WI PAPA BORJAY LOOK THEY TRYING TO SPOIL ME BACK! (by Dana Peltier)

Maryse was a vain girl. Everything always had to be all about her. A backstory shows that she grew up in a humble Haitian hillside home with her mom, siblings and her grandmother all of whom she adored.Of all of her family members however, her grandmother was the one dearest to her heart. Maryse and her grandmother who she called "Mam" had a bond that no one and nothing could sever. Mam taught Maryse all of the known Haitian customs and traditions, passed down from generation to generation. Maryse was very bright and learned all Haitian customs from cooking to weaving to even practising Voodoo. 

Maryse moved to New York at the age of 22 for the purpose of pursuing studies in Art. She was dazzled by the towering sky scrapers of Manhattan and instantly fell in love with the glitz and glamour of the new culture. At her new school, she ensured that she was Miss popular and was a favourite among students and teachers alike. 

During her second year of school, a new student joined one of her favourite classes. Her name was Shanna. Shanna was a pretty girl from Jamaica. The boys drooled over her curvy body and the other girls seemed to be entranced by her accent. Maryse was INSTANTLY jealous, and she was not ashamed to let it be known that she did not like Shanna at all.

One day, remembering everything that her grandmother had taught her, Maryse was cooking up a plan that would inevitably result in the downfall of Shanna. 

Just as she was finishing the ritual, her heart began to race, she got a sudden unbearable headache and she began to shake and lose her breath. Maryse was frightened. Had she done something wrong? Was Shanna countering her plan? This was bad. VERY BAD. Too afraid to continue, Maryse headed down to her dormroom. On her way there, she began sweating bullets, her body felt like it was on fire, and she grew anxious and fearful and she was absolutely CONVINCED that Shanna was out to get her. "Wi papa borj look they trying to spoil me back!" she exclaimed.

Eventually the episode ended and Maryse continued her school days more cautious than ever. A few weeks after however, the same thing happened again, and in an attempt to satisfy her confusion and her curiosity, she headed down to the local hospital to see if a doctor could help. 

At the hospital, the doctor reviewed Maryse's symptoms and suspected that she might had had Pheochromocytoma.

PHEOCHROMOCTYOMA is a tumor or tumors found on the adrenal medulla that secretes excessive amounts of catecholines. Inside the medulla are chromaffin cells that secrete the catecholines epinephrine and norepinephrine or what we commonly know as adrenaline. The tumors are usually benign and if they develop in the heart, bladder, neck, spine, abdomen or elsewhere they're referred to as a paraganglioma.



The major problem here is that the tumor is causing excessive adrenaline to be secreted which wreaks havoc on the body. Normally, the fight or flight response is good. In the case of encountering a bear in the woods, the release of catecholines is good. It increases heart rate and blood pressure, and is also causing glucose to be released which is the body's way of preparing to respond (fight or flee). If one has to run then the energy is already ready to be supplied. 

In the case of pheochromocytoma however, adrenaline is secreted without the persuasion of impending doom. The cause is genetic and people are usually diagnosed from early to middle age. 



To remember the symptoms, the FIGHTFLIGHT pneumonic can be used. 

F- facial flushing (due to hypertension)
I- increased heart rate and bp (this is a huge telltale sign of the    disease)
G- glucose levels are high (hyperglycemia)
H- headaches that can be severe and come on suddenly or in episodes
T- tremors
F- frequent sweating (due to increased metabolism,bp, thermogenesis)
L- loss of weight (catecholines burn calories)
I- increased anxiety or fear and palpitations
G- growing tumor in glands (can cause pain in abdomen)
H- heat intolerance
T- tired and weak from constant stimulation

The doctor explained to Maryse that the symptoms can come in episodes and can be triggered by certain things including eating foods high in tyramine (tyramine plays a role in blood pressure regulation). Foods high in tyramine include foods that are aged, fermented or pickled. They include foods like cheese, wine and smoked or dried meat. Symptoms can also be triggered by surgery, trauma or physical stress.

Diagnosis included the 24 hour urine test which was the initial test that the doctor used for Maryse. The test looks for high levels of catecholines and metanephrine. If the levels are high as was the case with Maryse, the doctor may order an MRI or CT scan of glands and blood tests.

Maryse had to undergo a bilateral adrenalectomy for treatment i.e. the removal of both of her adrenal glands (not even a unilateral adrenalectomy) and as a result has to take glucocorticoids and mineralocorticoids every day for the rest of her life. In addition, she needs to maintain a high calorie diet and regularly check her blood glucose and blood pressure levels. 

Maryse wondered about the Jamaican, Shanna and shook while she sat in her hospital bed. Wasn't it a queer that at the exact moment that she was about to commit her heinous deed she got a pheochromocytomic episode? Shanna was after all a West Indian like her and had knowledge of these things... Coincidence? SHE THOUGHT NOT. 

She shuddered as she pondered about the disease that had stunned her. What would she tell Mam? She sat there, and she wondered.