Help PCPs Know What How to "Treat" a Cushing's Patient

treat  

[treet] 

verb (used with object)

1.

to act or behave toward (a person) in some specified way: to treatsomeone with respect.

2.

to consider or regard in a specified way, and deal with accordingly: to treat a matter as unimportant.

3.

to deal with (a disease, patient, etc.) in order to relieve or cure.

This article is targeted to primary care physicians, often the first stop on a patient's path to diagnosis. Some patients face uninterested doctors with little medical curiosity. I did. You likely did. It is my hope that these physicians listen to their patients and begin to test for this not-so-rare-but-rarely-diagnosed disease. Primary Care Physicians must learn how to treat (1) Cushing's patients as much as they learn to treat (3) us.  This article offers guidelines for this front-line group. -- M

When to think Cushing's syndrome in type 2 diabetes

http://www.familypracticenews.com/news/diabetes-endocrinology-metabolism/single-article/when-to-think-cushings-syndrome-in-type-2-diabetes/7e58da25eede65a1fb4da2a45934b679.html

Pituitary damage an unexpected war wound

I have noticed the news stories and court cases of enlisted soldiers beating and killing their loved ones after returning from Iraq and Afghanistan. I have often wondered if soldiers who become ultra aggressive and harm loved ones are suffering from pituitary damage, since many outside the situation describe personality changes and aggression.  The article below suggests it is probable that blast-related injuries can definitely cause pituitary dysfunction. This is just another way that soldiers of war are changed forever.

In addition, I remain sad for the stateside significant others -- mostly wives, girlfriends -- who are lost to violence at the hands of loved ones from any cause related to any war. 

--Melissa 

Pituitary damage an unexpected war wound
http://www.latimes.com/la-me-pituitary-damage-20130801,0,579258.story

Excerpts:

[quote]"Tests revealed damage to Spires' pituitary gland. It was a rare finding in the military, but that may be because few doctors have been looking for it.

Emerging evidence suggests that pituitary problems may be going undiagnosed in victims of blast-related brain injuries, the defining wounds of the recent wars.

The symptoms often overlap, perhaps explaining why some patients do not fully recover and offering hope that hormone replacement therapy might help in some cases.

Trying to get a handle on the problem, the Pentagon last year issued guidelines to its doctors to screen for hormone irregularities when symptoms persist after concussions — the mildest and most common form of traumatic brain injury, or TBI.

The pea-sized pituitary gland secretes nine hormones that help regulate metabolism, sexual function, blood pressure and other vital processes. Housed in a bony pocket in the skull, it hangs from the base of the brain by a strand of neurons and blood vessels.

Experts long have known that serious head trauma can disrupt the blood supply and nerve connections. Over the last decade, the same damage has been documented in people who suffered concussions in car crashes and sports accidents. Only in the last few years did scientists begin to look specifically at the risk from blasts."[\endquote]

Cushing's patients will have global access to Korlym

Happy to read this news from today.

Go big or go home.

--Melissa

Disclaimer: I own Corcept stock. See sidebar.

Corcept Therapeutics Announces Partnership With Idis for Global Access to Korlym(R)

Corcept Therapeutics Announces Partnership With Idis for Global Access to Korlym(R)— Corcept Therapeutics Incorporated (NASDAQ: CORT) announced today that Korlym® (mifepristone) 300 mg Tablets is available to patients outside of the United States through an Idis Access Program. Idis Access Programs enable patients around the world to be prescribed investigational or approved drugs prior to their commercial launch in that country through a regulatory-compliant and ethical channel on a named-patient basis. Corcept, a pharmaceutical company engaged in the discovery, development and commercialization of drugs for the treatment of severe metabolic and psychiatric disorders, has been offering Korlym in the United States since April 2012 as a once-daily oral treatment of hyperglycemia secondary to endogenous Cushing's syndrome in adult patients who have type 2 diabetes mellitus or glucose intolerance and have failed surgery or are not candidates for surgery.

http://www.sys-con.com/node/2746247

Corcept is "Down but Far from Out"

The competition between Corcept and Novartis will actually provide Cushies with more treatment options after failed surgeries. The marketing efforts of both will penetrate both the medical and patient communities. -- Melissa

Disclaimer: I own Corcept stock. See sidebar.

