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justashell

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  1. I found endotext.org: We offer the only complete, authoritative, constantly updated, down-loadable source on clinical endocrinology, without registration or cost. Currently we receive 30-50,000 hits each day. Help us improve our website by clicking here and taking a brief survey. ENDORSED BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS Endotext.org is the web-based source of information on endocrine disease directed to physicians around the world caring for patients with these problems. It is comprehensive, authoritative, constantly up-dated, un-biased, and available without cost to physicians and trainees. All material may be freely downloaded for personal use. This site covers the broad area of Clinical Endocrinology, emphasizing clinical endocrine practice, including the most current information on the manifestations of endocrine disease, diagnosis and treatment. Endotext.org is the premier provider of well reviewed and organized clinical endocrine information on the Web. Endotext.org is solely responsible for all content. Our site is made available through the fantastic generosity of the authors and editors who have provided their articles as a service to the profession. We are supported in part by Educational Grants, and non-intrusive ads with hyperlinks to company sites providing product information. Please support our sponsors, who help make this site possible. We also welcome support in any amount from our readers (address above). For all questions on our site, advertising, and information, email . Copyright ? 2007 MDText.com, Inc. All rights reserved.
  2. Quote: Darned squiffy cells, thay can get nearly anywhere. You took the words right out of my mouth! (I love your descriptive words).
  3. When I read things like this, I wonder if we Americans are going to become medical tourists? Can't get it done here or can't afford it here...go somewhere else...and save your life and maybe some money...
  4. http://www.cossa.org/caht-bssr/selfmanagement.htm Wish I could have been there and shared some stuff with these guys... ******************************************************************************** **************************** CONGRESS BRIEFED ON SELF MANAGEMENT OF CHRONIC ILLNESS RESEARCH More than 45 percent of adults struggle with a chronic health condition that affects their daily activities.?? From diabetes to asthma, heart disease, depression, obesity, and AIDS, more and more Americans are living with chronic illnesses.? More than 90 million Americans live with one or more chronic illness; at least 22 million live with three chronic illnesses.? Coping with a complex chronic illness such as diabetes affects the individual as well as family members throughout the entire lifespan.? On March 12th, the Coalition for the Advancement of Health Through Behavioral and Social Science Research (CAHT-BSSR), along with the Decade of Behavior, the American Psychological Association, COSSA, the Federation of Behavioral, Psychological and Cognitive Sciences, and the Society for Research in Child Development, sponsored a congressional briefing to bring the need for additional research to help Americans effectively manage their chronic conditions to the attention of policymakers.? Three distinguished social and behavioral scientists, Jacqueline Dunbar-Jacob, James Hill, and Dana Goldman, discussed the current scientific knowledge about self-management and directions for research that have the potential to improve the ability of people to manage and enhance their health. Virginia Cain, Acting Director of the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research (OBSSR) served as the event?s moderator.?She informed the audience of Congressional staff, NIH officials, and scientific community representatives that the issue of self management is becoming critically important.? We are seeing more and more cases of chronic disease, Cain explained, that are not readily fixed and require ongoing management by the patient.? This includes issues surrounding adherence to the medical regimen, including medication regulation and/or behavioral intervention, frequently both, she noted.? Genetic progress, Cain pointed out, does not explain everything; individual behavior and the environment can affect outcome.? She underscored the fact that later disease states have routes in early behavior.? Accordingly, in its F 2005 budget proposal, NIH noted its intention to increase the agency?s focus on chronic disease, which, NIH stressed, has overtaken acute conditions as the nation?s leading killers. Complexity of Regimen Management Jacqueline Dunbar-Jacob, University of Pittsburgh, began the discussion by highlighting some of the difficulty individuals have in managing their chronic conditions in a presentation entitled Taking Control of Our Health ? The Complexity of Regimen Management in Chronic Illness.? She defined chronic disorders as ?permanent or ongoing conditions requiring long periods of observation and management.?? Such conditions include:? heart disease, arthritis (the most common), diabetes, cancer, chronic obstructive pulmonary disease, asthma, obesity, and HIV/AIDS, she noted. According to Dunbar-Jacob, chronic conditions are experienced by approximately 45 percent of Americans; 24.6 percent of children under age 18, 35.1 percent of young