Tag: doctor

A Source of Toe-tal Stress

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I don’t like horror stories.

I’m not big on scary things, in general (besides Halloween…I love dressing up)…but horror stories, in the form of tales told ’round the campfire or in media such as television or film, have never been my cup of tea. Probably because I’m a giant scaredy-cat, but I digress.

My disdain for horror doesn’t mean I’ve been able to successfully avoid it over the years. I’ve traipsed through my share of haunted houses, watched countless scary movies (with my hands over my eyes for a good portion of all films), and listened to spooky ghost stories.

The scariest story of all that I’ve heard over and over again has to do with…

Diabetes. And feet. Without going into more detail – because I’m shuddering at the mere thought – diabetes complications could lead to, um, amputations.

I’m not trying to make light of a very serious subject here: Let me be crystal clear when I say that diabetes complications are real and terrible, I wouldn’t wish them on anyone. They also frighten me so much that I tend to avoid blogging or even talking about them altogether. The slightest blur in my vision or tingling in my toes can send waves of panic through my brain that are so intense that I convince myself that I’m experiencing my first diabetes complications.

So when I discovered a cut on my toe several weeks ago, I couldn’t help but totally freak out, especially when I noticed blood around the site.

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As a person with diabetes, you’d never catch me barefoot and surrounded by all those rocks. OUCH.

For most people, a cut on the toe sounds like no big deal – you just put some antibiotic cream on it, wrap a Band-Aid around it, and let it heal. But for someone like me who has diabetes, a little cut triggers fears of serious issues like cellulitis or other infections that could lead to major problems.

It might sound ridiculous, but in the first couple days after I noticed my cut (it was a bit like a split in my skin), I had horrifying visions of my toe turning black and falling off. I became hyper-aware of every sensation I could and couldn’t feel in that area, and when I felt a slight stinging around the area a few times, I imagined that it meant that my days with all of my toes were numbered.

Was it silly for me to jump to such dramatic conclusions? Probably. Was I being paranoid? Definitely. But my overactive imagination was enough to convince me to at least consult my primary care physician about the matter.

I’m glad that I did. Over a two-week span, I had two virtual appointments with my doctor who took my concerns seriously. I described the issues and he gave me advice as to how to treat the cut (stop putting Neosporin and a Band-Aid around it each day, let it breathe, use a nail file to very gently proximate the wound, make sure I wear socks and shoes for all forms of exercise to better protect my feet). He agreed with my overarching concern: to heal it in order to prevent it from getting worse.

My toe is doing much better now, and after all that, I feel a bit (okay, a lot) sheepish that I made such a big deal about it in my head when I initially spotted the split in my skin. But in life with diabetes, everything related to my health has to be taken seriously, even if it means dealing with an added source of toe-tal stress.

 

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First Impressions: How I Feel About my New Endocrinologist

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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

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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.

 

A Farewell to my Endocrinologist

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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

When Diabetes Isn’t Responsible for an ER Trip

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If something unexpected happens to me in terms of my health, I can almost always safely blame diabetes for causing whatever it may be. But when I absolutely, definitely cannot blame my diabetes, I can’t help but feel angry at my body for rebelling at me in ways that it shouldn’t. Particularly when those ways end up with me making a trip to the emergency room.

Let me set the scene: It was a Tuesday evening, around 7:45 P.M. My partner and I were watching an episode of Stranger Things (we’re not caught up yet so please, don’t spoil it for me). Suddenly, I felt an itch on my upper left arm. Like anyone would, I scratched it. But then it got more intense. Like, really, seriously itchy. I rolled up my sleeve so I would be able to scratch with greater ease, and was surprised to feel some bumps emerging on the itchy patch of skin.

I peeled off my sweater and stepped into better lighting in the bathroom so I could examine the area better. There was a large patch of red, inflamed skin on my arm that was covered with bumps that looked like hives. I was dumbfounded. Unsure of what triggered the hives, but alarmed by how swollen and irritated my arm looked, I shot a couple text messages to my EMT father and nurse best friend, who both advised me to get my arm looked at stat.

