Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

Archive for the month “March, 2012”

March 19, 2012

Today has been one crazy day. I woke up in the middle of the night last night with an unbelievable sense that I needed to vomit, but I was extremely tired, so I rolled back over and went to sleep.

I swear that is what happened, but I can’t remember for certain because it feels like it might have been a dream.

I’m just not sure.

I woke up this morning with this nagging abdominal pain, and I contemplated going to the ER for it. I literally thought, “Wow, I haven’t been to the hospital in awhile. Maybe I should go.”

Now to be fair to myself, this abdominal pain has been coming and going for the past several weeks, probably a month or longer. I truly can’t remember for certain, but it’s been a long time and it’s just gotten to be horrible. Not because it’s excruciating, but because it’s continuous and random.

It’s so freaking frustrating to the point of where you would love to cut your abdomen open with a butter knife and dig around in that spot to take whatever it is that’s causing it out.

I’ve never had a toothache, but I’m really certain it would be like that. This deep throbbing, aching pain.

SO to have that continuously happen and then to awaken from a dead sleep with extreme nausea, well, I thought maybe today would be a good day to spend at the ER….but I didn’t go.

No, I couldn’t bring myself to spend at least 3 hours or more sitting in an uncomfortable, being prodded with needles to only be told, “we can’t figure out the problem. You aren’t dying, so here’s some pain meds. Follow up with your doctor tomorrow and come back if it gets worse.”

Instead, I decided to WALK to a nearby park with my 6 month old puppy and 3 year old daughter. The park is only a mile away or just over, but it seemed to be 3 or 4 miles at least. My daughter loved it. The puppy actually loved it, and I felt proud of myself for doing it. And then I made it back home and crashed for an hour before I had to leave for work.

Here’s the thing..this was a really crazy thing to do. I mean I didn’t feel well, and my poor puppy literally plopped on to the ground and refused to walk further about a block into the walk, so I had to start carrying her. She’s pretty small, maybe 6 pounds. I carried her for about a block but then my hand and arm started cramping.

It started as a dull ache and it built to this fairly excruciating pain. My arm became stiff and sore. The cramping became intense to the point that I wasn’t sure if I was going to be able to extend my arm. The same type of feeling was moving through my hips and right leg as well.

I wondered if it is all related. Is the abdominal pain, the nausea, the cramping all being caused by the same problem? I’ve had the cramping in my hands and feet for months now, but this is becoming a daily problem, and it’s becoming so severe that I wonder what I’m going to do in the future. How am I going to get past this?

So if you add this to the abdominal pain, the ER sounded like the right call this morning, but I didn’t go.

I’m certain that none of the doctors in that are in the local hospitals will be able to figure this out. I don’t know if it’s related to EPM. I don’t know if it’s related to one of my autoimmune issues. I don’t know if it’s purely random.

The only thing I do know is that this these issues are not getting better. I don’t know what I’m going to do. I don’t know how I’m going to live past it.

I guess it’s like everything else. You do it one step at a time.

It’s just like the walk I went on this afternoon. I was very much like my poor puppy. By the time we got to the end of the parking lot, my hips were cramping. By the time we got a block away, I felt like I could join the puppy, sprawled on the sidewalk, four legs to four corners and wait for someone to come and pick us up. I actually contemplated calling a friend to come and get us, but I kept saying to myself, “we’re almost there. we can do this.”

We didn’t make record time, but that’s okay. It wasn’t a race. Eventually, we’ll get to where we’re going. It’s all a matter of putting one foot in front of the other, and when things suddenly start to get more difficult, we keep on going because we can.

Don’t worry if you start to lag behind a little. I’ll walk beside you.

 

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A new MRI for identifying brain injuries:

Did you know that in it wasn’t until 1843 that a physician linked having dirty hands to passing infections?

