Will Weight Loss Surgery Improve Your Liver?

According to this, it will:

Mattar, . (2005). Surgically-Induced Weight Loss Significantly Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome. . Annals of Surgery, 242(4), 610-620. Surgically-Induced Weight Loss Significantly Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome. Original Articles Annals of Surgery. 242(4):610-620, October 2005. Mattar, Samer G. MD, FACS *; Velcu, Laura M. MD +; Rabinovitz, Mordechai MD ++; Demetris, A J. MD [S]; Krasinskas, A M. MD [S]; Barinas-Mitchell, Emma PhD [//]; Eid, George M. MD *; Ramanathan, Ramesh MD *; Taylor, Debra S. RN *; Schauer, Philip R. MD + Abstract: Objective: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients. Summary Background Data: Nonalcoholic fatty liver disease (NAFLD), a spectrum that extends to liver fibrosis and cirrhosis, is rising at an alarming rate. This increase is occurring in conjunction with the rise of severe obesity and is probably mediated in part by metabolic syndrome (MS). Surgical weight loss operations, probably by reversing MS, have been shown to result in improvement in liver histology. Methods: Patients who underwent laparoscopic surgical weight loss operations from March 1999 through August 2004, and who agreed to have an intraoperative liver biopsy followed by at least one postoperative liver biopsy, were included. Results: There were 70 patients who were eligible. All patients underwent laparoscopic operations, the majority being laparoscopic Roux-en-Y gastric bypass. The mean excess body weight loss at time of second biopsy was 59% +/- 22% and the time interval between biopsies was 15 +/- 9 months. There was a reduction in prevalence of metabolic syndrome, from 70% to 14% (P < 0.001), and a marked improvement in liver steatosis (from 88% to 8%), inflammation (from 23% to 2%), and fibrosis (from 31% to 13%; all P < 0.001). Inflammation and fibrosis resolved in 37% and 20% of patients, respectively, corresponding to improvement of 82% (P < 0.001) in grade and 39% (P < 0.001) in stage of liver disease. Conclusion: Surgical weight loss results in significant improvement of liver morphology in severely obese patients. These beneficial changes may be associated with a significant reduction in the prevalence of the metabolic syndrome. (C) 2005 Lippincott Williams & Wilkins, Inc.

Metabolic Syndrome is a collection of health-related problems and symptoms that link a person's likelihood of developing chronic heart, diabetic, high blood pressure, or other long-term problems. The Cleveland Clinic has a good overall description of Metabolic Syndrome here. In a nut shell Metabolic Syndrome is a combination of high bad cholesterol, low good cholesterol, high triglycerides (usually obtained from animal fats), high liver enzymes (which result from liver cells bursting like balloons and spewing their enzymes into the blood), and insulin resistance (often an onset to diabetes). Nasty yet becoming more prevalent in a world with ever increasing-sized people. In essence, Metabolic Syndrome is no a true medical condition but rather a collection of nasty side effects usually associated with overweight people. True, by itself, any number of the symptoms could be associated to genetics, but collectively they say you are fat. And fat people tend to have fatty livers. Fatty livers work harder and develop “scars” in the form of fibrosis an cirrhosis. They work hard but produce less. The strain on the body increases over time. So, what does this article suggest and why should you care? It says that in a majority of patients followed after having some form of weight loss surgery (the most in this study having a “gastric bypass” surgery which also results in less fats absorbed by the body during digestion) their livers improved. They stuck needles into the people to actually biopsy and test results. There are some interesting features to this study and they do mention it. First off, not all liver conditions they tested for were improved in a majority (>50%) of patients studied. Fibrosis only improved in 20% of the patients tracked. That is still a significant number, though (1 in 5). But did the weight loss surgery “cure” the livers? No, at least not directly. What they saw was a significant drop in Metabolic Syndrome which, again, is not a “single” systemic problem but actually a collection of related problems. 70% of the original patients (before their surgeries) had Metabolic Syndrome. At the conclusion of the study, only 14% of the now-post-surgery patients had Metabolic Syndrome. A look at the numbers in the abstract are a little confusing (I admit I do not have the entire study and wish I had all of the tables to look over...Bobblehead loves statistics!) because you see a wide-range of patients. Some are 5 years out from when the study was published. Others are 1 year or less (and hence probably not at their ideal weight, yet). Some have had a true significant weight loss and appear to be a a reasonable target. Others are still loosing weight and are breaking down fat cells grown over years and years, thus releasing lipids into to the blood and keeping the Metabolic Syndrome going. Likewise, you store glycogen in your liver and many people who have not yet lost a significant amount of weight are still relying on their livers. The fatty livers remain. Again, does weight loss surgery directly fix your liver? No.....but... Indirectly it does and that is good news. The livers are repaired (livers are marvelous organs fully under-appreciated by Western Culture!) fairly well on their own assuming massive chronic damage does not occur. Who cares that the livers get better, not as a direct result of the surgery, but rather as a pleasant side effect of curing excess lipids (fats) in the blood and getting your body to properly respond to insulin? In other words, by fixing the Metabolic Syndrome you end up fixing the liver. And the pancreas. And the heart. And the knees. And the kidneys. And the arteries. And that is very, very good. Now, I have to make a smart-ass remark to this article. Duh! Anyone could have predicted this. I saw this first hand in my tests. Yet, I agree this study should have occurred to at least give evidence to the situation. A similar study comparing two sets of patients, one that loses weight via a malabsorbtion surgery, and one set that loses weight through either non-surgical or restriction methods (Lap-Band) would be interesting. Also, tracking a set of patients with similar starting BMIs over time would have been interesting as well. In any case, the article give credence to the fact that if you have Metabolic Syndrome (and most morbidly obese patients do), losing weight and changing diet will help. If surgery ends up being a tool to accomplish this, your liver will thank you.

[posted by Bobblehead]

Another perspective on the Duodenal Switch Weight Loss Surgery

Jane's Story.

If you are interested in the DS procedure, take a look at Jane's story here: http://www.weightloss-surgery.com Jane wrote this back in 2002 (with some updates since). It is all still relevant and what Jane went through was fairly common. Jane is over 5 years out and doing fine. This site will go into a must read for people who seek me out about WLS. Jane setting up a web site with virtually every detail about DS is fairly common for people either waiting for surgery or under one year out. What is interesting is that Jane still maintains a blog on her life and health and often mixes in informative articles still current on DS. Now this is the Bobblehead's kind of woman! Yup, she talks about the weight loss and new body transformation, the vacations with family. She also throws in positive information on improving insulin resistance, problems with flatulence (uh,...wasn't me), and myths. This article lead me to her site:

Duodenal Switch Surgery Myths... [...] Sometimes though people omit the bigger picture. I read of non complying WLSers complaining of evil side effects and knocking their surgeries. Sometimes publically they admit to eating the wrong food types, not taking supplements, alcohol abuse, etc…well, what does one expect then? Of course a percentage of unlucky people comply, work hard at their surgery but it still is a nightmare for them. And they have every right to tell their story and feel resentful towards it at times. It’s hard when it doesn’t work. Their insight is invaluable as it helps those researching get more of an understanding of the reality in the sad event of a complicated surgery. Myths that make me laugh or sigh (depending on my mood) are ‘DSers have body odour, DSers wear nappies (Oh MY LORD! lol), DSers poop all the time. DSers have constant uncontrollable diahorrea. DSers pass wind all the time. DSers have thin hair.’ Myths are always black and white. Always a definitive statement. [...]

Excellent piece and right on the money. For the record, I do not stink, my hair did thin the first year but came back as Bobbleheaded thick as ever, I do not wear nappies (diapers), I do not poop all of the time...Sheesh!