adults (18-44), 67.7 mid-life adults (45- 64), and 87.6 of adults 65 years of age or older.?? Clearly, it is a major problem for the country and health care, she asserted. Dunbar-Jacob explained that the goals of treatment are to (1) slow the progression of the disease; (2) prevent complications; (3) maintain function; and (4) sustain the quality of life ?so that individuals can work and manage their own lives in their own homes.?? These conditions are managed through medication, physical activity, dietary modification, and other lifestyle adjustments. She observed, however, that any one chronic condition requires management of several regimens and used high blood pressure as an example.? An individual with high blood pressure, Dunbar-Jacob observed, needs to take one or two medications, maintain a salt-controlled diet, perform regular physical activity, and monitor their blood pressure.? At least 22 percent of Americans have two or more chronic conditions, she noted.? For instance according to Dunbar-Jacob, diabetes is often accompanied by high blood pressure, high cholesterol, obesity/overweight, vision impairment, or arthritis, each with its own regimen. Clinical support for regimen management for individuals with chronic disease averages only about one hour of health system contact per year, spread out over three visits.? Accordingly, after being diagnosed and given prescriptive advice, with episodic monitoring, patients must perform the day-to-day management of their own regimen and disease(s) themselves, she explained. How successful is this partnership in managing chronic disease?? Only 30 percent of persons with high blood pressure are controlled, a mere 28 percent of persons with diabetes are controlled and approximately 39 percent of individuals are of a desirable weight.? Conversely, specific modifiable behavioral factors account for:? 70 percent of stroke, 70 percent of colon cancer, 80 percent of coronary heart disease, and 90 percent of adult onset diabetes. Contributions to poor regimen management include:? errors in managing symptoms or sideeffects; errors in carrying out the regimen, both intentional and unintentional; belief about disease and/or treatment; tired of carrying out regimen; inadequate education and/or clinical support; and a lack of awareness/monitoring of behavior, explained Dunbar-Jacobs.? Behavioral errors, meanwhile, include:? failure to adopt the regimen, early stoppage of treatment, reduction in levels of treatment, over treatment, variability in the conduct of treatment, ?dosage? interval errors, performance errors, and management of symptoms, she further explained. To improve this picture, Dunbar-Jacob stressed the need for intervention research, behavioral assessment research (self-monitoring), and recognition of the factors that contribute to successful self-management. ?We need to develop and evaluate self-monitoring technologies that are accurate, provide feedback, and are portable and easy to use,? she stressed.? She also called for an examination of factors that contribute to effective self-management, noting that most studies have relied on self-report of behavior.? ?We are unlikely to change these data until we learn how to promote self-management capabilities among patients,? Dunbar-Jacob concluded. ? Self Management and Health Disparities According to Dana Goldman, RAND, Inc., there are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditionalarguments such as access to care and poor health behaviors.? Goldman hypothesized that there are health benefits to having a college degree.? Discussing his research, which examined differences by education in treatment adherence among patients with diabetes and HIV, Goldman noted that for both illnesses he found that significant effects of adherence are much stronger among patients of higher SES. Echoing Dunbar-Jacob, Goldman noted that there are a lot of new treatments available and they are complicated.? ?Treatment regimens often require high quality and persistent self-management on a daily basis, and not all patients are equally adept at complying,? he continued.? Compliance requires an understanding of the medical necessity and an ability to select the most appropriate regimens, he explained.? It also requires ?a willingness to internalize the future costs of incomplete compliance,? Goldman said. He noted that HIV provided a good test of his hypothesis.? Highly active antiretroviral therapy is complicated and often involves over two dozen pills daily.?In addition, medications must be carefully synchronized with meals and each other.? ?It is a pernicious regimen,? he explained.? If you do not adhere and are using such therapy as highly active anti-retroviral therapy, given the biological nature of the disease you are actually making your health worse, Goldman emphasized.? The better educated adhere to treatment, explained Goldman.? Education matters as much as race and sex for HIV adherence, he emphasized, noting that adherence explains health outcomes among HIV survivors. Diabetes, he noted, is the prototype chronic illness.? It is very hard to manage.? Tight glycemic control is the key to better outcomes for both Type 1 and Type 2 diabetes, he explained.? It requires patients to continually monitor levels of glucose-medication titration.? When it came to taking their diabetes medication, Goldman found that the less educated switched both oral medications and insulin