Click the following link to learn more regarding the history of hand washing: http://www.accessexcellence.org/AE/AEC/CC/hand_background.php

Originally, hysteria was categorized as an ailment that inflicted women after having babies. It apparently caused a host of symptoms such as, “anxiety, nervousness, fullness in the lower abdomen, erotic fantasies, paralytic states and fainting…”

Until the mid 1800’s to early 1900’s, it was believed that a woman experienced these issues because her uterus was “floating” around her body and choking her. Doctors treated it by causing orgasms in women. This was an actual selling point for vibrators. They “cured” hysteria. Use the following link to learn more, http://ije.oxfordjournals.org/content/30/4/904.full

So, what’s my point? Modern medicine and treatments are NEW. We know more about the human body and health than what our ancestors did, but there is still so much we need to learn, discover and understand.

This post is dedicated to a new technology that is in process to help those with minor and major brain injuries. This new advancement is promising as it is supposed to detect actual damage in neuro fibers in the brain. In my earlier blog posts, I mentioned how the injuries related to CPM/EPM are like having a short circuit in an electrical wire. This new type of MRI(High Definition Fiber Tracking) actually detects those short circuits! Where normal MRI’s and CT scans will show inflammation and bleeds, this MRI scan actual shows the neuron damage and can potentially predict how successful recovery will be.

This is exciting news for us!!! This might give us a definitive proof for the cognitive issues that we experience. It might show us how likely we will be to recover and to what extent. YEAH!!

For additional information on the upcoming information regarding this new MRI(High Definition Fiber Tracking) use the following links:

http://abcnews.go.com/Health/wireStory/finding-unseen-damage-traumatic-brain-injury-15830461

The following is a research article written about the MRI:

http://schneiderlab.lrdc.pitt.edu/sites/default/files/Pittsburgh%20HDFT%20TBI%20Diagnosis%20report.pdf

I had to copy the image (below)  from the above link, just because it is that freaking awesome!!

New MRI

I really believe that this technology could greatly benefit those of us who are suffering from the “unseen injury”. Be patient friends, because this new scan will probably not be covered by insurance companies nor will it be offered in the next few months. I’m guessing it won’t be available for another year or more. (If you are interested in possibly getting it earlier, there are research studies being done at the University of Pittsburgh now.)

 

Brain Injury:

This might seem utterly ridiculous, but up to this point, I did not realize I HAVE a brain injury. EPM and CPM causes a BRAIN INJURY. Maybe it would be more appropriate to state, that I didn’t realize what it meant to have this injury.

Of course, I’ve known that I have had damage to my brain, but that already happened, and for whatever reason, I did not consider that injury along the same line of having an injury caused in a car crash or stroke, etc.

The injury was in the past. It happened. It’s over.

This is the reaction that I’ve had from all of my doctors up to this point. Every doctor that’s treated me for issues related to EPM has stressed to me that the injury has happened. It will not happen again. The damage has been done and from that point forward I will only get better.

Many of my doctors have stressed that because my MRI has shown improvements, healing, then it’s just a matter of time before I’m 100% normal again.

Let me stress, this is NOT true. As, I’ve mentioned on numerous occasions, the MRI detects inflammation in the brain and even though the inflammation does dissipate in the months after CPM/EPM, it does not mean that you are going to be 100% back to normal. You may or you may not. The MRI images do NOT correlate to the symptoms you experience with this injury.

My MRI images have shown improvements. My doctors have told me that I am certain to get better, and I have been left struggling with wondering; Why am I not back to my normal self? It’s almost 9 months post injury, why am I not normal yet?

Further, NONE of my doctors touched upon the issues that have been most concerning to me, deficits in my cognitive abilities. It is extremely difficult for me to stay on task. I have short term memory problems. I have problems with reading and writing. I have difficulty thinking of words. I have attention deficits. The list goes on.

I recently was in training for work, and after 30 minutes, I couldn’t retain any more information.

Have you ever made manicotti? If you aren’t familiar with it, is a large cylindrical shell. In most cases, you stuff the shell with a cheesy filling.  The shell is hollow and open on both ends. My ability to retain information is like a stuffing a manicotti shell. You can keep adding filling, but it’s just going to leak out the other side.

I might have retained some of the information from our recent training, but at this point, I’d say 70 to 80% is gone. I might remember parts of what I learned at points in time, but I almost guarantee that I couldn’t sit down and recall everything.

