Thursday, February 18, 2010

Test RESULTS

Sooo...I am happy to say that the test results have come back with a 38 prolactin level, down from 45.  I have started increasing my dosage to 1mg twice weekly and the medication seems to be helping.  My doctor has advised me to increase my dosage slightly since I would like to conceive in the near future.  So I will do as the doctor asks.  I have been complaining about an increase in fatigue which they believe may be a result of the side effects of my medication but honestly at this point I don't care about the fatigue as much as I care about getting my prolactin down.  I purchased a new ovulation predictor (via saliva) which has been recommended to see if I can determine my fertile days.  We will start with that this month and see whether it works.  I am a little happier now that I know the medication seems to be working as we are increasing my dosage.  Fingers crossed - all aboard let's do this.

Wednesday, February 17, 2010

Exercise

The one word that everyone dreads.  I decided this past summer to start running again.  Although getting up at 5:15am doesn't exactly make me feel overwhelmed with joy the result is worth it.  I live in a very cold city come the winter season and the layers need to be piled on prior to your journey into the arctic wilderness.  Okay so it's really not the arctic but a few of these splendid mornings it sure did feel like it.  (the thought of summer is enough to cause a mental orgasm)  I digress.  So I think this helps to destress.  The dog doesn't mind it either, go figure.  I don't keep track of how far I run or how many calories I burn as I think the most important aspect is to get out there and feel better.  I do.  My legs hurt and I feel rejuvenated.   Now for the other aspect which I noticed several mornings - tender breasts. They friggin hurt like a bastard.  I feel as though I have been punched in the chest.  Time for a good sports bra - highly recommend doing your research rather than buying 6 and then determining.  (as noted - speaking from experience)  In the long run I have noticed that I feel better about myself - granted and I feel less stressed about the everyday issues and hormonal surges I have.  Thumbs up! I would definitely try to have a regular exercise routine regardless but I would really stress that if you have hormonal deficiencies - get on board and get fit while doing it.  I am still trying to locate my cross-country skis - garage is a little disorganized.  I am looking forward to getting out there on those skis as it's been ages (I believe I was 14).  So you may dread the word and the activity but definitely get your butt in gear.

Tuesday, February 9, 2010

Self Help

Need to start focusing on changing some habits.  Over the last few months my mood is all over the map and I need to start refocusing my thoughts.  I have been "maintaining" my life.  It's been at a stand still for quite some time.  I decided to try the self help books to see whether or not they could help with refocusing my thoughts and perhaps a new perspective on life.  I fully understand that the book itself is not going to help me solve my problems but I am thinking outside the box and what's the worst that could happen.  Exactly- live a little.  So far I have found it to be inspirational and I sampled a few before I found one that was not overly cheesy.  I do believe that I have tried to control aspects of my life but it's just not feasible or healthy.  Prior to my diagnosis I had a love for life and extraordinary enthusiasm.  I always enjoyed going with the flow and never regretted making decisions.  I guess in some ways I still don't but I can't help sometimes to think that there was something I did that caused this obstacle.  Bottom line I don't think I could of changed anything but it's stressful.  SO....... the book has helped.  It's helped to open my life to a new perspective and given me the spirit of life that I have sooo dearly missed.  It's nice to be able to take it off the shelf and dust it off.  I miss the old me and the love of life I possessed.   I would highly recommend grabbing one and sitting back to think outside the box.  I have also decided to start doing things for myself again.  Reclaim who I am and stop focusing on the negative aspect of infertility.  Bloody Hell, life is too short.  One of the exercises in my book; for one moment take in all the good, hold off on the bad and look upon your life and be grateful for what you possess, stop the negative thoughts from entering and realize the what you have right now is pure essence, and enjoy it.  When I took a moment to realize what I had I thought- wow this is pretty darn good.  I felt a release of pressure off my shoulders.  One of the biggest things I realized was that I was the culprit who kept putting the stresses on myself.  I can change that, and it's not my fault or anyone else's.  I am entitled to be happy.  Regardless of whether I can never have children there is something more to life and what I have is incredible.  "The minute you alter your perception of yourself and your future, both you and your future begin to change". - Marliee Zdenek

