The day finally came when we got to meet Lance's new podiatrist.
Prior to this, all of his feet examinations had taken place in Diabetes Clinic.
I had realised a few weeks before the appointment that the podiatrist, who I shall call Nicole, was two years my junior, and that we had attended primary school together. She had been recommended by our GP - apparently she had a fantastic reputation for treating adults with feet problems who had type 1 or 2 diabetes.
FINALLY, we could get some answers from a young, well-educated specialist, who is familiar with type 1 diabetes, and the different ways that pain manifests as a result of it. I was so hopeful for a positive outcome...
I was also sure that Nicole would remember me. I had hoped that our years at primary school together would eliminate any awkwardness in the consultation room.
(Today, one of the first things I tell people who are on a diagnosis journey is to "expect the unexpected" - and to expect the worst as well as hoping for the best, every time they attend an appointment. Expectations that don't eventuate for whatever reason in an appointment can leave you gutted for days...weeks...months...)
Lance was slightly nervous about meeting Nicole. Since the night his pain began, other things had changed as well. Besides the atrocious sleep disturbances, he often felt nauseous. He had lost a few kilograms and his desire for his favourite foods had waned. His blood sugar levels were much higher than we were used to - interestingly, this was most frequently at night. Night was when the pain was the most intense..In all of our middle-of-the-night adventures in the Emergency Room, not one medical professional indicated any concern about this. The fact that Lance's BGL's were so high (for him) at night made SO much sense to me.
If there is one thing I know for sure and certain, any physiological changes or disturbances in the body can cause elevated blood sugar levels. Even losing a baby tooth can result in higher levels for few days.I had begun ferociously studying and learning all I could about chronic pain, pain receptors - I had to know why pain happened in order to understand what was happening to Lance. (Somebody had to, right?)
Nicole acknowledged that she remembered me. She was polite, professional, pleasant, but clinical and cold.. I instantly detected that treating and relating to a paediatric patient would NOT be her forte- and sure enough, she later confirmed my theory -she said that she had never treated a child with type 1 diabetes before. Lance was her first.
Everybody has to start somewhere, right?
Things didn't start off well. They went from bad to worse to WORST, very quickly.
Firstly, the language Nicole used was not age-appropriate for Lance. One of the first questions she asked him was, "Lance, is the pain neuropathic or muscular in nature?" Don't get me wrong-Lance is as smart as a whip. At the age of eight, he had a reading age of eleven plus. However, the blank expression on his face indicated to me that terms such as "neuropathic" and "muscular" pain were completely foreign concepts to him.(As they should be - the average eight year old shouldn't know what neuropathic pain is to start with!!)
I translated the question to, "Darling, is the pain sharp rather than achy?"
"Definitely sharp, it's not achy pain at all." he replied immediately, without hesitation.
Nicole didn't like me interpreting her questions and translating them for Lance. She said that she wanted him to attempt to answer her questions before looking to me for explanation. From this point, Nicole refused to maintain eye contact with me. She kept her eyes glued to her laptop screen.
She finished taking notes and used nerve-testing instruments on Lance's feet and legs.
In the filament test, she observed that Lance had little reaction to a sharp sensation in his feet and legs. She typed manically on her keyboard, her face emotionless.
"Keep your eyes closed, Lance." she instructed. "Tell me when you feel a blunt prick, or a sharp prick."
(I wanted to ask her if she could show him what "blunt" and "sharp" felt like on his hand, so that he knew what to expect. I already felt like our personalities were clashing, so I decided to leave it go.)
She pricked his feet. He didn't respond.
"Are you concentrating?"
"Yes.."
"Can you feel any pricks?"
"Some.."
"Why didn't you tell me that you felt them?"
"I didn't know I had to."
She audibly sighed, and asked him to repeat the test. Imagine my horror when she abandoned the test, because he clearly was having difficulties with keeping his eyes closed. (Knowing Lance like I do, I knew he was incredibly anxious because he didn't feel comfortable with the way the instructions were delivered.) As a result, she concluded that his responses were based on what he could see, not feel.
Why was she being so dismissive and doubtful?
I could FEEL that she was annoyed.. Even slightly suspicious.
She then asked Lance if he could go and play in the waiting room. Lance and my eyes met immediately. This was something he had never been asked to do in a medical examination.Lance and I have always been a team. I told Nicole that if she had anything to say that she could say it in front of Lance. She insisted that she and I speak alone.
Reluctantly, I told Lance to go and read a book while I spoke with Nicole. I armed him with his tester and his jellybabies. Nicole interjected and said, "Oh Kate, he's only going to be JUST outside. I don't think that you need to prepare him for a hypo."
Our eyes met. My inner Mama Lion was growling. I could almost imagine my upper lip curling upwards.
"Nicole, Lance does not go ANYWHERE without his testing equipment and lollies. We just don't take chances." She accepted this explanation but again, my "Hysterical Mother" alarm bells were ringing.
