Hypokalemia and The Pitt

Two Thursdays ago, The Pitt, season 2, episode 3 aired. I didn't get a chance to watch it until Friday night.

ICU life with HypoKPP

Now, let me say, I love The Pitt. I love the format in which each episode is one hour of a fifteen hour shift. I loved E.R. back in the day as well. Both shows are insanely medically accurate, which is a pleasure to watch. And, funnily enough, both shows have had a patient with hypokalemic periodic paralysis. I'm always thrilled when Digger's disease is named, because it brings attention to his (mostly) invisible disease. When I first saw the episode, I texted Digger that he was going to love it when had a chance to watch it. (For a refresher on Digger's disease, click here and here.)

He did not love it, and with good reason. He said, "look, my disease is already a zebra, they didn't need to paint more stripes."

As his mom, I was just happy to have his disease mentioned, as it's rare (1 in 100,000). I've spent my time educating medical professionals about the disease, and I love to see it mentioned in an arena in which I know other medical professionals are watching.

When I asked him to explain why he hated it so much, he had some well-developed thoughts.

• In the episode, as they're going over the results, they said the patient had a potassium level of 1.2. Digger's lowest ever was 1.6 and they were planning intubation. The lab techs actually visited him in his ICU room, because they couldn't believe that he was awake and talking with a K+ level that low. His body is well accustomed to low potassium level; someone who has never had an attack would be dead with a K+ level of 1.2. Digger did a little bit of digging, and there is a woman with the disease who has survived a K+ level of 0.9.
• The two times his disease has been mentioned (ER and The Pitt), it's always a "drop attack", where the attack came out of nowhere. Those are so exceedingly rare that they're practically non-existent. In our experience (and that of Digger's entire paternal family), attacks are brought on by stress, sleep, hormone disturbances, food choices, etc. Hormones play a huge part in frequency of attacks, so most attacks begin in adolescence, then subside throughout the mid-twenties and thirties, only to come back again with a vengeance in the mid-forties.
• It's been a few years since I checked for any new/updated information on the disease and I was interested to see that there is a thyrotoxic form that effects primarily Asian males. I believe that's what the writers were aiming for, but they blew it. Let me explain: in the episode, as they were talking about the patient, they mentioned it was hereditary. Digger's biggest beef with this, is that unless the patient was adopted, someone in his family had to have had the disease and they would have been aware of it. The doctors go on to mention the thyrotoxic component of the disease. What it feels like to me is that the writers skimmed the overview of the disease, saw 'hereditary' and 'thyrotoxic' and mushed them together. Thyrotoxic hypoKPP and hereditary hypoKPP are two different things. Is the outcome of paralysis the same? Yes, but the etiology is quite different.

After speaking with Digger, I completely understand his frustration. He was very clear, and correct, when he said they treated his disease, which has greatly impacted his life, as a prop, and failed to bring factual representation of it.

I get it, and he's right. Just because the disease was mentioned, does not mean it was represented appropriately, and did not bring awareness to it.

I watched last week's episode, hoping to see a resolution for the patient, but that hour of the shift did not deal with it.

Bonsai Bar with Nebalee

I've probably talked about it before, but I prefer to give experiences as gifts rather than things. So for Christmas, I gifted Nebalee a sister date at a bonsai bar event. It looked like something she and her green thumb would really enjoy, and any time I can force sister-time, I'll do it. We don't get to spend nearly enough time together anymore.

The event was held at a brewery located between our two houses, so it was perfect. They provided everything we needed, and had 'extras' for sale. When we first got there, we were told to pick a tree that spoke to us. Now, a couple of years ago, I would have laughed at that, but now that I'm attempting to be a gardener, I listened and one chose me. 

We used dwarf jades for our bonsai.

The next step was to name it. Huh. Most of my plants have names, but the little tree hadn't given up his name yet. I told Nebalee that he would tell me eventually. Also, odd that the tree is a he, since most of my plants are female, so I guess he was talking to me a little bit.

Getting ready to dig in.

He didn't want to come out of the pot, but when he did, he reminded me of a Mandrake from Harry Potter. Minus the screaming, thankfully.

I imagine this is how we both looked once
I wrested the tree from his pot.

Everyone, meet Mandrake, Drake for short.

The hardest part, for me, of the whole endeavor was scraping away the dirt and loosening the roots. I'm always afraid I'll hurt the roots and kill the whole plant. Once we'd freed the roots, it was time to put them in their pots.

