It's Only Money

I know that most of us in the OC have frequent concerns about money, the cost of good health care and having our diabetes needs met now and in the future. I think about it a lot.

I needed to document some expenses for my '05 Health Care Spending Account at work and ordered an itemized hospital bill for my broken ankle surgery. I had heard the stories about "charging $5 for an aspirin" and didn't think much about it, until the envelope with 7 pages of expenses came in the mail yesterday.

Can you believe these charges?.............

• finger-stick blood sugar test $15
• one 250 mg tablet of oxycodone $22
• one 75 mcg tablet of synthroid $17
• one titanium plate (to hold the bones together) $560
• 5 minutes of instruction on using crutches $300
• one "Darth Vader" air cast $275
• one ace wrap $20

But the real whack upside the head was the insulin. I saw the first entry, "insulin/Humalog", $35 and thought, "well, that's pretty much in line - not too bad". Then, the same day I saw three more $35 entries. I called the billing department as I had a couple other questions and the rep said, "oh, they use a new bottle for each injection to avoid cross-contamination". A new bottle for my 3 unit dose to cover lunch? And throw the rest away? Good thing I was only there for 2 days. I then phoned my HMO case worker and we talked about this and she said this particular hospital had recently re-evaluated their policy and they were taking multiple doses from the same vial for each patient.

I had good coverage for the stay and am thankful that there was only a $500 co payment on my part. The total bill for the surgery and 2 nights was $17000. Go figure. Things do seem to be spiraling out of control in a big way and I don't know what to do about it.

It didn't help that the nursing care was fair, at best. I had asked for a toothbrush more than once and was never brought one. Beause of the diabetes I was supposed to have been sent home with detailed written instructions about wound care and inspecting the incisions along with several sets of new dressings (somebody forgot). When I was talking to the surgeon's PA after I got home, she asked how the staples looked and I told her I didn't know I was supposed to take the leg out of the boot. She said it was very important that everything be inspected 3x daily, per the "handout" so a runaway infecction didn't set in. She said to do so immediately while she was still on the line. I said "but I don't have any new bandages" and she suggested I use a minipad. I told her I was out and could I use a tampon instead? ...........she thought I was kidding; I was not.

I'm not planning on going to the hospital anytime soon, but, if so, I will ask for an itemized bill right away while things are still fresh in my mind. And I will not let my questions go unanswered.

The Great Minnesota Get Together

Every year my friends E and J and I mark the beginning of the end of summer by going to the Minnesota State Fair. It lasts for 10 days, but we always go on the first day while things are still nice and fresh.

The fair is a chowhound’s paradise - food stands every 10 feet, mostly offering things loaded with fat, sugar and salt - yum. For many people, the only reason to go is to eat themselves into a stupor (been there, done that)

About 4 years ago we tried something different. We went right after lunch, made the decision not to have anything but water. Since we each had then saved at least $30, we would close the day by going out to dinner at an upscale seafood restaurant in my neighborhood.

It has worked great each year - no stress over what to have, no guilt over unwise choices, and no lethargy from being stuffed to the gills. I also treat hypos only with glucose tablets. We all know that just one chocolate chip cookie when low can easily lead to an unbecoming episode (also known as a binge).

13 Foods I DID NOT EAT at the Minnesota State Fair:

Category I - easy to pass up
Deep fried pickle on a stick
Deep fried Twinkie on a stick
Deep fried Snicker Bar on a stick
Yogurt made from sheep’s milk, called “ewe-gurt”

Category II - I’m curious about these
Bayou Bob’s alligator tail on a stick (last year they sold 10,000 pounds worth)
Personal pan-fried nuggets of ostrich meat
Buffalo jerky

Category III - drooling all the way down the street
Giant cream puffs
Yard long red licorice whips
Apple fritters made with the Minnesota State Fruit - the honey crisp apple
Onion rings
Foot long hot dog
Homemade rasberry pie served by blue-haired ladies at one of the many church diners

Fun things we did:
Patted a porcupine
Held an iguana
Watched a race of miniature goats pulling little carts; one of them escaped and was still MIA when we left the arena
Had my posture evaluated by a chiropractic student - yes, I know that my shoulders are uneven from carrying that heavy purse all these years
Saw of likeness of this year’s “Dairy Princess” being carved from a giant block of frozen butter.

