Pretty good medical news

[pameladean]

I forgot to include this in the previous post. When one is diagnosed with diabetes, at least at an HCMC Clinic that uses MyChart, a huge raft of obligations springs up in one's list of Matters that Require your attention, all marked "overdue" even though you had no idea about any of this just the day before. I've been doggedly working my way through them (microalbumin test; dilated eye exam; diabetes education, which is one three-and-a-half-hour class and three two-hour classes; a foot exam with the dread word "monofilament" in it, which makes me think nervously of Sinclair monofilament, though in fact I have looked up the exam and it is no such thing). I was most worried about the eye exam, but put it off because most insurance plans within our reach, even with subsidies, do not cover routine eye care. I hate insurance companies. They should not be allowed within a million miles of anybody's well-being. Anyway, I had the eye exam last week and everything was fine; the diabetes has as yet had no effect on my eyes. They are a little the worse for wear after 63 years, but the ophthamologist said, "Your eyes look very healthy" in a tone of faint surprise.

The classes introduced HCMC's preferred dietary guidelines, which will drive me to distraction if anything does. "Diabetes," said the first instructor, "likes consistency." I hate routine. I hated it in kindergarten, I hated it in high school, I hated it when I had a day job, and I still hate it. Eating at the same times every day, keeping the same bedtime day in and day out, timing snacks, timing exercise, argh. My only comfort is that I have not been at this very long.

Anyway, any thought I had of controlling things by diet and exercise alone has been thoroughly squashed, so I'm taking metformin. After a month of 500 mg, it and my digestive system had come to a cautious truce, at which point, naturally, the medical profession decided to raise the dose. I complained at length both about having to take it twice a day and about the probability of more digestive side effects, so they gave me an extended-release version, which is taken only once a day and has fewer reports of nasty side effects. Not wanting either last Friday's hike or my weekend generally to be messed up, I collected the prescription last Thursday but only took the first larger dose this evening.

I've also spent quite some time down a research rabbit hole about possible ranitidine (Zantac) and metformin interactions, but concluded after squinting through a bunch of scientific papers and finding starkly contradictory statements on various websites for the use of laypeople, that nobody knows much about any of that and I should quit worrying over it. In addition to hating insurance companies, which I feel is quite a rational attitude to maintain, I also, with far less good reason, hate patient information sheets. I have hardly ever read a one of them that didn't send me into a tizzy for days. I don't think they strike the right balance between accuracy about the likelihood of the things they warn about, and specificity about the symptoms one should be on the lookout for. To me they all read like this: THIS REACTION IS VERY RARE BUT IT COULD KILL YOU! EVEN IF IT JUST SEEMS LIKE THE FLU, CALL YOUR DOCTOR! COMMON EVERYDAY MINOR SYMPTOMS COULD MEAN YOU ARE GOING TO DIE!

I think that's enough complaining for one entry.

Pamela

Comments

[naomikritzer]

That is exactly why I tend to carefully fold up patient information sheets, stash them in my purse, and forget about them. It's a self-defense mechanism.

Also, I was flabbergasted and enraged when I found out my health insurance didn't cover routine eye exams. My eyes are part of my body and glaucoma runs in my family. What the hell, you know? (Mind you, my teeth are also part of my body and of course dental stuff is not remotely covered ever by anyone, in part because of the myth that if you are virtuous with toothbrushing you will never have any problems ever.)

[pameladean]

I know, it's completely stupid. Even if you buy dental insurance, it has so many weird loopholes that you still pay a lot out of pocket. I remember my outrage when my dentist told me that dental insurance will cover an actual crown for your molar but not the process of preparing the molar for the crown, without which, of course, it cannot BE crowned at all. I don't think they should be let get away with that, any more than regular health insurance companies should be allowed to make routine eye care a fancy extra that only people with a lot of money can have covered. It should be right in there with flu shots.

P.

[naomikritzer]

When I was 13 years old and spent a year in the UK with my family, at some point in the spring I needed my teeth cleaned. We were there on a tourist visa and had private insurance for our medical care, which did not include dental, so my mother made an appointment for me at a nearby dentist and gave me some cash to pay for it.

They cleaned my teeth and when I tried to pay, they looked at me in utter astonishment. "You're under sixteen," they explained. "All dental care is covered." "But I'm not British," I said (which was obvious from my accent). "And I brought money to pay." "You are under sixteen," they said, firmly and more slowly, and I went home with the money.

