Pointing fingers: Taking the "easy out" with obesity

Dr. Ann Childers and I had an interesting twitter conversation (twonversation?) the other day. It went like this:

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AnnChildersMD I once saw a child who, at age 6 years, weighed more than 90 lbs. She ate a high carbohydrate diet, and drank a can of soda every day. 5 days, 22 hours ago from web

staticnrg @AnnChildersMD Lots of kids do that and don't weigh 90 lbs. Not healthy, but there is more at play than just food w/ a 6 y.o. 5 days, 22 hours ago from iTweet in reply to AnnChildersMD

AnnChildersMD re: prior tweet Her parents were poor, and soda is cheap (except for the medical bills). Children drinking soda is accepted in our society. 5 days, 22 hours ago from web

AnnChildersMD Nearly all my obese patients drink sweetened sodas. Ones that don't are ex-soda drinkers, looking for a substitute. 5 days, 22 hours ago from web

staticnrg @AnnChildersMD How many of your "non-obese" patients drink sweet soda? Have you asked? Your tweets sound biased to me...are they? 5 days ago from iTweet in reply to AnnChildersMD

AnnChildersMD @staticnrg Personally, I am "biased" against processed and refined carbs. But there is plenty of "bias" in the scientific lit against soda 5 days, 19 hours ago from HootSuite

AnnChildersMD @staticnrg Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement From the American Heart Association http://ow.ly/pzDG 5 days, 19 hours ago from HootSuite

staticnrg @AnnChildersMD Yes, bad for all, but majority of those who do those "bad" behaviors are not obese. Why are we pointing at only the obese? 5 days, 10 hours ago from web in reply to AnnChildersMD

RT @staticnrg Why are we pointing at only the obese? {I was actually pointing at soft drinks <:-}1:36 PM Sep 16th from web

staticnrg @AnnChildersMD No, last night you first mentioned obese--I responded to that & asked if you asked slim patients about soft drink habits. :) 5 days, 7 hours ago from web in reply to AnnChildersMD

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I realize Dr. Childers was well-meaning. I just don't think she and other doctors see what they are really saying. This conversation looks like Dr. Childers assumes only obese children drink "sweetened sodas" and slim children do not. I wish it were that simple. Now, I don't have a study to prove it, but I have observed in my 52 years a lot of folks who drink sweetened soda and are slim. I've also observed a lot of folks who do not drink sweetened sodas and who are slim, and others who are not.

I never drink a sweetened soda unless I'm sick, and was only allowed to drink them as a child about once a year. Oh, and a ginger-ale when sick then, too. I think we are too quick to point at food and drink as a culprit but forget that Grandma fixed sweetened tea, fried everything, potatoes, and more for meals all the time.

Yes, I agree these foods and sweetened sodas are not healthy. My parents were health nuts before it was fashionable, and I grew up eating healthy and drinking non-sugared drinks. Milk was skim, and we had eggs only once a week. Salad was a treat to us in the winter, but we grew the vegetables and lettuce in the summer. My mother taught school and my dad was a corporate manager. We were literate and they were wise. I believe my mother is the reason I kept my weight down even with Cushing's much longer than most. Sadly, that is not the case now, but I still eat like I should, not like I look like I do. My HbA1c is 5.4, and I work hard to keep it that way with high cortisol. (Ask @sixuntilme how hard that is!)

As I drift along in this post, my point is: Why ask only obese patients about sweetened soda? Slim patients have a lot of terrible habits, too. The tweets highlighted above show the point I'm trying to make. Obesity isn't the only problem caused by sweetened sodas. And there must be a factor at play other than the sodas when some can drink them and not gain weight while others drink them and do gain. Or even DO NOT drink them and still gain.

Of course, I must point out endocrine factors. This blog is full of them. Just the posts about bariatric surgery not working for those with endocrine diseases attest for that.

@jensmccabe has tweeted some very interesting things on epigenetics. I've poste a couple of things. Those need to be considered, too.

But my MAIN point in all this (and forgive my tired rambling) is that we are quick to point at the "bad behavior" of the obese without looking to see if that same "bad behavior" is duplicated in the non-obese population. It's poor science. You know what they say about "assume"...