I also artfully dodged a big glob of llama spit that flew over my shoulder. Its owner said, “now, honey, you went and provoked him - he doesn’t like being stared at and you made him mad”. (Ahem, what is he doing on display if he doesn’t like being stared at?)

We happily ended the day with a lovely meal of scallops, new potatoes, and key lime pie.
(Post prandial bg = 157).

Why the food thing worked:
It was planned behavior.
I had proof from previous years that it would work.
Other people did it with me.
There were many distractions
I knew that eventually there was “a treat” at the end of the day.

As we were driving home, I told E and J that I was going to recount my day at the fair on my blog and J said “oh, don’t - all those people will think we live at the crossroads between Hooterville and Lake Wobegon”. Well, we do, and I love it.

Be Careful What You Ask For.........................

I've felt that my clinic is a bit behind the times because they always draw the blood after my quarterly visit with Dr. S. I then wait a few days and start to get really anxious, looking for "the envelope" in the mailbox, then ritualistically lay it in a certain spot on my kitchen counter and wait a couple hours to open it.

Well.........this morning when I got to the check-in desk the lady said, "oh, we have a new procedure - your lab orders are already written up and you can go down right now so that Dr. S. can discuss the results with you today.

NO!!!!!!!!! they can't do that to me - I need time to psyche myself up to hear the result - I'm not ready for it today - this was not in my plans..................shit.

So I drag my heels down to the lab and then plod back up to Internal Medicine.
Dr. S. comes in and says I look upset and I mumbled something about not feeling very flexible or adaptable.

But, it was good to have it over with and be able to discuss the AlC number in conjunction with my logging records. Hell, I am a medical consumer, my HMO pays a lot for me to have these appointments and yet I feel like I'm going to the principal and have to defend myself for misperceived bad behavior.

When I was ready to leave I asked him to renew my prescriptio for test strips. I told him I wanted 200, and to specifically say "use as directed" He said, "ok, sure - so 200, that's a 3 month supply. " (Do the math, doc, I've just shown you a log book with 7 tests per day..............................) Ouch.

Because

Finish this sentence.........."Because of the diabetes.........'

I would say that............ 1) my life has been ruined
2) I have clnical depression and have to take meds
3) I weigh more than I'd like to
4) I'm stuck at a dead-end unfulfilling job
5) I have to spend a lot of money on co-payments for
oral meds, insulin, and office visits - money that I'd
like to be spending on clothes, recreation, new
furniture and vacations.........
(I decided I'd limit myself to 5 salient points.)
Rebuttal........................ 1) inconclusive, as my life's not over yet
2) clinical depression is rampant on my mother's
side of the family - if I been taken back 40 years, the
treatment of choice was electro-convulsive therapy -
lovely
3) what in the heck does diabetes have to do with me
stuffing my face?
4) well, probably not
5) well, maybe

Now for the next page:--please note that all things in bold face are advancements that occurred within the last 30 years.

1) Because of laser therapy, I can see out of my left eye.
2) Because of retinal angiography, the dr. knew exactly where to put the laser and did not have to destroy healthy tissue.
3) Because of the nitrous oxide bubble technique, I had the best possible chance of my detached retina healing well
4) Because of the ACE Inhibitors, my kidney function has returned to normal.
5) Because of June Bierman and Barbara Toohey, I am probably alive today. These dear sweet ladies launched their writing career with "The Peripatetic Diabetic", a book that I was initially annoyed with because of the PollyAnna optimism. But, it gave me hope in those early days to keep on living.
6) Because of Dr. Lois Jovanic and Dr. Charles Peterson, I was willing to try MDI. Their book "The Diabetes Self Care Method" launched a whole new world of matching carbs to insulin and getting rid of that wretched exchange system.
7) Because of blood glucose monitoring I no longer have to pee in a cup. I no longer have to guess when I'm low. I no longer have to leave a high untreated.
8) Because of the A1C test, I am given valuable information on whether things need to change or remain the same in my daily self-care.
9) Because of the glycemic index, I have an idea that not all carbs are the same.
10) Because of those obnoxious, sour-chalk glucose tabs, I can treat a hypo reasobably quickly, without a lot of overkill.
11) Because of books, magazines, and the world wide web, we get exciting new information right away.

