Kristy

The Anderson Network's "Ask the Expert" message board will be taking questions regarding bone health June 2 through June 6. Dr. Rena Sellin will be available to answer your questions about osteoporosis and other bone health issues. To submit questions, log on the message board at www.mdanderson.org/asktheexpert. Please note that the board will only be open for questions this week but past topics are archived and available to read. The questions are probably geared to bone health after Cancer, but I don't see why questions won't be answered after Cushings either, as Dr. Sellin is part of the Pituitary endocrine team at MDAnderson.

Movin' on up... to the top....

More... So, Dr. Lang... I know us Pit Patients don't have malignant brain tumors... but what about a virus for pit tumors?" (nose against the glass) "Smart Virus Eliminates Cancer in Animal Experiments A research team led by M. D. Anderson has tested a novel ?viral smart bomb? therapy that can completely eradicate brain tumors in mice while leaving normal brain tissue alone. The therapy, known as Delta-24-RGD, is thought to be the first treatment for malignant glioma, the deadliest form of brain cancer. It is a new-generation ?replication-competent oncolytic? adenovirus therapy, defined as a therapeutic virus that can spread wavelike throughout a tumor, infecting and killing cancer cells. There is no adequate treatment for these deadly brain cancers. Before this study, few experimental therapies tested in animals have shown much improvement. The findings, published in the May 7 issue of the Journal of the National Cancer Institute, are considered so promising that the National Cancer Institute is providing financial support to produce, in its own labs, a drug-grade version of the therapy to test in humans, possibly by late next year. Researchers also are collaborating with the U.S. Food and Drug Administration on the treatment. ?We believe this therapy has a lot of potential, but one that needs much more study,? says lead author Juan Fueyo, M.D., an assistant professor in the Department of Neuro-Oncology and the study?s lead author. ?We've never seen this kind of response before with any other treatment tested in either animals or humans.? Delta-24-RGD is designed in such a way that it can replicate only in cancer cells, not healthy tissue, in order to reproduce itself while killing the host cancer cell. It moves on to contaminate other tumor cells, and when no more cancer cells are left to infect, the virus itself dies. ?Biologic viral therapy like this may be just what we need to treat a complex disease like cancer,? says Frederick Lang, M.D., an associate professor in the Department of Neurosurgery, a primary investigator of the study. ?Cancer can be devious in that it does everything possible to evade destruction. But viruses are equally tricky in their quest to invade cells and propagate. ?In this experimental war between cancer and a viral therapy, the virus won,? Lang says. ?Of course, we hope to obtain similar results when patients are tested, but we cannot predict such success based on animal studies.? Fueyo, Lang and a team of researchers from M. D. Anderson, the University of Alabama at Birmingham and the Institut Catal? d?Oncologia in Barcelona, Spain, found in repeated experiments that more than half the mice that had human glioblastoma tumors implanted in their brains and treated with Delta-24-RGD survived more than four months, whereas untreated mice lived less than three weeks. The mice were considered clinically cured of their brain tumors. Investigators found only empty cavities and scar tissue where the tumors had been. Recent advances in the understanding of brain tumor biology have led researchers to target molecular defects in brain tumors. At M. D. Anderson, researchers have focused on a gene and protein product that malfunctions in nearly all malignant gliomas as well as in many other solid tumors: the retinoblastoma (Rb) protein. Found in all cells of the body, an Rb protein acts like a brake on cell division by preventing certain other regulatory proteins from triggering DNA replication. If the Rb protein is missing or nonfunctioning, a cell can replicate itself over and over, resulting in the development of a tumor. In normal cells, the Rb protein also prevents a virus that enters a cell from replicating. Adenoviruses, however, counteract that defensive measure by expressing their own protein, known as E1A, which binds to Rb to stop it from functioning. That allows the common cold virus to ?take hold? and spread in human cells until the immune system has a chance to destroy it. The Delta-24-RGD therapy is designed to take advantage of the mutant Rb protein in cancer cells by introducing a virus with a nonfunctioning E1A protein, researchers say. Investigators created a new virus with a 24-base pair deletion in the adenovirus E1A gene so that the malfunctioning E1A protein cannot stop Rb from functioning, allowing the virus to infect and kill only cancer cells. A healthy cell with a normal Rb protein can successfully defend itself against the virus, researchers say."

