BENJAMIN

Introduction
In the rush of daily life, we all push through periods when we don’t feel well. However, it is important for those of us with adrenal insufficiency to be cognizant of the difference between feelings associated with normal fatigue or illness and an episode of low cortisol requiring an updose.

Most of us have been taught that having a cold or flu puts stress on our bodies and that requires additional cortisol, with instructions to double or triple our replacement steroid dose within the protocols. That said, it is equally important to be able to recognize that emotional and injury-related stresses also deplete cortisol levels, and it is crucial that we adjust to accommodate for these situations.

To help our members recognize these situations, NADF is pleased to present a new feature we are calling “A Day in the Life". We hope these interesting and realistic vignettes of ordinary or extraordinary events will help you to think about your own daily routine and recognize yourself in these some or all of these stories. You are welcome to share your own story with us and tell us how you handled those not-so-average days. We hope you enjoy reading and reflecting!


Benjamin’s Story
True to form, Benjamin went to bed at 10 pm and got up at 6 am, completed his 30-minute morning run, and ate his high protein breakfast along with his morning fludrocortisone and hydrocortisone. He drove to school and studied in the library until classes started. His first class was English, which was always his worst subject.

Ben prided himself of never getting a lower grade than A-, just as he prided himself on his strict physical regimen. Although his diagnosis of adrenal insufficiency had annoyingly disrupted his sense of control, he approached it as a challenge to be conquered rather than an impediment to his command over his body and mind. He refused to allow his life to be altered, and he refused to let anyone outside his immediate family know about his diagnosis. Every morning after he got in his car, he took off the medical alert bracelet his parents made him wear, and put it back on every evening before he went back into the house.

During first period, Ben’s English teacher handed back the midterm exams, and he was enraged to see that she had given him a grade of B-. Because he had another class immediately after English, he could not approach her to protest the grade until later in the day. Nonetheless, this distressing disappointment gnawed at him throughout the morning.

Ben’s last class before lunch, gym, was one of his favorites. As he changed in the locker room, Ben found himself feeling slightly nauseous, but told himself it was just hunger. Besides, in gym class they were practicing running and jumping hurdles, which as a member of the track team, was one of the things Ben was best at. Just as Ben went into a jump, however, a couple of classmates were horsing around and bumped him, altering the trajectory of his landing. He heard a sickening crack before he felt the pain in his leg. As he rolled moaning on the floor, he could barely breathe for the pain.

When EMS arrived, his blood pressure was 80/40, and his heart rate was 130. Ben was clammy and could barely speak.  The paramedics braced his leg and started an IV.  Fortunately for Ben, they took him to a medical center that had his medical records on file so eventually the clinicians were made aware that Ben had adrenal insufficiency. Unfortunately, Ben was already in crisis, and was vomiting, disoriented, and had seriously low blood pressure.

​Questions

• How many cortisol-consuming stress events can you recognize in this scenario?
  • [ANSWER: running for half an hour before taking his steroid replacements, high emotions around getting the “bad” grade on the test, and the severe injury in breaking a leg.]
• How many symptoms of low cortisol can you identify in this scenario?
  • [ANSWER: nausea, vomiting, disorientation, low blood pressure.]
• What actions could Ben have taken to improve his situation?
  • [ANSWER: wear a medical alert bracelet or necklace at all times, inform responsible adults of his diagnosis, take his medication before putting the physical stress of running on his body, acknowledge his adrenal insufficiency and accept the compromises needed to manage it, put less pressure on himself to be perfect.]
• What could Ben have done to prevent his injury from leading to an adrenal crisis?
  • [ANSWER: wear a medical alert bracelet or necklace at all times, inform responsible adults of his diagnosis.]