more. Summarizing his findings from the Health and Retirement Survey (HRS), supported by the National Institute on Aging, Goldman stated his research shows that the better educated are more likely to maintain high quality treatment and high quality treatment leads to improved general health.? The findings of the research suggest several explanations for why education matters, Goldman noted.? Good adherence to a treatment regimen requires several attributes that may be strongly related to education, including complying with physician orders through comprehending what is being prescribed and adjusting the daily routine to execute it.? The results also suggest differential health outcomes across SES levels because of different abilities to self-manage a demanding behavioral regimen are amenable.? ?Less educated patients would benefit more from frequent follow-ups, simpler drug regimens, and clear instructions about how to comply and the consequence of noncompliance,? Goldman asserted. Goldman concluded by emphasizing that the study demonstrates that SES disparities can be altered through clinical intervention.? Intensive monitoring, he stressed, is more valuable for the less-educated. Our Most Serious Public Health Problem According to James O. Hill, University of Colorado Health Sciences Center, 75 percent of Americans will be overweight or obese if the current trend in obesity continues through 2008.? If those trends continued further, all Americans will be obese in 2040, Hill joked.? Hill cautioned that children are not immune to overweight/obesity.? Approximately 15 percent of kids are overweight/obese and that may be an under estimation, warned Hill. Obesity is related to the diseases we die from, Hill observed.? There are problems reversing the trend because of the complexity of the disease.? It is one of the most complex things we have ever dealt with, he underscored.? It is an issue that crosses disciplines:? biology, economics, sociology, and city planning.? A lot of people, however, are hung up in the complexity, he continued.? He cautioned that we cannot concentrate on individual behavior or environment alone. Sixty percent of Americans get no physical activity.? Today?s sedentary lifestyle is totally wrong for the environment.? We are using our heads instead of our physiology, Hill explained ? we have the right biology for a different environment.? We have taken the physical activity out of work and can go about the act of daily living without any physical activity.? We have more leisure time; we spend more time in front of the HDTV.?Change is hard to do in this environment, Hill emphasized.? We are not going to fix the obesity problem in the U.S. by the next election, he warned.? We have to come up with a logical plan and set specific behavior goals.? Hill stressed the need for individuals to manage their weight like they manage their finances.? We can get behavior change, he noted, but is difficult to sustain.? We also have to change the environment to support and sustain these goals, Hill continued. ?Prevention is Doable? ?There are huge benefits to a 5-10 percent weight loss, said Hill.? What we have to do first is to prevent weight gain.? ?Prevention is doable,? Hill emphasized. He cited his America on the Move program, based on research supported by the NIH, as an example of how to exact change.? We have to start where people are and make small changes.? Through the program, Hill and his colleagues test the hypothesis that small lifestyle changes can be achieved and sustained and can prevent weight gain.? He forewarned, however, that the program has not been successful in producing and sustaining large lifestyle changes. America on the Move inspires people to make small changes to stop weight gain.? He shared that most weight gain is caused by less than 100 excess calories per day.? Accordingly, most weight gain can be prevented by modifying energy balance by this amount.? This includes increasing walking by 2000 steps per day and choosing one behavior each day to eliminate 100 calories.? Individuals continue to make more small changes by making incremental changes in walking and improving diet quality.? The program also provides programs for target populations to reinforce the simple change messages.? It creates a grassroots initiative to get Americans excited about taking control of their weight, Hill explained. The program can be tailored for individuals, schools, worksites, churches and other organizations, families, health care professionals, and communities, said Hill.? The long term goal of the program is to work to change the environment and teach our children the skills they need to manage their weight in the current environment, which include skills in energy balance, skills learned in school, and skills reinforced in the ?real world? of restaurants and grocery stores. America on the Move works, emphasized Hill, because it focuses on the consumer and inspires change.? It is simple and fun.? It is about energy balance.? It advocates small changes; people can actually do what is recommended.? It starts where people are right now.? It provides a starting point we can live with ? stopping weight gain, he explained.?? For more information about American on the Move see:? Americaonthemove.org ******************************************************************************** **************************** Thought this was an interesting article...
