Wednesday, August 24, 2011

Braeden is OK - Home from PICU

Several of you have heard that Braeden was hospitalized last night.  He is well and at home tonight following his discharge from the Step Down PICU at our hometown hospital.  Braeden was received at the ER last night after we discovered that he may have received a single, unprompted dose via pump of roughly 30 units of insulin, which is 3 to 4 times his daily dose. 


In one sense, insulin offsets carbohydrate in order to keep blood glucose levels normal.  Imagine a lop-sided seesaw with carbs on one side and insulin on the other.  Considering Braeden's specific insulin-to-carb ratio, it would have taken nearly 1000 grams of carbohydrate to balance the dose of insulin we suspect he received.

The ER staff worked very efficiently to stabilize Braeden.  His BG never dropped below 30, and he never lost consciousness.  The ER staff administered glucagon, D50 solution boluses and drip, and carb-rich foods.  Around 1:00 am, he was moved to the intensive care unit, where he finally got some rest.  He continued to receive an 80 mL/hr D50 drip through the night (a meal's worth of carb/sugar each hour!).  Signaling a return to normalcy, the use of insulin therapy was finally resumed this morning, roughly 12 hours after Braeden entered the ER.

Friends (whom we so deeply love and appreciate) sprang into action to help.  Thank you, friends, for staying with Adam and Jill all night so that we could both be at hospital with Braeden.  Braeden's pediatrician was a saint, making calls ahead of Braeden's arrival at the ER to prepare the doctor and hasten treatment.  Each person involved remained so positive and did exactly what needed to be done.

We will spend the coming days working with the pump supplier to determine what may have happened to cause this overdose.  We need to do everything we can to ensure this never happens to anyone again.  The pediatrician made it clear that, if Braeden had not received such good care promptly, this would have been fatal for Braeden.

Tuesday, August 16, 2011

A Dog and Her Boy

Allow me to introduce you to someone very special. Her name is Jill. And, she really gets diabetes. You might see her around, and if you do you'll be sure to recognize her.  That's because Jill is a German Shepherd! 

Jill is Braeden's service dog, and she is usually the first to know when Braeden's sugar is going high or low.  It is pretty well accepted that dogs like her rely on scent to detect highs.  More of a mystery is why Jill can pick up early on lows.  When Jill does detect a high or low blood glucose, she alerts Jessica or me, often enabling us to treat Braeden before his sugar swings wildly outside of his control range.  Since the time she came into the family in April, Jill has helped Braeden avoid many blood glucose extremes.

Jill came to us from a guide dog company after being diagnosed with hip dysplasia, which can sideline a dog with pain and arthritis.  While the potential for mobility problems prevents her from becoming a full-on guide dog, she has a suitable temperament and work ethic that makes her perfect for other types of service.  Aware of Braeden's need, the guide dog company contacted us as soon as it was evident Jill couldn't continue in their program.  A few days later, she was part of the family.  But that's not the whole story...

29 September 2010 - near Sarasota, FL

September lasts forever in central Florida, and it is still summertime-hot even as leaves begin to turn elsewhere.  Today it will reach 90.  Brief rains from yesterday have stained everything with dampness.  The vacant lots among the average homes host stalky grasses and prickly weeds.  Spared the mower for months, the small patches--now suburban prairies--sport their 5 o'clock shadows. 

In one of these lots along 30 Avenue East, a stressed and anxious stray dog ponders her next steps.  If she could only know what her future holds, she might not worry so.  But now, hungry and homeless, she can think of little more than avoiding trouble and finding something to eat.  Whether abandoned, a runaway, or abused and forgotten, she cowers alone against the crushing world around her.  Everything outside the bounds of this lot seems ready to write her demise, whether car, human, or animal. 

At least, that's how I imagine it may have seemed.

Someone wary of the wandering German Shepherd called animal control, and before sundown, the gaunt and exhausted dog was noosed, loaded into a truck, and transported to the pound.

A short while later, The Manatee County Public Service Department, Animal Services Division, keyed an entry into the computer database and formally kicked off Jill's paper trail.  The kennel record says, "Intake Type: Stray/Field."  Days before her Due Out date arrived, Jill was adopted by a puppy raiser named Pat. 

An elderly lady, Pat canvassed kennels looking for certain unique qualities in those breeds that are most suitable for blind dog and vet dog service, especially German Shepherds.  She had adopted many young dogs and given them basic obedience and socialization training.  When these puppies matured a degree or two and continued to show promise, they were transferred to the guide dog company for serious program work. 

Jill no doubt felt love and thrived in Pat's home.  Pat fostered a deep connection with young dogs that made her so effective as a puppy raiser.  As the bond between the two strengthened, Jill intently observed Pat wrestling one of those things in this world that would not submit to Pat's will: Type 2 Diabetes.  Jill came to realize that the snacks, the test kit, and frequent bathroom visits weren't the only indication that Pat was plagued by an invisible demon.  Within the fibre of her being, Jill could vividly sense when Pat was loosing a battle. 

I think the recognition of Jill's intuition occurred the day she left Pat's side at the front porch and jumped the fence.  Jill had never done this before. She never did it again.  On this day, she roamed between the fence and the neighbor's house, raising the attention of the neighbor.  Recognizing the dog as one of Pat's puppies, the neighbor returned Jill inside the fence and found Pat languishing in the midst of a severe hypo.  Pat's condition was such that an ambulance was summoned. 

As a boy, I hunted grouse in the NC mountains with my dad over his Brittany Spaniel.  I could visualize the birds' scent by watching Blaze work among the wild grapes and scrub.  To him, the perfume of the feathers must have seemed as a thick fog, as he easily followed it left and right.  Smell is one thing.  Most dogs have it.  Intuition is quite another.  I marvel at the thing that made Jill choose to find the neighbor.  This is something she has repeated a hundred times in our own home, and still the marvel lingers. 

Tonight, Jill left Braeden's side in the bedroom and alerted to me as I sat on the back porch.  I immediately went to Braeden.  His CGM indicated his blood glucose was 94 (perfect).  He didn't exhibit the first sign of a high or low sugar.  But a quick check with a conventional glucometer told the story: 34 mg/dL. 

Now I sit reviewing the paperwork in Jill's file.  I just want to get the story correct as I pen this entry.  And, I can't help but look at Manatee County Kennel Card once again.  Then my eyes find it, the address where Jill was picked up by the dog catcher: "Found @: 2123 E 30 AVE, BRADENTON, FL."

There you have it.  From Bradenton to Braeden.  God's pretty cool, don't you think?

Hey there!