I told Lance I'd be as quick as possible. Nicole smiled at him. The second the door closed, her smile disappeared from her face. From this moment, ,I knew that she definitely disliked something about Lance's case, and I certainly knew that I disliked her approach.
"You and Lance are obviously very, very close. I'm wondering how close?" she asked.
"How about you just ask me what you really want to say?" I shot back at her.
"Is there a possibility that with all of Lance's JDRF advocacy work, he could have learned about diabetic complications?" she asked.
NO. Please don't go there.
"No. JDRF are very respectful -they do NOT speak directly about complications in front of the kids."
"I mean, could he have read about diabetic complications, in particular, diabetic neuropathy?"
SHE WENT THERE.
"NO.. I don't have reading material about complications lying about the house. Any newsletters or magazines I receive are of no interest to Lance. We try to find a way to make everything about his diabetes positive, or achievable."
"You have to admit that he's more switched on than your average eight year old though." she questioned.
"That's what living with a chronic illness all of your life will do to you...I've met and interacted with many other children who have grown up with type 1 diabetes - they are often advanced in speech, confidence, and often relate better to adults than children."
I couldn't believe that I was having to answer to these allegations!
"I'm just wondering if he's replicating symptoms as a way of obtaining your respect? He obviously knows that you are very passionate about type 1 diabetes awareness."
"Yes, he knows that and, no, he is my only child. He has my full attention. He has everything he needs. Can I digress and remind you WHY we are here? Did you discover anything abnormal in the testing?" I was seething at this point.
These were serious insinuations. This wasn't just me being overly-sensitive and reading into things too deeply.
She said that she would forward a comprehensive report to our GP in regards to her findings.
She then went on to say that if she googled type 1 diabetes and nerve pain that it would be very easy for a child of Lance's "switched on-ness" to feign symptoms for attention.
I was utterly flabbergasted and disgusted.
I told her that I was calling Lance back into the room. This subject was closed for discussion.
You can imagine my heartbreak when I opened the door, and discovered that Lance had been standing on the other side. He had his tester and lollies in his hands.. He had most probably heard EVERYTHING.
I paid the bill. I had a million emotions flooding my mind. I gave monosyllabic responses to Nicole's receptionist, who was painfully chirpy. (Nicole didn't even say goodbye to us. She told us that she would photocopy a form for me and meet us at the front desk. Instead,she paged her receptionist, telling her that the form was ready, and then asked her to get it to pass on to me. Nicole then returned to her consultation room.)My head was spinning. This was the last thing I expected from an appointment with a former primary school chum.
I'm so ashamed to say, that for maybe a total of sixty seconds, I considered her theories.
Was my son capable of symptom-searching? Is he really as well-adjusted as I give him credit for?
These questions were immediately erased, never to enter my mind again, with four little words.
An eight year old boy who had been describing lava flowing, hammers bashing, crystals scraping, electricity zapping, needles digging in his feet, then legs, then all over his body, for the past two months, hung his head and uttered,
"No-one believes me."
"
Sunday, February 20, 2011
Urban Truths of the Emergency Room
If you thought the night at the hospital with Doogie Howser waving his miraculous Panadol at me was a joke, then brace yourself for this post.
After Lance first begged me to take him to the hospital, we presented at Emergency EIGHT times over the next month. We were desperately waiting for an appointment with the podiatrist, and then our beloved endocrinologist - the man who diagnosed Lance back in 2002, and who had been seeing Lance every 3 months ever since.
Until then, we were on our own. Lance, Google, and Me.
At one of the eight A&E admissions, a doctor told me that Naproxen, a drug used for period pain, could be useful in settling down this "mysterious pain". She wrote him a script and told me to give it to him 3 times a day. It did nothing.
The second time, a doctor questioned me at length for forty minutes, asking me if my separation from his Dad could have been a trigger for this "mysterious pain". (We separated in 2003. At this point, it was late 2008/early 2009.) After he psycho-analyzed me, he too presented me with a bottle of children's Panadol.
The third time, a very junior intern asked me if we had considered acupuncture. I told her that at this stage, I was willing to try anything.
Big Mistake..
The moment I mentioned that I would consider it, she had the name of an acupuncturist written on a piece of paper and then practically pushed us out of Emergency.
The forth time, we were seen by a doctor whose Mother language was not English. He was more confused about the pain than I was.
The fifth time, I called the ambulance.I knew that the paramedics would get him "behind the scenes" and we wouldn't have to wait...wait...and wait some more. Lance was so overwhelmed with pain that he couldn't speak. He was hyperventilating, desperately communicating to me with his eyes. Those beautiful baby blues expressed so much fear, so much pain, so much despair. My child was averaging four hours of broken sleep a night.
All I could do was hold him tight.
The paramedics appeared - one male, one female, and one young female student who was doing the "rounds" with them. They appeared very confused as to why Lance was in such a state when his blood sugar levels were normal. I explained the story so far as consisely as I could to the male paramedic. He said, "It sounds like he has an all over body neuralgia related to his diabetes - that's what it seems like. One thing I know...
"He's certainly in distress, aren't ya mate?"
