New Endo Appt Update

I had my appt this morning with the new Endo .. I was pretty nervous going in, but was determined to go in with an open mind and a positive attitude. I’ll go over the facts from the appt and then y’all can let me know if I’m being too nitpicky? It’s been so long since I’ve had to find a new dr, that maybe some of these things are the norm nowadays?

When I was in the waiting room, they called me back but just called me by my last name and then when I went back with the nurse she never said “Hi” or “How are you?” No small talk.. Just told me to step on the scale, and then measured my height. Put me in a room and asked some basic questions. Then said the dr would be in soon.

(Side note: My old dr is in his own practice, and one thing that did keep me going to him for as long as I did was the one on one aspect of it – his office staff was very small, only 4 people, so everyone knew me as soon as I walked in and you do get treated differently in that type of practice. I knew that this would be a larger practice and I’d be giving that up but hoping that the good outweighs the “bad.)

A few minutes later, he poked his head in the door and said he’d be back in 5 min, but he had a big smile and was super chipper so I thought “so far so good!”

When he came in, there were no introductions, he just sat down and got straight to business. Still had a smile… but never looked me in the eye. First thing was he commented that he knows my former Endo (great *sigh*) and said that they have different styles of practicing medicine (good!) He asked why I was switching and I said it’s nothing personal against my old dr, but he’s very traditional and not very hands on, and I want to have more of a team effort, with someone in my corner to help/guide/support me. He said that this practice is much bigger, very involved in research, and has 6 CDE’s on staff that I would be able to meet with regularly. (Great!)

Then he starts talking about how people with diabetes don’t die from diabetes. They die from complications of diabetes, mostly heart disease related. (I already know this … and I suffer from pretty bad anxiety related to this. I feel like a ticking time bomb sometimes, just convinced I’m going to have a heart attack – but I digress.. )

He was flipping through my medical records and making conversation about how he likes to see an LDL of <100 … mine last year was 155 (yeah, I know … bad) but I told him that if he can find this most recent one from June, it had come way down. He found it and it was 97. (high five, right?) Then he said that he REALLY thinks it should be closer to 70. (Didn't you just say <100 was good?) Ok so we'll get it closer to 70. I've dropped it 58 pts .. what's another 30.

Then he sees my last A1C, which was 6.7. He said that's "fantastic" and he likes to see 6.5-7.0. And proceeds to tell me that there are recent studies that show that if you have an A1C < 6.5 there are higher risks of heart disease. (huh??) So yay me for having an A1c in a "perfect" range (according to this particular dr) but should I NOT try to improve it by going < 6.5 now??

He did check my feet, which my last dr only did maybe twice the entire 12+ years I saw him. (looked fine)

He checked my thyroid and noticed the nodule I have that was biopsied 3 yrs ago (benign) and said we'd keep an eye on it. Said it might be Hoshimoto.

He listened to my heart for MAYBE two seconds. If that. Did not listen to the back (lungs?) just in the front.

At one point he was typing on the computer and glanced over at me and said, "Yea, you're a tad overweight. If you lose some weight, your insulin resistance will be better." (huh??) I told him "Well, I weigh less now than I did when I got pregnant with my twins that were just born last year. It's coming off slowly but surely."

So after all that, he said he wants to raise my cholesterol Rx. Said BP was good so no change there. Wants me to see the CDE in the next few weeks (appt scheduled for end of August) and she and I will be able to work on tweaking my pump settings, etc. (I've been doing those myself for YEARS and am looking forward to having some guidance there.)

Then he got up and left the room … no "goodbye", no "nice to meet you", "see you in 3 months", nada. I had no idea if we were even finished? I sat there for a second thinking "is he coming back?" and when he didn't, I peaked out in the hall … nobody. So I assumed then that we were finished. I grabbed my purse and headed to check out. When I was checking out, the lady said "Ok it looks like he wants you to come back to have a ….. bone density test?" I said, "No, he wants me to see the CDE." She said "Ohhhh ok, that must be what DE means." (huh??)