Research is what it is. It's easy to "prove" those who are obese drink a lot of sweet soda. It's not so easy to prove that those who drink sweet soda are obese. Not to mention drinking diet soda may make one obese. How 'bout them apples? Uh...sodas...?

I'm all for eating correctly. I work hard at it. But I think we need to be careful when attributing behaviors to obesity and make sure they are ONLY obesity related. That's what I was trying to say, Dr. Childers.

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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.

The first article cited below is a plea for screening of obese patients prior to bariatric surgery. Dr. Ludlam is well-known in the Cushing's patient community because of his stringent protocol for diagnosis and treatment of Cushing's. He and the others who authored this article have dealt with Cushing's patients for a very long time.

In this article, the authors cite two cases where bariatric surgery caused the CS to be overlooked, resulting in a poor outcome. "One patient had progression of obesity, multiple vertebral compression fractures, poorly controlled diabetes and HTN during a 10-year period, and the second patient ultimately died." The second patient was 27 years old. His death is a tragedy.

The second patient had a rapid weight-gain at the age of 20. By the age of 24 he had undergone a Roux-en-Y gastric bypass to control the weight. After losing 170 pounds and with a BMI of 20 kg/m² he still presented with "symptoms suggestive of hypercortisolism. These included
lower extremity edema, facial plethora, facial rounding, a dorsocervical hump, acne, proximal muscle weakness, and neuropsychiatric symptoms." These had been present prior to bariatric surgery, also.

The article goes into much more depth than I am presenting here. It is one which I believe all doctors who treat obese patients should read. The authors suggest who to screen , which can be summarized:

1. Anyone with an adrenal incidentaloma
2. Anyone presenting with HTN and Type II diabetes
3. Patients with a "history of easy bruising, evidence of proximal muscle weakness, the presence of reddish-purple striae 1 cm wide, and facial plethora"
4. Patients with rapid weight gain, especially in combination with other symptoms
5. Young patients with "old" symptoms (i.e. HTN, osteoporosis, kidney stones, multiple infections)
6. Any combination of the above.

The authors also suggest following the guidelines of research previously quoted in this blog.

The second article cited below is a response to the first article. In this article, the authors emphasize the need for screening of obese patients.

...a recently published meta-analysis reported a prevalence of hypercortisolism in ≤2–5% when Cushing syndrome is systematically screened for in patients with poorly controlled type 2 diabetes and adrenal incidentalomas [2]. Conversely, the prevalence of Cushing syndrome in those with simple obesity is largely unknown. Moreover, a condition of functional hypercortisolism with subtle alterations of hypothalamic-pituitary-adrenal axis is frequently evidenced in those with simple obesity...

...However, despite the probability that the diagnosis of Cushing syndrome might be overlooked, the possibility arises that Cushing syndrome might be unrecognized among obese patients.

This article outlines possible contra-indications of bariatric surgery for obese patients, especially those with possible Cushing's. Those, along with the delay in diagnosis may cause "irreversible sequelae in patients with undiagnosed Cushing syndrome".

M FLESERIU, W LUDLAM, S TEH, C YEDINAK, C DEVENEY, B SHEPPARD (2009). Cushing's syndrome might be underappreciated in patients seeking bariatric surgery: a plea for screening Surgery for Obesity and Related Diseases, 5 (1), 116-119 DOI: 10.1016/j.soard.2008.09.011


S SAVASTANO, R PIVONELLO, A COLAO (2009). Bariatric surgery for obesity and hidden Cushing syndrome Surgery for Obesity and Related Diseases, 5 (1), 121-122 DOI: 10.1016/j.soard.2008.07.006

There's nothing nice about this "doctor" blog...

A Nice Way of Saying….

As you can see from the comments when you read the linked post on the blog "ER Stories - Shocking, Hilarious, Bizarre, and Sad Tales from the Emergency Room", it struck a nerve with the Cushie community. Frankly, I'm appalled that these so-called professionals talk this way openly on the web. I read quite a few posts. If I were one of their patients, I'd be suing the socks off of them. And I've never sued anyone.