HUGGING THE CACTUS - A T1D BLOG
Stranger things have happened in my life with diabetes (just had to sneak a pun in there)

And that’s how I found myself in a crowded emergency room, tearful and furious at my body, on a random weeknight. Part of me was relieved that my diabetes didn’t seem to have anything to do with this (but see my recent post on Metformin and you’ll understand that I have some theories about that being the cause). But the other part of me was so pissed off that my body just couldn’t be normal for once. I felt that my body was lashing out at me like an unruly child, declaring its anger towards me in the form of an incredibly itchy, ugly rash. I couldn’t help but stew over the whole situation the entire time I waited to see a doctor.

Long story short, a dose of Benadryl cleared up the hives within an hour. The doctor was unable to determine a cause, since I couldn’t think of anything new introduced to my diet or any new scents/lotions/detergents used in my household. And insect bites got ruled out because the doctor was certain that a bite would be more localized and not spread in a giant patch on my arm. I’m still perplexed at how it happened, but I guess I just have to make peace with the fact that it did and be grateful for 1) making a total recovery from it and 2) not experiencing any issues with my blood sugars as a result of it.

When diabetes isn’t responsible for an ER trip, it means that it’s okay to still be upset about it, but also glad for not having to explain the intricacies of diabetes to every doctor and nurse that walks into the room…because I can’t think of a single PWD that would ever feel happy about taking on that happy task.

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

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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.

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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?

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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.

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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.

Molly, Meet Metformin

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You may have read the title to this post and said to yourself, “Met-WHAT?”

Metformin is the new medication I’ve started taking (along with my typical insulin) to help regulate my blood sugars.

Maybe you didn’t make it all the way to that second sentence; instead, maybe you just Googled Metformin to learn more about it. And you probably immediately got confused, because the Google search results explained that Metformin is a medication normally prescribed to people with type 2 diabetes. You know that I have type 1, though, so what gives? Why am I taking this new pill?

You see, for about a year or so, my endocrinologist has been gently encouraging me to try Metformin. She expressed concerns over the fact that I’ve had diabetes for more than 20 years, and in that span of time, I’ve had to take a lot of insulin. Like, an incalculable amount. And while that insulin helps to keep me alive, there’s also risks associated with it. Namely, she explained to me that there’s research that indicates that people with type 1 who rely on large amounts of insulin have a higher risk of developing cancer later in life.

ClearanceYard Sale

Whoa. The “c” word. Something I never thought I’d hear during a doctor’s appointment. If you know me personally at all, then I’m sure it’s not hard to imagine that I pretty much shutdown at the mention of “cancer”. Almost immediately, I panicked and asked why she thought this research was worth mentioning. She said that it was part of her reasoning for wanting me to start Metformin. The idea is that it would make my insulin more effective, and ultimately decrease the amount of insulin I need each day. She went into a little more detail, mentioning that the only side effects tend to be nausea/upset stomach – and that’s when I stopped listening. I politely told her that I didn’t think Metformin was a wise option for me at that time, and later that day, when I took to Twitter to ask other T1Ds what they thought, I gained swift validation that I’d made the right decision: Other T1Ds with Metformin experience told me that the stomach issues they had when taking it were miserable and that they wouldn’t recommend giving it a try. Plus, I consulted with my T1D pharmacist aunt, and her opinions matched those of the other T1Ds on Twitter. So that was all I needed to hear to feel at peace with my choice to not take Metformin.

In fact, it was enough for me to turn my endocrinologist’s offer down during our next two or three appointments. I was relieved that she never pushed me to try it, but there was a small part of me that wondered whether I should give it more serious consideration. Maybe I should let her talk me into a little, rather than brushing it away and using fear as my excuse.

So we did talk about, during my most recent visit with her earlier this month. She gave me some more compelling reasons to consider taking it. Not only could I reduce my insulin intake, but it might also help me with some preexisting digestive issues I’ve had since childhood. When I asked her about the negative side effects on the stomach that I’d read about online, she told me that she would only prescribe me the “extended release” version of Metformin, which had a much lower (if any) chance of inducing nausea or any less…desirable gastrointestinal disorders.

This news definitely perked me up. We discussed a plan for introducing Metformin to my body: Start by taking one pill daily after dinner. Increase by one pill each week until I’m at four pills per day, the limit. At any point in time, I could message her with questions if I started to notice low blood sugars in the evening.

