Desperate times

From the very start, it wasn’t your typical stick-up. First off, the robber didn’t wave his gun in the clerk’s face, shout, or make threats. He merely lifted his shirt to show the gun in his waist band and then did the most unusual thing. The stick-up man apologized to the clerk and asked for $40 from the cash register.

What kind of robber asks for a specific amount? One with a specific need, that’s who.

The Fort Smith, Arkansas, E-Z Mart clerk was either drunk, stoned, or braver than me; as he told the stick-up man the money in the register wasn’t his to give. That’s then the robber fessed up. He is one of us. He needed the $40 for insulin.

Can you imagine needing your insulin so badly that you’ll rob an E-Z Mart?

I can.

The clerk, who deserves to go straight to heaven in my book, took out his own wallet and gave the robber $40. They shook hands and the robber thanked the clerk and left; now not only chronically ill, but a fugitive from the law as well.

What do you suppose an E-Z Mart clerk in Arkansas makes per hour? $40 was a big chunk of the clerk’s paycheck that day.

An E-Z Mart clerk did the right thing. It is time for the federal government to do the same.

The little red-headed girl

Low down dirty dog that I am, I have a new girl in my life. A fiery-tempered red head this time. And being male, officially at least, I couldn’t help but be distracted by her figure. She’s very thin. Groan. I confess. Beauty is only skin deep and, yeah, it’s what’s under the hood that counts, but sometimes you just can’t keep your mind on what matters and you totally fall for looks. And I guarantee that this girl will take any man’s breath away. Maybe a few women’s too.

In fact, since we’ve been hanging out together I’ve met dozens of new people, who just had to come over and meet us.

And how is my wife handling all of this, you ask?

She’s actually thrilled, because if I’m using my little red netbook, she can play Bejeweled 2 on the big library computer longer.

Yep. My new love is a netbook. A Sony Vaio “P” model; a ridiculously light, ridiculously thin, and ridiculously beautiful piece of technology.

All mine.

Well, not really. Not mine at all. Mine to flirt with, travel with, sleep with if I want too, but I can’t marry her. She belongs to the clinic.

After slashing our pay, eliminating our travel re-imbursement, and basically scaring the shit out of all of us…….the economic picture is now getting better. We’ve contracted billing to a professional outfit that knows how to squeeze the insurance companies and works for a modest cut of the action. We both win. Oh, and then a black man in a white hat rode into town. Well, he actually rode into Washington DC, but the effect was the same. All the 4,000+ community health centers in the United States got some stimulus money from the feds. First came a modest amount for salary and staff “restoration.”

Then came the capital funds. Larger money, for larger projects. The bulk of this will go to radiology at my clinic. We’ll finally have X-ray and ultra sound. Very cool. But there was a little bit of the pot left for all departments. I was told to make a wish list.

First on my list was an iPro; this is a Med-T device you’ve probably never heard about. It uses the same CGM sensors I wear, but it does not transmit. It stores. You can put one on someone and turn them loose for three days. They just wear the sea-shell. No monitor on the belt. No feedback to the patient. When they come back you download and you get three days of continuous data to mull over. Meanwhile, you slap it on the next patient in line. It’ll be awesome for filling in the fingerstick gaps.

It just came and the box is unopened on my desk. But not for long!

Next on my list was what I now know are called “Netbooks,” little baby laptops. Over the last year I’ve been more-and-more using computers to look at BGL patterns. I used to be able to (and probably still could, if I had too) look at a log book and visualize what the hell is going on with the patient’s blood sugar. But many patients don’t keep logs. Or they are less than… truthful… logs. Virtually all meters can be downloaded into software programs that vary from divine to awful. Anyway, all of them allow you to create some sort of graph laying time on one axis and BGL on the other and throw in almost any number of days you want.

It is an awesome way to look for trends and it makes adjusting meds a snap.

But then I discovered that showing the graphs to the patients and discussing the picture with them really helped my folks understand their diabetes in a whole new way.

