formal lighting

This is for photrablogger’s Mundane Monday #145: lamps/lamp shades.

I took this on our trip to Seattle. We stayed at the MarQueen Hotel, which was built in 1918 as the Seattle Engineering School. The rooms are small apartments, complete with a kitchen with basic dishes and full size refrigerator. This picture is at breakfast, which was included. I love the old apartments and furnishings. I wake stupidly early, and the attached cafe is very handy.

 

Make America sick again: diabetes

The trend in diabetes treatment is clear: keep Americans sick.

The guidelines say that as soon as we diagnose type II diabetes, we should start a medicine. Usually metformin.

A recent study says that teaching patients to use a glucometer and to check home blood sugars is useless. The key word here is teach, because when I get a diabetic transferring into my clinic, the vast majority have not been taught much of anything.

What is the goal for your blood sugar? They don’t know.

What is normal fasting? What is normal after you eat? What is the difference between checking in the morning and when should you check it after a meal? What is a carbohydrate? What is basic carbohydrate counting?

I think that the real problem is that the US medical system assumes that patients are stupid and doesn’t even attempt to teach them. And patients just give up.

New patient recently, diabetes diagnosed four years ago, on metformin for two years, and has no idea what the normal ranges of fasting and postprandial (after eating) are. Has never had a glucometer.

When I have a new type II diabetic, I call them. I schedule a visit.

At the visit I draw a diagram. Normal fasting glucose is 70-100. Borderline 110 to 125. Two measurements fasting over 125 means diabetes.

After eating: normal is 70-140. Borderline 140-200. Over 200 means diabetes.

Some researchers are calling Alzheimer’s “Type IV diabetes”. The evidence is saying that a glucose over 155 causes damage: to eyes, brain, kidneys, small vessels and peripheral nerves.

Ok, so: what is the goal? To have blood sugars mostly under 155. That isn’t rocket science. People understand that.

Next I talk about carbohydrates. Carbohydrates are any food that isn’t fat or protein. Carbohydrates range from simple sugars: glucose and fructose, to long chain complicated sugars. Whole fruits and vegetables have longer chain carbohydrates, are absorbed slowly, the body breaks them down slowly and the blood sugar rises more slowly. Eat green, yellow, orange vegetables. A big apple is 30 grams of carbohydrate, a small one is 15, more or less. A tablespoon of sugar is 15 grams too. A coke has 30 grams and a Starbuck’s 12 ounce mocha has 62. DO NOT DRINK SWEETENED DRINKS THEY ARE EVIL AND TOOLS OF THE DEVIL. The evidence is saying that the fake sugars cause diabetes too.

Meals: half the small plate should be green, yellow or orange vegetables. A deck of card size “white” food: grains, potatoes, pasta, whole wheat bread, a roll, whatever. A deck of card size protein. Beans and rice, yes, but not too much rice.

For most diabetics, they get 3 meals and 3 snacks a day. A meal can have up to 30 grams of carbohydrate and the snacks, 15 grams.

Next I tell them to get a glucometer. Check with their pharmacy first. The expensive part is the testing strips, so find the cheapest brand. We have a pharmacy that will give the person a glucometer and the strips for it are around 4 for a dollar. Many machines have strips that cost over a dollar each.

I set the patient up with the diabetic educator. The insurance will usually cover classes with the educator and the nutritionist but only in the first year after diagnosis. So don’t put it off.

For type II diabetes, the insurance will usually only cover once a day glucose testing. So alternate. Test 3 days fasting. Test 1-2 hours after a meal on the other days. Test after a meal that you think is “good”. Also after a meal that you think is “bad”. I have had long term diabetics come in and say gleefully “I found a dessert that I can eat!” The numbers are not always what people expect. And there are sneaky sources of carbohydrate. Coffeemate and the coffee flavorings, oooo, those are REALLY BAD.

For most of my patients, the motivated ones, they have played with the glucometer for at least a week by the time they see the diabetic educator. I have had a person whose glucose was at 350 in the glucose testing. The diabetic educator called and scolded me for not starting metformin yet. The diabetic educator called me again a week later. “The patient brought their blood sugars down!” she said. “She’s under 200 after eating now! Maybe she doesn’t need the metformin, not yet!” Ah, that is my thought. If we don’t give people information and a tool to track themselves, then why would they bother? They eat the dessert and figure that the medicine will fix it or they can always get more medicine.

Type I diabetes has to have insulin. If a type II diabetic is out of control, high sugars, for long enough, they too will need insulin. The cells in the pancreas that make insulin are killed by prolonged high blood sugars.

I went to a lunch conference, paid for by a pharmaceutical company, at the AAFP conference in September. The drug company said start people on metformin at diagnosis and if they are not in control in 3 months, start a second medicine, the drug company’s new and improved and better and beastly expensive medicine!!!

Yeah, I don’t think so. All of my patients are smart and they all can figure it out. Some get discouraged and some are already on insulin, but they are still all smart.

Fight back against the moronization of US citizens. Keep America healthy, wealthy and wise.

fab four

This is for the Daily Prompt: recreate. The American Academy of Family Physicians had a celebration last night at the end of the conference and included a painter who recreated this familiar faces right in front of a large audience. Then it was auctioned off to the highest bidder to fund raise for Houston hurricane victims. Bravo!

 

Armour Suit III

My trial run for this vacation is swimming 400 yards. The swim is slow but fine. However, at 4:30 am I start having vertigo and throwing up. Have to cancel clinic. Lasts about 4 hours. Not reassuring for our Christmas plans.

