…in a nutshell <ahem!>
Hypercortisolism Is Associated With Increased Coronary Arterial Atherosclerosis: Analysis of Noninvasive Coronary Angiography Using Multidetector Computerized Tomography
Journal of Clinical Endocrinology and Metabolism, 05/21/2013 Clinical Article
- Nicola M. Neary*,
- O. Julian Booker*,
- Brent S. Abel,
- Jatin R. Matta,
- Nancy Muldoon,
- Ninet Sinaii,
- Roderic I. Pettigrew,
- Lynnette K. Nieman and
- Ahmed M. Gharib
Program in Reproductive and Adult Endocrinology (N.M.N., L.K.N., B.S.A.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; Laboratory of Cardiac Energetics (O.J.B.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892; Integrative Cardiovascular Imaging Laboratory (J.R.M., R.I.P., A.M.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Critical Care Medicine (N.M.), Clinical Center, National Institutes of Health, Bethesda, Maryland 20892; and Biostatistics and Clinical Epidemiology Service (N.S.), Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
- Address all correspondence and requests for reprints to: Ahmed M. Gharib, MB, ChB, National Institutes of Health, Building 10, Room 3-5340, Mail Stop Code 1263, 10 Center Drive, Bethesda, MD 20892. E-mail: firstname.lastname@example.org.
↵* N.M.N. and O.J.B. contributed equally to this work.
Background: Observational studies show that glucocorticoid therapy and the endogenous hypercortisolism of Cushing’s syndrome (CS) are associated with increased rates of cardiovascular morbidity and mortality. However, the causes of these findings remain largely unknown.
Objective: To determine whether CS patients have increased coronary atherosclerosis.
Design: A prospective case-control study was performed.
Setting: Subjects were evaulated in a clinical research center.
Subjects: Fifteen consecutive patients with ACTH-dependent CS, 14 due to an ectopic source and 1 due to pituitary Cushing’s disease were recruited. Eleven patients were studied when hypercortisolemic; 4 patients were eucortisolemic due to medication (3) or cyclic hypercortisolism (1). Fifteen control subjects with at least one risk factor for cardiac disease were matched 1:1 for age, sex, and body mass index.
Primary outcome variables: Agatston score a measure of calcified plaque and non-calcified coronary plaque volume were quantified using a multidetector CT (MDCT) coronary angiogram scan. Additional variables included fasting lipids, blood pressure, history of hypertension or diabetes, and 24-hour urine free cortisol excretion.
Results: CS patients had significantly greater noncalcified plaque volume and Agatston score (noncalcified plaque volume [mm3] median [interquartile ranges]: CS 49.5 [31.4, 102.5], controls 17.9 [2.6, 25.3], P < .001; Agatston score: CS 70.6 [0, 253.1], controls 0 [0, 7.6]; P < .05). CS patients had higher systolic and diastolic blood pressures than controls (systolic: CS 143 mm Hg [135, 173]; controls, 134 [123, 136], P < .02; diastolic CS: 86 [80, 99], controls, 76 [72, 84], P < .05).
Conclusions: Increased coronary calcifications and noncalcified coronary plaque volumes are present in patients with active or previous hypercortisolism. Increased atherosclerosis may contribute to the increased rates of cardiovascular morbidity and mortality in patients with glucocorticoid excess.
- Received October 29, 2012.
- Accepted March 7, 2013.
- Copyright © 2013 by The Endocrine Society
- Cushing’s syndrome increased risk for coronary arterial atherosclerosis (maryomedical.com)
- Know Your Number (cushieblog.com)
- Coronary Artery Calcium Buildup Increases Heart Attack Risk (medindia.net)
HYPERTENSION is classified into two categories according to its cause: essential and secondary.
The vast majority of patients have essential or primary hypertension, while only about 5-10% of patients have secondary hypertension, which are mainly caused by kidney and hormonal conditions like renal artery stenosis, hyperthyroidism, Cushing’s syndrome, and even pregnancy, among others.
The exact cause of essential hypertension is still unknown, although it is certainly the result of a combination of factors, including increasing age, having relatives with high blood pressure (ie family history), a sedentary lifestyle, a poor diet with too much salt, drinking too much alcohol, smoking and too much stress.
