10 Medical New Year's Resolutions

2011 has been an exceedingly medical year for me. I had brain surgery, you know. So I have decided to make a list of my New Year's Resolutions for 2012, focusing not on the traditional "follow a diet quit smoking stop chewing your toenails" nonsense that is the bread and meat of new year's resolutions in general, but on solid and occasionally revolting medical matters of note.

And so. In the year 2012, I resolve:

1. Not to be in need of brain surgery or radiotherapy

2. To aim for a minimum of a 50% reduction in the amount of blood tests I have compared to 2011 (without a corresponding 50% increase in blood volume... that would be gross)

3. Not to get schistosomiasis

4. To learn how to pronounce schistosomiasis

5. To laugh at a homeopath (I am homeophobic)

6. To maintain an entirely appropriate heartrate at all times

7. To visit the Hunterian Museum and be suitably traumatised - and specifically, to see the skeleton of Charles Byrne, the "Irish Giant", a 7 1/2 foot tall man who suffered from acromegaly.

8. To disconcert my endocrinologist at least once by asking a lengthy and pointlessly technical question and then pretending to understand the answer.

9. To persuade my friend, a medical student who runs a Dermatology Society, that she should hold a dermatology quiz and pizza night, in which prospective dermatologists must diagnose which skin condition is represented in each pizza's toppings (eg. a pizza with olives hidden under the cheese could represent buboes. Yum.)*

10. To win the lottery (not technically a medical resolution, but that's no reason not to try)


Here's hoping 2012 will be an excellent year of few medical problems and many revolting pizzas. Happy new year!

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* Seriously, this is an awesome idea. You should do it.

IMFW: Beware Boxing Day

It's Boxing Day and all, so I'm keeping today's Interesting Medical Fact of the Week short, snappy, and slightly concerning; science informs us that you're more likely to have a heart attack on a Monday. Apparently, this is ascribed to the twin horrors of overindulgence at the weekend and the shock of returning to work. Given today's date, hopefully you're not back at work - but the "overindulgence" issue may well apply...

IMFW: Blood, Blood, Blood; or, Don't Move to Hong Kong

Today's interesting medical fact of the week is all about blood groups! Anyone who's done GCSE biology, or has donated blood (which you should do, incidentally) is probably aware that there are two most commonly used blood group systems. You're likely to be classed as Rhesus positive or negative - i.e. you either have, or do not have, a particular antigen on the surface of your blood cells - and then into one of the groups A, B, AB and O. People of blood type A react to blood with B antigens in, people with blood type B react to A antigens, people with blood type AB react to neither, and people with blood type O react all over the place, the whiners. Here is a handy chart from Wikipedia which explains it all clearly.

Apparently Back In The Day, kids used to routinely test their own blood group in school, thus gaining useful scientific understanding and practical skills. Unfortunately this practice was stopped, probably due to the dreaded Health and Safety, but (according to urban legend) also due to the fact that childrens' paternity kept being called into question by it.

Having given blood myself (after which I had a Funny Turn and was tragically forced to lie down eating biscuits for half an hour), I happen to know that my own blood type is A negative, which means that, were I to suffer significant blood loss, I could have a blood transfusion of either A negative or O negative blood. About 7% of the UK population is A negative- and about the same number have O- blood, so there's maybe 14% of blood stocks which would be available to me - probably a little less, because O- blood can be used for all blood types so it's used in emergencies where the recipient needs blood urgently and their blood group is unknown. So that's fine.

My parents admitted to me several years ago that there was a possibility we as a family could have moved to Hong Kong at one point in my childhood, which they mysteriously neglected to mention AT ALL at the time. Had we ended up moving to Hong Kong, our family's main concerns at the time would have been leaving behind all our family and friends, and not speaking the language. I doubt it would have occurred to anyone to even vaguely consider the fact that two of our family members have Rh negative blood. And in Hong Kong, and elsewhere in Asia, that is very, very rare. Only 0.69% of the population of Hong Kong are Rh negative. When your transfusion opportunities are restricted to A- and O-, only 0.5% of the population of possible blood donors are compatible.

I had no idea that this is actually a very real problem in Asia. There are numerous cases of people being unable to have treatment until donors of the right type are found, and if you suddenly lose blood in an emergency situation, things really don't look good. Because Caucasians have a much higher proportion of Rh negative people, foreigners often need to be targeted in blood drives.

It's also not something that I ever remember being informed about by anyone before travelling. The risk of needing a blood transfusion in other countries, if it's ever been mentioned to me, was framed as a risk of dirty or infected needles. One of the articles linked above, from a website for expats in Bali, notes that it's irresponsible for people to not know their blood type, and that all Rh negative expats should register to be put on a list of potential blood donors for emergency situations. It doesn't surprise me that people who travel out there aren't aware of this issue though, because I had never heard of it! And the problem is made worse by the fact that, due to vCJD ("mad cow disease") fears, many countries do not allow anyone who has lived in the UK or elsewhere in Europe to donate blood, further depleting the pool of possible donors.

So: be aware. And if you live in, or travel to Asia for an extended period of time, check out your blood type.

On a more lighthearted note: my favourite article from researching this post was a suggestion that people with RH negative blood are descended from aliens. Oh, and in Japan, blood types are used as we use star signs in the West, to categorise personality types.

My MRI Experience: Stuck In A Moment. And Also A Tube.

Today I thought I'd continue my story of diagnosis and treatment, admittedly with a slight gap in continuity from my last post, by talking about the first MRI (Magnetic Resonance Imaging) scan I had. Brain MRI scans are pretty cool; it seems very weird to be able to look at a picture of the internal apparatus with which you are looking at the picture of the internal apparatus that you're using to - well, you know what I mean. Brain MRIs get recursive fast!

Around this time last year, having had my introduction to my local endocrinology department, blood tests had decreed that I did not suffer from Resistance to Thyroid Hormone and therefore the doctors knew that I almost certainly had a pituitary adenoma producing Thyroid Stimulating Hormone (TSH-oma).

Endocrinologists tend to leave off MRI scanning of the pituitary gland when diagnosing these conditions until they've ruled out all other options. This isn't a Daily Mail-worthy example of NHS cutbacks; it's because small, harmless pituitary tumours are quite common. Finding one on an MRI scan might lead doctors to wrongly diagnose a pituitary condition like TSH-oma or Cushing's disease, when in fact the tumor is not what's causing the problem.*

I knew that things must be reasonably serious when my endocrinologists allowed me to jump the queue for MRIs at the hospital. In fact, I jumped it so completely that the NHS paid for me to have my MRI done immediately at a nearby private hospital, because there were no scanners available at the NHS hospital for a few weeks. It was slightly disconcerting, not just for the speed at which it all happened, but also because I had to travel to the mystery hospital on my own, by bus, to the middle of the countryside. The bus driver dropped me off with another girl who was fortunately also headed for the private hospital, and we were left in a random village with no signposts or map. Eventually we got there, and I heartily thanked the paranoia which had led me to leave home an hour earlier than I needed to.

Before my MRI, I didn't know much about them, apart from the fact that, as the scans work through big old magnets - hence "magnetic resonance imaging" - you have to remove all metal from your body or risk it moving around in the magnetic field; consequently, no pacemakers allowed. I wanted to know what to expect, so I scoured the NHS website and interrogated family members who had already had one. They said: you take off your watch, you lie in a tube, it's loud, you have to stay still, the technician shouts "stay still, damn you!", you leave.

NOW JUST HOLD YOUR HORSES.

An account such as the one above leaves out some crucial information for folk like me. For one thing, I didn't realise that, as it was my general cranial area being scanned, they would trap my head in a box stuffed with cushions to prevent it from wiggling. Then, head duly caged, you slowly roll backwards into the MRI scanner. Anyone who is claustrophobic would not be a fan, although they gave me a panic button which I could beep if I needed rescuing.

In fairness, the staff know that this is a freaky experience and repeatedly asked "Are you ok?". Towards the end of the scan, I also realised that the machine had a reassuring mirror placed just above my eyes, which means that patients can see the MRI technicians at work through a window at the back of the room. Or at least, patients who aren't stupidly and entirely blind without their glasses, like me. I am wildly shortsighted and consequently, even once I had realised that it was a mirror, and even though it was really pretty close to my face, all I could see was pinkish blurs.

