have an abnormal growth on their pituitary gland. If left untreated, some of these may harm the body’s natural hormonal function and result in an inferior quality of life or even worse, a shortened lifespan. Unfortunately, due to the lack of public recognition about pituitary disease, it can take years for someone with such a disorder to obtain the right diagnosis. It is important, therefore, to get the word out, as many individuals may be suffering needlessly. There is help if you take the time and make the effort to empower yourself or others around you that may be experiencing this ailment.</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">What is the pituitary gland?</span></span></strong></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The pituitary is a tiny, pea-sized endocrine gland, which is attached to the base of the brain. It sits in the middle of the head in a bony nook called the sella turcica and is connected by the pituitary stalk to the region of the brain known as the hypothalamus. Don’t let this tiny little gland fool you, though. This modest gland is considered a “master control gland’ as it plays a crucial role in the regulation of the secretion of a cocktail of hormones throughout the body. It sends chemical messages to the adrenal glands, thyroid glands, ovaries and testes, instructing them to produce cortisol, thyroid hormone, estrogen, testosterone and more. These hormones have significant effects on vital bodily functions and development, such as height, metabolism, blood pressure, sexuality and reproduction. Thus, disruptive pituitaries can cause an imbalance of hormones that in turn cause considerable repercussions for their landlords. One of the main perpetrators of pituitary dysfunction is a pituitary tumor, which can lead to the overproduction or decrease of one or more hormones. Too little or too much of a pituitary hormone can result in a wide assortment of symptoms. These types of tumors are usually not cancerous (benign) and are often referred to as adenomas but can cause endocrine disorders such as cushing’s syndrome, prolactinoma, hyperthyroidism, hypopituitarism and acromegaly.</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">What are some of the signs and symptoms of pituitary disease?</span></span></strong></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The following symptoms are not totally inclusive, and vary depending on the specific condition and the patient involved. However, a list is provided here as a mere guide:</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
· Headaches</span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Visual disturbances</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Irregular menses</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Infertility</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Lactating</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Impotence</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Sexual dysfunction</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Unusual hair growth/loss</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Fatigue</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Sleep dysfunction</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Depression</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Irritability</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Anxiety</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Loss of memory/cognitive dysfunction</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Muscle weakness</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Eating disorders</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Nausea/vomiting</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Belly pain</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Acne</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Weight gain</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Diabetes</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· High blood pressure</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Heartburn/GERD</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">· Rapid heart rate</span></div></span><br />
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<div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Be your own advocate!</span></span></strong></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Having been diagnosed with a Prolactinoma (prolactin secreting tumor) around 10 years ago, and then several years later having endured a severe decline in my overall health, I am now undergoing tests for suspected cyclical cushing’s disease. For many years, I bounced around between numerous doctors desperately trying to find out why I had so many debilitating symptoms, which eventually resulted in the loss of my much-loved career, financial security and happy social life. Both my GPs and endocrinologists advised me that my prolactinoma was being sufficiently managed with prescribed medication and that there was no reason why I should feel so dreadfully ill. It was not apparent to the medical community that 10% of such growths could be co-functioning and that the tumor can actually switch on and off. It was only when I discovered the Pituitary Network Association (PNA) that my quest began to locate the right doctors (for me, it was a pituitary endocrinologist)… I had finally realized that pituitary/hormonal disease was far more complicated than the general medical community was geared up for and that I needed someone in the right field of healthcare (i.e. a specialist in pituitary disease rather than just someone with a general knowledge of all endocrine disorders). Few doctors truly understand pituitary/hormonal disease. However, with the right tools and appropriate treatment from experienced doctors, your disorders can hopefully be cured/controlled and you can get back on track with your life. At this point in time, I don’t know whether or not I have cyclical Cushing’s disease, but at least I feel more empowered by understanding that I am more responsible for my overall well-being in life than anyone else on this planet, and that I need to be more proactive in both educating myself and others about pituitary disease. I hope you will get involved too!</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">More information can be found at the Pituitary Network Association – </span></span><span class="Apple-style-span" style="font-size: small;"><a href="http://www.pituitary.org/intro.aspx" style="color: #7f1d1d; line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">http://www.pituitary.org/intro.aspx</span></a></span><br />