Altered cold virus kills brain tumors in mice WASHINGTON (AP) ? Scientists have genetically altered a common cold virus so that it can destroy the most lethal type of brain tumor while not harming healthy tissue nearby. The experiment worked so well in mice that researchers hope to begin studying it in people with this aggressive brain tumor, called a glioblastoma, late next year. The scientists implanted human glioblastomas inside the brains of mice, then injected the experimental virus directly into the tumors. Untreated mice died in 19 days, but 60% of the treated mice were alive and thriving for four months. Then scientists euthanized the survivors to see what was happening inside their brains ? and found only empty cavities and scar tissue where the tumors once were. "Everyone here is excited about it because we've never seen anything happen with the mice like that," says lead researcher Dr. Frederick Lang, a neurosurgeon at Houston's M.D. Anderson Cancer Center. He cautioned that the dramatic results don't assure the virus will work in people: Scientists have cured lots of mice of cancer only to see the therapies fail in patients. "This is an interesting study," said Dr. Len Lichtenfeld of the American Cancer Society. But he echoed Lang's caution, adding that mutant viruses could prove too toxic to use. "We need to be very, very careful" in studying the experimental treatment, Lichtenfeld said. "There are too many situations where doctors and patients and families have gotten very, very excited about drugs and it's turned out ... that the drugs weren't effective. We need to avoid that." Still, the National Cancer Institute is intrigued enough that it is providing $1 million to produce enough of the mutant virus to begin human testing, said Lang, who hopes to start enrolling brain-tumor patients in a study of the treatment by winter 2004. The virus should target other solid tumors, too, he said. But "if there's any disease that needs a novel approach, it's really brain tumors," said Lang, who reported the experiment in this week's Journal of the National Cancer Institute. Glioblastomas are the most common primary brain tumor in adults, striking about 7,000 Americans a year, and the most lethal. Survival is only about a year, a dismal rate that hasn't changed in decades despite improvements in surgery and radiation and chemotherapy treatments. So how could the mild, sniffle-causing adenovirus tackle such a killer? Before the immune system detects and eliminates a cold, adenovirus spreads by infecting a cell and hijacking its reproductive machinery to make viral copies, killing the cell in the process. The key is to harness the adenovirus so it infects only tumor cells and not healthy tissue, something scientists have tried with limited success since the mid-1990s. This latest attempt uses a different approach. In normal cells, the retinoblastoma, or Rb, protein helps block an invading virus from reproducing. Rb protein also can block the uncontrolled cell division that is cancer's hallmark ? and thus solid tumors lack properly functioning Rb. Adenovirus contains a gene that disables Rb so it can take over healthy cells. M.D. Anderson's Dr. Juan Fueyo altered that gene, leaving a virus capable of infecting Rb-lacking cancer cells but not healthy cells. However, that mutant virus was relatively weak. So the next step was another genetic alteration that made it easier for the adenovirus to invade by binding to molecules called integrins that are common on the surface of cancer cells. The resulting virus, dubbed "Delta-24-RGD," swept through some ? but not all ? of the mouse brain tumors like a wave, leaving dead cancer cells in its wake. The big question is whether people's immune systems will attack the mutant virus before it can penetrate and spread through a brain tumor. The virus would have to be injected through the skull directly into the brain tumor, which could delay the immune reaction. "It's going to be a race," Lang said. But "our studies suggest that there's a certain window of time between the immune system gearing up and the virus being stopped." You can read about Dr. Lang Here Another version... "WASHINGTON (AP) - Scientists have genetically altered a common cold virus so that it can destroy the most lethal type of brain tumor while not harming healthy tissue nearby. The experiment worked so well in mice that researchers hope to begin studying it in people with this aggressive brain tumor, called a glioblastoma, late next year. The scientists implanted human glioblastomas inside the brains of mice, then injected the experimental virus directly into the tumors. Untreated mice died in 19 days, but 60 percent of the treated mice were alive and thriving for four months. Then scientists euthanized the survivors to see what was happening inside their brains - and found only empty cavities and scar tissue where the tumors once were. "Everyone here is excited about it because we've never seen anything happen with the mice like that," says lead researcher Dr. Frederick Lang, a neurosurgeon at Houston's M.D. Anderson Cancer Center. He cautioned that the dramatic results don't assure the virus will work in people: Scientists have cured lots of mice of cancer only to see the therapies fail in patients. "This is an interesting study," said Dr. Len Lichtenfeld of the American Cancer Society. But he echoed Lang's caution, adding that mutant viruses could prove too toxic to use. "We need to be very, very careful" in studying the experimental treatment, Lichtenfeld said. "There are too many situations where doctors and patients and families have gotten very, very excited about drugs and it's turned out ... that the drugs weren't effective. We need to avoid that."