Now we download almost every meter at almost every visit. And I rarely hear the old refrain of “I forgot my meter….”

My patients want to see their downloads (very few people here have computers, less than 5% of my patients).

Which brings me back to home visits. No way to down load a meter at a home visit. I’ve gotten so accustomed to Download & Review as part of a visit that not doing it is like leaving home without your cell phone. Yikes! I’m naked!

I dreamed of having a pocket sized computer to download meters at home visits…..

At a County Health Council meeting a few months ago, my “cousin” (my wife’s cousin’s ex-husband’s new wife) had an Acer. It had a foot print smaller than a sheet of typewriter paper, didn’t weigh too much, and was pretty thin. It set her back about three hundred and fifty bucks. Hmmmmmmmm…..

So I researched these new mini-laptops and choose a low-priced Leveno; the smallest one I found searching “notebook computers” on Google.

Third on my stimulus wish list was a Nonin pulse ox. Then some more anatomical models (you can never have too many), a set of laminated health condition charts with a stand, and finally a door stop. Yeah, money has been that tight.

I knew I wouldn’t get the whole list, but I was really hopping for the door stop.

I didn’t get the door stop. I still have to use a chair to hold our door open.

But I got the iPro and my boss liked the idea of a field computer. That was my medical boss. My administrative boss was thinking of giving me a cast-off from the nurses in the future when they upgraded. Sigh.

A month or two after I submitted my list I was told it looked good for my computer. I went on line to make sure there wasn’t anything new. That’s when I learned the word “netbook.” And that’s when I discovered the Vaio P. Smallest, thinnest, lightest.

A pound lighter than the competition. 65% smaller, in square inches. More than twice the dollars.

I revised my list and was called in to explain why I now needed a more expensive machine. Because it is pound lighter than the competition and 65% smaller…

I also reminded him of the several pounds of gear I carry at all times to make sure I personally stay alive, plus all the crap we have to take on a home visit. One pound is a big deal.

“OK. Why red?” Asked my Medical Director.

Because we are in the blood biz. The Vaio Ps actually come in gloss black, white, green, and red. Color has no effect on price. It might as well match my car.

I was told to order. I suspect my reward for being a loyal soldier during the money crisis. Nice to be loved.

So it also has GPS. And broadband. So now I can find a Starbucks anywhere. And surf the net while I sip a latte.

Actually, that sounds like a great idea. I’m off to Starbucks with my little red-headed girl…. Then maybe later I’ll make a home visit.

The sins of the mother

I learned something soooooooooooo cool today. A new word. A new concept.

Metabolic Imprinting.

In a nut shell this translates into: so goes the mother, so goes the baby. New research shows that out-of-control diabetic mothers are more likely to have babies that get diabetes sooner. This is above and beyond the genetic predisposition for diabetes that gets passed on from parents to the next generation.

So here is a way to think about this: our DNA is our hardware. Our in utero environment is our software. No matter how you are built, your software is how you are programmed to run.

While you are a fetus, your body learns to adapt to the environment it grows in. All human systems seek homeostasis, a biological steady state maintained by a constant dance of input and counter input, just like keeping a car in its lane requires constant subtle adjustments of the steering wheel and accelerator.

If you think about this, it is logical. If your body grows up in a high-sugar environment, it thinks that high-sugar is normal. The problem, of course, is that no matter how much battery acid you are exposed to; you can never adapt to swimming in it. High sugar is battery acid. It corrodes all living flesh in time.

But metabolic imprinting is about more than just blood sugar, it is about the entire balance of what makes us metabolically healthy or unhealthy. Lipids. Blood pressure. God only knows what else. The growing baby learns from its mother how to act. And just like a parent can be a good or bad influence on social behavior, so too, apparently, can she be a good or bad influence on metabolic behavior.

So the lesson for the day for the ladies: if you are planning a baby, get your metabolic house in order first. If you find yourself pregnant (oops!); get your house in order ASAP.