He gently patted Lance's head, and stroked his arm while he asked me some more questions.
The pressure to perform was on for the young student ambulance officer. The male paramedic asked her what she thought was suitable treatment for Lance.
She asked me if Lance had ever had the "green whistle", and suggested it would alleviate Lance's obvious distress and anxiety.
Lance hadn't ever had this kind of treatment. He was instructed to inhale and exhale deeply whilst sucking on the end of the whistle. Within about two minutes, he seemed much more relaxed, and maybe even slightly dazed.
The female student paramedic asked him if he felt any better.
He didn't reply.
She gently shook his leg and said, "Lance? Do you feel any better?"
Lance gasped, as if he had just been woken from a nightmare. His face was etched with sheer terror - I will never forget how horrified I was when my gentle, sweet little boy proceeded to punch her repeatedly several times in the arm, with every bit of strength he could muster.
I held his little hand back - his knuckles were white, he was clenching his fists with such might.
The male paramedic asked the student if she was okay. She seemed shaken, but she said she was alright.
(The other female officer stood back, observing, and writing down notes.)
Student Paramedic then asked me if Lance had any behavioural issues that they should be aware of, or if he could be a danger to them or to himself.
I replied, "None, and NO. How he reacted to you was obviously a reaction from the medication he just inhaled."
She shook her head repeatedly, and quickly informed me that she had never witnessed such a violent outburst, and that "people are usually relaxed and quite sedated" afterwards.
(I wanted to ask her exactly how many times she had administered the "Green Whistle" to be able to make such a claim. I chose to bite my tongue, though. These people, especially the male officer, were so kind, and sympathetic - I could tell they were genuinely concerned about Lance's state.)
It was decided that Lance would attend the hospital via ambulance. After the medication wore off, he grimaced and asked the student officer, "Did I really punch you or was that a bad dream?"
"It was for me!" she replied.
Mama Lion didn't appreciate that comment, and Student Paramedic obviously knew it, by the daggers I shot in her direction.
"It's okay mate, these things happen. I've had worse." she added.
The fifth visit, Lance was fortunate enough to be examined by the Paediatric Registrar.She listened very carefully, and spend a long time reading over the notes her colleagues had made.
She was the very first person who found it odd that this sudden onset, severe, neuropathic pain commenced after the commencement of insulin pump therapy. To her knowledge, there was no connection though;she just voiced that it seemed strange. She "pulled some strings" and got Lance an emergency appointment with the hospital registrar for four days time. She also wanted Lance to start on a drug called Carbamazepine - an anti-convulsant and mood stabilizing drug. I was initially confused as to why he would need to use anti-seizure medication for pain, however, she explained that it was often used off-label for many severe pain disorders. I agreed, and he started that night. We were told that it would take at least two weeks before we knew if there would be any signs of any improvement.
TWO WEEKS??
Would we still be living this nightmare in TWO WEEKS?
The kindness shown to me by that Paed Registrar reduced me to tears. She was a mother herself, and she was concerned, even though yet again, her examinations of Lance found him to be neurologically intact. She promised me that she would write a letter of support to the Hospital Paediatrician.
The other times don't warrant mentioning. They were such a waste of time and energy. In the end, Lance begged me NOT to take him to the hospital anymore.
"If I have to have this pain, I just want to have it at home. No more hospital, okay Mum?"
"No more hospital, sweetheart."
Those words haunt me to this day. Mothers aren't supposed to make promises they can't keep.
After Lance first begged me to take him to the hospital, we presented at Emergency EIGHT times over the next month. We were desperately waiting for an appointment with the podiatrist, and then our beloved endocrinologist - the man who diagnosed Lance back in 2002, and who had been seeing Lance every 3 months ever since.
Until then, we were on our own. Lance, Google, and Me.
At one of the eight A&E admissions, a doctor told me that Naproxen, a drug used for period pain, could be useful in settling down this "mysterious pain". She wrote him a script and told me to give it to him 3 times a day. It did nothing.
The second time, a doctor questioned me at length for forty minutes, asking me if my separation from his Dad could have been a trigger for this "mysterious pain". (We separated in 2003. At this point, it was late 2008/early 2009.) After he psycho-analyzed me, he too presented me with a bottle of children's Panadol.
The third time, a very junior intern asked me if we had considered acupuncture. I told her that at this stage, I was willing to try anything.
Big Mistake..
The moment I mentioned that I would consider it, she had the name of an acupuncturist written on a piece of paper and then practically pushed us out of Emergency.
The forth time, we were seen by a doctor whose Mother language was not English. He was more confused about the pain than I was.
The fifth time, I called the ambulance.I knew that the paramedics would get him "behind the scenes" and we wouldn't have to wait...wait...and wait some more. Lance was so overwhelmed with pain that he couldn't speak. He was hyperventilating, desperately communicating to me with his eyes. Those beautiful baby blues expressed so much fear, so much pain, so much despair. My child was averaging four hours of broken sleep a night.
All I could do was hold him tight.