Friday, February 5, 2010

the new frontier

Well I have started back on the "stay positive" band wagon.  Logically it's the only thing to do.  I am hoping that my next blood test results are better (fingers crossed).  They will increase my medication again if there is no change from the last time.  Not the greatest but the last alternative will be surgery.  As I have heard surgery does not always work so I am a little hesitant to discuss that topic at the moment.  I am looking forward to my appt on the 18th.  (for the recent results) For some reason my conscience believes the results will be better.  Ah- the ache if I am wrong.  I haven't been running as much lately.  I am becoming a little lazy.  I believe that my endurance is not what is was 4 mths ago.  I am exhausted after 3 miles.  Not good.  It might have something to do with my stress level and my inability to quit smoking.  Yes, I am a smoker.  Go figure.  My better half has scalded me because of it and I have no qualms about it, he's right.  I guess I feel that if my levels were low enough, I would stop for the sake of wanting to get pregnant and for the safety and health of myself as well.  Right now though, I am smoking on occasion.  Bad yes, but satisfying for the 10th of a second.  YEsSSSSS!    Now I am sitting in my office wondering and worrying about, well, I am not sure.  Lately, i feel as though there has been this incredible tension between my sweetheart and I.  He gets grumpy quite often about things that he can not change.  I believe that you take it one step at a time and hopefully it will work itself out.  I don't know.  He wants to help but there is nothing that he can do.  He just has to be patient and supportive.  Perhaps I am wrong but I am entitled to my opinion.  "I will wait for you, should I fall behind, wait for me".  Nothing like a little Bruce Springsteen to satisfy your soul.  I definitely need some chicky movies and a good blanket.  Scratch that.  I need a huge comfy bed, a ton of chicky flicks and one heck of a good bottle of wine.  (perhaps 2, but I am a lush).  Did I mention the view from the bed needs to be absolutely incredible.  Dark, windy, warm, ocean, quiet, and absolutely breathtaking.  Yup....daydreaming.....

Wednesday, February 3, 2010

daily issues

So I have begun to realize that over the past year my inability to stay focused has worsened.  I have difficulty concentrating on simple tasks throughout the day.  8 hrs of work seem like a lifetime.  I have been drinking more and more coffee just to keep myself awake and alert.   Which in turn makes me have significant highs and lows throughout the day.  I am stressed because I was able to multi-task throughout the day and stay focused.  Now I can barely stay focused long enough on one task to complete.  I work in sales so if I don't stay on top of my accounts and clients than we suffer as a team.  I used to contribute long hours when required but that has stopped since the 8hr day is too much never mind 10-12 hr days.  My lack of concentration is something else.  I feel as though I am a child in a Math class learning calculus for the 14th time and my ability to comprehend has diminished and I am now chomping on my pencil with eager anticipation that the clock is going to magically hit 4pm.  I used to love working in this industry and enjoyed the daily challenges.  Now I can't wait to get home and get into bed for a good 3hrs nap.  My bedtime has become 9pm and on some days I am in bed prior to our 9 year old son.  Sad.  I feel rested in the morning but by 9am I am ready for another nap.  The solution, cut back my hours, try and have a cat nap throughout the day (no employer would approve).  My bills need to be paid, and my job is not something that I can leave to the waste side and hope that I can pull through for a better day.  I don't have "better days".  I have been exhausted for 2 years.  My quality of life has changed drastically and I am now looking at any options (Traditional Chinese Medicine) to help cope.  Chinese Medicine is not cheap and insurance doesn't cover it.  In addition, many people do not understand this particular medical issue so they are blind as to what it does to you internally.  I am depressed.  I cry over the stupidest things.  I am very irritable.  My better half states that he feels we are living the life of a 75 year old retired couple.  I am at my wits end.  We have been trying to get pregnant for quite some time- no luck.  My levels have gone up then down then up again.  I feel as though I am on a sinking ship and the rescue boat is not insight.  I sound like a negative sap where I have always been a positive individual.  ouch.  I need to find a way out of this and back into the joy of life.  I miss being happy and refreshed.  I have anxious tendencies now where I never suffered these before.  I get anxious going out to any type of event or even driving to work.  I get anxious when I hear that we have an evening event to attend, because I know that it will be difficult to stay awake.  Naps turn into 3-4hrs.  My appetite comes and goes.  I am overly hungry sometimes and other times I barely want to eat.  My endurance of running every morning has decreased in distance because i just don't feel I have the strength.  I am tired.

