Wednesday 28 May 2014

May 2014 - The anniversary of my Pituitary operation

I've been blogging about this topic for nearly a year now.....The 28th May 2013, a date I will never forget. The day an expert neurosurgeon put some Endoscopic surgery tools up my nose and into my brain to remove my Pituitary tumour. 


The Pituitary gland

My actual tumour


I suppose I could have gone one of two ways with all this, had the surgery and just got on with my life, or had the surgery and spent some time reflecting and blogging about the whole process and what I can actually get out of such a big event in my life. Obviously I did the latter, and I'm glad I did.

The surprising thing is that one year on, a lot of memories are still so strong - elements of my time in the run up to the operation and the stays in hospital that I remember so clearly. There are other elements that I've forgotten (or purposely blocked out) that suddenly pop back into my head for no apparent reason when I'm least expecting it.

I thought I'd take some time to capture a few thoughts about my tumour and list out the things that have come and gone (and a few that have stayed) along the way. In case any other Pituitary patients happen across this blog and have similar symptoms.

In terms of symptoms, I've been thinking of all the things I used to have that I haven't got now and indeed some of the things I have now, that I didn't used to have. Some more explainable than others, but I thought I'd list them out below in no particular order. If the changes I've noticed are really all down to having a pituitary tumour removed, it's amazing to think just how much of your body is controlled by this unassuming little gland the size of a pea.....

Things that stopped after the operation
Black eyes
Deb sometimes used to say it looked like someone had punched me in the face....she probably felt like doing so on many occasions! But I had these black lines from the corner of my eyes down underneath at a diagonal. I just assumed it was an ageing thing (like so many of my other symptoms) but they have largely disappeared. Don't know why

Muscle spasms in the morning
When I woke up, sometimes the muscles in my back and legs would spasm and lock solid, I'd go rigid as a board. It would take a few attempts before I could move. Again not sure what that was all about, but I don't get it now.

Hip ache
Another one I'm not sure of, I used to get bad hip ache whilst laying in bed....I don't now. We did get a new bed last year, so perhaps it is down to that.

Nearly fainting and sweating when exercising
This is more explainable. Because of my lack of Cortisol, I really struggled with my stamina and fitness and would just run out of juice when exerting myself. We would go out for walks, and I would have these unexplainable crashes where I would sweat a lot and feel dizzy and nearly faint. Needless to say, I don't have these now, although I do still have the odd energy crash - but I am much better at spotting when these are coming up (just before my due tablet dose normally) so a quick tablet, drink and food and I'm sorted. When my low Cortisol was first diagnosed, my GP said he couldn't understand how I was still going at all with such a low level in my body....I found that statement strange at the time, but I understand it a bit more now.

Funny vision
Again very explainable, the tumour was pressing on my optic nerve so the funny black spots in my vision that I could never quite pin down, if only I'd known that these were an early symptom. Shame the eye specialist I visited didn't spot the issue when I saw him. Eyesight is all normal now.

Pale complexion
As soon as my consultant saw me, he said I looked like the typical Pituitary patient, a pale complexion and thin face. The times people said to me "are you ok, you don't look very well" - of course I thought I was fine. Well now I have a much more colour in my cheeks and have put some weight on, so look (and feel) a lot more healthy.

Dry skin
Another feature of lack of hormones can be dry skin, which I certainly had. It is a lot better now, but still have some areas that need attention. Also for many years I had a patch of dermatitis/eczema on the top of my head which I couldn't get rid of, that disappeared within a couple of months of my operation....I can't think that it can have been for any other reason.

Hayfever
About 10-15 years ago I started getting hayfever, I never used to have it when I was young. All the normal symptoms, sneezing, itchy eyes, streaming nose & occasional coughing fits. Not bad hayfever by a lot of people's standards, but annoying enough. However, since the operation, it's gone. I really don't know why, either it is because my sinus passages have been rummaged around in during the surgery or having the right hormones in me has sorted me out. My working theory is the latter, because as the tumour kicked in over several years and put my hormone balance out of kilter, so the hayfever appeared - now they're sorted, it's gone. Who knows, but I'm glad it has gone!

