I decided to go running this morning. I haven’t been for about two and a half years, but I remember how good I felt when I used to run regularly. I especially enjoyed running after we moved to Maine, because the climate is perfect and the scenery beautiful. After I figured out the confusing winding and dead-end roads, and no longer had to ask fellow runners for directions, it was a breeze. Since I started going to school and working full time, I’ve been feeling too overwhelmed to fit exercise into my busy schedule. Plus I haven’t been eager to brave the cold temperatures in the winter. I know. How can I call myself a “Mainer?” Anyway, anyone who gets out of a routine or habit knows how difficult it can be to get back into it.

My first motivation to get back into running was the gorgeous spring weather. Another incentive is the three grueling flights of stairs I have to climb at school. As I clear the last flight, using the railing to help pull me along, I try to feign complacency for those who may be watching. I work in the cardiology unit at the hospital which is on the ninth floor. For obvious reasons I use the elevator. One night my co-worker convinced me to take the stairs with her from the cafeteria. Midway up I wanted to punch her, kind of. As if that weren’t enough, my best boyfriend mentioned that I appear to be “squishier” than I used to be. He wasn’t trying to make me feel bad, but it got me thinking. Although I’m not overweight by any means, I am less firm than I once was. :-{

Brent and I decided to run the 5K “Race for Education” at Burns School this past Sunday. We became less enthusiastic as the race day was approaching. I think we might have talked ourselves out of it if it weren’t for our good friend Jason. He brought his 10-year-old daughter, and stayed at the back with her. We spent large portion of the race walking. When I kept stopping to tie my shoes, Brent thought I was just trying to get out of running; but I was actually bending over to give him a good view of my butt. ;-) You can view the results of the race, and you’ll find us way down at the bottom. Yes, it’s a little embarrassing. But we did beat three people out of 100. No one seemed convinced when I announced that it was our second time around. ;-)

All this inspired me to get back into shape. Apart from the obvious physical benefits of regular cardiovascular exercise, I love the euphoria that I experience from running. I’ve read about endorphin levels increasing with regular exercise, and I enjoy the feeling of invincibility–my “runner’s high.” I also much prefer the crisp, fresh air of the outdoors to running on a treadmill. My run is enhanced by my environmental surroundings–particularly on rural roads–as I clear my head, meditate, relieve stress, and peacefully take in the scenery…almost becoming one with it.

In a New York Times article, Dr. Henning Boecker and his colleagues of the University of Bonn performed a study to define and measure the “runner’s high.”

They recruited 10 distance runners and told them they were studying opioid receptors in the brain. But the runners did not realize that the investigators were studying the release of endorphins and the runner’s high. The athletes had a PET scan before and after a two-hour run. They also took a standard psychological test that indicated their mood before and after running.

The data showed that, indeed, endorphins were produced during running and were attaching themselves to areas of the brain associated with emotions, in particular the limbic and prefrontal areas. The limbic and prefrontal areas, Dr. Boecker said, are activated when people are involved in romantic love affairs or, he said, when you hear music that gives you a chill of euphoria, like Rachmaninoff’s Piano Concerto No. 3. The greater the euphoria the runners reported, the more endorphins in their brain.

I’d forgotten how happy I felt mentally, well after my running excursions. I admit, I didn’t push myself too hard this morning. I did more of a jogging/walking thing. My knees don’t seem to take the high-impact action so well, and the air was a bit cold. I don’t think my sweatshirt sleeve was pleased that I didn’t bring any tissues with me. ;-P It isn’t always easy for me to get motivated to go running at 4 or 5am. Once I get started though, I’m pumped…especially when I’m serenaded by Bon Jovi, Aerosmith, or Green Day on my iPod. Yes, I know, I’m old school. :-) Now that I’ve started running, I’m committed. And perhaps I should take the stairs more often.

Ready to roam the hospital corridor

Now that my neurosurgeon has removed a significant amount of my pituitary tumor, screwed the front of my skull back into place, and properly stitched the skin around the side of my face together; I feel like a new woman. Either that, or Frankenstein. I think it merits super powers or something. So far though, I haven’t noticed anything extraordinary.