Tuesday, February 2, 2010

Here are some symptoms of a pituitary disorder:

Symptoms of a Pituitary Disorder
Headaches
Depression
Mood/Emotion Swings
Anger
Loss of Memory
Loss of Sleep
Sexual Dysfunction
Lethargy
Weakness in Limbs
High Blood Pressure
Unusual Hair Growth
Eating Disorders (Anorexia, Obesity, Bulimia,Weight Gain)
Diabetes
Infertility
Impotence
Irregular Menses
Lactating

Please consult your doctor.

www.pituitary.org

Prolactinoma
These pituitary tumors (also called adenomas) secrete excessive amounts of prolactin and are the most common type of pituitary tumor seen clinically. Prolactin is the hormone that stimulates milk production by the breasts. Prolactin-producing tumors exist "silently" in up to 5-10% of the adult population. Prolactinomas generally have very different presentations in women and in men. In women, relatively small elevations in prolactin cause irregular menstrual periods or complete loss of menses (amenorrhea), ability to ovulate (remain fertile) and may cause milky discharge from the breasts (galactorrhea). In addition, women may have a reduction in their sex drive. The normal prolactin level is < 20 ng/ml. In most women the tumors are detected when they are small (microadenomas) and the prolactin level is only moderately elevated (30 - 300 ng/ml). In contrast, in men prolactinomas are usually not detected until they are large (macroadenomas), most have prolactin levels over 500 ng/ml. Most men diagnosed with a prolactinoma have some degree of loss of sex hormone production. They may also have visual loss (from compression of the optic nerves or optic chiasm) and/or headache. A minority of patients with large tumors may have bleeding into the tumor (pituitary apoplexy) causing relatively sudden onset of headache, visual loss, double vision, and/or pituitary failure.




DIAGNOSIS



Hormonal Diagnosis



The diagnosis of a prolactinoma is confirmed by demonstrating persistently elevated blood levels of prolactin. A prolactin level of over 150-200 ng/ml is almost always due to a prolactin secreting pituitary adenoma. In all patients with suspected pituitary tumors, a complete pituitary hormone evaluation should be performed. This testing is especially important in patients with potentially large tumors who are likely to have some degree of pituitary failure (hypopituitarism). It is important to note that moderate elevations of prolactin (30 - 200 ng/ml) can occur as a result of several other causes, which must be excluded prior to invoking a pituitary tumor. The most common causes are listed below:



pregnancy or in the post-partum period

stress (discomfort, exercise, low blood sugar)

low thyroid function (hypothyroidism)

kidney failure

liver failure

medications (such as anti-ulcer and antidepressants)

"stalk effect"

The "stalk effect": This may be seen with any disease within or near the pituitary gland and stalk that interferes with the delivery of dopamine (a neurotransmitter) from the hypothalamus to the prolactin secreting cells of the pituitary. Therefore, other types of pituitary adenomas, craniopharyngiomas or other tumors or masses may cause modest elevations in prolactin.



The "hook effect": In patients with very large prolactinomas, the initial prolactin level may be read erroneously as normal or only mildly elevated. In such patients, it is important to confirm that the laboratory performed multiple dilutions of the blood sample to avoid this error known as the "hook effect". When dilutions are performed on such a blood specimen, the actual prolactin level may be much higher.



Imaging



Most prolactinomas can be visualized on both MRI and CT scans of the pituitary gland. Such scans should be performed without and following contrast administration.



TREATMENT



Medical Therapy



In general, the first line of treatment for patients with a prolactinoma is medical rather than surgical. Approximately 80% of patients will have their prolactin levels restored to normal with dopamine agonist therapy. The most commonly used agents are bromocriptine (Parlodel) or cabergoline (Dostinex). Most women also have a return of menses and many become fertile again. The size of the prolactinoma will be reduced in the majority of patients to varying degrees, which often results in improved vision and resolution of headaches.



Bromocriptine is generally instituted slowly to minimize side effects. It is recommended that treatment be initiated with no more than one 2.5mg tablet per day at mealtime. This will minimize the major side effect of nausea and gastrointestinal upset. The dose is then gradually increased over several days or weeks up to a daily maximum usually not exceeding 10 mgs. The dosage is adjusted to achieve a normal prolactin level.