  5. Good story---thanks for sharing. Only thing I could add is --- that chronic illness hits all ages---not just the elderly---the AARP references may make some feel like the story is only for "old people". Here's something else to "chew" on (or "gum" on)..."approximately 60 million people (or 22 percent of the population) suffer from multiple chronic" illnesses... http://www.cossa.org/caht-bssr/selfmanagement.htm ...at least 45 percent of Americans have at least one chronic condition http://www.google.com/search?q=cache:_BNOd...p;client=safari Maybe our country is in greater danger from chronic illness, than we are terrorists...
  6. I'm not sure I completely understand all of it, but it sounds like this helps improve the IPS test's reliability.
  7. James Burke, in his book, The Day the Universe Changed, describes how doctors and surgeons roles changed as time went along. I hope we're at a point in time, when the medical and surgical fields change again---for the better.
  8. MK---I think things are much the same way here---the doctor's look for the obvious---and just treat the symptoms---which doesn't always save any of us money...sadly, some pay with their lives---as you've indicated. Healthy people are productive people---that should be what we're aiming for...not trying to save a nickel...
  9. Robin--- What a heart-breaking experience for the family to have to endure---but how courageous of them to share it with others. One of the passages---"He used to say he felt like he was in a bubble where everything he did inside it seemed to be normal but to everyone outside the bubble he appeared to be losing his mind." really hit me like a ton of bricks---this is the best description of something that happened to me a couple of times... If and when I ever get a diagnosis, I'm sending a copy of this article to my "former" doctors, who did not and could not help me when I was most vulnerable. Thanks for sharing this!
  10. (sigh...) I'd love to have someone look at my molecular mechanisms...
  11. What they say:But York Hospital has denied it did anything wrong. What they mean: Geez, we screwed up! What they say:A spokesman said: "The trust does not accept Mrs Wrightson's criticism of the care she received at York Hospital or the interpretation of the tests results undertaken on Mrs Wrightson ordered by non-medical practitioners outside the NHS. What they mean: OK---this woman is a "rare" case, or we better get our act together. What they say:"We are pleased however that Mrs Wrightson is feeling better and wish her all the best for the future." What they mean: Hope this keeps the broad quiet! What they say:Dr Peter Hammond, a hormone specialist at Harrogate Hospital, backed his colleagues in York, saying synacthen and saliva tests were different types of examination which checked for different things - and therefore the results were not necessarily contradictory. He said it was entirely normal for a synacthen test to be performed as it had been by York Hospital. What they mean: If we can keep patients and others in the dark, then we can protect one another.
  12. Victoria---

    I just want you to know that I care---we're all pulling for you---we know you're going through some tough stuff..

    Shelley

  13. MaryO, you are a GENIUS!!! Thanks for finding all these articles!
  14. There was a woman on Mystery Diagnosis who developed diabetes insipidus after a car accident. Her head hit the windshield, but the doctors didn't think it caused any real damage. There were two times I remember suffering a hit to the head---the first is when someone swung around and accidentally hit me "between the eyes"---I was about 12---and I saw "stars". The other time is when someone knocked me from behind and I landed on the back of my head---thankfully we were on a playground of grass---but I really had a bad headache from that one. I was in high school at the time. I didn't develop any symptoms until after I was pregnant. That's when things started going downhill for me.
