Sunday, July 1, 2012

An "Aha!" Moment

Since Alex has been home from the hospital, one of the changes we’ve noticed is that he seems to have some loss of motor function, likely caused by the medications that are intended to keep his anxiety and aggression under control. He isn’t as sure on his feet, but more significant has been the effect upon his mouth. While Alex used to be an extremely neat eater, lately he seems to have trouble chewing and often lets food fall out of his mouth, leaving crumbs all over the table and on the floor. In addition, he has had difficulty for the first time taking pills, something he mastered at age five. This has created a new concern because he has nearly choked on his food a couple of times because swallowing appears more labored for him than previously.

Yesterday, we had a frightening experience that resolved itself quickly and led to a welcome “Aha!” moment. When Alex awakened yesterday, he was agitated, so Ed and I needed to stay with him every moment because his behavior was unpredictable. This meant that we even accompanied him to the bathroom because we didn’t trust him to be alone, even though he has toileted independently for years. After he finished, Ed and I happened to look in the toilet at Alex’s first morning urine and panicked at what we saw—instead of its usual yellow, his urine was quite dark, almost the color of iced tea. The fear in Ed’s face, I’m sure, mirrored my own, and I began to think of reasons why his urine would look abnormal.

At best, I suspected Alex might have a urinary tract infection that would cause the dark color, but I was more worried that he might be bleeding internally. This fear was intensified because Alex had two nosebleeds last week. The medications Alex is taking seem to make his skin dry, so we thought that they probably had made his nasal passages dry, as well, making them more likely to bleed. In addition, we had been giving him antihistamines for allergies, which probably intensified the dryness, so we stopped giving him those after he had the nosebleeds. Yesterday morning when Alex awakened, I had noticed that he had dried blood on his lips. At first, I thought his nose had bled some in the night, but closer inspection revealed that his nose hadn’t been bleeding; his mouth had been bleeding instead. This mouth bleeding, along with the dark urine, made us decide that we needed to take him to be checked to make sure nothing serious was wrong.

Wanting to avoid a trip to our local ER, we headed to a local urgent care facility affiliated with St. Anthony Hospital, where Alex had stayed this spring to get his medications adjusted. I figured that the urgent care would be faster and less traumatic; plus, they would be able to access his records from his hospitalization. Before we left, I grabbed a list of his medications and dosages along with our legal papers showing that Ed and I have medical power of attorney to make decisions regarding Alex’s health care, even though he is legally an adult.

When we arrived at the urgent care clinic, we were the only ones there, so I was able to talk to a nurse and doctor immediately. The doctor listened to my concerns and explained that she thought he would need to have lab work done, but they were not able to do lab work there. She told us that we would need to go to the ER instead, which was not what we wanted to do. As we were getting in the car, reluctantly headed to the ER, the doctor came running out to our car and suggested that we might want to go to their new ER facility in Chesterton, which may be faster than our local ER. Again, they would have Alex’s records, and since this ER was only a fifteen-minute trip away, we took her advice and headed to Chesterton Health and Emergency Center, affiliated with St. Anthony Hospital in Michigan City.

At the Emergency Center, the staff immediately greeted us since we were the only ones in the waiting room. As I filled out minimal paperwork because they were able to access Alex’s records, a friendly triage nurse took Alex and Ed back to an examination room where he took Alex’s vitals, which were normal. He then took us back to a very nice room in the ER with a private bathroom. The ER nurse sympathetically listened to our concerns and assured us that the doctor would see Alex soon. A few minutes later, the doctor examined Alex, showing great compassion for us, reassuring us that many people had come in with dark urine this week, probably because the intense heat was causing slight dehydration. As she examined his mouth, she noted that he had cheilitis, a yeast infection, in the corners of his mouth, as well as inflammation of his mouth, likely caused by the yeast. I had noticed the irritated spots on his mouth, but I thought he had a cold sore on one side and dry skin on the other, so I had been treating him with L-Lysine cream for the cold sore and Blistik for the dry skin.  She understood our concerns about infection and/or bleeding and ordered lab tests on his blood and urine.

Fortunately, Alex seemed to view this trip to the ER as fun and didn’t seem to be in any discomfort, so he was calm, pleasant, and cooperative with everyone who examined him. He didn’t even flinch when the lab technician took a blood sample, and he generously cooperated when he had to provide a urine sample. As we waited for test results, the nurses checked on us frequently to see if we needed anything and provided Alex with juice and applesauce while we waited. However, we didn’t have to wait long before the doctor came to tell us that all of Alex’s test results were normal—thankfully, no sign of bleeding nor infection, other than the yeast infection of his mouth. I explained that Alex has had yeast infections in the past and that he responds well to the antifungal drug Diflucan. She gave him a prescription for Diflucan to address his infection systemically along with a prescription for a topical antifungal cream to heal the rash around his mouth. We were thoroughly impressed with this ER. Not only were the facilities comfortable and new, but also every staff member was very kind and capable, especially in how they treated Alex. An added bonus was their efficiency, which meant he was seen, tested, evaluated, and treated within a short period of time without having to wait and worry needlessly.

Finding out that Alex had a yeast infection came as a relief because not only did it mean that he didn’t have a more serious condition, but also this diagnosis made complete sense, causing me to have that “Aha!” moment. Alex’s difficulty with eating and swallowing his pills were probably caused by the irritation in his mouth and lips. In addition, we had noticed that he sometimes seemed to have trouble swallowing, as though he had a sore throat. This, too, was likely caused by the yeast infection. He has been a little more agitated this week, which can be a sign of yeast overgrowth in people with autism, and I’m hoping that as his mouth heals, he’ll feel better and be less irritable. Ironically, a few days ago, Alex had told me totally out of the blue that he needed Diflucan. He hasn’t taken Diflucan in years, and we hadn’t talked about yeast, so this proclamation baffled me at the time. However, Dr. Alex had diagnosed himself; like his mother, reading those medical books comes in handy at times, I guess. Anyway, we were pleased to have such a good experience at the ER and get the medicine he needed. We’re hopeful that he will heal quickly so that he can feel better, which we hope will also address some the eating and agitation issues.  We’re also thankful that once again God led us to good people who could help Alex, reminding us that He will take care of our every need.

“Cast your cares upon the Lord and He will sustain you; He will never let the righteous be shaken. “ Psalm 55:22


K. C. said...

I hope the medication is helping. It sounds like a good experience in Chesterton for you all! Good to know!

Pam Byrne said...

Thanks, K.C.! He's gradually getting better with the medicine. I'm just thankful that our ER experience was such a good one, and we had a doctor who diagnosed him quickly and accurately.
Take care,