LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Thursday, May 27, 2010

More stormy seas

No booze. No caffeine. No smoking. And of course, sex is out of the question.

So this is what hell must be like.

OK, so were to start? Or more correctly, where to continue? I guess we’ll pick up our story with the ER Doc, who came back it to my cubical an hour and a half after the MRI with a big grin on his face, waving a radiology report over his head, “The good news is that nothing is bad enough to justify operating on your back!”

Lovely. And the bad news?

So it turns out I have “degenerative disc disease” plus some arthritis. Mostly typical upper-middle-age stuff. One bulging disc too. No evidence that any nerves are being impinged on. But five of the six lower spine discs are involved, and virtually all the bones. The ER Doc thinks that this is a case of lots of little things adding up to a lot of pain.

He views the problem as actually two problems. First, we need to knock down this acute flare up. Second, there will need to be an ongoing treatment plan for the chronic problems. The second phase will need to be addressed by my PCP, but his opinion is that continued daily use of flexeril, continued daily use of the TENS unit, some physical therapy, and avoiding stress will take care of me most of the time. Well, I can manage three of the four.

He assumes a flare up or two per year requiring more aggressive intervention will be likely. (My PCP later agreed to this plan with the added—as she is in the loop on the problems with the Human Tumor— “Why don’t they fire that fucking bitch? Don’t they know how much you’ve done for the diabetics over there?)

But back to the ER, fixing the current inflammation is apparently going to be the hard part.

“I wish you weren’t diabetic,” says the ER Doc. “I’ve you weren’t I’d use a steroid.”

If you don’t already know, steroids are notorious for wildly elevating blood sugar, even among non-diabetics. I tell the Doc I know exactly what steroids do to my kind, but that I’m not a run-of-the-mill diabetic. I’m a Super-betic with a CGM, a pump, and a vast reservoir of knowledge and resources.

Let’s do this, I say.

Please recall at this point I look more like a homeless drug addict than a Super-betic.

He regards me for a long time with an unblinking stare. I feel he’s weighing the evidence. What his eyes and ears behold must be quite at odds.

At last he sighs, “Let’s do this.”

I’m given prescriptions, a CD of the MRI pics of my back, and am discharged just in time to get to my pharmacy fifteen minutes after they have closed. In addition to the steroid, I’m given an NSAID medication for pain an additional anti-inflammatory action.

I head for the nearest Walgreens drive-though so I don’t have to get out of my car. Of course, the wind snatches my insurance card out of the tray under the bullet proof glass. No shit, this is the second time this has happened to me at a Walgreens.

Then, the day almost over, I get to head home.

But recall that I am CGMless, and I know where there is a spare sensor. In my office at the clinic. It is late on Saturday afternoon when I arrive in the empty parking lot, we’re closed on weekends.

I park right by the back door. Spend fifteen painful minutes getting out of my car, then unlock the clinic door. The pre-alarm sounds and I carefully punch in my alarm code, being careful not to enter my ATM card code like last time.

The place is eerily quiet. My office door has been closed and being postage-stamp sized and full of computers, is staggeringly hot. It is like I have stepped into the Sahara.

I expect it to feel welcoming, like a hug from a loved one. But it is surprisingly sterile. Things have changed, it no longer feels like home.

Out of habit, I throw my keys on top of my desk.

My phone is blinking messages waiting. I know there must be a million emails. But I have strength for neither. There is a strange FedEx box, which turns out to be a new Bayer Contour USB meter. Cool. A new toy to play with and review here.

I get the sensor, tuck the FedEx box under my arm, and head out.

I enter the alarm code and slip out of the building. When I get to my locked car I set the boxes on the hood and start padding my pockets for my car keys. What follows is an increasingly panicked key search Macarena dance.

Then, clear as day, in my mind’s eye, I can see my keys still sitting on my desk. I have locked them in the deserted clinic.

I am locked out.

I am also locked out of my car, which has my go-bag, cell phone, PDA, and my blood glucose meter.

Fuck. Double fuck. Triple fuck. Now what?

I have only the vaguest idea of where my various local co-workers live, and no clue who might be home. And I’m not in much shape to walk, either.

After standing in the hot sun for fifteen minutes trying to jump-start my brain, it finally occurs to me to walk over to the ambulance building, which is manned 24-hours a day, is about 50 yards from me, and is owned and operated by my clinic.

I hope to hell they are not out on a “run.”

I pound on the door. In a couple of minutes an impossibly young looking EMT opens the door. Remember that I still look like a homeless drug addict, and an now in a desperate state of mind.

Hi. Ummmm… I’m not sure we’ve met, I work over at the clinic… and…

The kid brightens up, “Oh, I recognize you sir. We’ve only met once. You run the diabetes program.”

So I give him the reader’s digest version of my day and my predicament. But he has no keys, no employee phone list. But he does have phones, internet, and the local phone book.

First I call Deb. Our land line is down. Something to do with a late bill. Her cell phone has lost signal. I can’t reach her.