On August 25th I went in for my supra orbital craniotomy. The operation lasted three hours. Amelia, who went through the CNA training course with me, was my CNA again. She took care of me when I was admitted for my transsphenoidal surgery in May. Brent was great at keeping me company. Dr. Florman suggested he bring the girls to see me before my face started bruising up. I guess he thought it might scare them. It was nice to have them there, and they were great, as usual. My friend Maggie came to visit me several times. She helped teach my CNA training course, and she also works with me in the cardiology unit. She made me a delicious strawberry shake and got the girls treats as well. She is awesome!

Maggie and the girls

I slept a lot and quickly tired of lying in bed all day. The nurses were good about keeping the morphine and other pain medications coming. One of the doctors came in and removed the drain from my head. It didn’t hurt much, but I began to feel fluid coming out of the hole and dripping down the side of my face. His expression and response were that of surprise, concern, embarrassment, or a combination of the three. He said, “Um, just a minute,” and promptly ran off. After cleaning up the leak he sealed it off with a big glob of glue. The technology these days is amazing. ;-)

The physical therapist came a couple days after surgery to assist me in walking. She got me a walker with wheels and helped me shuffle down the hall. I was a bit unbalanced and dizzy. I think the double vision and lack of depth perception I was experiencing had something to do with it. Brent asked the PT if we could put tennis balls on the feet of the walker. He’s such a comedian. :-) She wanted me to get a walker to bring home with me, and have a PT come to the house to assist me. Uh…definitely not!

Brent loves his iTouch. The girls like the games on it.

I had several medications temporarily added to the regular hormone replacement medications I am currently taking. I believe the anti-seizure medication played a big part in the headaches and nausea (and what comes with it) I experienced the entire week and a half following my surgery. Also, perhaps I overdid it with the oxycodone, especially as I wasn’t eating much. I recently saw my endocrinologist though, and happily discovered that I do not need to add to or increase my current hormone replacement medications.

Dr. Florman did an excellent job, I think. He did not shave any hair, and the scar is neatly hidden behind the hairline around the top right side of my face. I ended up with a swollen black eye, which took a couple weeks to heal. When I was able to get out of the house, it seemed that I kept getting sympathetic looks from people while Brent would get dirty looks. One of our friends suggested he wear a t-shirt that reads “I didn’t do it.” :-D

My eye 1 1/2 weeks after surgery

Once again, I’m incredibly thankful for Brent and his loving support. He took more than a week off work to stay home and take care of me. He was vigilant and diligent about keeping me from doing anything I wasn’t supposed to (like getting out of bed). When I tried to do anything the least bit strenuous, he would warn me, “your face is going to fall off!” He took fantastic care of me and the girls. The girls were also wonderful and understanding. They’re such troopers!

I started back to work 2 1/2 weeks after my surgery. After trying out a couple six-hour shifts, I went up to my usual twelve hours. I’m feeling good, and keeping up with my 16 credit hours of school as well. I have an MRI scheduled for next week. If the tumor is safely removed from the nerves, I will then go talk to a radiation oncologist about having radiation therapy. Hopefully that will cut down future surgeries and significantly increase the time between each one.

The transsphenoidal operation I had this past May was unsuccessful in removing the tumor (a macroadenoma) from my pituitary gland. According to my MRI, the tumor had moved up, and Dr. Florman, my neurosurgeon, wasn’t able to get to it through the nose.

We previously discussed having radiation therapy to slow down the tumor growth. However there is a risk of damaging the surrounding healthy cells and nerves. The optic nerves in front of it are especially sensitive. Dr. Florman strongly recommended that I have a supra-orbital craniotomy so that he could effectively remove enough of the tumor to allow for safer radiation therapy. Before agreeing to this type of surgery, I decided to get at least one other opinion. I saw Dr. Christensen, a neurosurgeon in Lewiston, Maine, who concurred with Dr. Florman. He held high regard for Dr. Florman and believed him to be the best for this particular surgery. I was discouraged that I really do need to undergo the surgery, yet I felt reassured that I am in good hands.

Dr. Florman explained to me the operation process, complete with the drilling, and insertion of plates and screws. It made me a little apprehensive, I admit. I am scheduled for surgery this Tuesday, August 25. This particular type of craniotomy is a subfrontal approach, so no (or very little) head shaving necessary. :-) Oh, and if someone asks me if I have a screw loose, I’ll simply say, “Uh, maybe.”