The paramedics appeared - one male, one female, and one young female student who was doing the "rounds" with them. They appeared very confused as to why Lance was in such a state when his blood sugar levels were normal. I explained the story so far as consisely as I could to the male paramedic. He said, "It sounds like he has an all over body neuralgia related to his diabetes - that's what it seems like. One thing I know...
"He's certainly in distress, aren't ya mate?"
He gently patted Lance's head, and stroked his arm while he asked me some more questions.
The pressure to perform was on for the young student ambulance officer. The male paramedic asked her what she thought was suitable treatment for Lance.
She asked me if Lance had ever had the "green whistle", and suggested it would alleviate Lance's obvious distress and anxiety.
Lance hadn't ever had this kind of treatment. He was instructed to inhale and exhale deeply whilst sucking on the end of the whistle. Within about two minutes, he seemed much more relaxed, and maybe even slightly dazed.
The female student paramedic asked him if he felt any better.
He didn't reply.
She gently shook his leg and said, "Lance? Do you feel any better?"
Lance gasped, as if he had just been woken from a nightmare. His face was etched with sheer terror - I will never forget how horrified I was when my gentle, sweet little boy proceeded to punch her repeatedly several times in the arm, with every bit of strength he could muster.
I held his little hand back - his knuckles were white, he was clenching his fists with such might.
The male paramedic asked the student if she was okay. She seemed shaken, but she said she was alright.
(The other female officer stood back, observing, and writing down notes.)
Student Paramedic then asked me if Lance had any behavioural issues that they should be aware of, or if he could be a danger to them or to himself.
I replied, "None, and NO. How he reacted to you was obviously a reaction from the medication he just inhaled."
She shook her head repeatedly, and quickly informed me that she had never witnessed such a violent outburst, and that "people are usually relaxed and quite sedated" afterwards.
(I wanted to ask her exactly how many times she had administered the "Green Whistle" to be able to make such a claim. I chose to bite my tongue, though. These people, especially the male officer, were so kind, and sympathetic - I could tell they were genuinely concerned about Lance's state.)
It was decided that Lance would attend the hospital via ambulance. After the medication wore off, he grimaced and asked the student officer, "Did I really punch you or was that a bad dream?"
"It was for me!" she replied.
Mama Lion didn't appreciate that comment, and Student Paramedic obviously knew it, by the daggers I shot in her direction.
"It's okay mate, these things happen. I've had worse." she added.
The fifth visit, Lance was fortunate enough to be examined by the Paediatric Registrar.She listened very carefully, and spend a long time reading over the notes her colleagues had made.
She was the very first person who found it odd that this sudden onset, severe, neuropathic pain commenced after the commencement of insulin pump therapy. To her knowledge, there was no connection though;she just voiced that it seemed strange. She "pulled some strings" and got Lance an emergency appointment with the hospital registrar for four days time. She also wanted Lance to start on a drug called Carbamazepine - an anti-convulsant and mood stabilizing drug. I was initially confused as to why he would need to use anti-seizure medication for pain, however, she explained that it was often used off-label for many severe pain disorders. I agreed, and he started that night. We were told that it would take at least two weeks before we knew if there would be any signs of any improvement.
TWO WEEKS??
Would we still be living this nightmare in TWO WEEKS?
The kindness shown to me by that Paed Registrar reduced me to tears. She was a mother herself, and she was concerned, even though yet again, her examinations of Lance found him to be neurologically intact. She promised me that she would write a letter of support to the Hospital Paediatrician.
The other times don't warrant mentioning. They were such a waste of time and energy. In the end, Lance begged me NOT to take him to the hospital anymore.
"If I have to have this pain, I just want to have it at home. No more hospital, okay Mum?"
"No more hospital, sweetheart."
Those words haunt me to this day. Mothers aren't supposed to make promises they can't keep.
Thursday, February 17, 2011
Simple Analgesics and Simple Doctors
Lance experienced nocturnal bouts of feet burning and pain for two weeks straight. I was simply exhausted. He wasn't sleeping until 2 or 3am every night. He was also starting to get pain in his ankles, knees, shoulders, elbows and ribs - simple pain relief like Ibuprofen didn't alleviate any of them.
I was having a midnight shower one evening - Lance had gone to sleep, (only out of pure exhaustion) and I desperately needed some time to myself. I took the opportunity to wash my hair and shave my legs in peace.
Suddenly, I had a feeling that I was being watched. I glanced over my shoulder and gasped when I saw Lance sitting on the floor, with his back up against the wall.
"Mum, I need to go to hospital. Please take me. Please. I can't stand it anymore."
What child begs to be taken to hospital at midnight??
I quickly dried myself off and sat down on the floor with him. He told me that it felt like someone was bashing his feet with a hammer. He also said that it felt like there was a "heartbeat" in his feet, and every time it throbbed, he felt a burst of pain. After two weeks of paracetamol (panadol) and ibuprofen that did absolutely nothing, I realised it was pointless giving him simple analgesia.
We were greeted by a cheery staff member at the Accident and Emergency Department of our local hospital.
"What are you doing here at this hour, Lance?" she asked. (Lance is the kind of kid you'd never forget once you meet him. He had also many stints in A&E over the years due to severe hypoglycaemic episodes.)
"I have pain; it won't go away", Lance replied softly.
After the routine observations were performed (blood pressure, weight, blood glucose test, temperature,) we were taken to a room for paediatric patients. The curtain was closed, and we were told we would be seen by a doctor within the next 30 minutes.
One hour passed. Lance was pacing around and around the bed. It was the only way he could displace the pain. So much for hospitals being clean - the soles of his feet were BLACK.)
Finally, we were seen by a VERY junior registrar. I could feel my right eyebrow arch involuntarily. My past experience in hospital emergency rooms told me that there very little chance that this guy would be of much assistance to Lance.
He performed a host of tests on Lance's feet as well as checking all of his joints. He prodded his feet with the ball of his pen, and asked Lance if he could feel it. He said he could.
"His feet are sensitive. There's nothing wrong there!" he said, with too much finality in his voice for my liking.
"Can't you see that he's in pain though? I understand that he's neurologically intact - he has had all of these tests performed before - we came here because my son begged me to take him! Now, please help him!" I pleaded.
"In all honesty, it sounds like you are asking for something. Are you asking for pain relief for your son?" the intern asked.
"YES, I am, but more importantly, I NEED you to help him. This has been going on for two weeks. His GP says it's growing pains, but as you can see, it isn't growing pains at all. No child with growing pains suffers this much!" I nodded towards Lance, who was almost in a trance-like state, shuffling around and around the bed.
"Okay, well I'll need to speak to one of the senior doctors about how to help him get some relief, and what their suggestions are. I'll be back."
Fifty long minutes later, he was back. He was back with a dose of children's paracetamol.
"With the utmost respect to you and your senior colleague, ARE YOU SERIOUS?" I exclaimed. "I could have given him paracetemol at home!"
"Well, lets just try it, and see if it helps. I'll be back in 30 minutes to see if he's had any relief."
I was frantic. It was almost 3am, and my son couldn't sit still. He couldn't lie down. He couldn't get comfortable. He didn't cry, or complain, but he was clearly stuck in the middle of a pain bubble. And they want to give him PANADOL? (It would occur to me many months later, that if Lance was the complaining type, and if he DID scream, shout and go completely ballistic, we would have had a much different outcome.)
"I think, that you need to keep giving paracetamol every 4 hours. So, in four hours time, give him another dose. Then four hours after that."
"Well, I've basically been doing that!" I could hear my voice starting to tremble, out of a mix of fear and infuriation.
"You're more than welcome to bring him back if the pain persists. In the meantime, there's not really a lot we can do for him this morning. Just keep up that Panadol, though, okay Mum?"
I carried my listless son in my arms, and followed a line back to the emergency desk. The same cheery nurse who had greeted us when we arrived was just finishing her shift.
"Aww. He's all tuckered out. Are his blood sugars playing up?" she asked.
"No - it's apparently nothing. Nothing that panadol won't fix anyway," I spat back at her. Lance had finally given in to sleep at 4.20am. There were birds chirping and the it was no longer black outside. We were leaving worse off than when we arrived.
I was having a midnight shower one evening - Lance had gone to sleep, (only out of pure exhaustion) and I desperately needed some time to myself. I took the opportunity to wash my hair and shave my legs in peace.
Suddenly, I had a feeling that I was being watched. I glanced over my shoulder and gasped when I saw Lance sitting on the floor, with his back up against the wall.
"Mum, I need to go to hospital. Please take me. Please. I can't stand it anymore."
What child begs to be taken to hospital at midnight??
I quickly dried myself off and sat down on the floor with him. He told me that it felt like someone was bashing his feet with a hammer. He also said that it felt like there was a "heartbeat" in his feet, and every time it throbbed, he felt a burst of pain. After two weeks of paracetamol (panadol) and ibuprofen that did absolutely nothing, I realised it was pointless giving him simple analgesia.
We were greeted by a cheery staff member at the Accident and Emergency Department of our local hospital.
"What are you doing here at this hour, Lance?" she asked. (Lance is the kind of kid you'd never forget once you meet him. He had also many stints in A&E over the years due to severe hypoglycaemic episodes.)
"I have pain; it won't go away", Lance replied softly.
After the routine observations were performed (blood pressure, weight, blood glucose test, temperature,) we were taken to a room for paediatric patients. The curtain was closed, and we were told we would be seen by a doctor within the next 30 minutes.
One hour passed. Lance was pacing around and around the bed. It was the only way he could displace the pain. So much for hospitals being clean - the soles of his feet were BLACK.)
Finally, we were seen by a VERY junior registrar. I could feel my right eyebrow arch involuntarily. My past experience in hospital emergency rooms told me that there very little chance that this guy would be of much assistance to Lance.
He performed a host of tests on Lance's feet as well as checking all of his joints. He prodded his feet with the ball of his pen, and asked Lance if he could feel it. He said he could.