The radiography folk gave me some sexy earplugs to wear, to block out the noise of the MRI scanner going mental with magnets. Unfortunately, these kept falling out and, because my head was wedged in with cushions, there was no way of putting them back in. MRI scanners really are incredibly loud, and it's not just the loudness that's the issue - the noises they make are weird and erratic, much like a young Kate Bush. When it all goes quiet, you find yourself tensing in anticipation of the next staccato burst of noise, and when it suddenly starts shrieking in your ears it's pretty tricky not to jump out of your skin, especially if you're pumped up with thyroid hormone and thus pretty jumpy anyway.

The technicians do not like this.

Partway through (the MRI took about 40 minutes, I think) I was pulled out of the machine. My heart leapt - time goes a bit screwy when you're in a weird screaming machine - perhaps it was finished? But no, they just wanted to inject contrast dye into my arm and bung me back in.

I whiled away the time by trying to remember and recite poems in my head. I did "The Jabberwocky" a couple of times, the prologue to Romeo and Juliet, my favourite speech from Macbeth, a couple of poems and odd verses from Siegfried Sassoon, and pretty much anything else I could remember. I was very bored. Pro-tip: learn some new poetry before having an MRI and then take advantage of the time to test your memory.

Anyhow, I realise I may have made my MRI scan sound like a horrific experience** but actually it was totally fine, and I much preferred it to having endless blood tests at the hospital. I admit I was irrationally afraid that there would be a previously unknown bit of metal embedded somewhere in my body that would rip out in a bloody mess.

Fortunately, this did not occur.

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*Such tumours are known as "incidentalomas".

**Or I may have just made myself sound like a massive whinger...

Addisonian Crisis... or stressful football match?

I found an article on BBC News about how a woman was recently diagnosed with Addison's Disease, and one of the key clues to her underlying condition was her extreme response to the stress of watching particularly close and high profile football matches. They think that treatment for her condition may have cured her extreme reaction to tense games of football... but they can't be sure because her treatment and diagnosis has happened at the same time as a run of easy matches for her favourite team!

Addison's Disease is a medical condition which occurs when the body does not produce enough cortisol, a steroid hormone - basically it's the opposite of Cushing's Disease. Some people who suffer from pituitary problems due to a pituitary tumour, or after surgical removal of a tumour, are unable to produce ACTH, the pituitary hormone which stimulates the body's production of cortisol, and consequently they need to take steroids to make up for the lack of cortisol. The tricky part is that the body needs more steroid hormone when it's under stress, so when people who take steroids are sick or injured, they need to double their dosage.

After pituitary surgery, most people including me, go onto steroid replacement pills just in case there's been any damage to the part of the pituitary that produces ACTH, and take them until doctors are sure that the body is producing steroids naturally.

The aim of this is to make sure they don't suffer an Addisonian crisis, which is an acute medical emergency where there is a severe shortage of cortisol, usually in a high-stress situation. If untreated it can lead to death or coma, so people whose bodies don't produce cortisol on their own usually have some form of medical ID in case they're in an accident, to inform paramedics that they will need steroids immediately.

Famous People with Cushing's Disease?

Being a blogger with a TSHoma (a.k.a. TSH-oma,* a.k.a. thyrotropinoma, a.k.a. a freak) has its pros and cons. On the plus side, as far as I can tell I have definitely found a niche in the market - no mean feat, given the number of enthusiastic and generally excellent blogs written by people with everything from diabetes to acromegaly. On the down side, there's none of that nice cosy caring and chit-chat over tea and lanreotide injections that you get from support groups with other people. People who understand how rubbish it is that your heart's going too fast/your hands have grown enormously/your nose just fell off. So being me, I have been ambling around the internet, happily barging into other people's support groups and demanding to be paid attention because I have a tumour on my pituitary gland too.

A little while ago I found the lovely Acromegaly Bloggers, and more recently bumbled across a blogging group for people with Cushing's disease, called Cushie Bloggers. People with Cushing's disease can at least console themselves with the fact that referring to themselves as "cushies" makes them sound incredibly cute and fluffy and generally charming.

But anyway, finding the blog and reading the experiences of some of the bloggers got me thinking: in an earlier post, I went on a hunt for famous people with pituitary adenomas. Obviously there were no cases of TSHoma/thyrotropinoma - that would be too much to hope for. But there's Russell Watson with his unspecified adenoma, and numerous celebs with acromegaly - even more than I included in my post, in fact: acromegalovelies are all over the shop, from Andre the Giant to Pio Pico.

But where are all the famous Cushing's sufferers?

I've found it difficult to find information specifically on the incidence** of Cushing's Disease, probably due in part to the fact that it's a subtype, as it were, of Cushing's Syndrome, accounting for about 70% of endogenous Cushing's syndrome cases. I have found the incidence of such new cases quoted as about 13 cases per million, so we're talking 9 new cases per million per year, compared to an incidence of 3 - 4 new cases of acromegaly per million, per year. So it is seemingly rather more common than acomegaly, although the massive tendency towards underdiagnosis of both illnesses (and TSH-omas as well) makes these rather shaky figures.

Given that it's relatively easy to find well-known figures suffering from acromegaly (even outside the field of sports, where young sufferers' large frames could be considered to give them an attractive advantage in sports like basketball or wrestling) and given that Cushing's is more common, you'd think it would be easier to find a celebrity with Cushing's. (You'd also expect to find people with prolactinomas, but I suspect that (particularly male) celebrities might prefer to generalise prolactinomas as "tumours" rather than publicly imply that they're leaking milk from their manboobs.) Celebrities diagnosed with Cushing's, on the other hand, are (I would have thought) surely be more likely to publicise their condition, to explain that any excess weight gain was not due to greed or laziness but a medical condition.

So where are they all? I've looked around the place and all I can find is a vague hint that Elvis may have had Cushing's syndrome (as distinct from the disease, Cushing's syndrome does not necessarily imply a pituitary tumour, but could be caused by steroid overdose or adrenal tumours etc). If true it would certainly be something of a PR coup for cushies, but one article in the Daily Mail is not much to go on. The Daily Mail seems to have a little bit of a penchant for Cushing's Disease (is there a sufferer amongst the editorial staff?) and I've also found an article suggesting that King Henry VIII may have had Cushing's Disease. Who knows? When it comes to historical figures, it's fun to speculate, but speculation is all it can remain.

The only - literally the only - modern-day sufferer I've found who comes close to the designation of "celebrity" is J. Jordan Bruns, an artist featured in this article - but he's not exactly a household name, lovely though his art is.

Come on cushies, come out from the woodwork!

UPDATE: If you're interested in reading about famous people who suffer from pituitary tumours, see my other posts looking at famous pituitary ademoaners here and here; my post about Russell Watson, the opera singer who had a pituitary tumour; or check out my post looking at famous women with acromegaly.
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*Never doubt the power of punctuation. If you search for the wrong one, Google will offer you Tshoki Tshoma's naked photos. Nice.

** I would prefer to write about prevalance but I've found it harder to find figures for that.

Let's Get Technical, Baby

Apologies for my lack of posting lately! I have been doing exams. They are now over, and my new excuse is that it's Christmas (in case you hadn't noticed). But, as of a phone call from the hospital on Wednesday last week, I have been meaning to give an update on my health. In short: my thyroid stimulating hormone levels are still normal, but I will have to start new treatment shortly... because I have high levels of the TSH alpha subunit.

"The what-now? What in god's name is that?" I hear you cry.

Don't cry.

My endocrinologists have always been cagey whenever I've tried to get them to explain what the alpha subunit actually is,* although in fairness, my shrewd personal judgement leads me to believe that this is probably less because it's a dark and terrible secret and more because they're not paid to teach biochemistry.

