On Not Dying

Regarding the Hospital Visit of 12-2-08 This may not seem an entirely reasonable place to start, but I’m pretty sure my brain has re-entered a fairly normal (what ever that is) range of function, so please just stay with me here, it’ll all make sense shortly. Question: Does Fresca (the soft drink) taste like Grapefruit? I really would like to hear responses on this one. To me Fresca just tastes like Fresca in the same way, TAB, the other diet drink so many of our mothers drank, only tastes like TAB. Fresca is citrus fruitish, sure, but in a red dye #2 New Jersey chemical plant sort of way, or so I assumed. By now I’m assuming you are wondering, and quite reasonably, what the hell grapefruit has to do with it. Well, if you were to google the words “medication” and “grapefruit” you will find a large body of research on a chemical called furanocoumarin which interacts with a specific enzyme in the intestines to cause trouble, (it’s always an enzyme isn’t it?) I’ll let the Harvard Family Health Guide give you the short version of the technical specifics for all my neuro-chemically savvy friends like Jeni. “Grapefruit’s culprit chemical does not interact directly with your pills. Instead, it binds to an enzyme in your intestinal tract known as CYP3A4, which reduces the absorption of certain medications. When grapefruit juice blocks the enzyme, it’s easier for the medication to pass from your gut to your bloodstream. Blood levels will rise faster and higher than normal, and in some cases the abnormally high levels can be dangerous.” And, in the case of my particular medication, dilantin, make you crazy, blind, lame, panicky and shit scared and that’s before it goes for the lethal stuff like you heart and breathing. My particular adventure began at some point fairly recently when, for whatever reason, I started drinking Fresca, which I discovered yesterday has a good deal of real grapefruit juice in it. It’s worth noting that I take an unusually large dose of dilantin because I happen to metabolize the stuff quickly and it takes a lot to get me to a therapeutic dose which is somewhere between 16 and 21 somethings (unit of measure for blood level.) So this explains the suddenness and intensity of the symptoms I’ve been experiencing, culminating in yeasterday’s whopper. I’ve felt pretty weird at times over the last few weeks, but when you already have some spooky neurological shit going on it makes it difficult to know when to sound the alarm. There are many things that happen in one’s mind when this sort of thing happens to you. Past a certain point, of course, I thought maybe I should talk to my neurologist. I didn’t have an appointment until January and I called and requested an earlier appointment if one opened up, though it took me awhile to do this. I think this is because, in the back of one's mind there is resistance to this because, well, you already know something is very wrong and you just don’t want the bad news legitimated. (Incidentally Dr. Greg Lipschutz, is a wonderful doc, and I have had some real shit-bird neurologists. And his nurse Ellie, is great too and plays a vital role in my not deadness, which I will explain shortly.) I feel like a bit of an ass for allowing this feeling of dread to influence my decisions: friends please, if you can’t keep your balance and are seeing double a good deal of the time, find a buddy and have them drive you to the Emergency room now, not in two weeks when you are staggering and careening off parking meters on Bay State Rd. and basically taking leave of your senses. I know Deb knew something was up and I told her a bit about it, but went to fairly great lengths to hide it. This too: she trusts me not to be a fucking idiot. However, on the other hand, you don’t want the person you love to have to worry about mysterious symptoms that keep inexplicably disappearing and seeming to have gone away altogether. The long and the short of it is I thought I was toast. Then I thought I was just being paranoid. Rinse. Lather. Repeat. Repeat. Repeat. Every second Tuesday Deb and I drive in to town. Fortunately, yesterday was a second Tuesday. When I got out of the truck I was having incredible difficulty keeping my feet and my visual field was pitching enough to cause fairly significant sea sickness. It was an order of magnitude worse than anything previous, I could not have walked without Deb’s assistance (she’s strong, it’s hot) When we got to Deb’s office, I called Dr. Greg and he wasn’t in, but the receptionist got ahold of him and he called me back fairly quickly. The possibility of medication toxicity hadn’t even occurred to me, I just thought I was dying or had MS or something. Toxicity was his first guess and he had me come to Cambridge Hospital to have my blood taken. Now at this point I’m doing a bit better and I can walk without assistance so I feel a little less nervous. So Deb takes me in and I get the blood drawn and we are ready to go, but Deb has he presence of mind to wonder aloud, "is there anything we should do?” Though I was operating on impulse power it occurred to me that Dr. Greg’s assistant Ellie might be able to help, and the office is in the building a few floors up. Now, Ellie, is one of those people I like more or less immediately and we get on fairly well. She’s efficient but not overly nurse like, and pays attention to the human details. I thought she would probably take the time to give us a bit more to go on while we waited for the test results. She took a look at me and instantly registered that the situation might be a bit more extreme than anyone thought. It turns out the Deb’s intuition that we ought to get more information and Ellie’s intuition that something was serious made a very large difference. Ellie couldn’t do much but she put a stat on my blood work, it had been priority but she bumped it up. Deb and I got lunch and we went back to campus. She dropped me at the office and went to park the car, but before she could even get back I got the call from Dr. Greg. “Um, hi George, yeah we got your blood work and your dilantin level is at 48. So we’d like to get you in for an EKG.” You know it’s funny, there is that tone a doctor uses when he does not want to alarm you because alarming you could kill you, but he does want to get you hooked up to an EKG machine before your heart more or less explodes. Ok, 48 is so toxic it isn’t even on the chart and there was reason to believe it could still be climbing because I’d had my morning dose only a little while earlier. I had wondered why my heart was pounding, I thought it was just the overall intensity and stress of the day. I started taking very deep breaths and called Deb. She drove back to the office where her trusty second in command Becca had escorted me to Comm. Ave. so I could hop in and go. We got to the hospital, I was treated, I was able to lower my own heart rate and blood pressure myself so I didn’t have to take any unpleasant purgation drugs (shout out to Patanjali for passing that yoga practice my way.) I was observed for some time and sent home, Deb and I both fulla Joy. I’m not going to die. I’m not even damaged. Once again I’m grateful for the luck, and the family (chosen family and regular) in my life, you have no idea how I love you.