5 Biotech Stocks That Are Down But Far From Out

Jun 24 2013, 12:59 | by Craig Keolanui | includes: ARIA, SNTA, CORT, INFI, SCMP

Sometimes having drugs earn FDA approval or even having some good trial results to go along with good cash positions simply aren't enough to keep investors entertained. When investors lose faith or question when they will ever see a return, it can initiate selling that leaves the door open to great opportunity. For these five stocks, there has recently been more selling than buying and yet not much seems to have changed. There are some approved products that have great potential, some products in trials with some positive results and even some pretty sound cash positions to consider. The time is now right to take a second look at what they each have to offer.

....

Corcept Therapeutics (CORT)

Corcept Therapeutics has taken its share of knocks lately primarily because the marketing of its approved drug Korlym has failed to deliver anticipated results with revenue. Korlym is approved for controlling hyperglycemia associated with Cushing's syndrome and represents the first FDA-approved oral therapy for the treatment of patients with this rare disorder. Since being launched in April of 2012, revenue growth has been slow to develop. Now Korlym faces competition from Novartis (NVS) and its competing drug Signifor which also was approved for treating patients with Cushing's syndrome in December. There is more for Corcept to prove with Korlym in treating psychotic depression and there is more marketing left to do for Cushing's syndrome in order to realize some of Korlym's potential. Some hope that Novartis and their entry into the Cushing's syndrome marketplace might actually work to Corcept's favor with their first-mover advantage with Korlym and the marketing might of Novartis educating patients and physicians alike.

Corcept has been struggling to make money, but at least has experienced increasingrevenue since April of 2012 up from $875K in 2nd quarter of 2012 to $1.7 million in the 1st quarter of this current year. Corcept even has plenty of cash reporting about $81.5 million at the end of the first quarter of this year. The $11-12 million cash burn might appear to be pretty extreme, but opening up a marketplace for Korlym to treat psychotic depression should really get things going for Corcept and its stock. The stock is down 59.3% from a year ago, now at $1.79 a share, and is a little above its 52-week low of $1.27 a share. If Novartis can help educate practitioners and patients alike to further the understanding of Cushing's disease, this could be all Corcept needs to finally break out of its slump. On the other hand, if Novartis does too well or doesn't do enough, Korlym's hopes and Corcept's too will depend on the ability to treat psychotic depression. After a nice 5.9% gain on last Friday it might be a signal that some investors think it can.

http://m.seekingalpha.com/article/1518522

AMA declares obesity a disease

AFP PHOTO/RONALDO SCHEMIDT

The American Medical Assn. voted Tuesday to classify obesity as a disease, a decision that should prompt doctors to get more aggressive about helping patients maintain a healthy weight.

BY MELISSA HEALY AND ANNA GORMAN,Los Angeles Times

June 18, 2013, 9:43 p.m.

The American Medical Assn. voted Tuesday to declare obesity a disease, a move that effectively defines 78 million American adults and 12 million children as having a medical condition requiring treatment.

The nation's leading physicians organization took the vote after debating whether the action would do more to help affected patients get useful treatment or would further stigmatize a condition with many causes and few easy fixes.

In the end, members of the AMA's House of Delegates rejected cautionary advice from their own experts and extended the new status to a condition that affects more than one-third of adults and 17% of children in the United States.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately 1 in 3 Americans," said Dr. Patrice Harris, an AMA board member.

Tuesday's vote is certain to step up pressure on health insurance companies to reimburse physicians for the time-consuming task of discussing obesity's health risks with patients whose body mass index exceeds 30. It should also encourage doctors to direct these patients to weight-loss programs and to monitor their often-fitful progress.

The federally funded Medicare program, which insures an estimated 13 million obese Americans who are over 65 or disabled, already covers the costs of "intensive behavioral therapy" for obese patients, as well as bariatric surgery for those with additional health conditions. But coverage for such obesity treatments has been uneven among private insurers.

Insurers who are members of the California Assn. of Health Plans cover many services to treat medical conditions associated with obesity, including bariatric surgery and diabetes, said President and Chief Executive Patrick Johnston.

The AMA's decision essentially makes diagnosis and treatment of obesity a physician's professional obligation. As such, it should encourage primary care physicians to get over their discomfort about raising weight concerns with obese patients. Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight — a result not only of some doctors' reluctance to offend but of their unwillingness to open a lengthy consultation for which they might not be reimbursed.