  15. Isn't it amazing that when you get kicked in the head, people take you seriously---when something starts up for unknown reasons, you're crazy. This is exciting news---and perhaps doctors will be more willing to listen to us who have problems. OK---I'm putting my kick-boxing career on hold. How about the rest of you?
  16. Gee, maybe the diabetes endos out there will start looking for Cushings... Thanks MaryO!
  17. Thanks you guys---I thought this was something "old" 'cause the reference date was like 1998---but they had this on their website like it was something "new"---and hope springs eternal. I also included it because it referenced pseudo-cushings---something that either does or does not exist---depending on the doc. This must have been the test that I "failed" at OHSU---my testing buddy got all "flushed" and was ready to jump out of her skin...now I find out that being on a sub par dose of thyroid at the time may have skewed my tests... sigh...
  18. I don't know how "news-ish" this really is, but was surfing around and saw it: A new test reliably distinguishes between patients with mild Cushing's syndrome, pseudo-Cushing's states, and normal individuals. Yanovski and others from the National Institutes of Health [J Clin Endocrinol Metab 83:348-352,1998] have reported results of studies employing the dexamethasone-suppressed corticotropin-releasing hormone stimulation test in normal volunteers and patients with mild Cushing's disease. A cortisol level obtained 15 minutes after the administration of corticotropin-releasing hormone was more accurate in the diagnosis of Cushing's disease than basal urine studies and dexamethasone- suppressed urine cortisol levels. This test seems useful in the evaluation of patients with suspected Cushing's syndrome that have normal or minimally elevated urinary steroid levels. http://www.pituitarycenter.com/site/whatsnew.php#cush Input from those of you who are "up to date" on the efficacy of tests is greatly appreciated.
  19. www.idahostatesman.com/103/story/78072/html Boise Hospital Director Takes on Health Care Myths By Gregory Hahn - Idaho Statesman Edition Date: 04/04/07 If you think you know all about America's health care system — Ed Dahlberg wants you to think again. The president and chief executive officer of the St. Luke's Health System hears myths and misconceptions about medical care all the time, he said. In a speech Tuesday to the Boise Metro Chamber of Commerce, Dahlberg said people need to throw out the myths and gather all interested players to the table to tackle the mounting problems facing health care today — because the system won't last. Medical costs already consume 17 percent of the gross national product, he said. More than 40 million Americans are uninsured. "I've got bad news; it is not currently sustainable," Dahlberg said. "We have to find a different way of thinking. We have to face the music." He outlined some of the common misperceptions — here are a few: Myth: Costs rise because hospitals are expanding Hospitals are expanding because the Treasure Valley is growing, Dahlberg said. He listed some of the top factors boosting costs instead: technology, prescription drugs, aging populations and more. Myth: Medicine is an absolute science Also not true, Dahlberg said. He showed some research from the Dartmouth Atlas, a nationwide study that compares how doctors in different regions treat various diseases. Idaho doctors are more likely to perform knee replacement surgery than physicians in Hawaii, for example, but not as likely as those in Nebraska, which has the highest rate. He showed the states with the highest number of back surgeries, cardiac catheters and other procedures, and those with the lowest. The problem, he said: "We don't know which one of these columns is right." Idaho, incidentally, was somewhere in the middle each time. Myth: We can absolutely measure quality In reality, some data is often two or more years old, he said. It is analyzed by people who can be more subjective than objective — and it's hard to measure the severity of illnesses. For example, St. Luke's had three companies evaluate the same death rates in 2004, to see where the hospital stood among national averages. One company said the Boise hospital's track record was 18 percent better than average; another said 16 percent better; the third said 8 percent worse. Myth: Health care has no return on investment So health care costs consume more and more of the national dollar — what does that get? Dahlberg argued that it gets a lot. He quoted a study of health outcomes over two decades for heart attack, diabetes, stroke and breast cancer. In the 20 years, the overall death rate dropped 16 percent. Life expectancy rose 3.9 years. Disability rates for the elderly dropped by a quarter and people spend 56 percent fewer days in the hospital. To offer story ideas or comments, contact reporter Gregory Hahn at ghahn@idahostatesman.com or 377-6425. ******************************************************************************** ******************** I thought some of you might like to read this---it sounds like at least one hospital administrator is conceding that there are problems with health care in America. Well, there you have it---a peek into what is going on in at least one hospital administrator's mind. Maybe we will start to see some real reform in the health field. PS---I think it's up to us to lobby for change---on a local, regional and national level.
