First Impressions: How I Feel About my New Endocrinologist

Last week, I wrote about how I had an appointment with my first new endocrinologist in about 10 years. I compared my thoughts and feelings about the whole thing to a first date: Many of the same anxieties are felt in both situations.

By now, I’m sure you’re wondering…how did the date go?

Well…I don’t know that there will be another one.

Freedom is the atmosphere in which humanity thrives. Breathe it in.
This blog post serves as a bit of an endocrinologist evaluation.

Before I dive into my appointment postscript, let me just clarify that my thoughts and feelings are just that. They’re my opinions on how my experience was with this particular doctor. That doesn’t mean that she isn’t a great endocrinologist; in fact, I’m certain she is. But I just don’t think that we are doctor-patient soulmates.

For starters, the appointment got off to a weird start because none of my typical vital signs were measured upon arrival. I’m used to having my weight, blood pressure, blood sugar, temperature, and heart rate checked at the beginning of every appointment. But this time around, the only thing that was looked at was my…blood pressure? It was kind of random, and I never got an explanation as to why nothing else was looked at by the nurse, but whatever.

The actual appointment with the doctor herself mostly went as I expected it to. We spent about 20 minutes together (about 5 minutes longer than I usually get with the endo) and I told her a little bit about my diabetes history. She offered me some advice on what to do about the high blood sugars my new inhaler was causing (more on that in another post) and checked my feet as well as my thyroid, just like my previous endo did at every appointment. But she did not check my eyes, and she also…did not review my A1c with me.

This was pretty huge, though not totally unexpected. I knew this clinic didn’t have finger stick A1c machines like the previous clinic did, and that I would have to come to the lab at another point in time to get a current A1c reading. But it was surprising to me that she just glossed over it, like it wasn’t super important at that moment. She didn’t even review my Dexcom/OmniPod/Verio IQ meter graphs with me, despite having downloaded information from all three devices. However, these weren’t the most shocking parts of the appointment.

What caught me off-guard the most is when she said that I could come back in six months instead of my usual three.

In my 22 years with diabetes, I’ve gone to see my endocrinologist every three months, no matter what. Some of these appointments were more like maintenance checks to make sure I was on track with everything, but other appointments came at crucial times for me in terms of improving my diabetes management. I asked the new doc why six months instead of three, and she said something along the lines of…

“Well, it seems like you have everything under pretty good control. And you seem in-tune enough with your body to know to contact us with any questions.”

That latter statement is true, but the former…I don’t know about that. How could she have this impression after talking with me for a mere 20 minutes? It was mildly alarming. I probably could’ve pushed for another appointment in three months, but I got the distinct feeling that I would’ve been rejected had I done so. As a result, I walked out of the clinic that day with another appointment set for July and a feeling of unease settling in the pit of my stomach.

I don’t know that I can wait that long to see an endocrinologist, and I don’t even know if I’ll want to see the same person again. I have no idea how she’d be able to remember me, for goodness’ sake, especially given the brevity of our first and only meeting (so far).

Among all these unknowns, there’s one absolute truth: I miss my old endo.

Just Breathe

Just breathe…a mantra easier said than done when each breath flows in and out smoothly, instead of in ragged, wheezing gasps.

I’m no stranger to asthma. I dealt with it throughout most of my childhood. The details are blurry on when I experienced my first asthma attack, but all I know is that it left me rasping and feeling (on top of sounding) like the cute little penguin from the Toy Story series, Wheezy.

The only thing that would keep my asthma symptoms at bay was nebulizer treatments. The nebulizer is one of those loud machines that generates vapors – albuterol medicine – that must be breathed in through a mouthpiece. I hated these treatments because they left me feeling shaky for a long time afterward and often caused high blood sugar, but it was much easier and more comfortable to breathe after them…so they were worth it.

Throughout my teenage and most of my young adult years, though, asthma slowly became a distant memory. I experienced it less frequently until it stopped altogether, and suddenly diabetes was the only thing I had to worry about. And I was glad for it.