Says Malaysian Society of Hypertension president and Universiti Malaya Department of Primary Care Medicine senior consultant Prof Datin Dr Chia Yook Chin: “Each factor increases blood pressure by just a little, but when you add them all together little by little, it raises it by quite a lot.”
Despite not knowing the root cause of hypertension, it has been established that there is overstimulation of the sympathetic nerves in people with this condition.
This in turn increases the secretion of certain hormones involved in the regulation of sodium and fluids in the body, called renin, angiotensin, and aldosterone.
The amount of salt and water in our body affects our blood pressure – the more salt and water present, the higher our blood pressure.
These two elements are regulated by our kidneys through the three hormones mentioned above, which are produced by the adrenal glands located on top of the kidneys.
The overstimulation of the sympathetic nerves also results in increased vascular tone, which causes our arteries to become constricted, thus, also raising blood pressure.
From The Star
- Hypertension, commonest cardiovascular disorder, says Cardiologist (vanguardngr.com)
- World hypertension day: Know your numbers (business.inquirer.net)
- If you have high blood pressure yoga just may help you (housewivesmag.wordpress.com)
There are apps that turn your smartphone into a metal detector, a musical instrument and a GPS system, and now there’s an app that may help doctors save your life if you’re having a heart attack.
The app, which was designed by engineers and critical care physicians, helps doctors rapidly diagnose certain kinds of severe heart attacks, called STEMIs, before patients get to the hospital.
The app currently is in the experimental stage, but it has undergone field testing.
In a STEMI heart attack, which stands for ST segment elevated myocardial infarction, a clot completely blocks blood flow to the heart. About a quarter of a million people have STEMIs each year in the United States.
These kinds of heart attacks create a unique pattern of pulses when doctors hook up patients to an electrocardiogram, or EKG, machine, which measures the heart’s electrical activity.
The problem is that doctors need to see the EKG reading, which is called a tracing, to properly diagnose the attack and quickly assemble the team of specialists that is needed to clear the clot.
There are proprietary systems that use EKG machines hooked up to modems to send images back to hospital computers, but those systems are expensive and not all hospitals and EMS systems can afford them.
As an alternative, paramedics can use their smartphones in the field to snap a picture of the tracing and send it to a doctor at the hospital via email.
But as anyone who has ever tried to email a picture from their phone knows, it’s far from foolproof. Large, high-quality images — the kind doctors need to see — can take several minutes to send and receive.
To address the issue, Dr. David Burt, an associate professor of emergency medicine at the University of Virginia, challenged a class of systems engineering students to develop an app that could shrink images to make them faster to send, but still maintain the clarity needed for diagnoses.
“It’s very easy to use,” Burt said. “You hold it over the EKG tracing, you snap a picture.” Hitting a button sends the image. When it’s finished, the app shakes and makes noise to alert senders to the successful transmission.
“It’s very simple but we want it to be very rugged, so that it’s kind of like a hammer — it always works,” he said. He also wants to offer the app at no cost to doctors and hospitals.
So far, Burt said, they have tested the app more than 1,500 times using different wireless carriers in a city.
They also have pitted the app against the alternative method of using an iPhone to email a picture. In that study, the app consistently sent images within four to six seconds. Emailed images could take nearly two minutes to go through. The app failed less than 1 percent of the time, while the emailed images flopped between 3 percent and 71 percent of the time, according to the study.
The study is scheduled for presentation Friday at an American Heart Association meeting in Baltimore. Studies presented at medical conferences are considered preliminary because they haven’t yet undergone the scrutiny required for publication in a peer-reviewed journal.
Dr. Iltifat Husain, founder of the iMedicalApps website, which keeps up with news about technology in medicine, said he was impressed by the app, but also by how thoroughly the team has been testing it. Husain estimates that less than 1 percent of apps that are developed for doctors are field tested to see if they actually work.
“Something like this would have to be tested before it was put to use because of how critical the information is that you’re relaying,” said Husain, who was not involved in the research.
Husain, who also is an emergency medicine resident at Wake Forest University in Winston-Salem, N.C., said the time the app shaves off image transmission could be critical.
“The longer you wait, the more heart muscle dies, so every minute counts,” he said. “Actually, every second counts.”
