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Anna Was Born.
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Anna Has Sickle Cell Disease
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Health Choice With Sickle Cell As A Child Part 1
Make good nutrition a family affair so your child doesn't feel punished when they're drinking milk and everyone else has a soft drink.
Eat from a rainbow of fruits and vegetables paired with grains, proteins (such as eggs, fish, chicken, lean meat, beans or tofu) and nuts.
Get plenty of calcium-rich foods such as low-fat or fat-free milk, yogurt, and cheese, leafy green vegetables and calcium-fortified foods such as soymilk, orange juice and tofu. -
Health Choice With Sickle Cell As A Child Part 2
Provide healthy, high-calorie foods including dried fruit, nuts and nut butters, or smoothies if your child doesn't have much of an appetite.
Discuss vitamin D testing and supplementation with your healthcare provider. While sun exposure, eggs, fortified milk and yogurt provide vitamin D, it often is difficult to replenish vitamin D with food alone. -
Health Choice With Sickle Cell As A Child Part 3
Encourage plenty of water to prevent constipation.
Forgo sugar-sweetened drinks for milk or calcium-fortified orange juice, which provide better nutrition. -
Anna's First Diary Entry Part 1
So, I’m back in the stupid hospital again. This time, the pain is in my chest and my leg. My chest pain is really deep, making it hard to breathe-probably an 8 on that 1 to 10 scale the doctors always ask me about. And my leg is throbbing so much that it even hurts when my mom tries to rub it for me-it definitely gets a 10. I tried all things the doctors tell me to do at home-take my pills, take a warm bath, rest…but nothing worked and my mom had to bring me here. -
Anna's First Diary Entry Part 2
Plus I had a fever this time and everyone seems to get really nervous when I get a fever. I guess they get worried I have some sort of infection, which mom tells me can be really, really serious for someone like me-someone whose spleen doesn’t work like it should (they showed me a picture of a spleen once-it was purple!). Until I turned six, they actually made me take antibiotics every single day to try and keep me from getting infections. -
Anna's First Diary Entry Part 5
I get a little sick to my stomach when I think about all the work I’m gonna have to make up this week. I wonder sometimes if Mrs. Collins really gets why I’m out so much—I don’t want her to think I’m a bad kid, or a stupid kid, or a kid who pretends to be sick to get out of going to school. -
Anna's First Diary Entry Part 3
Now I don’t have to take those pills anymore,but my mom makes me wash my hands like 50 times a day…Anyway,we sat in the emergency room for like four hours. The nurse had to stick my arm FIVE times before she found a vein for my IV. The needles don’t bother me too much anymore, but I am SO bored right now. Some kids think it must be fun to sit here all day and watch TV, but I’m sick of it. Plus they’ve got me on the pain meds that make me feel so sleepy, so it’s hard to even stay awake. -
Anna's First Diary Entry Part 4
All my doctors and nurses are really nice, but I’m still really bummed because this week is the science fair at school and I worked really hard on my project. And how am I going to make up all the work I keep missing? I used to get straight As, but now it’s really hard to do that ’cause I miss so much school for doctors’ appointments and trips to the hospital. -
Anna's Second Diary Entry Part 1
Sometimes I really hate this sickle cell thing. It’s always getting in the way!! I’m so sick of missing out on things at school and with my friends. Like last month? I didn’t get to go to my friend’s birthday party because I was in pain…It stinks! I miss out on a few days of school or a few activities and it’s like people kinda forget about me. None of my friends have sickle cell disease so no one really understands. Sometimes I just feel like screaming! Ugh! -
Anna's Second Diary Entry Part 2
Well, I gotta go cause physical therapy is here to help me get out of bed and do some exercises. Usually, we walk up and down the halls of the hospital together to try and get my legs moving. It hurts at first but it always hurts worse if I just sit in bed all day. After we do the exercises, they let me sit in the warm whirlpool for a while, so I always have that to look forward to. -
Anna's Second Diary Entry Part 3
And later, I have to get that ultrasound again… I think they call it a “Transcranial Doppler”… I can’t remember what that one is for (I think maybe it checks to see if there are any problems with the blood in my brain)—there are so many tests I can’t always keep track. -
Anna has Diabetes
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Health Choice With Dabetes Part 1
Making healthy food choices, including controlling portion sizes and reading food labels, is an essential step in maintaining a proper body weight and preventing or managing diabetes.