But life has not been perfect, either. The Bobblehead is very religious about taking the right supplements but I still have a vitamin D deficiency and am still anemic. There is a theory (!THEORY!) that my hypoglycemia is caused by the massive weight loss. No one seems to say that DS patients have not been linked directly to this issue. And on and on. If you are thinking of having weight loss surgery or, even better, if you are long-timer like me, Jane's blog is special. The number of journals for people past year 2 is low. Jane's blog is at http://satorijane.com/blog and I have become a subscriber.

[posted by Bobblehead]

A “clear cut” definition of a Basilar-Type Migraine

From Ron King's Migraine Mastery:

Basilar Migraine A Basilar-Type Migraine is a Migraine that has aura symptoms originating from the brainstem and/or affecting both hemispheres of the brain at the same time, but with no motor weakness. The aura of BTM usually lasts less than 60 minutes, but in some cases can be more extended. Basilar-Type Migraine presents symptoms that can mimic other, far more serious conditions. It is essential that the diagnosis be definitive and correct. An imaging study such as a CT scan or MRI should be performed to rule out other causes for the symptoms, and an EEG is often performed to rule out seizure disorders. As with other forms of Migraine, BTM can be disabling. Basilar-Type Migraine is one of the most frightening of head pain disorders, but the symptoms are usually more frightening than harmful. [emphasis mine]

I would agree with most of this. However, “clear cut” is a word I am finding seldom applies to Basilar-Type migraines. Doctors are either too fast to diagnose them or diagnose around them. My symptoms dance and jiggle around what Ron writes, however the aura has lasted for hours on end and the cycle continues every day. I do have triggers built right into my body (hormone fluctuations due to the hypoglycemia, the vestibular issues, the neck injury throwing everything off including proper blood flow to the head...damn, sounds like I am ready to lay down and die...) so your milage may vary. As for the symptoms being more frightening than harmful...Ron is both right and wrong. True, by themselves BTMs are not too harmful. There is an elevated risk of stroke and transient ischemic attack or TIA. However, the symptoms can confuse everyone including Emergency personnel. My first bad BTM threw the ER staff for a loop while they ran CAT scans of my brain and ordered up a lumbar puncture (spinal tap) of my spine. The symptoms threw everyone, even migraine experts, on several wild goose chases. Today I do not leave my home without some sort of medical ID information on me. Many emergency personnel are not aware of BTMs. My cousin, a newly graduated fireman and EMT, had not heard of BTMs and was convinced that I had a stroke (it sure seemed that way from appearance). So even listing “Basilar-Type Migraines” on an ID bracelet is often not enough. I carry an ID with a phone number and web-link back to detailed medical information including a description of medical symptoms associated with BTM. Now, if I do get a stroke, my luck, they will not test or treat me because they think it is a BTM...Bobblehead cannot win. Ron has other migraine definitions as well. It is a nicely ordered migraine site. My goal is to present all sorts of medical information, not just migraine info. And, more importantly, I want to link to the human side of the conditions as well. It is one thing to read about symptoms, another to hear true stories. Well, about time for work.

[posted by Bobblehead]

Women are more likely to suffer from migraines than men

I know. Duh!
But it makes sense. What with those hormones running loose each month. I know, while my brood does not appear to suffer from migraines (El might...either that or tension headaches) I am the only one with a respectable amount of testosterone running through my veins.
Take Deborah at Weathering Migraine Storms. Her blog, besides a window into her life, shows a pattern of coping with pain. A must read if you are a regular sufferer. She writes about a research grant from The Migraine Research Foundation.
Go give Deborah a holler and tell her the Bobblehead sent you.

[posted by Bobblehead]

Dr. Bobblehead and Mr. Hyde

El pretends she is the Bobblehead's alter ego

Being a Bobblehead is not easy. The constant dizziness and distractions took a toll on my spirits something terrible. I became listless and moody. Insomnia is something that still plagues me even after seeking treatment. A combination of a Migraine attack that lasted for weeks, the slow loss of being able to do things I loved and needed: driving, exercise, reading, music...eventually even spending a day walking around was forsaken for a day in the wheelchair. The fatigue from the insomnia enflamed my moodiness. Hypoglycemia dropped my sugar and made me out of touch of my moods. It was a storm brewing that I had a horrible time hemming in.

Many chronic migraine sufferers have clinical depression. I definitely had some of the symptoms. I avoided taking any antidepressants. Sleeping aids were avoided but in the end needed. Fatigue worsened my overall ability to make it through the day.

Those I loved around me usually brought on the wrath of my despair. I usually made it through the work day without getting too riled up, but once home and amongst formally comfortable people and surroundings, my pain seeped through. On more than one occasion I found myself shouting insults and vulgarity at my wife and children. As always, I felt ashamed and slinked away and begged forgiveness. Then, sometimes within minutes, I felt buttons pushed and started up, again. I clearly recognized an abusive cycle with me in the roll of the abuser. Yes Bobblehead has a temper, but this was different. This was fear and pain leaving myself in an attempt to cleanse. Truth, however, was that my soul was vilified and those I loved were suffering. I wanted to avoid medication but also knew I could not keep this path for fear of the pain I was inflicting on those who were reaching out to me.

During a calm day, I sat down and discussed the concept of Dr. Jeckyll and Mr. Hyde with my two girls. I told them that inside each of us lies another being, one of darkness and despair. I needed to remind myself that I needed to remain as Dr. Jeckyll and I needed to keep the Mr. Hyde personality deep inside. Easier said than done, but this concept worked for me very well. A few days later I had picked up El's cell phone to charge it. She had snapped some silly photographs of her sister, her cat, and her friends with the phone's camera. I came across this photo and immediately started to laugh. El had donned the mask of a friend and was acting silly. Yet this photo displayed the essence of what “Mr. Hyde” meant to me. I mailed it to my own phone and computer. It is now the wallpaper of my cell phone and my laptop. “Scary El” is a visual reminder of what I want to avoid in myself. Often, when I feel frustrated or discouraged I will flip open my phone and just gaze at this brazen image of the demon within.

Visual reminders are a good coping tool to assist with many recognized flaws. I have a tendency to talk and not listen. I keep a small plastic hour glass on my desk to remind myself to take a turn and then stop and let others have turns as well. Dice and the concept of randomness in life are another symbol I use. I love control but often have to concede that in the end, none of us are fully in control. We can only cope with the random rolls of the dice that come up.

A friend of mine is having problems at work. She is in a turf war with people in an other organization. She is weary of fighting yet leery of surrendering when she feels she is right. In the end, she is best off fighting the tide. I call her Don Quixote de la Mancha and suggested that she put a copy of the famous painting by Pablo Picasso on her desktop and wall. A little windmill is another wonderful analogy for her. Again, this is her visual queue and no one besides herself need know the iconic connection between the image and her desire to cope with a frustrating situation.

I went out during a full Bobblehead moment and purchased a copy of The Strange Case of Dr. Jeckyll and Mr. Hyde by Robert Louis Stevenson at a local bookstore owned by a friend. Due to the Bobblehead's constant double and blurred vision and lack of attention span, this short novella was a long read that I only finished this morning. It was not quite what I expected. Having only the image from modern cultural references and never read the original the duality portion was clear, but Jeckyll's desire to transform in Mr. Hyde was never conveyed. I thoroughly enjoyed the novella and portions did translate well into the case of Bobblehead being a sh*thead at times. It is a must read.

