Hypopituitarism – A Loss of Identity

As I write this I am sure there may be some other patients that will disagree with me.  One of my challenges throughout this illness has been figuring out who I am now.  I read a description of a person with a chronic illness as forever walking down a dividing line between the past and the future. Looking backward, he can see everything the illness has taken from him or has forced him to relinquish. Looking forward, he can’t see anything quite clearly. There’s no going back to the past, and the future is uncertain.

My story is my own and I accept that some of the things that define me now are not the same as others following their own path.  For me, my life changed a lot during this illness. Being misdiagnosed for many years, as many others have been, we either dealt with the symptoms, or we sought out medical advice to find the answers.  With a non functioning pituitary tumor that took years to grow, the changes in me happened so gradually that for most of my friends and family, they didn’t notice.  It wasn’t until the last couple years that people could say they actually saw the changes in me.  Changes that I didn’t notice myself.

Loss of aggression was one of the first major clues.  Which sounds OK but in the construction business world you need aggression to deal with consultants and contractors on a daily basis.  Loss of sex drive.  This happened really over a couple years on a slow decline until i felt I was no longer functioning as a man or husband.  It was the most difficult thing to admit  and what finally got me to see my doctor.  It was then that I was told at the age of 44 my testosterone was nil.  The good thing was my doctor did not just prescribe me testosterone and leave it at that.  He said to me, yes your testosterone is nil but we need to know why.  Thankfully he sent me to an endocrinologist that completed the testing and found the golf ball tumor on my pituitary gland.  Anyways you can read about all that in some of my previous stories.

For 12 years before being diagnosed I pushed my life to forward my career and provide for my family.  I spent 70% of my working life traveling on the road for many years.  In the last few years, I had worked my way to managing those people that would now spend their days travelling, and I had the chance to slow down and spend time at home.   I had built an addition on the home for my wife to build her own business.  Our future was planned and I had goals and dreams to pursue. We had been married for 22 years when the tumor diagnosis was found.

I wrote this to discuss the loss of identity. During the last, I would guess, two to three years before diagnosis, I made many mental mistakes with my life.  I began to lose who I was.  I can blame my hormone levels for being in the toilet if I choose.  Really I don’t know.  I gave up a career because I was struggling mentally but didn’t know why.  I assumed I needed a change after so many years so I decided to start my own business. My marriage struggled.  The mental challenges continued during this period until being diagnosed six months after giving up my career.  They say everything happens for a reason…I am still trying to figure out the reasons.

Six weeks after surgery to remove the 4 cm tumor from my head, my wife tells me she wants a divorce.  It destroyed me.  I would love to tell everyone that I took it like a man and sucked it up and moved on.  Truth is, being deficient on all hormones, adrenals, thyroid, growth hormone, sex hormones…I was a basket case.  It was at this point that I lost who I was. Along with my identity, many other feelings came across. A loss of comfort, sexual function, career, income, self-efficacy, freedom, cognitive function, intimacy, pride, joy, self-esteem, self-control, independence, mental health, hope, dignity, and certainty. Over the last couple years I have felt these over and over again.  Sorting though the grief alone is a tremendous challenge.

Until you yourself live through a complete hormone deficiency, you will never understand what those effects have on a person.  My endo tried to describe it when replacing all these hormones synthetically that it was like going through a medically induced depression, puberty, menopause, and a mid life crisis  all at the same time.

When you go through a tumor in your brain, many people you thought you were close to will step away.  They don’t mean to be rude or not sympathetic but they don’t understand and it puts them face to face with their own mortality.  They do’t know how to face you or what to say.  Going through this tumor, plus a divorce, seemed to disconnect me even further.  I went from the career guy with family and lots friends to the sick separated guy feeling alone and on my own to deal with this.  I know people going through divorce normally go through some of these feelings.  It was just magnified for me with the illness.

It was something that everyone I knew would never understand.  You tell them it’s hypopituitarism and you get the blank stare.  I was no longer the person that they used to know.

It has been almost three years now, since my original diagnosis.  Tumor was removed in Oct of 2013.  It has been two years of trying to synthetically replace all the hormones that others create on a regular basis but we have to balance and figure out correct dosages regularly.  As much as I have tried to explain to family and friends, they will never truly understand what we work through daily.  Yes…”I am fine”…I tell them.  “All good!”  What else can I say?  I don’t want their pity and I don’t want them to watch me struggle.  It’s written on the inside of my face.  For people who are hypopituitary, our losses are multiple and permanent and therefore difficult to explain. They are infinite losses that will effect our quality of life forever.

Well-meaning individuals, whether friends and family or even doctors can make it more difficult. Some may try to add a helpful perspective by saying, “It could be worse” or “You look fine!” All these statements do are invalidate our physical and emotional challenges.  It is very dismissive of the pain we are experiencing and the type of grief we are trying to manage. Everyone has a right to how they feel, and for us we just say, “It could be better.” There’s also a lot of pride in those of us with chronic illness and it makes us reluctant to ask for help from friends or loved ones.  Sometimes we live in denial about our own limitations.  We often retreat from our social networks, leading to poor social support. Our relationships will often suffer as we become more and more isolated. The depression can worsen to the point where some hypopituitary patients become actively suicidal or passively suicidal or just stop taking care of themselves in any meaningful way.

I gave up a while ago trying to explain the bad days because I really can’t explain them to myself.  I am glad they have become fewer and further between than before.  But how do you even try to explain when hormones are out of whack one day, but good the next?  You can’t explain what its like to have your brain in a fog, pain in your body, emotional disconnect from others, a want to just be alone and a want to just be with someone that understands.

