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Saturday, June 16, 2012


It's been a while since I've posted - life has been hectic, and there's no sign of things slowing down.  We're actually heading into the busiest time of our year, so I don't expect to be posting regularly for a while.

It's probably silly of me to be starting a post now, when it's past 1:30am, but I feel the need for a rant.

First, a bit of background.

We lost our family doctor.

We're not sure what happened to him, other then he went on medical leave and hasn't come back.  I had been expecting to hear back about the ultrasound I had done to try and figure out why I'm having pains in my lower left side, near where I had a large cyst removed over a year ago.  Though the discomfort is usually mild - it feels like I pulled a muscle or something, except it doesn't go away - it sometimes becomes uncomfortable to the point that I can't sit up straight.  Every now and then, there are sharp, shooting pains as well.  I figured it would be a good idea to get it checked out, rather then just put up with it, like I normally do with such things.

When I didn't hear from our doctor's office, I figured it was one of those "no news is good news," things; they had no reason to have me come in.  Then Dh needed to see the doctor and called to make an appointment.  There was an automated message saying the doctor was on leave for medical reasons (which has happened before) and giving the name of a doctor at another clinic that was willing to take our doctor's patients, if needed.  We were willing to wait for our own doctor, so never called the other one.  Eventually, though, Dh needed to get updated prescriptions and called again.

The number was no longer working.  Not even our pharmacist had a working number to get an updated prescription.  We ended up having to pay an extra fee for the pharmacy to able to get a 1 month prescription renewal for him.

Dh ended up calling the College of Physicians and Surgeons and, while they didn't know what happened with our doctor, they were able to see that all his files were sent to a holding company in Ottawa!

Long story short, we found ourselves in need of a new family doctor for the 4 of us and, based on a recommendation from our pharmacist, we found one almost immediately at a new health centre just up the block from our pharmacy.

Sort of.

 Dh ended up needing to see a doctor quickly, and they were able to get him in on the same day.  I made appointments for me and the girls for a meet and greet at the same time.

Except we never actually saw a doctor.  Nurse Practitioners (NP) do the majority of the visits with patients now, including being able to prescribe most medications.  We all ended up with the same NP.  Dh had his visit, got written up for a new and very thorough set of blood tests.  The girls and I came back a few days later for our meet and greet appointments, which we were able to do together, saving a whole lot of time.

Before my appointment, they were able to look up the results of the ultrasound for me.  The only thing that was found was a 6mm benign cyst on my left kidney - not something that could be causing the discomfort I'm feeling, nor anything of any concern.  Also, my liver is slightly larger then expected - a "fatty liver" - but I knew that already from an MRI I had done a few years back.  It's also not a health concern.  Everything showed healthy.  I got written up for a very thorough series of blood tests as well, and that was that.

At this point, I was feeling cautiously optimistic about the situation.  Sure, we weren't actually seeing a doctor, but if an NP can do the job, I'm good with that. 

Then I came back for a follow up visit.

The results of my blood tests were pretty much as expected.  My thyroid is working fine, my cholesterol is fine, my liver had one slightly elevated reading, but that was expected and is not a health concern, etc.  There was one reading however, that was off.

My blood sugar was at 8.2  This, apparently, is now considered very high.

Now, I've been pretty aware of my blood sugar levels.  When Dh was first (mis)diagnosed as diabetic (the high reading was before he got his CPAP, and it normalized after his sleep apnea was treated) we charted both his and my blood sugars several times a day for a week for comparison.  Both were well within normal ranges, though mine were on the low side of normal.  Years later, he was re-diagnosed, and this time his blood sugars really were consistently and extremely high.  We still tested my blood sugars every now and then, just to compare.  'cause we're like that.  Mine continued to test normal.

In all these years, my blood sugars have been well within the normal range, and no sign even of "pre-diabetes."  The most recent series of blood tests were about a year ago, and there was nothing odd about them.  My blood work has consistently tested right where it was supposed to be.

But with this one reading, she was ready to pronounce me a diabetic.

Now, if this had been my old doctor, I would not have been suspicious or concerned.  With the NP, however, there were a few things she said that made me increasingly bothered.

First, there were the comments in regards to diabetes itself.  She had some pages printed out from a medical website she referred to as her "Bible." (It turns out diabetes is a specialty of hers.)  I can only half remember the name, and in searching for medical websites, I can't find anything even close to what I'm half remembering.

Anyhow, she started reading off about diabetes to me from this printout, including the part that mentioned that the percentage of people with diabetes is 75%.  I did a double take, but didn't say anything, as she kept on talking, but this sounded really off.  I've looked it up since then, and the Canadian Diabetes Association says that there are 9 million diabetics and pre-diabetics in Canada.  Hardly 75%.  Did she actually believe that 3 out of 4 people were diabetic, whether they knew it or not?  Did I missunderstand what she was saying?  Unfortunately, I can't find anything that could clear that up.