Being cold
[added 29/05/2014] Forgot about this one! The final 6 months or so before the operation saw be being frequently cold, really feeling the cold like I'd turned 80 years old. This has gone now, and I think is down to having the correct hormones in my system, particularly Cortisol. Blooming good job too, it is much nicer being toasty all the time :-)

Mouth ulcers
[added 10/06/2014] Just thought of another one. When I bit the inside of my mouth, more often than not it would turn into an ulcer - painful little blighters...I probably had one a month before. Well, although I still bite the inside of my mouth every so often, I haven't had a single mouth ulcer since my operation, not one. My body must be producing efficient anti-ulcer hormones now.

Things that have changed since the operation
Tastes
After I got better from my second stay in hospital I suddenly got a taste for a few different things, some of them revolved around sweet things such as fruit. To this day I enjoy fruit a lot more than I ever did...melons, oranges/satsumas, pineapples, grapes, mangos etc. along with Coke, lemonade and orange squash....All go down a treat. I also enjoy the odd alcoholic beverage more than I used to, particularly cider. Perhaps there is that fruit link again!

Fingernails
I had very 'ridged' fingernails before my operation, then afterwards there was a distinct line across all my fingernails where they suddenly started growing much more normally. They continue to do so to this day, as if I was lacking something before. They look much more healthy now and are less brittle.

Weight
As mentioned above, I've recently put some weight on....at just under 11 stone (70kg) it is the heaviest I have been in a long time. After my second stay in hospital I was under 10 stone and it took quite some time to get back to my normal weight of 10.5 to 10.75 stone. It is the weight I have been for years and probably about right for my 5' 6" frame. I'm not panicking or going on a diet just yet, but I'll keep an eye on my weight, I like to think the weight gain is all muscle ;-)

Diabetes Insipidus
I haven't mentioned this for a while, as I think finally I am finally getting over the mental scar it left me with. I had it twice during my recovery and it was a result of my surgery. I think it has gone for good now, which is fine by me. Good riddance Diabetes Insipidus.

Lost sensation/tingly foot and leg
This isn't anything to do with my tumour or operation, but it is something I have now that I didn't have before. Tests are still ongoing, but I get the feeling there is nothing to be done except hope it will heal itself in time. It doesn't stop me doing anything, it is just a niggle that I wish wasn't there....

Cramp
I never used to get cramp, but ever since my operation I have in my legs, toes, jaw and fingers/hands. Sometimes just my thumb would lock up whilst I was gripping something, or my calf muscle would lock solid in the middle of the night. I never appreciated just how painful a locked calf muscle could be, so cramped that I could stand on the leg and I couldn't push my foot back to a normal position. I've thought there were various reasons for this over the months, hormones, lack of exercise, lack of salts, dehydration etc. as the months have progressed I've discounted each one. No-one could give me a definitive answer, although Indian Tonic Water did seem to help, as it has Quinine in it (thanks to Jean the Portsmouth QA Endocrine nurse specialist for that tip). However, of late I have (on the advice of my consultant) upped the dose of my Testosterone and suddenly the bouts of cramp are all but gone. Could be a coincidence as I haven't changed anything else, I've been 3 or 4 weeks virtually cramp free and not drinking the tonic water.

Nervousness/making me jump
I used to be a bit of a bag of nerves, it was very easy to make me jump. I hadn't really thought about it lately, but it suddenly occurred to me that I'm not like it now. Presumably being pumped with the right hormones has put something straight.

Mucky nose
A result of the endoscopic nose surgery unfortunately. I do still get a mucky nose and a bad smell up the nose periodically, not badly - in fact it is better than it was - but something I'll probably put up with in the hope it will sort itself out. Probably if I got a referral to the ENT department the first thing they'd want to do is stick a camera up my nose to have a poke around....and that's what caused it in the first place...so I'm thinking I'll avoid this if possible. As long as it doesn't get any worse it'll be fine.