Cabergoline (Dostinex), an oral long-acting dopamine agonist, has been approved by the Food and Drug Administration for hyperprolactinemia. It has the advantages of only being taken twice per week and generally has fewer side effects than bromocriptine. It has also been shown to be effective in patients whose prolactinomas are resistant to bromocriptine therapy. The usual starting dose is 0.5 mg twice per week. The dose may be increased up to 1.0 mg twice per week.



Surgery



Women with microadenomas - Transsphenoidal surgery can be considered as first line therapy in women with relatively small tumors (micro-prolactinomas) that do not invade the cavernous sinus and whose prolactin level is 200 ng/ml or less. In these patients, the long term cure rate is generally as high as 80-90%.



Macroadenomas (men or women)- For larger tumors, the surgical cure rate is generally considerably less. In men with large invasive prolactinomas, it is particularly low, averaging less than 30%. For this reason, dopamine agonist therapy is usually tried first. In patients who present with loss of vision, dopamine agonist therapy is also usually indicated first unless the visual loss has occurred relatively suddenly over a period of one to two weeks or less. For the minority of patients that do not respond well to cabergoline or bromocriptine, surgery should generally be performed within 6 months of starting dopamine agonist therapy. After more than six months of such therapy the tumor may become more fibrotic and more difficult to remove.



Pituitary Apoplexy associated with prolactinoma- Patients with macro-prolactinomas may have acute hemorrhage into the tumor (pituitary apoplexy) causing relatively sudden onset of headache, visual loss, double vision, and/or pituitary failure. Urgent transsphenoidal surgery is generally required for such patients.



Radio-therapy



Because most patients with prolactinomas respond well to dopamine agonist therapy, radiation is indicated in only an occasional patient. Stereotactic radiation is generally preferred over external beam radiation therapy because a higher dose of radiation can be delivered to the tumor with less radiation being given to normal brain structures.

Monday, February 1, 2010

The insanity plea

I am not sure how we get through months of trying to conceive.  I think about how much time is spent in trying to surf the internet to determine whether we have any signs of the early stages of pregnancy....hours, perhaps days, years.  The biggest problem with prolactinoma is your body already has the signs of pregnancy.  It is difficult to distinguish whether these are your usual hormones affected by your prolactinoma or the symptoms of actual pregnancy.  I do believe that I know all the websites that characterize the early signs of pregnancy by heart and I hope as I google more that one of them would have the answer.  It's quite depressing at the same time it's pure insanity.  The more I think about it the more pressure and stress seems to develop. AHHHHHH! yes, I know I do it to myself.  I personally believe it's an act of pure insanity.  I then decide that it's not in my best interests to be viewing these sites and let it be, but there's a little voice inside my head that draws me back.  Especially those little ovulation calculators, birth due date, etc. they should be illegal!  Alright so I am a little freakish.  I guess I am hoping for a miracle, a revolution within my body.  I always think back to years when this was not an issue and I would say to my close friends that I wasn't planning on having children until I was ready.  Ummm, I am ready.....so release the eggs and let's begin.  Perhaps I am just to eager.  Nope that's not it.  I am a driven person.  That being said I understand that if you put effort into something that you would like to achieve you will succeed.  There may be failures along the road, but those are to obstacles you overcome.  You see the light at the end of the tunnel and you can anticipate your end of the road at some point.  Unfortunately I am not in control of this at all.  Well, let's just say that I have a hard time when you can't see the light at the end of the tunnel.  Don't get me wrong- I am positive although it sounds as though I am curled up in the fetal position and refuse to remove myself from the path of the oncoming freight train, but I am.  It has been a year and a half.  I think by now the energizer bunny would of died long ago.  I believe "our greatest glory is not in never falling but in rising every time we fall"- Confucius.  I have a strong belief that there are options and those options may not be the greatest but there ARE options.  Ah yes, I also understand that these OTHER options could have a financial strain.  (Look if you have money to buy a 60" flat screen tv or haircuts for the next five years- I believe you can find a saving jar for the "OTHER OPTIONS OF PREGNANCY".  I will say that I would probably use the money for a nice relaxing trip on the beach or touring Europe.  I believe it will be if it was suppose to be.  I will keep trying all the options, but I really don't know how women deal with all this pain, stress and well....more stress.  We put a lot on to ourselves and why?  It's not your fault.  I guess I can answer that myself because we want that one sweet moment of motherhood to last a lifetime...............