Category: epilepsy medications

Medication and Hydration

(THEN and Now for Chapter 23: Toxic with a Timer)

Your body is set up as two fluid compartments. Molecules and ions move across the membranes between these two compartments by diffusion or active transport. Diffusion moves from a high concentration to a low concentration. This requires a solvent for the solutes, in this case medications.

That solvent is water. That magical, universal solvent that makes all life possible. To move medications takes water. Cells need to have water inside them and around them to work properly. Drinks like soft drinks (and alcohol) actually pull water out of the system because they are hypertonic. So not any fluid will do.

If you or your patient does not like to drink water, then splash in some juice for flavor and color(not red). You may require the patient to drink a glass of water before a glass of a favorite drink.

Think of water as a transport system like little rivers in your body taking substances back and forth to and from your blood vessels. These tiny waterways between cells are essential for movement. Solutions need dilution to get to a proper concentration level to move ions between the two fluid compartments.

Not enough water leaves good substances on the ships and bad substances on the loading docks. Water keeps it all moving in or out.

Medications require proper hydration to get where they need to go. Keep everything moving with water. You will feel better.

P.S. To avoid holiday ‘cotton mouth’, drink copious amounts of water after a binge. Keep a tall glass by your bed for that moment when you awake with a dry mouth and a headache. You may want to set two pills of some sort out with it.

Keep it moving!

FLOW

Nobody Argues with Paper

Write everything down. Take notes on envelopes and receipts. Keep all this in one place. Just date it and throw it in the box or drawer. That way these facts are not swirling around in your mind and cluttering your thinking. When you need some bit of information from your stash, get a notebook, paper and tape. Use them to organize the scraps. We use dividers to separate the years.

I cannot tell you how many times I started worrying about something in the middle of the night and had to go to “the drawer” to retrieve a forgotten piece of data before I could go back to sleep. All those pieces of paper saved Rose and resulted in our book.

We made a chart for each year and wrote down any event. We can glance at that one page and get a sense of how our lives were at that time. It is nice to put this away for safe-keeping instead of remembering it over and over.

A year in the life of our Rose.

When medications were being changed quickly, we made a different chart with drugs, days, seizures and side effects right there in black and white. We took these to appointments. Nobody argues with paper.

The chart from HELL. Mercy!!!!

I learned this trick as a teacher. I posted the rules on the wall of my classroom. When a rule was broken the student might try to argue. It was then I would simply walk to the poster and point to the broken rule and pause. The rules had been up since day one. No reasonable person would argue.

So the file drawer eventually became two full file cabinets. They are full of marked up seizure books we have read, articles we researched. All her records of every prescription by years are in one drawer. Twenty years went by in the blink of an eye, but it’s all there if I need it. Nobody argues with paper.

The notebooks.

Once when we were leaving the EMU, Rose was being sent home on dosages that were too low. The doctor in charge was abrupt and intimidating. I meekly showed him my records of Rose seizing on that low dosage. He looked and paused, but said nothing. Her dosages were not changed. We went home. She had a long, strong seizure on the couch while the neighbors were visiting. I called back to the EMU, the dosages were raised immediately. I guess he did not want to be wrong until he was proved wrong. Nobody argues with paper.

Mama FLOW

Drugs can be Poison

Then and Now for Chapter 20: Drug Changes Change Rose

This period of time will always come back vividly due to the fear I felt every minute of every day. “Things fell apart. Months were a blur.” this chapter says. We were panicked by Rose’s decline. All we had were strong seizures and horrible side effects. I did not want to take my eyes off of her, but I was cracking up inside. Something had to give.

I have had to ask myself some hard questions about this stretch of Rose’s epilepsy. Why did we go along for so long? I am trying to be honest and careful here because I know some of you may be going through similar experiences.

When do you bail water or bail out? I think we bailed water too long here. Why? Ignorance and insecurity. We did not know what to do to help Rose, so we did what the doctor told us. A few hand slaps from a doctor makes one hesitant to argue. I was trying to study drugs and other treatments that I could barely understand. I had to trust somebody else to know what to do. But the doctor did not see Rose lying on the couch all day, listless and pail. She did have to support her as she walked. She did not hear her voice flatten and her eyes flutter.

If you are this scared of the drugs or the doctor, bail out.

GET A SECOND OPINION.

Tell them Flower sent you.

I cringe when I remember this period. If we had continued on this path, I am not sure that the Rose we have today would even exist now.

