Tag Archive for: Paula

Paula’s Adventure: What Happened and What Can We Learn?

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Before we explore the cause and what lessons we can learn, Paula and I want to thank you for your support and prayers for us. I know that some of you were very concerned, especially because of the way I presented it one piece at a time. I’m sorry. It just seemed logical to me to keep each piece contained and keep the reading to less than two minutes for the Tuesday and Thursday Memos. Next time, and I really hope there’s no next time, I’ll let you know the outcome and then tell you the story.

What Caused the Sodium to Drop to Dangerous Levels?

The physician in charge thought the cause was a diuretic Paula had been taking for edema (fluid retention) since her 20s. He concluded that she became over-sensitive to it and it began to eliminate too much sodium. That leads to hyponatremia, low sodium levels. That happens to runners when they drink only water while training in hot weather; that’s why sports drinks have electrolytes, and why sports drinks (or Pedialyte for kids) are a good addition to your diet when you’re very ill and vomiting or not eating.

I can’t say for certain—it’s not my area—but I think factors involved with that chronic cough, the OTC drugs we used, and not eating and not drinking enough contributed to the problem. The altering of our taste buds happened to both Paula and me; nothing tasted normal, let alone good. Lower intake of fluids and food also lowered sodium intake. As for the OTC drugs, guaifenesin found in Mucinex helps reduce coughing, but it can also contribute to dizziness and drowsiness. Then we add the benzocaine and menthol in the throat lozenges and the acetaminophen, dextromethorphan, and doxylamine succinate in Nyquil, and who knows what all that adds up to when combined with everyday meds? While the primary cause was the diuretic, the other factors probably helped bring it to crisis level.

What Can We Learn From Paula’s Adventure?

The Rule and Some Additions
You’ve heard me say, “When in doubt, check it out!” Do it immediately if you think it’s related to your heart, or after two weeks if it’s a chronic condition that doesn’t go away. Paula saw the doctor after 10 days, and I happened to have my physical about the same time.

Here’s the addition: do what Paula did. Write out every symptom that you noticed since it began, plus the medications you take, the OTC medications you may have added, and any supplements you take. If you’re experiencing anything, write it down. If Paula hadn’t written about her blurry vision and hearing sounds that weren’t there, they may not have sent her to the ER. She could have had something more serious happen such as a seizure. Write everything down and call the doctor’s office!

Review All Medications and Supplements at Your Annual Physical
Once every year or so, you should review your medications with your physician to see if there are any known interactions. Maybe a symptom is related to too much or too little of something you’re taking. That’s why a yearly physical with a thorough blood test is important for everyone, but especially as we get older. Another factor we discovered from Paula’s many blood tests was that her thyroid medication was working too well, so the doctor reduced her dosage.

It may be that you should consult a pharmacist. They deal with a wider variety of drugs, and they hear first about whether there are known interactions. Remember, there’s no research on interactions between medications or supplements. Physicians and pharmacists report it to the adverse effects hotline and it gets added to the list, but I’m not sure how widely that info is spread.

The Bottom Line

Paula wants to say how grateful she is for the exceptional care she received at Blodgett Hospital; we feel very fortunate to have excellent medical care here in West Michigan. She’s still recovering, and her energy levels are lower than normal.

I hope her adventure helps you understand that our bodies are complicated. Under stress such as that severe cough and cold, our bodies may respond differently than we expect. Take what we’ve learned and apply it to your life. That would make the experience worth it.

What are you prepared to do today?

        Dr. Chet

P.S. The next Dr. Chet Nutrition in the 21st Century is going to be in Atlanta on March 22. More details tomorrow.

Paula’s Adventure: ER and ICU

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We arrived at the ER and Paula was checked in on Tuesday morning, February 4. The cough was obvious as well as the difficulty breathing. They took her vitals, and her blood pressure was very high. Most likely because of the hallucinations, they did a CAT scan of her head, but there were no apparent issues. Also, no cats (that’s a family joke from Paula’s dad). They also took an x-ray of her lungs: mostly clear but a little sign of pneumonia in a lower lung. That seemed about all.

Then the results of her blood tests came back, and yikes. Normal sodium levels are 135-145 mEq/L; hers was 105 mEq/L. Her potassium was also below the normal range. She wasn’t going anywhere because she was in danger of having seizures, and our doctor said she’s surprised she hadn’t had one.

They immediately began to replace sodium and potassium in the ER before her admission. The trick is that it must be done slowly; if it went up too fast, she would also have been in danger of seizures and heart problems. She was transferred to a room in the ICU, because she needed constant monitoring, frequent blood draw—every two hours around the clock for the first few days—and they needed to be sure she wasn’t contagious because of the cough that was still present. (She was not.) I asked about her sodium level after each blood draw, and it consistently went up over the next five days. Once it hit 135 mEq/L, she was ready to be released.

My observation was that she was vastly improved by the day after her admission. However, that didn’t mean she was out of danger and she wasn’t going anywhere until she hit that 135 number. By that time, I had to leave for a speaking gig in Nashville. She was organizing the room, so I knew she was close to normal; still a little shaky but normal. She was on a heart monitor the whole time, and as she was organizing the room, a nurse came in and said, “What are you doing? Your heart rate’s up.” He suggested she quit futzing and sit down for a while.

She was released and brought home on Saturday by one of our pretend daughters, and I got home a few hours later.

What caused the sodium and potassium loss? More than that, what can we learn from Paula’s adventure? I’ll let you know on Saturday. I’ll also tell you when and where my next Nutrition in the 21st Century Seminar will take place.

What are you prepared to do today?

        Dr. Chet

Paula’s Adventure

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West Michigan has seen the cough and cold to end all coughs and colds. If you read “No Memos,” you know that it impacted everyone in the house. At that time, I was beginning my third week and Paula was finishing her second. By far, she had it the worst: chronic cough 24 hours a day and trouble breathing because her throat was so inflamed from coughing. She was taking OTC cough medication, ibuprofen, and throat lozenges and was on antibiotics because the nurse practitioner felt that, with such thick congestion in her chest, it had to be a sinus infection that caused post-nasal drip. Five days later, it was worse than ever.

She woke up during the night and typed out her symptoms. In addition to the cough and cold symptoms, she also had blurry vision, some dizziness, and headaches. She was walking like a drunk, and she hadn’t taken that much cough syrup! She had a couple bouts of vomiting and the chills. She then added to the list lack of focus, not remembering conversations, hearing the washing machine in the middle of the night when it wasn’t on, hearing me talking to her when I was asleep, and seeing things like a sweater on the nightstand that wasn’t there.

She called the doctor’s office and read the list to the phone nurse. When she got to the hallucination symptoms, the nurse said to go to the ER now. One thing that you don’t know about Paula is that she doesn’t leave the house unless she has at least light make-up, hair combed, and wearing appropriate clothes. Not this time; she put on a comfy dress, her coat, and was ready; something had to be really wrong and she wasn’t messing around. She had already printed out the complete list of symptoms and medications, so off we went.

The adventure continues in the ER and I’ll tell you about that on Thursday.

What are you prepared to do today?

        Dr. Chet