Anyway, the combined powers of Wikipedia and Google have provided me with the answer: it turns out that thyroid-stimulating hormone (TSH) is a dimer; a chemical compound of two identical or similar monomers: in this case, the alpha subunit, and the beta subunit. No-one wants to get bogged down in the detail, so at this point I promise not to use the word "glycoprotein" without extreme provocation.**

So: TSH is made of two kinds of stuff. And as it turns out, TSHomas (pituitary tumours which produce TSH) have a bit of a habit of producing more of the alpha subunit than would normally be expected. Normally you would expect the ratio of free alpha subunit to TSH to be less than 1. Before my surgery in April, my ratio of alpha subunit to TSH was 14:1. Currently, it's 7:1.

Obviously, 7:1 is better than 14:1. However, it is equally obviously Not Quite Right.*** Consequently it seems likely that the TSHoma is still active, and even though my total thyroid-stimulating hormone levels are within normal limits, it may still be secreting some TSH as well. Active tumour = growing tumour.

So I'm going to start having injections of some kind of somatostatin analogue again. I haven't really written about this up to now (it's on my list, promise) but for three months before my operation last year I was having monthly injections of Somatuline, the brand name for lanreotide. It's a synthetic form of a hormone naturally released by the hypothalamus,**** which inhibits the production of TSH and growth hormone, and which is used to treat pituitary adenomas which are releasing either one of those hormones. If you're lucky, it can shrink the tumours a bit - at the least, it should check their growth and can also help to make their structure less fibrous, which makes it easier for surgeons to chop them up.

It's also super expensive. When my GP first looked up how much it cost after my endocrinologist had requested a prescription, he laughed in a slightly manic way for about five minutes at the price. Awkward.

I'm going to start the injections again, probably in January, for three months, to assess whether they shrink the tumour at all and whether they bring down the high levels of alpha subunit in my blood. I'm not massively looking forward to starting again - the injections mess with your body a bit, last time I felt nauseous for three days after the first one, and they're a bit of a hassle because you have to order the injections a week in advance from the pharmacy, then drop them off at your GP's because they have to be kept in the fridge. The injections sting, they have to use a massive needle because the stuff is so thick, and you end up with a lump in your hip - basically it's injected under the skin where it sits and slowly decreases in size over the month as it gets absorbed into your system.

On the plus side, having these injections should (in theory) get rid of the last of my symptoms. And that would be very nice. I am really quite bored now of my hair falling out/heart randomly getting overexcited/headaches. As for what happens after three months, who knows. The injections are a possible long term treatment option although they are an expensive hassle and they're quite likely to give you gallstones sooner or later. So that brings you back to surgery/radiotherapy. Oi vey.

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*Apart from an excellent title for some kind of spy film.

**Incidentally, the α subunit is thought to be the effector region responsible for stimulation of adenylate cyclase

***I must stop using these technical medical phrases.

****Somatostatin.Lol.

IMFW: The Burzinski Saga

Less an interesting medical fact today, more an interesting medical story. Are we sitting comfortably?

Then let's begin.

I was reading the Guardian today, as is my wont, and I came across this article about the interesting story of Rhys Morgan, a 17 year-old Welsh blogger. Rhys wrote a blog post about the Burzynski Clinic, a US cancer treatment centre. Keeping it brief, the Burzynski Clinic runs (non-randomised) clinical trials of a therapy for cancer, and it charges very sick people thousands of dollars for the privelege of taking part in these trials.

So far, so US healthcare.

But Morgan and other bloggers have pointed out that although these trials have been going on for decades, the National Cancer Institute website notes that no randomised controlled trials of Burzynski's treatment have been published, nor have other investigators been able to duplicate the results found by Dr Burzynski and his colleagues in earlier trials. The treatment is not approved by the FDA for the treatment or prevention of any disease, but people from the UK are raising hundreds of thousands of pounds to travel to the US to try this treatment, and these bloggers questioned that.

Unsurprisingly, the Burzynski Clinic repudiated these claims of unethical behaviour. For their trouble, Morgan and others were ineptly threatened with legal action by the Burzynski Clinic's former PR man (nice work), threats which they responded to in a dignified and thoughtful way. You can read Morgan's very interesting correspondence with the clinic here.

IMFW: Arms for A Leper?

Leprosy. As no doubt you already know, it's primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract...

Ok, no. There are two things everyone knows about leprosy:

1. It's highly contagious.

2. Your bits fall off.

Interestingly, as it turns out, neither of these facts are actually true. Whilst it used to be thought that it was highly contagious, and sufferers were banished to live out the rest of their days in leper colonies, around 95% of people are naturally immune to the disease - it's possible that in the earlier days of medicine, it was sometimes confused with syphilis, hence the fear of infectiousness. Oddly enough, you can, however, catch it from armadillos.

Leprosy doesn't cause people to lose limbs or digits, but it does affect the nerve endings and impairs peoples' ability to feel pain. This means that people with leprosy tend to injure themselves easily, not realise, and then the wounds become infected, resulting in tissue loss. Fingers and toes can also become shortened due to loss of cartilage in joints.

To this day, despite high natural immunity and the availability of effective treatments, many sufferers around the world are forced to live in leper colonies even after they've been cured, because of the fear and misconceptions surrounding the disease.

Headache? Brain Tumour!

So I thought maybe I should write a post about the pituitary tumour headaches that I get. As I have almost certainly complained previously, for many years I never got headaches and then, gradually, I started having them more frequently. Every now and again, right after taking a couple of ibuprofen,* I would entertain the vague thought that maybe I should go to the doctor and get it checked out... and then laugh at myself for being melodramatic. Oops.

Because the thing is, they never happened that frequently. Maybe once every few weeks. I was under the vague soap opera impression that tumours in your head  gave you headaches continously, but apparently this is not necessarily the case! After my operation, I had headaches more frequently for a month or two (not particularly surprising given that surgeons had been rummaging around in there with sharpened implements), maybe a couple of times a week.**

My pituitary adenoma headaches are actually usually pretty similar. Previously, I would get pain all around the edge of my right eye socket, and right at the back of my eye - and it is somewhat disconcerting to feel where your eyeball must be - although since the surgery, it has improved (yay!) - I only really get it in the upper left-hand corner of my eye, which is where the pain used to be worst. I always feel slightly better if I massage that corner of my eyebrow; this has now turned into a habit which I catch myself doing even when my head is not hurting.

But ladies and gents of the internet - fret not if your headache sounds similar, for you probably do not have a tumour in your head (though that does not mean that your headache could not be seriously unfortunate). The Power of The Internet informs me that there are all sorts of different types of headaches even amongst pituitary tumour patients, so pfft, who knows. Just go hassle your doctor about it.

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* Paracetemol makes me cough. Apparently this is odd.

** I wasn't allowed to take ibuprofen due to being on steroids, and I wasn't supposed to cough lots, which ruled out paracetemol. This put me in something of a quandry for painkillers, but as they didn't tend to last too long I am INCREDIBLY BRAVE, I just did without.

My Heart Goes Sha La-La La-La

My rate of posting has dropped slightly recently, down from those heady days in November when I was continually finding out new facts about Russell Watson, and stalking unwitting commentators on the Guardian's website. This is not because I have lost interest in such matters - far from it - but because I'm taking exams at the moment and consequently dedicating my energy to revision and work, rather than obsessive tumourhead fact collection.

Incidentally, the most popular search term for my blog is currently "peoples big noses". Say what?

In any case, as well as spending my days drawing extensive mind maps, and making full use of my considerable collection of coloured pens,* I have discovered a new and interesting fact about my post surgery self; namely that my traditional mild pre-exam nerves (which previously I rather cherished for their ability to get me writing quickly) now serve to completely undermine my body's new-found ability to regulate its own heartbeat.  So, with a speedy speedy heart, the exam was a slightly more stressful experience than I had expected, and I will definitely be carrying beta blockers with me next time.

Ah, tachycardia.

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*Because that's what revision is about.

IMFW: Art Imitates Life?

Having written previously about Pio Pico, the last Governor of Mexican California who, it has recently been suggested, may have suffered from acromegaly caused by a growth-hormone producing pituitary adenoma, I got to thinking about this retrospective diagnosis lark, and I did a bit of reading. It turn out, doctors love arguing over whether Mozart had kidney failure or rheumatic fever, Schönlein-Henoch syndrome, trichinosis or the 'flu - and he's not the only famous composer to get the "what did he die of" treatment.

