Today is the 30th anniversary of my pituitary surgery at NIH.
As one can imagine, it hasn’t been all happiness and light. Most of my journey has been documented here and on the message boards – and elsewhere around the web.
My Cushing’s has been in remission for most of these 30 years. Due to scarring from my pituitary surgery, I developed adrenal insufficiency.
When I got kidney cancer, I had to stop the GH, even though no doctor would admit to any connection between the two. Even though I’m when I got to 10 years NED (no evidence of disease) from cancer, I couldn’t go back on the GH.
However, this year I went back on it (Omnitrope this time) in late June. Hooray! I still don’t know if it’s going to work but I have high hopes. I am posting some of how that’s going here.
During that surgery, doctors removed my left kidney, my adrenal gland, and some lymph nodes. Thankfully, the cancer was contained – but my adrenal insufficiency is even more severe than it was.
In the last couple years, I’ve developed ongoing knee issues. Because of my cortisol use to keep the AI at bay, my endocrinologist doesn’t want me to get a cortisone injection in my knee.
My mom has moved in with us, bring some challenges…
But, this is a post about Giving Thanks. The series will be continued on this blog unless I give thanks about something else Cushing’s related 🙂
I am so thankful that in 1987 the NIH existed and that my endo knew enough to send me there.
Held every September, this Capitol Hill Day event continues the momentum established in 2013, and includes nearly 300 national organizations coming together in support of the Rally for Medical Research.
The purpose of the Rally is to call on our nation’s policymakers to make funding for National Institutes of Health (NIH) a national priority and raise awareness about the importance of continued investment in medical research that leads to MORE PROGRESS, MORE HOPE and MORE LIVES SAVED.
The next Rally for Medical Research Hill Day is Sept. 22, 2016.
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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
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: agharib@mail.nih.gov.
↵* N.M.N. and O.J.B. contributed equally to this work.
Abstract
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.
An example of a heart attack, which can occur after the use of a performance-enhancing drug. (Photo credit: Wikipedia)
Preventing Heart Disease and Heart Attack Educational Video. U.S. Department of Health and Human Services
National Institutes of Health; National Heart, Lung, and Blood Institute; Act in Time to Heart Attack Signs; Item #56-042N, September 2001;
The dramatic, moving stories of three heart attack survivors and their families illustrate the importance of heeding heart attack warning signs and seeking medical care quickly. They vividly convey how a real heart attack may differ from the stereotypical “movie heart attack” and how getting immediate treatment can save lives. The warm and sympathetic narration by an emergency department physician explains what a heart attack is, the treatments that can save lives if given quickly, why many heart attack victims delay seeking care, and how to make a heart attack survival plan. Useful for health fairs, medical waiting rooms, community groups, and home viewing.
Producer: National Institutes of Health; Keywords: hhs.gov; public_safety; Creative Commons license: Public Domain.
Heart Attack Warning Signs. A heart attack is a frightening event, and you probably don’t want to think about it. But, if you learn the signs of a heart attack and what steps to take, you can save a life–maybe your own. What are the signs of a heart attack? Many people think a heart attack is sudden and intense, like a “movie” heart attack, where a person clutches his or her chest and falls over. The truth is that many heart attacks start slowly, as a mild pain or discomfort. If you feel such a symptom, you may not be sure what’s wrong. Your symptoms may even come and go. Even those who have had a heart attack may not recognize their symptoms, because the next attack can have entirely different ones. Women may not think they’re at risk of having a heart attack–but they are.
Learn more about women and heart attack. It’s vital that everyone learn the warning signs of a heart attack. These are: Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach. Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort. Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness. Learn the signs–but also remember: Even if you’re not sure it’s a heart attack, you should still have it checked out. Fast action can save lives-maybe your own.
After you learn more about heart attack, try a brief quiz to see if you know what to do if you or someone else has warning signs. How do you survive a heart attack? Fast action is your best weapon against a heart attack. Why? Because clot-busting drugs and other artery-opening treatments can stop a heart attack in its tracks. They can prevent or limit damage to the heart–but they need to be given immediately after symptoms begin. The sooner they are started, the more good they will do–and the greater the chances are for survival and a full recovery. To be most effective, they need to be given ideally within 1 hour of the start of heart attack symptoms. You can reduce your risk of having a heart attack—even if you already have coronary heart disease (CHD) or have had a previous heart attack. The key is to take steps to prevent or control your heart disease risk factors.