Individuals with prediabetes or diabetes have additional food considerations, especially limiting simple carbohydrates. Simple carbs are found in foods like table sugar, cake, soda, candy, and jellies, and consuming them causes an increase in blood glucose. -
Health Choice With Dabetes Part 2
With so many food options, it can be difficult realize which ones are healthy. If you have prediabetes or diabetes, this chart will help you determine the best choices. -
Anna's Third Diary Entry Part 1
This is my second month on hydroxyurea .The doctors decided it would be a good idea to start it since I’ve been having so many pain crises this past year. They said this medicine is pretty new but that it can actually help me live longer. -
Anna's Third Diary Entry Part 4
Oh! I forgot the worst part! The doctors said that if I were to get pregnant and have a baby when I’m taking hydroxyurea, there’s a chance the baby would have crazy birth defects. Now, I’m not planning on having a baby anytime soon, but they made me go on birth control just in case.m trying to stay hopeful that this medicine will make things better not worse. I try to keep a good outlook, but sometimes it’s really hard. -
Anna's Third Diary Entry Part 5
I feel different, look different (at least I think I do), and can’t do all the things my friends get to do. Just last week, my doctors told me that going on my senior skiing trip would be a really bad idea…you know, cause of the cold temperatures, the high altitude, and the bone problems in my hip. I begged and they agreed to let me go, but I have to stay in the lodge, bundled up the whole time…meaning I miss out on all the fun my friends will be having on the slopes. -
Anna's Third Diary Entry Part 6
Most of my close friends know the deal with me by now and they try to be really supportive, but I can’t expect them to sit back with me and stop living their lives. Sometimes my sickle cell just makes me feel really alone. I know adults always say that being a teenager is hard, but trust me, being a teenager with this disease is a whole different ballgame. -
Anna's Third Diary Entry Part 2
It should make me have fewer pain episodes and keep me from getting acute chest syndrome again (that was NOT fun—I actually ended up in the intensive care unit for a few days because my sickle cells were blocking blood flow to my lungs and I was having a lot of trouble breathing). I’m not so sure yet. I had another crisis last month but they say it’s still too early to tell if the hydroxyurea is gonna help me. -
Anna's Third Diary Entry Part 3
All I know is that it makes me kinda nauseous and tired, which they say is pretty common.Oh, and I think it’s making my hair fall out, which is NOT okay.Seriously, the other day I was combing my hair and I swear it was like I was shedding!My mom says you can’t tell, but I’m totally afraid I’m gonna wake up one day and have a big noticeable bald spot.So not cute.I already have weird yellowish eyes from my sickle cell and now I’m gonna have thin hair, too?It just keeps getting better… -
Anna's Fourth Diary Entry Part 2
The doctor says that basically, the bone is dying (causing my joints to collapse) because the main artery that supplies the blood to the bone has been blocked again and again by the sickle cells. I’ve been on daily arthritis medications for a few years now and always make it to my physical therapy appointments (which can be pretty torturous if I do say so myself). I even used a crutch last spring to try to give the joint some rest. But it still hurts. -
Anna's Fourth Diary Entry Part 3
And so I’m faced with the decision about whether or not to proceed with a hip replacement. Yup, a hip replacement! You know, the surgery that eighty-year-old men get after falling? That’s what I’m up against right now.