But this article takes things to another level. Professor Michael Baum takes his medical students around the National Gallery on a veritable orgy of slightly tenuous diagnoses, based solely on what they see in paintings. He and his students have suggested that The Ugly Duchess by Massys may show a woman suffering from Paget's disease of the bone, and suggested that An Allegory with Venus and Cupid by Bronzino has a hidden syphilitic message. Some of their arguments are more compelling than others, but it's an interesting article and I recommend following up the full versions of his analysis as well.

The T-Word

Considering that it's only six letters long, and half of those are cuddly-looking vowels, 'tumour' is a surprisingly big word.* When you put the word 'brain' in front of it, it becomes positively enormous.

I may be biased, but I definitely feel that modern science should devote a little time and energy to investigating the phenomenon of the Brain Tumour Face, which in my experience is virtually universal. The phenomenon is this: when you tell someone that you have a brain tumour, their eyebrows shoot up violently and their mouth goes to a perfect o-shape. They say "oh!", quickly try to get their outlying facial features under control, and then warily ask "is it cancer?" If the answer is "no" (which for me, thankfully, it is) they slowly start to relax again. They may attempt a few further questions which you are ill-equipped to answer and/or they are ill-equipped to understand. This part seems to be optional.

Possibly the Brain Tumour Face is the seventh basic facial expression, common to all peoples and cultures across the earth. It certainly is the reason that it took me so long to mention the tumour to my friends - and even then I chickened out and told most of them over Facebook (I am grateful that no-one clicked 'like'). The problem is that it then becomes a self-fulfilling prophecy; people don't use the word 'tumour' face-to-face, which only serves to increase its fear factor. Even when referred to as a pituitary tumour rather than a brain tumour, the t-word creates quite a reaction; referring to it as a pituitary adenoma merely gets you a blank look, which personally I find preferable.

Even doctors have succumbed to the power of the t-word. Unfortunately, some of the synonyms they end up employing are quite entertaining - my favourite is "lump", which always inexplicably reminds me of the slothful Onslow from Keeping Up Appearances. The first time I went to see my (very lovely) endocrinologist after an MRI found the tumour, he managed to say the t-word only once, right at the end of the appointment, although I did notice a couple of occasions where he started to say it and then quickly caught himself. Or maybe I misinterpreted him and the "tu- er- lump" really is a medical condition.

Personally, I prefer plain speaking. Admittedly, I don't call a spade a spade, but that's purely because I try to keep myself distanced from manual labour at all costs. There's a tumour in my head and frankly I am a lot more concerned about the thing itself than what it's called. It's good that doctors empathise with the fact that their patients are going through a scary time, but continually avoiding all mention of the t-word just makes the elephant in the room swell ever larger. And develop spontaneous tumours.

Naturally there are exceptions to the Brain Tumour Face rule, particularly amongst the medically inclined/drunk. One of my good friends, a medical student, tried to persuade me to go out clubbing one night with the immortal line "Your brain tumour wants you to go!"** Oddly enough, it worked.

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*Of course, if you're an American it's only five letters long, so the vowel quotient is significantly reduced. Does this correspond with a similar reduction in its bigness? Answers on a postcard, please.

** Hi, Havana.

Why I Love Blood Tests

One of those occasions where I wrote the post title first, then went "hmm" and sat back, doubtfully stroking the beard I don't have.* And then had to go look up the correct spelling of the word "occasion". I definitely feel it looks better with two S's.

I've never been a massive fan of blood tests, and my opinion of them hasn't exactly improved with much closer acquaintance. And trust me, diagnosing a TSH-secreting pituitary adenoma involves a very close acquaintance with the phlebotomists of your local hospital.

People are weird, so there's probably at least a couple of oddballs out there who positively enjoy having their blood weaseled away by an overgrown thumbtack, but I am not one of them.

Additionally, one of the things they mysteriously forget to mention before you undergo transsphenoidal hypophysectomy surgery - and frankly, who knows if I spellt that right - is that afterwards, you have blood tests every hour for the first six hours, then every two hours for the next twelve hours, then every four hours, etc. In layman's terms, this translates to being repeatedly woken in the middle of the night by a very nice nurse who is attempting the impossible, viz., sticking a dirty clean great needle into your arm without waking you up. It is deeply unpleasant.

But I do try to see the sunny side. For instance, blood tests are much more fun than injections, especially injections into muscle. And injections of lanreotide, which really smart; it's a bit like having liquid stinging nettles injected into your hip. Blood tests are also, I imagine, fun than diptheria. In fact, once you start to think about it, blood tests come out looking positively rosy. Plus, when I go in for blood tests I get the chance to catch up with the lovely endocrine nurses at the hospital/the lovely Caribbean & Australian nurses at my GPs.

I do tend to get a bit faint after having my blood stolen, particularly if they've taken a reasonable amount - I'm okay with one vial, but there have been occasions when they've taken fourteen, which does make me a little woozy. But I've had so much practise now that I inadvertently discovered the cure - a drink of Ribena beforehand does wonders, and sugary food afterwards is also good. For best results, return from the hospital to a glass of orange juice and platter of Haribo and chocolate orange slices prepared by a lovely boyfriend <3

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*Actually, following a youthful fall from the monkey bars, I do in fact have a large (yet fortunately solitary) beard hair which grows from the scar tissue in my chin. Sexy.

IMFW: Retrospective Justification

When I was a child, I hated sprouts.

No, wait - let me rephrase that:

I hate sprouts.

I have always hated them. I intend to continue hating them until I'm so old that my tastebuds have shrivelled up entirely beyond use - and after that I will still refuse to eat them, on principle. As a child, I was often served a Token Brussels Sprout at Sunday Dinner, which I had to eat if I wanted to get any pudding. And, as I always wanted pudding, I used to attempt to chop the sprout into as few pieces as possible and then swallow them whole, like a self-loathing vegan snake.

For years, I suffered this horror almost every week and was told off for my fussy eating habits. But now, it has been revealed that the hatred of brussels sprouts is, in fact, genetic. Or at least, probably genetic. Those people who have this gene can taste the bitter and hideous taste of a chemical called phenylthiocarbamide, which is extremely similar to a chemical found in brassicas, like brussels sprouts. And cabbage, broccoli, cauliflower... pretty much all the vegetables I and so many other sensible people hate.

Now, I've seen different theories suggested for why some people like sprouts and others can't stand them - but this is definitely my favourite. Because it means that all children everywhere, when faced with a plate of sprouts, can now scowl up at their parents and say: it's your fault I don't like them.

Owner of A Lonely Heart: Attempts at Diagnosis

When I was a very small child, a combination of my bad hearing and an obsession with ponies meant that I thought the classic Yes song Owner of a Lonely Heart was actually called Owner of a Lonely Horse. Ah, the folly of youth.

As the years went by, I became increasingly good at distinguishing between the hollow muscular organ which pumps blood through the circulatory system, and the large solid-hooved herbivorous ungulate mammal. No doubt this helped enormously when it came to talking to the doctors about my heart problems. Anyway. At the end of my previous post on the subject of my lengthy road to diagnosis, I had left my local hospital's A&E department with a heartrate of 140 and no explanation...

The next day, I went to my GP, who prescribed beta-blockers. Going through my symptoms (rapid heartrate, tremors, fatigue, hair loss, etc) it seemed that thyroid problems were an obvious possibility. I'd had my thyroid levels tested at A&E and they came back fine, but my GP checked again. They were still fine.

And that was the problem: in fact, my levels of thyroid hormone (free T3 and T4) were much too high. But when doctors suspect you have too much thyroid hormone - hyperthyroidism - that's not what they look at. Instead, they test your thyroid-stimulating hormone (TSH) levels. Low TSH implies hyperthyroidism (because your body is trying to lower your thyroid levels by producing less TSH) while high TSH implies hypothyroidism (because your body is trying to increase your thyroid levels).