Again, we had to make decisions. Turning the plant this way and that, we had to decide which was the front, then decide how we wanted it in the pot: straight up and down, or at an angle? So many decisions.

I wanted Drake to be at a sharp angle.

Drake did not, so this is our compromise.

Nebalee's tree, Jasper, liked the angle.

This is a bad picture, but Jasper has a much
more dramatic angle than Drake.

If I thought just repotting was hard, and had a lot of decisions to make, I was in for an awakening! The first prune was easy: trim the leaves a quarter of an inch from the trunk of the tree so we could see the 'bones' of the tree. Then, the decisions got progressively harder: choose one of two opposing limbs to cut off, then start thinning the crown and determining a shape for your tree. 

Fully planted, packed in diatomaceous earth,
ready to begin pruning.

Opposite branches pruned, ready to start the crown.

Once the crown was thinned to our liking,
it was time to shape the tree with wires.

Done. Drake on the left, Jasper on the right,
extra cuttings in the back.

I'm not in love with Drake's shape right now, and would have loved to add more swooshes to his branches, but I'm afraid of hurting him. Once he grows a bit more, I can adjust the wires to give him more shape.

We gathered up some of the cuttings to take home to try to plant some 'mame' (mini bonsai). Of course, the instructors were willing to sell us cute little mame containers for once they rooted, along with the drip trays for underneath our pots, and some special fertilizer. Nebalee took the cuttings home, and she'll be in charge of getting the mame started.

I was worried about where I'd keep Drake, especially when I heard the care instructions. I don't have a lot of sun windows in my house. I initially thought he'd be great in Maggie, but it turns out that she's not quite right for him. Maybe this summer he can go live in there, but even with all of the insulation, she'll still get a bit too cold for him in the winter. I ended up moving my Puerto Rican oregano from my bedroom plant shelf into the kitchen and put Drake in its place, next to my failing succulents.

I wasn't sure how well he'd like it, but the other day, when I was watering him, I saw new growth!

Now, of course, the question is, so I let him keep his new buds, or snip them and force him to continue to establish his roots. Okay, that's not much of a question, because I know the answer, but I'm loathe to clip those cute little buds. I'll give them until his next watering before they get sacrificed for the greater good.

I Get Angry, Sometimes

When I'm scrolling through my FB memories and I see something pop up about having to go workout, or starting a new diet, or trying to eat healthier, I get angry. I've been fighting my weight since my early 30s. I know there are people who have been fighting their weight their entire lives, and I'm thankful I'm not one of them. But I still get angry at how pervasive diet culture is. 

Jay and I went to an indoor garage sale last week, and we found these pamphlets from the late 1950s. No wonder so many people have disordered eating, this bullshit has been ingrained in our society for 75 years!

I finally was able to lose about 45# with noom, but between Mom and Bill's accident and fucking menopause, I gained 35# back. I learned a ton from noom, and believe that I've broken the diet culture mentality for myself. I no longer restrict myself, I eat what I want in moderation, I've lost my all-or-nothing thinking, and thought distortions are a thing of the past. Yes, I continued to count calories in my noom app, and was averaging between 1,300-1,400 a day. So how the hell did I gain back so much weight? My body betrayed me, that's how. I felt like crap, and couldn't even play circus without extreme frustration. 

I finally broke down and begged my doctor to start me on a GLP-1. I was on it six months before my insurance ran out, and lost 18#. I had some side effects, that's for sure. Pooping? Nah, fam, my colon will just hold onto that forever now. No appetite? Easy to lose weight when the thought of food makes you nauseated. Accidentally eat too much? Kill me now. I learned to work with it, and was fairly successful, losing half of what I'd gained back.

I'd heard about microdosing GLP-1s here and there, and when talking to a friend, she mentioned that she's still on noom and that they offer GLP-1s. Back to noom I went, and began microdosing. The weight loss is much, much slower, but the educational component of noom is what I love. Unlike what happens with a lot of people who are just prescribed a GLP-1 for weight loss and accept that they'll have to live with the side effects (like I did), the daily lessons help solidify the changes I've already made. I anticipate being able to transition off of the meds in the next few months. Time will tell whether or not my body will continue to betray me, but I'm hopeful. 

And, I feel pretty damn good that I've stepped away from all of the diet culture negativity: restriction, all-or-nothing thinking, etc. I'm taking the meds to lose the weight, because I was feeling like crap and unable to live the way I wanted to, once I gained the weight back.

