Partial muscle biopsy results (and other stuff..)

Kerissa • Oct 11, 2016

Hey friends,

A lot has happened since I last posted..

For those who were on FB at the end of September, you can just pass over this whole paragraph as I’m basically saying the same thing. lol  On September 22nd, I had an adverse medication reaction that exacerbated my mitochondrial disease….I was taken to the ER by ambulance because I experienced nausea/vomiting (that wasn’t resolving with my home anti-nausea meds), high heart rate/respirations, and weakness.  In the ER, I had to be given oxygen because my saturations kept dropping to 82.  My white blood cell count was high, and other labs were off.  This concerned the doctors, so they did a full infection work-up with urinalysis, blood cultures, and additional labs.  After not being able to empty my bladder for over 10 hours, I had to be cathed, too.🙁 *In August after my hip surgery, I had to be cathed then as well.  I’ll never get used to the procedure as it’s so painful!  I know it’s TMI, but I just want to share the unpleasant details sometimes to show how rough mito is.🙁*  I was admitted for 4 nights after this med reaction because I was so weak.  The doctors came to the conclusion that I had stress-induced leukocytosis—the body gets so traumatized that it starts preparing for something bad like an infection, hence the high WBC count.  Thankfully, there was no infection, and my labs soon normalized after numerous liters of IV fluids.  This whole hospital ordeal at the end of September took a lot out of me.🙁

I saw my GI dr. the day after I got discharged.  I had a pulmonary resting energy expenditure test done on Sept. 19th to calculate how much CO2 my body burns, how much protein I need, etc.  But he never received the results!  He’ll either call me or just wait until my next appointment which is at the end of this month.  Based on the results, he’ll adjust my IV nutrition.  When I was in the hospital, the hospitalist recommended I receive 1 liter of IV fluids (vs. my usual 1/2 a liter) a day for one week.  So my GI dr. ordered that.  I only have 2 more days of this regimen!  It’s hard lugging around a very heavy liter of fluids in addition to the IV pump for a total of 6 hours a day. :/

Last week, my eyes stopped oscillating completely….but that only lasted for about 4 days.  It’s now back.🙁 I’m grateful for that break, even though it was short!

I had my brain MRI, and it was a clean scan.  I know that’s good news, but I’m still having a throbbing, right-sided headache.  I told my neurologist, and she said there’s often no clear explanation for why chronic headaches get exacerbated.  It could be so many reasons.  I have a follow-up appointment with her at the end of the month to figure out what to do.

I turned 24 this past Friday, and while it was a special birthday (my family is the best!!), I didn’t feel super great—my hip was aching terribly, I had a bad headache, and I didn’t sleep well Thursday and Friday night.  Saturday evening, I threw up a ton—my stomach didn’t have the energy it needed to move the soft food and liquids I had that day out of the stomach and into my small intestine….it was the worst yet.🙁

Last week, I also saw my orthopedic hip surgeon.  Unfortunately, my surgery recovery/physical therapy progress keeps getting set back with each ER visit and hospital stay, so my hip isn’t doing well.  The pain is bad, and she said that’s not normal this far out of surgery..🙁 She thinks there’s scar tissue in the joint.  My physical therapist is also worried about the hip stiffness.  So my surgeon wants me to get a hip steroid injection to calm things down and help the inflammation.  Physical therapy has been very aggressive to work at this, and it continues to be twice a week at OHSU.

Today I saw my palliative care dr.  We discussed all that happened in September and talked about different ways to manage the headaches/pain better.  It’s definitely a trial and error process!

Oh yes, before I keep forgetting to tell, I received my initial muscle biopsy pathology results from OHSU (these aren’t the Baylor tests….still waiting to hear if they got authorized by my insurance…my neurologist had it all taken care of with the medical director of my insurance, but the director forgot to document everything, so my dr. has to start the process all over again!).