I had read this in other publications, but when I saw this on the AACE website, I thought I'd share... http://www.aace.com/pub/press/releases/index.php?r=20030425 Study Projects Growing Shortage of Doctors Specialists Who Treat Diabetes, Infertility, and Obesity in Short Supply as Need Grows (Alexandria, VA) - Endocrinologists, the doctors called upon to diagnose and treat complex hormonal disorders such as diabetes, thyroid disease, osteoporosis, obesity and infertility, are already in short supply, and that shortage will grow even worse over the coming years, according to a study jointly commissioned by the American Association of Clinical Endocrinologists (AACE), American Diabetes Association (ADA), The Endocrine Society. The study, an interactive workforce model of supply and demand to the year 2020, is being published in the May issues of the journals Endocrine Practice, Diabetes Care and The Journal of Clinical Endocrinology & Metabolism. The news comes on the heels of reports that health problems treated by endocrinologists such as obesity and diabetes have reached epidemic proportions in the United States. Currently, more than 17 million Americans are living with diabetes and its related complications. The prevalence of type 2 diabetes and obesity among children has also been increasing, signaling a growing need for care now and especially when this generation reaches adulthood. The study, conducted by the Lewin Group, predicts that already-long delays in getting appointments with these specialists will rise by 2020 unless the number of new endocrinologists entering the field increases. According to the study, the current supply of endocrinologists is 12 percent less than demand. What's more, the number of endocrinologists entering practice dropped from 200 in 1995 to 171 in 1999--a decline of nearly 15 percent. Increasing pressures on medical practices, such as administrative burdens, low reimbursement rates, and lessening autonomy, are also likely to increase retirement rates among practicing endocrinologists, contributing to the shortage. The study examined the number and demographic characteristics of endocrinologists presently in the workforce; the number of fellows currently in endocrine training programs; the effect of age and retirement rates on the size of the workforce; and factors that influence the demand for endocrinologists. "As our population ages and the complexity of medicine increases, the need for endocrinologists to treat patients with diabetes, thyroid disorders, and other hormonal disorders will increase," said Dr. Robert Vigersky, the Chairman of The Endocrine Society's Clinical Affairs Committee and the corresponding author of the study. "This study demonstrates that the current supply of endocrinologists is insufficient and will remain far short of the need for them until 2020 and beyond. While the reasons for this shortage are multifactorial, it is critical that we look for ways to meet the demand so that patients can receive the care that they need and deserve." According to the study, the current supply of endocrinologists is 12 percent less than demand. What's more, the number of endocrinologists entering practice dropped from 200 in 1995 to 171 in 1999--a decline of nearly 15 percent. Increasing pressures on medical practices, such as administrative burdens, low reimbursement rates, and lessening autonomy, are also likely to increase retirement rates among practicing endocrinologists, contributing to the shortage. At the same time, the demand for endocrinologists has been climbing and will continue to do so as the population ages and the prevalence of diseases such as diabetes, osteoporosis, and hypothyroidism increases. "As people in the United States become more overweight and diabetes continues to grow in prevalence, the specialized expertise of endocrinologists will be increasingly important," said Dr. Robert Rizza, incoming vice president of ADA and lead author of the study. "We need to take steps to stop the ongoing decline in the number of endocrinologists in training and find a way to expand the number of endocrinologists in practice in the years ahead." The study also found that there were twice as many office visits to endocrinologists between 1996 and 1998, compared with 1993-1995. Additionally, Medicare shows a 25 percent increase in office visits to endocrinologists from 1995 to 1998. Dr. Hossein Gharib, president of the AACE, said, "As a practicing endocrinologist seeing patients every day who directly benefit from the knowledge of a physician trained to treat their specific disorder, I am concerned that in the near future these and other future endocrine patients may not receive the quality of care needed for these highly complex and difficult diseases." Please visit the referring webpage at http://www.aace.com/pub/press/releases/index.php?r=20030425 for more information. We support our doctors! (If you know anyone in medical school...) :but:

Here is a brand new article on Cushings from Endotext. CUSHING'S SYNDROME Chapter 7 - Damian G. Morris and Ashley B. Grossman December 6, 2002 INTRODUCTION Cushing's Syndrome results from chronic exposure to excessive levels of glucocorticoids: its investigation and management remains an on-going challenge in clinical endocrinology. Although the condition is considered rare, the clinical spectrum of the disease is broad, and its investigation is frequently required given the high prevalence of many of its non-specific symptoms such as obesity, muscle weakness and depression. Clinicians are now considering the diagnosis in its earlier manifestations, often before the development of the more classic signs and symptoms as described by Harvey Cushing early in the last century. In its severe form and when untreated, the metabolic upset of Cushing's syndrome is associated with a high mortality, approximately 50% at five years (1) . However, more subtle excesses of cortisol may have significant effects on glycaemic control and blood pressure, and may therefore be an important cause of morbidity. http://www.endotext.org/neuroendo/neuroend...oendoframe7.htm TOC: INTRODUCTION PATHOPHYSIOLOGY & ETIOLOGY CLINICAL FEATURES BIOCHEMICAL CONFIRMATION OF CUSHING'S SYNDROME Circadian rhythm assessment Urinary free cortisol Low-dose dexamethasone suppression test Other tests THE DIFFERENTIAL DIAGNOSIS OF CUSHING'S SYNDROME IDENTIFYING THE SOURCE IN ACTH-DEPENDENT CUSHING'S SYNDROME Non-dynamic tests Dynamic tests High dose dexamethasone suppression test The metyrapone test The CRH test Testing with other peptides Inferior petrosal sinus sampling IMAGING Pituitary Adrenal Ectopic tumors TREATMENT OF CUSHING'S SYNDROME Surgical Management Transphenoidal surgery Adrenalectomy Surgery for the ectopic ACTH syndrome Radiotherapy Pituitary Other Tumors Medical Management Adrenolytic Therapy Neuromodulatory agents 5-HT Antagonists Dopamine Agonists Bromocriptine Somatostatin Analogues GABA Agonists Glucocorticoid Antagonists Monitoring Treatment Future Strategies for medical agents CONCLUSIONS

Thank Lynne for moving this topic up! The group had talked a little about Dr. Vance's views on pituitary radiation. It is good to see some of her published work too! I've posted some new research on the cerebral vascular risk factors under the Radiation subtopic. This set of articles applies to pituitary patients. Two seperate research articles from two seperate institutuions in two seperate medical journals were recently published. The topic is Risk Factors for Cerebrovascular Deaths, in Patients Operated and Irradiated This Blue Link will take you to the forum. I think it is important to know all of the benefits and risks to radiation for pituitary tumors. If you are going to have radiation, be well informed to your disease presentation and the long term successes and risks associated with the procedure.