I felt reassured by this logical plan, as well as her explanations of the benefits of Metformin. So I bit the bullet and I’m in my first week of incorporating it into my post-dinner routine. I can’t say that I’ve noticed even the slightest difference, which isn’t a bad thing. I imagine that will change as my dosage increases.

I intend to blog about this new journey with Metformin; not just for the sake of keeping track of how it affects me, but to also help inform other T1Ds who may have been or may be in the same situation that I was. We’ll just have to see how it goes, but for now, rest assured that I’ll be honest in my writings about my Metformin experience. At this moment in time, I can’t help but feel hopeful that down the road, I’ll be glad I made this decision when I felt ready for it, as opposed to when I was fearful of it.

A T1Diary of my Recent Endo Appointment

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I’m trying something new here today, folks. As you can see, this blog post features not just words, but video, too. How exciting! The aforementioned video shows the before, during, and after of my most recent endocrinologist appointment. I share a touch more than I normally would in this format, and I cover something that’ll be a big subject in one of my upcoming blog posts.

Originally, I shared this video (in short clips) directly to Instagram, where it would live in my stories for 24 hours before going away. But the thought occurred to me to save and splice the video segments together to create a full video, albeit a poorly manufactured one. I’ve decided to call it my first attempt at video blogging, otherwise known as vlogging.

Fear not, my fellow wordsmiths: I still plan on writing actual blog posts. I’m not sure how regularly I’ll be vlogging. But I can promise that if people kinda dig this, then I’ll make a point to vlog semi-regularly. I can also promise that the videos will be a bit shorter and shot in one take, because 1) I don’t think anyone wants to hear/watch me blabber for more than a couple minutes and 2) it’ll help ensure that I don’t jump around from topic to topic. And for the sake of full disclosure, I’m not lovin’ my once-a-month Favorite Things Friday post as much as I used to…so this may eventually replace it. We’ll see.

So, without further ado, enjoy this little video from me…and remember that it was initially created for Instagram, which encourages users to make very short video/photo clips, and helps explain why this whole package is a bit choppy. And please do let me know, in the comments or on various social media channels (accessible in the upper-right hand menu of the Hugging the Cactus homepage), what your thoughts are on vlogging.

 

Aim for an A1c of…What?!

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All my life, I’ve been told that I should do what I can to keep my A1c levels between 6 and 6.5. This is the “ideal” range, the sort of long-term goal I should bear in mind on a daily basis.

So when my primary care doctor suggested that an A1c of 7 to 8 might be a more realistic, sustainable, and healthy zone, my jaw dropped to the floor.

He explained his reasoning for saying such a thing: Since people with diabetes obviously have different needs when compared to people without diabetes, it’s not entirely logical to expect a person with diabetes to maintain an A1c that they might have with a functioning pancreas. He said that as time goes on, it could affect cognitive abilities.

And then he said that this was the range that would be recommended to a person with type 2 diabetes – there’s no new research that indicates any difference in desirable A1c levels for a person with type 1 diabetes, so, as my doctor said, I should continue to aim for 6 to 6.5.

This was such a WTF moment for me, for a couple of reasons.

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Does anyone else feel super awkward taking selfies in exam rooms? Does anyone else even take selfies in exam rooms?!

One being that I had NO IDEA why he was saying this to me. He built up this whole explanation as to what the “new recommended A1c” is, only to inform me at the very end that it was only safely applicable to people with T2D at this time. Was he confused? Did he forget that I have type one for a minute there?

The other reason I was flabbergasted by this little discussion was that we hardly ever go into detail when it comes into my diabetes. In fact, he didn’t even ask me when my last A1c test was, or any questions regarding my insulin pump/CGM. He just asked the standard “how is your diabetes” question, to which I replied with a super-lengthy, not-at-all vague response: “good”. He did put orders in for the standard array of tests that I take for each annual physical, which would inform him of my blood sugar at that moment in time, as well as my current A1c. But it was nothing that I’d be talking to him about during that appointment because the results wouldn’t be available until late in the day. So yeah, I found the whole thing to be pretty bizarre and mildly misleading.

Coincidentally, I’ll be seeing my endocrinologist in a few weeks, and let’s be real here: She’s the one doctor who can best advise me when it comes to diabetes treatments and protocols. So I’ll be sticking with her recommended A1c range for me, which I have a feeling won’t be any different from what I’ve been told all these years with diabetes.