I have forgotten much of the year during diagnosis and have been trying to rebuild since then.  I truly don’t believe all of the pieces are back in place yet. I am doing my best to move forward anyways but have yet to truly define or figure out who I am now.  I know I am no longer the same person mentally that I was before this tumor.  I seem to remind myself on a daily basis of this.  It doesn’t make me less of a person.  I probably help more people now that I ever did before because after going through this we find a connection with others that we never had before. My challenge is finding connection outside the illness itself.

In reviewing the psychology of this illness, I came across Maslow’s hierarchy of Human needs, he used the terms “physiological”, “safety”, “belongingness” and “love”, “esteem”, “self-actualization”, and “self-transcendence” to describe the pattern that human motivations generally move through.

What he says is there may not be any physical indications, but if a person is not meeting the most fundamental “physiological” needs as mentioned above,  and “Safety” we can go through anxiety, tension and depression. The next most basic level of needs, Maslow called “deficiency needs” or “d-needs”: love, belonging, esteem, friendship, and physical needs and finally self actualization.   Maslow’s theory suggests that the most basic level of needs must be met before the individual will strongly desire (or focus motivation upon) the secondary or higher level needs.

When you think about most of us that are diagnosed hypopituitary, we spend a countless amount of time searching and trying to understand our illness.  Trying to find answers to why and what is causing all of our challenges.  This is all part of the physiological state. Our next phase is security.  Whether that be in finally finding a balance with hormones or finding a doctor/endocrinologist that understands or is willing to listen or help.  Or having a partner or family member that is by your side for the duration and willing to love you no matter the challenges.  Or just a feeling of finally understanding our own illness and how to read our own bodies needs.

Finding the next step for me has been difficult.  A “love/belonging” or need.  The belonging or need came through the support groups.  I found peace and understanding with those going through the same as myself.  Helping others going through this illness as I have, became what drove me day in and day out.  But I am not fulfilled.

But I find myself still in this stage.  Somewhere trying to sort out love and passions.  What does it mean? What does it feel like? Why don’t I feel this?  Why is there such a disconnect? Somewhere between here and the next stage, working towards my own self esteem, is where I seem to be stuck.

The human mind and brain are complex and have parallel processes running at the same time.  Maslow said that the different levels of motivation could occur at any time in the human mind, but he focused on identifying the basic types of motivation and the order in which they should be met.  Once we find that level of esteem again, we can move into the Self Actualization stage.  Not everyone moves to this stage.  Some choose to stay at the point that they have great self esteem and that is an amazing place to be.

“What a man can be, he must be. This need we may call self-actualization…It refers to the desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.”

Self Actualization. To me this relates again back to finding my own identity. It’s no longer about comparing myself to who I used to be and trying to get back there again. I can only hope that one day I will be happy and find that new identity.  I have to learn not to curse the storm but instead to learn to dance in the rain!

 

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Growth Hormone Deficiency and Metabolism

Hypopituitarism and Weight Loss with Growth Hormone Deficiency.

I was asked to write some blogs on Nutrition, our Hormones and how we can find ways to better our health.  There is so much to write on the effects of Hypopituitarism that I am going to break these down by each hormone and work our way through them starting with Growth Hormone.  In my next blog I will address the next deficiency.

Before you read this and follow what I am doing, I always like to say that I am not a doctor and I am only writing on the things I have learned from my endocrinologist, nutritionists and hours of investigating online.  These are things that have worked for me.  Please remember these things may not work for everyone.  This is all based on science that you can look up yourself in reputable journals and medical studies.

Growth hormone is a major body system-wide metabolic hormone that regulates carbohydrate homeostasis (balance), protein and lipids (fat). Carbs, Proteins, and Fats!

Carbohydrates

Patients with growth hormone deficiency have traditionally been described as having increased insulin sensitivity (resistance).  Being Hypopituitary is close to what’s called having Metabolic Syndrome although ours is hormone related. Insulin Resistance has been studied and proven numerous times.  They have also shown that long-term treatment in GH-deficient adults results in persistent insulin resistance and abnormalities in how we process Insulin…even when on Somatropin.

Insulin is a hormone, just like estrogen, testosterone, cortisol and thyroid hormone. Insulin is secreted into our bloodstream by the pancreas to regulate the amount of glucose in our blood. Insulin allows our body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use.  Insulin is often described as a “key,” which unlocks the cells to allow sugar to enter the cell and be used for energy.  Insulin acts on many cells in your body, especially those in the liver, muscle and fat tissue. Insulin tells the cells to do the following:

  • Absorb glucose, fatty acids and amino acids
  • Stop breaking down glucose, fatty acids and amino acids; glycogen into glucose; fats into fatty acids and glycerol; and proteins into amino acids
  • Start building glycogen from glucose; fats (triglycerides) from glycerol and fatty acids; and proteins from amino acids

Blood sugar is like a vampire. It needs an invitation to enter our cells. And that invitation is insulin. Insulin is the key that unlocks the door to let the glucose in the blood to enter the muscle cell. When we have insulin resistance, we no longer have the ability to respond to insulin. Normal amounts of insulin are no longer adequate to produce a normal insulin response from fat, muscle and liver cells. In order to compensate, the pancreas produces more insulin. Insulin resistant cells cannot take in glucose, amino acids and fatty acids. Thus, glucose, fatty acids and amino acids ‘leak’ out of the cells. Exess glucose is converted into Glycogen. This then causes fat cells to absorb fatty acids and glycogen and thus expand.

