Hyponatremia-induced Cerebral Edema

I love my family. I used to be upset about how my family handled the situation in 2015 that I’m about to lay out, but this winter break, Dad helped me realize that there’s no reason to be upset. It’s not that they didn’t believe me. They couldn’t have understood. There were no physical symptoms to see. There was no blow to the head like a concussion. I didn’t bleed. They couldn’t understand what was going on. They did all they could, then they didn’t know what to do. My Dad’s side of the family connects with one another over making fun of each other and telling the same jokes for years. They have huge hearts, but aren’t the best communicators. My Dad’s probably the most sensitive, but confident, communicator in the family (surprisingly, but I’m realizing and appreciating it more all the time). If the damage was external, Dad and I have no doubt that they would have rushed to my aid.

I went to Myrtle Beach, South Carolina with the Barrons, the Weils, and Uncle Steve in the summer of 2015. Mom, Dad, and Cory stayed home. Cory had sports. My parents had work. There, I suffered  extreme effects of untreated heat exhaustion in the form of Hyponatremia-induced cerebral edema. It was the scariest few hours of my life.

What happened?

The temperature was in the 90s all week, feeling hotter in the sun. I remember the heat index was over 100, maybe 105? I was on a health kick that summer. I went running every morning. I bought all my own low-calorie, healthy food from Walmart to eat for the week. Like healthy food normally does, my food happened to have very little sodium. I also drank a lot of water. A LOT of water. That’s what they tell me to do in the heat.

There were signs of heat exhaustion that I didn’t think to investigate. I was oversleeping, a lot – up to 14 hours. I had headaches and felt lethargic and dizzy. One day, I was so happy to get back to the rented beach house at 1 p.m. but then we immediately were going out shopping. I was excited to shop, but not then. I wanted to cry, I was so upset about going out, but I kept my mouth shut. It was very, very hot out there. I kept telling myself “I can make it.” I couldn’t decide where we went, and where. I stayed pretty cheerful. I tend to make the best of situations. But I did ignore the signs.

The effects of cerebral edema struck out of nowhere, as it tends to do. I was texting Dad in the car. I couldn’t see my cursor, which was weird. I kept blinking my eyes, hoping my eyes would stop being weird.

We were shopping in a huge, warehouse-esque, air-conditioned gift shop. I was walking around and shopping like normal, until I looked at a t-shirt and saw a few letters that didn’t make a word, not centered on a t-shirt. The rest of the t-shirt looked fine, all green. The letters just looked weird. I called out to Emmy, “Hey Em. What does that shirt say? I can only see the first three letters.” She told me the full word, though I can’t remember what it was now. Army? Navy? Beach? I kept on shopping. I was walking around, talking to Zack and Emmy. I was talking, and I kept forgetting what word I was trying to say. That happens sometimes. I didn’t think anything of it. Eventually, I got really, really dizzy. I looked up and tried to read the signs – it wasn’t working. It was so frustrating that I was so dizzy that I couldn’t read. Was it the dizziness that made me think I couldn’t read? I’m not sure. Trying to read definitely made it worse.  I had to sit down. Everything was spinning. Emmy got Aunt Lisa. Aunt Lisa asked someone for a bottle of water. I was sitting on the ground, holding my head between my knees like Aunt Lisa told me to.  I looked forward, just at the bottom shelf in front of me. The water bottle was by my heels in front of me. When I looked at the water bottle, I could see the water bottle. When I looked at the shoe on the shelf next to the water bottle, I couldn’t see the water bottle. It wasn’t blurry. It wasn’t black. In my peripheral vision, I could see the floor and the rest of the shelf very clearly, but not the

I was really out of it. The Asian store lady kept saying “Does she need some air? Let’s get her outside.” I didn’t want to go outside. It was hot outside. That couldn’t make it better. That was probably the problem. I felt someone touching my head. If it was Aunt Lisa, that would be fine. It was the store owner lady. I didn’t like that. Don’t touch my head. I’m 20 years old. Don’t touch my head. I told her not to touch me. I think I whispered it and slightly ducked out of the way. I was very out of it.

I drank the water.