Here’s something that I don’t think I’ve discussed previously; I have found that my past memories have become extremely vivid and are constantly at the forefront of my mind. It’s so frustrating. I don’t know why these things are so blaring and concrete. I have no control over when they occur. I have no idea why they occur. They aren’t even significant events, but just random memories that are mundane and non influential.

Not all of them are mundane, and I have to say that’s even worse. Events that I would rather not think about come to my mind as well, bringing with me emotional turmoil and grief.

So why is it that I can remember sitting in the backseat of our beat up brown SAAB, as a kid, in the middle of the summer and arguing with my brother’s about Garbage Pail Kid cards, as we waited for our mother to come out of the grocery store around the age of 8, but I couldn’t remember to call my doctor’s office to schedule an appointment for the 4th day in row?

Folks, the stuff that filters through my mind on a daily basis in such GREAT detail about my past..from the weather and temperatures to clothes that I was wearing. It’s mind numbing. Why am I remembering these things constantly, but can’t retain 1/10th of events happening now?

After doing the research on my last post, Cognitive Therapy, I realized why. I HAVE A BRAIN INJURY!

CPM and EPM did more than just cause a temporary damage. I am utterly clueless why my current doctors who are treating me for this have been so adamant about not acknowledging this! I’ve spent the past 8 and a half months struggling to come to terms and prove that this isn’t something I’m making up. I’M NOT FAKING THIS, and now I understand why these things are happening to me.

I’ve had doctors tell me it was stress. It was from fatigue.  I’m faking these issues. It’s test anxiety. It’s not related to EPM. It’s long term ADHD. It’s from having high cortisol.

I’ve struggled to understand why these issues became a problem after I developed EPM. I’ve questioned my sanity. I’ve questioned the severity of these issues. I’ve wondered if I was exaggerating these problems.

I’ve had people try to tell me it’s normal. It’s what happens when you get older.

If you are reading this, then I’m here to tell you, those people are FULL of it.

Let me stress, the reason you have the issues that you do is because you have had a trauma to your brain!! The damage is not necessarily ongoing (though that is also questionable), but the cognitive issues ARE or at least can be.

I now have answers and understanding to why these issues are occurring AND I can share with you, hope.

I had no idea as to how much support there is for brain injuries. There is actually a tremendous wealth of information regarding what might be considered “minor” brain injury.

Now, I’m not going to classify EPM and/or CPM as a minor brain injury. There are people who are living their lives completely incapacitated, requiring 24 hour support. That’s not minor. On the other end of the spectrum, you have people like me, who have are “functionally disabled”. You can live your daily life with little or no assistance, but you have not returned to your former self.

The following information I found online from Dr. Thomas Kay a renowned neuropsychologist who has specialized in minor brain injuries:

There is a known natural course of recovery for concussion, and the vast majority of persons appear to recover completely. (“Appear” is italicized because there is increasing evidence that there may be sub-clinical residual damage that can become manifest under certain circumstances, or can accumulate and cross a threshold after a series of presumably fully recovered concussions.)

There are predictable clinical deficits that occur immediately after most concussions: problems with attention, concentration, and short term memory; irritability; headaches; dizziness and balance problems; sensory sensitivity). These are often referred to as the “post-concussion syndrome.” However, because only some of these symptoms come from an injury to the brain, while others come from non-brain body systems, I prefer to avoid the phrase “post-concussion syndrome,” and try to refer to “post-concussive symptoms.”

A subset of persons who suffer concussions, or mild traumatic brain injuries, have long term residual symptoms, and a smaller subset remains highly dysfunctional. There is a long standing, often bitter, debate about why some people do not recover completely from concussion or mild traumatic brain injury. At one extreme, some advocates maintain that all problems are due to permanent brain injury. At the other extreme, skeptics maintain that anyone who fails to recover from a concussion/MTBI either has psychological problems or is malingering, and maintain that it is not possible to sustain permanent neurological damage from a concussion.

He goes on to state:

It is important to realize that multiple factors other than neurological ones can contribute to the appearance of brain injury, or exacerbate the apparent severity of brain injury. These include pain, sleep deprivation, depression (which is extremely common), anxiety, PTSD, and the results of medication (especially narcotic analgesics).