Past AMA documents have referred to obesity as an "urgent chronic condition," a "major health concern" and a "complex disorder." The vote now lifts obesity above the status of a health condition, disorder or marker for heightened risk of disease — as high cholesterol is for heart disease, for instance.

"As things stand now, primary care physicians tend to look at obesity as a behavior problem," said Dr. Rexford Ahima of University of Pennsylvania's Institute for Diabetes, Obesity and Metabolism. "This will force primary care physicians to address it, even if we don't have a cure for it."

The new designation follows a steep 30-year climb in Americans' weight — and growing public concern over the resulting tidal wave of expensive health problems. Treatment of such obesity-related illnesses as cardiovascular disease, Type 2 diabetes and certain cancers drives up the nation's medical bill by more than $150 billion a year, according to the Centers for Disease Control and Prevention.

Projected increases in the obesity rate could boost that figure by an additional $550 billion over the next 20 years, a recent Duke University study concluded.

In laying out the case for and against the redefinition of obesity, the AMA's Council on Science and Public Health argued that more widespread recognition of obesity as a disease "could result in greater investments by government and the private sector to develop and reimburse obesity treatments."

The Food and Drug Administration, which has approved just two new prescription weight-loss medications since 1999, would probably face increased pressure to approve new obesity drugs, spurring new drug development and more widespread prescribing by physicians, the council noted.

"The greater urgency a disease label confers" also might boost support for obesity-prevention programs such as physical education initiatives and reforms to school lunch, the council added. In addition, it speculated that "employers may be required to cover obesity treatments for their employees and may be less able to discriminate on the basis of body weight."

But the council also said that making obesity a disease could deepen the stigma attached to being overweight and doom some patients to endless nagging — even if they were otherwise healthy or had lost enough weight to improve their health.

It might also shift the nation's focus too much toward expensive drug and surgical treatments and away from measures to encourage healthy diets and regular exercise, the council wrote in a background memo for AMA members.

Dr. Daniel H. Bessesen, an endocrinologist and obesity expert at the University of Colorado Anschutz Medical Campus, called the AMA's shift "a double-edged sword." Though the semantic change may reflect "a growing awareness that obesity is not someone's fault," he worried that "the term disease is stigmatizing, and people who are obese don't need more stigmatizing."

melissa.healy@latimes.com

anna.gorman@latimes.com

AMA declares obesity a disease
http://www.latimes.com/news/science/la-sci-obesity-disease-20130619,0,4422080.story

Sent via Flipboard

Take Charge of Your Life: Keep Track of Your Tests Results

No doctor, lab tech, or office worker cares as much about you as you. Be informed.

AARP

 

Want Your Test Results? Don't Wait. Nag Your Doctor

November 30, 2011 by Candy Sagon

Patients who passively wait for their doctor to call them with medical test results need to wake up  – and start dialing.

As one doctor put it, "No news is not good news. If a patient gets a test done and doesn't get a result, he should follow up."

Failure to pass along test results promptly — or even at all — is a growing problem and partly to blame for the big spike in medical malpractice payouts, according to a recent study in the Journal of the American College  of Radiology.

Researchers found that annual malpractice payouts due to lapses in communications, including failure to pass along test results, more than quadrupled between 1991 and 2010, climbing to $91 million annually.

Of 306 malpractice cases in which test results were specifically cited as a factor, nearly half the cases were due to the patient not receiving the test results. A close second was that the doctor didn't receive the results.

For example, one Virginia woman, who assumed her mammogram was normal when she didn't hear from her gynecologist, discovered a year later when she returned for her annual exam that she had breast cancer and it had spread. The previous exam's results — which had shown the tumor — had been sent to the wrong doctor.

"Patients should expect to get test results even if (the results) are completely normal," Glen Stream, MD, president of the American Academy of Family Physicians told NPR's health blog. Don't assume that just because the doctor didn't call, everything is okay.

Here are some other ways patients can make sure they get their test results:

* Always ask your doctor which test is being performed and when to expect results. Mark that date on your calendar and be sure to call.

* If you're having several tests performed, ask your doctor what you can do to make sure you get all the results.

* Some practices allow patients to go online to view their test results. If your doctor has such a system, sign up for it.