er, um, I will die eventually, of course, it just looks like my life expectancy has returned to normal.

Comments

[Gina]

My goodness! That insidious grapefruit juice! I'm glad to hear you're alright hun. I think it's human nature to just avoid going to the doctor. You think you're crazy, you think you're healthy and it will go away, you don't want to bother your doctor with it (not to mention fear of the unknown)...and then all of a sudden you're way sicker than you should have been.

Anyway, glad you're recovering swiftly. And HUGE kudos to Deb for her intuition and her strength. Hopefully I'll see you both on Friday.

xoxo
Get well soon!

[Debbie]

...and still fulla joy today. :-D

[Jennifer]

Holy cow, that's really scary. I'm so glad you decided something was wrong enough to look into and you're okay now!

[Michelle]

Oh George! What a terrible adventure. I knew Fresca was up to no good. I'm glad to hear that everything is figured out and that you're doing ok. Take it easy these next few days. I'll see you on Friday!!

[Jen]

And I thought Fresca was good! But clearly it is an Abomination unto Nuggin. I'm glad you took care of yourself (eventually *frown*) and that you had Help from Ellie the nurse! Hugs!

[Shellie]

Don't do that ever again.

[Vinnie]

Even though I heard you explain this at the party, I wanted to read the blog too (wine much!). Um, wow. Fresca bad. :-D I'm glad that you came through this!

[richbachelor]

Bee and I are sitting here wondering about the original question. I posited that Fresca tastes like Squirt + chemicals.

We too are glad you did not die.

[Georges De Skookumchuck]

What I failed to make clear in the post was that I knew grapefruit juice was something I should avoid but I didn't imagine that actual concentrated grapefruit juice was in the stuff (third ingredient.) Fortunately, a long time ago someone said Fresca tasted like Squirt, which I didn't really buy, but squrt with chemicals seems about right. Still, I didn't think there could actually be real juice. I checked a bottle of Fresca in the little convenience store at the Hospital when I was getting blood drawn before going to the emergency room. My neuro Doc. was totally surprised. He's now warning all his patients.

[disco boy]

i'll be honest: i didn't even know you could buy fresca in this country anymore. i thought that was only available in mexico and belize. and if memory serves, it tasted like squirt and crystal lite. i figured it was pulled off the shelves years ago by the FDA for having some diet diuretic in it, like olestra or dexatrim. i would have never guessed that it had measureable levels of real fruit juice.

i'm glad that you're back to normal, and didn't end up as the "ripped from the headlines" episode of the week on "house". IT'S NOT LUPUS! (i've never actully seen "house", i just hear that's a running joke...)

i hope all's well back east, i hope you have power and heat (both in your abode, and emotionally... why not?) and that your holidays are filled with starchy peaks and real cream butter. i'm glad you aren't dead!