Friday, September 12, 2008


This study caught my attention. It is, in itself, quite interesting. But the thing that got me was that they did this and measured these subjects' cortisol levels several times throughout the course of the interview, once beforehand, and then at 30 minute intervals. And it occurred to me: Why do sick people have to beg to get cortisol tests to check for Cushing's?!

COLUMBUS, Ohio -- Researchers here have made a surprising new discovery: They've spent the last decade examining how stressful situations can alter the levels of certain hormones in the blood, weakening the immune system and increasing a person's vulnerability to disease.

But for some people in situations typically considered stress-free -- perhaps even pleasant -- the levels of one hormone, cortisol, may even rise. Scientists have long believed that cortisol levels increase in times of stress and decrease as the stress is eased. The new finding is puzzling researchers but also pointing them to an entirely new area for future research.

The work was described August 4 by Janice Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State University, at the annual meeting of the American Psychological Association in Washington, D.C.

The new work stems from a series of experiments done more than a decade ago and intended to look for physiologic changes
caused by stressful situations. A group of about 90 newlywed couples took part in the study at Ohio State's Clinical Research Center. The couples completed questionnaires and then were asked to discuss several areas of disagreement regarding their marriage.

Blood samples were taken from each subject at the beginning of the session and at 30-minute intervals until they were discharged. When researchers analyzed the data, they found changes in hormones and other bloodstream components that could indicate a weakening of the immune status.

Today's findings, however, arise from a new analysis of data from blood samples taken immediately after those "conflict" discussions. Following a short "transition" period, the newlyweds had been asked to discuss the history of their relationships - how they met, what attracted them to each other, how did they decide to marry.

"For most people, not surprisingly," explained Kiecolt-Glaser, "this was a pretty positive interaction. And they were coming down off the earlier discussion which was usually seen as a negative emotional experience."

When Kiecolt-Glaser and colleagues Ronald Glaser, professor of molecular virology, immunology and medical genetics, and William Malarkey, professor of internal medicine, looked at the levels of cortisol in the blood however, they were surprised.

"In 75 percent of the subjects, the hormone levels had fallen just as we expected - 26 percent on average for the men and 35 percent for the women," Kiecolt-Glaser said. "But in 25 percent of them, cortisol levels stayed relatively the same or, in some cases, actually went up."

Normally, levels of cortisol drop after we wake in the morning. The experiments were done in midmornings and the newlyweds were "coming down" off the negative discussion, which should have forced cortisol levels lower.

But in one of every four people in the study, the cortisol levels failed to drop. In some people, the levels even rose. The findings were especially interesting when coupled with information from follow-up surveys of the participants. The researchers had tracked down each person to check their current marital status and to find out if the newlyweds were still together.

They found that the women whose cortisol levels rose during the discussions of their relationship history were twice as likely to have been divorced from their husbands. No similar relationship appeared among men whose levels had risen.

The study also looked at the exact word choice the couples used in describing their relationship. They used an instrument called the Linguistic Inquiry and Word Count program which lists both "positive" and "negative" words - 261 which describe optimism, energy and positive feelings and 345 words suggesting anxiety, fear, sadness, depression and anger.

Cortisol levels for three-fourths of the men in the study dropped - on average 26 percent. They used significantly more words considered "positive" than did their counterparts whose cortisol remained steady or even rose. There was no similar trend in positive word choice among women whose cortisol had dropped.

Women whose cortisol levels failed to drop, or even rose, however tended to use more negative words as they discussed their relationship history. "What I think is happening here is that in some ways, cortisol levels may serve as a bellwether of what's going to happen," whether women's marriages would survive, Kiecolt-Glaser said.

The most important finding, she says however, is that this proves that "positive" interactions, along with their health implications, deserve as much study as "negative" interactions have garnered.

The National Institutes of Health supported the study.

Thursday, September 11, 2008

I Feel So Guilty

We went to Applebee's for dinner last night while on a trek to the "city" for my meds at Walmart. (BTW, I was able to get 3 months worth of generic Synthroid for $10!!! What a deal!)

