“Our study shows that BLA (bilateral adrenalectomry) for
persistent Cushing's disease provides patients with considerable improvement in
their Cushing-related symptoms with concordant increase in their quality of
life. After BLA, patients may attain the same (or better) quality of life as
patients initially cured by transsphenoidal pituitary tumor resection. We think
that BLA is a safe and effective treatment of the 10% to 30% of patients who
fail initial therapy for Cushing's disease, and should be considered
preferentially over other available therapies”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1877068/
I like that statement!
Today I am 25 days post-op my BLA surgery and my mantra is ‘slow
and steady’. I thought I would outline
this step of my journey for those who may be considering a BLA as treatment for
their persistent Cushings. Making the
decision to have this surgery is one not made lightly. There are sacrifices that will be made living
without adrenal glands, and making the decision to have a chronic illness for
the rest of your life is made with a heavy heart. When I first began researching Cushing’s two
years ago, and would read accounts fellow Cushies having a BLA I can remember
thinking “wow…so extreme…I’ll never get to that point” and yet so quickly I did. The rapid transformation of a healthy body to
one daily struggling with fatigue, weakness, pain, nausea, mood swings, brain
fog, insomnia, anxiety, swelling…..well it changed my perspective. I am tired of my days being consumed with my
disease and I want to move forward with life, define my new ‘normal’ and go
about living!
At my two-week post-op surgery #2 phone appointment with me
endo, he told me that BLA was my next step and it was devastating. I had at least 4 more weeks of surgery
recovery, had to wean off the replacement steroids so that I could begin the
grueling process of testing (AGAIN!) to prove active disease for surgery referral. And if I haven’t mentioned yet, weaning of
steroids is “not for wimps” as a wise Cushie friend often reminds me.
As a Cushie my body has got accustomed to high levels of
natural steroid, and for anyone who has taken a round of prednisone will tell
you that it does a body wonders. The anti-inflammatory
effect masking pain from physical symptoms such as losing all my muscle
strength (steroid induced myopathy) and carrying an extra 50 lbs, most of which
is in my abdomen throwing off my center of gravity, not to mention my back! So
lowering replacement steroids reveals prior masked aches and pains. Dropping
the levels of cortisol also bring on symptoms of Adrenal Insufficiency (AI) (nausea,
GI issues, headache, low blood pressure, heart palpitations, dizziness) Oddly
enough even if my cortisol levels could be higher than normal, or within normal
range, the change from higher levels to lower levels can bring on AI. AI can quickly worsen and lead to full blown
Adrenal Crisis, which is life-threatening; so weaning off steroids has to be
done slowly and carefully.
But nonetheless, has to be done in order to move forward in
the treatment process!
I was able to wean off my replacement steroids in 6 weeks,
another indicator that surgery was not successful. I geared myself of for marathon testing and
hit it hard…like my full time job. The
more I tested, the more likely I was to show the highs and the be done
testing! In just over a month of
collecting saliva, urine, and midnight blood draws…I had enough results for the
surgery referral.
During this time I researched surgeons, my biggest resource
being my online Cushings support group friends.
I have grown to trust these people for their knowledge and experience in
the disease.
Many of them had spent
countless hours researching surgeons, and were willing to share with me the
facts.
There were 4 surgeons that work
with my endo, and I knew I was going to choose one of them.
Two were in California so that alone crossed
them off the list.
The remaining two
were equal distance in travel time for me, so I pursued them.
I wanted a surgeon who had lots of experience
in removal of the adrenal glands, as there is always a small chance that adrenal
cells/tissue (microscopic) that mistakenly get left behind can regenerate and
begin to produce cortisol, causing Cushings to reoccur.
I choose
Dr. Douglas Fraker at University of Pennsylvania Hospital