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</span></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-45888024420093963562010-01-29T18:42:00.000-08:002010-03-20T19:06:58.495-07:00Another rant about invisible illness and those who judge: Those closest<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguOVkqkPd8pOr-68jHhqtD6RLAUW5tvtW5ubcXExDDqqU_bkpDZ4C2eFTAaBLdYGwkjjhnx9ELcg1GT1ZcKcHC91hpXYCMbQgUc0Mc5_OQQAJxwZeFCbFFk4gthtz7AsQQf4YH73mNMl4/s1600-h/GS+-+Abstract+Face.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguOVkqkPd8pOr-68jHhqtD6RLAUW5tvtW5ubcXExDDqqU_bkpDZ4C2eFTAaBLdYGwkjjhnx9ELcg1GT1ZcKcHC91hpXYCMbQgUc0Mc5_OQQAJxwZeFCbFFk4gthtz7AsQQf4YH73mNMl4/s320/GS+-+Abstract+Face.jpg" /></a></div><span class="Apple-style-span" style="font-family: 'MS Shell Dlg'; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><span class="Apple-style-span" style="color: #4b5d67; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 11px; line-height: 15px;"></span></span></span><br />
<span class="Apple-style-span" style="font-family: 'MS Shell Dlg'; font-size: small;"><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">In my last post, I briefly talked about how to better cope with an invisible condition when those around you may be unsupportive. As this seems to be a relatively significant problem for most patients within this scenario, I thought it might be worth revisiting the topic. Also, as human beings we are inextricably linked to our current state of emotions, and such regular encouraging affirmations will hopefully help us deal with these constant battles. Hopefully, in time our responses to such negative behavior will enable us to step back from the situation instead of resorting to the typical approach of doubting ourselves or feeling frustrated.</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Just to recap, an invisible illness is one where others are unable to detect any form of disease or disability, despite the fact that someone may be very sick. Indeed, people often tell me that I look well, and I suppose my upbeat personality would also likely reinforce this misapprehension to those who don’t really understand. Conversely, a visible condition can often be identified by supportive apparatus, body appearance and also by behavior. Like many others with an invisible illness, I don’t possess a wheelchair or have a limp, I don’t moan about my daily discomforts, and there are no other apparent deformities that one can observe from just looking at me. Indeed, I actually look the picture of perfect health! I wish that were only true. If I had the choice of picking a visible illness, would I change? To be quite honest, I don’t really know. On the one hand, others seem to comprehend issues better when they observe things visually. However, in our culture, people can be just as cruel about disfigurement or abnormalities. It can sometimes be a quandary as to whether to purposely demonstrate how poorly you feel to others in order to get them to acknowledge your medical problems. How much do you disclose to others? Do you start using a cane or sidestep the issue and be misunderstood? It is important to get others to recognize your situation but this tilts the scale for being able to fit in and to remain inconspicuous. I suppose the choice is a personal one. In the scientific community, the term “suck it and see” is often used, which basically means just try each step and see how it works for you.</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Prior to my chronic and debilitating illness, I was extremely fit and energetic: I walked eight miles a day, enjoyed a fulfilling and rewarding career that entailed global travel, and I also benefited from a wonderful social life and happy marriage. I seemed to have it all. When I became ill, everything changed, of course. Throughout my journey, I have encountered positive and supportive individuals, but like many of you I have not been immune to the occasional rudeness from others who don’t understand. Indeed, even after being diagnosed with a particular condition from a Board Certified MD, one (non medical) individual retorted by saying, “Don’t be silly, you haven’t got that!” In fact, this is not the first time I have received such a response and I’m sure that many of you have experienced similar circumstances. This can be a very challenging situation to deal with, especially when that person may be a close friend or family member. It seems quite bizarre to me that someone could witness a person’s whole transformation from a vibrant and dynamic existence to one that is practically housebound and screaming out for help, and yet they choose to define such a change as psychosomatic. However, just as it is for those who judge us, it is not pertinent for me to judge others, so I will say little more. All I can articulate is that nobody should feel discouraged by the shortcomings of others or let such behaviors negatively affect one’s overall well being. After all, most people’s understanding of illness is generally based on acute conditions, such as a broken leg or a bad cold, where patients remain inactive for a period of time while they are recovering. After this anticipated healing time, they are expected to resume normal activities to levels prior to when the sickness began. However, someone with a chronic condition that has limited capacity instead of being totally bedridden is not so clearly