In (very) good company

So our new Pres says we should talk to our enemies before we shoot them and bomb them back to the stone age. Ummmm….OK, I think I might have paraphrased that just a little bit. But I think the approach is prudent. Communication can kill conflict. It can ease tensions. It is civilized, and most problems can be solved in a civilized manner.

Who are the enemies of the D-tribe? Ignorance and Insurance, I’d say. Many others would say big Pharma is also our enemy. I wouldn’t go that far. They keep us alive and more-or-less healthy. But they aren’t exactly our friends either, are they?

One big complaint is that they are clueless to the needs, desires, and overall culture of D-folk. Now it seems one company wants to change that. Maybe. Or maybe something more sinister is afoot. In a minute you’ll see just how paranoid we D-folk are of people who are not quite our friends and not quite our enemies.

So I first got wind of this a couple of weeks ago when I was doing my morning routine of drinking Starbucks and visiting Amy’s blog, which I regard as the New York Times of Diabetes. I start each work day this way. No point in going to work if they cured diabetes, now is there? On this particular morning, Amy was talking about a Summit hosted by the folks at Roche Diabetes Care.

A summit between us and them. Hmmmmmmmmmm…..

It is officially called the Roche Diabetes Care Social Media Summit. Amy says they want to meet with the 25 “most vocal diabetes advocates on the web.” Roche themselves are calling it a gathering of “a small group of thought leaders in the e-diabetes community.”

Of all the players in Diabetes who really ought to listen to their customers, Roche came as a surprise to me. They make the terrible Accu-Chek meters and the terrible Spirit insulin pump. They’ve got a Byetta type drug before FDA…but…well, they always struck me as a “me-too” player in the D-gear and D-med biz. At least nowadays.

Do they have something new up their sleeves?

Do they really want to understand us, or are they trying to figure out a way to use the D-blogosphere as a marketing tool? Good luck with that. The wild-west has nothing on us.

Amy tells us the plan is to create a “manifesto” outlining how we can all work together for common good of patients; and to create a list of “Do’s and Dont’s” in the complicated soup of Pharma / Blogger relationships. Hmmmmm…. Sounds a bit more like a treaty rather than a manifesto; but isn’t that what Summits are for? Someone had better bring a peace pipe.

Anyway, diabetes having not been cured, I had to go to work and treat it. Next best thing.

Two hours later, at the clinic, I check my email and find an email from Roche. What a coincidence, I was just reading about you folks. When I opened it, I got the shock of my life. It was a save the date email. I was being invited to the Summit. I was one of the thought leaders. One of the most vocal of my tribe. Well, I know I have a big mouth, but….

It got even better. When I looked over the “CC” list on my email, I couldn’t believe my eyes. It is a virtual who’s-who list of everyone I know and love and admire on the D-blogosphere. And me too! Yikes!

I couldn’t wait to tell my wife when I got home, so I didn’t. I called her with the news. When I walked in the door that evening I said to her, So how’s it feel to be married to one of the 25 most important diabetics on the internet? To which she gave a non-committal shrug, popping my ego-filled balloon.

On the bright side, my Mother was appropriately proud, excited, and full of advice that I need to ramp up my writing again……

Ode to the Mean-Green-Machine

I love her, but she is killing me. Well, killing my wallet anyway. The turbo-charged PT Cruiser is a gas-guzzler. She’s also tricky to navigate up my rock-and-boulder strewn wilds-of-Australia driveway.

In the beater Accord I’d tank up once a week to take me to work for 4 days. I needed another tank if my days “off” required me to travel to Santa Fe or Albuquerque for one of my little side jobs or assorted missions for the D-tribe.

Now the folks at the gas station smile when they see me coming. That’s because it is taking me a minimum of 3 fill-ups to make it just through the commuting week. And she guzzles the mid-grade, not the cheep stuff.