The other thing she mentioned was the change in diagnosis.  It used to be that a blood sugar reading from 4-6.9 was considered normal, while 7 and up was considered high.  Now, anything 6 and up is considered high.  Way to make sure lots more people get diagnosed diabetic.  (It reminds me of how the range of "normal" weight on the BMI was dropped, rendering millions of people "overweight" in an instant.)  It also used to be that it took more then one test to determine if a high reading was not an anomaly, but it hasn't been done that way in a long time.  Now, all it takes is a single high fasting blood sugar reading, and that's it.  No matter how normal your blood sugars might be after that, you're still considered a diabetic, since diabetes is a chronic condition with no cure.

When I mentioned that this reading was a surprise and an anomaly, she said she was willing to give me "the benefit of the doubt."  She wouldn't diagnose me as a diabetic just yet (NPs can now render diagnosis without a doctor, apparently), and wrote me up for another blood test, this one for just fasting blood sugars.

As we were talking, we went back and forth with the other test results as well.  When she went back to my liver test, with it's one slightly elevated but not a concern reading, she mentioned treating it with weight loss.  ??  If something is not a health concern, why does it need to be treated?

The kicker was when she mentioned the normal thyroid results again, saying that we'd tested my thyroid to rule it out as the cause of my weight.

What?  When she wrote me up for blood tests, my weight was never mentioned at any point.  She certainly never mentioned anything in particular about testing my thyroid, since she was checking me off for a whole bunch of things that tend not to get tested for very often.  She had said she wanted to get a thorough blood work, and that's what I got.  The only thing that was mentioned in any other context was when she saw that I had some testing done on my liver in the past - some 5 or 6 years ago - because I'd been put on a prescription that had liver damage as one of the possible side effects.  I wasn't on that prescription long, so it was never an issue again.  That was partly why testing my liver was thrown on the list, too.

One of the things that she said was that, based on the 8.2 reading, she would put me on metformin.  She wasn't going to because of my saying this was an anomalous reading, so she'd wait for a second test to confirm that I'm diabetic.  She clearly already thought of me as such.

Because Dh has a series of follow up appointments coming up, she had me book a follow up appointment with her to go over the new test results, plus a dietitian, on the same day as Dh.  Hopefully, even at the same times, in that he'd be seeing the dietitian while I was seeing her, then he'd be seeing her while I saw the dietitian.  He also has an appointment with the actual doctor, whom we've yet to meet.  In the end, they were only able to book me in the afternoon.

Well, I didn't get a chance to take the test, so I've rescheduled my appointments.  I have to admit, though, I'm not happy with this.

Now, don't get me wrong.  It's entirely possible that I have suddenly become diabetic.  That's not how diabetes works, but it's possible.  I'm over 40 and fat, so my risk factor is a bit higher, however T2 diabetes has a strong hereditary factor, and both my parents are fat, and there is no diabetes in my family.

What gets me is that, if she really believes that 3 out of 4 patients she sees are diabetic, then she'd have decided I was diabetic right from the start, and before I was tested, simply because... I'm a fat, middle aged woman?  Granted, so is she, if not as large as I am, but still...

She also made no attempt to learn more about me.  No attempt to figure out why I went from normal health to diabetic within a year.  She did ask if I'd gained any weight, and I have - it was something I'd intended to bring up, because it's so unusual.  I've gained between 15 and 20 pounds in the space of a few months.  Curiously, I have not changed clothing sizes at the same time.

Oh, and we did also discuss the reason I wanted to see a doctor in the first place - the pain in my side.  I've been written up for another ultrasound.  The previous one was abdominal.  This one will be pelvic.  Beyond that, she really didn't know what to make of it.  It might be because of scarring from my surgery, but that's about all she could think of.  Hopefully, the new ultrasound with tell us more.

So I go to see a doctor (or not see one, as the case may be) about a pain in my side, and end up being told I'm fat and most likely diabetic.

From an NP reading off of online printouts with information I can't find anywhere else.

Since the appointment, I've found myself becoming increasingly angry about this.  Not because of her diagnosis - if I'm diabetic, then I'm diabetic - but because of the circumstances surrounding it.

Oh, and there was one more thing she said that has perplexed me from the start.  Near the end of the appointment, printouts for tests in hand, talking about the follow up appointment with her at the same time as the dietitian (because... I'm fat?  She is convinced I'm diabetic?), she gave me this sort of slyly humorous look and said, "you don't have to be diabetic if you don't want to be."


What does that even mean??  Is she saying that I can just ignore it and pretend I'm not a diabetic?  Or is she saying that I can physically choose to not be diabetic?  And if that's what she meant, how would I go about doing that?  Was it like with the liver test, in that I could "treat" it with weight loss?

I recall when Dh got re-diagnosed diabetic, and he picked up a new glucometer and other stuff the doctor prescribed for him, among the things he got was a booklet about the facts and myths of diabetes.  I'd skimmed through it.  Among the things the booklet said was, to paraphrase, "it's not your fault that you are diabetic; you did not do anything to cause it," and "if you are overweight, your weight did not cause your diabetes.  If you change your diet and exercise to control your blood sugar, you may lose some weight, but you might not, either.  Losing weight is not the goal; controlling your blood sugars is."  It also stated things like, "no, eating sugar does not cause diabetes, either."