Where does one draw the line with medical blogging? Is this a violation of HIPAA? Will other medical professionals condone this or condemn it? It's a gray area and one I'm afraid will become an issue if blogs like this continue. I am not for regulation of blogging, medical or otherwise. In my rose-colored world, professionals are professional in all aspects of life, including their blogging. But I am of the firm opinion this is unprofessional and inappropriate.

Physician, heal thyself.

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FYI, if you want to read some ER doctor/nurse blogs which I think are good blogging:

http://edwinleap.com/blog/

http://gruntdoc.com/

http://www.emergiblog.com/

http://www.impactednurse.com/

Eleven-month-old Colombian baby is the weight of an eight-year-old --Can you say "Zebra"?

Eleven-month-old Colombian baby is the weight of an eight-year-old

Although the Colombian doctors of this 11-month-old baby are exploring hypothyroidism, those of us in the Cushing's community believe it is much, much more. We would not be surprised at a pituitary tumor secreting both ACTH and growth hormone. Or a receptor defect. Or congenital hypothyroidism. Or all three. Hashimoto's, as discussed in the article, is very rare for an infant, but congenital hypothyroidism is not as rare. According to endodoc, "Congenital hypothyroidism (CH) is a very important pediatric endocrinology diagnosis" and one should be careful to not miss the zebra in the horses.

(My random thoughts: Since he wears only a diaper, and I know first-hand that hypothyroidism causes one to freeze, especially in the extremities, I wonder if he is uncomfortable/cold? It doesn't look like it in the video, but.... Also, central/secondary hypothyroidism is caused by a pituitary tumor. Could that be a possibility? I so hope they explore all the options.)



I hope this poor child gets the testing and help he needs. And I wonder what society and the medical community would have thought (stereotyped)if the mother had been obese? As a friend of mine wrote, "It hit me that if the mother were heavy and poor, they would probably be calling it child abuse and trying to remove him from the home."

Don't forget the zebras.

Click here to read the full article.

NIH study shows low levels of brain chemical may lead to obesity....

From the article:

The NIH researchers studied children and adults with WAGR syndrome, a rare genetic condition. The researchers found that some of the people with this syndrome lack a gene for BDNF and have correspondingly low blood levels of the substance. The people in this subgroup also have unusually large appetites and a strong tendency towards obesity.

"This is a promising new lead in the search for biological pathways that contribute to obesity," said Duane Alexander, M.D., director of the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development. "This finding may eventually lead to the development of new drugs to regulate appetite in people who have not had success with other treatments."

...Dr. Yanovski explained that BDNF is believed to work in combination with a variety of other substances that regulate appetite and body weight. Chief among these is leptin, a hormone found to be involved in signaling hunger. Dr. Yanovski added that release of BDNF in the hypothalamus, a part of the brain involved in controlling eating, is believed to be indirectly triggered by leptin. Studies of the relationship between the two, and of BDNF's action on tissues, may lead to the development of new drugs to treat obesity in some individuals.

To read more:
Low levels of brain chemical may lead to obesity, NIH study of rare disorder shows

InsureBlog: Carrot or Stick? Punishing obesity

InsureBlog: Carrot or Stick?

Positive reinforcement or punishment?

It's the age-old question which now is being applied in the workplace. Some employers are willing to reward employees who make lifestyle changes such as losing weight or stop smoking while others choose to punish non-compliant workers with a higher share of the premiums.

A few states are surcharging smokers. Now Alabama will be doing likewise for overweight workers.

Obese workers must be prepared to pay a $25 per month "fine" if they are not ship shape.

Voice YOUR opinion!!! Read more....

Is it AI or just electrolytes? Or thyroid? Or an infection?

Well, durn-it-all, I had to take an extra 5 mg of hydrocortisone again tonight. That's twice this week, and actually three times if I count last Sunday when I was flying across the country coming home. I'm trying so hard to wean off of the hydro but my body just won't let me. I don't know if it's because my pituitary still isn't making enough ACTH after my surgery 18 months ago or if it's cantankerous sometimes. Or is it my adrenal glands? Have they given up the ghost?

Between the nausea, being freezing cold in a 76 degree room, the fatigue, and the headache that comes with it, there was no way around my need for the drug I both love and hate. I fought for years to get rid of the bugger that was causing my body to be overrun with the steroid only now to be dependent on it. But I never want a repeat of a couple of episodes I've had with AI. No way, no how.