But then…let’s fast-forward to the week leading up to Christmas. I was busy. I mean, wicked busy. I was running all over the place, jetting from one party to another, interacting with all sorts of people who were bringing germs from all over to each of these merry gatherings. I was getting run down and sleeping less due to the holiday celebrations, so really, it shouldn’t have surprised me when I felt the first tinge of a sort throat in church on Christmas Eve. But when that sore throat was soon followed by a tight chest and a whistling sound whenever I exhaled, I was taken aback – not to mention straight-up annoyed.

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The rescue inhaler that’s been my best buddy the last couple of weeks.

I treated the initial waves of wheeziness with my rescue inhaler. But when that started to be less effective over shorter and shorter lengths of time, I knew I needed to get in touch with my primary care doctor. So I did, and I met with a nurse practitioner who diagnosed me with something new: reactive airway disease. I left the office feeling shell-shocked over a new diagnosis that would mean that I would have to use a different kind of inhaler twice daily for the next two weeks.

I was afraid to start it for many reasons, but the two biggest ones were 1) I was nervous it would make my blood sugar go up and 2) it can cause thrush (also known as an oral yeast infection, which sounds positively nightmarish) if I forget to rinse my mouth out with water after each dose.

Overall, though, it doesn’t sound like too big of a deal, right? If it helps my breathing, it shouldn’t be an issue to add this inhaler into my morning and evening routines.

Silly old me, however, did turn this into a big deal. I wasted far too much time fretting over this inhaler and saying “woe is me” for having to deal with yet another medication that was extremely expensive (I paid $56.83 for the darn thing…I have no idea what the total would have been if I was uninsured).

My logical self knows that this won’t do any good. So now, I’m getting my act together and just rolling with the punches.

I’m trying to gently remind myself…just breathe.

 

Why Meeting a New Endocrinologist is Scarier Than Going on a First Date

I have an appointment with my endocrinologist today. Or should I say, the person who I hope is my new endocrinologist. I really want this patient-doctor relationship to work out!

It’s my first new endocrinologist in about ten years and I am effing nervous. It’s comparable to going out on a first date with someone, only I’m not hoping to be wooed with flowers or treated to a fancy meal.

I’m hoping that this person is someone I can trust with my health…which I value a lot more than any of the associated costs of a first date.

Why Meeting a New Endocrinologist is Scarier Than Going on a First Date
There are higher stakes with a new endocrinologist than with a new dating-app match.

Why is this new doctor terrifying to me? For starters, I have so many questions. What if she doesn’t like me? What if I don’t like her? What if she judges me? What if she’s too lenient? What if…? The list goes on and on.

Plus, I’m seeing her after smack dab in the middle of holiday celebrations, also known as the most turbulent time of the year for me and my blood sugars. I’ve had so many highs in the last month that I’ve tried to stay on top of, but she’s bound to notice them and ask me if this is a regular thing for me. It’s also pretty likely that my weight has gone up as a result of the many indulgences I’ve enjoyed in the last few weeks, and I’m worried about whether comments will be made on that.

Not to mention that I haven’t seen an endocrinologist since…late August, I think? And that appointment was with my “old” doctor, who left to practice somewhere far, far away. It was a bittersweet parting, and it wasn’t on amicable terms because neither of us was ready for it to be over. So I’m heading into a new potential endocrinologist relationship with that in my mind, and my new doctor has a lot to live up to when compared with my old doctor.

I just want everything to go well. I know that if it’s not a perfect fit, it’ll be pretty evident straightaway, and I can seek another new endocrinologist. But to continue with the dating metaphor, it’s not as easy as just swiping along and seeing what other nearby options I have. There are other concerns beyond location: I need to make sure my doctor can accept my insurance, on top of them being likable, knowledgable, and eager to help me manage my diabetes. It might be surprising to learn that this particular combination is a tall order, but again, when it comes to my health I refuse to just settle.

Fingers crossed, it’s a match from the start and all of my concerns will be rendered invalid late this afternoon at the conclusion of my appointment…

 

Metformin Update #4: Here We Go Again…

Frequent readers of this blog are probably familiar with my journey with Metformin. If you aren’t, or want to brush up on my history with it, read here, herehere, oh, and here in order to get caught up.

Well, well, well…here I am again, taking yet another attempt at integrating Metformin into my daily diabetes routine.

I didn’t want to, certainly not after last time, when I thought it might be responsible for some unpleasant side effects I was experiencing.