Whew, that is some technical paper... I wish they'd put in an animation to show us how it works! Jinxie, that is my diagnosis... hypercortisolemia. I also tend to be cyclic too. I have had the differential diagnosis for depression, Polycystic Ovarian Syndrome, and Cortisol Resistence. I have none of the above. There has been some talk that my job is stressful and that is my problem. My question is Why is the hypercortisol issues not more constant then? Noone knows why. I have peaks and valleys over the 2 years I have been watched. My job stress, or lack of it, is pretty constant. I have the pituitary tumor... and even a second one, yet, it cannot be determined with conventional testing if cells in those tumors are behind my woes. If you have hypercortisolemia, your doctor will begin the differential diagnosis to try to figure out what is behind the hypercortisolemia. Is it Cushing's? Or is it something that looks like Cushing's. I hope your diagnostic process goes quickly. For now, I am being watched. I try to not worry about it. I am being kept a close eye on. I can't ask for better. I have really terrific docs. Maybe one day, my body will reveal what the real problem is and then I can get things straight. Now... I am moving forward (that is the only direction to go). The only thing I really have to complain about now is since I started my diabetes meds... I have the worst nightmares. k

Long-Acting Growth Hormone Study Trial Information Summary: Long-Acting Growth Hormone Study Protocol The purpose of this Phase I research study is to determine if an investigational, long-acting growth hormone preparation is safe for human use, to measure its levels in blood, and to determine the most effective dose to give to patients who produce less growth hormone than normal. If you qualify for this study, you would receive either a single dose of the long-acting growth hormone or two doses 7 or 14 days apart. If you receive a single dose, you would spend 24 hours immediately thereafter as an inpatient in the Clinical Research Center at the University of Pennsylvania and then make 12 or 13 outpatient visits there during the next 27 days. If you receive two doses, you would spend 24 hours as an inpatient at the Clinical Research Center after each of the two doses and then make 17 or 18 outpatient visits there during the next 34 days. Select the Blue Link. Hypopituitary Control and Complications Study Dr. Stanley Korenman of UCLA's Division of Endocrinology is conducting a study to look at the effects of the long-term use of Growth Hormone Therapy (Humatrope, an FDA approved medication). The study involves measurements of blood levels of hormones, bone density and body fat every 6 months for 5 years (a total of 11 visits). Select the Blue Link. You can find more clinical trials here.

Wow... that is double from the last budget. This is great news! Thanks Sue!

Adrenal incidentalomas can inhibit nocturnal TSH surge October 7, 2002 NEW YORK (Reuters Health) - Small adrenal tumors discovered "incidentally" on CT imaging are usually considered harmless, but findings from a new study indicate that such incidentalomas may actually inhibit the normal nocturnal surge in thyroid-stimulating hormone (TSH) levels. Dr. Vittorio Coiro, from the Universita di Parma in Italy, and colleagues compared the thyroid function of 8 patients with incidentalomas and 10 healthy control subjects. The researchers' findings are published in the September issue of the Journal of Investigative Medicine. Incidentaloma patients had lower nocturnal serum TSH levels than healthy controls (p Serum free T3 and T4 levels were comparable in both groups, the researchers point out. However, the TSH response to thyrotropin-releasing hormone was attenuated in the incidentaloma group. Incidentaloma patients also had significantly higher urinary free cortisol levels than control subjects. The current findings "support the hypothesis that even conditions of slight glucocorticoid excess," such as incidentalomas, can have an impact on TSH secretion, the authors state. J Investig Med 2002;50:350-355. :music:

My neurologist told me that one day, it might be possible that a tracer may be developed to target pituitary tumors and the days of pituitary surgery may be a thing of the past. He explained that the tumor may be able to be destroyed from within, non-invasively. I just wondered about that... and I still wonder. I know we aren't there yet, but I was intrigued to read this article on brain stem tumors this morning. Technique could one day treat deadly brain tumors Last Updated: 2002-10-04 13:01:06 -0400 (Reuters Health) By Amy Norton NEW YORK (Reuters Health) - If new animal research holds up, scientists may have found a way to deliver drugs directly to brainstem tumors that are currently incurable. The technique, developed by researchers at the US National Institutes of Health (NIH), was found to safely deliver a so-called "tracer molecule" to the brainstems of monkeys. What's more, researchers were able to use MRI scans to see that the agent was evenly dispersed in the brainstem region they targeted. This is significant because conventional chemotherapy, when it can cross the "blood-brain barrier" that shields the brainstem, does so in an ineffective, non-targeted way, Dr. Russell Lonser, the study's lead author, explained in an interview with Reuters Health. Because of a lack of effective therapy, brainstem tumors called diffuse pontine gliomas, which primarily affect children, are "universally fatal," Lonser noted. The hope, according to the researcher, is that this new drug-delivery technique can be used to treat these tumors, as well as other diseases of the brain. Lonser and his colleagues at the NIH in Bethesda, Maryland, report the findings in the October issue of the Journal of Neurosurgery. The drug-delivery technique, called convection-enhanced delivery (CED), involves using a cannula--a thin, flexible tube--to deliver fluid directly to the brain region to be treated. CED uses small differences in pressure to make infused compounds flow between cells and disperse in tissue. Lonser described the approach as "very targeted...You don't have to fill the whole central nervous system up with the drug." He and his colleagues found that they could safely infuse the brainstems of monkeys with a molecule called Gd-albumin, which they were then able to track using MRI scans. They found that the technique spread the molecule uniformly throughout the treated region. Gd-albumin molecules are similar in size to the molecules of many cancer drugs, and Lonser said these findings indicate that doctors would be able to track drugs in the brainstem should the CED technique be used in humans. He and his colleagues are currently trying to figure out which drugs might be useful. Lonser said they also believe the drug-delivery technique "could have widespread application" in treating other diseases of the brain, including Parkinson's disease and other neurodegenerative conditions. SOURCE: Journal of Neurosurgery 2002;97:905-913.

When I saw this article, I thought it was important to post it... seems that it hit a little nerve too. Let's see here. When I was first going through testing, I saw my pcp (been seeing him for 4 years). I had a sinus infection. While I was there, I told him that I saw an endocrinologist and that a pituitary tumor was found. He asked me if the tumor was hormone secreting. I told him that I did not have my labs with me, but I remember that there were some elevated hormones. He was in a hurry. I told him that testosterone was mildly elevated, that TSH was mildly elevated, and prolactin was mildly elevated... and He interupted me and told me that I could be on drug therapy for my prolactin and everything would be just fine. He handed me a script for antibiotics. I tried to tell him there was one more... He was out the door before I could say cortisol. Oh, that wasn't the first time that had happened, so I changed my pcp. Your experience, Valerie, is one of the pitfalls of having a case managed at a teaching facility. The patient is the "teacher". My personal charge out rate is...

Two minutes is all most patients need to tell their story September 27, 2002 LONDON (Reuters Health) - Physicians who let their patients tell the full story of their complaints do not risk listening for hours, Swiss researchers report in the September 28th issue of the British Medical Journal. In fact, they found that the majority of patients finished their litany within 2 minutes. US physicians give patients an average of 22 seconds before they take the lead in the conversation, probably because they are afraid patients will "mess up" their schedule if allowed to go on, note Dr. Wolf Langewitz and colleagues from University Hospital in Basle. But this fear has not been systematically put to the test. The researchers equipped physicians in the outpatient clinic of a department of internal medicine with a stopwatch, which they surreptitiously started at the beginning of the conversation and stopped when the patient said, "What do you think, doctor?" or otherwise indicated they wanted the doctor to take the lead. Of 335 patients seen by 14 doctors, the mean talking time was 92 seconds, and 78% of patients had finished talking within 2 minutes. Only seven patients talked for more than 5 minutes. "Even in a busy practice driven by time constraints and financial pressure, 2 minutes of listening should be possible," the researchers write. "We gathered data in a tertiary referral centre that is characterised by a selection of difficult patients with complex histories," they point out. "Patients in less selected groups might need even less time to complete their initial statement." BMJ 2002;325:682-683.