None of my associates appear in the local phone book or on the internet.

It does not occur to me until I’m actually writing this that our ambulance service is on our same servers and I could have accessed the internal documents drive that has all the papers, forms, manuals, and the master employee home-phone list.

After 25 futile minutes, I decide to tear my wallet apart.

As it so happens I have the business card for one of our Docs. I call his mobile and he answers right away, I had just intended to ask him for the numbers of some of the support staff who live nearby but he makes the mistake of casually asking how I am.

It all gushes out. I must have sounded like a maniac.

“I’ll tell you what, I’ll just drive over and let you in,” he says, concern in his voice.

Oh, uh, I don’t want to bother you, I know you live about 15 miles away.

“No problem,” he reassures me, “I have paper work I need to work on either today or tomorrow anyway, this makes the decision easy for me.”

So 20 minutes later I have my keys in my hand again, and after a brief interrogation, he is satisfied that the ER Doc has launched an appropriate course of action.

So, finally, at long last, I arrive home. And can take my new meds. The steroid had the expected effects on two fronts. In one hour my blood sugar went from 96 mg/dL to 552. And within three hours I could move without excruciating pain for the first time in days.

But steroids have another side effect too, as I learned reading the documents sent home with me from the hospital and pharmacy. They have a tendency to wipe out your immune system.

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment is you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication. Lovely.

And a reminder: Type-1 Diabetes is an autoimmune disorder. We have pretty crappy immune systems to start with.

The other drug, the NSAID, is contraindicated with three other meds I already take. And I’m also told:

This medicine can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use the medication. Double lovely.

And a reminder: heart attacks kill most diabetics.

And of course this mix of meds also requires no booze, no caffeine, and no smoking. Even so, it beats the hell out of the back pain.

Well, it is Saturday night, and I have an appointment with my PCP on Monday at the crack of dawn. I doubt these drugs will kill me between now and then. I’m supposed to return to work the next day, on Tuesday. But my work place is infection-city. We always joke it would be a nice place to work if all these sick people would stop coming in. I email my clinical boss and decide that if either he or my PCP think it is a bad idea, immune system wise, for me to return to work I will not. If they both give me the green light I’ll return as planned.

Of course I’m still not really ready to face the Human Tumor again, but so many people are urging me to return . . . I have to at least try.

So, being honest with myself, I don’t know if I am really afraid of getting horribly ill while my crappy immune system is compromised, or if I’m just grasping at an excuse to avoid returning to a situation that I view as fundamentally unchanged.

I don’t think the other person in this dance has changed her attitude at all, nor is she likely too. All I can change is my attitude. My approach. And I haven’t really figured out how to do that out yet.

One of my very good friends called today and gave me a useful tool to try. She told me, pretend for the moment that you work at the State Hospital (God forbid). You go in to see a schizophrenic patient. The patient goes bonkers and throws a chair at you. Would you take that personally? Hell no, this is a crazy person. The crazy person threw a chair at you because her mind is a mess. Same with the Human Tumor. She throws crap at you because she’s crazy and you can’t take it personally. Just picture her in a straightjacket, and you’ll be fine.

Hmmmmmmmm… I really like that image of the Human Tumor in a straight jacket. She likes to wear a long white “doctor’s” coat (as is her prerogative, as a licensed provider). It wouldn’t take too much imagination to convert it to a straightjacket in my mind’s eye.

I had generally been trying to image pianos and anvils falling on her head, but all around, I think the straight jacket image is healthier and more productive.

At any rate, my medical boss was away at a conference and never weighed in, but on Monday my PCP was adamant that I not return just yet. She would have preferred I stay quarantined until ten days after I stop the meds. She faxed a note to my clinic, but having already been gone two weeks, I’m not sure if I have any sick leave privileges left. She gave two dates, a further down the road “preferred date” and a minimum safe return date. We’ll see what happens.

Both about my return date and what happens next, when I do return . . .


Blogger Brent said...

Hey Wil,

Nice story today.

Don't sweat the 'degenerative disk disease' thing too much; pretty much everybody has it. It sounds like your disks are spontaneously disintegrating, but they're really just getting old.

My chronic back issues have been relieved by: 3/4" plywood under my mattress, lots of walking and cycling (no more running), 25 lb. less weight, and trying not to be macho in the way that I lift anything.

Good luck!

12:40 PM  
Blogger Scott K. Johnson said...

Well, I'm glad to hear that it is nothing uberly major - although the pain you were in sure makes even this stuff seem pretty major.

And of course you'd lock your keys in your office. You didn't expect for everything to go smoothly, did you?

Keep us posted on how you're doing. Both on the back pain front and the work front.

12:44 PM  
Blogger Bernard said...

Wil, just started prednisone on Saturday for my chest. It's easier to do when I'm on a pump and CGM, but my daily insulin dose almost doubles. And it's a sliding prednisone does, so it's different every 2nd day. I hope you don't have to use it again anytime soon.

12:43 PM  

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