My night at the ER

16 December 2007 Day 69
Originally uploaded by lilituc.

I was doing so well, and then on Sunday afternoon, I started vomiting. Nothing had changed, so it was pretty odd. I didn't have ketones and my bg was fine. My husband called the doctor on call - again Dr. S. This time he made Dr. S listen to my entire medical chart and wouldn't let him talk over him. Dr. S said it was no big deal and he'd call in a suppository. He also said to stop taking all the medications I'd been prescribed. He said we could go to the ER if we wanted to, but made it sound like we were being overly paranoid and there was no point. I'm not going to tell you what we call Dr. S in private!

Normally I'd wait longer than two hours to go the ER, but it was already 5 pm and I hate waiting all night long and not being able to sleep, so I figured we might as well go right then. We got to the ER just after 6 and I didn't get triaged until 7:15. To be fair, they had their hands full. There was a woman in her early 30s with severe abdominal pain, a two-year-old who'd had explosive diarrhea for several days, and an elderly woman with a possible broken hip. Actually, I can say "probable" after observing her for 20 minutes. So they triaged me and then I didn't get seen until 9:30. I had to keep getting up to vomit while I was waiting.

By the time they saw me, I had moderate ketones and was pretty dehydrated. They didn't check until after they'd given me one bag, so they kind of went overboard and took a bag right out of the fridge. I warned them cold fluids would probably make me nauseated (because of another medical condition), but they were all, "you need fluids" and wouldn't hear it. The weird part was another nurse randomly came in, walked over to me, taped the line up and down my arm twice, then left. So I was a million times colder. In retrospect, I should have just pulled off the tape, but I was kind of confused at the time. Anyway, I got really nauseated.

That's when they went into overdrive! I thought it was odd they thought that was such an emergency. The doctor came running in and the nurse and then they gave me Phenergan and I was out. So I didn't get to ask the doctor the questions I had or get a copy of my labwork. I was discharged around midnight.

For those of you who work in the healthcare field...what do you think of this - it's the best ER in town, but they don't have private rooms. The patient on the other side of the curtain was a homeless veteran who called 911 because he wanted to commit suicide, and while I was getting my fluids we basically overheard everything. The poor guy.

I had a surreal moment the next morning when Dr. S's nurse called to find out what happened. I explained to her about what had happened, but she didn't seem to grasp that diabetic + ketones + dehydration = super bad. Also, when I told her the Phenergan knocked me out, she actually said, "No, honey, you're thinking of the painkiller. Phenergan isn't sedating. Does your tummy still hurt?" So glad I didn't get Dr. S as my surgeon!

They never figured out why I was vomiting. I've been okay since then in that I've been progressing normally.

Oy

Well, I had the surgery yesterday morning. The surgeon said she'd talked to my doctor and they thought it would be better if they didn't sedate me. I wonder which one said that; I can't think of why they would. Still, I'd rather not be sedated.

They had trouble getting the IV in. Not too surprising since they decided not to use a heplock because I'm allergic to Teflon. They didn't have one of those brace things so they ended up strapping my arm to a board they found somewhere. I forget to tell them I'm allergic to heart monitor contacts, but they never mentioned they were going to be using them, either. Since I'd had 50mg of benadryl before the surgery, the reaction wasn't too bad. So the surgery mostly went well, although the anesthetic started to wear off at like #2. I was not upset, because that's usually what happens to me. It all went pretty fast, anyway.

When I got home I was pretty dehydrated, but I couldn't drink anything because we were supposed to try to stop the bleeding. You have to bite down hard on some gauze for 30 minutes, then make sure it's stopped and repeat if necessary. Well, we did this for about five hours and it didn't stop, even after we tried tea bags like they suggested. So, my husband called the office and got the doctor on call. It was one of the other surgeons, Dr. S. Well, Dr. S informed him that it was only bleeding because I wasn't biting down on the gauze right because I was groggy after the surgery. So basically, we were doing it wrong. He wouldn't listen to what my husband was telling him at all. That's interesting, because I wasn't groggy at all, and we weren't doing it wrong. I'm glad I didn't get that surgeon! Anyway, we tried the gauze again (by this point we'd run out of their gauze and had to use our own) and it mostly stopped, so I was able to eat some things and get my ketones down. It did start bleeding again three times that night, though, even though I wasn't doing anything when it happened. Nothing was even moving in my mouth; I was just sitting there and it started. And yes, I am being super careful. So I may end up with dry socket even though I followed all the instructions.

I was in a lot of pain the first day, when I couldn't take the painkiller right away due to the bleeding not stopping. It went right up to 9. I think some people would call it 10, but I've had 10 before. The odd thing is that Darvocet was abused in the 70s, but it doesn't make me feel high at all. It does work on the pain, which is great, but that's it. I'm not even sleepy. The pain was only as bad this morning as it is when I normally wake up, so like a 5 or a 6, but now it does hurt despite the painkiller, probably because of the swelling. I have to apply ice packs for the first 36 hours. The swelling should go down on day 3. It takes about a month to heal completely.