* Request that the imaging center or lab send the results to your doctor. Be sure they have your doctor's correct information and ask when the results will be sent. Then follow-up with your doctor.

http://blog.aarp.org/2011/11/30/test-results-dont-be-shy-nag-your-doctor/ 

Not Quite Done

Stress & Your Skin

Cushies see their bodies morph in dramatic ways as the body responds to high cortisol.

- Fat appears on the belly and abdomen.

- Stretch marks appear on abdomen, chest, arms and legs.

- Acne and blemishes flare up on the face and even on the back for some.

- Hair grows on women in places typically reserved only for men.

- Straight hair goes wonky curly and curly hair goes straight.

In addition, the skin goes through major changes. It dulls and fades. It bruises easily. Even small wounds take a long time to heal. On the occasions I wanted to wear and felt I needed to wear make up, it just doesn't look right on me anymore. Quel horreur!  

I remember my Movie Star Complexion phase of my 20s. I looked really nice then. Once a year, I would walk up to the Clinique or Mac counters bare-faced with no make up. The beauty consultant and I would choose everything from foundation, eye concealer, and powder to eye shadow, liner, and mascara. Lipstick and lip liner were necessary bonuses. That consultant talked through my colors and helped me choose what might look good on me. When I felt that I needed an extra sumpin' sumpin' to the whole shebang, skin care products would just mysteriously find their way into the shopping bag. An hour-and-a-half and $150 later, I walked out with a new face. Walking out of the mall, I was beaming. For weeks and months after that, I felt a little recharged and more confident. Add well chosen clothes and I felt pulled together. In those days, I was a professional working woman.

Since the start of my Cushie days, I haven't been able to work. Regardless, when I was really feeling low, I would go through the motions of the same comforting process -- clearly without the same success. I'd take my usual fun trip to the make up counter, spoke to the consultant who applied the make up and together, we decided it looked all right. I reluctantly went along, because when I would apply the make up at home, it just never looked right. It couldn't fix the dullness that laid upon my real skin like a layer of sludge. My make up bag sits way up high in my daughter's bathroom. I've used in three times in a year. I think.

My next step was to stop wearing make up all together. One, I was too exhausted to stand up and put it on; two, I wasn't going anywhere that often; and three, the make up no longer made me look or feel better. In fact, I felt it made me look worse. So hurting my back, hips and legs to apply make up that didn't even make me look better-- yeah-- easy to drop that daily ritual. Yet still, my skin has no brightness, no shine, no life.

 

***************

Recent blog posts relay the impact of stress on the general population.  The articles I've shared broadened my understanding the reasons behind the damage that cortisol has on each type of cells it takes on. These details are fascinating to me, and I am pleased to share them with my readers. 

Hope you enjoy these!

****************

The Effects of Stress on your Complexion

If you're worried about the health and look of your skin, it's unlikely that you'd think of stress as a possible problem. You may be surprised to learn just how tied your mental health is to your complexion.

Cortisol is the main culprit. When we're stressed, this nasty hormone causes many problems for our body and our skin.

Wrinkles

It's often said that the stress of the position makes Presidents age faster, and there may be a grain of truth to this. Cortisol causes the sugar levels in blood to rise. This encourages a process called glycation, which causes damage to collagen in the skin, making it more rigid and increasing the appearance of fine lines and wrinkles. Additionally, the ingestion of high amounts of sugar also contributes to glycation, so decreasing the amount of white sugar, high-fructose corn syrup, and simple carbs can help slow the process.

Dehydrated Skin

Suffering from dry or damaged skin? Again, cortisol may be to blame. It decreases our production of hyaluronic acid, a natural skin moisturizer, while also compromising our skin's barrier and allowing more hydration out. This, in turn, makes it harder for the enzymes that work to repair day-to-day damage to our skin to do their job. So when you're feeling stressed, make sure you keep a bottle of water nearby! And avoid caffeinated beverages (yes, even coffee!) which further dehydrate your body.

Dull Skin

Pregnant women are often complimented on their "rosy" glow, which is caused by an increase in blood flow to their skin. Unfortunately, when we're stressed, we experience the opposite. As a part of our natural "fight or flight" instinct, the chemical epinephrine (or adrenaline) is released, decreasing blood flow as well as the important nutrients it brings to the skin. Want to get the blood pumping again? Get moving! Exercise is a great way to combat this effect, and it's also a great coping mechanism for stress.

