Essay by Isabel Riches

Isabel Riches of Laguna Beach, CA, won the $500 Kuhnel Regional Scholarship.

I embrace the values of personal health responsibility, overcoming adversity through fitness, and never giving up. My college studies at Brown University, concentrating in Health and Human Biology, will prepare me for medical school, and then a career in endocrine medicine where I intend to help restructure care toward a more multidisciplinary and integrated approach. I have also experienced, first-hand, the transformational power of athletics, and am privileged to have helped my little sister, Charlotte, use her sport to overcome her medical disability.

The body’s functions and care fascinate me, and leave me wondering, “Why this particular treatment?” I also thrive under pressure, whether as a lifeguard treating a child’s injury, or when facing an aggressive water polo opponent. My temperament always pointed me toward emergency medicine. Yet in April 2016, when Charlotte was diagnosed with Type 1 Diabetes (T1D), my interest shifted to pediatric endocrinology.

Charlotte’s diagnosis left her feeling “broken” and worried about her future. Our family was in chaos trying to meet her medical and emotional needs. Her school lacked the understanding necessary for her safety. The 24/7 job of manually replacing pancreatic function overwhelmed her emotionally. Charlotte struggled to adjust insulin/carb ratios so she could resume water polo. My parents’ difficulties balancing work with her around-the-clock care was stressful.

I believed that Charlotte’s return to her sport was critical to her recovery and morale. I asked my mom to train me in her care. I learned insulin effect peaks/valleys prediction, basal and meal dose adjustment, bio-monitor installation, glucose level tracking, emergency intervention, and more. I researched blood glucose impacts of foods for pre/post-workout performance, and adopted other diabetic endurance athletes’ insulin dosing workout strategies. I invented a fitted, closed-cell foam collar for her semi-implanted Dexcom G5 glucose monitor for wear in the pool during games. After three prototypes, I saw success when Charlotte played a tournament without opponents knowing she wore the device under her swimsuit!

Fifteen months post-diagnosis, Charlotte led her team to 1st place in the national championships and was named tournament MVP. This was exciting and symbolic for us both. Independently, we had planned and strung-together her care infrastructure, with athletics as the vehicle to shift her survival mindset. Water polo is now Charlotte’s “island of competency”, her positive, personal focus for mental and physical energy, separate from her continual diabetes management.

Charlotte’s clinical treatment was excellent, just too limited. I want to design multidisciplinary care for patients like her, implemented from day one. It must include psychological support, athletics (kinesiology) guidance, biotech integration, nutritional counseling, and educational/legal advocacy.

In my college studies I will also I learn about environmental factors, as in hygiene hypotheses, which may trigger autoimmune “storms” and activate T1D genes. Additionally interesting to me are global health patterns and genetic predispositions of specific geographic populations, as in Finland and Sardinia, which have the highest global incidence of T1D. Though already bilingual, I will continue my Spanish language studies so I can help patients in medically-underserved Spanish-speaking communities.

I am also investigating obtaining a patent for the glucose monitor device collar I designed for Charlotte, and hope to be able to market it in the coming year.

 

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