defined. Further, after some time, when unable to return to a fully productive state, a chronically ill person with an invisible illness is often misunderstood as being lazy or of weak character, or perhaps that they are exaggerating the situation in order to seek attention or glean insurance benefits. The normal expectation within our society is that if you are seen to look healthy and to be functioning ok then you must be so all the time. Unless they live with you, they are unable to understand the constant fluctuations in your symptoms. If you applied the philosophy of resting in bed until you felt better, as a chronically ill person you will likely never get out of bed at all! This would not be beneficial as not only will you miss out on life, limiting yourself may lead to even lower function and more disability. It’s important, therefore, to participate in certain activities when you feel up to it but not to overdo things. It would be prudent to seek the advice of a medical professional to determine which levels of exertion may be suitable for your particular case.</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Although it is not possible to completely eradicate the disapproving responses encountered from others from time to time, I have endeavored to list a few basic coping tips in the hope that they may at least soften the blow. Please feel free to comment or let me know if you have any other strategies that you find are particularly helpful to you. Thank you.</span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Some Basic Coping Tips:</span></span></strong></div><ul style="line-height: 1.4em; margin-bottom: 24px; margin-left: 9px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><li style="line-height: 1.4em; margin-bottom: 0px; margin-left: 14px; margin-right: 24px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Write out a list of names of those people you have regular contact with and make a note of those whose relationships you enjoy the most – Spend more time with these people!</span></span></li>
<li style="line-height: 1.4em; margin-bottom: 0px; margin-left: 14px; margin-right: 24px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Join a support group so that you are able to communicate with fellow sufferers who have a better understanding of what you are going through.</span></span></li>
<li style="line-height: 1.4em; margin-bottom: 0px; margin-left: 14px; margin-right: 24px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Be your own advocate and read about your condition, and share your findings with those around you so that they will have an increased awareness.</span></span></li>
<li style="line-height: 1.4em; margin-bottom: 0px; margin-left: 14px; margin-right: 24px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">If someone insults you, think about where that opinion is coming from. Is this person worth justifying yourself to by providing relevant facts, or would you be better off by just letting it go so that you can prioritize on more important issues?</span></span></li>
<li style="line-height: 1.4em; margin-bottom: 0px; margin-left: 14px; margin-right: 24px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">No matter what anyone says to you, believe in yourself and try to remain positive. Do not let others’ negative opinions impact your quality of life.</span></span></li>
<li style="line-height: 1.4em; margin-bottom: 0px; margin-left: 14px; margin-right: 24px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Spend more time doing what you love… This will give you a positive focus and will help distract you from others’ negativity. If you don’t know where your passion lies, try taking up a new hobby – Remember the term “Suck it and See”.</span></span></li>
</ul><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">RESOURCES:</span></span></strong></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">The invisible Disabilitie</span></span></strong><span style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="line-height: 18px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; white-space: pre;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">s </span></span></strong></span></span><span style="line-height: 18px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; white-space: pre;"><tt style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="line-height: 19px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; white-space: normal;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Advocate </span></span></strong><span style="line-height: 18px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; white-space: pre;"><tt style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">- </span></span><span style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><a href="http://www.invisibledisabilities.org/" style="color: #7f1d1d; line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">http://www.invisibledisabilities.org/</span></span></a></span></tt></span></span></tt></span></div><pre style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><tt style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"></tt></span></span></pre><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><tt style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"></tt></span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">30 Things about My Invisible Illness you May Not Know</span></span></strong><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"> – A useful template that you can complete and send to others, or paste it on Facebook or your weblog - </span></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><a href="http://invisibleillnessweek.com/?p=2301" style="color: #7f1d1d; line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;">http://invisibleillnessweek.com/?p=2301</a></span></span><br />