-- note: see additional article about fighting dull skin (for normal folks, but maybe it could improve our dull state, too.)

De-stress to Keep Your Skin Healthy

Finding healthier ways to deal with stress can help keep the effects of cortisol and epinephrine at bay. What can you do?

Get more rest. Getting 6 to 8 hours a night can help keep cortisol in check. Is stress keeping you up at night? Try turning off all screens an hour before your bedtime, and read instead. The light from the screen can confuse your body's sleep cycle.

Relax. Yes, it's easier said than done but make a commitment to taking time away from work. Are you constantly checking your work email? Set aside times to turn your smartphone off, like dinner time and the weekends. You may be surprised by how much of a difference it can make for your mental state.

Find quiet time. Take a bath. Meditate. Do yoga. Or just try deep breathing exercises. Schedule this time just like you would any other activity. Often, by taking time for yourself, you'll find that you're better able to focus, enabling you to get more done anyway.

Laugh. Spend time with family and friends—and no, running errands together doesn't count! You may not have time to take a full-fledged vacation but you can take an hour or two here and there. Have a date night with your spouse, meet up with a friend during your lunch hour, or take your kids to the park. Make sure this time is spent with no work or other stressful distractions. Instead, focus on having a good time and unwinding.

Read more at http://www.business2community.com/health-wellness/the-effects-of-stress-on-your-complexion-0448026#aGFVDhdOQX5KMRP4.99 

News and Relief

This is grand news for all of us uncured by multiple pituitary surgeries. There is hope for us yet.

Improved Quality of Life After Bilateral Laparoscopic Adrenalectomy for Cushing's Disease

A 10-Year Experience

Sarah K. Thompson, MD,^* Amanda V. Hayman, MD, MPH,^* William H. Ludlam, MD, PhD,^† Clifford W. Deveney, MD,^* D Lynn Loriaux, MD, PhD,^† and Brett C. Sheppard, MD^*

Ann Surg. 2007 May; 245(5): 790–794.

doi:  10.1097/01.sla.0000251578.03883.2f

PMCID: PMC1877068

"Conclusions:

Laparoscopic bilateral adrenalectomy for symptomatic Cushing's disease is a safe and effective treatment option. The majority of patients experience considerable improvement in their Cushing's disease symptoms, and their quality of life equals that of patients initially cured by transsphenoidal pituitary tumor resection."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1877068/

Ready to Read MRIs, Junior Radiologist?

You have an MRI. The doctor is saying this and that, pointing to the shaded parts on the MRI with great confidence and speed.  All you learned after reading for weeks and weeks

was over in a flash of five minutes. 

You are trying hard to absorb it all, but your Cushie brain is blocking new information like a goalie at the World Cup.

You are not alone. After six years of getting pituitary MRIs for Cushing's, I still can't read an MRI and I still don't know the brain vocabulary.

Take a look at this Endotext.org chapter that uses over 30 MRI images to explain the different diseases associated with the pituitary.

I'm not saying you will retain all this info -- my brain glazes over midway through -- but I will say this is an excellent resource on the ever-present quest to understand our own MRIs. Bookmark it.

Pituitary adenoma (arrow shows dark shadowed area to the right)

- Radiology of the Pituitary - 

Endotext Chapter 4 : Neuroendocrinology, Hypothalamus and Pituitary

http://www.endotext.org/neuroendo/neuroendo4/neuroendoframe4.htm

Exposure To Low Doses Of Multiple Xenoestrogens Found To Strongly Distort Hormone Action

Endocrine disruptors. Patients with hormonal imbalances of unknown origin cringe when they hear these words. 

A recent study on the pituitary cells of rats show the unfavorable results of our complicated chemical-laden daily environments. 

If this doesn't scare you, read more.

Exposure To Low Doses Of Multiple Xenoestrogens Found To 

Strongly Distort Hormone Action

Summary:

"These things are all over the environment, and we need to know what they do so we can start figuring out what we need to change," Watson said. "They're probably disrupting and confusing hormones in people, and it's important to find a way to prevent that as soon as we can. We need to test these compounds for their hormone-disrupting activities before they are put into products, so we can redesign for safety very early in the process." 