Though I haven't had time to get the blood test done yet, or even make an appointment for an ultrasound, there are a few things I've managed to do.  I've borrowed Dh's glucometer, and I've been testing my blood sugars while keeping track of what I eat or drink.

I've also looked up information on diabetes.  Here's a list of symptoms for T2 diabetes, and my comments about whether or not I've got them.

Unusual thirst - no

Frequent urination - no

Weight change (gain or loss) - most sites just mention weight LOSS, not weight gain.  During the appointment, the NP said that my weight gain was probably a symptom, then mentioned weight loss as something that happens after many years. 

Extreme fatigue or lack of energy - no.   The only time I feel extreme fatigue is when I haven't slept.

Blurred vision - no, except when I haven't slept

Frequent or recurring infections - no

Cuts and bruises that are slow to heal - no

Tingling or numbness in the hands or feet - no

Trouble getting or maintaining an erection - n/a

Granted, diabetes can also be asymptomatic, so not having symptoms does not mean no diabetes.  What about risk factors?  Here's another list, with my comments added.

A member of a high-risk group (Aboriginal, Hispanic, Asian, South Asian or African descent) - no
Overweight (especially if you carry most of your weight around your middle) - yes

A parent, brother or sister with diabetes - no
Health complications that are associated with diabetes - no
Given birth to a baby that weighed more than 4 kg (9 lb) - one was 9 lbs 6 ozs, and there was nothing the least bit unusual suggested because of it; quite the opposite.  She's about to turn 16, so I think if that was a contributing factor, it would have shown up a lot earlier.
Had gestational diabetes (diabetes during pregnancy) - no
Impaired glucose tolerance or impaired fasting glucose - no
High blood pressure - no
High cholesterol or other fats in the blood - no
Been diagnosed with polycystic ovary syndrome, acanthosis nigricans (darkened patches of skin), or schizophrenia - no

The thing that made me most curious is why I would suddenly have a high blood sugar reading after all these years of testing normal.  It turns out that there are a few things that cause blood sugars to right in non-diabetics.  One is simply eating lots of carbs.  Not usually an issue with me.  Another is liver function.  Since our bodies always need glucose, our livers store it for later release when we're sleeping, which is why our blood sugars can be elevated in the morning, before we've eaten anything.  Other possibilities are illness and medication related, which doesn't apply to me, unless I count the discomfort in my side as an illness.

Then there was stress.  At first thought, I dismissed it, as I don't really think of my life as being stressful.  Then I thought about it and realized that, yeah, life has been VERY stressful lately!  In fact, once I started thinking about things, the list of stressers in my life right now is pretty friggin' long!  Some of them have been going on for quite a while now, with no respite.  So, yeah, stress could very well have something to do with that high fasting reading.

And what about the non-fasting readings I've been taking?

When talking to the NP about the diagnosis change in what's considered a high reading while fasting (from 7 to 6), I mentioned testing my blood to compare with Dh's, and that my numbers tended to the low side, not the high side.  She casually mentioned that 11 was normal for non-fasting numbers.

After keeping track for a few days (none of my numbers hit the 11 mark she mentioned, though I did get one that eeked above 10 after a restaurant meal), I went digging around for a chart of what normal, non-fasting readings throughout the day should be.  It was hard to find anything to say what's normal for non-diabetics (or any with the scale used in Canada), but from what I have found, my readings fall into the good to excellent range - and that's a very small range according to the charts and sites I looked at!  That 11 she mentioned, by the way, was considered high in all the charts I found, so again, I don't know what she was talking about.

As you can imagine, my confidence in the NP has faded dramatically.  I don't want to go back to her.  I plan to get that second test done, but I don't want to go back to her to go over the results. I sure as heck don't want to talk to a dietitian.  Somehow, I don't think that is going to go ever well.  You see, I discovered something else I was not aware of while keeping these records.  Or should I say, not aware of how bad it was.

I'm not eating anywhere near enough!

I don't obsess with eating or calorie counting, but I do have a problem when I start feeling hungry.  The hungrier I am, the less appetite I have, and the longer I tend to delay eating.  Even so, with my blood sugars normally tending to be low, I have long known I need to eat regularly to prevent them from dropping too much.  I try to, but things tend to get in the way and, before I know it, it's 2 or 3 in the afternoon, and I haven't had breakfast yet.  Some days, I've barely managed to eat a single meal.  I've been doing that far too often.  I hadn't realized how bad I had gotten. 

Somehow, I don't think a dietitian is going see me and my big round belly and bodacious butt and believe that I hardly eat.  I could be wrong and I don't want to prejudge someone I haven't met yet, but I'm already discouraged by what's going on with the NP.
I miss my doctor.

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