So, are my electrolytes off, or do I need more cortisol? And if I do, why? Do I have an infection? That's usually my first indication of an infection, but that's not the only reason I get AI. In fact, I'm still fighting that sinus infection and see my ENT on Wednesday. The last few times other than with sinuses, it's been UTI's. I didn't even know I had them until they got so bad and became Pyelonephritis. You know, it's all relevant and we "Cushies" tend to ignore signs others don't just because we've tolerated so much for so long. It's hard to know when one is sick outside of the endocrine disease itself.

I know, I know...time to go get some blood work done. I've been putting it off for too long. I spent the week with my daughters this past week, so really need to get on the ball and go. But, I can't go in the morning. Since I have to have the serum cortisol and ACTH done at 8 a.m. and I'm supposed to withhold my hydrocortisone for 24 hours prior...well....I blew that.

I know that my pituitary has quit making a lot of things, but the tumor did that. Surely it will make ACTH again. I hope it will, but yet, I'm afraid it will, too. The chance of a recurrence within 5 years is high, and since my tumor went into my cavernous sinus and had to be scraped off the wall there, just one cell can cause it to regrow. Most of the time I don't think about that, but every now and again....like tonight....I do.

Why would my pituitary start making ACTH and not the GH or TSH I need? Oh, I've read all the research and supposition that goes with a pituitary tumor and the hormones it affects. But think about it. The pituitary has a posterior and anterior section. It also leads into the hypothalamus. The anterior section is responsible for the majority of the hormones, and those are the hormones I'm missing. All of them. TSH, GH, FSH, LH, etc. So, why would I not produce them but still produce ACTH? Yeah, you see why I'd worry if I did produce enough ACTH? Why won't I produce all the other ones?

Oh, I know, as we get older there are a lot of other things that happen in our bodies that cause the GH and estrogen to fall. And I know there are feedback mechanisms that fail, too. In fact, the hypothalamus directs a lot of the action with the anterior pituitary, including GH production.

The hypothalamus is a very small portion of the brain, but wow, is it ever busy! I'll have to do a piece on it sometime. In fact, there is some new research involving the hypothalamus and obesity. It's very interesting. If the hypothalums is damaged, a lot of the hormone production of the body goes haywire or stops. You can read more about it in Testing 101: An introduction. So, is my hypothalamus damaged? Ok, y'all....I know some of you are saying "she's dain bramaged for sure!" ;) Yeah, yeah.... I'm just curious!

So, I'm still cold, my nausea has abated to a tolerable level, and my headache is tolerable, too. Maybe I can sleep again. At least my polar fleece blanket will feel good tonight!

Was it something I said or am I being paranoid?

I'm half joking, half serious. I posted a comment to Dr. Rob regarding his Medpagetoday piece,Touching a nerve, and it wasn't accepted. This piece was a follow-up to all the responses he got on his blog, "A Distractible Mind", regarding the piece called "Shame". I responded to his follow-up with the following:

Dr. Rob, I believe you wimped out on your response here. If I made blanket statements you would expect me to back them up with research. You did not. "Much of obesity is caused by over-eating and inactivity." Documentation, please. How do you REALLY know that?

Secondly, you talk like it's either one extreme or the other. It's either a self-inflicted problem OR a metabolic illness. That leaves a lot of gray area uncovered. Why do some people get physically ill when overeating? Why do others stay slim even when eating junk and not exercising? You have observed both of those phenomena, also, I'm sure.

This is about lives, not moral high grounds. Obesity is an illness. No one bothered to respond back to my RESEARCHED and DOCUMENTED comments in response to "Shame". Nor did anyone else bother to cite documented research. Why? Because no one bothered to read the research or didn't want to be bothered/take the time. Did you?

When the medical profession really gets rid of the mindset that most obesity is self-caused will it treat patients adequately.

With warm regards and respect,
Robin

Reading it now, it's obvious I wrote it way too late at night with a desperate need for sleep (as I'm doing tonight, too), but the message is there. It was not meant in an ugly way. I was very serious and sincere. Why are we held to one standard and doctors to another? Research and documentation are mandated in science.