READ (from Amazon.com):

• “Strange Case of Dr. Jeckyll and Mr. Hyde” (Easton Press)
• “Don Quixote (Modern Library Classics)” (Miguel De Cervantes)

If you want to know what it is really like in the OR, shut off ER and

Bobblehead is not a medical doctor. But I have been working in parallel to the medical profession for my entire year. Doctors are human although they often appear not to be. I have met some lousy doctors with great bedside manner and some great doctors with lousy bedside manner. The best, of course, is a good doctor and a good personality. Those are rare. They are out there, though.

Surgeons are an interesting breed. They cut. Into me and you. For money. Yet, as a whole, most of the surgeons I have dealt with have great bedside manner. Is it a trend? I am not sure. Maybe it has to do with the fact that they get to see what makes us tick up close each and every day and reminds them just how fragile sacks of water we really are.

Take Sidney Schwab, MD, and his blog Surgeonsblog. Here you get to read from a semi-retired surgeon what surgery and humans are really like. Want to know why bowel is cool, see Schwab. Want to know what it feels like to touch a liver. Yup, you can do that. Want to see surgery from a human perspective. Sidney is the doc.

I have subscribed to Surgeonblog for a while. The articles can be long but well worth the time. If medicine and TV shows like House and ER fascinate you, go give Sidney a visit and tell him the Bobblehead sent you.

Also, Sidney has a book. Check it out.

“Cutting Remarks: Insights and Recollections of a Surgeon” (Sidney Schwab)

Technorati Tags: Blogging, Medicine, Surgery

The Only Accurate Bobblehead Giveaway Lists

The living, breathing Authentificous Radioactive Whirling Recently-unwheeled Bobblehead of the Magical Atomic City on the Hill owns exactly....zero bobbleheads.

Dang! That's just not right. The little Bobbleheads have a few bobbleheads from a few years back for the Albuquerque New Mexico Isotopes, our local minor league baseball team. What could be better than radioactive baseball?

How about FREE BOBBLEHEADS?!?

And you can get them if you know when they are being given away. How do you know when they are being given away? Check out The Only Accurate Bobblehead Giveaway Lists: blog. I gotta keep an eye on it.

Then again, there is always Ebay. Maybe you can find a Monk Bobblehead for under $20...

Technorati Tags: Bobblehead, Monk

Why am I called the Bobblehead?

Saturday Jan 26, 8:00am in the Atomic City My daughter, El named me Bobblehead. During my recent bought with all sorts of crap my head would often lean heavily to the left. Always left. I also had a rolling or bob-&-weave motion to my head during a bad attack. My face would go white or green. Terrible. My wife, Mrs. Bobblehead, decided to document some of this. Here I am in full Bobblehead motion! Engage Bobblehead thrusters! Trying to drink while the room rolls and the horizon bobs like a cork on the ocean. Yup, this was Bobblehead near his worst! The look on Cl, Bobblehead's daughter, is one of concern with a touch of, “Dang, exactly how much of his DNA is in my genes?”

Yours, Bobblehead

Technorati Tags: Basilar-Migraines, Hypoglycemia, Migraines, Bobblehead, Hypoglycemia, Vertigo

Well, NOW the Bobblehead can sleep better at night...

According to CNN (via AP):

Pakistan says nuke arsenal is safe ISLAMABAD, Pakistan (AP) -- Pakistan is increasingly alert to the possible threat of Islamic extremists seeking control of its nuclear weapons, but its security system is fail-safe despite the rising militancy in the country, a top official said Saturday. Some 10,000 soldiers have been deployed to secure the U.S.-ally's nuclear facilities as part of a command and control system headed by President Pervez Musharraf and other top officials, said Khalid Kidwai, head of the Strategic Plans Division which handles Pakistan's nuclear arsenal. Kidwai said there was concern that Pakistan's weapons would fall into the hands of al Qaeda or Taliban-style militant groups. “Pakistan's nuclear weapons, fissile material and infrastructure are absolutely safe and secure,” he told journalists. Kidwai said his division still planned for any contingency and has reassessed the militant threat in light of escalating attacks on security forces and intelligence personnel, although it had received no intelligence of a terrorist plot against the nuclear facilities.

Good! I was starting to worry a little, seeing how stable the region is and how leaders are chosen and removed from office through diplomatic means...

Technorati Tags: Middle-East, politics

Healing and Journaling

Friday, January 25, 2008 5:18 AM Yup, you read the time above correctly. I was up at 4:45am. Bobblehead is still having insomnia however it is getting better. In addition, I am having tinnitus, a buzzing in my ears which has actually gotten worse since the treatments began. But hey, I am walking! It looks like no Bobblehead Whirling Wheelchair anymore. In addition, I am walking without the cane! Booyah! People are constantly telling me my color is back in my face. Life is good. I have tried to keep journals before and have had success on and off with them over the past. This is the second lifetime of Atomic City, the first was solely dedicated to Health and Fitness. It was fun and readership was actually increasing. But time took its toll. Likewise, another one of Bobblehead’s blogs was used to discuss my training for a Triathlon and Century Bicycle Rides. It, too, had gained a little readership. But blogging for others really is a commitment. I enjoyed it but it became a chore. This blog is for me. Even if I get few dedicated readers that is okay. I am doing this for my own health. I have kept journals on and off over the years but had a hard time being dedicated to them. This time is different. While at the Cleveland Clinic I ran across a book in the gift shop, Write for Life: Healing Body, Mind, and Spirit Through Journal Writing, by Sheppard B. Kominars, Ph.D. I bought it a few days later. It wasn’t until my vision cleared that I started reading through the book. He says what I have known in my heart but would not let my brain to accept. Lose the rules when you write for yourself. Try to do it a little every day but write. He also suggests using pen and pad as opposed to a computer. Paper means free flowing thought. Computers scream editing. He has a point. Atomic City is mostly written in an application for Journaling. Yet I went and dug out an empty paper journal and started writing. I do write in my laptop as well and many of the posts are personal and intimately involve people in my life thus making it unfair to bring to the cruel internet and stay encrypted on Bobblehead’s machine. Some get popped up with editing (I am trying to erase all names from Atomic City), and others, like this one, are more for the web from the beginning. Suffering is a human constant. How we cope with suffering makes us individuals. Some coping works well while others are destructive for both ourselves and those around us. Journaling has been shown to clearly help heal. Atomic City is for the Bobblehead and he will try to keep it constant and current and interesting. I would love if you joined me on a regular basis. If you are just passing through the Atomic City, welcome. As for your own healing, think about it. You need no fancy tools, no expensive wireless laptops, no leather bound journals. You need a good legal pad, a pen or pencil, and and soul. Go, heal. Oh, and if you do want to join Atomic City, Click Here To Subscribe either via email or a reader. Yours, Bobblehead "Write for Life: Healing Body, Mind, and Spirit Through Journal Writing" (Sheppard B. Kominars) Related Tags: blogging, journaling, tinnitus, Cleveland-Clinic, diary, triathlon

New Triptan Drug, FROVA, available to treat Migraines

From CNW News Group in Canada:

    MONTREAL, Jan. 21 /CNW Telbec/ - Teva Neuroscience Canada announced today
the launch of FROVA(R) (frovatriptan succinate tablets), a unique treatment
for patients suffering from migraines. The single strength 2.5 mg tablets are
now available by prescription in pharmacies throughout Canada. This is
important news for those suffering from migraines who are not receiving
effective therapy at the current time.
    FROVA is indicated for the acute treatment of migraine attacks with or
without aura in adults. "The launch of FROVA in Canada is further proof of
Teva Neuroscience's commitment to patients suffering from neurology
disorders", announced Dr. Jean Godin, General Manager, Teva Neuroscience
Canada. "While there are other treatments currently available for patients
with migraines, our research shows that many patients are not satisfied with
the relief or tolerability offered by the current medications. FROVA has a
unique profile that may benefit many patients."