But desperate times call for desperate measures…

METFORMIN UPDATE #2
Yep, I’m giving the giant white horse pills another go.

Long story short (because I’ve explained in previous posts that I had a rough September), my diabetes was totally rebelling against me about a month and a half ago. Each morning, I’d wake up, check my blood sugar (which nine times out of ten was very good, between 100 and 130), and prepare one of three of my standard breakfasts. I’d bolus for them just as I’ve always bolused for them, only to discover that my blood sugar was climbing much higher than it should have in the hour or two after the meal. It was so confusing. I thought it was only a breakfast problem, but when it carried over to lunch, and then dinner…I realized I was facing a bigger issue.

I’m sure you’re thinking that higher insulin dosages were the simple fix to what was happening. But I didn’t want to take approximately 30% more insulin each day to handle something that I couldn’t even begin to rationalize. I didn’t think that should be my only alternative. There had to be something else I could do.

Enter Metformin.

After consulting with my endocrinologist, we agreed that I’d take one Metformin each morning with my breakfast. I explained to her that I was reluctant to go back on it, but she gently reassured me that the side effects I’d mentioned were pretty rare and perhaps there was another explanation as to why I’d experienced them. She also made me feel a lot better about skipping doses here and there – I wasn’t sure if that would reduce the effectiveness of the Metformin – by telling me it would be fine if I forgot a dose or actively chose to miss one.

And so began my third go-round with Metformin.

As of this writing, I’ve been on it for several weeks. And I’ve noticed a difference. My total daily insulin intake is back at a number that I’m much more comfortable with, and I’m not having to take correction boluses multiple times throughout the mornings and afternoons just because I ate my regular meals.

It isn’t exactly the solution that I wanted, but it’s the one that I needed as well as the one that works for me, for now, anyways.

A Farewell to my Endocrinologist

Well…the day I’ve been subconsciously dreading has finally arrived.

It’s time for me to part ways with my endocrinologist…the diabetes doctor that I’ve seen for the last decade…more than one-third of my life.

She’s moving onto new things, and I’m sad to see her go. She’s helped me tremendously over the years.

She’s seen me at my “diabetes worst”, when I was a college student who cared more about having a normal college experience than managing my diabetes.

She was the one who finally convinced me to quit MDI in favor of an insulin pump.

She’s one of the few medical professionals I’ve ever interacted with who treated me like an equal – she never made me feel “less than” or inferior to her.

In other words, I was pretty dang lucky to be her patient.

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The “thank you” card that I plan on giving my endocrinologist, pictured with two devices I started using thanks to her.

I’m trying to take this forced change in stride. Maybe it will be good to meet with another endocrinologist. Maybe it will help me continue to improve. But I am allowing myself to feel a little upset and sorry over the situation; after all, it’s never fun to part ways with someone, especially when you had no say in the matter.

Guess what else I’m allowing myself to feel?

Gratitude.

I feel thankful for my endocrinologist, so I plan on giving her a card with the following message during our appointment tomorrow…because it’s important to me for her to know all the positive change she’s brought to my life:

Dear [Name Redacted],

I wanted to thank you for all that you have done to help me (and my mom and aunt) in the last several years. You have always motivated me to take better care of myself after every appointment I’ve had with you. I appreciate you for being patient with me, listening to my concerns, and inspiring me to try new technologies and treatments to improve my quality of life with diabetes. I don’t like having a chronic illness, but having a doctor like you around to help me deal with it means the world to a patient like me.

Wishing you all the best in your future endeavors!

Sincerely,

Molly

Why It’s Important to Remember That The Doctor Isn’t Always Right

We should always do what medical professionals tell us to do…right?

I mean, why wouldn’t we? They’ve gone through many years of extensive training. They’ve got the education and degree(s) to prove their medical expertise. So why would a patient question a doctor or a nurse when they’re telling them to do something that will improve the patient’s health?

Well, a patient might question a medical professional’s advice when it seems contrary to everything else that the patient’s been told by other, trusted members of their healthcare team.

This is exactly what happened to me when I went to see my primary care doctor a few months ago.

Actually, more specifically, I saw a nurse practitioner who works at my primary care doctor’s practice. I made an appointment with the office because I’d been experiencing some wheeziness that made me think I might have asthma that couldn’t reliably be treated with a rescue inhaler (which is all that I had) on its own. I figured it’d be smart to talk it over with my doctor, or at least someone at his practice, to see if I should start treating my symptoms with another kind of medication or therapy.