Love,

Flower

First Drug Down: Then and Now

Finding the right medication or combination of medications takes a lot of experimentation. We experimented for over twenty years. The drug that works for Rose had not been invented yet when we started.

You must be your child’s data collector. The doctor’s may keep records of the drug dosages, but you see the effects of those drugs. This is too important to leave to memory alone. Keep good records of mood changes, appetite changes, sleep issues and learning issues, as well as side effects and seizures.

This first chart is titration instructions given by her neurologist. This was helpful in filling Rose’s pill organizer. I could mark each day off as I filled the boxes.

This second photo is a chart we made of all the dosages tried and the results of each combination. As you can see, there were many changes. The side effects and seizures continued no matter the levels. This chart helped convince the doctor that this was not the drug for Rose. Keeping thorough records will prevent retrying combinations, especially if you switch neurologists at some point.

The last chart is a ‘Year on a Page’ that has all medical events for that time period. One of these is at the front of each year’s section in a series of notebooks we have on Rose’s treatments. I can glance at this page and then look through that section to locate specific events as needed.

PLEASE keep all your records together. You can sort them when the struggles diminish, but at least they will all be where you can find them when you need them. We kept everything in a cluttered file drawer. It is still a mess, but everything is in there…somewhere.

I am so glad we did this. I firmly believe our records helped get Rose to the right drugs. Only you can see the whole picture; medication dosages, side effects and seizures. Keep track of it all. It will make a difference.

Seized on an Island will be posted on Saturday, May 29, 2021

Handling the Hyper-emotional Events

Whenever something bad happens, we dread how Rose will respond.

We wonder whether she will explode or implode.

There is no moderate middle ground emotionally.

Rose has to be made aware of sad events slowly and gently.

It’s like we must postpone our own sorrow and grief to navigate hers.

I am not sure why this is.

I know hyper-emotional reactions is part of TLE(temporal lobe epilepsy), but we never found her seizure source.

Is it her medications? The proneness toward depression? The smallness of her world making everything bigger?

I do not know the cause.

I only know that a big wave is coming.

I hope I can save my Rose and myself.

Mercy!

Flower

 

 

 

 

A New Neurologist

Story 26 (September 2002)

After the toxicity scare, we no longer had confidence in neurologist #1. The doctor’s responses to our questions seemed short and unfocused. The drug and dose changes that she recommended seemed random. Our chart of drug changes was full of changes in dosages and seizures.
We asked for a second opinion. This first neurologist sent a letter of introduction for Rose to another neurologist in a different city. The letter described Rose’s condition and drug trials and requested a second look at Rose’s possible treatments for the future. I bet neurologist #1 was happy to pass hot-potato Rose off for some re-enforcements. I appreciated that a second specialist was going to have input into Rose’s care.
Our first visit with neurologist #2 took hours. He was very thorough and reassuring. He wanted to nail down the type and source of these seizures. He felt that Rose had been prescribed too many drugs on too small doses to rule them out as an effective treatment. He wanted Rose in an Epilepsy Monitoring Unit(EMU) to get a video-EEG. He said he felt we had been yawing around the pond of treatment choices.
This was a relief for us. We felt the same way. I was like Rose had been part of a badly designed experiment with too many variables. We were now going to get some hard data we could use to get better results. We finally felt hopeful.
We felt like this doctor heard what we were saying and understood what we were feeling. We didn’t just want to try something new. We wanted what we did next to be the right choice, not just a random change. We needed all the cards to be put on the table. It was time. Rose needed to learn and grow, not fall and fail.

Seizure Mama speaks to parents:

No one doctor knows everything. Each has his/her own training and experiences. It is always good to get a second opinion. Do not be afraid to ask for one. It may be just what you need to get a better result. Your current, struggling physician may appreciate your nicely worded, respectful request.
Do not, however, bounce from one specialist to the next in hopes of finding a quick fix. Patience is needed when trying out drugs and doctors. Do not secretly sneak around because each physician needs to see all your child’s records to make informed decisions and avoid repeating failed treatments.
I would also advise getting a second opinion for any surgical procedure. Even though installing a VNS(vagus nerve stimulator) may be a simple procedure, the device is permanent. You are making decisions for your child. Do it carefully and wisely. Get as much input as is reasonable.