Read article here: 

http://www.medicalnewstoday.com/releases/258435.php

SIGNIFOR - New Product Releases

Signifor is a new pharmacological treatment of adult patients with Cushing's disease for whom pituitary surgery is not an option or has not been curative.

Wow-- another potential medical therapy for patients like me.

http://www.empr.com/signifor/drugproduct/264/

Pituitary Stalk Lesions: The Mayo Clinic Experience

http://m.jcem.endojournals.org/content/early/2013/03/22/jc.2012-4171.abstract

Context: Pituitary stalk lesions have various etiologies, often not clinically apparent. Pathological samples from these lesions are rarely obtained, because of the critical location and function of the hypophyseal stalk.

Published online before print March 26, 2013, doi:10.1210/jc.2012-4171 The Journal of Clinical Endocrinology & Metabolism March 26, 2013 jc.2012-4171

15-yo Katie Rozena battles Cushing's and wins

Katie, brave Katie.

Thank you for sharing your story. 

It is so important for those who come after you.

Have fun in your disease-free, non-judgmental, forgiving life. 

Enjoy every day and live.

Sincerely, 

Melissa

Katie's transformation from 2006 to 2008:

Click here for photo gallery.

*******************************************

My battle with Cushing's disease

By Katie Rozenas

http://www.childrenshospital.org/dream/winter09/rozenas_essay.html

You may not know by looking at me now, but I recently fought a battle. All my troubles started in January 2007, when I was 15 years old, and I began gaining weight. As the year went on, it only got worse and my weight gain became more and more noticeable with every passing week. Over the summer, I tried different weight-loss programs but nothing worked. It got to the point where none of my clothes fit me anymore. A red flag went up in July 2007 when I stopped getting my menstrual cycle. I went to the doctor, but she said it was probably from my rapid weight gain, and that once I lost some weight I would get it back, but just in case she referred me to a gynecologist. In December I started Weight Watchers and ran on the treadmill for one to two hours religiously, but I still was disappointed when I got on the scale. Every week I would only either gain or lose a little, then gain again. I didn't know what I was doing wrong, since I was following my points and filling up on water. I knew then that I was fighting a battle within my body for my health and self-esteem.

I told the gynecologist my symptoms and she said I might have either polycystic ovarian syndrome or something wrong with my endocrine system, so she referred me to Dr. Madeline Fay, an endocronoligist in Worcester. Finally, after several tests, in March of 2008 Dr. Fay told me I had Cushing's disease. After a long and frustrating year of not knowing what was wrong with me, I finally had an answer. I was so relieved to find out that the weight gain wasn't my fault that I couldn't stop smiling.

Despite my happiness at knowing what was causing my symptoms, Cushing's is a rare and difficult disease. It's characterized by obesity, an inability to lose weight, a buffalo hump, stretch marks, a moon face, masculine qualities such as more facial and body hair, patches of dark brown or black skin on the neck, arms, breasts, or thighs and loss of menstrual cycle. I was very skinny before I started showing the symptoms. I had a fast metabolism and could eat whatever I wanted and not gain a pound. In all I gained 75 pounds in the course of a year. I went from 125 pounds to 200 pounds (at my heaviest). I had blamed myself for gaining the weight, thinking I had overeaten because of stress and my metabolism had slowed. So I was relieved when I found out I actually had a medical reason, but the "answer" to my problems was not simple. It is very tough having Cushing's because it's caused by a non-cancerous tumor on the pituitary gland, which is located in the brain. The only treatment for it is brain surgery. It was at this point that I knew I was facing my biggest battle ever.

The most painful thing was what my weight gain caused people in and out of school to say about me. It was so hard to wake up every morning and get dressed in clothes that would hide my body. My family thought I was eating excessively and blamed me for my weight gain. My classmates said things like, "I don't blame her for not wanting to go swimming. If I was like her, I wouldn't either" and "What, does she have diabetes?" and "Look at that girl, she's such a chunky monkey". It got to the point where I didn't eat or jump or run in front of people. I knew people were talking about me behind my back and that was bad. But if I found out what someone said about me, I was not only hurt, I also started to hold a grudge against that person. But the second I found out I had Cushing's, I told all my friends with a text message. I told people I knew, especially the big mouths in school. I did everything I could to spread the word. My parents told everyone they knew and I told everyone I knew. I would work it into a conversation, and say "Oh, you didn't know, I have a brain tumor. That's why I put on so much weight." I tried to keep my head up, but it was hard when I felt like the world was against me and time was passing me by.