FROVA is a triptan, a common migraine-buster. Like others, FROVA should not be used for Basilar Migraines or Hemiplegic Migraines. Like most abortives, overuse will likely result in the dreaded rebound headache. Trust, you do not want to tread there. What sounds promising about FROVA is the half-life of 26 hours. That means the drug will stay in your system longer so one dose will carry you further (1/2 the drug will still be active after 26 hours, 1/2 of that 1/2, or 1/4 will still be active after the next 26 hours. So 2 days after you take the drug, 1/4 is still kicking migraine-ass). The FROVA web site, http://www.frova.com (in case you could not figure it out) also says the drug is good for Menstrual Migraines. I also know first hand the role my hormones (insulin, adrenalin) have been playing with my condition, I could only imagine the result of a monthly hormone jolt to the system.

Statistics, AIDS, Africa, and the Bobblehead

From the Economist: ON THE face of things, a fall in the number of people infected with HIV (the virus that causes AIDS) from 39.5m to 33.2m over the course of a single year should be cause for rejoicing. That is the news from this year’s AIDS epidemic update from the World Health Organisation (WHO) and UNAIDS published on Tuesday November 20th. Indeed, it is good news, for it means there are fewer people to treat, and fewer to pass the infection on, than was previously thought. But the fall is not a real fall. Rather, it is due to a change in the way the size of the epidemic is estimated.

Factor that change in and the number of infected individuals has actually risen since last year, by 500,000. And even that is not necessarily bad news in the paradoxical world of AIDS. As treatment programmes are installed around the world, death rates are falling. According to the revised figures, the peak, of 2.2m a year, was in 2005. Now the figure is 2.1m. Since the only way for an infected person to drop out of the statistics in reality (as opposed to by sleight of statistical hand) is for him to die, such increased survivorship inevitably pushes up the total size of the epidemic.

The best news of all, however, is that the new figures confirm what had previously been suspected—that the epidemic has peaked. The highest annual number of new infections around the world was 3.4m in 1998. That figure has now fallen to 2.5m.

I mentioned this about 2 years back when the Atomic City was a health and fitness only blog. I had comments open to all and boy did I get slammed. I did acknowledge that the AIDS epidemic in Africa was real but that I had a hard time accepting the statistics. I felt the number was too high. There is precedent for that. A number of years back statistics in Canada showed an epidemic amongst straight women. However the numbers were misleading. In reality, the numbers were showing a small population of straight women having AIDS (or HIV) as opposed to an huge increase.

Boy did the Bobblehead get slammed in the comments. It was as if I were attacking the entire AIDS situation. No, I pointed out in vain, I was concerned that the statistics were misleading the proper course of actions for treatments and prevention. Oh well. The AIDS climb in Africa appears to have peaked in 1998. Also survival rate is up. AIDS is a terrible disease and Africa is ripe for a spread like this. While the Bobblehead is happy he was right (Told you so! Told you so!) he is still disturbed that decades later HIV is a nastier, adapting critter than we had expected. I expect to get slammed here as well...

Staying vertical all day Saturday

Sunday, January 20, 2008 12:05 PM The Bobblehead family went out to Santa Fe shopping. It was a long day with lots of walking. I did not use the wheelchair but I did carry the cane. I basically did not use it all day. I did buy a new smaller journal to keep track of health, diet, etc. That has come in remarkably handy. If you are having any kind of chronic health problems and cannot get doctors to pay attention, keep notes. A diary is indispensable. I had problems in Target. Since when did Target turn into Walmart? The aisles have become incredibly narrow. The constant cross traffic across my vision started to get to me. In a larger, more spacious store I did just fine. Near the end of the day I was stuck standing in line. The fatigue was hitting me. I started to do the Bobblehead patented “Lean to the Left” ® I finally gave up, walked out, and went to sit down. I am out of the chair for a whole week now. I hope to be driving my old rusty truck again within the next 2 weeks. The bitter cold in the Atomic City has been miserable. We wish it would at least snow and get some moisture. Currently it is 30°. I was hoping to get out and walk the dogs before now. It will have to wait. I spent hours getting my blog up and running. Now it should be a snap uploading to Atomic City. Bobblehead

What Exactly IS The Radioactive Bobblehead's Diagnosis?

Sunday, January 20, 2008 8:09 AM Cutting to the chase. A lot of people are asking what did the Cleveland Clinic actually find out? They told me what I do and do not have.

• What I do not have:
• A benign brain tumor in the pituitary gland
• A pituitary gland disorder
• A Human Growth Factor Deficiency (hypopituitarism) disorder

What I do have (and it is a series of conditions and events that cascaded together):

• Inner ear damage on the left. This was most likely caused by a virus. The damage is irreparable and I will always have some degree of vertigo. In addition, I am high risk of losing balance function in my right ear as well. Engage full Bobbleheadiness!
• You can read all about this condition on the Vestibular website.
• Drug side effects, withdrawal, and rebound attacks
• A cervical neck injury on the left
• Migraine attacks, often without headache. There is no doubt in my mind that some are more classic migraines and others are Basilar-Type Migraines (BTM)

What I also have but the causes are not currently diagnosed:

• Anemia (suspect is my weight loss and/or the Duodenal Switch weight loss surgery
• Non-Diabetic Hypoglycemia. There is consensus amongst my doctors that this is also because of my WLS. However, I am not finding evidence that DS patients are experiencing this.

How I am being treated for my Bobbleheadiness:

• I came off of the lorazepam, the scopolamine patch, and the Midrin
• I had 3 IV infusion treatments to break the migraine cycle. Drugs included were

1. Magnesium Oxide
2. Topamax
3. Depacon
4. Reglan

• Physical Therapy

1. I started Physical Therapy with the McKensie Method for cervical care
2. I will start Vestibular Rehabilitation Physical Therapy in a number of months

• I am taking the following drugs as preventive treatment for Migraines:

1. Nortriptyline (In a higher dose, this is an antidepressant. I am on a very low dose and I will taper off in a month or so)
2. Depakote ER (an anticonvulsant often used for epileptics and bipolar patients...no, I am neither)

• As a Migraine abortive I have been put on Voltaren (Toradol)

As for the rest: • I am on Procrit injections for my anemia and they work wonders • I am currently not controlling my hypoglycemia through diet and that is working fairly well. I am seeing a new endocrinologist at UNM Hospital in March, 2008. Dr. Pituitary at the Cleveland Clinic is recommending some tests including a 72 hour fasting glucose, a new IGF-1, and a cortisol test So far so good. As of today, I have been completely out of the Bobblehead Wheelchair Chariot for a week now. Hey, life is good. As for my impression of the Cleveland Clinic and details on how the trip and doctor visits went I will post more later. For now, all I can say was the entire Cleveland Clinic experience was incredible and I would not hesitate one second to have additional critical or chronic healthcare matters taken care of.

Vertical, clear-headed, and remarkably unBobbly Yours, The Radioactive Bobblehead

The start of my attacks as documented by emails...