My parents think I should do it, and I sort of understand the reasoning. I’m in chronic pain and it really takes a toll on my life. All the medications, physical limitations…sometimes I actually DO feel like an 80-year-old man. -
Anna's Fourth Diary Entry Part 5
Just last week, I talked with the Office of Disability Services and they said they can try to make sure my next semester courses are closer together or they can arrange for security to come take me to and from classes. I’m already that girl who walks with a limp—do I need to broadcast further my disability with a security chauffeur?
My big worry is that the doctors have said that if they do my hip replacement now, I will need another one in about ten years. -
Anna's Fourth Diary Entry Part 6
Yup, apparently these artificial hips are only made to last about ten years (which wouldn’t be a problem if I actually were an eighty-year-old man)…so I’d need another one in my 30s, 40s, 50s…you get the picture. Plus it’s a pretty major surgery—I’d at least wait until I graduate but then I’d still be looking at putting off the job hunt for several months...and I’d probably have to move back home for a while. -
Anna's Fourth Diary Entry Part 7
Recovery and rehab would be a pretty long process. But maybe it would be worth it?? Who knows, but right now, with this constant pain, something’s gotta give… -
Anna's Fourth Diary Entry Part 1
I just don’t know whether I should do it now or try to manage a little longer with this pain.My orthopedist says the avascular necrosis in my hip joint is just getting worse, which is why walking is becoming more and more challenging.Apparently,the last x-ray showed that the round ball part of my bone is all rough and jagged. -
Anna's Fourth Diary Entry Part 4
I’m not as mobile as I would like to be and it makes it hard for me to go out with my friends and enjoy life like college seniors are supposed to. Plus, it’s SO difficult getting around campus. I have to get up earlier than I’d like just to make sure I make it to class on time, and then when I do, I’m in pain and exhausted-kinda makes it hard to concentrate on Literary Theory when all you can focus on is the throbbing in your leg. -
Anna's Fifth Diary Entry Part 1
I married my best friend Alex a few years ago. I still can’t believe I married a man with the same last name as mine! Things between Alex and I have been going very well and we’ve been talking more and more about starting a family. Since I’ve been off the hydroxyurea for a few years now, there’s no longer a greater risk for birth defects, which of course is a good thing. -
Anna's Fifth Diary Entry Part 2
That being said, Alex has sickle cell trait (we found out just last month – he had no idea), which means that genetics are really not in our favor. I’ve always wanted to have kids, but thinking about the chances of having a child with sickle cell, knowing all that I’ve gone through – I can’t really wrap my head around my own child having to deal with the pain, the hospitals, the complications…And I would be knowingly taking that chance? -
Anna's Fifth Diary Entry Part 6
He gave me a recommendation of someone he works with over at the University Hospital, which generally has a great reputation. I suppose it wouldn’t hurt to have someone who specializes in this sort of thing talk us through our options. -
Anna's Fifth Diary Entry Part 4
And then there’s my mom. She’s not so thrilled about the idea of me getting pregnant.She’s worried about my health and the complications that could arise. Just the term “high risk” makes her get all frantic – and I suppose I can’t blame her given all she’s had to see me go through over the years. -
Anna's Fifth Diary Entry Part 5
Every time she calls, she’s worried about something new – whether the stress of pregnancy puts me at greater risk for stroke, how my artificial hip will manage the strain of pregnancy…she makes good points, and I know she’s just worried because she loves me, but sometimes I feel like she’s not being supportive enough of my desire to have a family.
During my appointment last week, my hematologist recommended Alex and I meet with a genetic counselor. -
Anna's Fifth Diary Entry Part 8
The idea of being able to choose only those embryos that are genetically free of sickle cell disease? That I could be sure my baby would be healthy? Who knew the science existed for that sort of thing? It’s really pretty amazing…but all still really scary.