Because I am sobbing very hard and don't want my keyboard to be ruined, I will sign off. (Why do we pwd have to feel things so deeply?)

Wait and See

I had my MRI follow-up appointment today, to see if I had a stress fracture in my foot. I was pretty confident that everything was fine because the pain was lessening every day and people at work were commenting on the fact that my limp was gone. Stopped and took my bp in the waiting room - 122/65. Yipee! The body is doing well today!
The nurse took me to the exam room and said that Dr. P. was out of town and Dr. D. would see me - “he’s the real kingpin around here - the Head of the Department - he really knows his stuff and you’re lucky to see him”.

Dr. D. soon then appeared and asked how I was doing, and I told him "much better”. He said, “Well, that’s good, but we found two stress fractures in your foot and we’ll have to wait and see. This is not uncommon; just wear good shoes, don’t go barefoot, no running or jumping and you should be fine. You can walk as much as you want."
I started crying and then sobbing at a grand level. I muttered, "I've been through too much and can't take any more - the last 'wait and see' situation was with my left eye, and ten days later I had a fully detached retina”.

He looked startled and annoyed. He slammed a box of Kleenex on my lap, and said “Now you listen here, missy - I’ve been practicing orthopedics for 30 years and have horror stories about diabetes and lower limbs that would give you nightmares. You were extremely lucky - your ankle healed without incident. Look - you had 49 staples on the outerside and 35 on the inner and you hardly have a noticeable scar. And now you’re hysterical about a non-eventful stress fracture - you’ve gotta get thing in perspective or you’ll make yourself crazy”.

By then I was down to a sniffle. He stood up and said “And oh, by the way - the best thing you can do at this point is lose about 20 pounds - even 10 would take a lot of stress off your bones.”

He left and a moment later the nurse came in and handed me a piece of paper. “Dr. D. said to give you his pager number and if you have any concerns, leave a message and he will personally call you back. "

The magic of this life is that the messages are always out there for us - we just need to be listening.

Build on the Victories. MN

Gertrude

This weekend is the Art Fair Weekend in Minneapolis - three art fairs. all in the heart of the city, each with something for everyone. Alas, I happen to live in the middle of one of them (and there is no "disrupting my tranquility" discount.
I went to all three, walked a total of 19,000 steps, thought I could tolerate a bag of caramel corn with all that activity, but had a nasty spike of 340.
I bought this tiny cloth figure, a "wildwoman doll". She looks sturdy, determined, and well-grounded. I told the artist that I was going to have to thinkf of a name for her, and she replied, "no need - her name is Gertrude". The only Gertrudes I know are a friend of my grandma's and my neighbor Charlie's Saint Bernard.
When I got home I looked up the meaning of the name, and it is Germanic for spear-throwing strength. (Gulp.) Oh my.
I'm going to have to think about that one. I'll let you know if anything comes to me.
But for now, I have fastened her to my bathroom mirror, to remind me that I can go forward each day, strong, competent, and willing to try something new

Further Comments on The Numbers

I was doing a lot of thinking about my last post and hope I didn’t convey the impression that I was trashing “the numbers”. The information the numbers provide is priceless - it’s just that I have a habit of getting emotionally entangled in them and sometimes it’s a tight corner to break out of.

I was running a bit low all day yesterday, and when I got on the bus to go home tested at 47. I have a pretty consistent pattern of a gradual rise in bg between 4-6 p.m., so decided not to treat the hypo and thought I’d be fine. I also really, really wanted to be able to record a “70” in my logbook rather than a “140”. Good Girl. Good Job. Your numbers looked great today…. ……….but, poor decision.