The biggest challenge I had to overcome was not the physical pain—even though that was very difficult—it was the emotional and mental pain. Although my parents were physically with me the whole time, I still always felt alone. My friends looked at me differently after I gained the weight and shied away from me. They treated me as an outcast. Guys stopped flirting with me and they hardly talked to me. Once my friends found out that "Katie Rozenas had a brain tumor" it was a whole different ballgame. Some were compassionate, some were scared, some were apprehensive and some stayed the same. People became my best friend after they found out. People I hadn't really had the best relationships with in years. I felt as if no one knew what kind of pain I was going through. No one else knew what was going on inside my head and I was always very emotional because of my elevated hormones. I overcame these challenges by looking to the future and what I wanted to accomplish. There was nothing I could do about my physical state. Until the surgery, no matter how hard I tried; I couldn't lose any significant amount of weight because of the tumor. It was extremely frustrating and depressing for me to be so helpless, but I had anchors. I had the perseverance to do well in school even though I was often absent to attend doctor's appointments. Although it got to be a hassle, I knew I had to keep my grades up. I wanted so badly to stay on National Honor Socaiety and to make First Honors again. I managed to maintain an overall A average throughout the year, and I did well in my AP U.S. History class. I didn't want this illness to beat me academically as well as physically. I also kept going to Girl Scouts, until I got very sick. All through this battle, I continued on my Girl Scout Gold Award, and continued to do service projects and volunteer work for my community.

"You have a brain tumor and the only solution is brain surgery to remove it". Imagine hearing that when you're 16 years old and have never broken anything and have only gone to the hospital two or three times in your life. That was my reality in March of 2008. I knew what was in store for me, but I wanted to get better so badly I was willing to do anything to get back to normal. My parents and the rest of my family were scared.

The night before my surgery, my friend Jordan instant messaged me telling me how great I was going to do and that I was such a strong person. She said she would see me Sunday when she was supposed to come visit me and then I signed off. I was so scared that that was the last time I would ever talk to her.

So on May 16, 2008 I woke up at 4 am and was brought to Children's Hospital Boston, walked into pre-op, was taken up to the 6th floor, given a hospital johnny, given anesthesia and wheeled into the operating room to have brain surgery. Everything went well, but I woke up with a terrible headache and a sore throat. It was horrible, but I got through it. I think now about what it was exactly that I "got through" and certain aspects come up in my mind. I think about the fear of going into the operating room alone without my parents, and the fear I had of something going wrong. I truly thought I was going to die. Then I think about how I stayed strong because I knew I wasn't the only one scared. My parents were in the waiting room with my aunt and uncle clenching each other's hands. After waking up from the anesthesia, I was so tired and my throat hurt so bad that I just wanted to sleep but when I heard my surgeon, Dr. Ed Smith, say he was going to talk to my parents, I told him to tell my parents that I loved them. When they heard that, they knew I was okay I think about my small veins, how hard it is to get an IV in, and how many I had; so many that my arms and hands were bruised. I didn't like seeing my blood on the outside of me and the IVs got so sore. Then I think it's only made me braver. So when I hear someone say I have to go get blood drawn today I just laugh to myself and think about how many times I had my blood drawn.

And I wonder, why me? Then I think about those kids at Children's who won't get better and I count my lucky stars that my disease was curable. I think about the 5-year-olds with cancer and I wonder why I am so selfish.

I think about how the ridicule of others has taught me not to judge others and to be more understanding because you don't know the real story. If there is one thing I want people to take away from my story, it is that you never know why the person sitting next to you on the bus is obese or what the rash is on that person who you always pass at the grocery store. I don't want people to feel sorry for me. I just want them to take from my story this moral and treat other people better. I have eyes that are less judgmental and a mind that is more open. When someone walks by me I think maybe it's not their fault. And that is one thing many people, not only 16 year olds, don't think about as they go through life.

I have lost 65 pounds since my surgery and I am feeling better. I am still on a lot of medicines but I am almost back to the way I was before. My old clothes fit me again and I feel more confident. However, every time I think about what I "got through" I think about and glance down at the battle scars that Cushing's left me that will never go away, for they will only fade in time except for when the blood pulses through my veins.

To read Katie's journal project for her junior year, click here: