Wednesday, April 29, 2015

Hypoglycemia 202: the hard way.

I’ve been procrastinating this post for a while now.  I’ve had a couple opportunities to sit down and write it, but I’ve been practicing my avoidance.  I’ve started to draft it once or twice, but found the delete button highly effective.  I’ve even had a couple “just do it” moments that instigated nothing short of the my slamming the computer closed out of complete frustration.  It’s not that I can’t find the words to write about the walk I took last week, it’s just that I don’t want to write about the walk I took last week.  You see, if I write about it, then I have to think about it.  If I think about it, I have to address how I feel about it.  And if I have to address how I feel about it, well, the can of worms just opens and makes for one heck of a mess that I frankly don’t have the time, patience or emotional fuse to clean up. However, if I never get around to writing this post I'll never actually move on from it, so I might as well get it over with.

So, I went for a walk last week.  Not a particularly noteworthy thing to do as it was scheduled at a somewhat predictable time, in a fairly typical place and it was with a girlfriend I see more often than anyone else in town that I’m not directly related to.  It started out just as normally as our previous walks had with swapped inquiries and empathetic anecdotes, but instead of being a refreshing jaunt and enjoyable time it turned into an uncontrollable tailspin as my glucose brought me crashing to the ground.  Literally.   

But to explain the situation fully, I have to go back a few weeks to frame the disaster: 

Since the baby was born I have been struggling with my diabetes.  I don't know if it is because of the baby weight that I am just. not. loosing. (uggggg!!), the stress that we’ve been under, the restricted diet I’m following or what, but my blood sugars are all over the map.  Shooting high when I expect to have them in control and conversely bottoming out when I’m fully prepared to fight them down from the rafters, I feel like glucose predictability and regularity are two key factors that are currently missing from my diabetic self-care wheelhouse.  Finding that I can sit down to eat the exact same meal with the exact same insulin dose from one day to the next and have my resulting postprandial be anywhere from the mid 50’s to over 350 mg/dL with zero rhyme or reason, I've somewhat resigned myself to a terrible HgA1C at my next endocrinology appointment since my blood sugar just doesn't want to play nice and I simply don't have the wherewithal to fight it.   

Unfortunately, no matter how emotionally satisfying this apathy and slack may be, this unpredictability is complicating my life because I am experiencing new symptoms that may or may not be diabetes related and with my blood sugar so out of whack I cannot confidently rule it out as the source of these new problems.  Knowing full well that hypoglycemia can cause the loss of sensation in extremities - something I am quite familiar with in my hands and, oddly enough, my mouth - the worst sensation I’ve recently started to experience is wide spread tingling and numbness in my legs that I’ve never before felt.  And while it’s entirely possible that this could simply be a new expression of my maturing diabetes (just kidding, it’ll always be juvenile), the occurrences of this numb sensation do not necessarily correspond with the low readings on my continuous glucose monitor and make me think they could be something entirely else.  Maybe a result of my muscle atrophy from all those pregnant months of non-exercise? Who knows. But, not feeling a dire need to know what's up immediately and finding comfort with the knowledge that my doctor's undivided attention is just around the corner, I've conscientiously pushed my concern for the hot mess that is my diabetes down the list of daily priorities. 

So, bringing this all back to the infamous walk, I double checked my glucose before we left the parking lot and found my numbers to be at a safe walking-pace of 130 mg/dL (which I'd like to point out is notably and randomly less than the previous day's 320 mg/dL for the same breakfast scenario) so I suspended my pump's insulin delivery to be on the safe side.  But, about a mile into the three mile loop, I started to feel the initial inklings in my quads that my legs were loosing sensation and my friend noticed that my stride began to be audibly sloppy.  Unsure if this was because of my diabetes we took a break to look at my glucose monitor.  Finding that my sugars had dropped down to 65 mg/dL, a minor low and a number I've always been able to power through, I reassured my friend that I felt capable to finish the remaining mile and a half back to our cars. Not feeling any other familiar symptoms of a low, we passively discussed that there was food back at the car to correct my glucose and set out down the path at a slower, less coordinated pace.

Found this, and a few others like it,
on my phone two weeks after the
 incident happened. I don't
remember taking pictures and had
 no clue these were there. 
With every quarter mile we knocked out, I felt like my body became more alien.   Conscientious that this low might be getting more serious, I felt trapped within my own head as the unfamiliar symptoms overwhelmed my faculties and I sank into the confines of hypoglycemia:  my arms weren't my own and pushed the stroller too fast or in the wrong direction... my feet were independent from my body and, in both pace and basic function, impossible to coordinate… my fully formed, yet simple thoughts were too complicated to translate into articulate sentences… my cheeks were tingling and prevented my lips from forming intelligible words... 

Ultimately, the carbs in my car were too many blocks away to aid the rapidly deteriorating situation my friend found on her hands.  Already pushing a single stroller of her own, she took over pushing GV in my stroller as well with three quarters of a mile to go... with a half mile to go she helped me remove FG from my Ergobaby carrier and strapped him to her own torso... with the second to last road crossing in view, she asked me if she ought to call HB for help, to which I think I said "no" since, logically thinking, he was farther away from the situation than we were from the car.

What happened next is fuzzy.  All I can confidently recall are snapshot like memories: a happy looking man sitting alone at a picnic table; my hand touching a black metal fence railing; my friend's voice above me; the distant sound of sirens echoing through the seemingly empty halls of my head.  I remember sitting on the side of the path and mutely trying to figure out which of the three electronic gadgets in my lap was my glucose monitor (doesn't help that my pump, my glucose monitor and my cell phone are all the same shade of blue). I knew I needed to figure out what my blood sugar reading was and that insulin delivery had to be stopped (I'd forgotten by that point that I had placed my pump on suspend at the beginning of our walk), but how to go about doing those tasks was completely beyond me despite my efforts to the contrary. 

More snap shot memories followed:  a woman and a man, both dressed in blue, asking me and then my friend questions when silence was my only response; someone holding my palm out to test my blood sugar;  the number 33 mg/dL being said over a radio; a male voice saying something about rapid glucose as my mouth filled with a sweet tasting gel; my friend mentioning something about shade and walking away with my baby and little girl; a random woman using the phrase "poor dear" in passing... 

And just as if flipping on a light switch, the world became clear again. I knew where I was.  I knew what'd happened.  I recognized the blue-clad individuals to be paramedics.  I registered the oversized bandaid on my finger tip from where it'd been punctured.  I easily picked up my glucose monitor and read that my sugar was up to 55 mg/dL.   

"How you doing?" the male paramedic asked.  "Want to take a trip over to the hospital?" 

"Much better," I responded.  "I'll be fine now that I've had sugar." 

"Let's at least get you back to your car before making that call," the female paramedic said. 

Insisting on walking the remaining block to the car rather than receiving yet another ambulance ride (the two I have already done are enough, thank you very much), I let the paramedic escorting me ramble about the heat and her job and Lord knows what else as I silently focused on getting to the kids.  Don't get me wrong, I knew they were in good hands and that I was the one in danger rather than the other way around, but with my world so severely rocked by this hypoglycemic episode I needed them - at the very least - to be back within my comfort zone.  Upon getting back to the car and signing the paramedic's waiver that I was stable and had declined further medical intervention, my friend informed me that she'd called HB and that he'd given her strict instructions to not let me leave until he arrived at the park in about 15 minutes.  Insisting that he work from the house for the remainder of the afternoon, HB took us home and let me collapse from the exhaustion that thoroughly consumed my body.  

Having never suffered the consequences of a low this severe before, I am still reeling from the enormity of this experience.  Physically speaking, my head has felt foggy and my thoughts slow in the waking periods between the hours I've needed to sleep the shock away.  My legs were weary and fatigued for several days to follow, difficult to lift and tiring to move.  The cuts on my knees from where I must have fallen - something I have no memory whatsoever of - are still red, but the scabs have long since closed the open wounds.  