As of this posting, my comment still has not been approved for public viewing. I did have problems getting a window to show for the comment section, and difficulty getting a submit button to show, but I managed to tab until I did. Perhaps it really didn't get saved anywhere, but it seemed to be working ok. I also could find no other place to respond.

I realize this wasn't a scientific journal or even a medical article. It was about observations in life. But if I made observations like that, I don't think I'd get by with them. And the fact it was posted in the MedPage Today blog instead of on the blog where the thread originated implied to me a more serious tone. I'm not seeing that in the response.

I don't want to make a mountain out of a molehill, but I do want to bring Moses to the mountain...uh, molehill.

See, I'm not paranoid. BTW, my internet connection went down for two hours today and I know "THEY" did it!! ;)

This is not about obesity...

...again. In Obesity is a popular topic these days..... I mentioned "epigenetics". Epigenetics could promote obesity in next generation was released that same day by Baylor College of Medicine although I didn't see it 'til today. Fate? Coincidence? I have no clue, but here it is. And it's interesting.

"There is an obesity epidemic in the United States and it's increasingly recognized as a worldwide phenomenon," said Dr. Robert A. Waterland, assistant professor of pediatrics – nutrition at BCM and lead author of the study that appears in the International Journal of Obesity. "Why is everyone getting heavier and heavier? One hypothesis is that maternal obesity before and during pregnancy affects the establishment of body weight regulatory mechanisms in her baby. Maternal obesity could promote obesity in the next generation."

I do not think the explanation for obesity is a simple one anymore than I think chills are symptomatic of one illness. Nor should anyone.

Obesity is a popular topic these days.....

Is it a fad or is there really such an "epidemic" of obesity that it's become the topic of the year? I really can't answer that right now because I need to study it in more depth. I do know, however, that the mainstream media can grab onto a topic and worry it like a dog with a bone. Sometimes I just want to say "bury that dead horse already". Sometimes. A lot of the time.

But I'm not opposed to talking more about obesity as long as those talking about it are willing to help come up with viable, workable reasons with solutions and stay away from the attacks. I'm not persuaded the media sees the topic as anything other than another way to make money. It's a "hot" topic. That and gas prices.

Why not put both together in one topic? Oh wait, someone did that already: Increasing Gas Prices Could Be A Good Thing.

"According to a University of North Carolina study, the end result could be a 10 percent reduction in American obesity over the next seven years."

We could even combine it with politics! Wow...now that's a topic. No, I'm not talking about the very ill Ted Kennedy. Shame on you for thinking that!

Mr. Sali also announced a draft bill to "propose that the force of gravity, by the force of Congress, be reduced by 10%" to combat obesity. Mr. Sali said it was meant to parody a bill to raise the minimum wage, which he felt ran counter to the laws of economics.

Poor Australia....they are getting hit from all sides about it. Even their pets are obese. 33% of their cats and 41% of their dogs are overweight. (Who goes around and weighs all these animals?)

No, I don't take much of the media hype about anything seriously. I do take obesity seriously though. I've been fighting it for ages. Thus, this is a problem for me. I don't trust the hype, but I do observe the problem.

On the flip side, the BBC reports: Can genes explain rising obesity?

Contrary to conventional wisdom, the obesity epidemic is not restricted to people in Western countries who eat bad diets and are not very active.

In developing countries, it is estimated that over 115 million people suffer from obesity-related problems.

Experts believe that in many of these people these problems are not due to lifestyle but a condition called metabolic syndrome...There are many uncertainties about metabolic syndrome but one thing is certain - it cannot be explained entirely by genetics or lifestyle factors.

Betcha didn't read that one anywhere recently, did you? It's not newsworthy. A student newspaper caught wind of it, though. Yes, you can tell it's a student, but the sources are excellent. Well worth reading.

"This tells us that nutrition in utero is largely responsible for our epigenetic
programming and that under nutrition in one generation could explain the rise in
obesity, heart disease and diabetes in the next! It’s a far cry from the popular
cultural view that lifestyle changes are the be all and end all determinants of
good, or poor health - that everything boils down to personal decision
making..."

