2-1-11 Tuesday Day +97

Most of my attention has been on trying to gain weight (I know for most of you this is the least of your worries).   I’m getting close to Paul McCartney’s lyric from Yesterday, I’m not half the man I used to be.”  In fact, I’m now a 70 kg man (154 lbs).  That isn’t a random designation.  It turns out that almost every problem or example in science and medicine refers to a 70 kg man, “How much body water does a 70 kg man …?”  “If a 70 kg man on ice skates collides with …?”  Why 70 kg?  I don’t know, perhaps people were smaller back then.  It’s like visiting London and seeing all the suits of armor that would only fit a man 5’ 2”.  Back then, a 6-foot tall knight was imposing indeed.  Now, you have to have a lot of talent at 6 ft. to make it in the NBA.

  The first mention of a big guy was Goliath.  His battle with David is chronicled in the book of Samuel, and referred to in the Dead Sea Scrolls. That text gives his height at 6’ 9”, a giant for his times if there ever was one.  Some other writings say he was 9 feet tall, but that’s seems a little over the top.  An endocrinology professor at Vanderbilt once speculated (and the thought has been picked up by many others) that Goliath suffered from gigantism (medically referred to as acromegaly).

  Acromegaly stems from an overproduction of human growth hormone from the pituitary gland at the base of the brain.  During early years of growth people with this condition just keep growing like beanstalks (I just threw that in because of the giant living at the top).  But after puberty when the growth plates on your bones close, people with continued growth hormone start showing signs of their bones thickening (they can’t grow longer) with facial distortions.

  Perhaps the most recognizable person with acromegaly was the professional wrestler Andre the Giant (real name André René Roussimoff).  He came to this country from France, and was the first inductee into the World Wrestling Federation’s Hall of Fame (one wonders if this is actually an honor).  Perhaps many others will recognize him as the benevolent giant in The Princess Bride (I mean how can you go wrong with a cast that includes Peter Falk, Mandy Patinkin, Robin Wright, Christopher Guest, Chris Sarandon, Billy Crystal, Carol Kane, Peter Cook, Fred Savage, from the Wonder Years, and directed by Rob Reiner).

  The overproduction of growth hormone often results from a benign tumor of the pituitary.  But because of its location, things growing at the base of the brain aren’t so benign.  In particular, a tumor growing at the base of the pituitary often impinges on a sensitive place in the optic nerves as they travel from the retina to the visual cortex at the back of the brain.  The optic nerves from each eye criss-cross here at a place called the optic chiasm.  Nerves from the right visual field of your right eye go through this junction and on back to the left visual cortex, and the nerves from the right visual field of your left eye, cross over and go to the left visual cortex as well.  So your brain sees what’s going on from the right from both eyes (the reason you have stereoscopic vision and depth perception).  The same is true for your left visual field, which goes to the visual cortex on the right.  Everything in the brain seems to control the opposite side of the body.  That’s why Congresswoman Gabrielle Giffords, who had damage on the left side of her brain is likely to have difficulty with the right side of her body.

   So back to the optic chiasm.  An impinging tumor is likely to first start injuring the nerves that detect the peripheral fields of vision, both left and right.  What happens is a gradual tunnel vision, like looking through a rolled-up magazine.  The speculation is that not only did Goliath have acromegaly, but tunnel vision as well.  David approached him from the side (either side would have been his blind side) and whacked him between the eyes with his sling shot.  Goliath finally did see it coming, but much too late.

   It’s getting late here as we prepare for tomorrow’s ice storm.  I know many of you have already or soon will have to deal with ice, snow, sleet, and freezing rain. Stay warm and stay safe.




10 Responses to “”

  1. Mitzi Krockover Says:

    So good to hear from you–I”m hoping that, judging by the length and detail of your note, that you are indeed feeling better.

  2. judy moss Says:

    Ahhhhh, The Princess Bride….our family’s favorite movie!!! We hope you are feeling better and will be able to gain weight. Stay warm and safe in the storm.

  3. Bill Israel Says:

    It’s great to have you back in lecture mode, Bruce — the sign that you really are getting back to yourself. We have lecture positions open in San Antonio for you anytime!

  4. wendy Says:

    It has been said (and I can’t quote where, but have read this) that the older we get the longer we live, if we are a little on the smaller side of norm. So you’re just getting a head start on some/most of us.

    great story, and the point was…. “better late than never?” Or “I’m late! I’m late, for a very important date.” TEE HEE.

  5. joel steinberg Says:

    A good explanation, Bruce. Operating (transphenoidally) on acromegalics is more difficult than on the other pituitary tumors because their faces and facial bones are larger and thicker than normal (“Give me the long instrument set, nurse!”). I’ve always thought that some of the NBA players one sees on TV look a bit acromegalic/pituitary giantish. Check out Bill Walton, for example. It is great to see you back in pedant mode. Joel S.

  6. Bill Crounse Says:

    I was at a business dinner last evening and ran into Mary Moslander who happened to be at the same restaurant in Bellevue having dinner with members of our HealthVault team. Mary told me about your illness. I was shocked. I shall be thinking about you and praying for you. I was just commenting the other day to my wife how many of our friends and colleagues have been hit by illness these past few years. I guess it is just a sign of getting older. But in your case, you are definitely way too young. My thoughts are with you.

    Bill Crounse, MD

  7. Peggie Neill Says:

    Neither snow, nor sleet, nor rain will keep any of us from the most heartfelt of celebrations of your day 100. A journey none of us would have wished for you, but a journey with which you have so many of us keeping up, keeping watch, keeping company, storming the heavens with prayers.
    When you wake up tomorrow, it will be “Wow – am I really here at day 100?” then listen to the noise in the distance of all of us screaming and yelling. YES!!!
    All of us reading your blog have been enriched – by knowing you, by following along on your postings, by empathizing with your reactions, by pausing in our day to think of you, by being humbled by the others who write comments better than this one.
    All of us are thankful for you, Bruce – thankful for day 100 but really, thankful for the richness your friendship has given to so many of us. No snow, ice, sleet or rain can dent tomorrow as a really, REALLY good day.
    Love you,

  8. Hopie Says:

    Friday , Day 100, Yay! just another day but what a DAY! 100 behind you and 1,000,000 ahead

  9. wendy Says:

    In anticipation of you completing day 100. The critical period. Don’t know what Hopkins entitles the next period, but I call it the CURE and the Miracle of LIFE. Here’s to all that you and yours have done on this journey to get through this critical period. Here’s to your new year, your new life and your new destiny.

    I heard there was thunder snow this week and I think that was simply the Gods applauding your GRADUATION all the way across the nation.

  10. mike magee Says:


    Understand your angst about gaining weight. Does play with your self-identity. “Who’s that looking back at me in the mirror?” And it takes time for the body and mind to accommodate a new reality. Like a year or as long as it takes to stop getting well intentioned expressions of concern from friends or at least stop having their concerns trigger inner fears. Glad to see your reporting voice coming thru again. That’s got to be a good sign!

    Best, Mike

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