The higher the insulin, the more the fat cells have to expand.  If you have insulin resistance and eat carbohydrates, up to five times the amount of insulin is necessary to bring your blood glucose back down to healthy levels. And some people with insulin resistance produce so much insulin that their blood sugar levels can drop way below normal, forcing us into a hypoglycemic state. When we experience intense cravings for sugary or starchy foods, there’s a good chance it’s due to hypoglycemia. I also believe that because we are not absorbing the glucose into our cells this is causing our lack of fuel for our energy levels.  We also need the glucose in the cells for our brains to function.

When insulin levels spike due to high glucose levels, it creates fat. And the more obese you are, the more insulin resistant you become.  Now the second issue comes into play for us that are Hypopituitary is that Cortisol which would normally be secreted from the adrenal gland is supposed to make fat and muscle cells resistant to the action of insulin.  Cortisol is also supposed to enhance the production of glucose by the liver. Under normal circumstances, cortisol counterbalances the action of insulin. Under stress or if a synthetic cortisol is given as a medication (like many of us), our cortisol gets used up quicker and we remain insulin resistant.  Low cortisol, low blood sugar equals hypoglycemia and possibly Adrenal Crisis.  Sounds like so much fun doesn’t it.  Cortisol and its effects on metabolism I will get into in my next blog.

Most people with insulin resistance don’t know they have it for many years—until they develop type 2 diabetes, a serious, lifelong disease. The good news is that if we find out we are borderline with high triglycerides, higher than normal blood glucose, abnormal (low) levels of good Cholesterol in our blood tests we can address insulin resistance early on.  We can often prevent or delay diabetes by making changes to our lifestyle.

What causes this insulin spike?  Sugars!  When people eat a food containing sugar, the digestive system breaks it down at which point it enters the blood.  Blood glucose levels then shoot up, and our pancreas creates the insulin as mentioned above.  Also Carbohydrates. When people eat a food containing carbohydrates, the digestive system breaks down the digestible ones into sugar, which enters the blood.  Repeat above.

In the past, carbohydrates were commonly classified as being either “simple” or “complex”. However, this does not account for the effect of carbohydrates on blood sugar and chronic diseases. To explain how different kinds of carbohydrate-rich foods directly affect blood sugar, the glycemic index was developed and is considered a better way of categorizing carbohydrates, especially starchy foods.  The University of Sydney has a great searchable index that can be found here http://www.glycemicindex.com/.  Low-glycemic foods have a rating of 55 or less, and foods rated 70-100 are considered high-glycemic foods. Medium-level foods have a glycemic index of 56-69.

Proteins

One of the other issues with Growth Hormone deficiency is that our Protein synthesis and flux are reduced. Growth hormone is the only hormone to exert its function directly to our cells. Growth hormone increases the rate of protein synthesis within cells by increasing the transport rate of Amino Acids into the cells similar to the method insulin uses.  Replacement GH increases synthesis initially but it’s not sustained long term like we require.  It is also proven that Insulin resistant cells do not uptake amino acids well as mentioned above.

During digestion the proteins we eat are broken down and converted into Amino Acids for our cells.  Twenty percent of the human body is made up of protein. Protein plays a crucial role in almost all biological processes and amino acids are the building blocks of it.

A large proportion of our cells, muscles and tissue is made up of amino acids, meaning they carry out many important bodily functions, such as giving cells their structure. They also play a key role in the transport and the storage of nutrients. Amino acids have an influence on the function of organs, glands, tendons and arteries. They are furthermore essential for healing wounds and repairing tissue, especially in the muscles, bones, skin and hair as well as for the removal of all kinds of waste deposits produced in connection with the metabolism.

Adults produce 9 of the 22 essential amino acids and the remainder come from food. Failure to obtain enough of even 1 of the 9 essential amino acids, those that we cannot make, results in degradation of the body’s proteins (muscle and so forth) to obtain the one amino acid that is needed. Unlike fat and starch, the human body does not store excess amino acids for later use.  Amino acids must be in the food we eat every day.

There are 9 essential amino acids which humans must obtain from their diet in order to prevent protein-energy malnutrition. They are:

  • Phenylalanine
  • Valine
  • Threonine
  • Tryptophan
  • Methionine
  • Leucine
  • Isoleucine
  • Lysine
  • Histidine

Increasing your protein intake and adding quality Amino Acid supplements is a good idea to help us get enough. It’s easy to add protein to your diet with Whey Protein shakes available in most stores.  Just watch for sugar content as they are not created equal.  I use a product from Precision Supplements up here in Canada and I get paid nothing for endorsing their chocolate!  YUM! I am sure there is another brands where you live.

Fats (Lipids)

Growth hormone promotes the use of lipids by promoting the breakdown of triglycerides and oxidation in cells. When people eat less fat, they tend to eat more starch or sugar instead, and this actually increases their levels of dangerous cholesterol, the small, dense cholesterol that causes heart attacks. In fact, studies show that 75% of people who end up in the emergency room with a heart attack have normal overall cholesterol levels.  What they do have is pre-diabetes or type 2 diabetes.

Eating a diet with good quality fat and protein prevents and even can possibly reverse diabetes and pre-diabetes.  Eating sugar and refined carbs is the primary cause of these conditions.  Healthy Fats do not increase insulin.  Dietary fat cannot be converted to blood sugar, and therefore it doesn’t cause serum insulin levels to increase.

It might seem counterintuitive to eat fat if you’re trying to lose weight and use stored fat for energy, but dietary fat does not induce the high levels of insulin secretion seen with a very high-carb meal. Therefore, when the body is relying less on glucose and more on fat for energy, insulin secretion is decreased.  Ultimately, this allows the body to continue efficiently accessing fat stores for energy.

 

Ok now that the science lesson is over, what do we do about it?  If you are like myself and working towards losing weight, we need to reduce our consumption of sugars and carbohydrates and increase fats and Proteins.  It sounds simple and truly it is.  But you have to be committed to it if you are hypopituitary.  Or at least, give it 30 days and see what happens.  30 days.  That’s all I ask.  See if you feel different.

