Hormones and Hospitals and Bullets

Beautiful weather for the Sunday Giro     

Early Thursday afternoon I unexpectedly found myself on the way to Ochsner hospital with The Daughter. She had been to the doctor earlier in the day, trying to figure out why she had been feeling so bad for the past few months. A few hours later the doctor called and said, essentially, you need to drop everything and get to the emergency room immediately. Not really what you want to hear. It actually happened to me once when I had mononucleosis and it started affecting my liver.  Anyway, it's kind of a long story, but Danielle and Candy had both picked up a particularly nasty virus around Christmas. One of those where the coughing and congestion and all hang around for weeks after the initial infection. Some time after that Danielle started getting extremely and uncharacteristically tired on relatively easy bike rides. She initially chalked it up to asthma and/or allergies. A few weeks ago we started thinking it might be something else. Specifically, we started thinking it might be an autoimmune disease. There were a number of candidates, some really bad, some no so much, but of course none good. She went to the doctor and although they didn't come up with a diagnosis, it was noted that her potassium level was kind of high.

I knew this all sounded familiar

Over the next few weeks, and heading in her exams, she was not improving and we were starting to notice some hyper-pigmentation that couldn't really be explained by being out in the sun too much. That started to sound familiar. Long, long ago in graduate school, probably in microbiology or maybe biochemistry, I had seen something like that, but couldn't quite put my finger on it. Anyway, the reason the doctor had become alarmed was because of Danielle's potassium level, which was way above normal and in the range where it could affect her heart, not to mention other muscles, along with shock from the concurrent drop in sodium.  Well, although Addison's Disease isn't very common, it didn't take very long for them to make the diagnosis. One of the ER doctors came in right away with three Residents so they could see what the pigmentation looked like. Initially, the Residents seemed a little disappointed. Then Danielle pulled out her driver's license so they could see her normal skin tone and their jaws dropped.  By the time all of this went down, Danielle had already been researching Addison's and knew a lot about it. They immediately started getting her potassium and sodium levels straightened out and started her on corticosteroids to replace the cortisol that she wasn't making. By morning she was feeling pretty good, although we were stuck at the hospital most of the next day waiting for the endocrinologists to show up to explain the treatment plan, prescribe the necessary replacement hormones, etc. So although this whole situation really sucks, at least Addison's is treatable and shouldn't have too severe an impact on Danielle's life.

Addison's is actually pretty interesting because of how the loss of cortisol screws up a whole negative feedback loop that leads to a couple of symptoms that aren't actually caused by the loss of cortisol per se.  That, of course, is probably why I remembered studying it. The next day I found my old collection of Scope Monographs, one of which was on the adrenal cortex. There were all of the pictures and text that I remembered, along with my highlighting and study notes. This whole situation was made even more complicated because Danielle had just finished exams (the stress is probably what pushed her symptoms into the red) and was scheduled to fly out to Washington on Saturday evening. We had a big rush on Saturday tracking down the right medications and especially an Addison's emergency kit, but it all came together and we were even able to make an appearance at Ben Bradley's graduation party. Ben will be doing his residency training at the University of Washington, which is where Danielle will probably be looking for an endocrinologist. It's a very good place to be if you're looking for a good MD, especially if you're looking for one with research interests. So we got her to the airport on time and she arrived in Seattle around midnight, our time.

Meanwhile, there was that shooting incident on Saturday.  Very odd.  I had gone out to the Giro Ride Saturday morning, and we had a particularly fast but otherwise normal ride. The Giro route returns via the I-10 service road and Bullard Avenue to Hayne Blvd. The stretch on Bullard isn't very long, and the pavement is pretty bad, so it's always kind of a regrouping or recovery zone before the final push on Hayne and over the two bridges. The Semi-tough group, does their own ride along the same route a little later, starting from downtown rather than the Starbucks on Harrison where the Giro starts. Well, as that group was returning on Bullard, one of the riders, Christopher Weiss, was shot!  Nobody can figure out where it came from, and luckily it was a small caliber bullet of some kind that wasn't going fast enough to penetrate too far. The bullet is still in there and it came dangerously close to one of his spinal cord nerve roots, so he's really pretty lucky.  The whole thing has people all freaked out. One of the guys behind him posted video of it, which of course had led to all sorts of conjecture about who did the shooting, but really they don't have much to go on and we'll probably never know if it was accidental, or if some idiot was, for some reason, using the group for target practice.

This morning the Giro did its usual route and as usual there were no incidents, not even anything like what we had a couple of weeks ago when there was a guy in the middle of Paris Road waving sticks at us and yelling "white people don't belong around here." The weather was really nice today and I'm enjoying the warmer mornings and earlier sunrise. It was the first morning I've ridden out to the Giro without lights this year. Next weekend is the Mississippi Gran Prix. I'm looking forward to it since I haven't had much of a chance to actually race this year. I'm setting my goals pretty low, which is to say I hope I can finish without getting dropped.