I got off the bus and headed to the grocery store to get some fresh blueberries. I then had the sensation that I was on a treadmill and the sidewalk was moving underneath me, rather than me moving above it - a nofail sign that I was headed south, rapidly. The store that I shop at always has these seductive trays of cheese cubes for sampling. I think the intention is to put just one on a toothpick. Well, I was getting very famished and started stabbing three or four on at once, furiously making my own personal mini-kebabs, and then tried a couple more but my coordination was down the tubes so I moved on to the brownie bites. Had maybe 6 or 7. My mouth was starting to tingle, another sign of a bad situation.

I was pretty lucky to have made it home - testing at 32!. I did not bother to change out of my work clothes and popped a Lean Cuisine in the microwave. When it was ready I stared at it, not quite recalling how to take the cellophane off, so instead opened some juice and spilled it all over my nice dressy skirt.

What an inexcusable chain of poor choices. If I hadn’t been so stubborn and taken 4 glucose tablets, I would have been absolutely fine by the time I got home, had a nice relaxing dinner, and not ruined my favorite piece of clothing. At 7:30 I was up to 360 and spent the rest of the evening chasing after the high and had to set my alarm for 1 a.m. to be sure I wasn’t bottoming out. I feel that caring for the diabetes takes up so much time, but so does sweeping out the trail of dust that is left by a dumb-ass attempt to keep my ego inflated. And, not to mention the fact that even though I’ve never passed out from a hypo, I could have easily been nose-down on the sidewalk.

Do I need another broken ankle? I don’t think so. Do I need a $200 co-payment for an ambulance ride? Probably not. Do I need to forgive myself and try again tomorrow? Yeah, you betcha.

Thursday lies ahead, and the weekend is in sight. Take care. If anyone has any foolproof tips for removing purple grape juice from beige linen, send them my way.

Caught Up in The Numbers

I had a nice day at work - focused and productive. I was happy to see one of my friends at the bus stop and we exchanged pleasantries about the weekend coming up. Then another person came along and said "oh, how can you stand it out here - it's 90 degrees!" Well, until then, I hadn't thought a smidge about the weather - no opinion whatsoever - it's July in Minnesota, no more, no less. But.......within a few seconds I started to feel a tad uncomfortable, and craned my neck to see the digital thermometer on the bank up the street. It said 96 degrees (in direct sun) and then I noticed that my face suddenly felt flushed, my hair was starting to frizz and my skin felt like the sweat was oozing out in big honking drops. All because of the numbers...............the numbers that dictate how we should feel at a certain temperature.
Since I started working on my control, I think a lot about numbers and sometimes they tell me how to feel. When I get on the scale and the numbers haven't changed, I feel like a big fat cow and hear "nothing's gonna make you look good today, so don't bother putting on anything nice". When I look at my pedometer at the end of the day and see 9950 rather than 10,000 steps, I hear, "you are lazy and undisciplined - why even bother". When I take my blood pressure and see 128/75 I hear "that's toward the top of the target range - I'd be really worried if I were you".
And when my dawn phenomenon is very active and I wake up with a blood sugar of 180, I hear "ha - your day is off to a rotten start so you might as well stop at Starbuck's and get a nice gooey cinnamon roll".
The numbers can change my mood in the second that it takes them to appear.
Yes, I am thankful for the wealth of information that numbers provide - when my meter tells me my blood sugar is 42, it's time to treat the hypo; when my A1C goes down .5 of a point, it's time for a pat on the back.
But, the next time the numbers threaten to throw me into an irational, undies in a bundle tailspin of shame, apathy, fear and depression, I'm going to calmly say, "you're not the boss of me" and walk away.

Them Bones.....................