There are many eating plans you can find online in regards to a Ketogentic way of eating and I highly recommend some of them.  The main benefit of ketosis is that it increases the body’s ability to utilize fats for fuel. Our bodies get very lazy on a high-carbohydrate diet. When on high-carbohydrate diets, the body can usually expect an energy source to keep entering the body. But in the state of ketosis, the body has to become efficient at mobilizing fats as energy.

I don’t follow the Low Carb, High Fat mentality of some keto dieters as I don’t believe it’s a long term plan for us due to other hormone and nutrient deficiencies…which I will explain in a future blog.  I do recommend the Moderate Fat, Moderate Protein, Low Carb way of eating. For fat loss (not muscle loss) we need to keep our fats a bit lower or equal to our proteins per day.  There is a warning I will give.  If you decide to give this a try you may experience what is called the keto flu.  What’s happening is your body transitioning from carb burning to fat burning.  It’s a rough ride and I did have to stress dose my cortisol a few times to make it through some days.  But once through it, you will notice a tremendous difference.  You will want to keep your electrolytes up always.  I also supplemented with Salt, Magnesium and Potassium while on this way of eating mostly through a One a Day Vitamin.

If you can, pickup a book called “The Art and Science of Low Carbohydrate Living” by Doctors Volek and Phinney.  They also have many videos on Youtube and blogs everywhere. Their website is http://www.artandscienceoflowcarb.com/.  There is also a great Facebook group you can join called Ketogenic Dieters.  There are others but I highly recommend this one.  To track my eating and ensure I keep my carbs, proteins and fats where I want them to be, I use My Fitness Pal which is an app or can be used on your computer also.  There is also a list of conditions where you should not try the Keto way of eating.  It can be found here http://www.ketogenic-diet-resource.com/support-files/who-should-not-follow-a-ketogenic-diet.pdf.

Lastly in regarding to nutrients I would like to add that if you are GH deficient you need to be on a quality Vitamin D3.  Even if your levels are normal this will help you.  Vitamin D3 is one of the most useful nutritional tools we have at our disposal for improving our overall health. This vitamin is unique because as a hormone, Calcitriol controls phosphorus, calcium, and bone metabolism and neuromuscular function. Vitamin D3 is the only vitamin the body can manufacture from sunlight. Yet, with today’s indoor living and the extensive use of sunscreens due to concern about skin cancer, we are now mostly deficient.

For more than a century, scientists have recognized that Vitamin D3 is involved in bone health. Research has continued to accumulate, documenting Calcitriol’s role in the reduction of the risk of fractures to a significant degree. The latest research, however, shows that Vitamin D3 deficiency is linked to a surprising number of other health conditions such as depression, back pain, cancer, “insulin resistance”, pre-eclampsia during pregnancy, impaired immunity and macular degeneration.  I recommend 5000 to 8000 IU per day.

I am certainly not saying in any way this is a cure for Hypopituitarism, or replaces the hormones we all need daily.  I have tried Keto myself and lost 25 lbs over three months. I felt stronger and began exercising which helped with my mental attitude and abilities.  I have proven to myself that eating like this is something I could maintain long term.  And I also have proven to myself that when I fall off of this ways of eating and go back to carbs, the weight climbs, I feel less energetic and the brain fog moves in fairly quickly.

Don’t kick yourself for falling off the wagon.  We all do it.  Just choose to climb back on as soon as possible.  We have enough other challenges to deal with daily with our hormones that although weight loss is important for our health, happiness is the most important.  Once you start to feel better hopefully you can start moving again and burn those extra fat cells off even quicker through some exercise.

The fact is, lowering insulin levels will may help you lose weight and make you thinner.  This is my recommendation and I always suggest you do your own research and discuss this with your physician before trying any nutrition and exercise routine.  However, remember too that most classically trained doctors don’t understand the effect of foods on the body, much less ketogenic diets, so if you ask your physician, you may get push back, and a terrifying “danger of ketosis” sermon.  Just remember the doctor is confusing nutritional ketosis with a more dangerous condition called ketoacidosis. These are two different conditions.  Ketoacidosis is a concern for Type 1 diabetics and others whose bodies are unable to make or process insulin correctly.  Educate yourself and be prepared like we have to do with our Hypopituitarism.

I hope this helps someone.  Please feel free to comment as I am always learning myself.  Take care all and live well!

Hypopituitarism – The Missing Puzzle Pieces

There has been a lot of talk in the support groups about the hormones that our pituitary glands create that science and medicine have not studied for our condition yet.  Extensive studies have been done on replacement hormones for Adrenal, Thyroid, Sexual Function, Antidiuretic, Prolactin and Growth hormone,  but no tests with hypopituitarism patients in regards to Beta Endorphines, Oxytocin and Melanocyte Stimulating Hormones.  All of these come from the same gland. This of course surprises me as who else is better to do research and trials on but those of us with non functioning pituitary glands.

I ask you my readers to comment if any of you have any experience or knowledge of replacing these hormones that can be shared with other patients like myself.

Beta Endorphines

Endorphins are a natural body chemical produced in the central nervous system and anterior pituitary gland. They produce the feeling of happiness and are released during exercise, danger, pain, excitement, an orgasm, or even by eating spicy food. They also work as a natural pain-killer. The term endorphin is an amalgamation of endogenous and morphine, which suggests that it is a naturally produced morphine. In terms of pain, endorphins are released in order to prevent nerve cells from releasing more pain signals.  Endorphins are the primary regulators of the immune system, representing 90% of immune system hormonal control. Ninety percent of the day’s endorphins are produced by the pituitary and adrenal glands between 2 a.m. and 4 a.m.