Surviving a STEMI depends on how quickly doctors can restore blood flow, which often is done by snaking a catheter up to the heart and using a small balloon to clear the clot.
“We’ll get an EKG reading and the ER physician will activate the cath lab. Once you activate it, a huge team has to be assembled,” Husain said. “If it’s overnight, people are sometimes coming in from home. If you can get someone coming in from home five minutes faster, I think it’s a big deal.”
For more about heart attacks, head to the U.S. National Heart, Lung, and Blood Institute.
SOURCES: David Burt, M.D., associate professor of emergency medicine, University of Virginia, Charlottesville; Iltifat Husain, M.D., second-year emergency medicine resident, Wake Forest Baptist Health System, Winston-Salem, N.C., and founder, iMedicalApps website; May 17, 2013, presentation, American Heart Association meeting, Baltimore
Read more at http://www.philly.com
We originally joined Great Country Farms so our son could see what farm life is like. Our son has long left home but we still love the farm, now more than ever. They deliver each week during the growing season and we can go out there whenever to pick our own. Sometimes, we go just to walk around in the country air.
By chance, I also found a winter CSA that I’ll join next fall and a buy-as-you-go farm that delivers each Thursday, if you want what they have on offer each week.
We’ve only had one of the East Side boxes so far, but the dog was very interested in the pineapple they brought us along with all kinds of wonderful things. She even looks like she’s licking her lips!
With all these fruits and veggies coming into the house, we’ve started eating more healthfully.
This is one of our newer recipes when I have the time to heat up the oven.
Oven roasting concentrates the flavors of the vegetables resulting in a flavorful side dish that’s still low in sodium.
6 cups assorted cut-up vegetables (1 1/2-inch chunks), such as red onion, potatoes, red bell pepper, yellow squash or zucchini (I also add green peppers when I have them)
2 tablespoons olive oil
1/2 teaspoon Thyme Leaves
2 tablespoons Mrs. Dash
Preheat oven to 450°F.
Toss vegetables with oil in large bowl.
Sprinkle seasonings over vegetables; toss to coat.
Spread vegetables in single layer on foil-lined 15x10x1-inch baking pan.
Roast 30 minutes.
Help us strengthen the rare disease community’s voice on Capitol Hill! Please take 3 minutes to ask your Member of Congress to join the Rare Disease Caucus at http://bit.ly/RareAlert.
It’s easy – the Action Center has a draft letter that will automatically be sent to your Member of Congress – just put in your name and address & click send. We also encourage you to personalize the letter to share information about your specific disease. If your Congress Member is already on the Caucus, the letter will automatically populate as a thank you letter instead – these are just as important to send!
It can take up to 10 letters from constituents for a Member to respond so please share this Action Alert with your friends, family & colleagues. Join our Facebook event & invite your friends: http://on.fb.me/17Mlpjg
- In the US? Ask your Member of Congress to join the Rare Disease Congressional Caucus (cushieblog.com)
- Cushing’s Awareness Challenge, Day 1: Rare Disease Congressional Caucus Briefing (cushieblog.com)
- Cushing’s on Capitol Hill: Cushing’s Awareness Challenge (cushieblog.com)
- Rare Disease Day 2013 (seattledizzygroup.org)
Amazing! It’s Been 7 Years, Already.
- Age. Your risk of renal cell carcinoma increases as you age. Renal cell carcinoma occurs most commonly in people 60 and older.
I was younger than this.
- Sex. Men are more likely to develop renal cell carcinoma than women are.
I am female
- Smoking. Smokers have a greater risk of renal cell carcinoma than nonsmokers do. The risk increases the longer you smoke and decreases after you quit.
- Obesity. People who are obese have a higher risk of renal cell carcinoma than do people who are considered average weight.
A Cushing’s gift
- High blood pressure (hypertension). High blood pressure increases your risk of renal cell carcinoma, but it isn’t clear why. Some research in animals has linked high blood pressure medications to an increased risk of kidney cancer, but studies in people have had conflicting results.
Never had this until the kidney cancer. It went away immediately post-op.
- Chemicals in your workplace. Workers who are exposed to certain chemicals on the job may have a higher risk of renal cell carcinoma. People who work with chemicals such as asbestos, cadmium and trichloroethylene may have an increased risk of kidney cancer.