The transsphenoidal surgery to remove my pituitary macroadenoma went well, and I am happy to be home. Dr. Florman anticipated my hospital stay to be at least three to seven days, but I was discharged after only two days.

Dr. Oppenheim, the endocrinologist following me during my hospital stay, wanted to closely monitor my urine output and my salt-water balance. I stayed in the unit for post-operative and head trauma patients. It was a long corridor of beds separated by curtains. A head trauma patient was in a separate room next to me. She had been there a month after having been in a car accident. The nurse said that being young (early 20s), this patient would recover fairly quickly. She was still confused though, and was constantly yelling out which made it difficult for me to read or sleep. The nurse was kind enough to give me earplugs. :-)

I believe I benefited from having an ENT surgeon, Dr. Makaretz, assist in the nasal portion of my surgery. I was very apprehensive about his removing the nasal packing the next day because I still remember the painful, drawn-out process it had been when my neurosurgeon had done it a couple years ago. But when Dr. Makaretz removed the packing, it was hardly worse than a sneeze! After my first operation I had a cerebrospinal fluid leak which put me flat in bed for a week. Prior to my operation this time Dr. Makaretz took a fat graft from my abdomen to block my nasal sinus in order to prevent the leak. I don’t know how significant the fat graft was, but I did not have a CSF leak this time. When Brent asked why he left such a big scar on my belly, Dr. Makaretz explained that he had to dig deeper because there wasn’t enough fat. Sure, I bet that’s what he tells all the patients. ;-) I will see him in a week so that he can remove the sutures and shunts from my nose.

It seemed strange to be a patient at the hospital where I normally work as a nursing unit secretary. Amelia, one of the CNAs who took care of me, was in a CNA training course with me last spring. This time when she took my vital signs, she wasn’t just practicing on me…at least I don’t think so. :-) I enjoyed visiting with her. She brought me a delicious strawberry milkshake. I knew the girl who brought me on the stretcher from recovery to the unit, and the man who wheeled me down to the car after being discharged. Normally I am the person calling them to transport patients! They were quite surprised to see me on the “other” side.

As a nursing unit secretary I frequently answer call bells from patients. So while I was there in the hospital this week, I had a strange urge to answer the call bell each time I heard it ring. I am aware that the nurses and CNAs sometimes get overwhelmed with excessive demands from some of the patients, and as a patient I did not want to be needy. I think I rang the call bell twice, only because the nurse wanted me to let her know when I was done washing up.

Brent has taken great care of me and spent a lot of time at the hospital. I was glad to have him there and I enjoyed his company. I had a nice visit with our friend Jason, who came by with a beautiful bouquet of flowers. He’s a great guy with an awesome wife and kids. I appreciate all the support, concern, and well wishes from family and Facebook friends. You know who you are! My sister Sara and my mom sent me an awesome care package filled with tissues, lip and face moisturizers, various Jell-O gelatin and pudding, Ghiradelli chocolates, and magazines. Skye, Jenna, and Hayley have been wonderful; understanding, responsible, helpful, and concerned. They’re such great girls!

My nurse Hannah had instructed me not to do anything that would cause any pressure or strain to my head, such as coughing, sneezing, sniffing, lifting, or drinking from a straw. Brent thought the girls should be aware of my limitations, so he gave them a briefing when I returned home from the hospital. He told them: “Don’t make mom sneeze or cough, don’t tickle her, and don’t scare her.” He added “Don’t punch her in the face.” Hayley looked genuinely offended, and replied “But I never punch Mommy in the face!” When Brent told them not to pour hot lava over my head, the girls relaxed a bit and began laughing.

Before Brent left to pick up my pain medication (hooray for Vicodin!), he told the girls to take care of me, watch me closely, and get me what I needed. He instructed them to make me stay in bed. If I got out of bed, they were to tell him and he would get me in trouble. Hayley seemed concerned and asked if he was going to spank me. :-)

I will see my regular endocrinologist, Dr. Bing-You, in a few weeks. After some testing he’ll determine whether I need to increase or add to my current medications. Dr. Florman said that with each operation the pituitary gland will become more damaged, thus requiring more hormone replacements. Sigh…I certainly hope not.

