You Want Me to Do What?

January 1, 2011 in Boring Posts, Cranky, Facts About Patient Anonymous, Head Injury, Health, Hospitalizations, Medicine, Meds, Neat Neuro Stuff, Patient Advocacy, Seizures, The Tummy Blues

That wasn’t verbatim.  I can’t remember what I said, but it was along those lines.  To whom? A doctor in the ER dept.

Starting this Depakene/Valproic Acid has been bad.  More than.  “Go To The Hospital Bad?” I’ve made several Anticonvulsant additions, titrations, but I have NEVER become such a train wreck as this! Probably the biggest side effect is that Non-Arsey Neuro is away until Tuesday.  I have no choice other than to hang on until then.  Maybe I simply can’t tolerate Depakene, period?

I sort of figured they may not be able to do anything, but maybe there was something “alarming” going on.  This might have been all that captured their attention, though.

After I was admitted, they put me on a stretcher in the hall.  They called me back to triage, I guess to be moved into an exam room.  I got up and hobbled over with Wonder Cane’s brother.  WHAM! I completely lost my legs in front of about 10-15 people.  I didn’t think I hit my head when I went down, but maybe I did.  Because it started to hurt a bit later.  Maybe it was even an Atonic seizure (although I lose consciousness with those.)  However, I had a Simple partial earlier that afternoon!

It caused quite a stir! They put me back on my stretcher, this time with the rails UP! Good thing PA already went to the bathroom before all of this.  Now PA trapped.  PA cognitively trapped, too.  She brought baby MacBook to write but gave up after only getting out two sentences–after an hour–no, probably more.

Alright.  Beware the Medical!

I really wanted a neuro consult but all I got was a lot of confusing blood work.  Initially, Dr. WAA (What’s An Anticonvulsant) wanted to measure my “Epival” levels.  Dude! Dr. WAA! What decade did you grow up in! Epival? Seriously? No one calls it that anymore except maybe in another country where that IS its name! And this isn’t one of them.

My Depakene levels came back as L 229µg/mL (µg/mL means microgram per milliliter.)  I just had to put that cute character in there because I love it.  You don’t have to care, though.  The most important thing is that labs come back highlighting anything flagged as high or low, so you can get it to a doctor stat.  Mine was simply L 229.  Note the “L.”  Low.

Of course I didn’t have my “Depakene Serum Reference Range” memorized before I arrived.  So, I asked Dr. WAA just what was “the normal” range.”  He told me roughly between 350-700µg/mL.  This is where my non-verbatim, “You want me to…?” thing sprang from my mouth.  He said that I may not have hit the therapeutic range, so I need to take more. Oh, really.  I reminded him that things were getting worse over time and they weren’t stopping. Does Depakene somehow work “backwards?” Well, why not? Nothing’s making any sense in my world now, so anything’s possible!

He wrote me a script and said I could increase it from that, keep taking it and wait for Non-Arsey Neuro, or just stop taking it altogether.  I was agog at his last suggestion.  Even though it hasn’t been long, you never discontinue a med or monkey around without medical supervision!

Now that I’ve had a bit of time to ponder Depakene blood plasma readings, check this out! Exactly my line of thinking!

The relationship of plasma concentration to clinical response has not been established for divalproex. In controlled clinical studies, 79% of patients achieved and tolerated serum valproate concentrations between 50 and 125 µg/mL.

Because, I really wanted to tell Dr. WAA about my other Anticonvulsants and stuff.  You know.  Maybe it was a little important?

Oh, but let’s chat more about my blood work.  Just for fun.  Okay, maybe my fun but not yours.  This is all about my kidneys, even though the vast majority of Depakene goes the liver route to say bye bye.  Or crunch crunch.  Or something.  Nonetheless, kidneys say bye bye to so much, that we really can’t say bye bye to the kidneys for this stuff–EVER.

My creatinine.  This filters, stuff out of my blood, via my kidneys and through my urine.  I’m a bit on the high side.  Just a tiny bit, though.  What’s really more important is to move beyond it, and look at (for one) my GFR (Glomerular Filtration Rate.)  That can ask, “What are my kidneys doing?”

There is an estimate system (won’t bother to explain) so, an eGFR.  Mine was a little on the high side, but again, not too high?

So, although Depakene primarily shoots through my distended, overmedicated liver, it does continue to meander along.  Then, it somehow finds my kidneys that look like broken colanders, where a lot of pasta will never, ever be saved.  But that’s a good thing! I like my pasta al dente, so let’s keep throwing the other garbage out!

Wait a minute.  Just like never saying bye bye to your kidneys, you can never say bye bye to these!

My bicarbonate.  A bit on the low side as well.  My calcium is getting down there.  Pretty close to the basement! Ditto my potassium! My electrolytes are looking like they’re going to need some kind of serious electricity to keep them going!

But, oh my! Look at that phosphorous! L 0.86 mg/dl.  Huh? Normal values are 3.0-4.5 mg/dl.  Go straight to a doctor if you are under 1 mg/dl! Hello! I’m here, doctor WAA!!!

Still, there’s this “thing” called an “Anion Gap.”  It’s an equation to somehow chunk a few of these metabolites/compounds together, and guess what! I’m somehow “perfect.”  My Biochemistry sucks.  I know it does but…?

Isn’t this great! On a final note, going back to the creatinine that got the whole ball rolling in the first place? There is another possible problem with my eGFR–and maybe everything else along with! The production of creatinine is basically due to muscle mass.  Just exactly how wee is wee PA? Just exactly how bad are wee PAs gastro problems? *shakes head*