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Are you misunderstood? Have you been told, it is all in your head? You are fat, get over it. You are depressed; anti depression, medications will help you. Do people look at you differently? These misconceptions are associated with Cushing’s Disease. Living with Cushing’s Disease affects your self- esteem, and injects self-doubt into your daily life routine.
Cushing’s Disease, a seldom seen affliction, is commonly missed by many doctors. The reasons why Cushing’s Disease is misdiagnosed are many. Cushing’s symptoms are commonly seen as individual symptoms, and the individual symptoms are being treated. These symptoms can give mixed messages to doctors, and distort the data. Which in turn, will cause a misdiagnosis, and the patient will only be treated for the secondary symptoms, but the root of the problem still exists, and it is going along with out being treated. You can draw this alliteration, your primary care doctor is treating the branches of the tree, but the entire tree is blighted, and is in need of treatment to cure the disease.
For many years, I followed the doctor’s treatment, but to no avail, the prescribed treatment was only a short-term fix. Many times, the treatments did not work. That left me with many unanswered questions. Where would I go to get the answers? I had no idea where to find the answers.
Furthermore, my personal experiences led me to believe, what I was suffering from was a classic case of depression. Obviously, I followed that course of treatment. If I find a way to get rid of the depression, I will get better. Was it that way? No, it was not that way. I was bounced from my primary care doctor, to a specialist, whom dealt with depression and brain chemistry. She was able to diagnose depression, and prescribe antidepressant drugs. Did the other symptoms go away? The other symptoms continued even though I was on anti-depressant medication. Counseling did not help either. This was a forum, where I could let my feelings out. I could address the issues that were bothering me. Yet, this did not seem to work either. I kept asking myself, what is wrong? I could not see an answer. I let time pass, thinking that time heals all wounds. Quite possible, time could heal this wound. Time did not heal this would, and it continued to grow. As time passed, I grew more and more despondent. Depression ruled my life. On top of that, my doctors told me it was all in my head. What was I to do?
Rock bottom was closely approaching, and there was no way I could avoid it. More questions came into my head. I kept asking myself, do I need to do something? I finally took a “leap of faith,” and enrolled in a clinical trial for anti-depression medication. Now, I have something to work with. Have I found the cure for what is causing me to think this way? I thought I did. Was I wrong?
During the enrollment phase of the clinical trial, I was required to have a physical. That went fine. However, the doctor performing the physical examination, recognized many of the physical conditions I had on my body resembled conditions and symptoms associated with Cushing’s Disease. She asked me if I had Cushing’s Disease. I couldn’t answer her, because I did not know what Cushing’s Disease was. I listened to her advice, and followed up with my primary care doctor. My doctor and the nurse practitioner performed all types of blood tests to exclude Cushing’s Disease. They were not able to either exclude, or include Cushing’s Disease. My primary care doctor felt my Cortisol levels were OK. The levels came back at 23. They are supposed to be less than five. Something is wrong with this picture. He felt the Cortisol levels were nothing to be overly concerned about. I felt the Cortisol levels were something to be concerned about. I went for the second opinion.
I thought, now, I have the ball rolling. Fortunately, for me, I was able to find a superior endocrinologist in Albany, NY. I cannot say enough. He walked me through many blood tests, and additional labs to either include or exclude Cushing’s Disease. It was a very long road that I traveled, but the proper diagnosis was made. It was only a matter of time before the proper treatment Cushing’s Disease could be executed.
Having the proper diagnosis of naturally occurring Cushing’s Disease, I now needed to have consultations with the specialists, who would perform the neurosurgery, and after treatment care. For me that would be several visits to the Neuroendocrine Clinic at Massachusetts General Hospital who sees many more cases like mine on a weekly basis. I was ready for the final stage of this journey.
What could go wrong now? I had one transsphenoidal surgery, but my Cortisol levels continued to be elevated. Further evaluation by neuroendocrine medicine and neurosurgery strongly suggested several additional treatment solutions. The procedure for the additional round of treatment was the call of the neurosurgeon. It was his discretion to determine if a second surgery was the safest and most practical solution. However, if the neurosurgeon felt that surgery was not the proper mitigating procedure, neuroendocrine medicine determined Ketoconazole, a Cortisol reducing medication and Proton radiation, or a Bilateral Adrenalectomy were the only other alternatives. There were downsides to all the options.