Overall, I am pleased with the outcome of this surgery. I wasn’t in bed at all today. Considering the operation was four days ago, I think I’m doing pretty well! (I may be cheating by taking Vikodin.) Brent said to the girls the other night, “Now girls, Mommy isn’t going to be as smart as she used to be, because they removed part of her brain.” Oops…I hadn’t considered that.

Related post:

One Down, Many More To Go
Kirsten Uhler, Cogitations, March 29, 2009

I often wondered why I recall events in my life as mostly happy and positive. Then this last semester as I was taking a sociology course, I came across a theory called the “Pollyanna Principle”. This is named after the book Pollyanna, about a young girl who fervently held a naively optimistic and grateful outlook on life. According to the Pollyanna Principle, the brain processes information that is pleasing and agreeable in a more precise and exact manner as compared to unpleasant information. We actually tend to remember past experiences as more rosy than they actually occurred.

In 1978 researchers Margaret Matlin and David Stang provided substantial evidence of the Pollyanna Principle. They found that people expose themselves to positive stimuli and avoid negative stimuli, they take longer to recognize what is unpleasant or threatening than what is pleasant and safe, and they report that they encounter positive stimuli more frequently than they actually do.

Matlin and Stang also determined that selective recall was a more likely occurrence when recall was delayed: the longer the delay, the more selective recall that occurred. Joshua Wolf Shank stated in his article “What Makes Us Happy?” in the June 2009 Atlantic:

Distortions can clearly serve a protective function. In a test involving a set of pictures, older people tend to remember fewer distressing images (like snakes) and more pleasant ones (like Ferris wheels) than younger people. By giving a profound shape to aging, this tendency can make for a softer, rounder old age, but also a deluded one.

Psychologist Christopher Peterson indicated his book, A Primer in Positive Psychology, that human minds at the unconscious level gravitate toward the positive, while at the conscious, thinking level they tend to focus on the negative.

L.J. Varner and H.C. Ellis evaluated mood congruent memory in 1998:

Mood congruent memory occurs when the memory for material that corresponds with an individual’s current mood state is retained and recalled more efficiently than information that contradicts the current mood state. In other words, happy individuals are more likely to recall pleasant/happy information, while sad individuals are more likely to recall unpleasant/sad material.

Obviously we should be realistic and take the bad with the good. It is appropriate and healthy to acknowledge and experience emotions natural to a negative event. We need to face and learn from our negative experiences and feelings rather than avoid or suppress them. However, I think it is healthy and important to have an optimistic perspective. I find that focusing on the positive makes me a happier person. Just call me Pollyanna.

Sometime in early 2005 doctors discovered in me a small pituitary tumor. After a year and a half of drug therapy failed to reduce the tumor it was removed transsphenoidally in August of 2006. My neurosurgeon said it would probably not recur. It has.

A recent MRI scan revealed the tumor has grown to 2.5 cm, which is larger than it was before surgery in 2006. Due to the location of the tumor there is pressure on and deformation of the optic nerve. To check for damage an opthalmologist performed a Visual Field Test a few weeks ago. The results of this test are normal. Vision loss typically begins from each side of the field of vision and leads to tunnel vision and then blindness.

Dr. Jeffrey E. Florman, MD

I was referred by my endocrinologist to a neurosurgeon, Dr. Florman. Dr. Florman is very personable and candid. My previous neurosurgeon assured us that the portion of tumor he was unable to remove would be cauterized and, therefore, unlikely to grow. Dr. Florman said these tumors always grow back. This tumor is growing very fast: about one centimeter in diameter per year. At the current rate I will require surgery every two years. Because of scarring and a weakening of the tissues, each successive surgery is more risky than the previous operation.

Dr. Florman advised me to consider radiation therapy after surgery. Radiation can significantly reduce the tumor’s rate of growth which would mean fewer surgeries.

My tumor, according to Dr. Florman, is not a prolactinoma, as diagnosed by my endocrinologists and previous neurosurgeon. The prolactin levels in my blood would be many times higher if the tumor was secreting. This explains why the tumor has not reacted to the tumor-reduction drug Cabergoline. He believes my tumor is a pituitary macroadenoma, which is a non-secreting tumor. I will continue the same pharmaceutical regimen indefinitely, including a daily growth hormone injection. Unfortunately, I might even have to take additional medications after the surgery.