As with everything, take what you are reading with a grain of salt. I even challenge you make sure the statistics that are being quoted are real statistics. Anyone can make up numbers. And anyone can write anything on the internet. Including me.

What is Cushing's Disease?

I have been asked that umpteen times by folks who care about me. Other folks just look at me like I'm from an alien planet, and even others just nod and go on like they already know. I'm sure they go right home and google it. Ok, maybe some of them do.

When you get right down to it, I've become a walking library of sorts with facts and figures most medical students and doctors don't know. It's a matter of self-preservation, but you already know that if you are fighting any illness.

So, what is Cushing's? There are two terms used with Cushing's: Disease and Syndrome. They signify the source of the illness, although the presentation is pretty much the same with both. Cushing's Disease is hypercortisolism due to a pituitary source of stimulation. Cushing's Syndrome is hypercortisolism due to an ectopic or adrenal source. There really is a third type of Cushing's called iatrogenic Cushing's which results from the overuse of corticosteriod medications. And actually another type called pseudo-Cushing's.

I want to discuss Cushing's Disease/Syndrome (CD/CS). CD/CS is an endocrine disorder caused by chronic exposure of the body's tissues to excess levels of cortisol - a hormone naturally produced by the adrenal gland. Pituitary adenomas, usually benign, secrete increased amounts of ACTH (adrenocorticotropic hormone), a substance that controls the release of cortisol in that feedback loop I mentioned the other day. It typically causes an overproduction of cortisol. Tumors of the adrenal gland and ectopic ACTH producing tumors can cause similar problems with cortisol overproduction.

What are the symptoms? The most common symptoms are:

• Striae
• Buffalo hump
• red-faced all the time
• sweaty or hard to control body temp
• High blood pressure (often hard to control even with medication)
• High blood sugars and/or insulin resistance
• Insomnia
• Fatigue
• Altered diurnal rhythm (See previous post)
• Secondary hypothyroidism
• Low hormones such as FH, LSH, testosterone, growth hormone
• Low Vitamin D
• Low ferritin
• Unexplained muscle, bone, and joint pain
• Easy bruising
• Difficulty when drawing blood
• Upper body obesity
• Muscle weakness
• Increased facial hair/body hair (hirsutism)
• Loss of hair on head
• Loss of menstrual cycle and/or ovulation
• Loss of libido
• galactorrhea

Not everyone has all the symptoms. And the weight gain can vary by individual. Some folks don't gain a lot. Others do.

Without prompt treatment for Cushing's syndrome, other complications may occur, such as:

• Bone loss (osteoporosis), due to the damaging effects of excess cortisol
• High blood pressure (hypertension)
• Kidney stones
• Diabetes
• Unusual infections
• Hypothyroidism

When the cause of Cushing's syndrome is a pituitary tumor (Cushing's disease), it can sometimes lead to other problems, such as interfering with the production of other hormones that the pituitary controls. It can also affect the optic nerves and carotid arteries if large. The majority of pituitary tumors that cause Cushing's disease are small (less than one cm in size).

Long-Term Remission Rates After Pituitary Surgery for Cushing's Disease: the Need for Long-Term Surveillance says:

Morbidity and mortality are higher in patients with Cushing's disease, with vascular disease a frequent cause of death.[2,32,33] Cardiovascular complications, including coronary heart disease, congestive heart disease and cerebrovascular events, contribute to the morbidity and mortality of patients with undiagnosed or untreated Cushing's disease.[34,35] Early diagnosis and successful treatment of Cushing's disease is therefore most important.

Now, diagnosis....that's a whole 'nuther ballgame. To mix metaphors, it is no walk in the (ball)park.

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A horse of a different color

Or should I say zebra? In med school, potential doctors are told ""When you hear hoofbeats, think horses, not zebras". Well, what about those of us who are zebras? What does that say to those who don't fit any mold of illness or have multiple illnesses which paint stripes?

As I said earlier, my primary care doctor sees horses, but every now and then she does notice a stripe. The thing is, she tries to get rid of the stripe instead of looking at what caused it. And she's not alone. Frankly, I'm wondering if there really are any horses out there? Ok...ok....I guess there are. Maybe.