I'm supposed to eat a lot of protein (which makes sense because my body is making new tissue), so I've been having Boost Glucose Control, Trader Joe's nonfat Greek yogurt cups, Special K protein water, and tofu pudding. I do have some pureed soups, but they're higher in carbs and much lower in protein. It's been hard enough keeping my bg down. I'm at 175% basal and 190% bolus from normal.

I am trying to get some rest, but I'm not even tired. Certainly not what I would have expected!

Constant vigilance!

Something I read on Amy's blog reminded me of this. Last year, right after we moved back to Seattle, we went to a local restaurant famed for its homemade breakfasts. I tested my bg while looking over the menu - it was in the 80s. I ordered coffee and noticed there was a cream container on the table. I asked the waitress if it was real cream, and she said, "yes, it is." Our housemate also got coffee, and takes it with cream. So we both had some coffee with cream. Our food took quite awhile to arrive. After about 30 minutes of waiting, I started to feel odd, so I tested again. My bg was almost 140.

I was confused for a minute, then realized I'd been drinking the coffee. I got out my diastix, tested the coffee, and it was right in the middle of the range. I tested it with my meter: same thing. It hadn't tasted any different than half-and-half, but it was pretty diluted in the coffee. When the waitress came back, I asked her again, "are you sure this is real cream?" She said, "yes." I said, "it's important to know because we're both diabetic, so are you absolutely certain it's real cream?" She said, "yes, it's real cream." I showed her the strip, explained it and said, "well, this container is full of sugar, so can we get a new one?" (I assumed that someone had poured sugar into it). Know what the waitress said then?

"It's nondairy creamer. We don't serve cream here."

Okay, so as it turns out, this restaurant only has nondairy creamer (loaded with sugar), 2%, skim milk, and margarine, presumably for "health" reasons. The food was actually really good (although some butter would have been nice), but we've never been back. I mean, she lied! Repeatedly! I can't understand why someone would do that. I've known people who are allergic to nondairy creamer. Anyway, what I learned was that creamer isn't a free food, so be careful out there!

Surgery

Well, the consultation was interesting. They did panoramic x-rays, which I like because the small ones are painful and don't fit in my mouth. The big x-rays were much clearer. Disturbingly clearer. the nurse and I both said, "oh no" when we saw them. Basically, I have bone loss and my teeth are really impacted. Then, the oral surgeon came in. She's from the former Soviet Union and very direct, with no sugarcoating. She kept asking me questions like she was testing me (she's a professor), and I guess I passed. She asked me how I would treat my diabetes for the surgery. I said I would reduce my basal by 50% and not eat anything for 8 hours, which was apparently the answer she was looking for. That was that, too; she didn't want to discuss it further. I thought she was great!

Since my wisdom teeth are right on the nerves, I have to get a CT scan next week. I will also need to have a bone graft. She said she usually doesn't do it in diabetics due to poor outcomes, but I showed her my A1c (LOL). Both the oral surgeon and the nurse told me there is a significant chance I may lose two back molars. I'm not that upset about it, because one is useless already and the other isn't very useful, either, being only partially erupted. (I don't have enough room in my mouth for my teeth already.) I'd be more worried about potential complications. Also, I have to have general, which I hate, but after seeing the x-rays I didn't really argue.

The doctor agreed that I need to take my other medication (asthma, beta blocker) before the surgery, although most people don't. They also want me to take Benadryl before, since I'm allergic to Teflon and so many other things. It may also help with the painkiller. I took Vicodin once and vomited for 24 hours, so I can't have anything similar and even what they're giving me (Darvocet) may cause me to react. Some people with my reaction don't have it if they take the medication with Benadryl. I really hope it works, because the backup plan is 600mg of ibuprofen, which I already know does barely anything for me. When people who never take painkillers tell me they needed the Vicodin for this, well...

As it turns out, I will need to have surgery again next year for a different problem. They said they could do it with only local, though. Unfortunately, that surgery is mostly not covered by my dental insurance. This one is really complicated, though, so it's a lot more than we thought. So each of the surgeries will cost about...27% of an insulin pump. They're going to make a good show of billing my health insurance, but it's unlikely they will cover it, since as we all know, your mouth isn't part of your body. ;(

Numbers lie

I saw my endo yesterday. My cholesterol is still good, but slightly worse than last time so I suppose I'll have to look into that. My A1c is what it's been the whole time I've had it tested at this lab: insane. It's lower every time, too, despite my bg not changing. Now that we've kind of ruled out lab error, the only thing I can think of is that there's something weird going on with my hemoglobin.

Previously I had A1cs like 5.8%, when my postprandial numbers were a lot lower and I didn't spend a lot of time out of the normal range, although that was at a different lab. This last A1c was under 5 and I don't believe it could possibly be accurate. I've tested in the middle of the night to make sure I'm not having lows or anything. What do I think? I think my A1c should be somewhere between 5 and 6, closer to the middle. I mean, yes, it's definitely a great number, but I just don't think it's an insanely good number...for a nondiabetic. What I know about my bg doesn't support that.

So, today I'm going to have a consultation for oral surgery. That's right, my wisdom teeth are horribly impacted and they have to come out now. I haven't been able to chew in a week. I am not looking forward much to the consultation, where I have to explain not only about my insulin pump, but about the millions of other special conditions that will affect it. The surgery is already scheduled for next Friday. Eeek!