Cushing’s And the Immune System

Greetings again my friends and readers!

Well, it has come time to talk about another aspect of Cushing’s, compromised immune system response.  Most old time zebras know well enough how vulnerable they are to opportunistic infections.  That’s one of the things long term exposure to steroids do is to make the immune system weaker and less able to ward off disease and infections.  And what is Cushing’s syndrome but long term exposure to steroids?

I was forcibly reminded of that fact this past week.  To set the stage I was having some problems with what seemed to be a stomach bug of some sort.  So I went to a clinic not far down the highway from where I live.  After seeing the doctor and being told I was suffering from “food poisoning” I waited out in the waiting room for my wife to pick me up since she’d run out to run a couple of errands real quick while I was in.  I collapsed right there in the waiting room and was rushed to the hospital where I remained until yesterday.

Although there are still some questions since I didn’t test positive for the flu or bacterial infection, it was decided that I had been brought low by a viral infection which affected more than one system and also severely dehydrated me in the process.  Right up to the last minute before release I was pumped full of antibiotics and fluids.

That is one of the things those of us who suffer from Cushing’s have to be aware of and watch out for.  Our immune systems become less able to cope with invaders over time and one can easily get into in trouble if one doesn’t stay on top of things, like I didn’t.  That means not waiting until what seems like a small problem gets out of hand.  So one has to treat almost every sniffle as something serious, don’t wait around to treat it and be ready to get help at the first sign of trouble.  I know doctors and insurers get a little bent out of shape by us “hypochondriacs,”   But let me tell you three days stuck in a hospital bed eating the low calorie diets us fat folks inevitably get put on in the vain hope we’ll lose weight is no fun.

Another thing I found while checking the net for this post was multiple reports on some research done which is another reason to be careful.  It seems there is some evidence that infections can cause the production of cortisols to go out of control in a victim of Cushing’s with fatal results.  Since all I could access were abstracts I couldn’t get down to the details.  So there’s another reason for anybody with Cushing’s to be careful, very careful.

That doesn’t mean a Cushie can’t live a reasonable life on that score.  Just exercise common sense and care.  Do that and you can generally avoid ending up in as extreme a situation as I ended up in.

My first Cataract Surgery Is Done

Greetings again my dear friends and readers!

My first cataract surgery is done.  I’m a week post-op as of today and everything went fine.  There were no complications and my sight is already better.  I have the second one done next week.

The way the process goes is that the patient has to scrub their eyelids with a special pad every night and start adding medical eye drops to their eyes starting two days before surgery.  When the patient goes into surgery the staff places him or her under sedation and adds more drops to the eye, including those which will anesthetize the eye for the surgery.  The doctor then makes a tiny incision into the eye and breaks up and removes the affected lens with a special tool.  The doctor then replaces the lens with an artificial one.  Be advised that insurance generally will only cover the cheaper monofocal lens, so you would have to pay out of pocket for the multifocal ones.  It’s all over in a few minutes and I was in and out of the clinic in a little over an hour.

After the operation there’s no more scrubbing the eyelids as this can cause the incision to reopen with disastrous consequences.  The patient wears a guard over the eye the first day and then uses it for sleep and naps.  The drops continue afterwards, in my case for about six weeks.  One avoids lifting heavy things for at least the first week after and avoids bending over or any other activity which may increase the pressure in the eye.

It’s great to be getting it over with.  I’ll let you know how it works out when everything is done.

Wikipedia On Cataract Surgery. 

Cataract Surgery, From An Opthalmic Surgeon's Site. 

Hey there my friends and readers!

This is just a short post to let you know what is going on.  This coming Monday, Dec. 3, 2012 I will have my first cataract surgery.  Then on the 17th of December I'm supposed to have the other one done.  So I am going to stay clear of the net for at least a few days after surgery to give each eye a chance to heal properly.  

Once I'm past the surgeries I will be back.  My wishes for a blessed holiday season to all!

Stanley Loper

The Moon Face

Greetings from the Original Zebra!

Take a look at the following picture of my mother in her teenage years:

 

This is probably one of the best examples of another symptom typical of Cushing’s syndrome, the round, or “moon” face.  The moon face is another phenomenon which often accompanies exposure to high levels of cortisols and is a sign which differentiates the victim of Cushing’s from other morbidly obese people.  Here is a picture of one of my friends on Facebook who has given me permission to use her images:

Here she is now as a confirmed victim of Cushing’s:

This is more typical of how the round face will appear.  This lady gained over a hundred pounds in a matter of months when she developed Cushing’s.  When you contrast it with my mother’s:

It is easy to see how Cushing’s can be a little hard to spot in some stages.  Yet my friend, unlike my mother, is a confirmed Cushie.  So we can see how this symptom of Cushing’s can fall in quite a range.  Yet it is still recognizable wherever it falls within its range.  Mother went untreated and from the first picture of her she suffered from "Mild" Cushing's all her life.  Yet she died at age 65 from the ravages of the disease.

