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[IP] Hospital Survival 101 - LONG!!!



Hello everyone:

I am back and feeling fiesty and am ready to share my "experience" with you -
not ALL the gory and disgusting details unless you ask personally, but the
things that sorta apply to us.  This is long.  sorry

I have diverticulitis - which is NOT related to my diabetes soo-prise, soo-
prise.  I mean, we all suffer a little constipation, us more than the average
non-diabetic, but it is pretty normal.  This is caused by poor diet and stress
and  it also usually affects older people (I am ...uh...34 (but don't tell
anyone) and it usually hits after 45 or 50.  They were calling it a non-
specific inflammation in my intestine and I had some free fluid floating
around in my pelvis all of which contributed to some really bad cramps.

I went to my diabetes doc (DREXLER) in pain on Thurs and he sent me to ER.  I
was there 13 hours before they finally admitted me - I had a CT scan, Xray,
ultrasound (inside and out!!!), sonogram and multiple rubber glove tests.  I
had eaten NOTHING since 8pm Wednesday night and was putting up quite a stink
about having to sit there with nothing to eat, no juice, nothing.  my sugars
were holding steady around 160.  They put in an IV around 1130pm.

 IF you are so very lucky as to be put into a teaching hospital, such as NYU,
you are assured of getting state of the art doctors and equipment...but you
have to swim thru a sea of interns, residents and students to get there...and
if you have to get ugly - DO IT.  Make sure your diabetes doctor knows whats
going on and he HAS to talk to your attending physician for whatever you are
in for.  In my case, Drexler needed to talk to the gastro-???ologist.  Both
docs, by the way are considered top in their field, which made me feel better,
except for the aforementioned residents, interns and students I had to wade
thru to get to them.
Both docs were there in ER with me on and off. 

OK, now - file this away:  In a 1 litre bag of D5% there are 190 calories - 5%
f that bag is pure dextrose - you can figure the CHO.  In the 1 litre bag of
D2.5%, there are 85 calories.  This is the so-called sugar water they hook you
up to on the IV.  Drexler ordered the D2.5, but they put on the D5 by mistake.
I hollered about being put on sugar water until DREXLER reminded me that your
body needs APPROX 150 grams of CHO to function (YMMV).You need that much to
keep from going into STARVATION KETOSIS.  Your blood sugars will read normal,
or low, but check yer pee!!! Your body needs fuel and if you don't get it from
CHO, you will get it the BAD way - fats and muscles etc. 

You have to figure out how much you are getting - Look at the flow rate on the
IV machine - if it says 100 - that means you are getting 100ml per hour, so a
1 litre bag of IV is gonna last ya 10 hours...If you are on D5%, you will get
that 190 calories spread out over 10 hours.  If you are at 250 rate, you will
get the whole 190 calories in 4 hours...and so forth.  THIS IS IMPORTANT TO
KNOW SO YOU CAN REGULATE YOUR BASALS.  

OK, so Drexler ordered D2.5, I got D5.  I guess that is the Standard operating
procedure for most patients.  Then the emergency room nurse realized and
changed it.  Then I had to drink the contrast stuff for the CT scan - they put
it in Tang so it tastes less like shit and more like rotten orange juice, but
they have NO CLUE how much tang is in it (one resident goes..."is there sugar
in tang???")  So I drank it.  ALSO NOTE:  if you are having problems with your
kidneys at all - DON'T LET THEM DO THE IV CONTRAST in the CT scan without
talking to your diabetes doctor.  The stuff you drink makes the test a little
less telling, but the stuff they shoot you up with is BAD for the kidneys - I
did not have it, cuz Drexler happened to be there when they were ordering it
and he knows my kidney situation.

Around 3AM they decided I was staying.  They had not ruled out anything,
including appendicitis, ruptured cysts, diverticulits.  They did say I
couldn't just eat some prunes and be on my way, however.  They said no food,
which freaked me out!!!   NATURALLY, I had not planned on staying in the
hospital when I went to the doctor that day.  I was gonna eat lunch on the way
back to work and had left my desk a wreck - I was supposed to leave for LA
this weekend.  And more importantly, I did NOT have my emergency pump kit with
me.  All I had in the pump was about 20 units - and 1 bottle of test strips.
I was testing every hour to hour and a half - mainly cuz I was so bored, but
also since I was so hungry.  