A deficiency of endorphins causes depression, chronic unexplained pain, and a low tolerance for pain. In many instances, low endorphin levels are misdiagnosed as depressive disorders.. Also known as endorphin deficiency disorder (EDS), a deficiency of endorphins can be difficult for doctors to diagnose initially until testing shows the lack of endorphins. Many of the symptoms associated with EDS are similar to the symptoms that occur in depressive disorders, such as manic depression and bipolar disorder. Depression, chronic or intermittent, and general body aches are the two most common symptoms, and a person may also have a tendency to cry without a logical reason or feel pain more easily. EDS makes it difficult for people to be generally happy in their lives.

I have read of depression patients utilizing opiates to stimulate levels of beta endorphins and reducing depression and anxiety symptoms.  Unfortunately the medications I read about only increase the existing and are not a replacement in those that possibly don’t create endorphins anymore. I have not found any replacements for us in the works or studies being done at this time.

Oxytocin

Oxytocin is produced by the hypothalamus and stored and secreted by the posterior pituitary gland. Oxytocin creates intimacy, trust, and builds healthy relationships. It’s released by men and women during orgasm, and by mothers during childbirth and breastfeeding. Studies on Oxytocin have shown an increases fidelity; men in monogamous relationships who were given a boost of oxytocin interacted with single women at a greater physical distance then men who weren’t given any oxytocin. The cultivation of oxytocin is essential for creating strong bonds and improved social interactions.  In addition, low oxytocin has been linked to depressive symptoms and it has been proposed as a treatment for depressive disorders.

Scientific research has uncovered brain oxytocin’s specific ability to modulate social behavior, including effects on motherly care and aggression, bonding between couples, sexual behavior, social memory, and trust. Brain oxytocin also reduces stress responses, including anxiety – and these anxiolytic effects have been demonstrated in a number of species.

A new study has found that higher levels of the “cuddle” hormone oxytocin are linked to stronger social skills in both healthy children and in children with autism. The research is published in the journal Proceedings of the National Academy of Sciences.  It was previously believed that low levels of oxytocin were the cause of autism. The new study reveals that a deficiency in oxytocin does not cause the disorder but that the hormone’s ability to increase social skills may still help treat a subset of autistic children.  The researchers found that higher oxytocin levels were linked to better social functioning in all three study groups.

A study was published in the International Journal of Psychology in August of 2013 that provides the first evidence that Oxytocin increases people’s willingness to share their emotions. Importantly, Oxytocin did not make people more talkative (word counts were comparable across the two groups) but instead increased the willingness to share the specific component that is responsible for the calming and bonding effects of social sharing: emotions. The findings are all the more remarkable because they were obtained among men, who may be less inclined than women to express their emotions.

There have been no studies that I can find on Oxytocin deficiency in hypopituitarism patients.  There are few patients that I have talked with that have found doctors willing to prescribe it in either nasal spray or tablet form although none know for sure if there will be any long term effects.  So in essence, we as patients become guinea pigs in order to try to find solutions. A 24-hour urine test is required to capture a full day’s secretion.  This 24-hour perspective is critical because oxytocin secretion can be highly situational, triggered by social and sexual activities.  A 24-hour perspective therefore affords a more comprehensive oxytocin assessment compared to other methods that only measure an isolated snapshot in time.

Melanocyte Stimulating Hormone

Melanocyte-stimulating hormone also called intermedin or melanotropin is a collective name for a group of peptide hormones produced by the skin, pituitary gland and hypothalamus in response to ultraviolet radiation.  It plays a key role in producing colored pigmentation found in the skin, hair and eyes.  It does this by inducing specialized skin cells called melanocytes to produce a pigment called melanin; melanin protects cells from DNA damage which can lead to skin cancer (melanoma).

Although known for its stimulation effect on pigment cells, studies have shown that melanocyte-stimulating hormone can also suppress appetite by acting on receptors in the hypothalamus in the brain.  This effect is enhanced by leptin, a hormone released from fat cells.  Its is also thought to affect a range of other processes in the body; it has anti-inflammatory effects, can influence the release of the hormone aldosterone which controls salt and water balance in the body and is also thought to have an effect on energy homeostasis and sexual behavior.

A deficiency in melanocyte stimulating hormone results in a lack of skin pigmentation and subsequent loss of natural protection from UV rays of the sun.  In secondary adrenal insufficiency, damage to the pituitary gland prevents release of adrenocorticotropic hormone and melanocyte stimulating hormone and there is reduced pigmentation of the skin.  Melanocyte stimulating hormone deficiency can cause increased inflammation, pain, and sleeping problems as well as a reduction in the levels of antidiuertic hormone which causes thirst and frequent urination.   Melanocyte stimulating hormone deficiency may also result in increased food intake and obesity.  Apparently it also plays a critical role in the ability of our gut to function properly and is being studied as a treatment for celiac disease and bowel disease because of its anti inflammatory effects.

Synthetic versions of MSH have been developed for human use. Two of the better known are afamelanotide (melanotan-1), developed at the University of Arizona and is in testing by Clinuvel Pharmaceuticals in Australia.  Clinuvel has warned consumers against the use of what it terms are “counterfeit”, drugs sold as “melanotan I and II” that are promoted by citing research on afamelanotide.

In the US. Bremelanotide is being developed by Palatin Technologies in New Jersey.  The strange thing with Bremelanotide is it was also effective in treating sexual dysfunction in both men (erectile dysfunction) and women (sexual arousal disorder).  It is still in Phase studies and not available to patients yet.

