A Tsunami Of Chronic Preventable Disease Is Coming
An article in the CrossFit Journal by Jason Cooper, and ICU nurse, discusses the case of a 21 year old female at death’s door from diabetes, which he argues is preventable with diet and exercise. But there is no profit for Big Pharma or in standard medical practice for preventing a disease that rakes in billions ($20B estimated sales of insulin alone by 2020)
“Cooper, you are getting a patient from the ER,” the charge nurse said.
“Cool. What do we have?”
“Twenty-one-year-old female in DKA (diabetic ketoacidosis). She’s critical.”
“Shit. Seriously, man?”
The patient arrived tachypneic and tachycardic, and she was the color of skim milk.
Tachypnea is a respiratory rate over 20 breaths per minute, the norm being 12-20. Tachycardia is any heart rate over 100 beats per minute, while the expected rate is 60-100.
She was breathing 30 times per minute, and her heart rate was 135,
Her blood pH was 6.8. Most humans would not be speaking with a pH of 6.8. Most would be intubated on a ventilator. The normal range is 7.35-7.45 to maintain organ function—higher or lower and the body goes into distress. Her blood was far too acidic.
Her blood glucose was 675 mg/dL, which is 554 mg/dL over normal.
Please don’t code. Please. Please, God, help me stop this.
A “code” is short for a “code blue,” which is applied to any event that leads to respiratory arrest or cardiac arrest. This young lady was about to experience both, resulting in CPR. Her gray pallor and all her other clinical symptoms let me know she was close to coding.
“I’m so thirsty,” she whimpered.
Her voice was more a distant thought than a voice.
“Please give me something to drink,” she pleaded.
“Stop talking,” I said.
I need to be fast. God, help me to be smart with my choices, smooth and fast. Smooth and fast.
“I’m sorry. I’m not trying to be rude. I need to think fast and move fast.”
“Am I dying? Am I going to die?”
“I need your husband’s phone number, sweetheart. Hey! Open your eyes. I need his number.”
“He’s my boyfriend. I have a 9-month-old baby. Please don’t let me die,” she cried.
She cried and she cried. Were we normal, we would cry, too. But we are not normal. We are critical care. We do the things that need to be done.
“There’s no dying today. OK? We are really fast and we are really good. God brought you here because of what we do. I’m not letting you die.”
Why in the hell would you tell her that? She still might die. She has a 9-month-old baby? She has freckles on her face? Are you even old enough to have sex? Please don’t die. A 9-month-old baby is going to be motherless. Move.
As I assessed the patient, she continued to plead with me.
“Please, please. Please just let me have a Coke or a Sprite.”
“Who told you can have a Coke? Who said that’s OK? You know that Coke raises your glucose levels, right?”
I was inserting a Foley catheter into her bladder.
“My doctor at the clinic I used to go to,” she said. “My doctor at the clinic said if my sugar is low to drink a Coke.”
Insulin pushing, carb counting.
“Your sugar is not low, though,” I said with irritation as I spiked a bag of saline to thin out her blood sugar.
“Well, it’s what I drink when I’m thirsty.”
Damnit. Son of a bitch. Damn it to all hell. What in the actual hell? Coke? Really?
“You can have some ice chips, ma’am.”
The Foley held barely 10 cc of urine.
She’s not making urine. Her kidneys are shutting down. Her pH is 6.8. She’s pale, clammy. She’s going to die.
I moved quickly, spiking bags of saline and insulin. Her heart rate climbed to 155, and she was barely keeping her eyes open.
Fuck the protocol, save the patient.
“RB, let’s move dude. She’s close,” I said to another nurse. “Pharmacy, call me on 262, stat!”
To the pharmacy: “Hey, homie. Got a kid in DKA. She’s close to coding. I need 3 amps of bicarbs stat. Her carb level on the CMP was less than 3. It doesn’t even register. She’s tachy, gray and looks like shit.”
“The state of Texas is on backorder for bicarb. Can’t find any anywhere. It’s only for emergencies,” he said.
Bicarbonate, specifically sodium bicarbonate, is used intravenously to buffer acid and to neutralize acid in the bloodstream in the event our kidneys and lungs cannot buffer acid fast enough. Breath fast when you run? That’s the human body blowing off hydrogen ions—acid, essentially.
I hung up the phone fast.
Do we want her to code? Backorder? Emergencies? WTF do you think this is? This is the ICU.
I ran to the Pyxis drug machine and overrode for bicarbonate.
You can’t fire me for saving a brand new mom.
RB and I moved like dolphins in the water, smooth and fast, never exchanging words or logging onto computers to document our advance because talking and typing were too slow. Seconds count. As he moved to one task, I knew what the next was before it was happening. We danced around the room like electrons at light speed.
Sugar is 455. Anion gap is still 27. PH still 6.8. Bicarb is still less than 3. Resp rate 40. HR 160.
I pushed all 3 ampules of bicarb, gave her a max dose of insulin, opened up two bags of fluid wide open. When the bicarb hit, her heart rate dropped to 145 and she opened her eyes.
“Please let me drink something,” she said, sounding raspy.
I ignored her. Within five minutes of the insulin, isotonic fluids and bicarb, a miracle happened: A trickle of urine started to form. And then a bit more, and a bit more until she began to diurese.
Thank you, God. Thank you, God. Thank you, Father God. No dying today.
The heart rate dropped to 120. Her respiratory rate dropped to 20.
“Oh my God, I am so thirsty!” she said with wide eyes.
“I’ll go get you some water.”
They are telling her it’s OK to have a Coke.
I handed her the cup of ice water and she drank all 8 oz. in one power sip.