Good golly, it took me awhile to get the hang of all this - templates, settings, formatting, editing, but I think I'm on my way.
About a year and a half ago I fell on the ice and broke my ankle, needing 2 plates and 2 pins and 8 weeks on crutches. Every time I went to the clinic I was upset and angry that the Dr.'s main focus was the diabetes -
"because of the diabetes, the bone might not heal", "because of the diabetes, the incisions might become infected", "because of the diabetes......blah blah blah". It was an endless tirade that remnded me of things that I knew were true but were tucked away in the back file. I even heard the nurses out in the hall whispering "she' diabetic". I felt like standng in the middle of them and swinging my crutch 360 degrees and whacking as many people as possible.
But, thankfully, I healed quickly and completely. The day I looked down and saw shoes on both my feet was fabulously liberating.
About a month ago I started having weird pain on the top of the same foot, and immediately went to the symptom checker websites (the hypochondriac's gold mine) and concluded that I should be evaluated for a stress fracture. Went back to the same clinic and this time the doc said, "we'll have to do a full set of xrays of the lower leg and foot, just to be sure your ankle's not falling apart - there's an uncommon complication callet 'Charcot's joint' and if you've got it you're in big trouble". Well, I'm familiar with Charcot - one of my cousins had it and was completely disabled. He left the room and that familiar gut wrenching cold sweat terror sank in, that primordial fear that leaves you pleading to whoever will listen, "please, not me". I hate that more than any of the other unpleasant emotions that accompany a health issue. It is paralyzing and send your common sense reeling away.
After many drawn out minutes, the xrays were taken and transmitted to my computer file. He pulled them up on the screen and said, "the ankle looks fine, and stress fractures don't show up on xrays". So, I am scheduled for an MRI and some physial therapy.
I am disappointed in myself, becaue I was so sure that I'd gotten stronger, much stronger in the last couple of years during my retinopathy experience, feeling that I could handle whatever else came along, but there I was, a near basket case in the ortho clinic.
I asked the PA if I could continue to walk on it and go shopping, (because I had taken the whole day off) and she said "sure" so off I went to the Mall of America and consoled myself with some picket fencing and sidewalks from LegoLand.

My Maiden Voyage

Greetings to everyone in the circle. This is my maiden voyage in posting. I ran across an article by Gabrielle Kaplan-Mayer in Yoga Journal and found she had written a book, went to her website, didn't know what a "blog" was and had to find out, went to Scott Johnson's page, found out he was a fellow Minnesotan, and here I am. Diabetes has led me down some rocky paths over the years and now I'm about to take a side trip.
I grew up in an extended family laden with Type 1's - my grandmother had 12 brothers and sisters and their grandchildren's generation was afflicted - 36 of us at this count. By the time I was diagnosed I had witnessed nearly every devastating complication and after a few months of "good-girl compliancy" said "f--k it" and decided that if I was gonna end up like one of them, I might as well have some fun along the way. I spent 25 years wandering around with a blood sugar of 350 or more, sometimes feeling smug that nothing bad had caught up with me. I ate what and when I wanted (and never gained any weight). The only sensible thing I did was convert to multiple daily injections when they became the treatment of choice - somehow that assuaged the guilt from the other stuff I was doing. But even with that aspect, I embraced self destruction like a crazywoman and reused syringes and injected through clothing.
About six years ago I nearly died during an episode of ketoacidosis, and believe me, I was ready to go. Yet ten days later I was on the sidewalk outside the hospital, waiting for a cab, thinking "now what"?
There was no big "aha" moment, but it was the beginning of the cleanup of my act. Since then I've had several A1C's under 7, and this last January learned that the microalbumin in my urine had completely disappeared. But facing the reality of the disease left me in a major state of clinical depression. When I finally found a med that worked, it was refueled by a stint with retinopathy.
But my life today is pretty okay. I work and do my job well; I'm a good friend and family member; I have many interests in diverse areas and thankfully the reasonable health that allows me to pursue them.
Spilling my guts in these few words has left me emotionally exhausted.
As I write this I still think it's about somebody else - no, not me. But, when I read everybody's wonderful posts and discover that other people with diabetes are extremely bright, articulate, compassionate and funny, I may come to see that it's not such a bad clan to belong to after all.
Build on the victories.