I suppose I should just go ahead and make the appointment with the counselor to find out more. It can’t hurt, right? -
Anna's Fifth Diary Entry Part 3
Would I end up with a constant feeling of guilt, feeling responsible for doing this to my child? Or could I be in a better place to help him or her through it all since I’ve been there myself? Why does sickle cell always have to make everything so complicated? I would really love it if just one decision in my life could be a simple one…The stress is really taking a toll on me and in the past few weeks, I’ve noticed that it’s really taking a toll on my relationship with Alex. -
Anna's Fifth Diary Entry Part 7
I’ve done some research online (even though my docs always tell me not to!) and I’ve read that some couples decide to avoid pregnancy altogether (and start families other ways), some choose to have the baby only if prenatal tests show that the fetus is healthy, and some choose the help of preimplantation genetics. This last option was totally foreign to me, but after doing some research, I can’t say I’m not intrigued. -
Anna Was Referred To A Cardiologist For A Full Cardiac Evaluation After Two Incidents Of Self-Resolved Chest Pain.
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Anna Has Heart Disease
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Anna Was Admitted To The Hospital For Extreme Pain Associated With A Sickle Cell Crisis.
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Anna Is Released From Hospital
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Anna Started Noticing Strange Urinary Symptoms
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A Sample Of Anna’s Urine As Sent To The Laboratory To Identify The Exact Pathogen Responsible For The Infection.
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Person's of Interest: Doug Greene
Doug is Anna’s neighbor and friend who called the police.
Doug last saw Anna when she was walking her dog at 6:30 a.m. yesterday morning.
Doug reports that Anna usually walks her dog every morning, but that recently she’s been skipping the morning walk. He stated that Anna lives alone, has no family that lives close by, and her closest companion is her dog.
Doug and Anna recently were involved romantically, but Anna abruptly ended the relationship last week. -
Person's of Interest: Lucy Leffingwell part 2
Last saw Anna at work yesterday. Anna left work a little early because she said she had something to take care of.
Lucy mentioned that Anna had been in the hospital recently, but assumed that she was feeling better as Anna told her that she was no longer taking the antibiotics prescribed to her. Anna did however note that she had been experiencing back pain radiating towards her sides. -
Anna Is Dead
Died at 11am -
Person's of Interest: Alex Garcia
Alex is Anna’s former husband.
Alex and Anna went through a nasty divorce last year. As soon as the divorce was finalized, Alex quickly remarried a much younger woman.
Alex and his new wife are currently expecting a baby.
Alex is rumored to be having financial difficulties and is still the beneficiary on Anna’s life insurance plan.
Alex last saw Anna last night when he went to her house to discuss some paperwork. -
Person's of Interest: Erica Piedmont
Erica is the new wife of Alex Garcia.
It was reported that Erica was seen sitting in a car parked on the street in front of Anna’s house the day before her death.
Erica and Alex were seen at a local diner recently having a heated argument. -
Person's of Interest: Lucy Leffingwell part 1
Anna’s best friend and co-owner of a local bakery.
Business has been doing very well lately, but Anna and Lucy have been arguing over whether or not to expand the business and create a sugar-free line of products. Lucy really wants to expand, but Anna refuses.
Lucy has been debating whether or not to buy Anna out of her half of the business. The conflict with their business arrangement has caused a lot of strife in their friendship. -
Anna's Autopsy: Laboratory Results Part 1
Toxicology: Preliminary Blood Results; No evidence of alcohol - BAC (% by volume), 0.015.; Trace amounts of acetylsalicylic acid present.; No evidence of overdose of non-prescription or prescription drugs.
Blood: No evidence of alcohol.; No evidence of non-prescription drugs or overdose of prescription drugs.; Blood glucose level 280 mg/dL (normal range 70-125 mg/dL); A1C-11%; Hydroxyurea, trace amounts – used to treat Sickle Cell Anemia.; Evidence of statins, equivalent to 40mg/day. -
Anna's Autopsy: Laboratory Results Part 2
Stomach Contents: No evidence of toxins or poisons.; 125 mL of partially digested food present.; No evidence of non-prescription drugs or overdose of prescription drugs.; Microalbumin test reveals significant protein in the urine.; Ketones in urine. -
Anna's Autopsy: External Examination Part 3
Trunk: The chest and torso are an appropriate size; no visible sign of trauma. Abdomen is distended.
