Endo Visits Must Be Logged....

....or else they didn't happen, right?

Hmmm..

He still loves me and wishes every patient was just like me. I'm pretty sure he doesn't say that to everybody. That's my story and I'm sticking to it.

A1c is still 6.3, which is where it's been since last June. Ok, then. I guess that's just how I roll. I was surprised, because the past few months, diabetes has kicked my butt a few (dozen) times, and I thought that would be reflected in the numbers. But I guess not. So....yay?

He gave me some Novolog pens to try, just to see if I like them better than my needles. I would tell you, but I keep forgetting to actually use the pen, so at this point in time, I have no opinion. I need to just keep it with the rest of my stuff, instead of in the fridge, where I just forget about everything until it's time to switch insulins.

It's HOT here.

The rest of my lab numbers should be showing up in the mail anytime now. All I got over the phone was "everything else looks good, kidney and liver is fine, cholesterol is good, your white blood cells were a tad low, but since everything else is fine, I'm not concerned."

Which of course sent me running to Dr. Google and had me self diagnosing everything from leukemia to a basic viral infection. I'm pretty sure I have everything. I would like to see what the cholesterol is, that's what everybody seems to care about, anyway. And so I get to watch my mail with anticipation, which actually brings me great joy. I always love it when there's something other than credit card offers and junk mail. But it also sent me running to my old labs and I can't actually see any WBC counts run before. He always just ran a CMP, not a CBC. And so I have no baseline! Was I always running a little low? A little high? Did I change? These are mysteries that will never be solved.

I know I've had CBC's in the past.

There's got to be one here somewhere.....

A LOT of crap thrown out there at once.

So the other day, I bolused too much because I forgot what I ordered.

Today, I went to In-N-Out (do not judge my food choices) and realized I had forgotten my insulin altogether. My whole kit. No meter, no insulin, nothing. I couldn't test OR bolus.

Fabulous.

I called my husband to see if he could steal some insulin from his diabetic co-worker. No dice. They guy didn't have any extra needles for his pen.

I realized I was right by my endo's office, so I ran in and begged for a sample of Novolog. They gave me one, no problem-o. Whew.

Then I went to my Primary Care for a "physical" because I hadn't seen him in a while, and they were threatening to drop me as a patient. I complained about this. They blamed the insurance companies. They said "Oh yeah, you're here because insurance sent you a letter, right?" I said "No, I'm here because you said I couldn't come anymore unless I scheduled this."

So when my PCP walked in, he said "Hi, Heidi, I heard we strong-armed you into showing up." I laughed. And waited for the next question. Oh, yes, here it is:

"How's the diabetes?"

I always want to answer this question with "Killing me slowly, thanks, but I'm doing everything I can to make it SUPER slow." But I chicken out, and say "I'm controlling it as best I can."

And then the phsycial consisted of basically scrolling through the computer looking over all my labs from the past year or so. I wanted to be off the cholesterol meds.

"But they're working. And you need to lower it a little more. Your LDL is still high for a diabetic. As soon as Lipitor goes generic, you should switch to that."

"They have long term side effects. The cholesterol is genetic. (We won't discuss the In-N-Out). I have a family history of high cholesterol but no heart attacks. High cholesterol is a fake problem. Statins prevent second or third heart attacks, not first ones."

"The medical data would suggest otherwise. Although, yes, they are better at preventing subsequent heart attacks."

"They create long term memory issues."

"The benefits outweigh the risks. Especially for you. You're diabetic."

And that's always where the discussion ends. At "you're diabetic." Automatically high-risk for pretty much everything under the sun. At least he didn't try to throw BP meds or aspirin at me "just in case."

And he gave me a copy of my last labs that didn't get sent to me. I told him I always ask for a copy but sometimes they send one and sometimes they don't. He told me if the doctor doesn't make any notes like "discuss with patient" or "needs to change x" or even "looks good" than the lab work doesn't even go to the MA for her to send out. And thus the mystery of sporadic labwork was solved. And my last CRP (0.4 vs.1.1) was awesome, which boosted his "pro-statin" stance.

Whatever. I do take the meds, I just whine about it.

I showed him my Dexcom, which fascinated him to no end. He had never seen one. And whenever a doctor besides my endo sees it, they always say the same thing, and so I waited....waited...yep. Here it is:

"That's one step closer to an artificial pancreas. They've almost done it!"

Yes, yes they have. Next week I'll go pick it up. (Maybe if Phineas and Ferb worked on one...)

In other medical news, I did mention that I've been hoarse for about 6 weeks now. He gave me a nasal spray, told me to try that, if that doesn't work, try heart burn meds, and if that doesn't work, then I'll need to see an ENT.

In the meantime, the fact that I get paid to do voicing work is a problem. Especially since the voicing I do is for medical reminder calls. (If you get an automated medical reminder call, it might be me. It probably isn't, but the possibility is there. Just remember that.) Who wants a message that says "Your appointment is at 3 p.m." from somebody who sounds like they're horribly contagious? Nobody, that's who.

Well, if you made it to the end of this post, good for you. Truly.