As my checkbook is shrinking, my black mood is growing.

About a month into this expensive relationship, my wife caught me composing an email to the dealer, asking what they might have on the lot that would get better mileage and be as close as possible to a straight trade. My spouse, who didn’t leave me over my fascination with a certain drug rep, flatly stated she’d leave me if I got rid of the car. “I know you love that car,” she stated, no compromise in her voice.

So I stuck with my frequent gas station visits, hypnotized by the speed with which the gas gauge plummeted. Until Tuesday. That was when the dam broke. When one too many straws were put on the camel’s back.

I was invited to hawk some books at a medical conference in Albuquerque. I had to leave home at 4:30am to get to the city-center location in time to beat rush hour. I had a bad night’s sleep too. It turned into a miserable day all the way around. The speakers were….awful. The participants totally uninterested in the subjects. They were only there for a day off of their usual jobs and to get free Continuing Education Credits needed for their licenses. They belong to one of my least favorite branches of the medical community, and I refuse to say more than that.

By the time I was driving home I was sooooooo stressed I couldn’t even turn my head from side-to-side because my neck muscles were totally locked up, concrete, granite, steel.

I had a dinner date with two colleagues in Santa Fe, and would have actually called and bailed on them except I’d had yet another technology failure. The screen of my cell phone exploded. Yep, looks like a 60’s acid trip. Wild tie-died colors in a shatter pattern. This is actually the second time it has happened. The first time I was convinced Rio had somehow broken it and really grilled the poor kid, who protested his innocence. Oops. Well, parenthood is more of an art than a science. Bottom line, the phone works, but I can’t look up any numbers. If you ain’t on speed dial, I won’t be calling you.

Stressed and depressed and in Santa Fe early for my dinner date, I swing by my car dealership to complain about how much gas the mean-green-machine guzzles. I can’t turn around without filling up. Other than the Harley Davidson, what the best mileage machine on the lot? In talking switch-or-trade-with-low-dollars I’m livid to learn my green machine has been in an accident, greatly reducing its trade value. The sales guy at this same dealership where I bought it not two months ago had told me that it had a clean car-fax report. I guess my fault for not asking to see it.

As I’ve bought seven cars for various family members from this outfit over the years, and am now I’m really pissed, they want to make nice. They loan me a very old diesel VW Jetta to try out for 24 hours. It is dark in color, always bad in New Mexico; and has an uninspired interior. But it is powerful, handles well, and is fun to drive. I haven’t had a “stick” for a couple of decades but somehow my muscles have retained memory. I drive it 75 miles home and the gas gauge dose not budge.

When I get home I find that 8 out of 10 owners of this car would rather have bamboo shoots pushed under their fingernails than buy another one. The consensus is: great car when it is not in the repair shop; which is most of the time. How did we survive without the internet?

Wednesday morning I take it back and pick up the mean-green-machine. The VW clocked a mileage of 49.6 miles per gallon. Holy crap, even with diesel being almost 50 cents more per gallon than the mid grade the PT Cruiser needs, I could still save a couple of grand per year in gas alone. But I live in too much stress to deal with a car that needs lots of shop time.

I drive back to work in my gas guzzler, my stupid food looking for the clutch every time I slow down. I can’t believe my body has re-programmed itself for standard transmission after only two 1-hour drives.

Friday dawns cold and wintery. WTF? I thought it was Spring? Mean-green needs an oil change and she has one of those nagging yellow engine lights that I try to ignore. I’ve also got a funny little interment wine. When I called to schedule service, the folks that sold me the car pass me to the competition: the Dodge Dealer.

Mom’s Subaru is going in for its 7,500 mile service and I’m at Dodge. The two are about 50 yards apart. Rio is restless, so despite the cold, the fierce wind, and the occasions blasts of snow, we brave the various car lots to kill time.