Dr. Florman is concerned because of the cerebrospinal fluid leak I developed after my previous surgery. He expects I will have one this time, too. As a preventative measure he plans to take some fat from my belly and insert it into my nose to block the spinal fluid from entering. Before surgery I’m going to request he remove any excess fat stores he finds in my tummy and to make the right and left sides look even. He might as well do a tummy tuck while he’s in there. :-)

We are scheduling the operation for mid-May so it won’t interfere with school. In the meantime Dr. Florman wants me to pay attention to my peripheral vision. I told him that I would have Brent periodically sneak up on me, just to test it out. Any vision loss, if left untreated, would be permanent.

This news, obviously, was not pleasant to hear. I certainly appreciate my neurosurgeon’s candor. He thoroughly answered all our questions until we were satisfied. I’m feeling overwhelmed that I must deal with this tumor and it’s requisite surgeries, and frustrated that I have been getting so many different opinions and diagnoses. I am also stressed about the financial burden it is on our family (thanks to our inadequate U.S. healthcare system). I have been through this before and know what to expect. I have a lot of confidence in my neurosurgeon. Mostly I’m just numb. I have been so busy and preoccupied with everything else that I haven’t thought much about it, nor do I care to. Brent has been wonderful. He is my greatest support. He reminded me to “Change and improve what you can, don’t stress about things you cannot, and appreciate the good things in your life.”

I enjoy an occasional glass of wine, but I don’t really know that much about it. If you want to be truly enlightened about wine, do yourself a favor and use this resource, Winegeeks. You will learn about the different types of grapes and wines; the wine making process; smelling and tasting wine; buying, ordering, and storing wine; and how to throw a glass of wine into the face of a cheeky scoundrel. (Just kidding about the last one.) Also Kenwood Vinyards has a very helpful glossary of terms pertaining to wine.

It took me a while to acquire a taste for wine. Now I am starting to appreciate both the potent and subtle aromas, flavors, and textures that make each wine unique. Terms like astringent and full-bodied are used to describe the texture. Some wine scientists came up with the “aroma wheel” to describe all the different possible smells present in various wines. My personal favorite: Microbiological: yeast, sauerkraut, sweaty, horsey, “mousey.” Brent likes to use the term jet fuel to describe the taste of wine. Now I wonder how he knows what jet fuel tastes like…

I learned some interesting facts from John Cleese in “Wine for the Confused”. Many growers try to prevent the grapes from growing; they’re kept very small so the flavor is concentrated. Yeasts, which are necessary to produce alcohol, exist naturally in the vineyard and collect on the grape skins. Once the grapes have been crushed, these yeasts (or artificial yeasts added by the winemaker) interact with the sugar in the grape juice to produce alcohol, a process known as fermentation. Wine can ferment for three days or three years, depending on the style of wine the winemaker is trying to produce. The winemaker must also decide which type of container to ferment the wine in. Oak and stainless steel barrels are today’s most popular choices. So what are the differences are between red and white wine?

White wines are wines that contain little or no red pigmentation. These wines are almost always made from white grapes, but can be made from black grapes as well. Winemake rs can make white wine from black grapes because the juice in most black grapes is actually clear. White wines can be sweet or dry, or somewhere in between. Popular white wines include Chardonnay, Pinot Grigio / Pinot Gris, Riesling and Sauvignon Blanc.

Red wines are made from black grapes and have a red or blue tint. Most grapes have colorless juice, so to make red wine the grape skins, which contain nearly all of the grapes’ pigmentation, have to remain intact with the juice during all or part of the fermentation process. Besides the difference in color, the primary difference between red and white wines comes are tannins. They are found in the grape skins, and are transferred into the wine while the skins are in contact with the juice. Found mainly in red wines, they provide a dry, puckery sensation in the mouth and in the back of the throat. They also help preserve wine, allowing most (but not all) red wines to be aged longer than white wines. Popular red wines include Beaujolais, Cabernet Sauvignon, Chianti, Merlot, Pinot Noir and Zinfandel.