The evaluation of MTBI is complex, and needs to sort out the various contributing factors. Comprehensive evaluation should be delayed until the natural course of recovery has been completed (often up to a year), and major psychological complications have receded. Briefer screenings can track cognitive recovery. Patients who are depressed will often perform much lower on cognitive tests, than when they are not depressed.

Tests of effort are also an essential part of neuropsychological testing. Multiple studies have shown a tendency for a high percentage of persons with MTBI to fail tests of effort, and underperform on cognitive tests. In my opinion, tests of effort may be failed for a variety of reasons having to do with motivation. In order for neuropsychological test data to be interpreted as valid, tests of effort must be passed. (Failure of tests of effort does NOT necessarily mean a person does not have a brain injury.)

Clinical treatment of persons with MTBI will depend on the relative contribution of neurological, physical, and psychological factors. The neuropsychological approach I take is determined entirely by the presentation, dynamics, and needs of each individual person. I conceptualize treatment of MTBI as the restoration of an effective sense of self. Limits on this restoration may or may not be set by neurological injury. Each individual is different.

I am going to elaborate on this post in the near future, but before I end tonight, I just wanted to share this exciting news. Yes, folks, we have a brain injury, and if you are experiencing these issues than you are not alone and there are people who will believe you and your issues. Most importantly, now you have a source for help. 🙂

Keep checking back on this post for the next few days because when time and energy allow, I will be updating with more detailed information for support and direction.

 

The Updates:

This is I believe an amazing quote:

Brain injury is not an event or an outcome. It is the start of a misdiagnosed, misunderstood, under-funded neurological disease.

This quote is from the Brain Injury Association of America:

http://www.biausa.org/

I really believe it is absolutely true. I’m hoping it is not true for you, but it describes me to a T.

Update:  This person found my site and after reviewing it, I really found the information extremely beneficial. I recommend checking it out: http://brainhealthresources.wordpress.com/2012/05/09/there-is-help-for-battered-athletes-and-tbi-patients/

Cognitive Therapy:

Yesterday  (this was actually March 9 but I’m still writing this post :), I met with a cognitive therapist. I had done this earlier in my rehabilitation, but I found it to be a waste of time. My previous therapist worked with people who had major damage. If you read to them three to seven words, then asked them to repeat it, they weren’t able to do it.

I can repeat things back initially, but in five minutes, I can’t remember half of what you said. In ten minutes, I can’t remember 70% of what you said. The extent of this issue varies dramatically by how stressed I am, how much sleep I’ve had, how focused I am, if there are distractions,etc.

This is so stressful to me.

My first therapist didn’t seem to understand my frustration or the variability of in my symptoms.

Because my previous therapist recommended it, several months ago, I bought this really nice journal that I could fit in my purse and carry around with me so that I could keep notes. I did awesome with it the first week to 10 days, after that I have no idea where it went. NO CLUE!

I’ve looked for it. I’ve forgotten about it. Then I remember it and look for it again.

It’s so frustrating because I have no idea where it is, and I wrote down several things that I needed to remember, but now that I can’t find it, I don’t know if those things were really that important or not.

I had expressed to my original therapist that I had no problems with writing things down, but remembering where I wrote those things or what I did with the list or paper is the issue. She suggested the notebook, and as I mentioned above, this was a huge failure for me, and a continuing source of frustration and anxiety.

I wonder what the freak happened to it. Did it enter the Twilight Zone? Did my kid take it to school? Did Tom put it away somewhere? Is it shoved in a dark crevice of my car? (Notice, I how I’ve mentioned every other person as being responsible for it except myself. Despite the fact that I’m the one with brain injury, it is EXTREMELY difficult for me to accept that I am the one who has a deficit.)

You have no idea how much this eats at me. Thank God, by the end of the night, I will forget about it completely until the next time I remember it.

It’s frustrating for me that these things are happening. It’s not just not being able to remember but the frustration of being constantly distracted. I’m at a public library right now, and there’s SO much noise. There’s the ding of the elevator doors. There’s people coughing, talking, flipping through books, even the sound of my own typing is driving me crazy and causing me to lose focus.

