Journal Entry #3

-Updates with Research 

Since my last journal entry, I've been going through a trial and error phase of working with my salt tablet. I planned in my second journal entry that I would work with the NUUN electrolyte tablets to see if I could work with that recipe for creating my own salt tablets. I'm glad that I worked with the NUUN tablets I have at home because while they seem fabulous for light-intensity athletes, I don't think they'd be sustainable for POTS patients. The most possibly viable edition of the NUUN tablets for my research would be the NUUN sport tablets because they have the highest number of electrolytes with 300mg of Sodium and 150mg of Potassium. As I previously mentioned, while this may be suitable for electrolytic recovery after a workout for an individual with a traditional autonomic nervous system, NUUN's electrolyte numbers are measly compared to that of the commercially available oral rehydration solutions. 

The recipe that I've been working with contains 3.5 grams of sodium chloride, 1.5 grams of potassium chloride, 2.9 grams of trisodium citrate dihydrate, and 20 grams of dextrose, all mixed in and added to 1 liter of water. Accounting for conversions and dilution concentrations, this recipe has roughly double the amount of salts and a significantly greater amount of glucose. Besides the high salt content that is crucial for POTS patients that may suffer from orthostatic intolerance and low blood volume, the glucose content of the oral rehydration solution is significant as well as it helps with keeping one's blood sugar supported, and it contributes to the sodium/glucose co-transport system which helps the body absorb and maintain electrolytes.

Infographic provided by NormaLyte on the sodium/glucose co-transport system 

After I determined that NUUN was not a viable option, and as I've been testing out my own recipe, I ordered a few packets of a solution by the brand name of "NormaLyte." It was two gentlemen who created the brand, and as pharmacists, part of their aim was to help people stay hydrated, as well as help those with POTS. They ran medical trials back in 2019 testing the efficacy of oral rehydration solutions compared to intravenous infusion and, from what I could find, their testing supported the same conclusions that I found elsewhere: oral rehydration solutions are just as effective, if not more so, than intravenous infusions at tackling orthostatic intolerance in POTS patients. Not to mention, their "Pure" packs contain the equivalent of 4.4 grams of Sodium Chloride, nearly a whole gram more of sodium chloride added to a liter of water compared to the commercially available oral rehydration solution. As of now, I haven't received my NormaLyte packet to test with, but I'm looking forward to working with that this week. 

As far as my other prototype, my gender medicine checklist, I've recently been compiling bits and pieces of other medical checklists, both from the patients' perspective and from the physicians', to see what kinds of questions may be crucial to ask. 

Checklist includes tasks of encouragement for physicians to follow through with 

Checklist calls on physicians to acknowledge possible cultural factors that may be influential 

These checklist items may be as simple as reminders to be crossed off, much like the function of a to-do list, or they may require as much as an in-depth discussion of the holistic view of the patient. Regardless of the complexity, each prompt / question is integral in assuring that women are acknowledged by physicians for their physiological differences. 

Consulting: Mentors, POTS Patients, Family, etc. 

In my last journal entry, I expressed that I was considering meeting with Mrs. Peck about my project. This coming week, I'm looking to follow through with that and touch base with Mrs. Peck to see if she has any insight regarding both the checklist and the salt tablet that I'm making. When I took her Intro to Medical Sciences class last year, we read portions of Atul Gawande's Checklist Manifesto, which I've been referencing throughout my research for my checklist for this project. With this in mind, I find it fitting that I might be able to ask Mrs. Peck about this checklist of mine that I'm writing. Also, Mrs. Peck and I have talked about POTS before and being a woman as a patient of medicine and the challenges that come with it, so I think she'd be a useful resource for me, at the very least, to interview and gain more fodder of topics I should be aware of to include in my checklist. Not only might Mrs. Peck have some suggestions about where I should further pursue my project, but she might also be able to connect me with another specialist either in gender medicine and/or in POTS research. 

Beyond Mrs. Peck, I'd also like to check in with Mr. Burkett about my salt tablet specifically. I know that he has a background in organic chemistry, so I'd like to ask him questions about anything I should be aware of as I'm mixing all sorts of compounds. After clearing that concern with him, I'd like to see if he has any insight into how I may be able to dehydrate my solution into a tablet, or at the very least power, form. 

Not to mention, I'm curious to see if he knows anything about the sodium/glucose transport system as it plays into the body maintaining electrolytes, considering that he's also my cross country coach and he knows quite a great deal about rehydrating after practice, meets, etc. Assuming it works for Mr. Burkett, I'd like to meet with him the week that we get back to school from our service projects so that I can present to him the information that I have thus far and gather his opinion on it. 

Outside of our STEAM classroom, I've briefly shared my project with my parents. Both my mom and my dad thought that I had interesting ideas and solutions when it comes to Gender Medicine, and they're both health-conscious and curious when it comes to exercise and rehydration, so we had some interesting conversations about the need for glucose in electrolyte drinks / oral rehydration solutions. As far as my checklist goes, my mom is a fan of Atul Gawande and she's familiar with his book "The Checklist Manifesto," so I think she sees a viable possibility in the efficacy of my checklist. 

Even beyond my parents, I've spoken with a few close loved ones of mine that have been diagnosed with POTS and I figured out that some of them have tried the NormaLyte packets before and have found them to be effective. With this in mind, I'm certainly eager to have the NormaLyte packets that I ordered come in so that I can work with them. 

Among the women that I've spoken to that have been diagnosed with POTS, it was disheartening to hear all the stories about being gaslit by physicians and questioned incessantly about the reality of their condition. Nevertheless, I chose to find it motivating as it is these very instances that I am aiming to remediate with my checklist. 

Goals for this Coming Week

For this coming week, I have a few things I'd like to get done, and a few goals I'd like to hit with my research. 

For my salt tablet: 

• Once my NormaLyte packet comes in, dilute it and compare it to the NUUN tablets, the commercially available oral rehydration solution, and my working recipe in terms of sodium, potassium, and glucose 
• Refine my ORS recipe 
• Connect with Mr. Burkett regarding safety concerns and/or amounts of salts/glucose and confirm a date/time to work with him on my ORS recipe 

For my checklist: 

• Gather wide research for all ranges of questions/prompts (using my spreadsheet) 
• Have at least a few sources of fodder to make questions regarding age, gender identity, cultural background, and sexual orientation 
• Conduct some informal interviews with women to ask them what the most frustrating thing about working with physicians is for them 
• Write up a working draft of my checklist 
• Connect with Mrs. Peck and share with her my checklist draft