Unfortunately, my TSH level was within normal ranges, even though the whole time I had a tumour sitting on my pituitary gland, giggling frantically to itself and oozing TSH with the enthusiasm and verve of a naughty child left unattended with a box of felt tips and a newly papered wall. It was on the high end of normal, but without measuring the T3 and T4 you'd never realise that it was too high for my body. I should point out at this stage that I don't blame my doctor for not doing the other blood tests. A pituitary adenoma producing TSH (a.k.a. TSHoma) is a one in a million illness.*

It's not my doctor's fault that he didn't recognise how incredibly special I am.**

So the next obvious possibility was that my sinus tachycardia (rapid heartrate) could be due to - gasp - a heart problem! And boy, did they ever check me out. I wore 24-hour heart monitors on several occassions - once I was wearing one when I went to a formal dinner, and had an interesting half-hour beforehand trying to find a way to conceal the bloody great thing using only a lace bolero and my native wit - and I had an ultrasound scan of my heart. Ultrasound heart scans are pretty cool to look at, but I can't help thinking that they must be more fun for men, who (in most cases) don't have boobs. Boobs are not usually a problem, but they aren't half inconvenient when someone's trying to use The Power Of Sound to examine the circulatory organ located somewhere beneath one of them.

After six months I finally got to see a cardiologist. He told me that I didn't have a heart problem, that it was almost certainly hormonal and I should have further blood tests, and that I should stop taking my beta blockers.

Two out of three of those statements were correct.

I'm still not entirely sure why he ordered me to stop taking my pills immediately, when every other doctor I've seen since has emphasized the importance of coming off beta blockers slowly to prevent rebound tachycardia. And equally, I'm not sure why I didn't protest more. Regardless: I came off the beta blockers, spent a week feeling as though walking across a room was a labour worthy of Hercules, then angrily phoned the cardiology department and insisted that I was going back on the bloody medication.

But despite this slight hiccup, progress had been made. The cardiologist had ordered the right blood tests. I was referred to endocrinology...

UPDATE: You can click here to read about how I finally got a diagnosis. Or click here to go back and read about my first trip to hospital.

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*In fact, a friend of mine who's a medical student told me that one day, when a group of med students were med studenting, a patient's symptoms were described and they were asked for possible diagnoses. One girl suggested a TSHoma. The doctor's response: "Don't be ridiculous, that never happens." I asked my friend if she stepped in to mention that she knew someone with a TSHoma. She did not, apparently because the girl who suggested it as a diagnosis was a bit of a know-it-all and was overdue a put-down. Of such fine things are doctors made.

**Interpret "special" as you will...

Russell Watson, It's Not All About You

Following my last post about Russell Watson, I felt inspired to find out about some other famous people who have had pituitary adenomas, using the trusty-yet-woefully-incomplete-and-indeed-quite-inaccurate Wikipedia List of Brain Tumour Patients. And I have learned about:

Pío de Jesús Pico

last Governor of California under Mexican rule.

Governor Pico is my absolute favourite discovery. Not just because I love a guy with a sexy beard, not just because of his awesome name, but also because he is a very intriguing case of retrodiagnosis. Pío Pico lived from 1801 to 1894; acromegaly was first identified in 1886 and he was never diagnosed in his lifetime. In 2010, this paper was published suggesting that he suffered from acromegaly. Looking at pictures of him from 1847 to 1858, he progressively exhibits more of the characteristics associated with acromegaly; this picture from 1858 clearly shows a large forehead, big nose and enlarged lips, a hairless face and hairloss from the eyebrows, which could indicate secondary hypothyroidism, and misaligned eyes which could be due to the tumour pressing on cranial nerves. If you look at the article I linked above, there are more photographs which show his huge hands.

But that's not where the interesting ends. The Governor lived well into his nineties - no mean achievement for a Victorian - while the article suggests that around 80% of patients with untreated acromegaly would be expected to die in the first ten years after diagnosis. It seems instead that his pituitary adenoma spontaneously infarcted sometime after 1858; pictures of him as an old man show that his facial features and hands have become much smaller, he has a full beard and his eyebrows have grown back.*

Kevyn Aucoin

American make-up artist and photographer

Another pituitary adenoma and a really sad case. Kevyn Aucoin was a well-known make-up artist and photographer who had worked for Vogue and Revlon, wrote books and appeared on TV. He was diagnosed with acromegaly aged 39, although it's believed he suffered from the condition for some time before it was diagnosed, and the pain of it resulted in an addiction to prescription painkillers. After surgery for his pituitary tumour, his use of painkillers intensified and he died, only a few months later, from liver and kidney failure. You can read about him on his Wikipedia page and this article.

Sun Mingming

7'9" basketball player

You could probably guess from the subtitle that Sun Mingming also has acromegaly (an overrepresented condition in this sample! I guess because the symptoms are so unusual, lazy journalists don't just write "brain tumour" and move on). Pituitary adenomas which secrete growth hormone and develop before puberty result in sufferers becoming very tall; in adulthood it's all about the growth of soft tissues. Sun underwent gamma knife radiosurgery at the age of 23 and is still playing.

James Murphy

Death metal guitarist man

It's been kind of a challenge to discover much about James Murphy and his pituitary macro-adenoma, but in this article he certainly emphasises the fact that it's a benign tumour rather than cancer, and that although it can cause some serious problems and, rarely, death, the prognosis is nowhere near as bad as a cancerous brain tumour. One online forum I bumped across in my researchings was castigating celebrities who fail to make this distinction, so good on him.

From the hints about his ongoing "hormone inhibiting treatment," which on one site is said to be bromocriptine, and the fact that he's not obviously acromegalicious** I'm guessing he has a nasty prolactinoma, but that is just a guess. I'm kind of hoping so, purely because I've found it so hard to get examples of famous pituitary tumourheads who have something other than acromegaly.*** His tumour seems to have been pretty badly located, as they operated basically through his face rather than the nose or mouth, something I hadn't come across before.

***

So there you have it, a brief run down of some famous folk. There are actually quite a few more cases of acromegaly which I came across - people like Andre the Giant, for instance. But that's enough for now.

UPDATE: True to my word, I have written another post about more famous people with pituitary adenomas. I've also written about famous people with Cushing's Disease and the question of whether there are any famous women with acromegaly.
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*Sadly, the article notes that he suffered a lot of abuse and discrimination in his lifetime for his unusual appearance.

**Acromegaly sufferers: you should use this word.

***Acromegalicious folk are obviously awesome, but I'm trying to be balanced here. As for finding anyone famous with a TSHoma like me - it's difficult enough just finding published case studies.

IMFW: heART

It's not precisely an interesting fact this week; more like an interesting set of pictures. But still cool. The British Heart Foundation ran a competition, inviting scientists to submit the best images they have of their work on heart disease, and the results are surprisingly artistic.

Medical imaging has certainly come a long way from the day that Röntgen first used x-rays to create an image of his wife's hand. She was purportedly unimpressed with his efforts, believing that the picture of her own skeleton was a herald of death - although as she lived for another 25 years, it was a herald rather ahead of its time.

Russell Watson

I was originally going to make the title "Russell Watson: What You Got, Son?" but obviously, that would be stupid. So I decided not to mention it.

Ahem.

Anyway, today's post is (surprisingly) about international singing sensation and all-round famous guy Russell Watson. Ever heard of him? NOR HAD I.

But last year he popped up on an episode of Never Mind the Buzzcocks, which aired on the evening of the 2nd December. I had an important exam the next day, so obviously I was watching. Mr Watson mentioned that he had had a brain tumour. I, as yet undiagnosed,* thought nothing more of it, not least because the notorious buffoon Tim Westwood was hosting the show and I was quite busy despising him.

About a week later, I got the call from the hospital announcing that I had a pituitary adenoma. Russell Watson was far from my mind. But then one day, as I was waiting to collect a takeaway in my local Chinese, I began paging through their ancient and tattered copies of the Daily Mail** and came across a month-old article about the same Mr Watson and his second round of brain surgery for a "benign brain tumour".

So obviously I had to look it up. After a bit of searching, my suspicions were confirmed: Russell Watson's pituitary gland also enjoys cultivating adenomas in its spare time. I can't really say why knowing this made me feel better, but I guess it's just vaguely reassuring to know that there are other people out there. The poor guy had a particularly nasty case of the pituitary tumour as well, he's had two surgeries and radiotherapy, and the first surgery apparently had a knock-on effect to his pituitary function, something which so far I've been lucky enough to avoid.