I noticed he joined too... guess he wanted to message MaryO. Oh... I think we have other doctors that lurk too . Wonder if they will join CUSH? baaa.gif

Good point.. Tammy Goode. There is some research that discusses the incidence of these tumors is higher in patients who have had a family member that has clinical depression or alcoholism too. I cringed when I read that. I am not a high stress person...but I do have that depression and alcoholism tendency on one side of my family. Perhaps with that tendency there and when a series of motions went into effect during a time in my life and some of those amino acid and chemical messenger switches did get stuck in the "on position"... and even though I have made lifestyle changes and I don't drink, don't smoke, have a stable marriage, and a good job... it wasn't enough to overcome. I spend quite a bit of time working through the mental aspects of having pitutiary disease just so I can function. I don't blame myself or others around me. I had a hard time when I was told I had one pituitary tumor. I had a hard time adjusting when I was tested for Cushings the first year. I was really thrown for a loop when I was told I had the stalk tumor and the stalk thickening and I am still wondering what lies ahead. Part of me wants to tell the whole bunch to take a long walk off the deep end and leave me alone... that I've had enough. Tammy Goode, why do I have to see how it is on your side of the fence? I appreciate your point of views on matters ever so much as I continue through my own journey. In short... don't blame yourself for what was... but do try to do what you can to heal yourself the best you can. You do have to live in the present. The healing process is a mind body spirit process. I am learning though, that it begins at diagnosis. You are not a victim... you are a survivior. Always remember that the doctors that research us patients have never walked a mile in our shoes... they just tie our shoelaces. There is so much medical science just does not know.

My neurologist, Dr. Randolph Evans, has published many papers on the use of this drug for migraine prevention. I am one of the few of his patients that have not lost weight on this drug (imagine that)... But, I do believe that it has helped me from gaining more than the ten pounds that I gained this last year. An office mate of mine does have epilepsy and does take this drug, and she has lost 40 lbs... and looks wonderful! The drug can give you the tinglies in your hands and feet and this is easily remedied (from what Dr. Evans told me) with potassium supplements. It worked for me. I also realized that I needed to keep up my multivitamins too. Sometimes, I still have migraines. I have a 'buster' for those and they only come maybe once a month now. If you do have migraine headaches... see a neurologist that specializes in managing these headaches. Don't suffer needlessly. Thanks Mary...

Good point... Being that there aren't any others with my presentation and there isn't anyone to compare me to or to compare my case... there are alot of unknowns. I can see where I would be an interesting case. Still need to close the loop with my managing endoc... rest of team is pretty much in support of the recommendations.... I don't like the high dive. :look:

I think you should go for it. MaryO can answer those questions. As a research subject though, you will be researched... just so you know.

You can call too, to see what protocols you may qualify for. Some require a referral from your doctor, while others do not.

Just thought I'd share... "Dr. Marnie Rose, 28, who shared her valiant brain cancer journey with the national audience of "Houston Medical," passed away Aug. 23 at M. D. Anderson. Throughout the six-week show, Marnie put a human face to her disease ? inviting the television crew to join her during chemotherapy, surgery and radiation therapy. Marnie also graciously invited viewers into her life ? she was seen with her family and friends, working as a pediatric resident and even on a date, teaching us what it means to "live fully with cancer."