Emmy took one of the thick plastic signs for me to use as a fan. I walked around a little longer. I was still feeling dizzy, but I could talk and follow Emmy around. It was ok. Then I started to feel weird again. I remember deciding to find Aunt Lisa and ask for another bottle of water. I remember walking toward Aunt Lisa, deciding what to say. I got to her at the counter, and tried to speak. In that moment, I couldn’t find the words I wanted to say. I searched for replacements. I felt like every word I knew was slipping through my fingers. I felt each word falling away and I got scared. I started crying and looked at Aunt Lisa, repeating “I can’t words. I can’t words. I can’t. I can’t. Words.” That’s all I had. I was crying uncontrollably. The store owner said “get her outside” they got me two more bottles of water. They brought me into the car and I downed both in seconds. They must have thought it was heat exhaustion, because they put me in the center of the van. They pointed all the fans at me to cool me down. I started shaking uncontrollably. I looked down, and I breathed. I could speak again. Short sentences, but I could speak. I was shivering violently, but I insisted they keep the fans on me. I remember saying, “cold is better than hot.” We got back to the house. I sat on the couch. I tried to lay down, but that didn’t feel good. I moaned. I think I had a headache. No, I was definitely dizzy. They took my temperature. It wasn’t high. It wasn’t heat stroke. That’s what they thought it was – heat stroke. Once they figured out it wasn’t heat stroke, no one knew what to do.

Uncle Mike sat down next to me and started saying words. I knew that he was talking. I could hear his voice, but I couldn’t understand anything he said. It was like he was speaking a different language. He gave me a paper bag and mimed breathing into it. I breathed into the paper bag. I was definitely hyperventilating before when I was crying. I may have took a lot of deep breaths trying to fix whatever was going on with me, worsening the hyperventilation. Breathing into the bag felt a little better.

I couldn’t understand what anyone was saying. Looking up at the TV confused and upset me. I couldn’t understand what they were saying or what was going on. I sat on the couch and stared down at the coffee table.

They called mom. I got on the phone. I could speak, but only ve..ry…ve..ry..slow…ly. One syllable at a time. I could only understand mom when she spoke very, very slowly. I remember being so frustrated by how slow I was talking. I wanted to talk faster. I remember that mom’s voice on the phone went from being an unintelligible string of noises, to clear words when she spoke slowly. She talked to Aunt Lisa about bringing me to the hospital. I remember Aunt Lisa saying that if things didn’t get better in an hour, they would bring me to the hospital. I remember Emmy sat next to me the whole time. She was crying. Later, she told me that I was saying random words that made no sense at one point. She said it was scary. She said someone yelled at her for crying, for being worried about me. (Part of why I was upset for a year, but, now, I see that this was probably their way of trying to calm Emmy down, telling her it’s all going to be all right).

I remember switching between thinking without any words at all, and being able to speak in my head. When I could speak in my head, sometimes I was able to begin a sentence to Emmy, but mid-sentence, not being able to finish it. I remember not remembering how to make certain noises with my mouth, though I had the word in my brain. I remember trying to act out things to communicate to Emmy.

It was terrifying.

The crazy part was, I wasn’t thinking of whether I would die or not. Later, the research said that the effects could have been fatal. Nope, I was thinking about what kind of career I would have with brain damage. I mourned over the fact that I wouldn’t be able to finish my Notre Dame degree. I love school. I love Notre Dame. I love reading. I mourned the loss of my ability to read, to comprehend on a deeper level. I thought about living a life without intelligently reading or writing.

Emmy sat with me the whole time. I think I remember that I kept telling her thank you. This scary situation definitely made us closer that summer. She defended me. They said I was just having a panic attack. What did I have to panic about? Just because I’m more emotional, it’s a panic attack? I might be emotional, but I have control over my emotions.

A couple hours later (Emmy told me later how much time had passed – I had no idea at the time), Aunt Lisa came back to the couch laughing, saying “your mom’s Googling all the way from Illinois,” and dropped a couple of bottles of cranberry juice. She said something about electrolytes. Thank God for my mother. I love my mother so much. In that moment, I was overwhelmed by an internal power, feeling from afar how much my mom cared for me, how scared she was for me, how smart and strong and powerful she was to say “I’m going to freaking figure this thing out for her if no one else will.” She did. I love her so much. I felt cared for. I felt loved. I felt saved. She figured it out. She figured out I didn’t have enough sodium. I didn’t have enough electrolytes.

I drank the cranberry juice and felt a little better. I drank 4 more mini bottles of cranberry juice. I thanked Aunt Lisa – these were her juice bottles. My ability to speak and understand got exponentially better from there.

Then I puked. I puked a lot. In a huge pot, I puked a lot. I didn’t leave that couch. That’s when I figured out that it’s way more comfortable to puke while sitting up with a pot below your face, than hunched over a toilet bowl. I think humans were meant to puke sitting up. I sound terrifying when I puke. My body hates puking. I sound like a freaking velociraptor dying. It’s terrible. Zack still remembers how I sounds when I puke… but that’s pretty funny, lol. I’m not at all ashamed of my crazy puke noises.