  20. Wow Robin, you are the tech. wizard! I have no idea what "flake" ing is---despite your wonderful description---I'm just getting used to the web I guess---but I'm very interested in seeing what you have! Thanks! OK---I think I'm starting to understand this---it looks very interesting! (Now I've got to do some more investigating!) OK---Did some more poking around---this is very interesting!!! Thanks!!!
  21. I finally decided that I needed to do what I could to find out my medical history---I am adopted and my birth mother was from Oregon---one of the states mentioned where there appear to be "descendants". I also identified with some of what was written in this article---I have a tendency (at times) to have absolutely NO PATIENCE with anyone or anything---and I'm a "fighter" not a "flighter"---there are days when I think I could whip terrorists single-handedly. I shared this with my mom---I've been told all my life that I was the sweetest kindest person---until something happened and I would just go into a tantrum---I don't know if it's because of how I was raised---or if I've just learned a stupid way of dealing with stuff---but I'm going to check stuff out. By the way---I'm going to see the neurologist again---she told me that I had some weird formations in my brain---and that sometimes people with whatever it is I have---I'll find out and let you know---just drop dead---for no apparent reason. Again, this made me think that maybe there is something I need to figure out. In addition, my mechanic, whom I've written about earlier this week (he has an adrenal tumor) and has had all sorts of cancer and other "weird" health problems---he mentioned that his sis-in-law has Cushings---and a few years ago, he told me about how he and his wife traveled to Wales---to do genealogy---they lived there for awhile with some friends whom they met on-line, I think---anyway---he did a lot of research when he was over there. When I last saw our mechanic (who has been so kind to me and my family for more than 20 years), I started realizing that he seemed to have many of the physical symptoms that we talk about here on the boards. I have tried to do all I could to figure out things---and so far, I'm getting somewheres---but not fast enough, dang-it---I don't know where my quest is going to take me, but I have decided that I need to track down all sorts of leads, no matter how small they seem. Valerie---The writer of the story could live anywhere---but you can contact the Associated Press for more information about the writer. The article appeared in Friday's Idaho Statesman.
  22. http://blogs.chron.com/medblog/archives/20...ws_youve_1.html September 27, 2006 Bad news: You have an 'incidentaloma' Sometimes in medicine, you stumble across a $10 word for a 10-cent concept. "Incidentaloma" is one such noun. An incidentaloma is a benign growth or tumor found by coincidence when a doctor is looking for something else. The annoying part is they cause worry and may require expensive workups to show that, yes, it is a benign growth, and no, it is not a lucky discovery of early-stage cancer. Whole-body CT scans are notorious for this. Incidentalomas are frequently found on the adrenal glands. The adrenals are triangular glands that sit atop each kidney and influence the body's metabolism, salt and water balance, and response to stress by secreting a variety of hormones. The National Institutes of Health says: "Based on autopsy studies, adrenal masses are among the most common tumors in humans: at autopsy, an adrenal mass occurs in at least 3 percent of persons over age 50. Most adrenal masses cause no health problems. A small proportion, however, can lead to a number of serious hormonal diseases; approximately 1 out of every 4,000 adrenal tumors is malignant." Anyway, this popped into my mind when I went to an optometrist who used a high tech camera to photograph my retinas. There she found two "freckles," or choroidal nevi, I didn't know about. There's an off chance these freckles can turn into melanoma. So now I've been to an eye doctor, had the retinas photographed again, and will go back in six months to see if anything has changed. I'm grateful to have insurance that enables me to monitor my health. But the older I get, the better I understand the aversion to routine check-ups. Posted by Leigh Hopper at September 27, 2006 10:25 AM