I used to be able to study in the extremely busy passageway in the basement of a major university, and I could shut out everything without issue. I could go into my own little world in my mind, close the doors, and concentrate on physics or organic chemistry for HOURS. Literally, I would be able to do this for 8 to 12 hour stretches with just brief breaks. I was like a meditating Buddhist Monk. Now, I have the attention span of a fish, and that might be an unfair correlation on behalf of the fish.

I really thought when I started to see this new cognitive therapist that it would be useless. What could this person do to help me? How could she possibly know what I’m going through? I was very on guard prepared to argue my case on how EPM works and about how reading back simple lists probably wouldn’t help me get to my goal. I felt absolutely certain that because I’ve run into so many doctors who have raised their eyebrows and have doubted my sincerity, this would be just one more person that I would have to convince or teach about my condition.

Yesterday (03/09), I was having a bad day, and I certainly wasn’t at my best.  After my appointment, I left feeling relieved. Yes, relieved! This person gets it. She pulled out a sheet of paper that described what I’ve been experiencing to a T. This made me feel so relieved. I mean she knows what I’m going through. She understands what problems I have, and she’s going to try to help me get back on track.

More excitingly, she understands that I was a very capable, intelligent person before the injury, and she knows what I want to accomplish in the future. She’s looking at me as if I have a chance at still achieving my goals!!

Not only is she looking at me as if taking and passing the MCAT is absolutely achievable, but she worked with someone who was an ER doctor who had a brain injury and granted he’s no longer an ER doctor, but he’s a successful GP. This gave me a huge sense of hope.

I have not had any doctor at this point be able to do that. TRULY!! and I’ve seen dozens of them for this problem, but what she did for me in the two hours that I was there was give me a sense of hope. THIS MIGHT WORK!!

Let me try to explain a bit more about this. I’m not saying the doctors that I’ve seen previously to this point were just a waste of my time or were uncaring(some were, some are absolutely awesome). Some have really tried to assist me, but they didn’t have any plans. They didn’t pull out diagrams and wall maps with a step by step solution on how to get me back to where I was previously.

From almost every doctor, I’ve  gotten a response of: we think you’re going to be just fine. Just give it time.

I’m going to try to give you an idea of how this is such a screwed up way to handle an injury. If someone had a broken leg and you knew it was broken, would you tell them; you have a broken leg. If you wait about 6 to 12 weeks, it’ll heal. Then send him down the road?

NO! They’re right. The leg will heal, but will it heal correctly? No doctor would treat a patient like this. Once they determine the injury, the make plans. They either do surgery, put it in a cast, give the person crutches, and steps on what to expect and how to help it heal. Further, they asses the person over time to determine if they need physical therapy or additional steps to make the best recovery possible. They don’t simply state, well your leg is broken; have a great day.

When I left the hospital, I was walking into the unknown. Up to this point, I did not have anybody who said, this is what you need to do or I can help you get to where you want to go AND she knows where I’m going. She knows what I want to accomplish. She understands that I’m not just wanting to be able to sit down and read a book without forgetting what I read the day before; she understands that I want to be a doctor and that I need to have the ability to think on my feet.

So, what does this mean. This means my friends, Don’t Give Up!!! It’s been 9 months since I received this injury, and it’s been extremely difficult, but you don’t know what lies ahead, and you don’t know what’s going to happen next. Or if the next doctor’s appointment, is going to give you the person you need in your life who will reach out their hand and help you get to where you need to go. HAVE HOPE 🙂

Finally, I want to leave you with the information that my new therapist has given me because if it doesn’t hit the nail on the head, I don’t know what will.

Ok, folks, I spent over an hour trying to find a link to this doctor’s book, but I couldn’t find it, so I’m going to list some of the information from the pages that my therapist gave to me:

Excerpted from: “The Unseen Injury”, by Thomas Kay, Ph.D-neuropsychologist:

Statement of the Problem- We (a group of rehabilitation specialists in NY University Medical center) discovered that these patients appeared fine until they attempted to resume their responsibilities at home or at school. When they did so a significant number experienced great difficulty. They complained of inability to remember, concentrate, organize, handle a number of tasks at once, and get as much work done as efficiently as they used to. Their relationships with family, peers, and bosses often suffered and they developed psychological problems. their doctors were unable to find anything wrong with them and they were thought to be having psychiatric problems-or worse yet, to be faking.