Hair
[added 29/05/2014] I've always had quite fine lank hair. But for whatever reason, probably the Testosterone, my hair is thickening up now and getting some body to it. Strange really, with the male hormone installed I expected all my hair to fall out! In fact it looked like it was going to for the first couple of months on Testosterone, but it seems to be regrowing with vigour. I'd rather that way around than being a baldie!
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So one year on, what gives?
So how do I feel after the last year? I think the best phrase/words I can come up with are "a hell of a lot better" and "lucky". I am lucky in that I eventually went to the doctors and got checked out, and that the tumour I had was benign and still of a size which could be removed without major permanent damage. There is also a certain amount of luck (or maybe fate) involved in the type of tumour I had, how big it had got and how I recovered from it. I have learned that there are many different types of tumour, each tumour can have different effects and even someone with the exact same type of macro adenoma that I had may not experience the same outcome as me. I have just two hormones deficient at the end of the process (Testosterone and Cortisol) whereas other people may have had no Pituitary function or full Pituitary function and anywhere in-between....depending on the success of the surgery and how their body healed. 

There is no luck element in the diagnosis and removal of the tumour, that was much more about skilled doctors practising evidence-based medicine at their very best. 

Dr Kar (Endocrinologist) in Portsmouth QA Hospital and Mr. Mathad (Neurosurgeon) in the Wessex Neuro Centre in Southampton UHS Hospital worked together as one team and, in order to protect my eyesight, only 10 days after the MRI scan that confirmed my tumour, it was removed. Amazing. (not forgetting the unseen NHS teams that support all this great work) 

(I can't emphasise this next bit strongly enough.....) Can you even imagine the skill needed to put endoscopic surgery tools up someone's nose through their sinuses & skull and into the base of their brain and extract a 3cm tumour to the point where virtually/totally none of it is left - doing all that whilst avoiding any damage to vital parts of the body such as carotid arteries, optic nerves and of course the Pituitary gland itself. It's mind-bogglingly incredible, that's what it is, my hat gets tipped in your direction Mr Mathad.

As for my health and fitness now, I take it a lot less for granted than I did. I spent a large chunk of my life being fit and healthy because of being young and being in a job that kept me fit (Postman) so I didn't really think much about that side of things. Now I realise that I need to work at staying fit, that health will only stay if you look after it more. Have I become the perfect fitness and health machine, no I haven't....but I have more determination now than ever before to make sure I keep up my activity levels to give myself the best chance of living to a healthy ripe old age. I'm walking several miles every week, going to Pilates classes and doing some light weight training. My parents both vegetated as they got older, they didn't see the point in doing much in their retirement....my Mum had dementia when she died and it looks like my Dad has it too. I don't want to go that way....as the saying goes "live every day as if it is your last".



As for future pituitary blog updates, I don't plan on doing many more updates to this blog. I think it has run its course now, one year of me rambling on about my operation and my experiences is probably enough now. I may revisit from time to time, I may even kick off a 'general' blog about stuff, we'll see. I hope you've enjoyed reading my story, if you are a pituitary patient I hope some of this helped. 

A quick word of thanks to www.pituitary.org.uk who provide a huge amount of support on their website for Pituitary patients. I've used the site a lot.

Anyway for the time being, bye bye.

Cheers, Carl.

Sunday 25 May 2014

May 2014 - The other side of the story

During the last year, I've talked a lot about my experiences, what I've had to face and my recovery. But the side of the story that isn't told in this blog is that of my wife's. She isn't really that bothered about telling it either, blogging wouldn't be her style and in fact we haven't spoken that often about how she felt during the period of a year ago. So unless Deb decides otherwise, her story will remain largely untold.

