Most Read Posts for 2009

Although not all were written in 2009, listed below are the most read posts in this past year with a brief excerpt from each. To read the entire post, simply click on the title of each one.  Thank you for reading and sharing with me this year.

1. Vitamin D:  "Normal isn't normal anymore:   Dr. Bruce Hollis' latest published research on Vitamin D questions the definition of "normal". Since many of us with Cushing's Disease and/or other endocrine problems suffer with extremely low Vitamin D ranges, defining a normal range is very important.
   
   Vitamin D is not really a vitamin. It is a steriod and exists in two forms, D2 (ergocalciferol) and D3 (cholecalciferol). D3 is the more active form and is found naturally in the human body. D2 is derived from radiating fungi and is only found in very small amounts in the body. Most over-the-counter (OTC) supplements use the D2 form rather than D3. Also, there are two prescription forms of it: Drisdol and Calciferol. D3 may be purchased without a prescription. (This is a Research Blogging post)
   
   
2. Martha's Story: (Martha died in 2008 due to complications from Cushing's Disease.)  Stacey and Martha had been together for 11 years. During most of those years Martha struggled with IBS and acid reflux. About 6 years ago, they noticed her cheeks were getting "bigger" but her legs and arms were very thin. In fact, until the last 5 years she was a thin/normal woman. Stacey said she would squeeze Martha’s cheeks saying "look at those chipmunk cheeks".
   
   Five years ago her health started dramatically changing. She had an ovarian cyst burst, then after problematic periods she had a fibroid tumor removed and a D&C performed. After that she never had her period. Her GP told her she was going through early menopause. Her strength was never the same. Stacey and Martha thought it was because she was pushing herself too hard with a long commute and getting up very early in the morning....
   
   
3. Dynamic MR Imaging of the Pituitary:  Same tools, different technique (but wow, what a difference!): Those of us who have suffered or still suffer with pituitary adenomas have heard way too many times "your MRI is normal". I did, for years. Yet, I ultimately did have a proven adenoma which caused my Cushing's disease. If the MRI had shown even an inkling of the tumor to the trained eye, perhaps a doctor would have taken my symptoms more seriously....
   
   ...What makes a dynamic MRI different from any MRI using contrast?
   Typically, a series of images are taken prior to contrast and then the MR imaging is stopped while contrast is injected. Once that is finished...
   
   
4. Grand Rounds Volume 6, Number 4:  When I chose the theme for this week's Grand Rounds, I chose it because it is near and dear to my heart. Before I knew what it was called, I was looking for a "participatory medicine" model. Long before I heard the term "ePatient", I was one.
   
   Since the Society for Participatory Medicine is the next evolution of the group at http://e-patients.net/, it makes sense to start by having them spell it out. Their new Journal of Participatory Medicine is launching next week at Connected Health, and Co-Editors-In-Chief (a physician and a patient, of course) explain the purpose clearly on the Society's blog, in Why the Journal of Participatory Medicine?
   
   
5. Stars Go Blue: "Sam[antha] lay dying for 13 hours with Seattle CHildren's endocrinologists standing around watching and wondering why the continual 15 mg [of cortef] they were giving her wasn't working."
   
   
6. Central Hypothyroidism:  A Cushing's Disease problem, too: Since approximately 80% of Cushing's Disease/Syndrome is caused by a pituitary adenoma, other hormones produced by the interaction of the hypothalamic-pituitary-adrenal (HPA) axis are often deficient. This includes thyroid-stimulating hormone (TSH).
   
   
   Primary hypothyroidism is often detected by elevated TSH values. This is due to the normal feedback-loop of the HPA axis. Central hypothyroidism (CH), however, is not typically detected by measuring TSH which is low due to a disruption of the pituitary's stimulus and is not produced as needed. The most common cause is a pituitary adenoma.
   
   
   In Mechanisms Related to the Pathophysiology and Management of Central Hypothyroidism, the authors state, "Given that the prevalence of pituitary adenomas in the general population is greater than 10%, the true prevalence of CH might be much higher than that reported". When speaking of the method of measuring TSH levels alone, they say this "approach works, however, only if the hypothalamic-pituitary-thyroid axis is normal. Conversely, the strategy of first-line TSH measurement can miss patients with CH." (This is a Research Blogging post)
   
   
   
7. Cushing's:  An invisible illness, too:  We are zebras, but our stripes remain hidden behind loose clothing and no one peeks beneath....
   
   
8. My health care records:  My property:  I want my health records. I believe they are mine. And I want to be able to access them electronically. Frankly, I'd like to access them, amend them (or at least notate and comment on them), and share them with those I choose.
   
   Recently, Dr. Rob posted about how this made him feel...
   
   
9. We need an elephant specialist! :  He walked into the exam room, introduced himself, and as he sat down,
   he asked, "Has anyone ever suggested you might have Cushing's disease or Cushing's syndrome?"
   
   My name's Kim, and I'm 49 years old. I have two children, two grandchildren, and two full-time jobs. On the weekdays, I'm a writer and editor specializing in education issues; evenings and weekends, I'm marketing director at an international and arthouse movie theater. I had to pick up this second job to pay for the medical expenses not covered by my health insurance. And, as you may know, there are a lot of medical expenses involved in this
   disease/syndrome....
   
   
10. Bariatric surgery: Not the answer for obesity and "hidden" Cushing's Syndrome: Although I'm posting this as research (which it is), this is also personal for me. I was told by multiple doctors to have bariatric surgery. This included endocrinologists. I even went as far as making an appointment with a bariatric surgeon, going through the pre-surgical "talk" and consult, and asking a lot of questions. I didn't find him cognizant of the endocrine problems that might hinder recovery with bariatric surgery. Frankly, he dismissed my questions and walked out on me.
    
    I'm glad I did my research. And now, the medical community is looking at the repercussions of bariatric surgery to control weight without first testing for endocrine-related causes, especially Cushing's Syndrome.... (This is a Research Blogging post)

Actually, the "Testing 101" series is read more than all the others, but those are very old posts, so I didn't include them in my list.  Also, the group of posts dealing with radiosurgery are read a lot. 

Happy New Year to all....