Ariel

Introduction

This is the second of a series of vignettes in which young people with AI have unrecognized or unacknowledged symptoms of low cortisol and the results of their ignoring these situations.  Our goal is to help you recognize your own symptoms of low cortisol and circumstances that deplete your cortisol levels so you can adjust your activities accordingly.  In the rush of daily life, it is too easy to lose track of time, especially when we are not on our usual schedule, and miss an all-important dose of our medication.

The consequences and risk of missing a dose, however, can be serious.  At best, we feel really, really lousy, and it takes a day or several to get back to our baseline.  At worst, we could end up in a life-threatening adrenal crisis and be unable to advocate for ourselves. 

To prevent serious ramifications from missing a dose, it is important to be attuned to what our particular low cortisol symptoms are, be they foggy thinking, muscle and joint pain, clumsiness, or some combination.  Becoming symptomatic should cause us to think about whether we missed a dose or need to take a small booster dose.

Ariel's Story

Ariel was five minutes late for work.  Again.  Ms. Preston, the office manager, scowled at her as Ariel sat down at her desk and turned on her computer.  Upon opening her email, the top message instructed her to report to the branch manager’s office.  Ariel sighed and put her head in her hands. 

She’d already received a second warning about tardiness, but she felt that the administration was nitpicking. As she told them at the last counseling session about her attendance, for her to get to work on time, she would have had to take a bus that got her to the office almost half an hour early. Since no one could enter the office until opening time, she would have to wait outside in the cold and weather.  She almost always worked overtime and often worked through lunch.  She was the highest producing member of her unit, and she had received a recognition award the previous month.   
The previous night, Ariel had been out late celebrating her birthday with friends.  She had, perhaps, drunk a little more than she should have, but how often did you have a birthday, anyway?  Ariel had felt queasy when she woke up that morning, so she skipped breakfast.  Unfortunately, she also forgot to take her cortisol and fludrocortisone.
Ariel went to the branch manager’s office and was stunned when she was informed that she was being terminated for repeated tardiness after multiple warnings.  She suddenly felt a dizzy, sinking feeling.

When she woke up, she was lying on the floor of the branch manager’s office, and he was splashing water on her face. She blinked at him, but she could not process what was happening and why she was on the floor. Ms. Preston stood over her and scolded her for being melodramatic. Although Ariel wore a medical alert necklace, it was under her turtleneck sweater, and she had not told anyone in the office of her diagnosis of adrenal insufficiency. 

​The branch manager and Ms. Preston pulled Ariel to her feet and accompanied her out the door of the office and the building.  Ms. Preston handed Ariel her purse and told her the staff would be mailing her belongings from her cubicle.  Ariel leaned against the building, unsure of where she was and what was happening.  She slid down the wall and sat on the sidewalk.  Fortunately, a medical professional happened to walk by, and recognizing a person in distress, called EMS. The paramedic found her medical alert necklace, and as soon as she arrived at the ER, the doctors gave her IV cortisol.

Questions

• How many cortisol-consuming stress events can you recognize in this scenario?

  • [ANSWER: staying out late, overindulging in alcohol, skipping breakfast, missing medication, being late for work, getting fired, fainting, being put outside while disoriented.]

• How many symptoms of low cortisol can you identify in this scenario?

  • [ANSWER: queasiness upon awakening, dizziness, sinking feeling, loss of consciousness, disorientation.]

• What actions might Ariel taken when she felt faint?

  • [ANSWER: pulling out her medical alert necklace to let the administration know she needed medical attention.]

• What could Ariel have done to prevent some of these cortisol sapping events?

  • [ANSWER: Maintaining a regular sleep schedule, not skipping meals, taking medications on time, not overindulging in alcohol, making sure people that regular contact with her knew of her diagnosis.]