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.

HOLY SHIT: it's NATIONAL PITUITARY AWARENESS MONTH!

As you ALMOST CERTAINLY already know, October is National Pituitary Awareness Month, that special time of year when pituitary tumourheads (and all our brethren in glandular ineptitude) come together to make sure that the rest of the world is giving us enough sympathy.

If I were a teenager and this was Facebook, I'd probably put at least six exclamation marks after that sentence. But I'm not and it's not, so you'll just have to imagine how excited I am. When I saw the announcement on the Pituitary Foundation's website, I pretty much looked like this cat.*

However, I quickly realised there was a problem.

You see, October isn't just National Pituitary Awareness month.

According to The Internet, it's also Lupus Awareness Month, National Cyber Security Month, Breast Cancer Awareness Month, LGBT History Month, National Dental Hygiene Month, Tuberous Sclerosis Complex Awareness Month, Fire Prevention Month, Black History Month and National Masturbation Month.** I mean, damn. How can the cruel and unusual defects of a little gland in your head compete?

So I decided that, in honour of National Pituitary Awareness Month, I would stand up and Do My Bit. And my bit consists of explaining exactly why you should ignore all the other months clamouring for your awareness.

Lupus Awareness Month.
Anyone who's ever watched House knows the answer to this one. It's never lupus.

National Cyber Security Month.
Frankly, I'm not sure it takes a whole month to work out that the Nigerian prince doesn't actually want to give you a million dollars. Next.

Breast Cancer Awareness Month.
Now, I'm not one to downplay the seriousness of breast cancer. But while there are bundles of breast cancer and general cancer charities in the UK, and they fundraise all year round, there's only one UK charity which covers the entire range of exciting things that can go wrong with your pituitary.

Nevertheless, while you're reading this, I guess you could give your boobs a quick jiggle.
Just to check they're ok.***

National Dental Hygiene Month.
Dental hygiene is normally a cause I can really get behind. But National Dental Hygiene month is sponsored by Wrigleys, and the website seems to put a lot more effort into persuading you to chew gum than to, you know, brush your teeth and not drink Ribena all the live-long day. Cynical marketing gimmicks do not a national month make.

Unless anyone wants to sponsor Pituitary Awareness Month, of course.
That would be different.

Fire Prevention Month.
Because the rest of the year, that smoking chip pan can take care of itself.

LGBT and Black History Months.
I am too big a fan of history to support restricting LGBT and black history to one month in a year. Straight white guys get 11 months a year (white girls get a look-in in March, for some reason) virtually to themselves? No, thank you.

Now, go and read about Bayard Rustin, Alice Dunbar-Nelson and Josephine Baker. But please make sure you look them up again in November.

Tuberous Sclerosis Complex Awareness Month.
Aw, shucks. I knew there was going to be something to weaken my resolve. I'd never heard of tuberous sclerosis complex. I was all geared up and prepared to laugh at the fact that no sane person who'd come into contact with Transport for London recently would touch anything tuberous with a bargepole.

But no. I have crumbled, like a poorly made biscuit wrenched prematurely from baking paper. Tuberous sclerosis complex sufferers have a crappy and obscure disease, and they probably do need a month and a bit of sympathy.

I guess maybe we could share October, after all.


So now, go forth and multiply, in full awareness of pituitary adenomas and tuberous sclerosis complex!  Awareness: Because some day it might come up in a pub quiz.
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*Ok, no more cat pictures today. I promise.

** Just kidding. That's in May.

*** If you are a man, I suggest you find a volunteer. Or grow a nice pair of moobs. HINT: a pituitary adenoma producing prolactin will help.

Hot Off The Press

I have struggled to write an introductory sentence to this post, and having tried and subsequently deleted four separate attempts, I've decided to do what I should have done in my German A Level exam and Just Get On With It.*

The Bad News

Just over a month ago I had a phone call from one of the many endocrinologists who like to talk about me behind my back (they call it having "Multi-Disciplinary Team Meetings", but I know the truth). Unfortunately, despite my surgery in April, my recent MRI has shown there's still a lot of tumour left. The tumour originally had an "area of cystic degeneration" (i.e. it was liquid inside like some kind of hideous chocolate fondant pudding) and although they managed to get rid of that, pretty much everything else (ie. the actual main bit of the adenoma) is still there. Which is obviously really rubbish. I'm not exactly surprised; although some of my symptoms have improved a bit since the operation, I am nowhere near better yet. But it's still disappointing, especially as the surgeons were optimistic that it had been a success. When you've had your skull drilled into, you expect results!

The Good News

The rather more surprising news came when I was at college a couple of weeks ago. I was sitting in a three-hour-long lecture given by a woman whose incredibly shouty teaching style implies that she may have been a sergeant major in a previous life. My phone went off; I dashed out, in the happy knowledge that midday phone calls are almost always from the hospital. It was indeed my charming endocrinologist, to inform me that the blood tests I had done a few days previously had come back completely normal. My thyroid hormone levels were all fine.

Obviously this was something of a (very welcome) shock, seeing as I've still got a lot of symptoms - my heartrate is improved but still high, I still shake and my hair is still falling out pretty badly. Apparently it can take a really long time for symptoms to clear up, even after your hormone levels are normal. Darnit!

From what my endocrinologist said, this is definitely A Good Thing. Apparently sometimes this kind of pituitary adenoma does seem to switch off-and-on in their production of hormones, so it's possible that my levels of thyroid hormone will go back up. On the other hand, it's not impossible that the tumour is finally paying attention to the Cease And Desist notices which the rest of of my body has been sending it for years. Even if it does start producing hormones again, at least my body will have had a bit of a break.

I have been trying not to get too excited about this and resign myself to the fact that, chances are, it will start up making hormones again. But it is kind of a challenge not to prance around a little bit. I was due to have a range of exciting metabolic tests plus a PET scan; those have all been cancelled. Instead of spending several hours in a tube being irradiated, I will be having blood tests every few weeks to monitor my hormone levels. The downside of this: it means that I shall spend several nervous days fretting about what the results will be.

Blood tests are on tuesday, not sure when the results will get back but I'll update this as soon as I know!

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* For those of you interested in my youthful academic failures (and let's face it, who wouldn't be?) I managed to get a D in one German A Level paper about the Nazis because I spent the first forty-five minutes of the exam endlessly trying to write the first sentence and then crossing it out in disgust. The only German phrase that kept popping into my head was "Hitler beging Selbstmord",** but as the question was about the siege of Stalingrad, this was not helpful.

**"Hitler committed suicide"