Six Key Steps To Reduce Heart Attack Risk; Taking these steps will reduce your risk of having a heart attack: Stop smoking; Lower high blood pressure; Reduce high blood cholesterol; Aim for a healthy weight; Be physically active each day. Manage diabetes.
Blood pressure check (Photo credit: Army Medicine)
Whether you’re among the 1 in 3 Americans with high blood pressure or have so far avoided this deadly disease, these tips will help prevent becoming a statistic.
Heart disease and stroke rank among the top five causes of death in the U.S. They’re also both commonly caused by one condition: hypertension.
One in three Americans suffer from this often symptom-less condition, also known as high blood pressure and the silent killer.
“You can have it for years without knowing it,” say the National Institutes of Health. “During this time, though, HBP can damage your heart, blood vessels, kidneys, and other parts of your body.”
The ideal blood pressure reading is generally 120/80, with higher readings considered pre-hypertension or, if over 140/90, hypertension.
If you don’t know what your blood pressure is, step one is finding out by checking with your doctor. In the long run, that visit will cost less than letting the problem remain undiagnosed – and uncontrolled. Even if you require medication, it’s cheaper than the long-term costs and complications of untreated high blood pressure.
In some cases, high BP can be managed or prevented by low-cost lifestyle changes alone. So in honor of Heart Month, we’ve rounded them up…
Pass the salt. Limiting sodium helps control high blood pressure in those who have it and helps prevent it in those who don’t. According to government dietary guidelines, adults should limit their daily sodium intake to 2,300 mg. But for people with hypertension, diabetes, or chronic liver disease; children; adults over age 50; and African-Americans – about half the U.S. – the limit is 1,500 mg. Beware especially of processed and packaged foods, fast foods, and canned foods – all common sources of excessive salt.
Eat enough potassium. This mineral helps lower blood pressure. The recommended daily intake for adults is 4,700 mg. Bananas average 451 mg – foods with even more include cantaloupe, avocados, dates, raisins, dried apricots, prune juice, baked potatoes (with the skins), yogurt, sardines, and flounder. Check out the University of Massachusetts Medical School’s downloadable list of Sources of Dietary Potassium for more.
Change your diet. The DASH diet, or Dietary Approaches to Stop Hypertension, helps fight high blood pressure by emphasizing fruits and vegetables, whole grains, and lean sources of protein. U.S. News & World Report also recently ranked it the No. 1 best diet overall, No. 1 best diet for healthy eating, and even the No. 1 best diabetes diet. Check out Dr. Oz’s recent segment about the diet to learn more.
Watch your weight. Blood pressure tends to increase as weight does. Last year, a University of Illinois study found that even among hearty college students, a weight gain of as little as 1.5 pounds was enough to raise BP. Fortunately, it’s also true that BP tends to drop as weight does.
Relax. The connection between stress and high blood pressure isn’t fully understood. But researchers do know that (1) stressful situations can cause temporary BP spikes and (2) stress management and stress-lowering activities can help lower BP, according to the Mayo Clinic. Getting enough sleep, deep breathing, meditation, yoga, and exercise can help reduce stress. Check out 7 Cheap Ways to Relieve Stress for more ideas.
Avoid alcohol.According to the Mayo Clinic, not only does too much alcohol raise blood pressure, repeated excess drinking can lead to long-term BP increases. Women should limit themselves to one drink, men to two.
Indulge in dark chocolate instead. An Australian study published last year found that a daily dose of dark chocolate or other cocoa products rich in natural compounds called “flavanols” helped to lower blood pressure. Just don’t overdo it and gain weight.
Heart Attack Warning Symptoms speaks to the 7 main symptoms of a heart attack. It uses real women’s stories to personalize the heart attack experience, and encourages women who experience these symptoms to get checked out.
MaryO'Medical 