It is all too easily overlooked how our loved ones cope with a worrying situation like ours, that they have to just get on with life and still do the things that need doing. Deb is certainly someone who does "just get on" with stuff. On reflection, the person affected, having the operation, being in hospital has somewhat of an easier deal....or at least that is the way I'm looking at it now. I was the one with all the different things happening, things to take my mind off what was about to happen. I lay in a hospital bed with all sorts of unusual things happening, blood tests, xray's, ECG's, blood pressure, life in a busy hospital ward (D Neuro)....not very pleasant in the moment, but a diversion away from what was coming up (an operation). But my wife, sat at home on her own with our dog for company, still needing to cook meals, go to work and run the house but all the time knowing a loved one is not well and that can't have been easy. We have talked about her point of view of the whole thing, and in some ways it was very different to mine. She could see how worried I was, of course I was trying to hide it...a pointless task trying to hide emotions from a loved one, it never works. Then the 2nd time I was in hospital when I was arguably a lot more ill than after my operation - that time I had no clue how ill I was, because of course I was pretty ill! Deb however saw in graphic detail just how ill I was and having chatted a bit about it, it was clear how frightening it was for her. I regret not having paid more attention at the time, but it's done and dusted now and it all worked out in the end. 

Today was another anniversary, the day the Wessex Neuro Surgery department in Southampton general hospital rang me up and "invited" me to go for surgery. We had a busy day in the garden on the 25th May 2013, it was a bank holiday weekend, and the weather was lovely. We had grand plans to turn the garden around, we had been a bit behind sorting things for one reason or another. We were sat watching telly having had the traditional Saturday evening pizza dinner when the phone rang. It was a Southampton number and the first thing that popped into my head, was "it's the hospital". I don't know why I thought that, because I had no reason to, but I think I just knew. I didn't realise they were going to say "come in tomorrow", I was thinking more along the lines of "you've been referred to us by Dr Kar in Portsmouth, come in for an appointment to see the surgeon and discuss"....but of course they were highly unlikely to do that on a Saturday evening were they! So sitting there dazed and confused on a bank holiday Saturday evening, it dawned upon us both that I was going to have an operation, my very first operation. My very first brain operation on my very first tumour. 

Bloody hell!

Sunday 18 May 2014

May 2014 - the MRI scan anniversary

Yep, today the 18th May, 1 year ago today since I went to the QA Hospital in Portsmouth and had the MRI scan that detected my pituitary tumour.

I couldn't possibly have known the sequence of events that would unfold as I lay there that day, being scanned....all sorts of thoughts were running through my head. But it still hadn't really dawned on me that it could be a tumour, and that if it was that I would need an operation. I think I had blocked those thoughts out and in the absence of any hard facts, I had my head well and truly buried in the sand. Quite natural I suppose.

But that's all I've got to say for today...I've been busy preparing a bit of a mega-posting for a bit later on this month ;-)

Friday 9 May 2014

May 2014 - quick update

Not really much going on right now - I've been preparing a blog post to mark the anniversary of my operation...thinking back on all that has happened. I am around 2 weeks away from the anniversary of my diagnosis and under 3 weeks away from the anniversary of my operation. It seems incredible how fast time has flown by.

The only update really is on my cramp. Ever since the operation I have suffered with cramp in my calf, toes, fingers and jaw. I never suffered cramp before, so clearly something in my body has been out of balance. That has changed recently though, with the increased dose of Testosterone. At least that is what I am assuming, because it is the only thing that has changed. When I had my last blood tests my Testo levels were still low so the dose was upped slightly and has been upped again slightly. On the second increase the cramp seems to have stopped. Only time will tell as to whether it stays away.

Other than that a quick rant about our 111 service (out of hours doctors telephone number). We phoned the service on behalf of my dad, nothing too urgent but on balance it was something worrying me enough to contact them. Initially everything went well, a clinician rang dad and she thought it was worthwhile getting a doctor to ring dad. Unfortunately dad wasn't as communicative with the doctor as he was with the clinician. So we had a confused doctor leave us a message on our answerphone asking to call him back via the 111 service. So we duly rang the 111 service quoting the reference number the doctor had given. We got the follow reply from the contact centre operative:

"oh sorry, when you rang this morning you spoke to a different 111 call centre and we haven't got access to the same computer system as them so we can get access to details about the call. You will have to give us all the details again".

What the heck!! So go through it all again we did, different clinician and doctor ring dad again and come to the conclusion he was probably fine. But how on earth can you run a national service like that and not be able to share call details between centres. Madness.

Rant over.... :-)