My attacks started in full on August 13, 2007 in the morning. I was not journaling then, but I did send out a number of detailed emails. I am not correcting spelling errors in this post. It is amusing to see my writing wax and wane as I get drugged, fatigued, and zoned out. All names are edited out. They paint a bleak picture... ____________________ To my wife. It started with some irony. I emailed her about doing a Halloween bike ride in Albuquerque in costume. This was sent in the morning when the attack was first going on. I never did the ride...(8/23/07) I AM AM AM doing this event. Day of the Tread Almost two months later, my wife found my original email and sent it back to me. It was funny and pathetic at the same time. I felt like sh*t and the last thing I wanted was being reminded of how I was slowly giving up the things I enjoyed, one at a time. i replied to her in October. (10/3/07) Yeah, I know. This looked like a fun event and the girls would have had a blast. I doubt I will be up to it. D ____________________ To my colleagues (8/14/07) I went to the ER yesterday from work. My blood sugar continued to drop and finally bottomed out at 57. We finally got it back up. Good news is that the CAT scan shows I still have a brain... Am very fatigued. I am staying home. If you need me, you can try this email address or my cell (xxx-yyyy) but no assurance I will be quick on the upswing. D ____________________ To my colleagues (8/16/07) I made it to Smith's (a local grocery store. D.) yesterday on the way to work where I ran out of steam. My wife took me home. I slept much of the day. Sorry for not checking in. My mind has been wandering. I took some strong sleeping pills last night and slept well. I am feeling better but am still weak. Will try to make it back in tomorrow. Am able to wobble around a bit. Am scheduled to see an ENT for the vertigo although the doctor and I doubt this is an ear problem. The hypoglycemia combined with my hypothyroidism is the main suspect. We are also looking at a metabolic connection. Can anyone recommend an Endocrinologist (B has). What baffles us is the more I eat the LOWER my glucose levels drop. We are looking at C-reactive protein levels now. I also am looking into a neurological possibility. I keep telling my wife she gets on my nerves! (Actually she has taken this whole in sickness and in health thing pretty well....) It is frustrating stumbling along like a drunk and having my mind work in slow motion. Sorry to be out. WIll have my cell phone although I expect another diazipam is in my immediate future... D ____________________ To a friend. You start to see a break down of thinking, more based on the drugs at this point (8/21/07) i see an ent next week. There isa possability this coul be meniere's disease although I hVE an MRI thursday. ____________________ An email to a colleague. Here, I am feeling better and think I am over it all. I also point out an increase in dizziness after I eat, a confirmed symptom even today (8/25/07) According to all of the tests I am fine. Blood is fine. CAT scan and MRI on my brain is fine. My ears are fine. I am suspecting an increase in insulin production after I eat. This is not the same as a diabetic insulin insensitivity...just the oppersite. I found an article in the NEJM that perfectly describes my symptoms in other long-term post gastric bypass patients. I am finely over this attack...it lasted 2 weeks. I still have a battery of tests to do. But my first hunch is the one I need to pursue...see an endochronologist. I need to go to occ med and try to go back to work today. I peter out at about 3pm so I might try 1/2 days for a week. D ____________________ To my friends. So far, according to every test I took so far I am fine. I am being sent to an Ear Nose and Throat doctor. While in the end they would also miss the subtle clues in my test results and misdiagnose me, I was and still am grateful my local doctor sent me. It was the audiologist tests that eventually sent me on the correct path. (8/28/07) I wanted to say thank you for your letters of concern and thoughts. I appologize for not replying more coherently earlier. I have been very out of it. I have been going through non-stop testing and exams and am too tired when I come home to read email. The drugs have been kicking me down pretty bad as well. First the good news. The brain CAT scans & MRI show no tumors, leasions, clots, plaque, MS, etc in my brain. The radiologist's quote on her report was "The patient's brain is unremarkable." Good news but did kind of hit the funny bone. Blood tests show normal or almost normal levels for everything (with one exception below). My thyroid levels are okay (I am on synthroid because I have 1/2 a thyroid gland), my pituitary gland is okay, normal metabolic screen, no heavy metals, slight anemia. The ENT is pretty sure I do not have Menier's disease. But he is going to spin and zap me next week to see my dizziness thresholds. He doubts an ear connection to this problem but will check it out anyway. So far, this has been a game of exclusion of conditions...I had a hearing exam and passed above normal. I was told that I am not allowed to pretend that I did not hear my wife when she asks me to take out the trash... It could still be neurological. I doubt it now personally. It does not explain the extreme rapid hypoglycemia. What is happening is a drastic drop in my blood glucose levels after I eat, especially simple carbs. I had two donuts right before my attack a few weeks ago. I have been trying to look for patterns and this one seems to be emerging. There is a condition where the pancreas secretes too much insulin after one eats. However, unlike a diabetic, I am NOT insulin intolerant. There are several conditions which could cause this. Tumors or cancer in the pancreas, or other altered morphology in the pancreas. I did find someone else that is a long-term post bypass patient report the almost exact symptoms. I tracked this down and found a few articles in the NEJM which described almost exactly what I am going through (not easy to read scientific articles while on several narcotics and antihistamines and hypoglycemic...). I am going to try to alter the order in which I eat my food and supplement with some Chromium. I need to get into an Endocrinologist that specializes in a metabolism disorders. There is one at UNM. I had a CAT scan of my pancreas yesterday and have yet to see the results. I suspect a biopsy is in my near future. Peanut butter. If I start acting loopy give me peanut butter. I need protein in my system to stabilize the glucose levels. I will keep a jar at work. I am functional but very, very tired. This attack kept coming back in waves for 2 weeks. I have never ever felt like this before (actually I felt basically nothing). My wife has been an angel in driving me around to doctors, the ER, keeping me awake when needed, etc. She deserves an upgrade from fries to onion rings the next time I treat her to Sonic. Hell, she is worth it. I hope to come back to work 1/2 time until next week. I am waiting for a call from my doctor. Please be patient with me when I do come back. I am still a little slow and "zone out" pretty easily. I forget things easily (last week I could not remember simple things like my full name, what year it is (1973?)...but I remember that all now). Everything happens for a reason. I do not know what the reason for this is (and may never know) but life is good to me. With much thanks, (Vertical) D ____________________ To my colleagues. I am still drugged out. (8/29/07) Well, no pancreatic cancer, increased islets, or tumors. Still high insulin production. My nurse practioner does not want to controdict my doctor so I am not sure when I will be back to work. Hopefully soon. I am tired but not in a fatigued sick way. I see my main doctor on Friday morning. In the meantime, go ahead and read INKHEART by Funke. Very good book so far (considering I can only read a few pages before I zone out) (By the way, I finally did finish the book and it was amazing. D) Hope to see everyone soon. D ____________________ To a friend on an article about motorcycles. Here I start worrying about ever getting on any bike, again. Chances are I will not ride for a while, even now. Also I am back to work and note that it is almost a month between this email and the last one. I was just too exhausted after getting home. I was still walking and driving in late september. (9/26/07) Well, considering I am having a hard enough time even WALKING, getting a bike is starting to fall off of the radar. But for now, maybe an update to the Hurt report on motocycle crash causes: Motorcycle USA I hope you are doing well and enjoying your new job. Miss you! D ____________________ To my friends and colleagues. My stubborn nature to accept my frailty shines through. (10/24/07) Well, once again my wife has shown me the evil of my stubborn ways. She pointed out something clearly obvious to her but lost in my logical but faulty analysis of risk. In other words, she called me a dope...