And while I expect these bodily symptoms to fully pass with time and rest, I am fearful that the emotional ramifications of this walk are lingering in a way that may prove to be permanent.  Bruising my pride and mettle, the fact that I have never before fallen out from under my own vigilance and become prey to a low has me unsure of my own abilities -- the symptoms were there, but they weren't what I'm used to and they progressed faster than I ever had hope to catch.  Unconfident in my hypoglycemic awareness and insecure in my capability to execute independent action, I feel like my lifetime's accomplishment of adult autonomy collapsed along side my body on that path and both shattered into an all too scary reality of helplessness.  I was fortunate this go around to be with a friend who is capable of action in the face of crisis, but the reality is that I am at the mercy of my blood sugar and, in the bleakest of moments, all I can do is pray that the circumstances I find myself - and potentially my children - in isn't life threatening and that someone capable of help is at hand.   

But where does that leave me?  Should I risk a solo-training run or wait for a pair of babysitters - one for the kids and one for myself?  Is another solo half marathon even remotely responsible?  Does that first alarm on my glucose monitor mean the heads-up it has historically or should the cavalry be called in to  forcefully drive my sugars back up from whence they'd come?  Must I broadcast my disease as my summary introduction or does my name still suffice?  Should I resign my aggressive glucose control for my nursing or potential future pregnancies and accept a higher HgA1c for the "safety" buffer it places between me and hypoglycemic oblivion?  What of the organ damage such a compromise would present -- do I risk dialysis, neuropathy and blindness to guard against seizure and unconsciousness? 

Half of me feels the answers to these questions are crystal clear and the other half is no longer sure.  I've worked so damn hard these past four years to have my sugars under tight control that the corresponding risk of increased hypoglycemia is logically increased, but at what point does one's good intentions cause right to become wrong?  I thought I knew, but now... I don't know. 

Do you know how to help someone suffering from hypoglycemia? 
Check out my post Hypoglycemia 101 for more information

Monday, April 13, 2015

Well Baby and Follow-up Appointments

Today was a big mile stone for little FG as he had back-to-back appointments with the pediatrician and the pulmonologist this morning.  Beginning with his routine two month well baby appointment, we found out that despite the struggles we've been having with his reflux and sensitive tummy, FG is growing exceptionally well.  He has put on several pounds and a few inches to become a 25 inch, 16 lb 8 oz eight week old baby -- which, yes, is off the growth charts!  I have been warning GW and GV to eat their  dinners and not fight about the brussels sprouts for fear that they'll be out paced in growth by their baby brother, but until today, I'd somewhat considered that to be an empty threat.  Suggesting that we revisit the reflux topic again at his four month well baby appointment, we're under orders to merely stay the course as, thank God, it appears to be working. 

The appointment with the pulmonologist was a one-month post discharge follow up - which, I find hard to believe was already 30 days ago.  Fortunately, the appointment was predominantly positive as the doctor was able to reassure us that the lingering post-bronchiolitis symptoms we're seeing are entirely normal for his current place in the recuperation process and that the additional vibrations and grumbling that we've been fighting are likely caused by his reflux and not originating as a new lung infection.  Giving us an infant respirator as well as a large prescription for albuterol, he expressed comfort with the current PT routine and any as-necessary use of the albuterol between now and the end of the summer.  Asking us to make a follow-up appointment for just before the school year, he stressed the importance that we make a game plan before the onset of the next RSV season to ensure that if - or more likely when - FG gets RSV again that it doesn't become another hospital-worthy case.  Appreciating his candor, we're on the books for a late August appointment and hoping that there is nothing worthy of note that occurs between appointments.  

Happily cooing and going while watching me type this, I am feeling pretty good about the trajectory of FG's current status and I pray that things continue on the up and up.  He's such an easy going, content little guy who likes nothing better than eye contact and snuggles so I'm feeling pretty blessed.  Seems like the worst (knock on wood) is behind us.

Sunday, April 5, 2015

Lingering Symptoms... Lasting Fear.