 However, I would like to take this opportunity to glower at the British press for their woeful lack of precision when reporting on brain tumours. It seems that any distinction beyond that of "benign" and "cancerous" is completely beyond them. For anyone who knows their oligodendroglioma from their meningioma, and particularly for anyone trying to identify famous fellow tumourheads, it makes life rather challenging. Are the details of a diagnosis too much to ask for?

Also, while I don't mean to sound like a stalker who's read every article on the subject, I have to say that I particularly empathised with the last lines from with Russell Watson in this article: "Specialists repeatedly told him that he was only suffering from stress, to which he replied: 'The only thing that's stressing me is this pain in my head.'"

Just like all the years of me visiting various doctors complaining that my hair was falling out. And my heart was doing funny things. And I felt tired all the time.***

UPDATE: You may also be interested in further posts I've made about famous people with pituitary adenomas, which you can find here and here, and there's also this post specifically looking at famous people with Cushing's Disease and another post looking at the strange shortage of famous women with acromegaly when compared to their male counterparts.
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*Though admittedly in the realm of "we're pretty sure it's a pituitary adenoma. Because it's the only idea we have left".

** Oh god. I know. I'm so sorry. I'll never do it again.

***Any doctor treating me in future may be interested to know that if any symptom I may display is ever put down to "stress" again, I will not be held responsible for my actions. Of course, being accused of suffering from "stress" comes with the unfortunate Catch-22 that anyone repeatedly insisting that they're not bloody stressed looks exactly like a stressed-out mentalist. Le sigh.

Another gem from Terence

Following my earlier post today, I've stalked Terence Hale, who is certainly rather an opinionated chap, around the Guardian website. Interestingly, he signs his earlier comments as Dr Terence Hale but then becomes plain Terence Hale later. This is relevent in no way to pituitary adenomas, but I had to share it anyway.

I was intrigued to gain a small insight into the marriage of this mysterious character...

"Miss or Mrs Winfrey (if Mrs., poor man) makes her money by televised sermons to extravagant, don't wash-up or take the dog for a walk stuck to the television all day women like my wife."

And yet:

"In Switzerland most supermarkets have restaurants which usually means the wife go's shopping and the husband in the restaurant.
Regards Dr. Terence Hale"

Terry's Top Tips for Valentine's Day:

"1) Open the oven door
2) Block both ears
3) Play Jimmy Hendrix
4) Walk on water
5) Have a nervous break down
6) Find a duck pond that smells
7) Cut your self

Don't phone me, I'll phone you.
Regards Dr. Terence Hale"

His thoughts on the Royal Wedding:

"Just helpful advice for the Royal marriage. Usually people who get married are in love. This is where the problems starts. Love in like a piece of cheese, the first day nice and soft, the second day a little harder and the third day it smells terrible.
Regards Dr. Terence Hale"

And finally:

"Many people, including myself have reservations in disclosing close encounter with aliens because of being ridiculed.
It takes much courage to confide such an encounter.
Regards Dr. Terence Hale"

IMFW: Pituitary Newsflash

I have to make a confession. I've been writing my Interesting Medical Fact of the Week posts in advance and lining them up to post automatically every week. Which is fine, until I read something new and exciting and physically cannot wait to post it, for fear of literally exploding with excitement.

And no-one wants to have to clean that up.

So as I was browsing for news of new medical marvels, I came across this article. For those of you incapable of clicking the link, I'll break it down for you: scientists in Japan have taken stem cells from mice embryos and successfully grown working pituitary tissue, which, when transplanted into mice with pituitary defects, began to produce some of the hormones that these mice were lacking.

EXCITING. Obviously a long long way from any kind of human treatment, but I'm sure there are plenty of folk out there who jumped for joy in the middle of their growth hormone injections at the vaguest prospect of such a thing.

Also an entertaining read is the comments section at the bottom of the article. One user rails against any money being spent on researching pituitary problems when more people die from malaria and AIDS and advises a Benthamite strategy for prioritising areas of medical research.* I also particularly like a comment by "Terence Hale" which states that:

"There are many endocrine glands in the body with the main ones being the pituitary gland, thyroid, thymus, adrenal glands, and the pancreas, but one often forget the Hypothalamus which links the nervous system to the endocrine system via the pituitary gland is “the captain of the ship”, a clock work. Putting things in between such as hormones or gland implants is “rocking the boat”. Hormone therapy has help many but has it's costs. The implant in such a clock work could present problems."

I think we all feel enlightened after that. I'm assuming that Terence's trouble expressing himself is down to Google Translate,** because a little bit of further research throws up another comment of his, giving a recipe suggestion in which he suggests taking a worm chicken embryo and placing it in an Irish Gnome Bowl before chopping it up with a Saudi Arabian execution sward.***

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*Of course, we could save even more money by just killing all the sick people. And thus prevent the spread of communicable diseases, too. Why has no-one thought of this before?

**When will those bastards get it right?

***Full recipe, because it is quite funny: "20 g of freshly cut wheat corns are socked in dulcolax juice and given to nearby chicken who has less than 5,000 fly hours. This produces a shelled embryo. The embryo is then take while worm and placed in saucepan. After exactly 3 min. the shelled embryo is taken from the saucepan with a teaspoon, coffee spoons are not suitable and placed in an Irish Gnome bowl. The embryo is prepared for eating by using a horizontal guillotine placed of the right side of the embryo and moved to the left side with the embryo in the middle. A Saudi Arabian execution sward may also be used."

My Head Revisited: First Trip to Hospital

I have set this post to appear online at precisely 11.11am on the 11/11/11. If I could define it down to the second, believe me I would. Because I am lame that way. Anyhow. On to the story...

***

In January 2010, a chain of events was set in motion which led to the first of my many trips to hospital and, incidentally, the first time I tried sushi. Of the two experiences, I preferred the latter. From what I've seen, hospital visits rarely come with a side of pickled ginger.

And I love pickled ginger.

Sadly I can no longer remember the date in question, but I think it was around the 18th January; I was back at university and, being a studious and dilligent character, I had spent the entire day sitting in my room reading books about Old English poetry. Consequently, I couldn't quite work out why, ever since I'd woken up, my heart had been beating as fast as though I'd just run for the bus.

At about four o'clock, I used the excellent online stopwatch to work out that my heartrate was around 140 beats per minute. So I decided to do what any sane individual would do when their local doctor's practice is a two-minute walk away. I called NHS Direct.

NHS Direct sent me to the doctors. Feeling like a bit of an idiot, I ambled into the reception, was immediately rushed in to see the nurse (ever wanted to skip the queue? Just develop heart problems!)* and found myself wired up to an EKG, which looked rather like some kind of creepy mechanical chest octopus. I sat there for a few minutes and the nurse agreed that yes, my heart was rather speedy. Then I was sent to a doctor, who took a look at the creepy mechanical chest octopus printout and agreed that yes, my heart was indeed rather speedy.

So the doctor sent me to the hospital. My very nice college booked and paid for the taxi to take me to A&E and I grabbed my very nice friend Cherry to accompany me.

"Heart problems" is one of those magical phrases that gets you rushed through A&E much faster than, say, a mere broken bone or accidental breadknife incident - although of course it does mean that, as an entirely healthy-looking young person, you're liable to get a few evils from the folk who've been waiting there, oozing gently, for an hour.

Once I went through to see a doctor, the fun really started. Immediate assumptions were that either:

1) I must be having a panic attack.
or
2) I must have taken some kind of exciting illicit substance.

I think that option 1 was rapidly discounted due to the carefree nonchalance with which I munched my way through a packet of McCoys** and giggled as the doctor on duty made me blow through a small tube and massage my neck in an attempt to get my heartrate down. Of course, no matter how many times I insisted that option 2 was not an option, they refused to believe me.

Eventually they admitted defeat and sent me deeper into the hospital, where I got a whole bed to myself. Yay! I had a smorgasbord of blood tests and was wired up to another heartrate monitor which, annoyingly, was set to beep frantically any time my heartrate went over 140bpm. As it spent the whole time hovering around the 140 mark, this quickly got extremely irritating.