(I hate it when she calls me a dope and ends up being right...) My attacks have a clear pattern of being set off by loud, pulsating noises and flashing lights. Like those of, say, a fire alarm... So while I eagerly say, Sure, I can walk down the stairs if needed, the reality might be that the alarm itself might incapacitate me. In which case you have a choice of sacrificing me (I can think of plenty of people that wish to burn me in effigy) or treat me as luggage and drag me down the stairs. We will see what happens if I happen to be present during an alarm. Please forward this to Da as she is the safety officer. Thanks, D ____________________ To my wife’s cousin. He is a pulmonologist in Texas. Here you see concern about my liver. You also see an original diagnosis of Basilar Migraines which turns out to be partially correct. The low IGF-1 sets off a long journey into seeing if I have a pituitary problem resulting in low Human Growth Factor. This turns out to be a red herring as we would find out at the Cleveland Clinic in January of 2008. (11/5/07) R, I am trying to get into the Mayo Clinic in Minn In a nut shell, here is what is going on: Vertigo: Menniere's has been ruled out. An audioneurological test showed my right inner ear is working at 50% compared to my left. My left over compensates and I fall to the left. The problem is that no one is sure if this is truely an ear problem or a brain problem. My ENT prescribed a low dosage of nortryptaline (25mg). My neurologist is suspecting basilar migraines. No triggers have been identified. The nortryptaline is being prescribed as a preventive drug. I had a terrible reaction to compazine. Triptans are to be avoided for basilar migraines. I was on Midrin for a migraine buster. It did not work. And because of the tylenol component in midrin, I went off of it. I saw an endocronologist also. I have a constant bout with hypoglycemia. I am not diebetic. My fasting glucose is about 55-65. My fasting insulin is normal as is cortisol. What is low is my IGF-1 at 72. We immediately suspected human growth hormone deficiency. The insulin tolerance test is difficult at best and not performed in most hospitals in NM. UNM performs it but since I need to travel, what the hell. I hear Minnesota is wonderful in the wintertime! My liver enzymes were up (L sent you the numbers). I had them retested a few weeks later and they doubled. I freaked and called my primary. IGF-1 is produced in the liver and low levels can also indicate liver disease. I had a fatty liver before my weight loss. A current CAT scan of my liver indicates a crystalline where before there was fat. I had brain CAT and contrast MRI. No abnormalities. However, the resolutions were not high enough to locate microtumors on the pituitary (major cause for HGF Deficiency). I have been anemic for years. I am on procrit and my latest hemoglobin was about 14. I also tend to spill some protein in the urine. Blood work shows few abnormalities. slightly high sodium, slightly low potassium. Low vit. D. normal vit B12. normal WBC. normal CRP and c peptide. An abdominal CAT scan showed no abnormalities. A small cyst was seen on my kidney but no one seems alarmed by that. No insulinomas. No pancreatic cancer or tumors. So, the general concensus is that the hormonal levels are triggering the migraine. However, I have not had a formal diagnosis on ANYTHING as of yet. D ____________________ The longest email of all. By this time (end of October) I had moved to a wheelchair, was stuttering and shaking like a leaf, was wearing my sunglasses almost full-time inside, and had given up driving. This was me at my lowest ever in my life. (10/21/07) Please feel free to forward to anyone you wish. And appologies for the length of this "tome." ___ October 21, 2007 Well, the rollercoaster ride is not over. It just took some unexpected turns. Last week L, C, E, and I flew to Florida to attend my cousin's wedding. He looked scared out of his mind when the ceremony began but he quickly recovered. His new bride and her family are charming. The trip made us nervous. It has been a rough few weeks since I last wrote. We are still screwing around for a definitive diagnosis. My neurologist is strongly hinting at a call of migraines call Basilary Migraines. These attacks occur in the brain stem which controls autonomous and reflex functions. They are most common in women, and not in all women. The classes that are most prone to these attacks are pubescent girls and menopausal women. Middle age men are usually not hit. However the symptoms seem to follow mine very closely. Vertigo, double-vision, weakness, headaches in the back of the head (although these attacks can occur without headaches), slurred speech, amnesia (don't believe Hollywood. Normal amnesia is basically short-term memory loss), automatic behavior, ringing in the ears, extreme mood swings, anxiety, misinterpretation of what one sees, irregular body movement. Yup, that is a big check mark after each of these. The joke at home is we never know which D we will see today. Maybe today is Stroke-like D. Or Turrets-D (without the cursing…this IS a family show, after all), or Parkinson's D, or Epileptic-D, or Normal-D, or Sleeping-D, or Paranoid-D. Never a dull moment. Migraines usually have triggers. We have not figured mine out. I had been placed on a very low dose of nortriptyline. This drug, traditionally used as an antidepressant, can in low dosages help prevent various migraine attacks. I had just started it about a week before the trip. And 2 days before the trip I ended up with a serious problem. I appeared to be a full-blown Parkinson's patient. Extreme body shakes, loud, syncopated stuttering, head Bbing, nervous ticks…the works. What was strange was I actually did not feel that bad. I just looked like hell and scared the crap out of everyone. One colleague at work said that she could just feel the energy pour out of me into my surroundings. It was surreal. I had a difficult time speaking. By the end of the day I was exhausted just from the tremors. I had read and also spoke to someone at work that this could happen from the drug I was taking after about a week. The shakes should subside in a few days. L and I fretted. What about Florida? We decided, what the hell. I worked 1/2 a day and we were scheduled for the red-eye into Tampa. We hit massive traffic on the way to the airport due to several wrecks. We basically made it to the gate as boarding began. We made the decision to take a wheelchair along with us. At security we ran into some minor problems. TSA made me take out my CPAP (new regulations now require that since August). To make matters worse, the CPAP tested positive for nitrates ( i.e., explosives). So everything went back through x-ray again. I had to get out of the chair and get patted down. They went over my wheelchair. Normally I would have taken that in stride. While I was pretty much symptom-free all day, I broke down in security. The shakes, the stuttering, the head-B. Yup, I was loopy. And I stayed that way through a lot of the weekend. To make matters worse, the cabin pressure change on landing killed me and sent me into a full-blown vertigo attack. On the second flight things got worse. A woman behind me opened the luggage compartment above me and dropped my cane SMACK on my head, She felt terrible. Then in trying to get off of the plane I fell over backwards onto the seats and hurt my back on the armrest. Things were not starting off too well… When I finally got to see my family there was a combination of shakes and the LEAN to the left. The look on everyone's faces really got to me. It was a "Holy Crap Are You Dying?" look. The weekend was a blur. C and E did a great job in pushing me around in the chair and just plain taking care of me. L forced me to take naps and ran shotgun. I could not have made it without their help. At the reception a combination of the loudness of the band (they were very good), the chaos, the flashing lights of the photographers, and the lateness of the event pushed me over the edge. I remember getting up to leave the reception early. Then nothing until I was in the hall outside the hotel room. L tells me she half carried me out of the hall and that Leslie helped get me into the wheelchair. To make matters worse, we had to be on the shuttle for the airport at 5am. Man, we are dumb! So, before I go any further, apologies to all of my family that I never had a chance to say good-bye to. I am glad I did go but also regret it as well. It was hard on the girls (although they all say sit down, shut up, hold tight, here we GO!). A few days later I was at my Endocrinologist's office. I was getting results of extensive blood work I had done before I left for Florida. We were expecting a few possible things. One was a low fasting blood glucose accompanied by a high dose of insulin. This would be evident of either a pancreatic problem (such as insulinomas) or "dumping syndrome" which could be a result from my weight loss surgery. Another suspect was low testosterone levels. This could act as a trigger for the migraines. No. While my fasting blood glucose was low (63) my insulin levels were normal at 6. Insulin was not the problem. This pretty much ruled out my weight loss surgery. Testosterone was slightly HIGH. That made me want to yell out, "Who's ya Daddy?" in my best Barry White baritone that I could manage. I did fail one test. My IGF-1 was very low. IGF-1 is produced in the liver. What is special about IGF-1 is that is used as an indicator for another hormone. If IGF-1 is low, that hormone is usually low as well. The hormone in question? Human Growth Factor. It is produced in the pituitary gland located right under the brain. As a child, low amounts of HGF leads to dwarfism. High amounts lead to gigantism. I had normal amounts while I was growing (I am 6' 1"). In adults, HGF regulates muscle mass, energy levels, and also acts in tandem with insulin and cortisol. A low HGF would lead to hypoglycemia. A misbalance in hormones could act as trigger to my Basilary Migraine attack (although I have not seen anyone