"His feet are sensitive. There's nothing wrong there!" he said, with too much finality in his voice for my liking.
"Can't you see that he's in pain though? I understand that he's neurologically intact - he has had all of these tests performed before - we came here because my son begged me to take him! Now, please help him!" I pleaded.
"In all honesty, it sounds like you are asking for something. Are you asking for pain relief for your son?" the intern asked.
"YES, I am, but more importantly, I NEED you to help him. This has been going on for two weeks. His GP says it's growing pains, but as you can see, it isn't growing pains at all. No child with growing pains suffers this much!" I nodded towards Lance, who was almost in a trance-like state, shuffling around and around the bed.
"Okay, well I'll need to speak to one of the senior doctors about how to help him get some relief, and what their suggestions are. I'll be back."
Fifty long minutes later, he was back. He was back with a dose of children's paracetamol.
"With the utmost respect to you and your senior colleague, ARE YOU SERIOUS?" I exclaimed. "I could have given him paracetemol at home!"
"Well, lets just try it, and see if it helps. I'll be back in 30 minutes to see if he's had any relief."
I was frantic. It was almost 3am, and my son couldn't sit still. He couldn't lie down. He couldn't get comfortable. He didn't cry, or complain, but he was clearly stuck in the middle of a pain bubble. And they want to give him PANADOL? (It would occur to me many months later, that if Lance was the complaining type, and if he DID scream, shout and go completely ballistic, we would have had a much different outcome.)
When Doogie Howser returned to Lance's bedside, there was obviously no improvement.
"I think, that you need to keep giving paracetamol every 4 hours. So, in four hours time, give him another dose. Then four hours after that."
"Well, I've basically been doing that!" I could hear my voice starting to tremble, out of a mix of fear and infuriation.
"You're more than welcome to bring him back if the pain persists. In the meantime, there's not really a lot we can do for him this morning. Just keep up that Panadol, though, okay Mum?"
I carried my listless son in my arms, and followed a line back to the emergency desk. The same cheery nurse who had greeted us when we arrived was just finishing her shift.
"Aww. He's all tuckered out. Are his blood sugars playing up?" she asked.
"No - it's apparently nothing. Nothing that panadol won't fix anyway," I spat back at her. Lance had finally given in to sleep at 4.20am. There were birds chirping and the it was no longer black outside. We were leaving worse off than when we arrived.
Monday, February 14, 2011
Bittersweet Sympathy
Lance was stretched out in my bed, a half-read book open on his chest. A slight frown had etched itself into his forehead.
He had both feet pressed up against a pedestal fan.
This was the very first indication that something was terribly wrong with my child.
(If I didn't realise it at the time, I most certainly realise it now.)
I instantly expressed concern for the safety of his feet, and asked him to remove them from the fan.
"My feet feel like there is lava flowing through them..."
(That sentence pained me to write. It actually made my stomach knot. )
Lance asked me to feel how hot his feet were. I sat on the bed and placed both of his feet on my lap. They were both cool. No heat coming from them at all. No discolouration. Nothing at all. It was a beautiful, temperate Spring day - it wasn't like the weather was a factor.
He held his feet back up to the fan. "It's so uncomfortable, Mum. I can't even go to sleep. It's so annoying."
Finally, at 12.30am, he drifted off to sleep.
I was worried. I had read about people with diabetes having neuropathic pain and nerve damage as soon as 15 years after diagnosis. I was familiar with the words, "Peripheral Neuropathy." As soon as Lance finally drifted into a sound slumber, I sat at my computer and googled the keywords, "Type 1 Diabetes burning feet".
My heart sank and broke at the same time when the results flashed before me on the screen.
Every article or story on the first page had horror stories or grim outcomes about nerve damage as a result of unstable blood sugar control, and I saw the word "neuropathy" over and over again. I silently berated myself for trying to obtain a diagnosis from Google and went to bed. If the burning sensation had not stopped by morning, I would be definitely taking him to our family doctor.
The next morning I was so relieved when he said that the "lava" sensation was gone.
However, later that evening, he was wide awake, pacing backwards and forwards up and down the hallway, and soaking his feet in a bucket of cold water. Again, he went to sleep to sleep well after midnight.
The next morning, I wrote down the words, "Peripheral Neuropathy" on a piece of paper. I rang my doctor's surgery and secured an appointment for later that day.
Our family doctor has been treating Lance since he was 4 years old. He has seen Lance at both extremes; the worst hypo Lance ever experienced occurred outside the doctors surgery. Our surgery is notorious for running behind schedule, and on this particular occasion, by the time we had completed our appointment, two hours had passed. I had not even been out of the premises for one minute, and I had to return with my baby, a dead weight in my arms, totally limp with a pallor that was almost translucent, complete with a blood sugar level of 0.6mmol/L (10.8mg/dL). TWO glucagon injections were required to stabilise him and steer him our of the danger zone. (It took 48 hours for him to recover from that hypo. He was paralyzed with a blinding headache, and his ribs ached from his the constant vomiting and heaving - these were obviously symptoms from the overdose of glucagon. The most alarming after-effect of that hypo was confusion,jumbled sentences and thought processes. He was so frustrated with the words that would come out of his mouth, because they weren't the ones he wanted to say. He was clearly displaying signs of some loose circuitry over those two days. No one, (excluding me) seemed particularly concerned though.)