Diffuse Brain Injury- there is evidence that the subjective complaints and cognitive problem encountered by some persons after MBI, may have an organic basis. This microscopic stretching and tearing occurs because of mechanical forces. (In toxic and hypoxic injury, nerve impulse transmission maybe interrupted/damaged).

Because of the very nature of diffuse MBI, the resulting deficits are not specific to particular domains of cognition (such as language, perception, etc.) Rather, it is the overall speed, efficiency, execution and integration of mental processes that are disrupted in a general way.

Nature of the Deficits- A.) Speed and capacity of information Processing persons with diffuse MBI process information less quickly. They react less quickly, especially when faced with a choice, and simply take longer to mentally process most tasks. This goes hand-in hand with a reduced capacity to process large amounts of information at any one time as fewer details can be handled simultaneously. The threeshold for becoming overloaded with amount or speed is significantly lowered.

B.) Complex Attention Most persons with MBI have great difficulty splitting or shifting their attention among tasks, and can not efficiently execute complex operations that require multiple simultaneous in temporary abeyance. Similarly, flexibility of thinking may be reduced. there is a failure to shift to a new strategy or grasp alternative solutions, when the one presently being employed is unsuccessful. As a result of the above difficulties, there is often a decrease in complex problem solving.

C.) Learning and Memory: Additionally, failure to effectively sort out, organize and quickly store complex incoming information often leads to “missing” obvious details, or the inability to recall accurately and becomes experienced as a problem with “memory.” As a result, it is much more difficult to learn new routines, or large complex amounts of new information. There is great difficulty storing and retrieving NEW information. This may be auditory information, visual information, or both. Old information is intact. Most commonly, there is also a deficit in the spontaneous recall of newly learned information.

D.) Integrative and Abstract Thinking   Because of its highly intergrative nature, there may be deficits in the quality of abstract thinking. The ability to spontaneously make connections between ideas may be impaired and interpretation of the statemetns of others may be either overgeneralized or too concrete. There may be difficulty expressing thoughts concisely and accurately. Ideas may be expressed in an imprecise, roundabout, wordy manner. It may be difficult to find the right word resulting in deliberate speech with numerous pauses, at times, “talking around the word”.

E.) Executive Function  The process by which we plan, organize, initiate, monitor and adjust our thinking and behavior. The person with deficits in executive functioning may have difficulty setting realistic goals. They may be unable to efficiently plan and organize their thinking or behavior and this may manifest itself most dramatically in new and unstructured situations. they may be deficient in initiating new activities, once they are planned, and may be misperceived to be unmotivated. They may fail to notice when their performance is off. They may act impulsively or erratically, having difficulty modulating their behavior. Finally, executive deficits may take the form of failing to complete tasks as things are abandoned and never brought to completion.

F.) Emotional and Behavioral Control    Damage to the orbital under sided portions of the frontal lobes, and basilar and medial aspects of the temporal lobes, can result in the disruption of emotions and behavior. There is a disruption in the balance between lower emotional impulses and higher rational cortical control due to the disruption of nerve connections between these two areas. Emotions may suddenly erupt. The person may seem irritable.

There you have it folks. This describes me almost perfectly. I really would recommend that if you are suffering from a brain injury to print out this post and take it with you to your doctors appointments, give it to your friends and family, etc. I think it helps for them to realize, you aren’t making these things up. It’s coming from an outside source, a legitimate neuropsychologist.

I also want to stress that this does not mean that you will have all of these issues or that you will develop them in the future if you haven’t developed them as of yet. Keep in mind this is to give you an idea as to what has been seen in brain injuries.

Hope this helps!

 

Update:  This person found my site and after reviewing it, I really found the information extremely beneficial. I recommend checking it out: http://brainhealthresources.wordpress.com/2012/05/09/there-is-help-for-battered-athletes-and-tbi-patients/

Savannah Hardin: Murder or Medical Malpractice

Let me start by saying, Savannah’s death is a tragedy, and I pray for her family and her friends. I hope this post might help shed light upon what caused her death.