OHSU performed basic histology and ultrastructural studies, and sadly, the results are a lot worse than my muscle biopsy histology results done at UCSD back in 2014..  It’s kind of hard to explain, but in 2014, my basic histology was normal…it was only when they ran more tests that they found the mtDNA depletion (a significant one!).  But the histology test done at OHSU in August of this year showed “diffusely pale” tissue which indicates that I hardly have any mitochondria in my muscle. :/  The pathologists noted “paucity of mitochondria.”  Paucity means scarcity.  A lipid depletion was also found, but I don’t know what that means specifically in my case..  Since my histology shows tissue evidence of a mtDNA depletion, that probably means my depletion results (once it’s completed at Baylor!) will be even worse than the 2014 depletion study..  We don’t know if all this means disease progression or what..  I will be seeing my mitochondrial disease specialist in San Diego again this coming January or February to go over everything.

Phew, hope that last paragraph was easy to understand!😉 Sorry for the super long update!!  I no longer journal like I used to (my hand cramps up from the muscle weakness), so I like typing all the details here to remember everything.🙂

By Kerissa Lee 16 Apr, 2024
Read Part 1 if you missed it.  | Part 2 | Just 2 days after I was discharged from the hospital, I started experiencing severe nystagmus (shaking eyeballs) along with nausea, vomiting, and retching. I didn’t know what was happening and was again so scared. 😔 I was told to go to the ED since I wasn’t tolerating any of my oral medications. The doctors gave me IV fluids and lots of different IV anti-nausea and pain meds. They told me I needed to be admitted and talked with the neurology and internal medicine departments to see which one should admit me. But….to my dismay, both teams made a bad judgment call when they decided not to have me admitted (my mom has since talked with a patient advocate for guidance on what to do if “this” happens again). Even the ED observation unit didn’t want to take me because I was “too complex.” 🥺 I was sent home still vomiting and in so much distress (with mitochondrial disease, anything like untreated vomiting/diarrhea is a big “no-no” to put it simply because it’s a huge stress on the metabolic system). My body was really struggling, and I experienced very drooping eyelids and worsening weakness all over. The next day, I was seen by my PCP’s colleague, and after much discussion, he directly admitted me to the internal medicine floor. I’ll always be grateful to him for his quick action and the very thorough letter he wrote. There were sadly no beds available, so I waited at home. But, the following day, God was so kind to bless me with a private room that became available. Once I was inpatient, the doctors tried to get a handle on the nystagmus and vomiting. All the usual IV anti-nausea meds didn’t resolve things, so they gave me an “off-label” medication that can sometimes help nausea. That did the trick, but another issue soon arose—I started showing signs of mental confusion. I remember not being able to explain what was on my mind, and if I did talk, it didn’t make sense! For example, 2 nurses were in my room helping each other, and I made a comment about them being married. 🫠 Another instance, my family later shared that I asked them if they could see the ocean out the window. I can’t recall a lot of my time in the hospital because I was so confused.. My mom wondered if the confusion was from the off-label nausea medicine, so the team immediately discontinued it. By God’s grace, that did the trick…. Hospital life was definitely a roller coaster. You know that whack-a-mole arcade game? Once one problem ended, another popped up. After not receiving proper nutrition for many days, I started trying to eat orally again and resumed j-tube feeds, but for some reason, I wasn’t able to tolerate either like before. My stomach became so huge and distended….even with the feeding pump setting of just one teaspoon per hour. It didn’t make sense, especially since I tolerated a high rate of tube feeds two weeks earlier when I was admitted for the neurological weakness. I kept trying to increase the tube feed rate, but my GI tract didn’t tolerate it. The doctors brought up the possibility of TPN (IV nutrition). I was very discouraged and so homesick. With no progress increasing the formula rate, I did in fact have to be placed on TPN. Emotionally, it was a struggle dealing with this new problem on top of the mitochondrial crash.. 😢 Up next: Part 3…
By Kerissa Lee 13 Apr, 2024