Toxic with a Timer

Story # 23 (August 2002)

Rose’s latest drug combination became a recipe for disaster. Now she was constantly dizzy and nauseated. She was limp and barely moving or responding. She was silent. She was being poisoned.
We put her on the couch so we could all keep an eye on her. At this time, she was on three drugs,one of which was an extended release form. One drug must have amplified the affects of the other two. Her nausea and vomiting soon turned to dry heaves and bile. Her seizures were clustering. We knew she was in danger.
We called the on-call neurologist at about 11PM. The doctor’s foreign accent made our conversation difficult. My husband and I were both on the line listening. We thought the doctor said to use the emergency drug if Rose had another seizure and then take her to the Emergency Room if she had another seizure after that. Was that really what the doctor said? Two more seizures and then the ER?
The next morning Rose was very pale, weak and, listless. She barely moved. We tried desperately to get her to eat and drink each time she woke up. She was fading before our eyes. I called the doctor’s office as soon as it opened to report Rose’s condition. I cried as I explained that she seemed poisoned by these three anti-convulsant drugs.
The wise nurse calmly told us to get a timer. She said to set it for twenty minutes. Every time it went off, we were to wake Rose up and make her sit up, and sip some water. We set and re-set the timer all day long. For hours we watched her and waited for the timer’s bell to ring, over and over.
Hours later she began to improve. The poison was being diluted. Rose was re-hydrating. The color came back in her face. She was safe. No trip to the Emergency Room required.

Seizure Mama speaks to parents:

We kept gel in the refrigerator to put on Rose’s arm for nausea. There were several times when her vomiting led to seizures because she had thrown up her medication. We began sifting through her vomit if it occurred soon after a dose of medications. I know this seems gross, but you need to know whether a dose needs to be replaced or not. Doubling a dose may be worse than missing a dose. You need to be sure which to do.
This particular situation was the exact opposite of seizing due to lack of medications. Rose was sick and seizing before ever throwing up. Her dosages were too high. The combination was too much. She was listless and unresponsive. I still distinctly remember this because I was so afraid.
Know your child’s dosages and drugs. If you go to the Emergency Room, drawing blood and checking drug levels may be an important piece of information for the doctors involved in the treatment.
We wrote down all dosages on a calendar and used a pill organizer. There was no guessing about the medications that were taken. We also recorded how the dosages affected her. This information was used to convince the neurologist that she needed a different drug or combo. Do not count on your memory. Write it down.

The Forgotten Fob

We moved Rose back to the university yesterday.

She did all the packing. We just helped load and unload the truck.

Just before we left, as an afterthought, her dad suggested I check the medication drawer.

I did it just to make sure a bottle of medicine had not been inadvertently left behind.

What I found instead made my heart stop.

She had forgotten her fob.

IMG_8323

Her necklace with all her epilepsy information and a fob with emergency pills in it.

This is her lifeline.

(I had to pause while typing this and take a deep breath.)

I took the box with the necklace, tag and fob in it to where she was

and held it out for her to see it.

I told her “If you have a seizure and no one knows what to do you could die.”

She nodded and looked down guiltily. Her response was “I did die.”

“Yes,” I replied “but I saved you. I will not be there next time.”

She has had her helicopter mama all summer. Maybe she just forgot where it was?

Maybe she wants to believe epilepsy has left her.

It is a nice dream.

But she must be prepared for the next seizure, even if there never is one.

This epilepsy belongs to Rose now.

I hope she will not forget the fob again.

Seizure Mama = standing down.

 

 

 

The Emergency Delivery

Story 16:

Rose was busy playing in our workshop, which has a concrete floor. Her dad and I were both busy with our own art and construction projects. Rose was making something of her own while standing at my workbench. She suddenly seized and fell to the floor between the workbench and the sink. Thankfully there was a large, but dirty, rug under her on the floor.
The first dose of her emergency medication did not stop the seizure. We waited a few minutes and then used the second syringe. Finally the convulsions stopped and she lay still on the floor. Our relief was short-lived. We realized that we now had no more emergency medication and it was a Friday afternoon.
I called our friend at the pharmacy and explained why we needed more of Rose’s emergency medication as soon as possible. Unfortunately,this particular drug was not kept in stock because it was very expensive and had a short lifespan. It also had to be protected from temperature extremes. The pharmacist explained that the drug would have to be ordered and then delivered, which would take time.
He knew, just as we knew, that we may not have that kind of time. We could be in the middle of a status situation with nothing to save Rose. The pharmacist was thinking out loud when he offered that maybe he had some of a “dead girl’s medicine” at the other pharmacy. A dead girl’s medicine? We needed a dead girl’s medicine to save Rose. I was so stunned that I hung up the phone before I started crying.
We knew that Rose’s emergency bag with more medication was in the principal’s office. It was 4:30 on a Friday afternoon, but maybe someone would answer the phone. When I called the school’s office, the assistant principal answered. She and the guidance counselor were there wrapping Christmas gifts for needy children and their families in the community. We told her what we needed and that one of us would immediately come and get the big red bag. She offered to deliver the bag to us, so that we both could stay with Rose.
Here was one good person taking her time to do something helpful. What a blessing. We could relax. The drugs were on their way. Rose would be safe now. What a gift that was.