A friend of mine posted comments regarding a blog she read about a 9 year old girl who was run to death by her grandmother (Joyce Garrard) and step mother (Jessica Hardin). When I read the title, I reacted immediately like I’m sure everybody did. I believed that these abusive people needed to pay for their crime,  then I read further.

The girl was forced to run for three hours because she had eaten a candy bar! Wow, this was definitely abusive. After running for three hours, she apparently went into a seizure. At this point, the step mother (who was 9 months pregnant) and paternal grandmother called 911.

This happened on a Friday afternoon and evening, and the girl died on the following Monday while in the hospital.

The autopsy revealed that she was dehydrated and had low sodium at the time of her death.

The report also stated that Savannah had a medical condition that involved her urinary system that required her to have monthly doctor’s visits. Apparently, eating chocolate could cause her serious complications which provoked the paternal grandmother into punishing her with running.

The step mother and  grandmother are being charged with murder. The grandmother is being charged with capital murder, so if she is convicted, she will face the death penalty.

Most of the information I’ve cited comes from the following article:

http://news.yahoo.com/2-charged-death-ala-girl-forced-run-082216169.html

My question is: what really happened to Savannah Hardin?

I have very limited information regarding her personal story, but I have a lot of information regarding hyponatremia. (Please see all of my posts regarding hyponatremia to find out more about this very common metabolic condition, and its life threatening consequences).

I really believe that her death was caused by or contributed to by medical malpractice or at the very least lack of appropriate medical care.

When I read the article regarding Savannah, so many questions come to mind. Did the women give the child water while she ran?

It is commonly believed that a person can exercise for long periods of time if they are provided water. (This is the case with many school athletic programs who push children to the extreme every year as long as they provide water breaks every 20 minutes.

Most people don’t realize how dangerous water is when exercising. When a person sweats, they release large amounts of salt through their sweat. If they proceed to drink large amounts of water, this will further dilute their blood sodium levels. It is so dangerous.

If Savannah’s guardians provided her water instead of an electrolyte based refreshment, like Gatorade, then this could have caused her sodium levels to drop dangerously low.

To further complicate her condition, Savannah had a urinary disorder/disease. Depending on what type of disease she had, this might have contributed to her ability to develop low sodium.

The basic symptoms of  severe dehydration and hyponatremia are the same: headache, nausea, vomiting, muscle cramps, seizures, dizziness, delirium and unconsciousness. Some of these symptoms may occur or all of these symptoms may occur. A big differentiation regarding those with dehydration is that they stop sweating.

Dehydration rarely causes seizures though, so I believe that when Savannah experienced seizures after running, it was because she was hyponatremic not dehydrated. It would be extremely difficult to determine without reviewing all of her medical records and questioning her family.

If her family was providing her with water, in combination with her physical condition and intense exercise, this would have been the perfect storm leading to her developing hyponatremia.

Why do I think there could have been medical malpractice?

It has been recognized that the standard treatment at the time of hospitalization for dehydration is IV fluids. These fluids tend to not contain sodium at all. If a person is treated with these nonsaline fluids and they actually have hyponatremia, then this treatment can be fatal.

It dilutes already diluted blood sodium levels. This would cause brain stem and cerebral swelling, further seizures, coma and brain death.

By the time the hospital receives the lab work showing low blood sodium levels, it is already too late to change the IV fluids to a low sodium based fluid, especially in children.

Please read the following information regarding the susceptibility of children for hyponatremia and how it is supposed that it is being caused mostly by hospital malpractice:

 It has now become apparent that the majority of hospital-acquired hyponatremia in children is iatrogenic and due in large part to the administration of hypotonic fluids to patients with elevated arginine vasopressin levels. Recent prospective studies have demonstrated that administration of 0.9% sodium chloride in maintenance fluids can prevent the development of hyponatremia. Risk factors, such as hypoxia and central nervous system (CNS) involvement, have been identified for the development of hyponatremic encephalopathy, which can lead to neurologic injury at mildly hyponatremic values. It has also become apparent that both children and adult patients are dying from symptomatic hyponatremia due to inadequate therapy. We have proposed the use of intermittent intravenous bolus therapy with 3% sodium chloride, 2 cc/kg with a maximum of 100 cc, to rapidly reverse CNS symptoms and at the same time avoid the possibility of overcorrection of hyponatremia.