It has been a long, long night.  I know that FG will continue to demonstrate symptoms of RSV and bronchiolitis as his lungs recuperate from the infection that had him hospitalized, but around seven o'clock last night his symptoms changed and scared me half to death. 

While standing in the kitchen holding a sleeping FG to my chest while chit-chatting with HB and Grandmama, I noticed his breathing become much more audible than it has been previously.  Going from the occasional wheeze and sputter to a constant deep grumbling, I placed my hand on his back to better see his face and alter his neck angle in case his position was causing the change or inhibiting his "normal" rate of breathing.  But as my hand came to rest upon his back, I felt it: vibration in his chest that corresponded with the rhythm of his inhale and exhale.  

Calling the pediatrician immediately, the on-call nurse's line promptly said "given his history and the severity of his symptoms, I need to contact the on-call physician to assess the situation."  Within a matter of minutes (rather than the typical 45 to 60 minute lag time I am used to), the doctor was on the phone instructing me to get him into the bathroom with the hot water running and to count his respiratory rate.  Knowing full well that anything over 60 breaths a minute is considered "rapid" and therefore dangerous in these little guys, I wasn't necessarily comforted that his rate of breathing was 54 breaths a minute.   Concerned by this but not "get to the ER right now" kind of worried, the doctor talked me through the process of giving FG respiratory physical therapy by banging on his back - harder than typical of a burping motion - to move whatever mucus was causing the obstruction and, therefore, his new symptoms.  

So sitting on the bathroom floor with my back to the bathtub and the scalding hot water rising into steam behind me, I pulled FG upright on my chest and began to pound on his back.  Within a few minutes, his vibrations and grumbling stopped.  Expecting this to be a temporary solution, the doctor then instructed me to continue this PT process as long as it continues to resolve the symptoms as they reoccur.  "BUT," she says, "if these symptoms return and the PT does not change them, you need to bring him to the ER immediately for evaluation." 

Thanking her and hanging up the phone, I glanced at the clock which now read 8:30 PM and knew it was going to be a long night.  Agreeing with HB that we should pull shifts to watch over him throughout the evening, we set up several humidifiers in the nursery and I settled into my Grandmother's old blue chair for the first shift.   With FG propped upright against my chest, I had to place my book down every few pages to administer another PT session but, thank the Lord, they continued to work.  But four o'clock this morning I couldn't maintain my vigil with confidence in my care so I woke HB who brewed a few cups of coffee, grabbed his work bag and relieved me to sleep until the family went to Mass in a handful of hours (which, admittedly, I have missed since going to the hospital for fear of the crowds).  

So far today, FG appears to be in good spirits and is continuing to respond well to this new routine of respiratory physical therapy.  In talking briefly with the doctor again this afternoon, she indicated that as long as we can keep the mucus moving and prevent the onset of additional lung infections brought about by mucus build-up, he should be fine and shouldn't need to be seen between now and his one month post-RSV follow-up appointments next Monday.  I'll obviously keep them on speed dial just in case, but I feel reassured (albeit thoroughly exhausted and still quite a bit terrified) by the fact that there is something we can actually do to help keep FG safe at this point.  He doesn't seem to mind all the adamant back-patting he's been getting, so from a comfort stand point he seems to be doing alright.  

I truly wish that this waking nightmare of infant respiratory issues would end and we could go back to a normal state of parenting.  I feel like we must be the only third-time parents out there who are treating their third born as if he were the first -- "Don't use that blanket, it touched the floor!" "Wash your hands before saying hello to the baby!" "No, I'm sorry, you may not meet the baby. Maybe by the time he is four." "You want me to take him where? The grocery store? Sorry, I'd rather starve." -- but after the scare we've had I can't begin to justify the risks of laxity and complaisance with any of these children, regardless of their ages.  Obviously I cannot hold GW out of school for fear of germs and GV is at that thoroughly difficult fingers-to-mouth phase, but I unapologetically feel that any unnecessary exposure that we can proactively guard against isn't worth the cost of ER admission.  I am grateful that FG "only" needs constant PT at this point, but I pray to never, ever again be in this same position.