Melanocyte Stimulating Hormone can be measured measured by direct radioimmunoassay. Reference Ranges:
Children: Up to  25 pg/ml
Adults: Up to 5.0 pg/ml

So there is a quick rundown on the three missing pieces to the Hypopituitarism puzzle as I know it at the moment.  As i mentioned earlier, if anyone has more information, is taking them or has been tested I would love to hear your comments.

And I am sorry I did not link or show references to the studies mentioned.  I am not a professional writer and have not figured out how to do that yet.  But if anyone wants them I am happy to share.

Pituitary Tumors and Hypopituitarism – Effects on Relationships and Marriage

 

I recently read an article that stated the current divorce rates are 55%.  For those with a chronic illness it increases to 75%.  I have not found a study specifically for those of us with Pituitary Tumors or that are Hypopituitary but I would have to assume we are in the 75% category.  A study completed in 2004 found that 1 in 2 Americans has a chronic condition.  This could be anything from Cancer, to Arthritis, migraines or extreme back pain.  That same study also estimates an increase in chronic illnesses of 1% per year to the year 2030.  If my math is correct that would mean that 50% plus another 16 years is 66% of people will have a chronic condition. Will that mean our divorce rates will jump to 91%?

I’m not gonna lie, I was in shock at the number even though I am currently going through the separation/divorce process.  That is 3 out of every 4!  When people get married, they hope that it is forever and the old words “in sickness and in health, till death do you part” come into my mind.  They should change the vows to “Only in Health, until sickness do you part”!

The problem I see from talking with so many Pit Tumor/Hypopit patients is some of them had obvious symptoms that effected their lives and relationships that they noticed right away but could not get a diagnosis.  Or the others where the tumor grew so gradually that the changes came without notice.  We attributed our pains and inability to function “normally” or as we used to as getting older until it became debilitating to some extreme.  In my case it came on gradually with a slow growing tumor.  I know of at least six years of misdiagnosis but really have no idea how many things were affected in me before that time.  What I hear for other patients is the minimization and disregard from partners, family, friends and coworkers for the condition.  Whether they believe we are faking the illness or exaggerating the symptoms for sympathy.  Yes there are those with tumors that will never know they have one so they have no symptoms.  Yes some will be found and cured. Yes some people will do well on medication and live a full life.  But there is a large amount of us that struggled to recover.  There are those that are still fighting, and some that will never fully recover.  Same is true for many other debilitating diseases so don’t minimize our illness.

The fact is; being seriously ill impairs our ability to do the things we used to do as a couple. Feelings like guilt, anger and the accompanying miscommunication then follow. When you lose your social and sexual partner as a result of a disability, it has a huge impact.  There’s a whole psychological layer. When you get married, it’s not to be somebody’s nurse, and then suddenly, you are somebody’s nurse. Financial problems only make the situation more difficult. A dual income home can quickly become a single or the higher income earner can longer support the family.  There are also the cost of healthcare as it rises, medication costs, increasing the tension at home and can further impact a relationship and push it over the edge.

I once discussed this with a wife of a chronically ill friend.  The truth was she knew she was being unfair, but she was lost, tired and burned out. She knew her husband was not to blame, but she didn’t know where else to direct her fear, anger and resentment.  So it unfortunately goes in the direction of the one person they used to know but don’t understand anymore. They see the shell of the person they used to love.  The strength they used to admire in their partner is no longer visible.

One of the stories I also heard was a couple where the wife became completely debilitated due to her illness. The husband did everything he could but because they had no insurance there came a point that he could no longer afford the care she needed.  He had to divorce her in order for the state to have to take over her care and he could survive financially.

So that means married people, like myself, diagnosed with a serious health condition may find themselves struggling with the impact of their disease while also experiencing the stress of separation and divorce, and financial implications that come with it. Studies have found that women are doubly vulnerable to the end of a relationship in the face of illness. Not only is divorce more common when women get sick, but women are also more likely to watch their husbands die first of a serious illness before divorce.  There are two theories to this; gender norms and social expectations about care giving may make it more difficult for men to provide care to ill spouses, and divorced men have more choices among prospective partners than divorced women. But another article stated more of these divorces are initialized by women.  What they found was when women become ill, and their husbands are not doing a very good job caring for them, they would rather that he just go it alone and they rely on friends and family who will take care of them.

A growing number of articles are now being written about the role social media is playing in divorce but not specifically those with chronic illnesses.  However, many of us with chronic illnesses find ourselves searching for cures, ways to help deal with symptoms and more often…other people with our illnesses that may understand how we feel and what we are going through.  There are Facebook and support groups where we can find that sympathy and support we may not be getting at home.  So our feelings are put out to strangers and we are vindicated.  We consider these connections friends and share personal thoughts with them instead of our loved ones that we get tired of explaining things to.  We start to value our worth based on followers, comments and messages and what we do to help others with our illness.  Unfortunately many drift away from the emotional and mental connections we have with the person or people right in front of us.  I truly understand the need for these connections. Would it not be better for us to dedicate and invest more time to teaching our family, friends and the public about our illness so future patients do not have to deal with the same stigma?

Now… in reference to the quote header that I posted with this blog; “Some individuals who claim never to have felt romantic love suffer from Hypopituitarism, a rare disease that doesn’t allow the person the feel the rapture of love.”  The quote refers to information in a book by John Money (1980) Love and Love Sickness: the Science of Sex, Gender Difference, and Pair-Bonding.  I will be totally honest and say I have not read this book yet but agree this could be possible if Hypopituitarism goes untreated. I have seen this quote before and have heard from patients that do find issues with social anxieties, bonding, making new friends and keeping existing relationships. There have been discussions that these may be caused by a possible Oxytocin deficiency, or deficiencies of Beta Endorphins. Both of these are not given to us in medical replacements even though they are linked to pituitary dysfunction (along with the estrogen and testosterone which we do replace). This post is not to debate those, only to suggest more studies certainly need to be done to find out if there is a link. Could these hormones be linked to why our relationships fail?  We all know in regular marriages the effects hormones can have.  Just look at menopause and what they call a mans menopause the “Mid Life Crisis”!  Both are hormone related.