[asakiyume.livejournal.com]

"You are under sixteen," they said

Imagine that: a time and place where a government felt that it was the right thing to offer a level of care to all people. Period. Just that. All people. Makes me weep for here and now.

[ethelmay.livejournal.com]

My dad was in England sometime in the 1980s, I think it was, and came down with a UTI, and when he went to the doctor and said he wanted to be treated as a private patient, they said something like they hadn't a form for that and it was easier to just squeeze him in. I don't suppose he was actually treated off the books, but at any rate he didn't have to pay anything, except possibly for the antibiotics.

[pameladean]

Wow.

P.

[naomikritzer]

There was a lot wrong with the NHS in the mid-1980s, mind you. (Thanks heavily to Maggie Thatcher.)

But it still beat the hell out of being uninsured in the U.S.

[pameladean]

I dealt with them briefly in the 1970's when I was on the Carleton London program, and they were just great then. (I had a yeast infection and was massively embarrassed, being in my early twenties and all.)

P.

[pameladean]

I can't resist information, even if I know it will make me miserable. I know people who only look up side effects if they think they have some, but I just have to read the damn things at once.

P.

[minnehaha.livejournal.com]

Wretched hassles designed to deflate you, but I am glad your eyes are in fine shape!

K.

[pameladean]

Thank you; me too!

And I'll try not to be deflated.

P.

[mamculuna.livejournal.com]

My husband was diagnosed with diabetes last year and we went to those classes. I was amazed but he took it to heart, stopped with the bread, milk, candy, and ice cream, took metformin, lost about 40 pounds, and got his A1C back down into the normal range within 6 months. He's still eating well, but he does not eat consistently AT ALL. He nibbles all day long and a good bit of the night--he just switched to nuts and cheese and cole slaw and almond milk. I really hope it lasts, and I hope it goes the same way for you.

[pameladean]

I already stopped with things like soda, candy, and ice cream when I turned up pre-diabetic, and this particular regimen strongly discourages reducing carbohydrates too far -- you are supposed to limit them but not reduce them beyond two or three servings per meal and one per snack.

It is nice to hear that grazing is not necessarily the stroke of doom for getting good numbers, though; thanks, and best of luck to your husband.

P.

[mamculuna.livejournal.com]

My husband is a big guy so they told him he should have at least 100 grams of carbs a day, but he switched to whole grains instead of simple sugars. I think that made a lot of difference. And he was probably eating 200+ grams before! No wonder his a1c was high. But I think he also just ate less. Losing weight is easier for a big guy.

Our counselor told him that many small "meals" were actually better for keeping blood sugar stable. Maybe the consistency thing is to have one pattern or another--not graze one day, have a huge meal the next, combine the two the next, etc.

Good luck, again!

[pameladean]

*sulking* I already switched to whole grains, ten years or more ago. I think my diabetes is not really a result of diet, it's genetics plus my antihypertensives, several of which are known to raise blood sugar -- and probably a strong tendency to be sedentary, which I have conquered for nine months of the year more or less but revert to in the winter..

I bet you're right about the grazing -- as long as that's what one does all the time, and maaaybe as long as one eats consistent amounts more or less, it works all right. I guess I'll find out.

P.

[vass]

A weird and gross thing that they may not think to warn you to expect, with reference to Metformin XR: there is such a thing as a "ghost pill".

How to put this delicately? If you discover evidence that the pill might not have been digested, don't worry: that's the pill matrix. The active ingredients still should have been absorbed.

[pameladean]

Actually, this must have freaked out a lot of people, because it's noted on the patient information sheet AND the actual pill bottle. But I appreciate your mentioning it, as it would have been, yes, disconcerting.

P.

[firecat]

Congratulations for getting through all that stuff.

My diabetic eye exam has always been covered under my medical insurance; it's not routine eye care.

If you hate the dietary guidelines, there are other ways.

[pameladean]

Thank you.

I got a letter from the insurance company detailing the difference between preventive and maintenance care, and diabetic care is not preventive, so I pay out of pocket until I meet the deductible. Obviously I should have gotten diagnosed earlier in the year. With luck I can find a better plan next time.

Please, could you tell me what are the other ways? LJ private message or email are fine if you don't want to discuss it in the comments. pddb at demesne dot com.

P.

[firecat]

Sent you email.

[lblanchard.livejournal.com]

If I ever develop a condition requiring a routine more complicated than "take this pill some time in the morning and put these drops in your eyes right before you go to bed" I will probably die. I've adapted (reluctantly) to the 24-hour cycle but that's about as far as I'm willing to go.

