It's been a long time, Dr. Santos. I was doing some research on my sister's paranoid schizophrenia and suddenly remember this conversation. Then, I remembered that I never really finished it and felt I needed to tell you what happened. So, here goes.
When my aunt took a turn for the worse, it was because of the pneumonia. It was in both of her lower lobes. With the constant threat of renal failure, the doctors refused to put her on any antibiotics. The doctor came in the day after I wrote my last message to you in fact, and I had asked him about the antibiotics. He said that if he put her on antibiotics, then she'd surely die from renal failure.
I'm not a doctor, but I consider myself to be fairly intelligent. I knew what he said was likely, but I also knew the results of doing nothing. I talked to the family and told them to tell the doctor to put her on antibiotics anyway... So, when he came in they asked him about antibiotics and he told him he didn't recommend it, because it would likely kill her. Then her daughter and husband said, "Oh, ok..." As the doctor walked out, I was furious...
I sat there in disbelief for about 20 seconds before storming out of the room, grabbing the doctor, and discussing the issue in private. He said that one antibiotic couldn't be guaranteed to work on her pneumonia and would shut her kidneys down with the average dose/time. I thought about this for a moment and realized that if she was gonna die anyway, what was there to do but try something drastic.
I offered the doctor an idea... I told the doctor that if he gave her two different antibiotics (the strongest he could find) and gave her high dosage for a short time (2-3) days, then it would definitely shut down her kidneys, but they'd have a chance to "bounce back." And if they didn't, well the pneumonia pretty much guaranteed a 0% chance, so we had to try something. It was a tough 3 days... Everyday I was wondering if I had made the right call. No one in the family argued, because I think at that point they had finally given up hope... I noticed she stopped passing any fluids within hours of starting the antibiotics and over the 3 days her swelling got quite worse. But, her pneumonia did indeed go away.
Her kidney's were doing much better after another 3 days. With her sugar in check and everything looking good (good for her usual health, anyway) she was able to go back to the nursing home for therapy. After a few months, she requested to go home even though they wanted her to stay for dietary and physical therapy reasons. She came home and did relatively well. Altogether, she survived another 1 year and 2 months after our original conversation on this site took place. It wasn't the best of outcomes, but she got another year of life with her family and we all enjoyed that much.
The last day I saw her, she asked me to pray with her (even though I'm not a christian) so we prayed. Not about her or her health. She wanted to pray for her children, me, and the family in general. Make sure someone was looking out for us after she was gone. I left the hospital at 2 a.m. and got a phone call at 4 a.m. She had passed. It was okay. Tough, but okay.
I still don't know why I'm writing this, lol. I just felt like you deserved to hear the end of the story. Thanks again, Dr. Santos. :)
How are you? I'm sorry to hear about this news. It's been 5 days since your last post and I still would want to hear positive update. But it would really help if the underlying cause was known. It would have helped others who are also experiencing the same symptoms. Take care always.
Well, she took a turn for the worse... The doctor said that they're not gonna move her, because she has no chance of getting better. They're keeping her in our hospital and they put her in a room. We're trying to get all the family together, to see her before she passes away. The doctor said she's got 2, maybe 3 days. I guess that's check mate, then... Let me thank you again Dr. Santos, I really appreciate the effort.
It is good that your aunt is being referred to a better hospital. This may bring light to whatever is causing her condition. Her kidney's condition should be monitored and may indeed take a while to be controlled. Your aunt is very lucky to have you by her side. Just hold on and think positive always. I will be praying for your aunt's speedy recovery. Take care and best regards.
Thanks for all the help. When her doctor said, "We have no idea...," I knew that I'd have to try and get help determining what caused her glucose problems. You've honestly been extremely helpful. I did ask her doctor about her glucose dropping and he literally no idea of what could cause it. You've given me several possibilities, all of which I'll research and bring to her doctor's attention. I think that rest would be best before running too many more tests on her. They're moving her to a better hospital and hopefully that'll help, too. If and when she gets a little stronger, then we'll try to figure out what started all this. Thanks again Dr. Santos. And I'll let you know how everything goes, just keep this post on your watch list, because the doctors said if she does get better, it'll take a long time.