Fun times at the endo. Plus CAPS. LOTS OF CAPS.

So, I went to the endocrinologist last week. He still loves me, thinks my attitude of "I want more beta cells and I don't care what I have to do to get them" is great. My a1c is still 6.3.

It's a nice rhyming number. (A1C! 6.3! There's a cheer in there somewhere.)

My LDL is also down to the 150's, so that's better, but we're still treating it. HDL still high, so that's good.

He also did some kind of sensitivity test, and my cardiac risk is low. I'm not sure what the test is called, because they DIDN'T SEND ME A COPY OF MY RESULTS, even though I ask every time.

I swear that nurse/tech/whatever her title is doesn't like me. I also left without a follow up appointment. It was weird.

"OK, I think I need to make an appointment for 3 or 6 months out."
"He didn't say. When you get your lab work then he'll tell you."
"It's never worked like that before. Can I just make an appointment now?"
"No."

OK, I'll leave now.

So, the real question I had for my doc was regarding my Dexcom. CGM. The Golden Ticket. WHY didn't I get one last time? Denied? What can I do now?

"Huh, I never heard back. Let me check on that."

Then he said he could trial me for a week, but they one they have cost him $800 out of his own pocket, and it wasn't charged, and I would have to BRING IT BACK because it cost him so much money, and I would have to be careful, and the nurse that usually educates on it isn't here, and it was pretty clear he didn't want to hand it over.

And...as it turns out, they never sent the request. That could be why I didn't get one. If my insurance or the Dexcom people don't know I want one, they don't magically send one out randomly. Funny how that works. So this time I stayed there until the request was faxed.

Then I went to lunch with my husband, after being scolded for wanting follow up care.

At lunch the Dexcom people called me. YES. They aren't in-network, but they know people who are, they will be calling me in the next couple of days.

Yada yada yada.....a bunch of phone calls and nagging of my doctor's office later.....IT'S HERE. TODAY. I AM JUMPING UP AND DOWN.

Did I mention that my deductible is met and it didn't cost me anything? 2 weeks later, that would have been quite the different story.

Did I also mention I don't have a clue as to what I'm doing? I guess I will be calling tomorrow to go meet with the nurse to have her show me what to do. While there, I'm going to schedule a follow up appt. You know, if they let me.

"Cause I've got a Golden Ticket...."

In Which I Reveal Confidential Medical Information

So, went to the endo yesterday. Reminded him that I was his favorite patient. He laughed and admitted that I was "one of his favorites". I bet he says that to eveyone who insists on favoritism.

Demanded stem cells. No dice.

Asked about a pump and a CGM. He said he was a fan of pumps for some people, but my control is good on the MDI's, so unless I REALLY REALLY wanted it....he didn't see a reason, and you know what? Shots are fine with me. They really are. The CGM, however, I do REALLY, REALLY want.

He said if I had more days where I woke up super low (like I did right after Easter) then he would definitely fight for me to get one. He also said he would only do Dexcom, not Medtronic. I told him that was great with me. So...do I give myself more insulin to have scary scary daytime lows and get a CGM? NO. Even the thought scares me, and I would never put myself at risk that way. But do you see what the insurance companies have reduced me to????

Speaking of insurance, I found out today that my deductible went up by $1000 (from 3k to 4k) on June 1st with no warning whatsoever. The fact that my daughter's ER visit in April would have COVERED that doesn't seem to phase them. I. AM. BITTER. I'm still going to call and whine at them on Monday, even though I will probably get lost in voicemail hell. (*please say your ID number* *sorry, I didn't quite catch that*)

OK, lab stuff - A1c - 6.3. I'm OK with that, although frankly, I like it to hover at 6 or below. My doctor was thrilled. My husband told me that if I didn't like it, then I had "something to work on for next time." I wanted to punch him in the face. But I didn't. Because he was on the phone. Also I love him dearly.

LDL - still really really bad, and at 196. HDL is up to 57, so that's good. Doc and I had the following conversation:

So, I'm going to put you on blah-blah-statin.

This in instead of the simvastatin?

You're already ON cholesterol meds? And these are your numbers?

Um, yeah. But I forget to take them half the time. That could be the problem. (GREAT with shots, terrible with pills.)

OK, I'm going to up the dose, and even if you miss a few, you should still see some benefit. I'll call it into Walgreens. Put your pills by your toothbrush or something.

All right.

I hate high cholesterol. I kind of think it's a fake problem, because bringing down cholesterol isn't necessarily reducing the number of heart attacks. (Also, my father in law just had a triple bypass and his cholesterol was perfect. My dad's had high cholesterol all his life but at 77, nary a twinge of chest pain.) But I digress, and I will take my pills like a good little girl. I was kind of hoping to go off them, though - I don't like the long term side effects reported. Guess THAT didn't happen.

And it was at that trip to Walgreens, where I decided to pick up my refill of test strips along with my new horse pills, that I was asked to pay over $200 for said strips since the deductible wasn't met yet. I asked them to hold them for me while I railed on my insurance company for a few days. They're cool with that. I'm still going to have to pay it, though - I can feel it in my bones.