Cherry kindly volunteered to read aloud my book of translated Old English poetry to me, which resulted in her learning quite a lot of new and exciting vocabulary, like "seraphim", "fetters", and "vassal". Quite inexplicably, she lost interest only partway through a poem.

I sat in the hospital, waiting for my blood test results to come back, until about 11 o'clock at night. The doctors weren't sure whether I'd have to stay overnight, and so Cherry, as well as looking after me very well, (although I can never forgive her lack of interest in Anglo-Saxon literature) also had the fun job of phoning my parents and boyfriend, to let them know what was going on.

Finally, late at night, having had no dinner, it was announced that all my blood tests had come back fine, they had no idea what the hell was wrong with me, and that I should go home. If my heartrate was still fast in the morning, I was told to go back to the doctors.

It was good to be able to phone my parents and reassure them that I was not on death's door, but attempting to go to sleep with a heartrate of 140 is virtually impossible, and I was not reassured when, the next day, the doctor incredulously asked me "they let you go home from hospital with a heartrate of 140 and no medication?", with a look of horror on his face.

But more of that at a later date...

UPDATE: Click here to read my next post about getting a diagnosis. Or click here to go back and read more about my initial symptoms.
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*N.B. This doesn't work as well in the supermarket.

**Incidentally, I hadn't noticed until recently that McCoys advertise themselves as "man crisps". WTF. Seriously, are their marketing team like five years old? Wikipedia, my one true love, tells me that McCoys are, and I quote, 'promoted by United Biscuits*** "as the only overtly male-targeted crisp brand"'.  Don't believe anyone would say something that stupid, let alone base an ad campaign around it? Here's the website.

***Words fail me.

Health, Wealth & Happiness

In the ladies bathroom* at my place of work, a minor change was recently wrought when the former hand-drier/paper towel dispenser combo were replaced by a single hi-tech hand drier, of the new variety which seem designed not merely to blow water off your hands, but to have a crack at taking the skin off as well.

It's highly efficient, no doubt, and proudly states that by using it, you are helping to reduce landfill and thereby save the world. But today, after walking to work in a downpour, I found myself reflecting on the fact that its highly-specialised hand-drying design has come at the cost of other convenient functions of the hand-driers of old: namely, drying off wet clothes and hair and warming you up a bit. Of course, you can still use the Air Force Sandstorm Erosion™ to dry your hair. Providing you don't mind being scalped in the process.

But anyway, it got me thinking about its designers, who were no doubt given a clear spec: make the best hand-dryer possible. And they did. And everyone was delighted. It probably wasn't until monsoon season rolled its way around to Dryer Towers** that someone thought: 'Hang on a minute - the old hand drier was far less exciting and high tech, but at least it could deal with waterlogged socks.'

And, in a really obscure and slightly convoluted fashion,*** health is kind of like that, in that you don't notice what you've got til it's gone - but even then, sometimes it can take a surprisingly long time to catch your attention. I went from someone who never, ever had a headache to someone who got them regularly, but the change was so insidious over several years that it never even occurred to me that maybe I should mention this to a doctor - even after my heart had made it blindingly obvious to all and sundry that there was Something Clearly Wrong. Yes, I am just smart that way.

 Now, I find myself (thank everything) on the flip side of that because I am (thank everything again) currently slowly getting better. Yes, I'm still not quite right, my hair's still falling out and my heart gave a very brief but exciting display of acrobatics as I ate my pasta last night,**** but I am so much better than I was. And I'm still in that happy honeymoon zone of improved health, where every now and again I have to take a moment to appreciate the fact that I can run for a bus without hyperventilating, that I can dance for an hour without needing a sit-down, and that my bruising has improved to the point where most days I can wear a skirt with no tights and not look like a victim of domestic violence.

 Obviously the hope that I'm hoping ever so fervently is that I'm fixed and will continue to be fixed and, bar the odd MRI and pituitary-adenoma-related chat (for old times sake) I will darken my local hospital's doorstep much less frequently. I don't know if that will happen. But, although no doubt we'll all get used to the new hand dryer in time, I hope that - for as long as this improvement lasts - I don't lose my appreciation for feeling healthy :D

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* I say bathroom. I mean toilets. There is no bath in there. Because that would be weird.

**Just to clarify, I am making this up.

***Or, if you live in my head, a really obvious and straightforward one.

****Because the pasta was just that good. Incidentally, another side effect of this illness has been that I've completely lost all ability to appreciate lines in songs like "my heart skips a beat". I just hear them and think: Quick! To the cardiologist!

IMFW: Tom Thumb or Toe Thumb?

The Interesting Medical Fact of this Week is that a man who had his thumb sliced off has had his big toe sewn on to replace it. You might think that this would look roaringly obvious, but interestingly enough there is in fact a medical condition called clubbed thumb, which results in a thumb that looks a bit like a toe. And is consequently commonly known as toe thumb.* Don't believe me? It's on Wikipedia, so it must be true.

Rather hearteningly, Megan Fox keeps the hand models of this world out of penury by suffering from toe thumb herself.

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*Also as murderers thumb, but let's not cast nasturtiums.

IMFW: Hedgehogs

Given the runaway success of my previous post about British spies wanting to sneak hormones into Hitler's food,* I have decided to attempt a regular weekly post about interesting medical or medicine-related facts. I have, you'll be pleased to know, imaginatively decided to call this series the Interesting Medical Fact of the Week, or IMFW for short.

Anyone who knows me well can tell you that I love hedgehogs greatly, and if I actually owned a house and could look after it properly, I would have one of my very own. It occurs to me that responsible pet ownership is probably one of the dread Seven Signs of Adulthood; when I was little, I would have happily housed a pony in the bathroom - if only my parents had bought me one. Damn them.

Anyway, as it turns out, I'm not just rambling incoherently about hedgehogs for no reason! Because the topic of this week's IMFW is the sonic hedgehog gene, a.k.a. SHH. If you ever want to send it mail, you can find it at chromosome 7, where it snuffles around in bars and punches anyone who calls it a rat.

I first heard of the sonic hedgehog gene in my first year at university, from friends who were studying medicine, and (not unreasonably) I initially believed that they were pulling my leg about its name. As it turns out, I should have had more faith in the doctors of the future. Its name originates from the fact that, when researchers created fruit fly embryos which lacked this and other similar genes, the embryos grew spiny protuberances. Apparently, researchers are always doing this kind of thing to fruit flies. Not out of scientific interest, you understand - they're just sick in the head.**

The sonic hedgehog gene (and its woodland genetics counterparts, the indian hedgehog gene and desert hedgehog gene) are cunning beasts, no doubt, but if you want a detailed description of what they do then you can head to wikipedia. Or simply grab a first year medical student and shake them repeatedly. Essentially, SHH is important in the development of embryos, as it codes for a protein which helps to signal the layout of bodyparts.

What I find particularly interesting is the debate around its name; a couple of years ago I listened to an interesting program on Radio 4*** which looked at the naming conventions in genetics, and lighted on the sonic hedgehog gene as a particularly good example of the fact that a name bestowed on a gene in the lab might seem hilarious in the light of certain spiny protuberances, but will sound rather less funny to the parents being told that their child has a serious disability because of a mutation in his or her sonic hedgehog gene.

A hedgehog, though not an obviously sonic one.

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*Yes, you heard me - a whopping seven or so people read it. Crikey.

**Like me! :D

***Old before my time? Moi?

Awkward Turtle

I may or may not have mentioned (who knows?) my crack team of endocrinologists* who seem to be as numerous as the autumn leaves.** On the one hand, I enjoy meeting new people; on the other, I have an incredibly poor memory for names and consequently can only remember the names of two-and-a-half of the endocrinologists who've actually treated me.***

For the first four months or so of my treatment I consistently saw the same doctor when I went to the hospital; then, for reasons never specified he disappeared. Since then, I've seen different doctors every couple of months. I can only presume that I'm committing some kind of hideous endocrinological faux pas without realising it.

Anyway, the other weekend I was at the local train station, and joined an epically long queue to buy a ticket. As I was standing there, I suddenly became aware that in the queue in front of me was.... my original endocrinologist, Dr ---!

