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!

BLA

Thanks for waiting dear friends and readers.  Since this is also a chronicle of my journey with Cushing’s syndrome I’ll take just a moment for an update.  My sonogram came up negative for any tumors.  That doesn’t mean there weren’t any micro tumors there, just that if there were they were too small for the scan to visualize.  They did find another problem which will require me to go back to my urologist.  So my endocrinologist wants to do more testing to see where things are at.

Surgery is out, of course, since they couldn’t see anything to justify it.  There is only one surgery which is often done in cases where adenomas can’t be located, that’s the bi-lateral adrenalectomy or BLA for short.  The BLA is performed when they find tumors in both adrenal glands, in the case of recurring pituitary tumors and in the case of ectopic tumors.  The BLA is simply the removal of both adrenal glands.  The idea in the case of ectopic Cushing’s and recurring pituitary tumors is to shut of the production of the cortisols at their source.  Since tumors generally produce ACTH, the hormone which signals the adrenals to produce cortisols that is considered the logical way to deal with the problem in many cases.  After the two glands are taken out the patient is put on hormone replacement therapy or HRT for short.

The adrenal glands sit on top of the kidneys and are protected by the lower ribs.  Not many years ago the surgeon had to break the ribs over the adrenal glands to get at them for removal.  But now days, at least here in the United States of America, a new method is used to remove them.  The surgeon uses a laparoscope which requires relatively small incisions and which snakes up under the ribs to get to the adrenal glands.  Another great aspect of this kind of surgery is that the patient isn’t placed on their stomach for the procedure, which is contraindicated in my case.  The advantages of this kind of surgery are low recovery time with less pain and less time in the hospital.

After the surgery the hormones which the adrenal glands produce have to be replaced or there will be trouble.  So the patient goes on HRT which involves testing and adjusting the hormone levels through time.  The patient is also subject to going into Adrenal failure (AI), which I’ve discussed in two other posts, and having to seek emergency treatment for that problem.  So a BLA is a surgery with serious consequences and the patient and their family have to be familiar with what to watch out for and always ready to take them for emergency treatment.

Although one has to be watchful, the surgery does cure the Cushing’s and the patient will generally lose weight, even achieving normal weight in some cases and they will have a more normal life when compared to what they had with Cushing’s.  So while it is a procedure with serious consequences, including death in some cases, it is a surgery to consider in many cases.  According to a study done by doctors in Oregon, it is a surgery which can result in a good quality of life for most.  I’ll link the study at the bottom.

http://home.comcast.net/~staticnrg/Cushings/QualityOfLifeBLA.pdf

Pictures: A Gallery Of Cushing's Syndrome

Welcome to my Cushing’s blog again dear readers:

Today I’m going to treat you to some pictures.  One is fairly explicit as it is of a younger Cushie who decided to do a picture of herself in a bikini so folks could see what Cushing’s has already done to her body.  I have her permission to use her picture and plan to point out a few things from it.  So here it is:

Look at her face, how round it is.  That is called a “moon face” and is one of the signs of Cushing’s syndrome and disease.  Next is the “buffalo hump” behind her neck.  Because of the color of the door in the background it doesn’t stick out that well.  But if you have the ability to zoom in and look it is there.  Note how her fat is somewhat concentrated on her torso.  In her case it’s not as extreme as some I’ve seen, myself included, but her obesity is somewhat truncal.  Lastly get a load of those stretch marks!  Those are huge and stick out prominently.  Every Cushie knows the look of those, as do pregnant women.  But then women enter a pseudo-Cushingoid state while in pregnancy and stretch marks like those are the bane of their existence aren’t they.  And look at how dark some of them are, especially those towards the back.  That isn’t just a play of light as Cushing’s stretch marks are often darker than normal, even sometimes achieving a dark purple in color.

Usually we only get to see this sort of thing from nude pictures taken by doctors.  And those aren’t the easiest pictures to get to see much less legally use.  So I’m thankful to this lady for having this picture done and even more thankful for her permission to use it.

Now for a few before and after pictures, the first is a single picture a lady posted on Facebook showing before, while she had Cushing’s and after:

The lady is clothed in this one, of course.  However, one can clearly see what truncal obesity looks like as hers is more pronounced in the picture of her as a victim of Cushing’s.  See how skinny those arms are in comparison to the rest of her body?  That look of toothpicks stuck into a basketball is the classical look of the Cushie as the disease progresses.  Cushies both tend not to have much fat, if any, on the arms and legs and they’ll lose muscle mass as well.  Hence the distinctive profile we see here in this picture.

Next I’ll give you a picture of my mother:

That’s my young bride with her back in early 1982.  But focus on mom.  The way she’s dressed you can really see most of the symptoms we’ve discussed today on display.  You see the moon face, the buffalo hump and the pronounced truncal obesity.  Mother was almost fifty in that picture and only had about fifteen more years to live before the ravages of the disease took her.  Later in life mother developed COPD and extreme heart problems, both diseases morbidly obese people often die from.  Mother was never officially diagnosed with the disease although she had virtually all the known symptoms of the disease, including the mental health issues.  The doctors just weren’t interested in going down the road as they were thinking horses instead of zebras.

Finally, I’ll finish up with two more photos.  The first one is a “before” picture of me at age fifteen in 1971:

The next picture is my graduation picture from Waycross College in 1994 when I received my associate’s degree before moving on to a university.  I’m thirty-eight years old in that picture:

That’s quite a change, isn’t it?  I’m obviously extremely obese and have the classical moon face in that picture, more so than in my later pictures.  I was probably around 400 pounds in that picture.  That’s what Cushing’s syndrome does to a person.

Of course the picture isn’t all negative.  That last picture is on the occasion of my first graduation from a college.  I would go on to earn a Bachelor of Science degree in the same field, though I haven’t been able to get a job because of my disability.  I still have those and smaller triumphs in the face of Cushing’s syndrome and still try my best to spit in its eye.  I’m hoping that my next visit to my endocrinologist will have some good news and that I may finally get treated.