Diabetes, you say, is a horse. Nope.... Did you know that endocrine disease can cause it? And that it is just a secondary symptom? You didn't know that? Don't worry. Most endocrinologists don't seem to, either. Thankfully, I never had that particular stripe.

Ok, how about thyroid function/disease? Nope, not that one either. It's actually a stripe in the zebra of endocrine disease, especially a pituitary tumor. Secondary/central hypothyroidism is linked to a pituitary tumor suppressing the pituitary, and hyperthyroidism can be linked to a TSH producing tumor.

Low hormones? Oh, that must be early menopause or pre-menopause with females, right? Wrong. Just stripes of another color in the zebra of pituitary tumors.

How about high hormones? Well, guess what? Do I need to say it? More stripes...... Pituitary adenomas are famous for growth hormone and ACTH overproduction.

PCOS and metabolic syndrome are often the horses with which a Cushing's patient is diagnosed. Too often, it's just too easy to camouflage the stripes with those diagnoses.

Oh, and my favorite. Obesity. "You need to eat less and get more exercise." How many people do you know who want to be extremely overweight? Those doctors who don't listen, ignore the stripes (some literal ones called striae) and keep repeating that mantra need a A Swift Kick in the ASP. They don't know that fat is an endocrine organ. They also don't know it is actually possible to literally starve while remaining obese.

I do not know the answers. I do know there is a problem. Instead of heading to the dude ranch, maybe med schools ought to take their future doctors on a safari.

Metamorphosis

.....

I haven't always been fat. In fact, I haven't always been sick. And since, in my case, those two go hand-in-hand, it's obvious to me that one caused the other. Noooooooooo.....the fat didn't cause the sickness. It's the other way around.

"Yeah, right." I can hear the remarks now. I hear them all the time. On the news, in the grocery store, walking in Wal*mart. I see it in the faces of those I meet and with whom I work. And I am not upset with them. How could they know? My family and friends who have known me for a long time still have a hard time accepting it. Actually, I think my family is relieved there is a medical reason. Me, too!

There is a lot of guilt associated with being overweight. The psychiatrists would tell us that's what drives many to overeat. Compensation. But for those of us who suffer with endocrine maladies which led to the excess weight, it's almost insufferable. Even when we did everything right, we still gained the weight. It has to be my fault, right? The doctors say it is. Of course, it doesn't help when a bariatric surgeon tells you to lose 30 pounds in order to have the surgery just to show commitment. "Man, if I could lose 30 pounds, I wouldn't be here!" But that's another tale for another time.

I was actually pretty cute at one point in my life. Ha! Seriously, though, it is hard to tell when I was first affected by the pituitary tumor which was discovered years later. I know it was always very tough for me to keep the weight off, but with my mother's very wise advise, I did for many years. It always seemed harder for me than for anyone else. I know in my teen years and on into college, the harder I exercised, the more I hurt. I never seemed to be able to push past that and get my muscles "toned" like everyone else. I sure did try, though.

I managed to stay fairly slim during my teen years and into my twenties, although at 5' 2", that wasn't always easy. And with the inherited hips and thighs, even tougher. I remember feeling self-conscious about those. I wish I knew then what I know now. I would have been a lot happier with myself. Funny, I probably am more at ease with my body now than then, although it's not nearly as pretty.

Not realizing for years that I had a pituitary tumor or that it as the cause for many of my mostly ignored health issues, I managed to live an active, healthy lifestyle raising my two daughters, working, and staying active in my community. Although an eventual divorce put us pretty much on our own, I kept up the pace. But it finally caught up with me and I was no longer able to ignore what the doctors assured me was "normal" and I just needed to "eat less and exercise more".

Without getting into the specifics of what was wrong, let me say that I eventually changed tremendously physically even though I fought hard against it. The physical aspects of Cushing's Disease are probably as outwardly devastating as the biological terror that is wreaked within the body. I was virtually unrecognizable to those who hadn't seen me in a while. As you can see, the night before my surgery I was like a pufferfish in a company of guppies. It has been 17 months since that surgery. The surgery didn't fix everything overnight, but it did make my life better. Every day there is change. Every tweak in hormone adjustment brings change. The metamorphosis continues.