Dear friends, It’s been almost 3 months since I last blogged.. So much happened, and it’s very hard to believe how quickly things changed. I know many already know the whole story. But for those who haven’t heard it, I will try to recap here. It’s quite the tale, but I wanted to share it on my blog to look back on because God truly carried me through the unimaginable. ❤️ When I requested urgent prayer for the sudden onset numbness and weakness in my whole left leg back in January, I had a routine follow-up already scheduled with my primary care dr. on January 25th. I was so thankful I could see him right away for this new issue. I showed him my worsening weakness, and he sent me straight to the ED to make sure I didn’t have a condition called Guillian-Barre Syndrome (GBS). While waiting for a bed to open up on the neurology floor, the muscle weakness spread to my right foot and up my right leg to the point that I could barely lift both legs up. Words can’t express how truly scared I felt that I was going paralyzed. 🥺💔 It was the hardest time of my life, and I continually wept, not just because of the physical pain (which was the worst leg pain I’ve ever experienced) but also because of the emotional distress.. The “foot drop” in both feet was so severe that my soles were almost parallel to the hospital bed when laying down. It was devastating. Due to the weakness, I couldn’t even walk to the bathroom and had to use a bed pan. The team was concerned about possible heart/lung issues, so I had to be placed on a continuous cardiac telemetry monitor (which is different than the standard one). Twice, they asked me if I’d be okay with life-saving measures like getting intubated (placed on a ventilator) if the weakness kept spreading like it was.. I underwent countless neurological exams by nurses, medical students, residents, and attending neurologists. To rule out GBS, a spinal tap had to be done as well as extensive brain and spinal MRIs (cervical, thoracic, lumbar, and sacral). Not feeling well, it was incredibly difficult to lay in the very narrow MRI tube for more than 2 1/2 hours without a break. When GBS was ruled out, we still didn’t know what was causing the weakness. To be honest, in a way, I WANTED to have GBS because they explained GBS has a good treatment. So, not knowing the outcome and prognosis was very hard. 😢 Looking back, I remember how I shared a verse from Isaiah when I wrote my “2023 reflections” blog post at the beginning of this year: “Let him who walks in darkness and has no light trust in the name of the Lord and rely on his God” (Isaiah 50:10). When I posted that on January 1st, I never could have imagined how dark life would get. I knew God had a plan, but I was still so terrified. And there was nothing I could do but trust him (even though my faith felt so weak while in the thick of it). I cried so much and struggled with great fear. But in the midst of that dark time, I thought of a well-known passage from 2 Corinthians: “So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison…” (2 Corinthians 4:16-17). A phrase stood out to me: “light momentary affliction.” This trial weighed heavily on my shoulders….it definitely didn’t feel “light” OR “momentary.” I had so many questions. Could I surrender all and trust that God has my best interests at heart? I prayed that he would grant me the eyes to see everything from an eternal perspective and use this hard time for his glory and good purposes. After spending 9 days on the neuro floor, I was sent home.. The neuro team attributed this whole event to a “very unusual mitochondrial crash.” And only time would tell how I would recover. Up next: Part 2…
By Kerissa Lee 23 Jan, 2024
Hi, friends, I had a whole other post ready to go with some good news, but instead, I have an urgent prayer request. I started experiencing sudden onset numbness, tingling, and weakness in my whole left leg, and it’s been so scary. 🥺 It just came on out of the blue. I was doing so well with physical therapy each week (able to walk fast on the treadmill and leg press 40 lbs), and now, I have to limp because my left leg is soo weak. I really want to avoid the ED as much as possible, so I saw one of my doctors today. She’s concerned I’m having a big motor nerve issue. 😭 The plan is to see a physical medicine specialist, have a nerve conduction study, get an urgent MRI done, as well as see my PCP and pain doctor on the 25th and 29th for further evaluation/testing. I know I already said this, but it really has been so scary to lose function so quickly. Can you pray that I will trust the Lord and not worry? It’s been very hard, so I’d really appreciate your prayers and support in the coming weeks. Thank you so much. ❤️
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