report it in my limited searching and assuming that is what I have). My endocrinologist has been one of the most thorough doctor I have ever seen. She took a complete and extremely detailed family history. She poured through all of medicines and supplements. She ordered a battery of tests and found this out (I also have some elevated liver enzymes and low vitamin D levels, neither of which explain what I am going through. Indeed the liver enzymes might be due to the meds I am on). The bad news is that she cannot fully diagnose or treat me. The treatment for HGF deficiency is injections in the muscle with synthetic HGF which is very expensive. And the problem is that we have not actually tested HGF levels. We tested levels of a related enzyme, IGF-1. The actual test is quite complex. I have to be hospitalized. I am injected with high levels of insulin and brought into hypoglycemia. My glucose levels as well as the levels of cortisol, IGF-1, and HGF are measured over time. The test is risky. I could pass out, go into seizures, and even possible coma. Not fun. And not a test that is conducted at most hospitals. To make matters more confusing, I present only one symptom of low HGF: hypoglycemia. Other symptoms that I do not possess include weakness, low stamina (yes now, but no earlier considering a triathlon and three Century bike races as well as weight lifting), extreme depression, and unexplained weight gain. Also the usual cause of low HGF is tumors on the pituitary gland. No tumors were seen in my CAT scan or MRI (although I am not sure of the resolution of the scans. These tumors traditionally are very small, about the size of the period at the end of this sentence.) While this possible diagnosis does explain some symptoms, it may not be all encompassing. My endocrinologist wants me to check into a well-known research hospital. University of New Mexico hospital in Albuquerque is a possibility. However, I am looking closely at other options out of state. I conferred with my primary care doctor and we will be discussing options this week. I also need to work with my insurance company. So, I am entering my ninth week of this crap. I have no definitive answer for my neurological and vertigo attacks (we suspect Basilary Migraine but it has not been specifically diagnosed that way.) We do not know what is causing the hypoglycemia (although we are suspecting low HGF). I wanted to close by saying thank you to all of you that have been sending me love and support. And prayers. We are all a little scared but no one said life was easy. You know me; I do not turn away from a challenge. I am grateful to my wife and wonderful daughters for helping me. I am not used to receiving help and being weak. Much love to all and stay tuned to the station. The soap opera is not quite over, yet! D. ____________________ There were several replies back and forth. Here was one to a friend. I was scheduled for the Mayo Clinic in Minnesota. This eventually fell through. But, like I always say, “Things happen for a reason.” Mayo falling through lead me to the Cleveland Clinic where I eventually was diagnosed and treated properly. (11/07/07) A quick responce and I will try to get a longer one out later today or tomorrow... We have NO diagnosis. We keep hitting walls and are steered in new directions. I do NOT have either insulinoma or "dumping syndrome" as originally though. My fasting insulin and cortisol are normal although my fasting glucose is in the fifties. Not good. What was off was IGF-1 or insulin-like growth factor 1. This is made in the liver. It was very low. This points to two possible places for a problem. It could be human growth hormone deficiency (made in the pituitary gland right underneath the brain) or certain liver disorders. To top it off, my liver metabolic enzymes are up and have doubled in a few weeks. It could be medicine doing that or something else. Both conditions could lead to hypoglycemia. The liver is serious (potentially) and I am see a doctor tomorrow to discuss doing an MRI of the liver taken by inserting a tube into my stomach. Yuch... My balance is off most likely due to something called basilary migraines. They suck. Again, no definitive diagnosis but I do see a clear fit of my symptoms to this condition. No reason as to why they have hit hard. I am in a wheelchair for most of the day. I can walk but each step is a conscious effort and I get exhausted. I also surrendored my truck keys. I take the bus to work. I am scheduled to go into the Mayo Clinic in February but we are trying to bump that up. L, the girls, and I do get a f bit frustrated but you know me. I do not give up easily. I am driving the doctors a little nuts because I am coming in after reading the medical literature and asking very specific question. Of course, I am not technical.... Hey, tell you neighbor I say hello. I LOVE Hammergel. It is great stuff. And if he has any size medium Hammergel Tee-shirts (for the poor cripeled triathlete..snif snif sob!) then I would gladly take them off of his hands ☺ Hey, don't worry. Life is good. As the Black Knight would say, it's a meer flesh wound! Take care, D ____________________ From my wife’s cousin, the pulmonologist. (11/15/07) Dear D and L: Thanks for filling in the blanks with your email D. That help me put your elevated liver enzymes into perspective. Great news on the liver. The liver can regenerate itself, which is a plus. Most other organs can't. Sounds like he is not out of the woods yet. Sounds like the doctors have made an effort to rule out most cancers (I guess there is still a question about the pituitary). But, the walking funny can be explained by an inner ear dysfunction. Between the hypoglycemia and the migraines and the hypertension he is still not well by any means. Even thought the liver enzyme are better, it sounds like there is achronic issue with the liver (fatty vs crystalline). I have not heard the term crystalline liver before. Cirrhosis and fatty liver are fairly common descriptors. Maybe the the Mayo clinic folks can shed some light. R And my response back to him. (11/16/07) We are confident that the elevated liver enzymes are from an allergic reaction to compazine. There is a clear, documented inner ear problem. The issue is there are one of three possabilities: 1. It is in the inner ear 2. It is in the nerves that relay the messages from the ear to the brain. 3. It is in the brain not interpretting the signal accurately Low HGF actually explains the hypoglycemia (with normal cortisol and insulin levels) and the vertigo. It could also act as a trigger for basilary migraines. However, there are some clear marker symptoms of low HGF that I am not displaying (extreme fatigue, deep depression, etc.) So, we are guessing. My liver was fatty in 2002. No sign of cerosis but some indications of previous fatty deposits. I seriously doubt that the liver is the original factor and the others are comorbidities. so, on another note... SEND PICTURES OF THE KIDS!!! With love to you, T, and the kidos... D ____________________ To my wife. We are still trying to get in the Mayo Clinic and it looks like we will succeed. (12/3/07) I was told it should be decided upon in the next 72 hours and it looks like a go. 10 visits until March 31. Not final, can still fall through. The UHC case worker was blown away on the case! I doubt she can contribute anything, though. D ____________________ To friends and family. At this point, tests and doctors were pointing towards possible brain surgery for a pituitary problem. I found this article on a really bad case of hospital brain surgery screw-ups. (12/1/07) Why D does not just want to go ANYWHERE to have brain surgery: ...but I bet they are IN NETWORK for United Health Care... The Article D ____________________ To a friend. Here I am still trying to get into Mayo Clinic but I also see that it will probably fall through. At this point, we have given up on neurologists and are focusing on pituitary disorders. I find that Oregon Health and Sciences University, OHSU, has a major pituitary center. They are top notch and I actually get an appointment that I end up canceling because of my trip to the Cleveland Clinic. OHSU would have been a fantastic choice but would have been a bust. The problem is not in my pituitary.... (12/4/07) Mayo is still our first choice. Should find out soon if UHC will pay for it. We are looking through the UHC database to see where we could go. The problem is we are not sure what is wrong, still. Clinical tests point right at my pituitary. Radiology is inconclusive. Symptoms kinda fit but not quite. I give it 85% that it is my pituitary but that leaves 15% of "I dunno?" So, for now, we are looking for pituitary experts and centers of excellence. OHSU is at the top of the list and UHC will pay for the medical there (out of pocket for travel but I can declare those on taxes). Sleep on it. Like I said, I have NO dates set up yet. I promise as soon as I know, you will. Many thanks, D ____________________ And finally: I made it to the Cleveland Clinic. L and I flew in on January 9, 2008. As it turns out, my visit to the endocronologist on Jan. 10 gave me good news that still shook me. No pituitary problems. On Jan. 11 I saw the neurologist who specialized in balance disorders. I will post more on his visit later but in a nutshell, he has me (literally) on the straight and narrow. The trip saved my life and the live’s of my family. It is amazing to take this trip back through time. (1/10/08) I see Dr. Pituitary this afternoon and Dr. Vertigo tomorrow. Long but boring trip in. D

