Saturday, May 29, 2010

Cushing’s Disease: Fighting back to fitness

Cushing's Disease

Sian Fletcher was overweight, unfit and depressed after undergoing brain surgery, but was helped to recover by a gym instructor. Now she has qualified to become a fitness instructor herself. Suzanne Savill reports

Tears were rolling down Sian Fletcher's face as she stood on the treadmill at the Fitness First gym on Bristol Harbourside.

"I just broke down and started crying because I felt so hopeless," she recalls.

"I'd only managed to do about 15 minutes. I was overweight, exhausted and depressed.

"At that point it would have been very easy for me to have given up going to the gym altogether."

About a month earlier, Sian had undergone brain surgery for a tumour on her pituitary gland that had caused her years of mysterious health problems.

But as she staggered off the treadmill, it seemed that her health problems were going to continue despite the operation. However, her personal trainer Phil would not let her give up.

"He told me that I was doing a fantastic job by even getting on the treadmill after the operation I'd just had," says Sian, 23, who lives in Whitchurch with her husband Andy.

"Phil was very professional and managed to encourage me to keep going."

At that time, Sian – who is just five feet tall – weighed about 10 stones. Today, she is seven stones and she is also a qualified fitness instructor, and studying to become a personal trainer.

"I trained as a chef, and I'd worked at some of the best restaurants in Bristol, such as Quartier Vert, Bordeaux Quay and Taste in St Nicholas Market," she says.

"But I wanted to give something back to people like me, just as Phil did for me. He made me see that I could get through it, and that it just took time."

Sian first began feeling ill in 2007, when she suddenly developed stretch marks on her abdomen, legs, and arms.

She says: "I was getting a little 'round' in the middle and I was just not feeling well, but when I went to the doctor I was told that some people do develop stretch marks for no reason.

"Later that year I went back to the doctor, complaining that I was very thirsty in the morning and also kept having headaches that would turn into painful migraines on the right side of my head.

"They gave me some blood tests to rule out diabetes and some other routine tests. When they came back they said I had low potassium levels and my B12 vitamins were low. They recommended eating a banana a day. I accepted this and bought a bunch of bananas!"

But Sian's health continued to deteriorate. She was still putting on weight, and noticeable hair had begun to appear on her upper lip and neck.

"I felt horrible and totally unfeminine, although my boyfriend Andy – who is now my husband – was lovely and just accepted me as I was," she says.

"I was quite big by then, and a friend very kindly told me that she had a free pass to the Fitness First gym at Bristol Harbourside and asked me if I'd like to use it.

"I wasn't too sure, as I was never one to play sport or do exercise in school. In fact I'd be the one forging notes or faking illness injury so I didn't have to take part!

"But when I went and loved it, I thought it would solve all my health problems, and I did manage to lose around half a stone, but then that was it.

"After several months of not losing any more weight I went back to the doctor. He said that I just had to be persistent with my diet and exercise."

The first signs that something was seriously wrong came after Christmas 2008, when Sian visited her GP for a routine check-up for her contraceptive pill. Her blood pressure was so high that her doctor switched her to an oestrogen-only pill.

Just over a week later, Sian had a motorcycle accident as she made her way home from her job at Chef Direct on the A38 Bridgwater Road.

Her Kawasaki 500 GPZ motorcycle collided with the back of a car, and she hit her head which resulted in a large gash on her nose.

Sian says: "My face was covered in blood. An ambulance arrived and I was put on a stretcher while they checked my pulse and blood pressure.

"I told the paramedic that my doctor had changed my pill about a week ago so my blood pressure would still be high. He said it should have dropped down by now, but it hadn't and I should go back as soon as possible."

Sian's doctor sent her to see an endocrine specialist in case she had a problem with her kidneys, and she also had to have an MRI scan.

By now her blood pressure was very high, at 163 over 98, her skin was bruising easily from the blood tests and her face was bright red and puffy.

Meanwhile, she had begun exercising with a personal trainer at Fitness First Harbourside, called Philip Shoyer.

"Little did I know that he would be so much help to me over the coming 18 months," she says. The tests and MRI scan revealed that Sian had a rare condition called Cushing's Disease, caused by a small tumour the size of a pea on the right side of her pituitary gland.

Sian says: "I was booked to have key hole surgery to remove the tumour in August 2008, but I was terrified of what was going to happen to me. I'd been told I may lose some of my vision and my fertility, and that I might not be the same as I was before."

"Phil pointed out that if I didn't have the surgery I could only get worse. I listened to his advice and decided to have the operation."

When Sian woke up at Frenchay Hospital after the operation she felt worse instead of better.

"I felt drained and tired. I was dizzy, I had a headache and I just wanted to sleep," she says.

Even after five days in hospital, during which time she had blood tests which showed she was cured of Cushing's Disease and no longer needed to take hydrocortisone, she was still feeling ill.

"I wasn't allowed to go back to work for six weeks, I couldn't lean forward, swim, or sneeze. I hated it," she says.

"Four weeks after the operation I had my first personal training session with Phil following the surgery. I lasted around 20 minutes before I broke down in tears because I couldn't do any more.

"He told me it was fine, and reminded me that I'd had major surgery only a few weeks ago, and we would just have to take it slowly until I felt better."

Instead of feeling better, however, Sian was diagnosed with depression just before Christmas 2009, and put on anti-depressants.

She recalls: "I felt ashamed. I didn't want to be depressed. I wanted to be normal – the person I was before. I wanted to go kickboxing and train five days a week like I used to. But I could barely stay awake on the bus after six hours' work.

"I was very unhappy and was beginning to wish I'd never had the surgery."

However, the anti- depressants began to work, and within weeks, Sian began to feel much better. She managed to lose two and a half stone by February and her body fat went from 33 per cent to 18 per cent, while her blood pressure became normal and she started to feel better.

By April she was back to training with Phil for an hour at the gym five days a week, and in September she took part in her first kickboxing tournament and won gold. She has now reached third kuy belt standard.

Fitness First holds an award ceremony for members, and earlier this year Sian was one of 12 members from around the UK selected to attend the final in London.

"I didn't win the award for Fitness First but was so proud to be there. I was finally realising that what I had gone through was a big deal and I had actually managed to push through it," she says.

Sian is now working towards her black belt in kickboxing and training to become a personal trainer, so that she can help other people in the way Phil helped her.

"I know I'll always be a pituitary patient and it will always be with me. But I believe that with people like Phil who give their time and patience to people like me, we can get better and feel 'normal'," she says.

"Without him and all the staff at Fitness First, plus my wonderfully supportive husband Andy, I would never be where I am today."

Cushing's syndrome develops when the body makes too much of the hormone cortisol, which helps to regulate blood pressure and blood sugar levels, and helps the body cope with stress.

The commonest cause of spontaneous Cushing's Disease is a small, benign tumour of the pituitary gland at the base of the brain.

Treatment usually requires an operation in which a surgeon makes a small cut in front of the upper teeth behind the upper lip, or inside the nose.

After the operation, patients need to take a replacement cortisol called hydrocortisone in a tablet form, as the body's normal production of cortisol will have been affected by Cushing's.

Sian no longer needs to take hydrocortisone for daily function, although she will need to take it again if she becomes stressed or ill.

For further information about Cushing's, contact The Pituitary Foundation, which is based in Bristol and can be contacted on 0845 450 0375. The foundation's website is


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