This same research paper also recognizes that most children that develop it are inflicted by an underlying urinary condition:

 In order for hyponatremia to develop, there must typically be a relative excess of free water in conjunction with an underlying condition that impairs the kidney’s ability to excrete free water (see Table 2). Excretion of free water will be impaired when there is either (1) a marked reduction in glomerular filtration rate, (2) renal hypoperfusion, or (3) arginine vasopressin (AVP) excess. Most cases of hyponatremia are the result of increased AVP production.

The paper discusses what I mentioned above regarding how the symptoms for the cerebral edema in relation to hyponatremia can easily be diagnosed as other conditions, such as dehydration:

Hyponatremic encephalopathy can be difficult to recognize, as the presenting symptoms are variable and can be nonspecific (see Table 3). The only universal presenting features of hyponatremic encephalopathy are headache, nausea, vomiting, and lethargy. These symptoms can easily be overlooked, as they occur in a variety of conditions. There must be a high index of suspicion for diagnosing hyponatremic encephalopathy, as the progression from mild to advanced symptoms can be abrupt and does not follow a consistent progression.

The information that is quoted above comes from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874061/

Now, here’s the take home message from the above article: if your child is being treated for ANYTHING in the hospital be sure they receive  .9% saline IV fluids.

I believe the hospital will be determined at least partially responsible for Savannah’s death. If the hospital had treated her for hyponatremia instead of dehydration in the beginning, Savannah might still be alive, and the reason I believe that they did not treat her for hyponatremia was because her autopsy showed that she was hyponatremic after being in the hospital for three days.  The media also implied that she was hospitalized for dehydration.

Please do not mistake that I condone the punishment the girl received: I DON’T. I really believe her punishment was harsh, but I am almost positive that her grandmother and step mother did not intend to cause her death, and I further believe that having the girl run that long did not DIRECTLY cause her death. It was a series of unfortunate events complicated by common ignorance, a medical condition, and the hospital incorrectly treating Savnnah for dehydration instead of hyponatremia.

 I hope that over the next few weeks or  months, more information becomes available so that people will better understand what happened to her.

We live in a democratic society, in which a person is presumed innocent until proven guilty. In our country, this has changed. We now get our information from the press, and we are quick to become the jury and the judge in such cases. I wonder if it will be a matter of time before we regress to a time where we will prosecute a person without a trial. This seems especially true in cases that involve children.

Who needs a judge or a jury, we have the press!

It is easy for me to sit back and criticize people for this type of reaction, but I am the same way. I read a story about a woman who microwaved her baby to death while in a drugged stupor, and my first reaction is that woman deserves to die a horrific death.

However, I refuse to read what the press publishes and believe that it is the whole story.

I may have several ideas as to what happened to Savannah, but it’s based on my very limited information. In order to know exactly what happened to her, a person needs to know: how long she ran; if she was provided fluids and what kind while she ran; what the treatment was that she received when she was transported in the ambulance and at the hospital; did the hospital recognize that she was hyponatremic and/or how long did it take for them to figure it out; what type of medical condition did she have and what was her urine osmolity?

If you are reading this, I pray that you pass this information along. It’s important that people know and understand the dangers involved with hyponatremia, especially regarding children. The more people realize the threat, the more pressure there is on a hospital to change their procedures for dehydration, and the fewer the number of children who will die or be forever brain damaged from hyponatremia.

UPDATE: According to news sources like the Huffington Post and ABC news, Jessica Hardin (Savannah’s Step-mother) is in the process of working out a deal with the prosecutors. Hopefully, the charges will be reduced, or her bail will be dropped to $500,000.

I do believe that there was a medical condition that caused Savannah to suffer from hyponatremia and that led to her death. I am hopeful that the charges will be dropped completely if it was, but unfortunately, innocence comes with a price.

http://www.cbsnews.com/8301-504083_162-57517645-504083/jessica-mae-hardin-ala-stepmom-accused-of-savannah-hardins-running-death-seeks-lower-bond/

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