Today’s post was composed on Thanksgiving Day, so here’s to all my friends and readers from this moon face. 

Happy Thanksgiving!

Cataracts and Cushing’s

Circumstances force me to interrupt my planned series for a short discussion on Cushies and cataracts.  I’ve been having growing problems with my sight lately and suffered from eye strain and headaches as well.  One day I noticed that when I closed one eye type on the monitor screen and in printed material simply disappeared.  I already knew I had cataracts in both eyes in the early stages and feared one of them had accelerated its development.  My fear was confirmed and my doctor wants me to have the cataract removed as soon as we can get it done while my eyes are stable.

Cataracts are a condition where the lens of the eyes becomes opaque.  As cataracts develop the patient experiences increasing difficulty seeing.  It will probably be things like not being able to read type which or an eye exam which will be the first clue that something’s wrong.  However, the cataract will eventually cause complete blindness in the eye if left untreated.

The formation of cataracts in cases of steroid treatment and exogenous Cushing’s syndrome (Cushing’s caused by medical therapy) is a well known side affect.  However, research seems to document that cataracts are not a common side effect in endogenous, or Cushing’s caused by tumors.  I didn’t find anything on it, but I imagine that cataract formation or acceleration would be a likely danger with the use of glucocortical steroids such as prednisone for the treatment of inflammation or injury with a patient who already has exposure to elevated levels of cortical steroids to begin with because of Cushing’s syndrome.  That is another reason steroids should be used with care to treat Cushies.

The treatment for advanced cataracts is removal and replacement with an artificial lens.   While reading through the brochure I was given I found out that great strides in advancement in both the surgery and the lenses have taken place since my days as a practicing nurse.  It is now possible in people with no astigmatism, or even certain cases of astigmatism to have such sight improvement after surgery that eyeglasses are no longer needed.  However, most cases of people with astigmatism will still require eyeglasses.

As with any other surgery there are risks.  According to the patient plan I was given they include cornea/retina injury, hemorrhaging, pain, blurred vision, double vision and loss of vision.  Since I’m on clotting therapy the risk of hemorrhaging is especially pronounced and I will probably have to go on a heparin bridge to reduce the likelihood of that complication.  That requires an added week before the surgery can be done.

Naturally I will not be in a position to write for awhile after the surgery and don’t know how long my recovery to the point I can resume writing will be.  But I will be back and will continue with the series I started.

Helpful links:

Do Steroids Cause Cataracts? 

http://ibdcrohns.about.com/od/prednisone/a/Cataracts.htm

Catarcts and Cushing's Syndrome

Truncal Obesity

Yes, that’s a brand new picture of me taken just this week.  That makes it among the most recent in ten years.  But let’s take a look at the rest of me:

As you can see I’m playing a guitar.  Flamenco guitar is one of my hobbies and I do enjoy playing it.  But the important thing to focus on is the fat.  My fat is concentrated mainly in my trunk area.  Look at how thin my arms are, almost like skinny sticks.  That is the classic portrait of what is called Truncal Obesity, the rather distinctive trait of Cushing’s syndrome.  Normally the morbidly obese have plenty of fat on their arms and legs as well as the trunk of the body.  However, those with Cushing’s syndrome, or a few other disorders such as PCOs (Polycystic Ovarian Tumors) will display truncal obesity to varying degrees.  Anytime one sees the pattern one should consider endocrine problems.

In the following picture you’ll see that my mother displayed the pattern as well:

Once again, we see morbid obesity combined with a relative lack of fat in the extremities.  With both my mother and me you could see the individual muscles in the forearm clearly.  It was the same with both our lower legs and my thigh muscles stand out really well.  In my case both my arms and legs are free of fat until I reach the joint with my torso, then some shows up.  Next I repost the picture of my friend:

I her case the differences in the trunk and extremities aren’t so pronounced.  Yet she does suffer the disease.  Look more closely at her forearms, though, and you will see the difference.  Finally I will repost another picture I’ve used:

In this picture which was posted on Facebook the woman shows the clearly distinct truncal obesity which is often the first big sign of Cushing’s.

This is the first in a series of posts on the things those with Cushing’s can see for themselves or which may be noticed by friends and family.  For some of those the clothes will come off, or the pictures themselves may be shocking.  I’m choosing the photos and getting permission to use them.  There are folks out there who are willing to expose themselves that those who are seeking to know what is going on with their own bodies, or those of loved ones.  They have my hearty thanks!