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</span></div></span>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com2tag:blogger.com,1999:blog-2109144868634693364.post-72497699314027078852010-01-29T18:17:00.000-08:002010-03-12T16:12:54.847-08:00Invisible illness: Those who judge<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmypSBkI8gMAWc9TTYaOsR0PSnv4dnYOS18EBfISCICLgQDafUCT2GnI7PEIo23jTjXG55nobU1QhagsYoq5_uncChWAseQ7Dv_2oGDlQB9sf7mM7GTKc_15vFuXTzG9pNutGuaos88yU/s1600-h/GS+Hanging+Judge.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmypSBkI8gMAWc9TTYaOsR0PSnv4dnYOS18EBfISCICLgQDafUCT2GnI7PEIo23jTjXG55nobU1QhagsYoq5_uncChWAseQ7Dv_2oGDlQB9sf7mM7GTKc_15vFuXTzG9pNutGuaos88yU/s320/GS+Hanging+Judge.jpg" /></a></div><div style="text-align: justify;"><div style="text-align: justify;"><br />
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<div style="font-size: 11px; line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">T</span></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">here are many chronic illnesses that appear to be unobvious to those looking from the outside, and some individuals are under the impression that if you don’t look sick then you certainly can’t be sick – Surely your problems are psychological and must be caused by depression, hypercondria or even worse… just plain laziness! This is especially true if one is unable to back up one’s lengthy symptom list with some tangible lab evidence. Contrary to what most people believe, it is sometimes tricky to obtain a definitive diagnoses for some circumstances. Indeed, I once experienced a situation where doctors couldn’t agree on whether or not I actually had cancer. On another instance, they were unable to elucidate why I went into serious adrenal dysfunction. Many years later, these episodes (as well as countless others) have merely retreated into the abyss of my meager memory, with no apparent clarification or remedy in sight. Doctors simply don’t understand what the cause could be, and the medical profession clearly remains inept at observing the body holistically. Meanwhile, I continue to take my roller coaster ride of ups and downs, reflecting times of optimism that is ultimately followed by defeat and disillusionment, and the lingering question of whether I will ever feel “normal” again.</span></span></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Invisible ailments include such illnesses as Chronic Fatigue Syndrome (CFS/ME), some pituitary diseases, autoimmune disorders, heart disease and even cancer, although this list is far from exhaustive, and I’m sure that many of you will be happy to tell me about your particular situation or ailment. I’m also in no doubt that a number of you will have experienced some negativity or perhaps dismissiveness from some individuals (whether doctors, family or friends), which will undoubtedly cause much frustration and anger. This is a natural human response to situations that seem to be out of our control. Indeed, if we didn’t feel irritated or upset with such a set of circumstances then there would be something wrong! It is my experience that many people who do not have an invisible illness will not fully understand, no matter what or how many times you try to explain it to them. In fact there’s a useful saying in Israel that sums this up: </span></span><em style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">“Let a man shave his own beard”</span></span></em><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">. Some guides have, however, been written on how to communicate such information effectively (I am unable to comment on the efficacy of such material) and you might want to experiment with it to see if it helps (see IDA link for further information).</span></span></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">I try to manage my reaction to such disapproving people by telling myself that I know who I am as a person, and I understand my physical limitations. People may decide for themselves that I look sufficiently well to host the perfect dinner party, but the reality is that if I do too much then </span></span><em style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">“payback is a <span style="font-family: Georgia; font-size: 12pt;">вiŧ©ħ!</span>”</span></span></em><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"> or in more refined vocabulary, I will experience what is generally referred to as “post-exertional malaise”. I have noticed through the years, that many people appear to be on what I term as the “conveyer belt of life” and, as a consequence, often end up being stuck in a rut. I’m certainly not saying that I’m glad to have this awful sickness or indeed would wish it upon anyone else (well, maybe for a week or so, so that they could truly experience and empathize with it!) However, I will say that it has really enabled me to grow in such a way that would not have been possible otherwise. In my prior life (i.e., before the illness), I was a workaholic and was always worried about what everyone else thought about me. As a consequence, I almost drove myself around the bend, continually trying to please others, and as a result, I was repeatedly abused and unappreciated. As my health progressively declined (if that makes sense), I realized enough was enough.</span></span></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">As a chronically ill patient, your priority is to take very good care of yourself, and if someone doesn’t understand that then they are really not worth bothering with – Especially if they are inclined to harmfully judge you. Nowadays, I try to limit my exposure to damaging relationships. I literally wrote out a list of names of those people I had contact with on a regular basis. (This list included face-to-face contacts, phone, calls, emails, text messages, and anything else). I then placed a tick mark next to those whose relationship I had enjoyed, and a cross mark adjacent to those who made me feel bad about myself. I then proceeded to eliminate the harmful ones from my life, and to spend more time with those whose company I took pleasure in. This has worked well for the most part – Obviously, it is not always possible to remove them all, due to certain responsibilities and so forth. Some family and work relationships could certainly pose problems, as it’s not always viable to just ignore them. However, it can be better to even avoid family ties if they become detrimental to your well-being.