Anyway, we were sitting there waiting for our meals, and an older lady was walking with 2 little boys holding her hands past our table. I looked at the little one, who was maybe 2 yrs old and at first I thought he was a little person or a handicapped child. But then I looked again. This baby was so obese he could barely walk. His belly was protruding. His cheeks were red and huge. I looked at my DH and said "That baby has Cushing's. Look." He, of course, has not studied our "kind" like I have. This was an obvious case. I thought I need to talk to them. The lady walked around the restaurant and sat far away from us - on the other side of the bar. I kept watching to see if any of them got up and moved around anymore. I thought I needed to tell them what is wrong with their child.

The group consisted of an older couple, a young couple, and 2 little boys. Everyone else sitting at that table was normal sized. I was going over in my head what I should say to them. Should I say "Does your child have Cushing's?" or "Have you ever heard of Cushing's?" or what? I didn't know what to do.

They got up and left. I didn't do or say anything. I feel so guilty! What if they don't know what is wrong with their precious little boy? I keep telling myself that of course they know. Any doctor who looked at him would know.

Wouldn't they?

Sunday, September 7, 2008

Doctors skimp on diet, exercise advice

I found this article today and it cracked me up. I mean, how many of us Cushing's patients can say our doctors never told us we were eating too much and not exercising enough? I wish they'd do a study on Cushing's patients and see how many got an endocrine work-up right away when they told their doctors they couldn't lose weight. But instead, we get this!

Doctors skimp on diet, exercise advice
By Melissa Evans, Staff Writer
Article Launched: 09/06/2008 09:56:59 PM PDT

New findings from one of the most comprehensive health surveys in the nation may shed light on one of the reasons obesity and diabetes are tough problems to solve - primary care physicians, the main gatekeepers of health information, aren't talking enough about the need for good nutrition and exercise.

Data from the California Health Interview Survey, an analysis of phone interviews from about 46,000 residents in the state, showed just 34 percent of adults said their doctors discussed exercise with them and 28 percent discussed nutrition.

The research "suggests that physician involvement may be a piece of the puzzle in obesity," said Sue Holtby, senior research scientist at the Public Health Institute, which conducted the survey along with the UCLA Center for Health Policy Research.

Physicians and nutritionists in the South Bay said they aren't surprised by the findings. Though knowledge about the dangers of obesity and its connection to poor diet and lack of exercise is improving, there is still not enough discussion taking place, said Dr. Lisa Santora, chief medical officer for the Beach Cities Health District.

"Physicians have so many competing demands in the office," she said. "They have more adults coming in with chronic illnesses, and their focus is on addressing patients' immediate needs. Preventative needs tend to get relegated to the back burner, especially when the patient is in and out in 15 minutes."

Most hospitals, including Torrance Memorial Medical Center, Kaiser Harbor City and Little Company of Mary, have nutrition programs and dieticians on staff, but can't control what is discussed in the privacy of patient rooms.
Little Company of Mary holds nutrition classes for the community, organized a series of community television segments on nutrition and hosts a community meeting once a month with an endocrinologist for people to learn about diabetes prevention, including nutrition and exercise.

Beach Cities Health District also holds numerous community programs and works closely with schools in Hermosa Beach, Redondo Beach and Manhattan Beach. One of the focuses of education has been improving healthful eating at home, with the hope that children will be the impetus for change.

Santora said one of the bright spots of the survey was the finding that, despite the dearth of discussion among adults, nearly three-quarters of adolescents said they discussed nutrition and exercise with their doctors.

"That is great to see," she said. "There has been so much education going into childhood obesity and the dangers of being overweight. It may be starting to have an impact."

The statewide findings, based on survey results from 2003 and 2005, also showed that:

Half of adults age 18 and older, and 14percent of teenagers age 12 to 17, are either overweight or obese.

One-third of adults said they got no moderate or vigorous exercise in the past week.

43 percent of teenagers and 28 percent of children age 2 to 11 ate at least one fast-food meal the previous day.

Smoking continued to decrease among adults, but increased among white male teenagers.

Findings from the most recent survey taken in 2007 will be released later this year or early 2009, UCLA officials said. The newest survey will include a wide range of health statistics broken down by county on obesity, nutrition, diabetes and lifestyle habits.

All I can say is Oh puleeze.