Miss Diagnosis: November 2010

Wednesday, November 10, 2010

Still Learning

Before I even get started with a new topic, I need to say YAY! For those who haven't already heard the MRI was fine. "No definite tumor".

Anyway, when we started with the new endo she suggested we increase Alex's dose of hydro. Dr. F. had suggested this as well. It's funny how resistant we are and how hard we fight against excess steroids after living with Cushing's. We have been vigilant about trying to reduce Alex's dose to the absolute minimum amount she could function on in hopes of further weight loss.

Sometimes it takes an outside perspective I suppose. Retrospectively, I should have seen it. Headaches daily, terrible fatigue, nausea...and it didn't dawn on me that this was all caused by not enough hydro? Add to that the labs and the fact that it was so incredible hard to wean? Needing extra hydro a couple times a week just to keep from puking? Oh, and two crisis siuations in a 5 month period?

So, over a month ago we increased the hydro from 15mg daily to 20mg daily. Guess what? She feels better! And, surprisingly, she hasn't been gaining weight of showing any other "Cushie symptoms". In fact, she has lost another couple pounds.

Like I said, still learning!

Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.