</span></span></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">On occasions when forced into a negative setting, try to take stock and “step out of the situation”. I know that sounds rather whimsical, but if you can, try to see the bigger picture and to acknowledge THEIR limitations, NOT yours. You are in charge of your own feelings. Nobody has the right to make you feel any particular way – Only you have that right. With a chronic illness you have enough to contend with. Let them just “get on with it”.</span></span></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">I hope this post will be of some help and consolation during difficult times. Just remember, if you can stay relatively sane through a diabolical illness, then that makes you a particularly strong individual indeed… Personally, I think that having an invisible illness is the “mother test of life”.</span></span></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: left;"><strong style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Resources:</span></span></strong></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: left;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">The Invisible Disabilities Advocate (IDA) - </span></span><a class="aligncenter" href="http://www.invisibledisabilities.org/" style="color: #7f1d1d; display: inline !important; line-height: 1.4em; margin-bottom: 0px; margin-left: auto; margin-right: auto; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;" target="_blank" title="IDA"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">http://www.invisibledisabilities.org/</span></span></a></div></div></div></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><div style="text-align: left;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Invisible Illness - What You Can't See Does Hurt Her - </span></span><a class="alignleft" href="http://www.socialworktoday.com/archive/novdec2007p18.shtml" style="color: #7f1d1d; display: inline !important; line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;" target="_blank" title="Invisible Illness"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">http://www.socialworktoday.com/archive/novdec2007p18.shtml</span></span></a><span class="Apple-style-span" style="color: #20124d; font-weight: bold; line-height: 15px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"> </span></span></span></div></div></div></div><div style="font-size: 11px; line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px;"><div style="text-align: justify;"><div style="text-align: justify;"><span class="Apple-style-span" style="color: #000066; font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: medium;"><b><i><br />
</i></b></span></span></div></div></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com1tag:blogger.com,1999:blog-2109144868634693364.post-90216320580162733882010-01-29T12:49:00.000-08:002010-03-12T16:11:57.593-08:00Your most important asset: Your health<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigQbYn4DOV8orGwL7m8Y-Tx_Y14PGdFT54djep1kfHSmwLDMtkxNjko1tfRpKAa66m5jwL-nnEY3Bnn2xAA00j6Ou2yfz5ioIZxu8Gndd42rC-woea1A2nlwcBr7oQuDKqrDJgVTSOCMY/s1600-h/Gallant+Strides+Post+01.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" style="text-decoration: none;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5432267366690601218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigQbYn4DOV8orGwL7m8Y-Tx_Y14PGdFT54djep1kfHSmwLDMtkxNjko1tfRpKAa66m5jwL-nnEY3Bnn2xAA00j6Ou2yfz5ioIZxu8Gndd42rC-woea1A2nlwcBr7oQuDKqrDJgVTSOCMY/s320/Gallant+Strides+Post+01.jpg" style="cursor: hand; cursor: pointer; display: block; height: 320px; margin: 0px auto 10px; text-align: center; width: 221px;" /></a><br />
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<span class="Apple-style-span" style="color: #4b5d67; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 11px; line-height: 15px;"><div style="font-size: 11px; line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><b><i><span class="Apple-style-span" style="font-style: normal; font-weight: normal;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: white;">Generally, it is not until we personally suffer from a serious or chronic health issue that we truly understand how dramatic an impact it can have on our lives. We often take so much for granted in this world, as if we expect to live the same way indefinitely. Poor health, however, can rob us of the many wonderful things that we normally possess, such as a rewarding career, good social life, and even the simple privilege of feeling independent. It can thus dramatically impact our financial stability, personal relationships and future goals.</span></span></span></span></i></b></div><div style="font-size: 11px; line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><b><i><span class="Apple-style-span" style="font-style: normal; font-weight: normal;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: white;">Such a scenario can also affect our loved ones such as family members, close friends, and co-workers, who often have to step in because of our physical limitations. It is crucial, therefore, that we take preventative measures to in order to avoid or alleviate damage to our bodies before it leads to a situation that may become irreversible. It is inevitable that our bodies will age and deteriorate over time, but there are simple measures that we can take in order to maintain as healthy a lifestyle as possible. Indeed, we endeavor to protect our material belongings in the form of repairing, cleaning and insuring them (preventative conservation), so aren’t we being remiss by not looking after ourselves?