I wish there was an answer.  I wish I could snap my fingers and change the reality of the marriage and relationship world today.  What I do want is you, the patient, to remember that you have value. Do not let your condition become who you are. Look in the mirror now and say “I am (insert your name), I am not my illness”. I am one of the lucky ones where my illness is close to being under control now.  Even though I am going through a divorce, there is a light at the end of the tunnel for me.  I have been dating and know there will be someone out there that will love the person that I am on the inside.

The same inside where my chronic illness lives.

 

 

What am I grateful for?

October 7th.  It is hard to believe it has been one year since the tumor was removed from my head that a few times hemorrhaged and almost killed me.  After six years of my health on a slow downhill slide, it sure feels good to be working my way back up the hill.  I am not there yet, but the top is visible with no fog surrounding it.

There is so much I still cannot remember over the last couple years and it may never come back to me.  A year ago I could not see how I was ever going to feel better.  Hell, six months ago was still a daily struggle.  People have asked me if I am back to “normal” yet.  I don’t know how to answer them.  It was for so long that I didn’t feel “normal” that I really don’t know what that means anymore. When is good enough…good enough? I can say am doing very well now and feel better than I have in years. I talk to so many others that are still fighting this illness so I am thankful every day.

They say everything happens for a reason.  I don’t know what that reason is for me yet. Maybe one day I will find it, maybe not.  I will take things as they come.  This illness that took so long to diagnose changed my entire life in the blink of an eye it seems like.  There were times earlier this year where I could not find my dreams, my goals, or myself, and I didn’t even know who I was anymore.  I was truly lost.  It is so hard to explain how dysfunctional a mind and body can be without having your natural hormones anymore.  In my case I now take four different manufactured hormones and finding the correct balance was a challenge.  There are also some hormones that are not replaced because the medical field does not know enough about them yet.  I also never realized how some people will assume, fear, judge or treat you when you have an invisible illness or an illness they don’t understand.  Thankfully my family and closest friends were there for me when I needed them.

Throughout this illness I have learned a few things.  Life is about overcoming obstacles and circumstances that are in or beyond my control.  It’s about making the most out of my relationships with family and friends, new and old.  It’s about finding my passion and the meaning in my life and doing everything I can to show that meaning to others and live that passion every day.  It’s about finding that person that will love me unconditionally and loving them back the same way no matter what the world throws at us.  It’s about forgiveness, and giving, helping others, and the notion of paying it forward.  And it’s about keeping things simple, laughing, and having fun.

Today I am very grateful for so many things.  I am still learning, searching, and a work in progress.  Honestly… this last year has taught me so much that I hope I always am!

Can you really see me? – The Face of Hypopituitarism

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Can you really see me?  We have all seen the look.  You tell someone you are hypopituitary and they get this look of confusion on their face.  “But you look fine”. Most people have never heard of it before.  Honestly I had never heard of it until being diagnosed.  It is an invisible illness that we feel on the inside.  The chains, ropes and cables that hold us back from who we used to be. Hypopituitary means our Pituitary Gland is no longer functional so we don’t create all or most of the pituitary hormones that people need in their daily lives.

For me this is still all very new.  Diagnosed almost a year ago with a golf ball tumor inside my head that was crushing my pituitary gland.  Surgery to remove the tumor in October.  It is June now as I am writing this and it has been a battle with the medical system to get all of testing required to get to where I am today.  You see, we have to artificially try to replace all of the hormones we used to have now.  It is a forever balancing act with our hormones and will be for the rest of my life.

So what exactly do people not see in us from this illness?  What is it?  Maybe you have heard of Addison’s disease, or Adrenal Fatigue.  How about Hypothyroidism or Hypogonadism?  Possibly Growth Hormone Deficiency.  Have you heard of Diabetes Insipidus? Maybe you know about Beta Endorphins, Melanocytes, or Oxytocin deficiencies (which even our medical system does not fully understand yet).  You see, all of these illnesses are each caused by one hormone being deficient in your body.

For some people living with just one of these conditions is challenging enough. For those of us that are hypopituitary, we live with all or most of them every day.  Every hour of every day we analyze how we feel and have to think which hormone is causing the issue today that needs to be medically adjusted to help us feel better.  The symptom list is massive and can change depending on which hormone is causing the symptom that day or what life challenges we face.  In people who do not have this illness, your body makes these adjustments hundreds of times per day automatically.  The tree of symptoms above that I created gives you a rough idea what we may go through. Sometimes these symptoms go away only to come back again stronger than before.  Its a forever balancing act.

We hear it all the time.  “At least it’s not cancer”.  “There is always someone worse off”.  Yes you are right but in our minds that belittles the daily struggle we have.  I have heard it from others like myself.  If it was cancer at least we could make the choice to fight it.  We may win or we may lose but we can fight.  We have to deal with what we cannot fight.  We wonder every day if the tumor some of us had removed is going to return or regrow.  For many of us the tumor grew so gradual over years we did not see the changes it made to our health, our personality, our mental state.  Now we look back and wonder who we used to be and when did we really change?  When was I actually the normal me?  How will I ever know if I am normal again?  What is it even like to feel normal?