Our doctor, (who I will refer to as Dr P) has also seen Lance dry reaching as a result of DKA - he had large ketones but in-range blood sugar levels as a result of a gastro bug. So, you get the picture. Our doctor knew to expect the unexpected when it came to Lance's diabetes.
At the appointment, I broached "the subject" immediately.
I pressed the piece of paper with "those words" in front of my doctor.
"What's the chance Dr P? There have been symptoms two nights in a row."
I told him about the nocturnal feet burning, and how it was so uncomfortable that it prevented Lance from being able to sleep. He shook his head and cut me off mid-sentence.
"No chance. There is NO chance of this happening. Not in a child. It just doesn't happen."
I breathed a huge sigh of relief. Dr P said that it was most likely a case of growing pains, and to administer liquid paracetemol two hours before bedtime, in an attempt to alleviate another potential episode.
Dr P laughed heartily after examining Lance's feet.
"You have been worried for two days over this? You've got nothing to worry about." I felt a lump form in my throat and my hot tears spilled down my face. I felt like a fool. Still, Dr P hadn't seen the level of discomfort that Lance had encountered.
That night, I gave Lance a dose of paracetemol as instructed. Sure enough, the burning sensations appeared again. By the end of the week, we were both delirious from sleep deprivation. I made another appointment with our doctor. "I'm not satisfied that this is growing pains. Can we get a referral to a foot specialist who specializes in type 1 diabetes?" I asked.
I could see a pained, "you're panicking over nothing" glimmer in my doctor's eyes. However, he knew I wasn't going to let up, so he reluctantly began to thump out a referral with two fingers on his keyboard.. The three of us sat in silence while he typed. The vibe in the room was overwhelmingly obvious-I knew he thought I was overreacting to an unhealthy extreme. He finished the letter with a sigh, printed it out and handed it to me.
These feelings of doubt, dismissal, and the implied accusations of being a hysterical mother did not sit well with me at all.
Little did I know, that over the coming months, these unspoken assumptions would soon become loud and clear, and I would have to fight like a demon to prove my sanity, and even worse,that my son's worsening symptoms were real.
Labels: diabetic neuropathy symptoms in a child, growing pains, hysterical mother, nocturnal feet burning
Sunday, February 13, 2011
Prelude
The hero in this story is my ten year old son, Lancelot.
From here on in, he shall be referred to as Lance.
My Lance is an everyday, Australian kid who has a passion for collecting coins, cards, rocks and books.
He loves words and has a pretty impressive vernacular.
He's a Gleek and an Adam Sandler fan.
He has the softest, most gentle nature. I call him my pink marshmallow.
Everyone who meets him falls in love with him.
He has a very old soul - people often comment that he's "been here before."
However, there's a side to Lance that not many people see.
It's not because we try to hide it - on the contrary. I guess, after living with it since the age of one, he's become accomplished at making it blend into his life.
My only child has type 1 diabetes.
Anyone who knows about this beast of a condition will know that it's NOT an easy ride. It's a diabolical
rollercoaster.Lance has had his fair share of challenges with his condition.
He's endured countless severe hypoglycaemic episodes..
He's lost chunks of time due to seizures -the final symptoms a person with type 1 diabetes experiences before lapsing into unconsciousness.
I've found him unconscious in his sleep on three occasions, and had to perform CPR on one.
In fact, up until July 29, 2008, our life was controlled by Type 1 Diabetes. Anyone who lives with a chronic illness isn't supposed to say that. That they are controlled by their condition.
But we honestly were. Lance was diagnosed as having brittle, difficult to manage type 1 diabetes right from the start.
However, in the beginning of 2008, I decided that enough was enough. Lance's quality of life was just terrible. He couldn't go anywhere without me following him. Even being in a different room in our house was a concern- there have been times where he hasn't responded to my questions or comments and I have found him "asleep" and slowly slipping away.
His endocrinologist promised me that insulin pump therapy would change his life. It was a chance to buy him a quality of life that was fitting for a child of his tender years.
And on July 29, 2008, our life did change for the better. It was better than better. It was as close to "normal" as one could achieve without a fully functioning pancreas.. After four days of pumping, Lance exclaimed, "Mum, I have so much energy! I've never felt like this before!"
Gone were the days of punishing lows in the low 1's, that would then skyrocket to the the 20's after consuming a mere 15g carbohydrate. (this equates to a small popper, or better known to our international friends as "juice boxes.")
My Lance almost seemed "cured"..His blood sugar levels were consistently in normal range.
It was nothing short of a miracle. I wept tears of joy and sheer relief that my son finally had a chance at leaving his fragile life behind him.
However, our smooth transition into insulin pump therapy was short lived.