I had to make a choice: say hi or stand by? And obviously I went for the stand by option - because when you're a doctor, I imagine it's very annoying to have former patients come up to you in a public railway station screaming "WHY DID YOU LEAVE ME? WAS MY HEAD TUMOUR NOT INTERESTING ENOUGH FOR YOU?" and wailing and gnashing their teeth. Also, he looked somewhat stressed and was doing that peculiar leg-hopping thing that means somebody's either running late or desperate for the loo.

Unfortunately, when I said that this was an epically long queue, I was exaggerating only inasmuch as the fact that, although it was extremely long, no-one had actually written a poem about it. To my knowledge. After a few minutes of trotting through a winding s-shaped queue, I think Dr --- may have recognised me, but by then the English Acknowledgement Horizon had passed and, having not acknowledged one another before then, it was officially too late to do so. Because I am English (well, English-ish). And those are the rules we live by.

So it was a somewhat awkward queueing experience.
If only I had defused it by means of the awkward turtle.

Inicdentally, I feel like what I had intended to be a short, short post about a very brief and really-not-that-exciting occurrence has turned into an alarmingly long and overinvolved essay. I promise, next time I will attempt to write about something more interesting.

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*N.B. that here that I use the term "crack team" in the sense of "expert professionals", not in the sense of "drug dealers".

**Or maybe it's just one guy with five masks. And a pair of fake boobs.

*** If you're interested, the half is for one guy whose nickname I remember, but not his actual name, which had about eight times as many syllables.

The One Where They "Feminised" Hitler

For anyone who's ever doubted the power of hormones: it turns out British spies wanted to sneak oestrogen into Hitler's food to make him "less aggressive".

Performance-Enhancing Drugs

I'm proud to announce that, as of last Friday, I am no longer on steroids. Not because I don't care about maintaining a terrifyingly muscular physique a la Jodie Marsh*, but because my endocrinologist has, after stealing a lot of my blood, confirmed that six months after my surgery, my pituitary gland is successfully producing adrenocorticotrophic hormone (ACTH) on demand. Or, in layman's terms: The Surgeon Did Not Fuck Up.

This is good news, because ACTH is needed for the body to produce cortisol, which is needed for the body to not collapse, flail around, and then die. Consequently, it's generally thought that the safest thing to do is to give replacement cortisol treatment to everyone who's had pituitary surgery until you can be 100% sure they don't need it any more. As well as coming off the steroids, my monthly prescription bill will be further reduced over the next week or so as I wean myself off the beta blockers I currently take (to slow down my overenthusiastic heart).

Obviously I was delighted to hear that I would once again be eligible to compete in high-level international sporting events and resolved to do so at the earliest opportunity.** However, just days after I resolved to dig out my skipping rope and get cracking with some sort of training montage, I was surprised to find out that as long as I'm still on beta-blockers I'm excluded from taking part in some sporting events.

Having always associated beta-blockers with elderly folk post-heart-attack, I was surprised to find out that their effects, i.e. slowing heartrate and reducing tremor, are highly desired in, and consequently banned from, Olympic sports including gymnastics, shooting, wrestling, ski jumping (?) and curling.***

So I'll have to wait a few more days before starting my career as a wrestler. Damn.


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*Against whose high standards I judge all my life decisions.

**Just as soon as the Global Egg and Spoon Race Championships get going
again.

***The fat kid of international sporting endeavour.

Like a pig in a china shop?

Back in the mists of a misspent youth (or rather, a misspent gap year) I used to work for a large yet mysteriously anonymous organisation in the south-east corner of our great nation. In my former workplace, we had several different ways to pass the time. Some of these hobbies were fun; some less so.* One of the least mentally-scarring pastimes involved coming up with pointlessly lengthy expressions of surprise and/or anger (for example, a phrase popularly directed at the photocopier was "jesus christ on a bike in the snow"). It's a habit that I've continued to indulge occassionally; when the printer just won't print, it's very soothing to call it an ingrate macaroon-munching shitwizard.

Anyway: today, in a very exciting move, I went to a dance class and entirely failed to drop dead in the middle of it. This may seem a paltry achievement to those of you blessed with the kind of ruddy good health featured in your nearest BUPA advert, but I was rather proud! And even more so when I stepped outside afterwards to check my heartrate** and found it running a cool 80-odd beats per minute. NICE. So much for my sinus tachycardia!

The downside was that the hall where the dancing takes place is possibly the World's Hottest Room. The windows had steamed up before I'd even arrived (and incidentally, the hall's managers - obviously keen to keep the title - have also had the windows chained shut). Consequently, I had only two-thirds of my brain free to focus on attempting not to a) fall over, or b) kick my dance partner, because the other third was busy having an existential crisis over whether or not I was actually melting. It was at this point that my mind went back to those happy days in Anonymous Office Space #1,*** and I tried to come up with as many creative permutations of the phrase "sweating like a pig" as possible.

 But I felt pretty proud/unpleasantly smug because I know that earlier this year I would never have been able to keep going through the whole class, especially in such a tropical climate. It just goes to show that things can change so quickly in a pretty short space of time, without you every noticing the baby steps along the way.


Short version of this post: Dance was fun and I feel THIS GOOD.
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*Like the time I was forced to listen as the terrifying woman opposite me explained that there was no point in buying whips from Ann Summers when - and I quote - "a tea-towel will do".

**Also, to leave.

***Which, ironically, was extremely cold after our department overspent on electricity and all the heaters were removed by grim-faced folk from Finance.

Embarassing Bo- OH DEAR GOD

This post is dedicated to my loving Auntie C, who sent me a text a couple of weeks ago which read: "Are you watching Embarassing Bodies on Channel 4? There's a young man with suspected pituitary tumour. x"*

Foolishly, naively, unthinkingly - always keen to see fellow tumourheads on TV - I trotted off to watch it. For those of you who've not been treated to this televisual extravaganza, rest asssured that it does exactly what it says on the tin: people with revolting medical conditions are lined up for your viewing pleasure. It's basically just a high-definition version of an old-fashioned freak show, but slightly more patronising.

Possibly I should have realised that this was not the programme for me when the mere sight of a man's nose on the credit sequence made me queasy. Yet I soldiered on. (Well, I hid the 4oD player in a different tab so I didn't have to watch it. But I listened to some pretty hideous commentary.)
Until they finally brought on Amir, a wide-eyed twenty-six-year-old with man-boobs and a secret.

Hint: the secret is that he milks himself every day.

You heard me.

HE MILKS HIMSELF.

EVERY DAY.

And has done so for the last three years. But why does he milk himself?

Because if he doesn't, his moobs hurt. Duh!

Amir meets Dr Christian and explains his problem, and as the world's stupidest game of Twenty Questions unfolds, we learn that even Amir's wife doesn't know about his milk mongering, although surely she can't have failed to notice the fairly impressive pair of puppies he's sporting. (It's not made clear whether or not they have children together - but if they do, I would imagine that Mrs Amir would be none too impressed to hear that, despite possessing an unusual advantage in the lactating stakes, her husband had failed to do his share of the breastfeeding).

Poor old Amir is shipped off to get his pituitary checked out and (of course!) he's got a pituitary adenoma which is secreting the hormone prolactin, aka a prolactinoma. And by the end of the programme he's on bromocriptine or something similar and all is well.

But the point is that this guy apparently preferred to sit and squeeze the milk from his man breasts every night for three years rather than just... go to the doctors. He could have caught it much earlier when it was smaller and easier to treat, but no.** Possibly he had seen, and been terrified into submission by, this advert from the Milk Marketing Forum, or perhaps the Breast Is Best campaign just really hit home for him. We may never know. But I think the moral of the story is that - whether you're a man who develops boobs and starts lactating, or a man who develops photographs and has an exciting facial deformity - just go to the freaking doctors. Seriously.

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* At this juncture I should point out that the 'x' stands for a kiss. It's not that Pituitary Tumour X is a particularly cool kind of tumour.

**Indeed, he could have caught it much earlier and not made a spectacle of himself on national tv. But we'll forgive him that because - at the very least - he may slightly have raised the profile of pituitary adenomas.