Where upon we find a Rio-sized car. A Cooper Mini. Now I’ve seen full-sized men driving these diminutive cars before and had wondered by what trick of physics this could be possible. It was unlocked so we had a seat in it. You can actually put the seat back far enough my long legs can’t reach the brake. It has a funky retro interior much like my mean machine.

A sales guy braves the storm to come talk to us. He’s very low-key. We tell him we’re just killing time waiting on the service department. Making conversation he asks how long we’ve had the PT and how do we like it. I tell him I love it, but the gas mileage is killing me and that I’m really pissed off about how the neighboring dealership has treated me. I’m thinking that next time I need a new dealership. His response surprises me. “Hey, if you’ve bought that many cars from them with good experiences, don’t jump ship. One bad experience out of seven is a fluke.” He sets Rio up with a giant yellow helium balloon. He doesn’t even give me his card.

So we are back and forth, Rio and I. Between the two dealerships. Between warm waiting rooms and the freezing grey pseudo-blizzard that is brewing. And the little Cooper is on my mind. Surely something just slightly larger than a bread box must get great gas mileage….

On the way back through the show room, the sales guy who came to talk to us is with a car-buying customer, so I casually ask another salesman what kind of mileage the little Coopers get. “Low to mid 20’s.” I’m shocked. “It’s a rocket,” says the kid. No thanks. I’m sick of gas guzzling turbos. He then nods towards the lot, “if you need gas mileage, take a look at the Caliber. She’ll get you 30 on the highway, easy.”

Hmmmmmmmmm…..

Now I’ve never heard of the Caliber. This one is dark metallic red with black trim. Exactly like my Presto meter, as a matter of fact. Its mother was a family sedan, its father an SUV. It has elements of both. It is an aerodynamic tear drop with an aggressive grill. It has a hint of fenders, like some sort of vestige evolutionary remnant that over generations of not being needed has receded from function to decoration. She sits a bit higher off the ground than a car, but not as high as a truck. The windows look smallish. Lots of metal to wrap around you and not too much glass.

Later, I will find out that my assessment of the Caliber’s lineage was correct. It is a new category of car called a CUV or Crossover Utility Vehicle; a mix of SUV and Car.

It is used. And locked. And it is cold. We go back across the street to the dealer where Debbie and my mother are. As it turns out, they’ve just finished Mom’s car. Meanwhile, having just checked, we know that they haven’t even started on mine.

So we do the only sensible thing. We go to lunch. Piping hot French Onion Soup at the little French Pastry Shoppe at La Fonda just off the Plaza. The day has totally gone to hell. Large goose-feather flakes are falling outside the half-steamed over windows.

I excuse myself from the table, step into the lobby and call the Dodge dealership, and ask for the low key sales man that advised me not to jump ship. I’m jumping.

Hey, go take a look at my PT in your garage and figure out what it would be worth as a trade in on that Caliber. Don’t write anything up yet, I don’t even know if I’d like the Caliber. I’ve never driven one, but that’ll change in about two hours.

I go back into the family and let them know where my mind is at. A lively discussion ensues. Rio cries. My mother “ends” the conversation by stating “this is Wil’s decision, and the rest of us should keep out of it.” Where upon for the rest of the day no one, including her, stays out of my business.

We had other errands to run. All I want to do is drive the damn thing, but I put that on the back burner. Family first. As we leave La Fonda, Debbie says, “Screw this. The suspense is killing me. Let’s do the errands later and go drive that car.”

So all the way back across town and down to the Auto Park we go. We had just started the test drive when my cell phone rings. Babe, would you get that please? Deb answers then hands the damn phone to me, who is driving a new stick shift, turning at an intersection, and in a town that tars-and-feathers folks for driving while talking on cell phones.

It is the service department….. “Ummmm….there’s some problems with the PT we need to talk to you about before going ahead with the repairs…” You know what? I’m actually test driving a car from your lot. Don’t do anything until I get back, 15 or 20 minutes tops.