Extremities:The extremities are symmetrical and without abnormalities. The ankles are swollen and signs of edema are positive with moderate fluid accumulation. The fingernails show substantial graying, indicative of low oxygen. The right proximal humerus shows signs of a recently healed break, as does the left distal tibia. Inflamed, red injection sites on left thigh. -
Anna's Autopsy: External Examination Part 1
General Appearance: The body is that of a well-developed, well-nourished adult Hispanic female who appears to be her stated age of 38. Body height is 64 inches and body weight is 165 lbs. No evidence of post-mortem tampering is present and rigor mortis is generalized. Nails on fingers blue/gray in color. -
Anna's Autopsy: External Examination Part 2
Clothing and Valuables: The body is admitted to the morgue clothed and within a body bag. One ring is present on the right ring finger. Clothes are not torn but are stained with blood. A small amount of vomit is present on the shoulder area of the blouse.
Head and Neck:The head is normally shaped with medium length, black hair. There is an injury to the right temple, including an open wound where pre-mortem bruising is evident. Neck shows no sign of injury. -
Anna's Autopsy: External Examination Part 4
Injuries: A head wound at the right temple, 2 cm in length, and 5 mm in depth at the center. Surrounding area bruised, limited bleeding evident. No skull fracture.Right elbow bruise, 2 cm in diameter, limited contusion. No other visible injuries.
X-ray: The following X-ray image was obtained of the heart and lungs before internal examination. Lungs appear normal with no infiltrates. -
Anna's Autopsy: Internal Examination Part 2
Head and Neck: Lens of the right eye appears cloudy. Blood vessels in both eyes are swollen. Abnormal blood vessels are present on the left retina. Vision was most likely compromised. Examination of the oral cavity revealed significant plaque buildup on the teeth as well as severely receding gums. 4-5 unfilled dental cavities were visible.
Trunk: Left kidney appears pale and shows the beginning signs of necrosis. Right kidney appears normal. -
Anna's Autopsy: Internal Examination Part 1
Gastrointestinal System: The mucosa and wall of the esophagus are intact and gray-pink, without lesions or injuries. The gastric (stomach) mucosa is intact and pink without injury. The mucosa of the three parts of the small intestine, the duodenum, the jejunum, and the ileum, and the mucosa of the large intestine, the colon and rectum, appears normal. Approximately 125 ml of partially digested semi solid food is found in the stomach. -
Anna's Autopsy: Internal Examination Part 3
Cardiovascular System: Examination of the heart revealed concentric left ventricular hypertrophy. There is also evidence of mild mitral valve prolapse. -
Anna's Autopsy: Physical Examination Results
Generalized pallor and evidence of oxygen deprivation.
Fingernails and toenails blue/gray color.
Evidence of vomit in oral cavity.
Blunt trauma to the head, wound indicative of a fall against a solid object, light bleeding suggesting lack of blood flow.
Edema of ankles visible. -
End of Autospy Part 1
Manner of Death: Natural
Cause of Death: Diabetic Ketoacidosis
Mechanism of Death:
Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc).
Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis).
The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. -
End of Autospy Part 2
DKA can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels.The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions.
Other Factors of her death:the noticeable red lines/red streaks on the skin is from diabetes,when diabetes affects the skin,it’s often a sign that your blood sugar levels are too high.For Anna this meant that her treatment for diabetes needs to be adjusted. -
End Of Autopsy Part 3
The ketones she had in her urine is from the UTI she had before she died. The abrasions on the head are from when she fell. The inflamed red injection site on abdomen are from insulin injections. And the three small abrasions on top of left thigh are from her attempting to inject insulin.
