The evening before her stroke, my wife received a call from her endocrinologist. Ann had broken her foot many months before and the bone was not healing. The investigative efforts were turning up nothing as the cause for this mystery. Then, one of the many physicians along the way wondered about an endocrine-related cause. Sure enough, the endocrinologist discovered that Ann had Cushing’s syndrome, caused by a tumor on either the pituitary gland or the adrenal gland. So, the endocrinologist was calling the night before her stroke giving her the news and beginning to discuss the next steps.
Cushing’s syndrome is an odd condition. As a result of this (usually) benign tumor, the body is exposed to prolonged exposure to massive amounts of the hormone cortisol. The result is a bizarre set of symptoms: rapid weight gain, insomnia, hypertension, thinning of the skin (results in frequent and easy bruising), moodiness and irritability, muscle and bone weakness (hence the inability of the broken foot to heal), and a whole host of other symptoms.
The thinning of the skin is critical for understanding the likely cause of her stroke. Nine days prior to this phone call from the endocrinologist, Ann was in a pretty severe automobile accident. Our relatively new car was totaled, but other than some soreness and being shaken Ann was okay. The next day she developed nasty looking bruises around her waist and a diagonal bruise from the left shoulder to her lower right side. If you can imagine the position of a seatbelt and shoulder harness, you have the idea of the shape of the bruise. The force of the crash created a bruise the entire length of the restraint. What we didn’t know was that the Cushing’s syndrome not only weakened the external skin, but also internal “skin”. Her right carotid artery dissected in the crash. The scar tissue took ten days to break off from the dissection in the carotid artery and worked its way to the brain and caused the stroke (at least this is my running hypothesis).
Ann was in the hospital for 35 days. The first task was stabilization, and then occupational, physical, and speech therapy to prepare her to come home. While in the hospital, the medical team thought they might as well check out exactly where this tumor was that was causing the Cushing’s syndrome. They already had plenty of head MRI and CT scans, so they knew it wasn’t on the pituitary gland. That left the adrenal glands to be checked out. We have two of them, one on top of each kidney. So, twenty days into the hospitalization, the pictures were taken. Sure enough, the benign tumor was found on one of the adrenals. But, unfortunately, so was something else on the other kidney. Renal cell carcinoma. Kidney cancer.
Needless to say, this was a stunner. Within a twenty-one day period, Ann had a massive stroke, and we learned she had Cushing’s syndrome and renal cell cancer. All of the specialists attending to Ann (and there were a lot of them) said that the cancer was the least of our problems. She first needed to go through the rehab from the stroke and recover to the point where she could manage the surgeries (one to remove the adrenal gland and one to get rid of the tumor). So, the surgeries were being scheduled for January. That would give her three-plus months of rehab time.
The next three months were intense with frequent doctor visits and rehab therapies. We had (and continue to have) excellent CNAs who helped with home care. Ann was walking fairly well and gradually left the wheelchair behind and adopted a single point cane. By the time January rolled around, Ann was well enough for the surgeries. They were scheduled on the same day with two different surgical teams - one right after the other. The pre-surgical preparation, the procedures and post-surgery recovery took longer than expected. Some bleeding issues (possibly Cushing’s related) slowed things down, but everything went well.
We thought we were in the clear. But, no…
Cushing’s syndrome is an odd condition. As a result of this (usually) benign tumor, the body is exposed to prolonged exposure to massive amounts of the hormone cortisol. The result is a bizarre set of symptoms: rapid weight gain, insomnia, hypertension, thinning of the skin (results in frequent and easy bruising), moodiness and irritability, muscle and bone weakness (hence the inability of the broken foot to heal), and a whole host of other symptoms.
The thinning of the skin is critical for understanding the likely cause of her stroke. Nine days prior to this phone call from the endocrinologist, Ann was in a pretty severe automobile accident. Our relatively new car was totaled, but other than some soreness and being shaken Ann was okay. The next day she developed nasty looking bruises around her waist and a diagonal bruise from the left shoulder to her lower right side. If you can imagine the position of a seatbelt and shoulder harness, you have the idea of the shape of the bruise. The force of the crash created a bruise the entire length of the restraint. What we didn’t know was that the Cushing’s syndrome not only weakened the external skin, but also internal “skin”. Her right carotid artery dissected in the crash. The scar tissue took ten days to break off from the dissection in the carotid artery and worked its way to the brain and caused the stroke (at least this is my running hypothesis).
Ann was in the hospital for 35 days. The first task was stabilization, and then occupational, physical, and speech therapy to prepare her to come home. While in the hospital, the medical team thought they might as well check out exactly where this tumor was that was causing the Cushing’s syndrome. They already had plenty of head MRI and CT scans, so they knew it wasn’t on the pituitary gland. That left the adrenal glands to be checked out. We have two of them, one on top of each kidney. So, twenty days into the hospitalization, the pictures were taken. Sure enough, the benign tumor was found on one of the adrenals. But, unfortunately, so was something else on the other kidney. Renal cell carcinoma. Kidney cancer.
Needless to say, this was a stunner. Within a twenty-one day period, Ann had a massive stroke, and we learned she had Cushing’s syndrome and renal cell cancer. All of the specialists attending to Ann (and there were a lot of them) said that the cancer was the least of our problems. She first needed to go through the rehab from the stroke and recover to the point where she could manage the surgeries (one to remove the adrenal gland and one to get rid of the tumor). So, the surgeries were being scheduled for January. That would give her three-plus months of rehab time.
The next three months were intense with frequent doctor visits and rehab therapies. We had (and continue to have) excellent CNAs who helped with home care. Ann was walking fairly well and gradually left the wheelchair behind and adopted a single point cane. By the time January rolled around, Ann was well enough for the surgeries. They were scheduled on the same day with two different surgical teams - one right after the other. The pre-surgical preparation, the procedures and post-surgery recovery took longer than expected. Some bleeding issues (possibly Cushing’s related) slowed things down, but everything went well.
We thought we were in the clear. But, no…
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