He also did not ask to see my BG log. Did not even ask anything about my BG's. Did not ask if I needed any Rx's.

There are several doctors in this practice… and I've heard great things about 3 or 4 of them – nothing about this particular one. But when I called to make the appt a few weeks ago, I was not able to get in to see any of the ones I'd heard about for various reasons (booked too far out, and one doesn't take new T1 patients.) So I'm debating whether or not I'm being too picky on some of these things that "bothered" me? He seemed nice enough. But I was naively hoping for less "worst case scenario" talk and more sincere conversation about my diabetes management. I definitely want to meet with this CDE – have heard nothing but great things about her from different people. So maybe if I really like her, and she's the one helping me with my pump settings, etc, then I can look past some of today's weirdness and hope that the next appt is better? Or should I try to see another dr in the practice next time? Not sure if that is frowned upon or not.

Would appreciate any feedback/opinions ……….. Thanks!

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Brittle… and not the candy

I am realizing that the term “brittle” can be very subjective, especially when referring to someone with diabetes.

When I was pregnant with my first son (who is now 6) my chart referred me as a “brittle diabetic”. I asked my OB/GYN what that meant exactly and she fluffed it off and said “Oh we just say that for anyone who has been diabetic for as long as you have.” Ok … whatever. I don’t really like the “label” but if it’s just for medical purposes, it’s ok I suppose.

Then I met a new friend last year who has become one of my closest friends. She has a now 5 yr old son who was diagnosed at age 2 1/2 and she refers to him as a “brittle diabetic”. I asked her once why she calls him that and she said the dr that dx’d him said his is a “very brittle form of diabetes because of how little insulin it takes to crash him, and how few carbs it takes to skyrocket him.”

Hmm.

With just those two definition alone, would it be better to assume that diabetes in general is a “brittle” disease? So many variables contribute to the level of control we can obtain/maintain.

Still not a fan of the term, though. When I hear the word, I think of bones. :)

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I got this

So I have my new Endo appt scheduled for this week (Wednesday morning). I don’t know why I’m so nervous about it … but I am. I haven’t had to switch Endos in over 12 years. And even though I know this move is long overdo.. I’m still anxious/nervous about it. Part of the problem with the last one was I’d gotten too comfortable with him. I was basically only going to him in order to get my Rx’s. And honestly, I’m worried this one will challenge me – even though I know that is a GOOD thing. I’ve managed it myself for so many years, that I tend to get defensive when someone questions why I do something a certain way, or why I DON’T do something a certain way … and I recognize that that is not a good thing – I know it comes from a good place. Just being real.

I am actually in better control, diabetes-wise, than I have been in as long as I can remember. So I need to give myself a pep talk to walk in there on Wednesday with my head held up knowing I GOT this. And maybe it’s just the idea of not knowing what to expect that has me so anxious..? I don’t know.

What I do know is that this is going to be a good change. And that like I said, it’s WAY overdo.

Curious, though, for those that have changed doctors in the recent years, are there any specific questions I should ask HIM or be prepared for – I feel like this should be a two way street. I’ve always heard of it as a “diabetic team” and I’ve frankly never had one of those. :/

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Wordless Wednesday: Update on test strip collection ;)

An update from my post in January… 196 days so far (plus the first few strips I’ve used today)

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Curiosity

I have a play yard set up in my living room for the twins to play in … because, well let’s be honest – when I’m home with just them and my 6 yr old, I’m outnumbered. haha So several times a day I go in the play yard with them and sit and play with them, read to them, whatever happens to be the case. :)

A couple of weeks ago when I was in there … one of the twins found my pump. Now he’s obsessed with it. He knows that if he lifts my shirt a little, he’ll find that little box clipped to my pants. His brother is now becoming curious. I let them look at it, I don’t want them to be scared of it, so if I say “No No” every time they get near it, then I think they’ll be “scared” of it … but I do want to teach them that it’s not a video game where they can start pushing buttons. haha One of them almost ripped it out the other day because he found it and reached for it so quickly, that he pulled his hand away with a handful of tubing. Close call! lol

But it’s funny to watch them – it’s like they’ve found some mystery toy that they’re super excited about. Doesn’t take much to excite a one year old, folks. Or two one year olds in this case.