</span></span></span></span></i></b></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: white;">Growing up in the western hemisphere, I felt confident that the medical profession had a solid understanding of the human body and that no matter what illness they faced, doctors would by and large be able to diagnose and treat it, accordingly – Ahhh! Those blissful days of pure ignorance… However, the reality is that this is often not the case. Although modern medical care has improved enormously over the last few decades, we are nevertheless a far cry from where we need to be and, as patients, it is important to be proactive in our overall well-being.</span></span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: white;">As expected, the majority of government funding is directed towards research for the most common types of disorders, such as cancer, heart disease and diabetes, and so forth. Millions of people (excluding those from third world countries) therefore continue to suffer with other less common chronic problems that may either go undiagnosed or be misdiagnosed… And in some cases, even if they are diagnosed correctly, they may still not be treated sufficiently due to the lack of appropriate treatments that are available for some types of illness. Indeed, some medications carry hefty side effects with them but there is sometimes nothing else available due to lack of clinical trials for that particular disease.</span></span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: white;">It is crucial, therefore, that you do your homework and make sure that you ask your doctor the right questions. Your doctor is certainly responsible for assisting in your overall medical treatment, but who cares about your future more than you do?</span></span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><b><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;">Further information</span></span></span></b></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="line-height: 15px;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;">* </span></span></span><a href="http://www.webmd.com/"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;">WebMD</span></span></span></a><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;"> - Better Information, Better Health</span></span></span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="line-height: 15px;"><span class="Apple-style-span" style="line-height: normal; white-space: pre;"><span class="Apple-style-span" style="line-height: 15px; white-space: normal;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;">* </span></span></span><a href="http://www.drweil.com/"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;">Dr. Andrew Weil</span></span></span></a><b><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;"> – </span></span></span></b><span class="apple-style-span"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: georgia;"><span class="Apple-style-span" style="color: white;">Trusted Health Advisor (Mind & Body) </span></span></span></span></span></span></span></div><div style="line-height: 1.4em; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 24px; padding-top: 0px; text-align: justify;"><span class="Apple-style-span" style="font-family: 'Times New Roman', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: medium;"><br />
</span></span></div></span></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0tag:blogger.com,1999:blog-2109144868634693364.post-59319799061349194242010-01-29T12:02:00.000-08:002010-01-29T14:31:51.885-08:00Welcome to my blog!<div style="text-align: justify;"><span class="Apple-style-span" style="line-height: 15px; font-family:georgia, serif;"><span class="Apple-style-span" style="color:#FFFFFF;">Hello and welcome to my blog! I hope that this site will provide both helpful and inspiring information, relating to a variety of topics, that you will enjoy. This weblog will have a particular emphasis on health issues and how to manage chronic illness, although many other positive and exciting topics will also be discussed.</span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style=" line-height: 15px;"><span class="Apple-style-span" style="color:#666666;"><span class="Apple-style-span" style="font-size:small;"><span class="Apple-style-span" style="font-family:georgia;"><br /></span></span></span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="line-height: 15px; "><span class="Apple-style-span" style="font-size:small;"><span class="Apple-style-span" style="font-family:georgia;"><span class="Apple-style-span" style="color:#FFFFFF;">More coming soon…</span></span></span></span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="color:#666666;"><span class="Apple-style-span" style="line-height: 15px;"><br /></span></span></div><span class="Apple-style-span" style="font-size:small;"><span class="Apple-style-span" style="font-family:georgia;"><span class="Apple-style-span" style="color:#666666;"></span></span></span><div style="text-align: justify;"><span class="Apple-style-span" style=" line-height: 15px;"><b><i><span class="Apple-style-span" style="font-family:georgia;"><span class="Apple-style-span" style="color:#000066;"><span class="Apple-style-span" style="font-size: small;">Disclaimer:</span></span></span></i></b><i><span class="Apple-style-span" style="font-family:georgia;"><span class="Apple-style-span" style="color:#000066;"><span class="Apple-style-span" style="font-size: small;"> This blog and the opinions given are not intended to replace the advice of your physician. These posts are merely here to provide you with information about my own personal experiences. Please consult with your health care professional for your own individual care.</span></span></span></i></span></div><div><span class="Apple-style-span" style="font-family:Verdana, Arial, Helvetica, sans-serif;font-size:100%;color:#4B5D67;"><span class="Apple-style-span" style=" line-height: 15px;font-size:11px;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana, serif;"><span class="Apple-style-span" style=" line-height: 15px;font-size:medium;"><br /></span></span></div></div>Dilys Strideshttp://www.blogger.com/profile/04019415189877978927noreply@blogger.com0