Drexler came in the next morning with pump supplies and insulin and my
roommate showed up later with more test strips and a real pillow and some
jammies with a covered butt

Basically, I spent 4 days with no food or drink - no water.  Needed to rest my
intestines.  I was on the 2.5% at a rate of 125 per hour most of the time and
kept my sugars between 120 and 170 (8-)) .  I had a low on Saturday morning 10
am and the resident on call said I could have bread and skim milk - I was like
- "I htought I couldn't eat" and the nurse said "well that is what the
resident said you could have."  I asked them to check with Drexler.   I turned
the pump OFF and paged Drexler.  His partner called and "no I shouldn't eat."
I asked the nurse for some glucose tabs - THE HOSPITAL DID NOT HAVE ANY!!!!!!
So I ate 1/2 the bread and 2 sips of milk and was better soon.  That night
around 10 pm I went down again.  I was not being nice at this point.  I told
them I did not want my sugars below 100 for my eyes, and here I was at 83 and
going down.  BY THE WAY, all my basals had been dropped drastically, but not
yet perfected obviously.  I told them to give me some  juice NOW and the nurse
rolled her eyes and gave it to me.  As I was sitting there, taking care of my
sugar, the dumbass resident on call walks in and FREAKS that I have juice!  I
yelled back at him and said he could take care of my shit problems and I would
take care of the diabetes - well that isn't exactly what I said, but its what
I wish I had said.  He was pissed but I just walked away (of course, I was not
walking too good - the cramps had me doubled over and the IV thing weighs a
ton and the wheels worked like the ones on a grocery cart...)

About an hour later the nurse comes in and changes me to the D5% - I am pissed
- she said the resident ordered it, I ranted a bit then told her she would
need to wake me up every 2 hours for the rest of the night so I could test my
blood (the rate was 150ml per hour),.  At 1:45 I was 248 - first time over 170
since Thursday!  I covered.  At 4am, I was 220, I covered (using unused
insulin ratios).  Then at 6:30 I was 255!  I covered.  AGHHHHHHH

The next day Drexler's partner came by, with some glucose tabs for me, and had
me changed back to D2.5 but only at 110.  My sugars stayed 120-170 the rest of
the day.  Monday, Dr. Liang, the tummy doc came in and said I could start on
liquids and ordered a 1800 calorie diabetic diet and then cut me back to 75 ml
per hour.  You know what I got for lunch?  Diet jello, diet gingerale, chicken
broth and tea, and 1/2 cup apple juice.  I said if this is all I am getting
for lunch and dinner, this will not be enough CHO.  I convinced the kitchen to
send me up a real ginger ale at lunch, and again at dinner.

After dinner Dr. Hissy Fits (aka Dr. Arkivitz) came in - he is the resident
who works with Liang - I saw him in ER and thought he was awfully cute - of
course I had the ultrasound thingie stuck up my...well never mind, but anyway,
he proceeded to yell at me for having anything to eat at all - I said LIANG,
his boss and my attending, said I could.  And then he bitched about it not
being diet and I said my BUN (or something like that in my blood) was low
according to Drexler, and he wanted me to get at least 150 grams of CHO to
keep me healthy. Arkivitz had his hissy fit and stormed out to see the nurse.
She came back in with D5% - I said what is this?  She said, per the resident,
to keep my sugar up.  I refused it, saying I don't care if he is the resident
God, (I really did say that one - pretty god, eh?) and she went out to tell
him. I could hear him scream at her in the hall - she said "I'm only relaying
the message"  He came back in, glowering, and said fine do whatever you want.
I really did try to explain to him the theory behind starvation ketosis and
how I needed to figure the CHOs in what I was eating, etc. but he was just too
full of himself.  He came in again about 1/2 an hour later and actually
apologized, and I told him I truly had the utmost confidence in his abilities
as my tummy docotrs stand-in, that as it related to the diverticulits, I was
happy to abide by anything he said without too much question, and that I
didn't really want to be difficult, but that the diabetes was mine alone, with
Dr. Drexler.  I didn't want him to hate me, but wanted him to understand he
did not know everything.  

I tell you all this with a bit of sarcasm and humor, but I really did not try
to be difficult and make it hard for them to care for me, I want to help, and
need to be involved, or they can count on me being difficult.

By the way, if you wake up one morning to find that they changed you in the
middle of the night, and you weren't aware, cuz you had begged for Demerol the
night before, you may wonder why your nice controlled blood sugars are so
outta whack.  This happened when I had my vitrectomy back in 94!

So So So,  did fine on the liquids -never even got close to that ordered 1800
calorie diet - including IV, I had maybe 500 calories on both Monday and
Tuesd.  Started real food on Wednesday - piece of bread, juice, cheerios, no
milk - that was fine, lunch was turkey on bread, diet jello, diet pudding,
mashed potatos, and was released about 5pm.

Instructions - eat low fiber for the nxt 4-6 weeks - no nuts, seeds or skins
(ie apple skin, potato skin).  No whole wheat bread or cereals, no chunky
monkey.

It was all over the hospital that i was there and teams of residents and
student nurses would come up and have me show them how to work it, how I
figure carbs, how the basals work.  In fact I had one student nurse with me
for like 4 hours, and then he had to go teach everyone else what he had
learned - he was all excited cuz no one else had gotten towork with it but
him...I shoulda chared them all $100 per lesson!

WELL  are ya still reading?  Congrats, but thanks for listening.  Next chapter
will be about some real weinies with Type II diabetes that I met a BUNCH of
this past week - oh and then there is the story about my lesbian Jewish
roommate and her black lover - that really threw the nurses for a loop!!!

Thanks again to all who have sent their good wishes.  You guys are all great -
even Buddy!

Love Sara