For many of us with this illness we become obsessed.  I see it in the forums and Facebook groups every day.  We obsess about everything we feel, every new symptom, and wonder if it is related or how to fix it.  The obsession is part of the illness and many don’t even know they are distancing themselves from the family.  The want and need to feel better is powerful.  Feeling exhausted and tired of fighting every day wears on a person.  The problem is the obsession we have drives us away from our family, friends, new relationships and our lives.  We hide from the world in hopes we get back to some reality of normal.  Many live with fear, anger, anxiety and depression.  Because our illness is invisible, many of our friends and family will distance themselves because they don’t understand.  In reality this is the time that we need these people the most.  We need them to understand and we really need their help.

To use me as an example, I wake up every morning and take my thyroid meds first thing on an empty stomach.  I go for a shower and after I apply my Testosterone. I will be switching to injections soon so I will also have to take another medication to ensure the testosterone is not converted to estrogen. An hour after waking up I take my large dose of adrenal system medication with food.  I need this one to survive daily.  Without it I would fall into adrenal crisis, a coma, and then possible death without emergency treatment.  This medication has an eight hour life in my body so I know when I start to get low.  This medication I take three times a day.  At night before bed I inject for growth hormone.  This is the standard day for me not including vitamins that have to be carefully sorted around meds to not interfere.  I use alarms on my phone to remind me of each.  Luckily for me I no longer have Diabetes Insipidus so that’s one less medication off my list.  In the last six months I cannot even count how many blood tests and medication dosage or brand changes I have done. There will be eye testing and MRI’s consistently for a while to watch for growth.  

Through the forums I have met many people that have had to change careers because they can longer function at the same capacity they used to.  There are those that cannot be around groups or out in society because of anxiety.  I have met those being treated for depression.  Patients that this illness has caused separation and divorce. People who are lost in the medical system fighting for a proper diagnosis or just for basic medications because they have not found the right doctor.  Those that are fighting their insurance companies because they will not cover the cost of the medications we need so they go without.  And I have seen the face of death and suicidal thoughts from some because they cannot take it anymore. 

I chose to advocate and spend time listening and helping those going through this illness as best I can.  

These are faces of the people with Hypopituitarism.  Can you really see us now?

The Psychological Behavior Changes of Pituitary Tumors

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Although many advances have been made in the treatment of Pituitary Tumors physically, there have not been many studies on the emotional, psychological effects these tumors cause or the end results after removal and the disruption to the endocrine system that follows.

Only in the last decade has there been interest in how hormonal function or endocrine dysfunction effects psychiatric illness. The relationship of endocrine disease to psychological distress, despite all the research, is rarely mentioned in the literature of endocrinology. Endocrinology textbooks and journal reviews mostly ignore, or only incidentally mention the psychiatric effects of endocrine disorders.

More and more patients with pituitary disease are being evaluated and treated at cancer centers. In many ways, we resemble patients with other malignant brain tumors. Although the majority of pituitary adenomas are benign, the physical, emotional, and cognitive changes that we experience on our well-being is malignant. Those of us with endocrine disorders experience many emotional problems and personality changes, above and beyond the many adjustments that we must make in our lives.

There is a growing understanding that we may experience these emotional problems as a result of long-term effects that the pituitary tumor itself, the treatment, and the hormonal changes have on our pituitary release of hormones. Many patients have been treated for depression but showed no response.  More recently, doctors have found that treatment for apathy syndrome has shown improvement in patients.

Changes to a persons behaviour can include:

  • hostility and Anger
  • depression
  • apathy
  • increased irritability
  • anxiety and a decreased willingness to socialize
  • emotional insecurity
  • psychotic disturbances
  • cognitive impairment including memory loss and concentration
  • Mood changes
  • loss of motivation and lack of energy and drive
  • Insomnia and other sleep disorders

This all becomes very frustrating for us and we don’t always see the changes that others around us do because they come on very slowly. A depressed mood may have a large influence on our quality of life and on how we experience the endocrine disease process and our interactions with others.  There have been studies that show a correlation between Pituitary Tumors and Suicide. Upon autopsy, pituitary tumors were found in 47.7% of the suicidal group, while in the nonsuicidal (accidental death) group showed only 18.3%.  This is very significant.

People with pituitary disease experience many physical changes also. Our weight can undergo significant fluctuations as well as changes in our physical appearance. We may experience changes in our sexual and reproductive functioning, such as amenorrhea, impotence, and impaired orgasm. We may also develop medical illnesses such as diabetes, hypertension, and coronary artery disease just to name a few.

It’s natural for you and your family to have many questions throughout the diagnosis and treatment of a pituitary tumor. The process can be overwhelming — and frightening. That’s why it’s important to learn as much as you can about your condition. The more you and your family know and understand about each aspect of your care, the better.  You might also find it helpful to share your feelings with others in similar situations. Check to see if support groups for people with pituitary tumors and their families are available in your area although there are certainly not enough. Hospitals often sponsor these groups. Your medical team also may be able to help you find the emotional support you might need.

Many of these symptoms I have been through, or are still fighting, so do not feel you are alone. You will find it hard to explain to others how you feel because your emotions and energy levels can change on a daily basis.  The words that seem to come up in the studies are a lower “Quality of Life”.  My life has certainly changed and there are, of course challenges, but I refuse to call it “Lower”.  If anything, going through this has taught me many things about myself and what is important in my life.  You will find who the people are that stick by your side and support you through it.  There will also be those that don’t understand and chose avoidance or to leave.  I have accepted the loss of some relationships and my marriage but will never really know or understand if the tumor was the cause or not.

I am seven months post op for removal after many, many years and still working towards the hormone balancing act.  I still have many tests to go and for the rest of my life but working towards a better me each and every day.  There is still a fire within me.