  23. From The Idaho Statesman, April, 6, 2007: By Marilynn Marchione The most infamous feud in American folklore, the battle between the Hatfields and McCoys, may be partly explained by a rare, inherited disease that can lead to hair-trigger rage and violent outbursts. Dozens of McCoy descendants apparently have the disease, which causes high blood pressure, racing hearts, severe headaches and too much adrenaline and other "fight or flight" stress hormones. No one blames the whole feud on the condition, called von Hippel-Lindau disease, but doctors say it could help explain some of the clan's notorious behavior. "This condition can certainly make anybody short-tempered, and if they are prone because of their personality, it can add fuel to the fire," said Dr. Revi Mathew, a Vanderbilt University endocrinologist treating one of the family members. The Hatfield's and McCoys have a storied and deadly history dating to Civil War times. Their generations of fighting over land, timber rights and even a pit are the subject of dozens of books, songs and countless jokes. Unfortunately for Appalachia, the feud is one its greatest sources of fame. Several genetic experts have known about the disease plaguing some of the MCCoys for decades, but kept it secret. The Associated Press learned of it after several family members revealed their history to Vanderbilt doctors, who are trying to find more McCoy relatives to warm them of the risk. One doctor who had researched the family for decades called them the "McC kindred" in a 1998 medical journal article tracing the disease through four generations. "He said something about us never being able to get insurance" if the full family name was used, said Rita Reynolds, a Bristol, Tenn., woman with the disease. She says she is a McCoy descendant and has documents from the doctor showing his work on her family. She is speaking up now so distant relatives might realize their risk and get help before the condition proves fatal, as it did to many of her ancestors. Back then, "we didn't even know this existed," she said. "They just up and died." Von Hippel-Lindau disease, which afflicts many family members, can cause tumors in the eyes, ears, pancreas, kidney, brain and spine. Roughly three-fourths of the affected McCoys have pheochromocytomas---tumors of the adrenal gland. The small, bubbly-looking orange adrenal gland sits atop each kidney and makes adrenaline and substances called catecholamines. Too much can cause high blood pressure, pounding headaches, heart palpitations, facial flushing, nausea and vomiting. There is no cure for the disease, but removing the tumors before they turn cancerous can improve survival. Affected family members have long been know to be combative, even with their kin. Reynolds recalled her grandaterh, "Smallwood" McCoy. When he would come to visit, everyone would run and hide. They acted like they were scared to death of him. He had a really bad temper," she said. Her adopted daughter, another McCoy descendant, 11-year-old Winnter Reynolds, just had an adrenal tumor removed at Vanderbilt Children's Hospital. Teachers thought the girl had ADHD---attention deficit hyperactivity disorder. Now, Winnter says, "my parents are thinking it may be the tumor" that caused the behavior. "I've been feeling great since they took it out." Dr. Nuhet Atuk at the Universtiy of Virginia in Charlottesville and geneticists at the University of Pennsylvania studied the family for more than 30 years, Rita Reynolds said. "They went back on the genealogy and all of that stuff," she said. They called it madness disease. They said it had to be coming from the BHL. Our family would just go off, even on the doctors." Rita Reynolds had two adrenal tumors removed a few years ago. Her mother and three brothers also had them. So do McCoy descendants in Oregon, Michigan and Indiana, she said. When you have these tumors, you're easty to get upset," said Rita's mother, Goldie Hankins, 76, of Big Rock, Va., near the Kentucky-West Virginia border. "When people get on your nerves, you just can't take it. You get angry because your blood pressure was so high." The "feud" has taken a civil tone and all but disappeared, members of both families say. THe last time it surfaced was in January 2003. McCoy descendants sued Hatfield descendants over visitation rights to a small cemetery on an Apalachian hillside in eastern Kentucky. It holds the remains of six McCoys, some allegedly killed by the Hatfields.
  24. Thanks for the heads up Cat---it's always something, isn't it??? Hope you are doing well...
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