I, too, am a “Cushie” and I know firsthand about the speech and language difficulties that appear to accompany Cushing’s. I researched the literature and found only a couple of mentions about language and cognition with Cushing’s. For the most part, the cause of these difficulties appears to be unknown and are clearly still under study. From contact with other “Cushies”, several things are clear; adrenal patients experience these difficulties as well as pituitary patients, and patients can experience these difficulties either pre and/or post surgery. In my case, they occurred post pituitary surgery.

Before my surgeries on April 16 and June 4, 2007, I expressed to my surgeon and to the team at the Pituitary Center at Cedars Sinai Medical Center, that one of my biggest concerns was a cognitive deficit after surgery. They all assured me that there was no research to support such a concern. The pituitary is a small bulb-like gland that hangs in front of the brain and this was not going to be “brain surgery”, it was for removal of the tumor on my pituitary gland. (The second surgery removed my entire pituitary.)

Call me skeptical, but I continued to have a feeling that anytime something in the noggin is being worked on or removed, the brain is going to react. It would be like removing only a small part of the engine in your car and not being concerned that it would have an affect on how it runs. Even though I don’t know much about how cars actually do run, I do know what affects trauma has on the brain and consequently on speech and language.

As an SLP for over twenty-five years I recognize certain characteristics about my speech and language that were much better pre-surgically. I wrote an article entitled “What Every SLP Should Know About Cushing’s Disease” for the ADVANCE Magazine for Speech Language Pathologists and Audiologists. It was published in October, 2007. In that article I hoped to inform SLP’s about Cushing’s syndrome and the affect it has on speech and language. If you experience these speech/language characteristics, it would be advised to have your doctor write a prescription for a speech therapy assessment.

I would like to share with you, my “Cushie” friends, some of the details of what I have found to be “off kilter” since my surgeries. I am using many strategies to help improve these areas. I hope that these can work for you as well. Please keep in mind that these characteristics vary from day-to-day and with physical well being. They may be worse on days when I do not get enough sleep or have a cold, stress, etc.

Speech or Language Characteristics and Improvement Strategies

Word Retrieval

This is when you cannot come up with certain words. You search for words and can only describe what you are meaning. Such as saying something like: “Let’s take a (plane).” You cannot retrieve the word plane and refer to it as the thing in the sky, the big vehicle, etc., etc.

Strategies

The Brain Game by Radica. This is a hand held game that challenges your brain with four different activities and various levels. My goal is to get to 50% of anything! There are also many other hand held and computer games that are great for anyone.

Categorizing – Divergent categorization is where I name a category such as animals, food, toys, furniture, and then my husband and I take turns naming items in that group. Convergent categorization is where my husband or I name an item and then find various categories that it can go in. An example is “apple” and it goes in such categories as food, fruit, round, red, sweet, etc.

Part/whole – I name a part of any item and someone else names the whole thing – take turns going back and forth. Leg – back – seat =chair.

Memory

As with any aging or memory problem, you are better at long term facts than at recent facts. You may remember what you did two years ago but two hours ago is gone.

Strategies

• The hand held Brain Games.
• Concentrate very hard by saying things out loud that you want to remember.
• Make lists for yourself about anything.
• Use all of the visual cues that you can. Don’t rely on auditory or listening alone.
• Test yourself on it – all of the time.

Confusion

I’m not sure of the proper term for this but it occurs. You interchange letters within words. You want to say “board” and instead you say “ford” or “chord.” You hear it and know it instantly and sometimes you can correct it. I recently used the word “freight” and meant to say “straight.”

Strategies

I think that rhyming words has been my best strategy for overcoming this confusion. To me it has been the easiest area to find my peace with. I rhyme by myself or with others. Words like: all (ball, call), bike (like, tyke). Don’t try that with MONTH or ORANGE, the only words in the English Language that you cannot rhyme.

License plates – I love the vanity plates. Try to figure them out and if you can’t, make up your own idea for that plate.

Sequencing

Primary to all language is the order in which things occur. This can be in simple word order in a sentence such as “The pajamas wore the boy.” as opposed to “The boy wore the pajamas.” Or it can be in sequencing events such as what you did first, second, third in your day.

1. Good Night Moon is a popular children’s book. The child or the child in YOU says good night to the things around you. Sequence those good things of your day from when you got up in the morning.
2. Put your life in order as to what you’ll do this day. Make a list for yourself. You can rely on your list as much as you have to throughout the day.
3. Sing songs – rhythm is produced on the right side of the brain and language on the left side.

* As with anything in life, first you go for accuracy and then you go for speed. Don’t be afraid to start off slowly.

Reward Yourself! Honor Yourself! Celebrate Yourself!

Remember that you have been through a lot and that your brain is trying it’s hardest to please you. Please it back. Since my surgeries, I have become forgiving of my brain and tell it to heal, but it can’t do that on its own. I push myself everyday, maybe too hard, or maybe not enough. Continue to write, sing, read, work on the computer, play board games, card games, video games, and then give your brain a well deserved rest. I find a need for that right now.

I welcome your correspondence and if you have ideas, please share them with all of us.