“I feel so much better.”
“Well you aren’t out of the woods yet. But you started making urine and your vital signs look better. Talk to me. What’s going on? Why did you stop taking your insulin?”
“The clinic is free. We don’t pay for that. But the insulin script they gave me is so expensive. I take a long-acting insulin and a short-acting insulin. They cost me right at $600 a month at Walgreens.”
She continued: “I haven’t had money for diapers or formula. I chose to put my baby before me. I paid for the formula and the diapers, baby food. It’s so expensive.”
“Has no one advocated for you? Have they not paired you up with a case manager to get you cheaper insulin? You know Wal-Mart can get you insulin for less than $40 a month?”
Like that’s any better. Cheap insulin has made it easier to be a diabetic.
“Oh my God, that would help. But it’s not just the insulin. It’s the cost of the Accu strips for my glucometer. It’s all just so expensive. Can’t the hospital give us insurance or something? Can’t they help us?” she asked.
If you only knew. If you only really knew.
“No. The hospital isn’t going to help you. So is that why you use so much formula, because you smoke weed?”
She looked ashamed at my question. I continued: “Hey. I’m not here to judge you. I want to help you. You aren’t breastfeeding because of the weed, right?”
“How did you know?” she asked.
“We tested your urine once you started making urine.”
“It is. I don’t want my baby to get high from my breast milk. All the doctor wants to prescribe me is Norco and Neurontin. I thought weed would be safer.”
“Safer for what? Are you having neuropathy? Are you already in pain?” I asked, concerned.
“I am. My feet hurt all the time. The doctors at the clinic I used to go to were condemning me for smoking weed, but they were OK prescribing me Soma, Norco and Neurontin. That’s why I stopped going to the clinic.”
“Same dude that said it’s OK to drink a Coke when your sugar gets low?” I asked.
“Yeah. Same guy.”
She’s barely legal and already having neuropathy. And here we are doing what we do. Hooray for us. And that insulin-pushing dick is condemning her for weed and pushing Norco and Soma.
“I’m sorry. I’m so sorry. I wish there was something I could do for you. I’ll get one of our case managers to talk with you.”
I swallowed my tongue, holding back all of what I really wanted to say about that clinic and what I know that could help her. Any attempt on my part to discuss treatment outside the hospital’s protocol or partnerships could bring disciplinary action.
Her heart rate was 90 now. Her respiratory rate had dropped to 17. Her pH was 7.0. I never thought I’d be happy to see a 7.0 pH. She was falling asleep now. The color returned to her and she looked less like a dying child and more like a young woman.
No dying today. Next time RB and I might not be here. It might be the C team, and your number might be up. You need to get fit and die hard, baby girl. It’s still not too late.
A tsunami is coming—sound the alarm. The tide is rising. Can you hear its roar?
“Diabesity” as a genetic trait has been packaged and sold to us for so long that it’s the new normal, and any notion of defeating metabolic derangement has become myth. The food lobby and the pharmaceutical lobby have so deeply infiltrated our society that the idea of choice has been stripped from our conversation. People believe they are doomed to be overweight and sick, and the day is coming when the ratio of sick to fit will be so disproportionate that we might never overcome its devastation.
CrossFit affiliates, we are not just picking up things and putting them down. We are teaching people to prevent and overcome conditions the medical system claims are inevitable. The system says chronic disease is age induced and genetically induced, but we know these conditions can be controlled—and often eliminated—with proper nutrition, metabolic conditioning, gymnastics training, weight training, and a life lived in sport and play.
The Centers for Disease Control (CDC) predict that up to one-third of all adults will be diabetic by 2050. UnitedHealth estimates over half of us will be diabetic or prediabetic by 2020. Everything the CDC predicted in 2000 for 2010 came to pass, so predictions for the future are terrifying. My 16 years in the ICU showed me that the situation is actually much worse than many people think.
The evidence is mounting: 80 percent of all chronic disease is metabolic, preventable and oftentimes reversible. This is true even with most variants of cancer. But hospital protocols and education are provided by insulin and pharmaceutical companies. The training in nursing schools and medical schools is limited by design and doesn’t cover nutrition or exercise. Doctors are taught to treat disease with medication, which ensures astronomical profits for Big Pharma. The global human insulin market was estimated at about US$24 billion in 2014 and is expected to grow to almost $50 billion in 2020.
The pharmaceutical industry does not benefit from lifestyle changes related to diet and exercise. Prevention doesn’t cost enough.
But prevention and lifestyle changes work. CrossFit affiliates have provided the proof around the world. We are the evidence that chronic disease can be treated with lifestyle changes.
As CrossFit affiliates, if we know this to be true, why do we not yet fully embrace our place as superior in health care? And why do we not label hospitals as nothing more than damage control? At what point do we as affiliates call ourselves advocates for change and recognize what we are?
The day we kept that girl from coding at the hospital, we didn’t save her from chronic disease. We just helped her live another day. We helped her get by—until the next time. When her doctor prescribed medication and told her it’s OK to drink Coke, he ensured there will be a next time. The system is broken, and it won’t save that girl.
But CrossFit Founder Greg Glassman’s Theoretical Hierarchy of Development pyramid can save her. CrossFit’s nutrition prescription—“meat and vegetables, nuts and seeds, some fruit, little starch and no sugar”—paired with metabolic conditioning can save her. CrossFit affiliates serving as advocates can save her.
But she’ll never hear about us unless we flip the market and boldly embrace what we truly are: The absolute cure for chronic disease.
About the Author: Jason Cooper is a registered nurse and the owner of CrossFit Enoch in Conroe, Texas.