Seizure Mama speaks to parents:

Saved by the bag again. I cannot stress this enough. You must always be prepared for a seizure. It is the only way your family can carry on responsibly and safely. You have no choice about where the seizures occur, but you can make the choice to always be prepared.

I want to add here that SUDEP or death by seizure will always be in the back of your mind if your child has the tonic clonic/grand mal type of seizures. Hearing the pharmacist offer a dead girl’s medicine, first sent my mind to her poor family and then to the possibility of Rose’s death. No one wants to have these thoughts. There is no point in dwelling on such sadness.

Yes, living with epilepsy is like living with a terrorist or a time bomb. But none of us knows what will happen in the future. Your life is now, with this precious child of yours, so live it now. I call it “nower.” It means the power of now. That’s all anyone has. Live now. Whatever will be, will be.

Story #34: Down in the Band Room

When Rose started to middle school, Mama went, too. There was an eighth grade science teacher opening which I applied for and got. There was a collective sigh of relief from all of our family and friends. The middle school was too far away from our house. I could not get there fast enough if there was an emergency. The route there was all two lane roads. What if there was a tractor, a train, a wreck…?
So Rose’s mama went to middle school. It was a good thing I did. There were sicknesses and seizures that had to be dealt with. The entire staff knew that Rose’s mama was only an intercom call away. I would hear my name followed by “Get to the gym.” or “Go the nurse’s office.” I would take a deep breath and run toward Rose as someone met me in the hallway heading toward my classroom to watch my students during my absence.
Adjacent to my classroom, I had a storage room for science equipment. We kept a fold-out cot with pillows and blankets in it for Rose to sleep off her seizures after being rolled to my room in the closest available rolling chair. It was a comfort to Rose and me that I could peek through my back door and check on her without missing a beat teaching my students.
This is how we handled her emergencies during those years. We were still searching for the perfect combination of medications. She had some learning issues and hearing issues. Then there were several surgeries. Rose needed support. I was the “mama in residence” again, there to make sure she was taken care of.
On a particularly hectic Friday, I was called over the intercom to the band room. There was a band concert. Rose played the trumpet in it. I ran to the band room to find her unconscious on the tiered floor among scattered chairs and music stands.
(Please pause here to envision this setting. A stair step type floor plan, rows of chairs on each level and tall, black, metal music stands everywhere. Lord, could we not have this seizure somewhere else?)
Two other staff members stayed with us in the band room until Rose woke up. Instead of her normally docile self, she woke up swinging. I could tell she did not know where she was. Sometimes she is blind after a seizure. I kept trying to talk calmly to her, but it was as though she did not recognize my voice. I tried not to panic as several music stands were knocked down, which caused more to fall. There was a domino-effect. More crashed to the floor. It took quite a while to get Rose calmed down. The band students were waiting outside the door. They needed to put their instruments back in their cases. It was time for school to let out. They needed to come in and get ready to go home.
Rose’s dad and brother came to help us. I made a call to the our neurologist. Drug 8K dosages would be increased. No one lost her head. The show must go on.

Seizure Mama speaks to parents:

I was very fortunate to get to work at Rose’s school. It got us through those years. They were not easy for any of us. I was a trained high school biology teacher with community college experience. I would not have chosen to teach middle school. I loved my students and my peers, but the stress slowly took its toll on my health. I knew this was not going to end well, but I had to make it through seven years.
The high school was right across the road from the middle school. If I did not get a job there when Rose went to high school, I would just remain the sentry across the street, only a phone call away and a quick drive across the road. The drive over would be followed by a panicked run to a designated location. I could endure seven years in eighth grade to save Rose. I could do that. I thought…
So what does this mean to you? There will be many sacrifices made for your fragile child. Do not let your own health be one of them. I lived through my time in middle school, but damage was done. I am better now, but there were times when I was truly terrified for my own well-being. I am very protective of myself now. I have to survive Rose’s seizures, too. Rose needed me whether she liked it or not. We were tethered together by her epilepsy. If one of us went down, we both went down.
Take care of yourself, too. United we stand.

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