After an hour or so, I was back. I ate a meal. I went to bed. The next day, we started the TWO DAY drive back to Illinois. Surprisingly, I learned that Uncle Mike drives not-so-smoothly (made me want to puke) and Aunt Lisa drives very smoothly (still didn’t feel great, but definitely more comfortable). I had an absolutely terrible headache. It was an awful, long drive.

When I got home, I experienced intense episodes of dizziness. I drank electrolytes. A couple times I was driving, and the dizziness would begin. My leg felt weird. It pushed either a little too hard or a little too softly on the gas. I pulled over. I was scared to drive. As the weeks went on (after I went to the doctor), I got much better at controlling the dizzy spells while driving. I would grit my teeth and focus hard on the road until it had passed.

I researched the CRAP out of this. I wrote down every symptom I could remember. I wrote down every dizzy spell. I read article after article after article. I worked very hard to find credible sites. I watched youtube videos for tutoring nursing students. I followed a string of nursing tutoring videos that cost money, so they only let you watch the first few minutes. That string led me from heat exhaustion, to hypotension, to Hyponatremia. I remember that the doctor in the video had only briefly mentioned it, saying something like, “If sodium levels are low and it’s not heat stroke, Hyponatremia is probably at play, so anyways back to heat stroke…” From there, I researched Hyponatremia and everything seemed to make sense.

I went to the doctor, bringing all my symptoms and my activity log since I got home. They took my blood pressure – the nurse seemed confused. She took it two more times. Apparently, I had very, very low blood pressure. It was just above the “danger” line. This made me think my blood pressure was even lower while on vacation, before I was careful to drink my electrolytes and salty foods. (I ate a lot of deli meat for a month) They told me that low blood pressure and sodium levels coincide. The doctor prescribed me salt tablets – 1000 mg? I can’t remember how much. Athletes take sodium tablets, I guess, after hours of sweating during practice and games. People don’t really take salt tablets, because salt is usually considered bad for you. We Americans have high-salt diets.

I took my sodium tablets on the days I got dizzy and usually the day after. Taking those tablets really make your stomach feel sick, though. It was like I dropped a rock in my stomach. I drank my electrolytes. I checked my blood pressure. I still have the tablets and my blood pressure-checker.

The next summer, Emmy reminded me over and over to have my salt tablets on me, to have gatorade on me. I’ve been safe in the midwest, since then.

Why did it happen?

(I did the medical research a long time ago, so forgive me for my lack of citations and forgive me if my word choice isn’t perfect. I swear, I did the research on reputable sites. However, for simplicity’s sake, here’s an excerpt from Wikipedia: Signs and symptoms of hyponatremia include nausea and vomiting, headache, short-term memory loss, confusion, lethargy, fatigue, loss of appetite, irritability, muscle weakness, spasms or cramps, seizures, and decreased consciousness or coma. From MDPI: When hyponatremia occurs, the resulting decrease in plasma osmolality causes water movement into the brain in response to the osmotic gradient, thus causing cerebral edema. From WebMD on cerebral edema symptoms: Headache, Neck pain or stiffness, Nausea or vomiting, Dizziness, Irregular breathing, Vision loss or changes, Memory loss, Inability to walk)

Recall that I was trying to be healthy during this vacation. My diet was extremely low-sodium, I was sweating a ton (I already sweat a lot, add the 90+ degree heat and the workouts), and drinking water in excess.

I was experiencing heat exhaustion, but it went untreated.

Like I said, the effects of Hyponatremia can happen suddenly. Basically, the cells in my brain had too much water in them (Hyponatremia (a.k.a. “water intoxication”), but my body didn’t have enough electrolytes to regulate the amount of water in those cells. As a result, the cells in my brain swelled (cerebral edema) and pushed my brain up against the side of my skull, cutting oxygen off from the parts of my brain that handle memory, speech, and vision.

Why was I there in the first place?

I don’t do heat. I don’t particularly like the sun. Beaches are pretty boring to me. Shopping is only fun when you have cash to burn, which I don’t. Why did I go on this vacation? Because I love my family, and it was a vacation opportunity.

I had a blast going zip lining through an obstacle course! That was incredible! Going through it with the family was awesome. The biggest, longest zip line was over the water – it was incredible. I also had a great time reading Tina Fey’s biography by the beach and the pool.

Yeah, it put a real damper on the end of the vacation, and it was terrifying, but it’s a really cool story to tell now that I’m experiencing no long-term impacts. It was so exciting to research and it’s been exciting to write my story here. An essay of 2,924 words isn’t bad.

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