So the little Caliber is great. It is comfortable, tight-handling, turns on a dime, zippy without being monstrously powerful. It is a bare-bones feature-free car. She’s a 07 with less than 20K miles. Power nothing. The mirrors need to be adjusted by manually rolling down the window and poking at them with your fingers. The dash-board is covered with blank fillers where the buttons for all the accessories this car doesn’t have would go.

I love it.

My old Accord was this way. Nothing fancy. Nothing to break down.

Deb is riding shot-gun. Mom, Rio, and the sales guy are in the back. I drive across a median and into a outlet mall’s parking lot. I want to check the turning radius; one of the Achilles’ heels of the PT Cruiser which can’t do a U-Turn to save its’ life.

I do a hard-over left and the nimble little Caliber spins like a merry-go-round. I go around about six times in a tight circle. Rio is delighted, “Weeeeeeeeeeeeeeeeeeeeee!”

We head for the interstate and wrap her up to 80, which I’m sensing is pretty close to top speed for her tiny little 4-cylinder engine. She’s not quiet, but the engine noises seem happy. I crack the window to simulate pipe smoking. The aerodynamics are good. It is not too noisy. It has air conditioning, an AM/FM radio, and a single-slot CD player. No cruise control is the only real bummer.

We exit the interstate to a side road, down shifting smoothly to reduce our speed. Oddly, I have a huge temperature gauge, but no tachometer. I short cut across a bumpy road-side parking lot. The suspension is tight.

Debbie turns to me. “I like it.”

The bomb drops when we get back to the dealership and find the new-to-us-low-mileage PT Cruiser has over a thousand dollars of repairs needed. There is a cracked fuel line, something wrong with some sort of throttle controller, the plugs are shot, the brake discs are glazed, and most seriously, the mystery intermittent whine is comes from what-ever-it-is that holds the front left wheel on the car. They don’t even have the parts. Is it safe to drive? The mechanic and the service manager exchange a looooooooooong look; neither wanting to speak first.

Bottom line, the front wheel could collapse at anytime. The brakes could wait a while, as can the plugs. The throttle thingamajig might crap out, but would only cause the car NOT to start. Once the car is running, no problem. Hmmmmm…that must be why on some days it turns over more times than others….

On the bright side, doing all of this should improve my gas mileage and if we do all this we’ll have a great little gas guzzler that I’m already starting to hate.

Let’s talk, I tell the sales guy.

Then starts the back-and-forth odyssey that I really hate. I do like the Caliber. I’ve now got a bad vibe all-the way around about my PT. Amongst other things that I worry about are the PT’s tires. They are those large, funky, thin things. The receipt from Big-O was in the glove box, and I found it the day I brought the car home. $680. Holy crap.

Caliber has normal sized tires, is four years newer, and has half the miles.

But I couldn’t afford the PT in the first place. Now this. And if I want to keep the PT, I need to come up with some big bucks there too. Life bites.

It is a long day. My mood is poor. I’ve been suffering from achy joints from the tips of my fingers to my shoulder the last few weeks. Today my throat hurts too, and my neck still hasn’t recovered.

I play hard ball. They want the biz, of course. In the end I have to finance at a percentage rate that makes me shudder. But, on the bright side my car payments will only be a few dollars more than my cell phone bill and the gas savings will cancel it out. I won’t really gain in cash flow but at least I won’t need so much Maalox at the gas station.

Hours later it was done. The family had abandoned me once the decision was made. I did all the reams of paper work solo while they went to Hobby Lobby then Albertsons. I pull all my possessions out of the PT and pile them into the back of the Caliber. Too cold, windy, and snowy to organize the car now.

I rendezvous with the family at the grocery store. Rio opts to ride home with me. It is getting dark so Deb pilots Mom’s car for her.

It is starting to get dark. The snow is falling harder. I notice that the cup holders glow fire-fly blue. Cool. The little Caliber is tight and warm.

As we headed out of town, Rio gazes out his window, “you know what Daddy? This is one sweet ride.”