Doing Better: No Wheel Chair Today

Friday, January 18, 2008 10:02 PM Well, I made it through the entire day without the chair. I even spent most of the day without the cane. I walked up and down the stairs and even for a sandwich. I am tired but it was very good. I found a physical therapist here that is certified in McKensie, I also ordered some McKensie books on neck and back treatment from Amazon. I called D yesterday to see how E is doing. She made it through the surgery. She had a lung collapse and is in neurological ICU in case she suffers another stroke. It will be a difficult recovery for her but she is strong and a fighter.

On The Airplane From Cleveland to Albuquerque

Wednesday, January 16, 2008 5:27 PM I made it to the airport just fine. I had time for a nice breakfast and a quick run to the bakery. I grabbed a few pastries for myself and a croissant for E. I spent a few minutes with her before I left. I hope she comes through the surgery, okay. She has a tough road in front of her. In many ways I am glad she does not quite realize how serious her condition is and that the surgery is risky. There is a real risk of stroke or major bleeding in the neck. She will have to have several lymph nodes removed. The fluid that was analyzed was yellow and most likely was lymph. The pathology report is not back yet. To make matters worse she is on high doses of blood thinners (heparin). When the phlebotomist took her blood she would not stop bleeding for a few minutes from her arm. I do not know if her grandchildren know how strong a woman E is. D and Do thanked me many times for looking in on her and taking care of her. It was, in many ways, quite selfish of me. Hey, I do not have to live with her ☺! E’s life, both before and after the war is quite fascinating. She told me a number of stories about herself and her parents. I am sure her children heard them but it is good for me to record them, if only for myself. E was young during the war. She mentioned growing up in Belgium how the Germans first came in with promises of fairness and liberation. After all, the Belgish and the Germans both came from the same Anglo-Saxon roots. Both were Aryan, of course the Belgish were mixed with French blood. Belgium was an economically limited country based upon trade and agricultural. There was little industrialization and virtually no major means to supply an army, either with men of fighting age and training or modern equipment. E talks about the Belgish troops on bicycles going out to meet the mechanized Panzers of the up and coming Third Reich. Resistance was made in small ways as open resistance would have meant ever increasing punishment. The German soldiers wore long, woolen grey overcoats which earned them the name “ghosts.” I have read many stories where during the early dawn or dusk hours, these ghosts were all but invisible as they blended in with the twilight sky and horizon. E’s father drove a street car (this sounded like a trolley running on set tracks). They had a home away from the station and after the last circle was made, he had to walk back 2 or 3 miles to home. After the occupation was established, naturally things started to change. Some we more subtle. E was made to remove a lapel pin with the Belgium flag by a German soldier. Others were drastic. People started to disappear. Officially Belgium did protest the treatment of their Jewish citizens but could not put up an ordered protest like Holland and Denmark (which both failed in the face of a ruthless occupying force). Friends and neighbors started to disappear. A classmate of E’s, a young Jewish girl, simply did not show up for school one day. As winter hit and more and more supplies and food were diverted to German troops, rationing set in. Able bodied men who were used to working in the fields were put to work in factories as forced labor to supply the German army. Many died in Allied air raids as the factories were not evacuated of these men and women. Less people tending crops also meant less food overall. Rationing was done via stamps. Even (especially!) during war time, the Germans were extremely organized and beurocratic. Ration cards were given out and stamps were issued based on the number of people in the household or family. It took 5 or 6 stamps to buy a loaf of bread, more for cheese or fruit. E did not mention meat (I suspect meat was a luxury, especially near the end of the war). The bread was rubbery and stale. E told me how she went into a shop for bread and had some money but not enough stamps. The shop keeper would not take the money. When the clerk turned her back, E made a break for it and ran. She looked me straight in the eye and said while she knew stealing was wrong, she was not ashamed and under the circumstances would do it again. She tells the story of going to an Aunt’s house to visit. She usually played up in the attic. Her aunt explained that a bomb had hit the house and the attic had a hole. E was not even allowed into the house. It turns out, her aunt was lying, and taking a huge risk. A downed English pilot was being hid in the attic. Her aunt was a member of the Resistance. If the secret got out, the pilot and everyone in the house would have been shot on the spot. I have no doubt that the aunt was scared to risk E finding out. If E would have slipped and told her secret it would have been the end. E’s father, as I mentioned, worked on the street car. He came face to face with Germans, both soldiers and officers, every day. I am sure he had to work hard to keep a good poker face as the occupation dragged on. E told me of one Christmas. The soldiers were getting care packages from home. While the Belgish people were slowly starving, the Germans were happily showing each other their boxes of bread, cheese, wine, chocolate, and other treats. One soldier was drunk and snoozing. A few circles through the town and all he would do is sleep. When E’s father and colleague tried to wake him to depart he would curse loudly, “Verdamte Schweinhunde!” (damned pig-dogs). Finally, they had enough. During the last circle they hung the drunk soldier by his belt on the cross-bar of a light post. Naturally, they took his Weinnachtenkoeffe (Christmas box). When they came into the depot, they were greeted by a patrol. Quickly they hid they box in a compartment used by the drivers to store lunches. Afterwards, the split the contents. E’s family had many treats for their Christmas meal that year. I know it is hard to believe now, in 2008, but the majority of the German soldiers, especially as the war went on and expansion was stopped in Russia and northern Africa, just wanted to go home. Like the forced laborers, many of them were also drafted into a cause they did not want to lose their lives over. Many, especially officers, became ruthless with absolute power and authority over their conquered people. Many just wanted to go home. I met many, many Germans during my time there who spoke of their time in the army. Yes, the country rose up to corrupt their civilized history. As a whole they accepted horrendous atrocities with cheers and complacency. Later, as an adult going back to Europe to visit, E would run into some older Germans who insisted Belgium attacked Germany first and instigated the occupation. Today, Japan uses similar arguments to justify their brutal occupations of China and the Philippines and their surprise (but strategically brilliant) attack on Pearl Harbor and the United States. War is unimaginably brutal, and often in a personal way. Rommel’s Fortress Europe did not hold. As he feared, too few forces and not enough armored secondary support lead to a complete breakdown of resistance during D-Day. Yes, it was huge and bloody, but once the Allies had a strong footing on the continent, the final days were beginning. The Battle of the Bulge, again slow and bloody, was a last attempt to stop the allies. After the finally broke through, Allies were on a steady course to Berlin. Naturally, Russia was ruthlessly pounding Germany from the East (where my father’s story takes place). Finally the day came where combined forces from the United States, Canada, and England liberated E’s home town (I am not sure where she lived. She said it was near Antwerp). Her father ran over and killed a soldier with his street car, broke and ran home. E saw German soldiers running in their underwear to get away. It was a day I know she will carry forever with her. E and her parents all survived the war. However, the celebration would soon change. It was only a few months later that her mother died of gastric illness, no doubt brought on by hunger and hardship. E’s story is typical and I have heard it many times before. I know that it is only a matter of time before E, my father, and countless others like them are gone. I found it my utmost duty to jot down what she told me, at the very least for myself and my children. Her grandchildren see a chatty, headstrong old woman. They are too young to see the frightened child hardened by war but also cradled with love that I saw. She was a breath of fresh air.