I'm really glad to be of help but I still recommend that you discuss with your aunt's doctors their management plan because they are in a better position to make decisions on your aunt's condition. Her medicines and laboratory test results are important considerations. I could only contribute differentials or theories because of the internet's limitations. It is good that her glucose levels have improved. The conditions of Whipple’s triad need to be met for the diagnosis of Insulinoma: symptoms and signs of hypoglycemia, concomitant plasma glucose level of 45 mg/dL or less, and reversibility of symptoms with administration of glucose. Whatever the cause of the fluctuations, the medicines given by her doctors may have helped in stabilizing her glucose. A CT scan or MRI may help determine if a tumor is present or not in her pancreas. At this point, it is best that you have close communication with her doctors. Take care and do keep us posted.
As far as we know, the renal failure didn't show up, until after she was in the hospital with the low blood glucose. Insulinomas is exactly what I was thinking, though I didn't know the word for it. I just did a lot of reading and used a little deductive reasoning. One question though... Her glucose levels have increased and, now, stabilized. If Insulinomas, or any of the other potential causes, are present, could her glucose levels have stabilized like they did? And, if so, are they likely to cause her glucose levels to drastically fall, again? Again, thanks for all the help. I'll stop bugging you after these last questions! We all appreciate the help that you're giving us. I've told the entire family that I'm communicating with you, and we're all anxious to hear what you have to say. Answer these last questions for me and I'll be hopefully be able to get with her doctors and make sure she gets the proper tests that she needs... Thanks!!!
I would like to clarify if the renal failure was present prior to the hypoglycemia episodes. Some illnesses that affect the liver, heart, or kidneys can cause hypoglycemia. In particular, sepsis and starvation are other causes of hypoglycemia. In these cases, treating the illness or other underlying cause will correct the hypoglycemia. Other differentials that I could think of are Insulinomas, which you have mentioned, and rarely hormonal deficiencies . Insulinomas are insulin-producing tumors in the pancreas. However, these tumors are also rare and do not normally spread to other parts of the body. Shortages of cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. Laboratory tests including hormone levels and can help determine the exact cause. Take care and all the best for your aunt.
Thanks for responding. She's still hanging on. The low glucose has been resolved, for now. But, what we're looking at is near complete renal failure. She is also developing pneumonia, which is making her labored breathing worse. Even though the low glucose is not a problem, anymore, I'm still wondering what would make her glucose be metabolized so quickly... I looked up countless conditions and didn't find a single thing that could account for it. If you have any idea why this could happen, please let me know. In the hopes that you may be able to pinpoint the cause, I'll give you what I know about her health. She's a borderline diabetic and she controls it with her diet. No pills or insulin. She hasn't had any major surgeries that I know of. There's nothing that runs in the family, besides diabetes. She's also obese, at nearly 400 pounds. As of right now, they're planning on moving her to a better-equipped hospital on Monday or Tuesday. The doctor said that she has a 50/50 chance of making it out of the hospital alive. That gives the rest of the family hope, but I know what 50/50 really means... If she can make it out of the hospital, and I know what caused her glucose problem, then we might be able to get her treatment for it, as the glucose is what nearly killed her in the first place. Thank you, Dr. Santos... If you have any ideas, please let me know and I'll discuss them with her doctor. And for anyone reading this... I'm not a christian myself, but she is a devout christian, so if you're a christian too, pray for her. She needs all the help she can get. Thanks again!
How is your aunt? I'm sorry to hear what she have been going through. Can you give some background or her medical history and her symptoms? Was she a diabetic or had a history of autoimmune disease? What tests were done? Hypoglycemia can be associated with taking too much insulin, critical organ failure (especially the kidney, heart, or liver), hormone deficiencies, tumors, inherited abnormalities and as a result of a previous surgery. I hope to hear from you soon. Take care and best regards.