My daughter has her wisdom teeth out on Monday before Christmas, so is instructed to not exercise heavily for five days. I got dry sockets and was sick as snot in college, but mine were much more impacted. She does fine, stops the hydrocodone in 24 hours, and drops to a 200mg ibuprofen three times a day by Christmas. On with the ski plans!

We head for a family resort on the east side. Up to to slopes on a hotel ski bus the first day, renting skis. For the first time ever, my goal is to ski gently. I have been skiing since age 9, but have not skied in five years and had two major bouts with strep A that affect my muscles. The second time my fast twitch muscles didn’t work for ten months. The first goal was to survive and the second is will I get my muscles back?

I rent downhill skis. Last time I skied telemark, but they don’t have any to rent, and anyhow, tele is harder. In college I had 190cm dead straight Heads for downhill, so now they rent me 163cm skis. We ride the lift up. 20 degrees at the top, an inch of new snow on groomed slopes and gorgeous. And… I can ski.

I am trying NOT to engage the armour suit. My massage person thinks that’s what made me sick swimming, reengaging it and just trashing my muscles. He’s right, I think. I just swam the way I always have, but slowly. My goal down the hill is NOT to fall into old patterns. I ski gently, let the skis do much of the work, carving swoopy turns. Every so often I get quickly and feel the suit kicking in and I back off. I drag my right pole for balance when I am tired.

My daughter asks for pointers on our third or fourth run. She has not skied for five years either. She is doing the work and I show her how to finish a turn using the curve of the ski. Finishing the turn lets her slow down, so she gets the swoopy feel in the turn but doesn’t lose control. On the lift we watch people. Nearly everyone drops their hands. Try turning your lower body with your arms dropped behind. Doesn’t work. Hands and shoulders down the hill and let the lower body do the turning….

I can ski! I ski with my toes lifted, not curled and gripping the ground. It changes my balance and I have to pay attention not to engage the suit. By 11 I want food and on the chair at 2 I am on my last run: I can feel the cold through my coat. We have a few more days, save energy. Also my right shin is informing me that I’ve bruised the crap out of it…

And the next day! Bruised shin, but more skiing, still gently. Now I have hope that I will get muscles back! Hooray for hope! Hooray for skiing toes up! Hooray for skiing without armour!

Step off the chain

There is a giant chain, with links about two feet long each. A ship’s chain. It is lying curved along the ground. On each link is the statue of a god or goddess.

There is one empty link. I am walking towards the link. I am dressed in flowing white robes, off the shoulder, Greek. I am not a goddess.

Something hits me. It is a small square pillow, four by four inches. I made a set of small pillows when I was first married. My husband and I would throw them at each other when we were upset. They would make us laugh. They were so light that they would bounce off anything and not hurt. They also would not break lamps and decorations. I still have this small square one. It does not hurt.

There are other pillows. Larger, couch and bed size pillows. They have ornate covers, with beads, tassels, rhinestones, gems and sequins. I know that when I step up on to the chain, the pillows will be thrown at me. They will hurt, because of the ornate decorations. They won’t kill me.

I stop. All of the other gods and goddesses on the chain are represented by statues, stone. I am the only living representation. I am not going to get on the chain. I am going to make a statue to the goddess and place it on the chain. It will not be harmed by the pillows. I will make it quickly with wood, and then replace it with stone when I am able.

I wake. I think, who is the goddess?

Artemis. It is Artemis, greek goddess of the hunt, archer, sister to Apollo, midwife, protector of young virgins.

I wake and read about Artemis.

In preparation

I wrote this on 9/26/14 in the midst of much frustration and my lungs still hurting three and a half months after I got sick. I am off from taking care of patients, but still have to try to get my business covered and my patients taken care of. I think there is a component of my vocal cords not working because I am told that I am wrong and to shut up so often.

Favorite example is a Seattle Infectious Disease doctor that I called to ask for help with an infection in our town. He said, “You are a rural Family Practice Doctor. Why would I listen to you?”

I said, “I’m a girl too.” and hung up in frustration. That attitude will not win him any referrals from me. On my permanent stupid moron list, along with an amazing number of specialists. They are either respectful or they aren’t.

Currently I am on no alcohol at all, because I have to do a special diet before a 24 hour urine test. Means no caffeine either, ouch, headache.

In preparation

Today I will start drinking
now
even though it’s only 9:40
in the am

I will stretch two beers
through the long hours
as the alcohol
blocks the receptors
and numbs my aching heart
and lungs

and I will stay home alone
today
so that I won’t talk

time
to rest my voice

in preparation
for the next round
of talk

where I am told
in no uncertain terms
to sit down
and to shut up

Cucumber love

Cucumber love

They say they love you

And they do

Sort of

One day you find yourself
Wearing a construct
An exoskeleton
Awkward
You can move
See out

You built it slowly over years
Because that’s what you were told to do
You wanted to be loved
It made you feel safe

There is praise
Or at least pressure to keep it on
You may not have known it was there
And slowly begin to feel
Who you really are
Awaken to the shell

One day you slip out

They are still saying how much they love you
To the empty construct

You watch bemused
For a while

You say “That isn’t me.”
“Of course it is,” they say

“I’m over here,” you say

Shock and outrage
“That’s not you!
You’ve changed, you’re depressed
Confused, manic, gone out of your mind!
Off the deep end!” 

You might even go back in
the construct for a little while

But now you’ve tasted freedom
You won’t be able to stand it for long
You will be out soon

Some people will see you as you really are

Some people will tell you they still love you
But as they say it to the construct
They act as if you’re still wearing it

They still think you love cucumbers
Though you ate that dish once to be polite
They hold the construct in their minds
Even after you’ve destroyed it
And behave the same as they ever did

As you walk away
You will wonder who they loved

first published on everything2 on June 9, 2009