Rosé wines are pink in color, and can be referred to as rosé, pink or blush wines. Rosés are made from black grapes, but don’t fully turn red because the grape skins are removed from the juice mere hours after contact. This brief contact with the grape skins gives the wine a pink color from the slight transference of red pigments from the skins. Rosés can also made by blending together white and red wines. This brief skin contact also ensures that a minimal amount of tannins enters the wine. Many rosés are sweet, with White Merlot and White Zinfandel serving as great examples. However, the best and most traditional European rosés are bone dry.

~Ryan Snyder, Winegeeks.com

There is also sparkling wine in which extra carbon dioxide is trapped in the wine; dessert wine which has a high sugar content due to late grape harvest; and fortified wine in which spirits are added to prematurely stop the fermentation process, leaving high amounts of sugar in the wine.

I often wondered why people swirl their wine around in the glass. Apparently the size and speed of the “legs” or “rivulets” of wine that streak down the sides indicate the wine’s body and viscosity. And the more impressive the legs are, the higher the alcohol content. “So what?” I say. You already poured the wine, so you may as well drink it whether you like the appearance of the viscosity or not. Oh, also the swirling lets oxygen mingle with the wine and allows it to open up so the aromas become more prevalent.

I also learned about wine from various countries. Italy produces more wine, and makes it in greater variety, than any other nation (2 billion gallons per year). France is the second-largest wine producer, and the standard for fine (and expensive) wines which tend to be more dry (less residual sugar) and acidic. German wine is lighter and sweeter with a typically low alcohol content. The wine from Spain is a balance between the serious French wine and the fun Italian wine, and is also the cheapest.

It has been well documented that consuming alcohol in moderation can reduce mortality by reducing cardiovascular disease and cancer. It accomplishes this by reducing bad cholesterol (LDL) and raising the good cholesterol (HDL) level, and it also acts as an anti-coagulant (blood clotting preventative).

Wine contains antioxidants which inhibit bad cholesterol from being incorporated in the artery wall. The antioxidants also reduce the damage caused by the body’s free radicals (toxic waste products) which help cause degenerative diseases in the body. Wine in particular contains the strongest antioxidants in nature, particularly resveratrol. It should also be noted here that the fermentation process of converting grapes into wine enhances the antioxidant level many times over, plus produces alcohol, which helps the absorption of antioxidants. This explains why wine is far superior for your health than taking concentrates grape extract which has been advocated by some misguided people.

~Dr. Philip Norrie, MBBS, MSc, MSocSc (Hons)

I have heard much about the health benefits of red wine in the past, which is why I tend to choose red wine over white. Red wine contains much more resveratrol than white, as it is found in the skin of the grape.

However, Dr. Norrie published an article with studies revealing that both wines reduce diastolic blood pressure, but white wine also reduces systolic blood pressure and reduces free radicals and blood clotting more than red wine. Why are the antioxidant molecules in white wine apparently more effective than those found in red wines even thought they are present in greater numbers in red wines?

The answer lies in the research of Dr. Troup, a physicist at Monash University in Melbourne. Dr. Troup used an electron spin resonance spectroscope to examine the actual size of the various antioxidant molecules in wine and showed that those in white wine are smaller and thus more effective because they can be more easily absorbed. A biochemical analogy would be to compare the smaller more effective immunoglobin IgG molecule which gets to all the bodies tissues to provide antibody coverage, whereas the larger immunoglobin IgM is restricted to the vascular system for its area of operation. In a letter to the Editor of the International Journal of Food Science and Technology titled ‘Free Radical scavenging abilities of beverages’ Troup et al pointed out that ‘if the health promoting properties of wines are related to their superoxide-scavenging abilities, then white wine is at least as effective as red’.

~Dr. Philip Norrie, MBBS, MSc, MSocSc (Hons)

Also, a recent study reveals that white wine contains the antioxidant, tyrosol, which may have the same effect as resveratrol in red wine.

Just remember: Drink in moderation. Moderate drinking is defined as an average of two drinks a day for men and one drink a day for women.

A drink is defined as 12 ounces (oz.) of beer, 5 oz. of wine or 1.5 oz. of 80-proof distilled spirits. The limit for men is higher because men generally weigh more and have more of an enzyme that metabolizes alcohol than women do.

~Mayoclinic.com

Now if you’ll excuse me, I’m going to go enjoy a nice glass of Sauvignon Blanc.