What? Me work?.
- Treatment for kidney failure. People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer. People who have a kidney transplant and receive immunosuppressant drugs also are more likely to develop kidney cancer.
Nope. Some sites also list polycystic kidney disease. I don’t have that but half my husband’s family does. Hmmm – wonder if that’s contagious
- Von Hippel-Lindau disease. People with this inherited disorder are likely to develop several kinds of tumors, including, in some cases, renal cell carcinoma.
I’ve wondered about this but, you know, it’s too “rare”.
- Hereditary papillary renal cell carcinoma. Having this inherited condition makes it more likely you’ll develop one or more renal cell carcinomas.
Not that I know of.
I owe him, the original doctor, and my Cushing’s doctors, my life.
The following are extracted from posts that were made during my kidney cancer diagnosis and surgery in 2006:
From Alice April 30, 2006
* Addendum: 9:30 AM – made some corrections to the 5 something AM post.
From Alice April 30, 2006
11 AM Update:
Mary had a brain scan this morning. She was supposed to have a bone scan today as well, but they’re doing it tomorrow instead, so they told her she could GO HOME TODAY (until she checks into the other hospital for the surgery)! She’s thrilled to be going home and I’m sure she’ll be here posting to all of you herself. You know Mary can’t stay away from computers very long. I’d venture a guess that if they looked inside, her arteries and veins would look more like computer cables (ducking).
Good, better, best
Never let it rest
Til the good is better
And the better, BEST!
From Alice April 30, 2006
Update – 2:15 PM:
Spoke with Mary. She’s home. She’s resting. The brain scan, chest/lung x-ray, abdominal scan all came out clean. The only test remaining that I know of is the bone scan, but it’s excellent that the above tests yielded good results.
P.S. An expression I remember my mother using, “The things we fear never happen. It’s the things we never think about that do!”
From Alice May 2, 2006
There wasn’t much to add yesterday. Mary was scheduled for a bone scan, but first had to have the radioactive tracer substance injection (I presume it was injected — she wasn’t sure herself). She was scheduled to have that around 10:30-11 AM, ET, and then had to return five hours later for the bone scan.
From Me May 2, 2006
First off, I’d like to thank you all for your good wishes, support and prayers. I could do the Sally Field thing and say “…and I can’t deny the fact that you like me, right now, you like me!” but I won’t 🙂
From Alice May 9, 2006, 09:10 AM
I’ve been in constant contact with Mary. Spoke to her at 7 this morning. She, Tom and their son, Michael, were on the way to the hospital. Mary sounded very good as she has all week. She’s going in with an excellent attitude.
She’s probably being prepped right now. The surgery is set for for 9:30 (ET). They anticipate the surgery will last 3 1/2 – 4 hours.
Now, all we can do is pray and wait. Tom will call me after the surgery is over. As soon as I hear something, I’ll make it a point to come back and post what I know.
Your support, love and prayers have been remarkable. Thank you on behalf of Mary. Please keep on praying until it’s over.
God? You listening? You’ve got someone very special to watch over this morning. We’re counting on you!
From Alice May 9, 2006, 12:33 PM
Mary’s husband, Tom, called me at 12:15
He said it’s going to be another 3 hours – around 3:15 PM – before they’re done. Surgery didn’t start as scheduled at 9:30, but more like 11:30. There wasn’t that much he could tell me except that the doctors said, so far everything is going as expected and Tom said, “so far, so good.”
I hesitate to draw any conclusions from that statement because I’m not 100% sure of what the doctors expected, so it’s a matter of waiting until it’s over.
I’ll keep you posted. Keep praying, please!
From Alice May 9, 2006, 2:00PM
Tom called at 1:15, but we had a bad connection. We finally connected.
The operation is over. Mary was being sewn up. Tom said according to the doctor, “the tumor and the kidney were removed.” The doctor is calling the operation a “complete success.”
I asked if they saw any signs of cancer anywhere else because Mary had told me originally that they’d said they might remove the gall bladder, too, but they didn’t remove the gall bladder – which is a good sign.
It appears as though everything was concentrated in the kidney.
Thank God. It’s over!
From Alice May 9 2006, 07:39 PM
Someone said: “… I told her that I would wait until she was home and feeling much better before I talked to her again and she agreed that she wasn’t sure she would be up to taking phone calls. Again, thank you so much for keeping us updated… this way we can know how Mary is doing without her having to take so many calls…”
That’s exactly how Tom and I feel. Tom suggests people not call the hospital. I wouldn’t even call his cell phone all day. I waited for him to contact me. I know he’s also exhausted. I figured he’d call when he was up to it. He called about 15 minutes ago.
It’s important that Mary get all the rest she can while recovering. Yes, everything turned out well, but she still had major surgery, is on morphine and needs her sleep. It’s important that we all allow her this time to rest.
It just so happened she was awake when he called and he turned on his cell phone’s speakerphone so Mary and I could talk for a minute. I was so happy to hear her voice. She sounded tired, her mouth was dry, but she sounded good.
Because this is a public message board, I prefer not to post details of the room she’s in. If anyone wants this information for the purpose of sending something to Mary, please E.mail me from the address you registered with on the board, and please include your user name. Thanks.
Another thing is that Mary has allergies, so for those wishing to send something to her, Tom and I (and Mary, as we discussed before she went into the hospital) agree she’s better off without flowers.
Finally, Tom said the doctor was very pleased with how her surgery went – that her body was quite robust, that there was very little bleeding, so no transfusion was needed, and he was generally very pleased with the surgery.
It’s been a very stressful day. I love Mary like a sister. We’ve been good friends for 11 years. I cried so after he initially called and said everything went well. I know all of you love and care about Mary, too.
All I’ve thought all day is, thank you, God, for watching over MaryO. I know all of you have thought the same thing.
That’s about it for now — she even cracked a personal joke when we said goodbye — she’ll be back to her old self again before too long.
From Alice May 13 2006, 08:10 PM
Saturday Update on Mary:
When she’s back on her computer, I know Mary will be thrilled to read all your thoughtful, beautiful and caring messages.
She’s doing well. The worst part is the incision which is quite large because the doctors originally anticipated the possibility of having to remove the adrenal gland above the kidney that was removed and the gall bladder as well. However, as I posted earlier, once they got in there, everything was found to be clean so they just took out the tumor and the kidney (as if that’s not enough). So, when she gets up to go to the bathroom, the incision is quite painful. I imagine an incision of that size will take a while to heal. Other than that she says she feels good!!
Additionally, the doctor was awaiting the results of the lymph node biopsy (just to be sure) and he told her yesterday, “everything looks clean.”
She was originally scheduled to go home tomorrow, Sunday, but . . . she went home TODAY!
Spoke to her after she arrived home (sorry I didn’t post earlier, but also have my Web site to deal with).
She sounded great and was glad to be home especially since a new person checked into her room yesterday and Mary wasn’t able to sleep all night.
That’s all for now – and all very good news, thank God!
From Me: June 17, 2006 post-op:
Thank you all for your prayers, good wishes, cards, phone calls, gifts, general “cheery-uppers”. They all really helped me on my road to recovery.
I do have a ton of thank you cards to send out to lots of people – I’m very slow at that. Under normal circumstances my handwriting is terrible. Now, post-op kidney cancer, I can no longer take my arthritis meds or any NSAIDs and my writing will probably be even worse sad.gif
I am very nearly better, not much pain anymore, a nasty big scar and my energy levels aren’t so great. Of course, they were awful before. I can no longer take the GH even though I’m deficient. In 5 years (if I survive!) I can take the GH again, supposedly.
I’ve had a lot of time to do a lot of thinking over the last 6 weeks. I know I was extraordinarily lucky to have my tumor discovered before it was too late. The lab reports and my surgeon reported that it would only have been a week or so before the tumor had hemorrhaged and caused major problems. Thank goodness the argenine retest for GH had caused me to bleed – at least I think that’s what set it off. If I hadn’t had all the blood and pain for one day only, I’d have had no clue that I had this cancer and who knows what would have happened in that next week.
I will be getting CT scans every 3 months for awhile to be sure that there is no cancer hiding out.
During my time of thinking, I have also been thinking about making changes to the boards based on what I have heard was going on here. I am not yet sure how these changes will manifest themselves but I do know that bashing others will not be tolerated. More on this later, in another area.
Again, thank you for all your support!
From Me July 6, 2006
Since I recently had surgery for kidney cancer, I’ve been looking around for another board to read and talk about this with other survivors (hopefully!) I haven’t found anyplace I’d like to visit or feel comfortable with yet, so I decided to make a new area here.
I know – or I think I know – that no one else here has had kidney cancer, although I know at least 1 other person has had a kidney removed and several others have reported kidney stones and other possible kidney diseases.
I’m sure that my recovery will be much the same as for any other major abdominal surgery, although I’d like it to be faster.
Before my surgery, I didn’t have time really to consider that I had cancer, and what it meant for my life. There was no going from doctor to doctor, running a different test each week, suspecting that maybe… Just boom, there it is. Cancer.
Now that I’m about 8 weeks post-op, I’m thinking more and more about this and how it might affect my future. I know that there are going to be lots of scans, every 3 months, just to be sure that there wasn’t a cell hiding out.
I know I have to be careful with meds – no NSAIDs so my arthritis is worse. No GH – it’s contraindicated for 5 years…assuming I’m cancer free then.
I’m supposed to be eating less protein, more fruits/veggies, drinking more water.
And I’m supposed to avoid playing football and other things that might damage my remaining kidney.
Normally, I know how very lucky I am. I just reread the path reports and know that the tumor was already hemorrhaging around the borders and the cysts contained hemorrhagic fluid. Things could be much worse.
Sometimes, at night when I can’t sleep, I wonder why I was lucky like this. What haven’t I done with my life that I should. Seems to me that I’ve accomplished what I should already.
And, in the night, I worry about the cancer returning, taking my other kidney or worse.
At this time, there’s no standard chemo unless it’s metastasized, although there are some promising clinical trials and radiation doesn’t seem to work for this kind of cancer, so if it returns it’s more surgery.
I suppose I could/should have put all this in my blog, but I put it out here in case anyone else should need this in the future. I hope not!
From me Aug 19 2006, 01:25 AM
Thanks so much for asking!
Unfortunately, I haven’t read the boards much lately – I’m spending most of my online time deleting/banning the InstaChat intruders.
I have been working on the websites, though, and that’s always fun! I’ve even added a new one to the roster and it has some cool stuff on it. New features to be announced in the upcoming newsletter.
I’ve been even more tired than usual now that I’m off GH. I can’t take my arthritis meds, or anything like Excedrin (no NSAIDs) so my joints are nearly always bothering me and I have to wait out any headaches. I’m also just getting over a UTI.
I just had my 3 month post-op CT scans and I hope they come out ok. At first I was grateful that I wouldn’t have to have chemo or radiation come to find out that neither has been discovered yet which works well with kidney cancer. Apparently, it can resurface any time for the rest of my life. I’m hoping that some of the chemo clinical trials show some good results so I can get this thing before it metastasizes somewhere.
I’m having trouble sleeping (1:20 AM here, now) although I’m always tired. My mind plays all kinds of tricks in the night. Those InstaChat people don’t help, either! When I wake up just a little, instead of falling back asleep, I’ll go check to see what they’ve done.
On the plus side – I survived the kidney cancer surgery, and it’s almost vacation time!
Even vacation will be bittersweet, though. 2 years ago, Sue went with us on vacation. She had a great time and she had asked if she could go with us again this year. Of course, we had said yes…
From me May 8 2008, 11:07 PM
I am feeling very maudlin, a bit down and depressed. It’s very nearly the anniversary of my kidney cancer surgery. I posted this in my blog a few days ago:
I’ve been feeling weird for about a week now. Last Friday, I went through the whole “Sending Prayers” topic (MKO’Note: this thread) that my good friend Alice started for me.After I read that, I started reliving all the kidney cancer events…again. I know I shouldn’t do this. My counselor says that this is a very stressful thing to do and it’s not good for me, for anyone. But I do it anyway, especially the pituitary and cancer surgery anniversaries. I wish I did this with good stuff, could relive that instead of the scary and painful.
After I finished rereading all that, I went back to my post in the cancer section: I guess I’ve talked about this more than I think! I just wish there was someone I could get answers and support from. I have never met anyone in real life who has shared my particular brand of cancer, haven’t talked to anyone on the phone or emailed anyone.
I even asked at my local cancer support center about support for me – they have all kinds of meetings, mainly for breast and prostate cancer, but other kinds, too. But they said that there weren’t enough kidney cancer people to have a meeting. The one and only book that the library there has on kidney cancer was given to me by the author to donate there.
Lucky me – two rare diseases that no one gets. According to statistics I should be a black man who smokes and works in the iron and steel industry or is exposed to certain chemical and substances, such as asbestos (a mineral fiber that can be used in construction materials for insulation and as fire-retardant) and cadmium (a rare, soft, bluish-white chemical element used in batteries and plastic industry), also increase the risk for renal cell carcinoma. I should have polycystic kidneys and not drink the copious coffee.
So…where did it come from? A mutation of my parents’ and aunt’s colon cancer or do I still have that looming on my horizon?
And the Cushing’s came from nowhere, too. I know that no one knows these answers but I think of them a lot, especially at night.
Although I’m not afraid of death and would like it to be as peaceful and pain-free as possible, I still dream at night that I’m dying or have died. These dreams have been going on since before the cancer and I can’t seem to shake them although I’m taking them more in stride now and can go right back to sleep.
And from last year’s post on this topic, these still concern me:
What if the lung nodules that “aren’t growing” turn out to be something on the next scan? Is the stomach distress I’m currently feeling a cause to ask for my next colonoscopy a bit earlier?
Is the pain on the other side the other kidney causing trouble? Or something new with an ovary?
What if, what if…?
Seems like in my addled brain any new symptom could be cancer, not the simple stomach bug or pulled muscle.
Had they told me in 2006 that I only had a year or two to live, I’d have thought it far too short a time. I guess how long a year is depends on the frame of mind!
I hate going for scans because they could show something but I get nervous when there are no scans because there could be something else! Seems like my mind is setting me up for a lose-lose situation.
I’m sure as I get closer to Friday that other thoughts will come to me. I am so grateful that I’ve had these two “bonus years”. I feel like there is so much still to do with the Cushing’s sites and I will never get them done in my lifetime but I plan to keep trucking along!
And from Wonderful Words of Life…
I’m acquiring the title of an old hymn for this next post.
After I was finished with the long Cushing’s diagnostic process, surgery and several post-op visits to NIH, I was asked to give the scripture reading at my church. The man who did the sermon that week was the survivor of a horrific accident where he and his family were hit by a van while waiting at an airport.
i thought I had written down the verse carefully. I practiced and practiced, I don’t like speaking in front of a crowd but I said I would. When I got to church, the verse was different. Maybe I wrote it down wrong, maybe someone changed it. Whatever.
This verse has come to have so much meaning in my life. When I saw at a book called A Musician’s Book of Psalms each day had a different psalm. On my birthday, there was “my” psalm so I had to buy this book!
Psalm 116 (New International Version)
1 I love the LORD, for he heard my voice;
he heard my cry for mercy.
2 Because he turned his ear to me,
I will call on him as long as I live.
3 The cords of death entangled me,
the anguish of the grave came upon me;
I was overcome by trouble and sorrow.
4 Then I called on the name of the LORD:
“O LORD, save me!”
5 The LORD is gracious and righteous;
our God is full of compassion.
6 The LORD protects the simplehearted;
when I was in great need, he saved me.
7 Be at rest once more, O my soul,
for the LORD has been good to you.
8 For you, O LORD, have delivered my soul from death,
my eyes from tears,
my feet from stumbling,
9 that I may walk before the LORD
in the land of the living.
10 I believed; therefore I said,
“I am greatly afflicted.”
11 And in my dismay I said,
“All men are liars.”
12 How can I repay the LORD
for all his goodness to me?
13 I will lift up the cup of salvation
and call on the name of the LORD.
14 I will fulfill my vows to the LORD
in the presence of all his people.
15 Precious in the sight of the LORD
is the death of his saints.
16 O LORD, truly I am your servant;
I am your servant, the son of your maidservant;
you have freed me from my chains.
17 I will sacrifice a thank offering to you
and call on the name of the LORD.
18 I will fulfill my vows to the LORD
in the presence of all his people,
19 in the courts of the house of the LORD—
in your midst, O Jerusalem.
Praise the LORD.
I carry a print out of this everywhere I go because I find it very soothing. “when I was in great need, he saved me.” This print out is in a plastic page saver. On the other side there is an article I found after my kidney cancer. I first read this in Chicken Soup for the Surviving Souland is posted several places online.
The Best Day Of My Life
by Gregory M Lousignont
Today, when I awoke, I suddenly realized that this is the best day of my life, ever! There were times when I wondered if I would make it to today; but I did! And because I did I’m going to celebrate!
Today, I’m going to celebrate what an unbelievable life I have had so far: the accomplishments, the many blessings, and, yes, even the hardships because they have served to make me stronger.
I will go through this day with my head held high, and a happy heart. I will marvel at God’s seemingly simple gifts: the morning dew, the sun, the clouds, the trees, the flowers, the birds. Today, none of these miraculous creations will escape my notice.
Today, I will share my excitement for life with other people. I’ll make someone smile. I’ll go out of my way to perform an unexpected act of kindness for someone I don’t even know.
Today, I’ll give a sincere compliment to someone who seems down. I’ll tell a child how special he is, and I’ll tell someone I love just how deeply I care for her and how much she means to me.
Today is the day I quit worrying about what I don’t have and start being grateful for all the wonderful things God has already given me.
I’ll remember that to worry is just a waste of time because my faith in God and his Divine Plan ensures everything will be just fine.
And tonight, before I go to bed, I’ll go outside and raise my eyes to the heavens. I will stand in awe at the beauty of the stars and the moon, and I will praise God for these magnificent treasures.
As the day ends and I lay my head down on my pillow, I will thank the Almighty for the best day of my life. And I will sleep the sleep of a contented child, excited with expectation because know tomorrow is going to be the best day of my life, ever!
When I’m feeling down, depressed or low, reading my 2 special pages can help me more than anything else.
- Renal Cell Tumors More Likely To Metastasize Better Identified By Chemical Shift MRI (medicalnewstoday.com)
- Kidney Cancer Association European International Symposium Webcast (prweb.com)
- Kidney Cancer Survival Premiums (heartdiseasecauses.wordpress.com)
- Spectrum Health joins kidney cancer study (hollandsentinel.com)
- New Subtypes Of Kidney Cancer Identified By Researchers (medicalnewstoday.com)
Johns Hopkins is managing my post-Cushing’s care. I’m so glad that they’re still here to take such good care of all of us!
On this day back in 1889, the Hospital first opened its doors, setting the standard for patient care, research and education for the next 124 years. Thanks for being part of the journey with us.
Photo on left: “[Johns Hopkins Hospital, front view of buildings and grounds with horse-drawn cab on left.]” Photograph. 1889. From the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions: Buildings Photograph Collection. Item 47919. www.medicalarchives.jhmi.edu/
Photo on right: By Keith Weller.
This is a video showing Coronary Artery Bypass Grafting being done through left 4th intercostal space by a 6-7cm incision.
We are routinely doing Coronary Artery Bypass Grafting, single vessel or multivessel through left 4th or 5th Intercostal Space depending on position of apex of heart and the target arteries on routine chest x-ray and coronary angiogram. We are using skeletonised LIMA and Free Radial Artery to construct a ‘Y’ and then pick all the vessels to be grafted sequentially. Single Lung ventilation using an endobronchial tube is essential.
Team Includes Dr.Kshitij Dubey (Chief Cardiac Surgeon), Dr. Vikas Gupta (Chief Cardiac Anaesthetist), Dr. Krishnpal Singh (Anaesthetist) Mr.M.V.Krishna Mohan (Sr.Clinical Perfusionist), Rajshree Hospital & Research Centre, Indore, Madhya Pradesh.
- Heart attacks: What you should know (maryomedical.com)
- Effects of Off-Pump and On-Pump Coronary-Artery Bypass Grafting at 1 Year (maryomedical.com)
- News From The Annals Of Internal Medicine: April 23, 2013 (medicalnewstoday.com)
- At the heart of a keyhole revolution (telegraph.co.uk)
- CABG Surgery Generally Not Associated With Long-Term Cognitive Dysfunction (medicalnewstoday.com)