Thyroid, CMP, everything else was "fine." Still waiting for the lab results in the mail so I can obsess over them and see what "fine" means. Hopefully I'll get them, I did ask the tech 3 times to send them, but that didn't work last time.

Ok, then - off to check my sugars, then swear at my monitor, wash my hands, and check my sugars again. Last night I shaved 50 points off doing that. How did so much "sugar" get onto my hands? I don't know - it's a mystery.

And So I Add Another Pill

Had a doctor's appt. last Monday. He still loves me. He ran some blood tests.

Thyroid is good.

Vitamin D level is good.

Cholesterol - Bad. HDL and triglycerides are awesome, but that $%* LDL - crept up to 191. That's pretty dang high. My doc is very cautious about treating cholesterol, but that number got his attention.

Phone calls from your doctor on a Saturday morning are never good. Ever noticed that?

He was sweet, though, and said "It's nothing you are doing. Your body just makes LDL because of your family history." It's like he read my last post or something!

And so last night I began a low dose (10 mg) of simvastatin. I really wanted to avoid cholesterol meds, but I guess that was not meant to be. Hopefully it can be short term use - I don't know if that's normal, but it is something I'm going to ask for.

Plus, it wasn't a fasting cholesterol. I had eaten breakfast already. I thought cholesterol had to be a fasting number?

I'm a little bummed. More evidence that my body doesn't work all that well.

More Numbers

Man, this is boring, boring stuff. You know, if you're not me.

VAP test results came back today. Apparently, the fat is pretty fluffy. Good.

Also, when they ran my lipid profile in July, my LDL was 162(considered high), HDL 47 (good) total 221.

NOW the LDL is 146 (moderately high), HDL 52 (very good) total 215.

Of course, the total number doesn't mean much, it's all about what kind of cholesterol you have.

These tests were run almost exactly a month apart. So things are headed in the right direction - although the triglycerides went from 61 to 73, but both of those are still quite low.

As far as the extended results from the VAP, the Lp(a) cholesterol (a very dangerous inherited LDL cholesterol that does not respond to statins), very good. 6. (Under 10 is what you want.) All LDL is pattern "A" the large, buoyant kind. Whew. Pattern B is dense, and often associated with diabetes. I have none of that, not even any A/B pattern. It's the Lp(a) and the pattern that you really want to look at, and the main reason for the VAP.

CRP = 1.1. Under 1 is low cardiac risk , but 1.0 - 3.0 is average cardiac risk, so I'm on the low end of average.

So there you go. No statin for me. The numbers do kind of fascinate me, but then, they're my numbers.

Statin update

Well, I called the study and they got back to me and said I could go on Zocor, but I had to go off during the infusion time. (October) Going off and on seemed a little strange, so I decided to wait until after my infusions to take it.

I wanted to talk to my endo about it. I had my appointment yesterday, and talked to him about waiting until after the infusion to start the statin. He thought that was a good idea, although he wasn't sure he wanted me to treat the cholesterol at all.

I have a family history of high cholesterol, but no history of heart disease. Have I mentioned how much I love my endo? He knows the ADA guidelines, and the reasons behind them, but he firmly believes in treating the individual. He was saying all the stuff that I was reading, that treating high cholesterol doesn't necessarily prevent heart disease, and that some high numbers don't necessarily a sick person make.

HOWEVER, seeing as you do need to be a tad more aggressive when dealing with diabetics and cholesterol, he ordered a VAP test and a CRP test, and he was trying to describe what it was for, and I said "to see if my fat is fluffy?" He laughed, and said "how do you know that term? That's exactly it." I said, "they told me in class."

So there you go. Let's all hope for fluffy fat.

Statin, statin, who wants a statin? Do I?

So, I switched PCP's recently. The new dude ran a lipid profile, since the one I had done at diagnosis was hideously bad, but nobody takes that as accurate, since high sugars also bring up your cholesterol. (Seriously, is there anything high sugars do not screw up?)

Anyway, the LDL was high, and he sent me a card with the results along with a prescription for simvastatin, the generic for Zocor. The rest of the numbers were good, btw. Triglycerides, HDL, all that. And it is light years better than what it was in January at diagnosis.

I'm a little torn about this. On the one hand, I know high cholesterol is bad, especially for diabetics. Bad, bad, bad. On the other hand, I've been reading about statins, and they seem to be pretty well tolerated in for short-term use, but long term, the side effects and risks really start to outweigh the benefits.

The thing that really concerns me, however, is that they have recently learned that they seem to lower your blood pressure as well, which has a lot of people saying "Great! 2 risk factors lowered in one drug!" For me, though, it is not uncommon for nurses to take my blood pressure multiple times, saying "hmmm....that's a little low...let me recheck." And I am constantly hearing "Is your blood pressure usually this low? Is this normal for you?" My last BP 2 days ago was 80/50. So yeah, I run low.

Plus, I'm not sure if I can take a statin while on this study, and there's no way I'm jeopardizing my status in the study for this pill. I asked the study nurse, she should be calling me on Monday to tell me whether or not it's OK.

So that leaves me staring at this prescription, wondering whether or not to fill it. What do you think?