On the evening of the 14 September, 2008, a mere six weeks after having close to perfect blood sugar levels for the first time since his pancreas died all those years ago, everything came crashing down.
Our lives, quite simply, would never be the same.
From here on in, he shall be referred to as Lance.
My Lance is an everyday, Australian kid who has a passion for collecting coins, cards, rocks and books.
He loves words and has a pretty impressive vernacular.
He's a Gleek and an Adam Sandler fan.
He has the softest, most gentle nature. I call him my pink marshmallow.
Everyone who meets him falls in love with him.
He has a very old soul - people often comment that he's "been here before."
However, there's a side to Lance that not many people see.
It's not because we try to hide it - on the contrary. I guess, after living with it since the age of one, he's become accomplished at making it blend into his life.
My only child has type 1 diabetes.
Anyone who knows about this beast of a condition will know that it's NOT an easy ride. It's a diabolical
rollercoaster.Lance has had his fair share of challenges with his condition.
He's endured countless severe hypoglycaemic episodes..
He's lost chunks of time due to seizures -the final symptoms a person with type 1 diabetes experiences before lapsing into unconsciousness.
I've found him unconscious in his sleep on three occasions, and had to perform CPR on one.
In fact, up until July 29, 2008, our life was controlled by Type 1 Diabetes. Anyone who lives with a chronic illness isn't supposed to say that. That they are controlled by their condition.
But we honestly were. Lance was diagnosed as having brittle, difficult to manage type 1 diabetes right from the start.
However, in the beginning of 2008, I decided that enough was enough. Lance's quality of life was just terrible. He couldn't go anywhere without me following him. Even being in a different room in our house was a concern- there have been times where he hasn't responded to my questions or comments and I have found him "asleep" and slowly slipping away.
His endocrinologist promised me that insulin pump therapy would change his life. It was a chance to buy him a quality of life that was fitting for a child of his tender years.
And on July 29, 2008, our life did change for the better. It was better than better. It was as close to "normal" as one could achieve without a fully functioning pancreas.. After four days of pumping, Lance exclaimed, "Mum, I have so much energy! I've never felt like this before!"
Gone were the days of punishing lows in the low 1's, that would then skyrocket to the the 20's after consuming a mere 15g carbohydrate. (this equates to a small popper, or better known to our international friends as "juice boxes.")
My Lance almost seemed "cured"..His blood sugar levels were consistently in normal range.
It was nothing short of a miracle. I wept tears of joy and sheer relief that my son finally had a chance at leaving his fragile life behind him.
However, our smooth transition into insulin pump therapy was short lived.
On the evening of the 14 September, 2008, a mere six weeks after having close to perfect blood sugar levels for the first time since his pancreas died all those years ago, everything came crashing down.
Our lives, quite simply, would never be the same.
Dedication.
This blog is dedicated to every mother...
who trusted her gut instinct and was right.
whose love for their child is so fierce that, even on the darkest of days, they never stopped fighting or gave up.
who stood up to a medical professional who was wrong.
who taught a medical professional something they didn't know.
who has survived misdiagnosis/misdiagnoses.
who has been branded crazy, a nut job, a whacko by medical professionals because they kept fighting and searching and hunting for answers.
who has been hurt by malicious accusations and assumptions cast upon them by medical professionals.
who has felt doubt and dismissal cast upon them in a consultation room.
who has had to hold their child's hand, look them in the eye, (whilst doing everything in her power to keep it together) and tell them "the doctors don't know what's wrong with you."
who functions on the bare minimum of sleep.
who has watched their child in agony.
who has asked God "Why are you doing this to MY child?"
who has graduated to reading medical papers and speaking the lingo of a world class specialist.
who spent their life savings trying to find an answer for their child.
who considered marrying an American citizen for affordable access to the Mayo Clinic.
These are women who seldom get recognition, who constantly put themselves before others, who sacrifice their own health and wellbeing day, after day, after day.
I'm one of these women.
I'm proud of Me.
who trusted her gut instinct and was right.
whose love for their child is so fierce that, even on the darkest of days, they never stopped fighting or gave up.
who stood up to a medical professional who was wrong.
who taught a medical professional something they didn't know.
who has survived misdiagnosis/misdiagnoses.
who has been branded crazy, a nut job, a whacko by medical professionals because they kept fighting and searching and hunting for answers.
who has been hurt by malicious accusations and assumptions cast upon them by medical professionals.
who has felt doubt and dismissal cast upon them in a consultation room.
who has had to hold their child's hand, look them in the eye, (whilst doing everything in her power to keep it together) and tell them "the doctors don't know what's wrong with you."
who functions on the bare minimum of sleep.
who has watched their child in agony.
who has asked God "Why are you doing this to MY child?"
who has graduated to reading medical papers and speaking the lingo of a world class specialist.
who spent their life savings trying to find an answer for their child.
who considered marrying an American citizen for affordable access to the Mayo Clinic.
These are women who seldom get recognition, who constantly put themselves before others, who sacrifice their own health and wellbeing day, after day, after day.
I'm one of these women.
I'm proud of Me.
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