Lemon Squeeze
As patients, we should always do what the doctor says…right?

My appointment barely lasted 20 minutes. I met with a nurse practitioner who I’d never seen before. I explained how I’d been wheezing the last several days, and how it got worse when I went to lie down in bed at night. Before I could get another word out, she asked me if a rescue inhaler was all I had to use in these situations. I said yes. She proceeded to tell me that rescue inhalers aren’t designed for daily use because, as the name implies, they’re for emergency situations. Then she started telling me about a steroid that she thought I should begin to use twice daily.

I cringed at the word “steroid” because I know that they don’t interact well with my blood sugars. Steroids can make blood sugars go high rapidly, and it can take hours for blood sugar to come back down to normal levels. I told her this, and she shrugged off my concerns by telling me that the inhaled steroid would be going directly to my lungs, not my entire body like a typical steroid. I remember nodding uneasily and asking her how to use the steroid – I wasn’t going to leave the room until I had a satisfactory amount of information on this new, unfamiliar drug.

She told me I’d take it once in the morning and once at night, before brushing my teeth. Apparently, I would need to be careful and remember to rinse my mouth out with water immediately after administering the medication in order to prevent…thrush. (If you’re unfamiliar with that word, it has something to do with oral, yeast, and infection…A.K.A. something that sounds like a nightmare.) That’s when I really became alarmed. I told her that people with T1D are already more susceptible to that kind of infection, and wouldn’t it be a bad idea to even risk it by taking this steroid two times a day? And again, she essentially disregarded my protests and told me I’d be fine as long as I remembered to rinse. Then, she sent the prescription to the local pharmacy and left me in the exam room in a confused daze.

I went to pick up the prescription, but I never used it. I decided to trust my judgment and avoid a steroid that seemed like it would cause more harm than good. I also figured that since the weather had abruptly gotten cold, then perhaps my asthma symptoms would subside before long; in the meantime, I could use my rescue inhaler as necessary. And you know what?

I was right. My breathing was normal again in a matter of days, and I only had to take a few puffs from the inhaler when it was all said and done. My decision to take my health in my own hands was further validated when I went to go see my allergist soon after this ordeal. I told her all about it as we ran through the list of medications that I regularly take. She was incredulous that I was prescribed the steroid in the first place, seeing as my asthma is practically non-existent. To quote her, “You’re (meaning me) already sweet enough, you don’t need this steroid or a risk of thrush!”

That remark alone sealed it for me: I did what I thought was best because I knew I was capable of making a decision about my body; nobody knows myself better than me…even a medical professional.

Is it Weird That I Love Looking at Lab Results?

Is it just me, or does anyone else anxiously await checking lab results after getting blood work done? And am I the only one who excitedly reads through results, looking for anything abnormal so I can see which area of my health I need to work on? It’s kind of like whenever I handed in a paper or took an exam in college – I always logged onto the student portal multiple times in the days after to check for posted grades. I do the exact same thing with my patient portal.

I know, I know, I’m weird. I prefer to call it quirky.

Lab reslts
An *utterly fascinating* screenshot of some of the allergens I’ve been tested for in the past.

I started thinking about this little idiosyncrasy a few days ago, after I got lab results back from my allergist. She had me go into a lab to get 10 vials of blood drawn so it could be tested to see what types of allergies I had. Fun!!! In the days following, I checked my patient portal dozens of times to see whether the results were up. And when they finally were, I was obsessed with poring through them and seeing how much sense I could make of them.

And I’ll admit, I love looking at lab results because I have a historical view of just about anything and everything I’ve been tested for in my life, and that includes my A1c levels. On more than one occasion, I’ve fallen down the black hole of comparing and contrasting my results over the years. It’s interesting to see how I can trace back certain A1c levels to different events going on in my life at the time it was checked, and more than anything, I enjoy seeing how much I’ve improved in the last decade.

So if this habit of mine sounds plain strange to you, then I don’t want to be normal…I want to be informed. I always want to be informed when it comes to my own health, because ultimately, I’m the one responsible for it, as well as the one who will do everything in her power to improve it.