Friday, May 2, 2008

Health Issues

I'm having a serious medical issue, and I think it's time to share it with you. It's
been building for some time, and I've finally figured out what's going on.

You know, when I lay it out here it's going to seem really obvious to you, but life
really isn't so cut-and-dry. There are events that happen every day that we don't pay
attention to, or dismiss as not pertinent. So, when I distill out the basic facts, it's
going to seem really obvious to you, so I'm going to try to walk you through the
confusing steps so you can see how I arrived at this.

When it comes to ignoring physical symptoms, I believe men are more likely to dismiss things about their bodies than women. Women identify with their bodies, and we are more likely to judge them by their appearance. Men are more likely to regard their body like a pair of sneakers: something you value and take care of, but not something you worry a lot about.

So...I think I'll start the story last October (2007) when I went for my annual physical. My doctor told me I was really healthy, which was good news. But...

"Hey, it feels like my sexual libido is a bit low."
"OK, let's order a testosterone test."

When the T results came back, they were low-ish, but within normal range. My libido was low, but hey, don't fix it if it ain't broke, right? After all, I *am* 50 years old, so I shouldn't expect to act and feel the way I did when I was in my 20's, right?

Well, over the winter my libido dropped significantly further. Whereas last fall I would have given it a "3" on a scale of 10, where 10 was how I was as a crazed 14 year old teenager, it dropped to somewhere just above a "1".

I went back to my doctor, and took another T test. This time it came in *below* normal.

"Ah-HAH!" I thought. "Looks like things might be wearing out."

I told my doctor that I wanted to do our due diligence, to try to figure out *why* my T had gone low, so he ordered another test. This time he wanted to see if my pituitary was screaming like mad at my gonads to create testosterone and they weren't producing, or if something was wrong further upstream. So, he ordered the FS/LH/Prolactin measurement, and there I was, back at the lab giving more blood.

As I waited for the blood results, I started thinking about my athletic performance over the last year. Low testosterone is *so* nonspecific. I spent the late part of the winter running as well as biking and dieting, and my weight wouldn't go very far down.

But, hey, I'm 50 years old, right?

My running never seemed to get much faster, but I just figured that I'm not much of a runner. But I never seemed to be able to affect my strength or my speed much.

I've spent all fall and winter biking, but I don't feel much stronger. And my strength training in the gym has been...insipid.

When I did the Birkenfeld brevet, it seems like it took an extra day or two for me to recover.

I had a serious phase about three weeks ago where I was incredibly *grumpy*. I mean, I have some cool little pink pills I take for anxiety and OCD, but this was very different. I upped my dose of the little pink pills, but all that happened was that it made me sleepy.

A couple of days this last blood test, I woke up at about four in the morning. Usually I have to make a trip to the bathroom about once a night, but I noticed that I was covered in a cold sweat. And, I recalled this had happened the previous night as well, and that I'd had this happen very occasionally over the last few months.

Hot flashes! (Insert menopausal woman joke here.)

So, I called the doctor's office yesterday, anxious to hear the results of the blood work. Hey, if I need testerone replacement therapy, I want to get on with it.

The FSH/LH levels were low.

They've ordered an MRI scan to look for a brain tumor, which I'll have Monday, and the doctor will consult with me on Wednesday.

This is when my Internet research went into high gear. If it is a tumor, I have about an 80% chance of living another 5 years. Did I mention that I'm prone to anxiety?

Whatever's happening to me, I've fallen off the tail of the bell curve. Pituitary tumors usually cause overproduction of hormones, but*they occasionally cause hypopituitarism. Pituitary tumors usually cause headaches and occasionally visually disturbances, but not always. See what I mean?

So, here's some optimism. One of the causes of hypopituitarism is...head injury. In fact, some endocrinologists estimate that hypopituitarism may present in as many as 25% cases of traumatic brain injury (TBI).

Why is that pertinent? Well, in the summer of 2005 I had concussion in a bicycle fall. I suffered a half minute "gap in the Nixon tapes" (short term memory loss), and I was a bit woozy for about two weeks after that. They scanned my head at that time and determined I wasn't going to die, and after that I didn't think much about it.

But...I think that by the time summer of 2006 rolled around, I was noticing slight effects in terms of my libido.

So, back to the Internet research. One study analyzed about 500 cases of PHTH (post head trauma hypopituitarism) and had a bunch of intriguing statistics. Most patients presented with profound symptoms in less than a year (though there were indeed ones who presented longer after the fact).

Most interesting is that fully ninety percent of these patients had hypogonadism. (The pituitary also generates TH (thyroid hormone), HGH (human growth hormone), and some other thingies I don't remember. They even speculate that the gonadotropic cells in the anterior pituitary may be particularly susceptible to damage.

Again, about 50% of the patients in this study presented symptoms of this really strange thing called diabetes insipidus. Look it up. Never heard of it, it certainly doesn't fit any symptoms I've had. So, here I am, at the tail end of the bell curve.

Now I'm waiting to take the MRI and to get the results. Odd, how I would regard the absence of a brain tumor as good news. They *do* have reasonable treatments for secondary onset hypopituitary hypogonadism. (Ironically, it's generated from the urine of post-menopausal women, who have high FSH and LH levels in their bloodstream.)

But still, it's making me crazy. It's the waiting and not knowing that's the worst.

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