Good luck with all your medical stuff and I'm glad your eyes are good to go.

[pameladean]

Yep, that's me. Perhaps we're from another planet with variable-length days.

The diabetes educators have emphasized over and over that stress can raise blood sugar, so I'm not going to stress myself by being too rigid about the timing of meals and so on.

Thanks for the good wishes, and yes, I am much relieved about my eyes and want to keep them that way.

P.

[asakiyume.livejournal.com]

This is the horrible hazing period, like the first days in a new level of school, when you're made to fill in lots of forms and told that at the bell you will have just! three! minutes! to get to your next class, and that the cafeteria works thus-and-so and so on. But then a few months in, you're done filling out forms and it turns out things are a lot more fluid than they said they were.

With having had to deal with your digestion all these years, you're an expert in your body and how it feels and what its warning signs are. You're already advocating for yourself (getting the slow-release pill). This part stinks--and there's no good side to having an added burden like diabetes thrown on you--but you're going to get through it. One thing that some doctors realize (not all, alas, but good ones) is that setting up a program that's impossible for the patient to comply with is essentially denying care, because what good is a program a person can't comply with? So if the regimentation is going to be impossible, see what ways it's okay to deviate from it. like mamculuna's husband.

Very glad your eyes are a-okay!

[pameladean]

Thank you, that is very comforting. Hazing, yes, it's just like mild hazing where they aren't allowed to lock you in a closet or even abuse you directly.

I find myself repeatedly recalling the maxim of a website for people whose cats have chronic renal failure, which is: "The best food for a CRF cat is a food that the cat will eat." So that goes for me too.

P.

[sartorias.livejournal.com]

Very glad about the good news portion.

Hell yes, about insurance companies, and patient 'info' sheets. The mass I got after my stroke was enough to give me another one--a horrible combination of legalese, medicalese, and dire warnings about everything, including breathing. ("If you are short of breath . . .") reading that mess made me short of breath! I finally threw it away, after a week or two of anxiously trying to keep track of all 14,784 different symptoms that were Five Alarm Fires.

[pameladean]

Eeeeee, yes, talk about inducing the results they were trying to prevent! I think there is a legal aspect to all these things, and it interferes with actually presenting information in a useful way. I'm glad you threw it out.

P.

[inlaterdays.livejournal.com]

So glad about the good news and the great eye exam.

Patient information sheets are awful. I tend to react idiosyncratically to meds, so my doctors usually have to fuss with different meds and dosages until they find something that works for me and doesn't give me nasty side effects.

I hope that the dietary guidelines turn out not to be too awful to stick to.

[cat-sanctuary.livejournal.com]

Insurance companies should be recognized as a health hazard.

Healing vibrations are being sent through the computer :-)

[pameladean]

Thanks so much!

And yes, insurance companies should come with a very strongly worded information sheet about how they are trying to kill us.

P.

[mle292.livejournal.com]

This is advice, which you didn't ask for and is possibly worth less than you paid for it, and which you should feel free to ignore - especially because you may have already tried it without success.

I have had great luck with calling CUB's pharmacy and asking to have a pharmacist explain likely and unlikely drug interactions to me. You may need to leave a phone number and ask for a call back once the pharmacist has time to look everything up - I still find them more helpful than the internet for such things. You don't need to have filled any prescription with them to get a response, but their helpfulness has made me loyal to them. They are well trained professionals, and understanding and researching interactions is what they were trained to do. My experience has been that many of them are nearly giddy to do something more interesting than count pills.

[pameladean]

*sigh*, I answered you as a top-level comment, just below yours.

P.

[pameladean]

I had no idea Cub was such a resource. The HCMC pharmacy is insanely cheap, so I won't likely be using Cub for meds. I did ask the HCMC pharmacist about the metformin/ranitidine interaction, but failed to specify which one I meant, and she answered me as if the concern were that the ranitidine, which reduces stomach acid production, might inhibit absorption of the metformin. It took me a while to figure out that this was what the answer was about. And that's a possible interaction, just not the one that worried me. If they aren't too busy next time I pick up meds, I might ask again and specify what exactly I'm worried about. I think most pharmacists are almost like reference librarians in that they are just delighted to answer questions and provide information.

Anyway, I almost never mind unsolicited advice; it's kindly meant, and there's nearly always something useful in it.

P.