Perseverance: YOU Be that One in a Million!: First 19 Chapters of No More Tears: A Physician Turned Patient Inspires Recovery

by Margaret Aranda, MD, PhD.

Written from hospital bed to hospital bed as I learned how to read and write again, speak and process brain information. Traumatic brain injury (TBI) is sometimes followed by a more rare condition, diabetes insipidus (DI) that has nothing to do with blood sugar.

DI occurs because the posterior pituitary gland, that hangs from the brain like a dangling apple, gets smashed on its back, onto the skull. A hormone (i.e. DDAVP, or vasopressin, or anti-diuretic hormone) gets "knocked out," so a 'higher' hormone completely loses communication with it.

What happens next is that this 'higher' hormone, located in the hypothalamus of the brain, speaks and speaks and speaks and speaks and speaks to the pituitary gland (not knowing it is "broken" or "severed")...and the body pees itself to death. Because the pituitary gland is missing "anti-diuretic" hormone, there is nothing any more to tell the hypothalamus "We're in the desert. Stop Peeing!"

So most people with TBI die of DI via dehydration and kidney failure, perhaps mostly in their sleep. They are thirsty, thirsty, thirsty, yet keep peeing, peeing, peeing. They don't know that they can NEVER catch up in the drinking. I have had it twice now, and it is no fun. Titrating salt and water, water weight and Na levels ~ That's because the DDAVP is gone. Treatment? DDAVP or vasopressin, or Anti-diuretic hormone. No one wants to be on this drug regimen to "fake" an illness, as I was accused of doing. The unneeded drug will kill a person. Anyway, that's your pathophysiology lesson for today.

Pituitary gland. Posterior pituitary is in blue. Pars nervosa and infundibular stalk are not labeled, but pars nervosa is at bottom and infundibular stalk is at top.)

Image 1. The Posterior Pituitary Gland. It receives signals from the hypothalamus, to determine total body water (TBW) an prevent either hyponatremia or hypernatremia (both lead to death; the first by turning into a water balloon and having water toxicity; the second leads to death by kidney failure). Resource: Wikipedia

That is just one bit of the scientific, historic, humanistic, philosophical aspects which this book covers. If you or a loved one have suffered a TBI or ANY chronic illness due to accident or misadventure (i.e., Lyme's disease), then this book is for you AND your family AND your doctor AND the caregivers. No one else can "tell it like it is" the way that someone who has "been through it" has. And I have.

Dedication: Even if life is difficult, I learned at an early age that one has some control over one's destiny. Thank you, Dad, for teaching me from a young age that I can strive to achieve and never give up.

This book is dedicated to Dr. David S. Cannom and Los Angeles Cardiology Associates, which he founded in 1985. It is also dedicated to Keck School of Medicine at USC, Dean Tranquata, Good Samaritan Hospital of Los Angeles, and their cardiology department with Dr. Cannom.

I appreciate all the efforts turing the Tilt Table Test as wee as the special care you gave me on the cardiology floor. (Being the only patient without gray hair was iconic) Thank you for all your nursing, administrative, and physician efforts on my behalf. It is a great pleasure to donate a portion of the proceeds of this book to Good Samaritan's Campaign for Cardiology.

Had it not been for Stanford's University of School of Medicine and the departments of anesthesiology and critical care, I never would have learned how to argue my own medical cases using concepts such as orthostatic hypotension, mean arterial pressure, orthostatics, ataxia, and the relevance of ataxia on the vertebral artery for balance. That little thing called, "balance" that we use when we get up to walk? Most of you take it for granted. We stand up and faint, as the blood pools in our legs and leaves our heads. For this reason, I give with great pleasure some proceeds of this book to Ronald G. Pearl, MD, Ph.D., Chairperson of the Anesthesiology and Pain Management Department, to put it towards his chosen effort.

No More Tears: A Physician Turned Patient Inspires Recovery

Foreward

Acknowledgments

A Place with "No More Tears"

Introduction

Introduction to My Life

The Accident

Picking Garlic and Doctor Shopping

Before the Accident

Dysautonomia and Living with 'Brittle Dysautonomia'

Fifty Ways to Fall Out of Bed

The Gift of Prophecy