I decided to have a second transspheniodal adenomectomy. The probability of being cured of Cushing’s, at this point was 50%. I could live with those odds. Medical research has shown that there can be damage to the pituitary gland, if additional surgery is performed (Swearingen, 2008). My pituitary gland was not functioning properly, anyway. I wanted the additional surgery, even though the odds were only at a 50% success rate. My case is the exception, not the norm.
I had the second transphenoidal adonamaectomy performed by Dr. Brooke Swearingen on Febrbray, 28, 2008. Surgery went fine. I felt like I was ready to get up in the recovery room and dance the jig, or something of that manner. Everything appeared to roll along without complications. Was I wrong! The night of the surgery, I suffered some complications, diabetes insipidus and a post -operative fever. Diabetes insipidus was the more serious of the two complications. However, my doctors and nurses treated me through the night, and stopped the effects of diabetes insipidus. The 50% odds were looking good. I might have beaten those odds. Was I wrong? My Cortisol levels came back during the following week. Those levels were not even close to the range that they needed to be. I was set back again. Plans one (1) and two (2) appeared to not accomplish what was meant to be.
I was invited to participate in a clinical trial for a new medication used in the treatment of reducing Cortisol levels in Cushing’s patients. Once under control, do I have the option of proton radiation? However, not everyone who suffers from Cushing’s has the opportunity that I had. I now felt a bit more relieved, because a glimmer of light was starting to glow at the end of the dismal tunnel. By participating in this study, I took the proactive approach to control Cushing’s Disease. Some times the monster of self-doubt inserts itself into the equation making you feel like you have made the wrong choice. Is there a right or wrong answer or right or wrong choice? It is entirely up to you. After all, you control your destiny.
After four months on the drug, things were great. Unfortunately, the drug seemed to cause temporary damage to my liver. That was not the result that my medical team or I were looking for. It looked like I was back to square one? I hoped not. This journey has been one trip full of vicissitudes. There hasn’t been any happy medium. When everything appears normal, the wind in my sails suddenly changes direction, or even stops entirely. At this volatile stage of my treatment, despair seemed to edge out other feelings. Others can live a normal life, but I cannot. Is that fair? In general, life is not fair. You, as an individual, must make the most from the situation that is before you. In my case, I have been working my best to achieve that place called normalcy. Only time will tell if this goal can be reached.
I did have one last plan to follow. Even though, it was not the preferred choice, it will cure me of Cushing’s Disease. Because I have an anatomically cramped sinus area, traditional medical treatment has not worked the best for the treatment of my Cushing’s Disease. I choose to rely on the efforts of the radiation oncologist and his pedagogy concerning Proton Radiation therapy. Again, I had some of the same questions. What are the chances that you will be able to find the adenoma?
I had the Proton Radiation Therapy. It is time for me to allow Physics to play a major role in my recovery. I will let you know in six (6) months to one (1) year the outcome of Proton Radiation Therapy. Time has been my enemy; yet I will wait patiently for the next outcome. After reviewing my time budget, it was one (1) year to the day from my initial diagnosis to the execution of Proton Radiation Therapy. It is now time to construct the pages of the new chapter in this saga, known as Cushing’s Disease. These new pages will be revolving around medical treatment through the drug Ketaconozole, while waiting for the effects of Proton Radiation. The duration of the treatment will be much longer, at least several years before any concrete data can be retrieved for the determination of the eradication of this horrible disease. Three months post Proton Radiation I am finally hearing those words, your Cortisol levels are within normal range. I feel like doing the happy dance. I hope and pray that normal levels will continue. It’s about time that something has gone as it was supposed to happen with this particular treatment of naturally occurring Cushing’s Disease.
I sometimes feel alone in this situation. However, I know that I am not alone. I have one of the best support systems in place, my family and friends. Because Cushing’s is rare, there are not many local support groups, and you have to make due with what you have. Do many doctors in your community see cases of Cushing’s Disease? I believe the patient percentage is extremely small; about 15 out of 1,000,000 people are diagnosed with Cushing’s Disease. I just happen to be one of the 15 people out of the 1,000, 000. I am not alone, but I am part of a small minority In my case, my family helps me through these rough and turmoil-ridden times. I also have to compliment all of my doctors, who have been supportive through the treatment of my disease. The medical staff of the Neuroendocrine Clinic at Massachusetts General Hospital, and others associated, have been stellar in trying to educate me on the complexity of Cushing’s Disease.
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