How I feel inside is beginning to align with how I look outside, and that's been my big picture since I started noom in 2020.

Also, this is not an advertisement. It's just my experience. 

And Then, the Wind Came

I was so excited to have the Magical Potting Shed done enough to start decorating, and playing in. And then, we had a "wind event". Wind isn't new to our area, we get our share. Sustained, high winds, though, that's out of the norm. The wind was a sustained 25-35 mph, with gusts double that.

We live north of Greeley, out on the plains.
I'm fairly certain that our gusts were stronger.

Unfortunately, I did have to leave the house on Friday (dang it!). I really didn't want to, because it was so gross out, but I had a private lesson to teach and money overrides my displeasure over wind. When I pulled into the driveway, I was dismayed to see part of Maggie's roof flapping in the wind.

I took video, but for some reason can't get it to upload. I wasn't going to mess with the metal panels while the wind was whipping, and decided I'd deal with it once everything calmed down.

Mom came over on Sunday, which was still kind of cold and breezy. I had no desire to go look at the destruction of the roof, so I told her, "as long as it doesn't snow Maggie will be fine until tomorrow, when it's supposed to warm up." 

That seemed like a safe thing to say, since we haven't had any snow since December 20, and that was a joke. It barely counted as snow. Prior to that, our last snow was December 3. So what if my weather app was calling for snow? Weather apps are always wrong, and we've been unbelievably dry.

I woke up to this ...

It would figure that the one time I'm counting on the weather app to be wrong, it got it right. Well, a broken clock is right twice a day, as they say.

Luckily, it was just a dusting, and by the time Mom came over to help with the roof, the sun was out and most of the snow had melted. We bundled up and headed out. I thought it was going to take both of us to wrestle the panels back to where they belong.

I climbed up onto the potting bench, lifted the tin panel, and the poly one slid right back into place. It is cracked a bit, but the crack is well under the tin panel. It took a whopping two seconds to fix. I should have done it on Sunday.

I thought I had anchored the panels to the cross beam, but obviously hadn't. When I took the time to think about it, I realized that I'd placed it on my "to-do" list and forgotten about it. When we first placed the panels, the metal ones had such a huge overhang that we couldn't reach the cross beam until they got trimmed down. When Chief did trim the panels down, I plain forgot about climbing back up there to secure them.

With the cold and snow still being on the roof, I again chose not to drag the ladder out to fight with securing the panel to the cross beam, and suspect I might regret it in the future. My plan was to do it this weekend, but we've got some really cold temps coming. After all of this unseasonably warm weather this winter, now it gets too cold to work outside.

Maggie's Complete (ish)

I finally threw in the towel and admitted to myself that I was never going to get around to putting in Maggie's insulation and putting up the walls, so I hired Autobot and her S.O. to finish it up. They finished placing the insulation and covered it with OSB. Not the prettiest of wall choices, I'll admit, but cheap.

Since Maggie is supposed to also double as a guest room on occasion, it'll be much nicer now that she's insulated. There's just enough room for a twin-sized blow up, or a camping cot in there, so I'm looking forward to sleep overs with Mav when he's old enough to want to spend the night with Lola. When we start our seeds this spring, a little oil heater plugged in at night should keep the seedlings nice and warm.

Mom came down this past Sunday and helped me paint and organize. It definitely is more fun to "play house" with someone else. When she was sweeping out all of the dirt and sawdust, I told her that it felt like we were playing Boxcar Children.

There is an art to sweeping, and Mom
has mastered it.* The floor was clean enough
to eat from when she was done.

It took us a good couple of hours to finish painting and organizing, but it was fun. Now all that's left is the fun decorating-type stuff.

My Amanda gave me my little gnome, and my
young friend built him a house. When 
Autobot and Co. were putting up the walls, I
asked them to cut his house into the walls.

Yes, I know the tines should face inward for the
Gremlin's garden tools, but they don't fit the hooks
that way, plus access is currently blocked by the chalkboard.

The candelabra will go up on a shelf, once I get one built.
The antique recipe box on the right stores all of our seeds.
We built the potting shed around that amazing cabinet that
is now our potting bench.

Various planting/maintenance implements on the
little cart. Yes, that's a vase full of bones from the yard.