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Education is Key

Today I had my annual eye exam – I actually missed last year’s exam (hey, I’d just given birth to TWO humans … I get a free pass lol) but am happy to report that again, my dr claims he sees “no signs of diabetes” — which is always nice to hear. :) I’ve worn glasses since ’92, around 6 mos before my dx … but so far no “damage” has been done by this disease, and for that I am very thankful!

I had a couple of interesting conversations with both the nurse and the doctor, though.

First, the nurse was taking my information and asking questions.. it came up with the “what has changed since you were last year?” and my answer was “Well, I’ve had twin babies since then.” lol And then we talked about my diabetes, I mentioned I’ve been a Type 1 diabetic for almost 22 years now. She asked about my insulin pump .. I told her my A1C (when she asked what range I’m usually in) and at some point I forget what I said but her response was, “So you had to still keep taking insulin even after you had the babies?”

*sigh*

I was very nice, though. I paused and said, “Yes, with Type 1, I am insulin dependent and have to give myself insulin 24/7 for the rest of my life. It was not gestational diabetes, which typically goes away after pregnancy.”

So then the dr comes in later, and I’ve been going to him for almost 10 years now so it’s not like I’m a new patient … He was reading my info and said “So is your Endocrinologist happy with this A1C?” Huh? I am actually pretty proud of that number .. it’s lower than it’s been in a long time … when I answered “Yes” He said “Hmph. Ok.” What is THAT supposed to mean ???

Then he also asked about my insulin pump .. how much I take daily on average, etc. I told him and he said, “How’s the pump working out for you?” I told him it was great .. I’ve had it on this time for 7 years but I’ve worn it off/on for about 17 years. He said “Where do you have it now?” He was asking where it’s inserted… I was wondering how that is even the slightest bit pertinent to my EYE exam but I told him in my stomach and he seemed satisfied with that answer and we moved on ….

Sometimes I’m reminded of how uneducated people are about diabetes .. but hopefully I planted a couple of seeds today that both of them will remember the next time they’re talking to another diabetic. :)

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Changes are a-comin’ …

Well… I posted recently about wanting to find a new Endo, and regardless of how I want to look at it, the decision was made FOR me.

I had my last checkup with him about 3 weeks ago, and it went well. Everything looked “great” and I was good to go for another 3 months. Then about a week after my appt, I got a letter in the mail from his office… saying that he could no longer “provide medical services” to me due to my “not paying my medical expenses.” The back story on that all goes back to an insurance glitch from when my insurance changed last year. It was not a large amount at all. And he never said a word about it when I was in his office. Neither did his staff. In fact, his wife, who works at the front desk, asked me about it only twice last year and both times I explained it was an insurance glitch and I was going back and forth with them to get it taken care of – both times she said no problem.

BUT I’m looking at this as a blessing.. because I was obviously having a difficult time pulling off that proverbial Band-Aid. :) In fact, I’ve already booked an appt for later this month with the practice that I’ve been referred to by several other T1s. It wasn’t with the two doctors I have personally heard about but I’m sure the one I’m seeing is just as good, and if anything he’s GOT to offer better care than I’ve received the last 14 years…. (Side note – my “current/former” Endo is a very nice person… just not providing anywhere near the level of service that I feel I need. He basically just writes my Rx’s for me. And as my friend pointed out recently, I could go to a regular GP and get that done if I had to. But I want more than that. I deserve more.)

Stay tuned … fingers crossed this goes well. I’m nervous to start over after almost 14 years.. but I do feel at peace with it, and am looking forward to a new chapter and stepping up my diabetes management. :)

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