http://www.endotext.org/ I ran across this today and thought I'd share. This is a new site with contributions by top docs in the field of endocrinology. Some of the links are not up and running yet... but check back as they will be. There is already lots of great information. The site was started 6/11/2002... ok...I'm slacking geez.... lmao Here are the sections: Neuroendocrinology and pituitary disease Michael Besser Carbohydrate metabolism and diabetes mellitus Ira Goldfine ?and Robert J Rushakoff Endocrinology of the male ?Robert McLachlan Endocrinology of the female ?Robert Rebar Thyroid - www.thyroidmanager.org ?Leslie J De Groot Adrenal function and disease George Chrousos Parathyroid and bone disease Andrew Arnold Diffuse hormonal systems and Endocrine Tumor Syndromes ? Aaron Vinik Pediatric Endocrinology Maria New Obesity and Nutrition Jose Caro Endocrinology of Aging Marc Blackman Endocrine disease and pregnancy Gerard Burrow Endocrine Testing Protocols I selected Neuroendocrine and pituitary disease and this next menu came up: 1 Normal and Abnormal Physiology of the Hypothalamus and Anterior Pituitary Prof A. B. Grossman 2 Normal and Abnormal Physiology of the Hypothalamus - Posterior Pituitary (Including DI and SIADH) Prof P H Baylis and Dr S G Ball 3 Pituitary Histopathology In Man: Normal And Abnormal Sylvia L. Asa, M.D., Ph.D. 4 Radiology of the Hypothalamus and Pituitary Victor Haughton, MD and Todd Peebles, MD 5a Normal Physiology of Growth Hormone and Growth ?in Childhood Dr CCamacho-Hubner ? 5b Disorders of Growth Hormone in Childhood Prof M O ?Savage ?and Dr CCamacho-Hubner ? 5c Normal Physiology of Growth Hormone in Adults Prof Jens Sandahl Christiansen 5d Adult Growth Hormone Deficiency Prof. John P Monson 5e Acromegaly and Giantism Dr.P.J. Jenkins 6 Prolactin Disorders Michael O Thorner, MD 7 Pituitary Dependent Cushing's Disease/Ectopic ACTH Syndrome Prof A. B. Grossman 8 GNRH and Gonadotrophins: Gonadotroph Adenomas Alan ?C Dalkin, MD 9 TSH: Control of Thyroid Function Prof Stephano Mariotti ? 10 Thyrotropin-Secreting Pituitary Adenomas Paulo Beck-Peccoz, MD and Luca Persani, MD, PhD 11 Pituitary-Hypothalamic Tumor Syndromes: Children Dr Richard Stanhope 11b Pituitary-Hypothalamic Tumor Syndromes; Adults Prof Klaus von Werder 12 Hypopituitarism Prof. John P Monson 13 Surgical Management of Pituitary Adenomas Profs Edward Laws and John Jane 14 Treatment of Pituitary Syndromes by Radiotherapy Prof Nick Plowman 15 The Pineal Gland and Pineal Tumours Prof Josephine Arendt Check it out!

Wilson: Williams Textbook of Endocrinology, 9th ed., Copyright ? 1998 W. B. Saunders Company ? Most comprehensive endocrine manual Goldman: Cecil Textbook of Medicine, 21st ed., Copyright ? 2000 W. B. Saunders Company Good general medicine book Ravel: Clinical Laboratory Medicine, 6th ed., Copyright ? 1995 Mosby-Year Book, Inc. ? Guide for interpreting Lab Tests. :music: Shauna... yes, I'm interested. Let me know via msg what I need to send you to cover expenses.

Books for general patient reading or medical sort technical reading? Course...I followed some of your advice and I went to the bookstore a found a book on inspiration and working on my own internal health. I thought I was a nut doing so, but, I have actually enjoyed The Dark Side of the Light Chasers by Debbie Ford... and I have been working on daily devotionals and have been actually enjoying ?Until Today by Iyanla Vanzant. I needed to do some peace of mind type stuff (this disease is emotionally tough!). I really appreciate you taking time in your own battles to pull us down to regroup. When ever you are ready to hail the battle cry again we are here for you and have been...yesterday, today, and tomorrow. Let me know... I may not get back with you until this weekend (work is crazy!).