While I love the small bit of light let in by the 'skylights', I'll likely end up insulating the ceiling, in which case, they'll be covered up. Maybe. Autobot and Co. might be able to frame it somehow so that I still get a tiny bit of light.

Everything else that needs done really is the fun decorating stuff. I've asked Jay to paint a 'home' around the gnome's opening. My SIL, Mrs. Deejo, made me a really fun mirror that needs framed and hung, L.E. gifted me the perfect framed puzzle for Maggie, and there are just a ton of other small little things I want to do.

I'm so thrilled that I was able to get Maggie built, and she truly lives up to her Magical Potting Shed name.

*I have a very similar picture of Mom sweeping out the shop when Bill ran the electric to it. 

Plea Deal

 

Beel and Ranger Danger

I've been dragging my feet on posting about the plea deal that Daniel Graska (a/k/a Sincere DeValencia) was offered and accepted. The virtual pre-trial hearing, when he was offered the deal, was on January 5th at 10:00 a.m. (1,141 days (3.13 years) since the accident).

We'd been joining in on all of the court proceedings via Webex since the whole thing started. The link to join had never changed, so at our prescribed time, we attempted to log in. Mom, from the Lodge; me from work. The Webex link that we've been using since the very first court date didn't work. We were texting back and forth frantically, and I finally went to the Utah state courts website and searched for the case that way. I was able to get in about four minutes late, but my audio wouldn't work. My coworker tried helping me to get my speaker to start working, but nothing happened. I could see that, for once, our case was first up and already underway, but I couldn't hear what was going on. I tried the "call me in" option for audio, only for my spam filter to block it without any way for me to recover the number. I watched, horrified, as that awful man answered the judge. I'm a terrible lip reader, so I started clicking around, looking for the closed captioning, and finally found the automated transcript.

Everything happened so quickly, that by the time I found the transcript and started taking screen shots so that Mom could see what was going on, it was over without representation from our family. 

Apparently, the courts used a different log-in for this court date, and no one had bothered to let us know. I was beyond livid. This was just one more way the Utah court system had failed us, and I wasn't shy about letting our victim's advocate know how I felt about it.

For a refresher on the original charges, go here.

They dropped the charge for almost killing Mom completely, and offered him this:

• Automobile Homicide. 3rd degree Felony; 0-5 years Utah State Penitentiary; $5,000 fine, plus 90% surcharge.
• Metabolite DUI. Class B Misdemeanor; 6 months jail; $100 fine, plus 90% surcharge.

That's it. 

Bill's death is worth $5,100 in fines according to Utah state law. Mom's injuries were insignificant enough in the eyes of the law for that charge to be dropped. As I said in my last post, we have a legal system, not a justice system.

I will say that the judge has been consistently good, and has taken no shit from Mr. Graska or his attorney. We do have the opportunity to influence the judge to give Mr. Graska the maximum sentence via our victim impact statements.

My anger with the court system is not because of the prosecutor or the judge, who are working as well as they can being handcuffed by the laws. My anger is due to the fact that it took so long for the investigation to be finished (590 days (1.62 years)), and the charges to be filed (725 days (1.99 years)). Add in the fact that we were never given the link to the pre-trail hearing, and I'm less than pleased with the Utah Court system. By the time he's sentenced on March 16th, it will have taken 1,211 days (3.32 years) to close this case.

The sentencing will be in person, and we will be present. Then, it'll be as over as it can be, and we can continue to go about rebuilding our lives without Beel.

New Year, Still Waiting for Justice

It's been six months or so since I posted the update for the court stuff regarding the accident that almost killed Mom, and did kill Bill.

The County Attorney spoke with Mom again on Tuesday, and delivered a gut-punch. They're really pushing for a plea deal. Currently, they want to drop the 3rd degree felony charge (for Mom's injuries) and decrease the 2nd degree felony (for Bill's death) to a 3rd degree felony in exchange for a guaranteed conviction for DUI and felony homicide. The plea deal would put him in prison for only two years. So, we're to disregard that he nearly killed Mom, and give him a "oops, we know it was a mistake" pass on killing Bill?

Mom can still push for trial, but the attorney warned us that if even one juror wants to throw out the drug charge, everything drops to a misdemeanors and he'll probably not do any jail time.

I think Mom's going to talk to the attorney about a counter, but we don't know what that'll look like. She has until Friday to get back with the attorney, but it's ultimately his decision. Pretrial is set for Monday, January 5th, so we will either have a plea deal or be headed to trial the last week of January.