August 20, 2010

Why is this the message we are given when diagnosed?

Why are we letting them get away with doing this? Again, I need to bring in something Tom Ross has written about on his home page.

I quote: “The usual, depressing message about diabetes is sometimes tactfully disguised, but anyone who has been diagnosed with the disease soon learns to decipher it. The message is: "Give up! Resistance is futile. You are now in the grip of mysterious, uncontrollable forces, and there's nothing you can do about it. Please resign yourself to a life of helplessness, drug-dependence, disability, and early death. Have a nice day!"

Oddly enough, this message generally fails to energize and inspire people. In fact, once people realize this is the future that has been mapped out for them, they tend to become depressed and apathetic. The result is that a lot of people who have been diagnosed with Type 2 diabetes fail to do any of the things that could improve the situation. They don't know, or don't believe, that there actually is anything they could do to improve the situation. And there might as well not be, if people don't try! A solution which people don't take advantage of is effectively the same as no solution. Therefore, there is an urgent need for patients to find out what they can do, and do it.Unquote. (My emphasis in bold)

While I do not always agree with the wording, the message is exactly right and is often the result of the medical profession not wanting to face the patient. Many doctors do not want to talk with the patient about this chronic illness that the patient now has. It is also because the medical professional does not know how to communicate or lacks the communication skills to explain the consequences clearly of not dealing with the chronic diseases – diabetes in this case. For a doctor's honest perspective, read this.

Often, the doctor does not have the time or resources to aid the patient. By resources, it needs to be understood, it is the trained people who can spend the time to get the patient off on the correct course of action to gain control of their diabetes. What even these doctors do not realize is how easy it is to recommend them to some people that are trained in this type of assistance. There is also websites on the internet that can be used to give them assistance or at least get them started.

Why then will they not use these resources? Often because they don't trust these sources and do not want to give their patients sources that may conflict with with what they want their patients to know. Some do not want to spend time answering what they consider silly questions. Other doctors do not like that fact that some, if not a good share, of the resources on line do not have professional degrees or are not operated by people with professional degrees. And regrettably some of the medical professionals just feel that they are the only source their patients need.

If you say, “not good enough”, then you are right. While almost all of the sources on line do say that for medical information that they should consult with their medical team or doctor, they do have much information that can take the fear out of their diagnosis, get them started in the right direction and maybe the biggest advantage is showing the patient that there is hope, and that there are others in the same or similar situations and that there is help available for those willing to be proactive in their care.

I feel it is important to say at this point that the doctor is not the person living with the disease (although some do have diabetes) and that this disease is your diabetes. You, the patient, are the person in charge, who with the doctors assistance can learn to control and even manage your diabetes to prevent it from progressing rapidly to the finality of the complications and that you can live a long and good life. The doctor is not the person taking the pills or injecting the insulin. They are also not the ones sitting beside you telling you what you can eat and what the effect will be if you do eat that.

They can advise you and keep tract of the HbA1c results to know how well you are or are not managing your diabetes.

Some doctors don't want you testing your blood glucose levels as they think this will only discourage you and not motivate you to do more to control your diabetes. So they do not give you a meter or prescription for one and the test strips. Bad move by your doctor. Ask for a prescription and don't be put off. If you can't get a prescription, consider this a clue that you desperately need a different doctor.

Your meter should be your best friend and it will tell you how the meal you just ate is affecting your blood glucose levels. This meter will also let you know if you either need to eliminate this food or reduce the quantity eaten.

For more information about the best methods and how to use your meter check out these blogs by Alan Shanley. SMBG means self-monitoring of blood glucose.

Blog 1, blog 2, and blog 3.

August 18, 2010

The attitudes of diabetes

Tom Ross, who writes in his home page at Not Medicated Yet explains some of the nature of type 2 diabetes very well.

I quote… because of an unusual aspect of Type 2 diabetes: it's a treatable disease, but it can't be treated by doctors. The practitioner who is going to be administering your diabetes treatment is you. Doctors can advise you, and they can give you legal permission to buy certain controlled substances, but (unless you happen to be in a coma), they can't treat your diabetes for you, any more than the GPS device which advises you to take the River Road exit can drive your car. Doctors simply aren't in the driver's seat, because they cannot live your life for you. Success or failure at getting healthy (and staying healthy) after a diabetes diagnosis will be determined mainly by what goes on during that part of your time which is not spent at the doctor's office or the pharmacy. Diabetes care involves a lot of things, and getting prescriptions filled is a pretty small part of the picture. (For me, so far, it's no part of the picture at all.)

Although the idea of solving your diabetes problem by taking pills (and doing nothing else) has a certain appeal, it's clear by now that this approach doesn't work very well. It's also clear by now that there is another, better approach available. Most doctors try to talk their patients into adopting it. Unfortunately, most of their patients would rather be given pills than advice on how to live. "Why change my habits when I can simply take prescription drugs?", they ask themselves. That would be a valid question, if the drugs were enough, by themselves, to keep diabetes patients healthy and safe. They aren't. Unquote.

Tom manages his diabetes with exercise and nutrition (diet for those who prefer the term - that fails for so many). This takes effort and dedication, something that many patients decide to bypass. Tom covers two of the attitudes of diabetes, those of many patients and many doctors, and hints at the third attitude – his - a lifestyle change.

Although the attitude displayed (pushing pills) by doctors is common, and hides other motives, this commonality is an attitude that must be challenged by every patient. Will this happen? When we read the attitude Tom described by the patient, it is highly doubtful. Too many patients are in the “pill cure attitude, and let's get on with life”. What these patients do not understand is that the oral medications can be much more harmful than nutrition and exercise, or even insulin. At least some in the medical community are trying to emphasize the change in lifestyle as a viable route in controlling diabetes.

Leaving Tom's attitude aside, I need to cover something I did in my blog on Doctor – Patient Relationships in my blog of May 18, 2010. The first type of patient has an attitude that too many patients subscribe to. They could care less about pills from the doctor and some won't even take them. As soon as they are outside the doctors office, they are on the cell phone or on their way to the local health food store to check in with someone to find out what the local snake oil salesman has for diabetes, or to talk to a neighbor about what to take that is natural for diabetes. If these people are in the early stages of diabetes, they may have some temporary relief, but this will not last long and they will be in big trouble, unless they change their lifestyle.

If they have the desire to change their lifestyle and among those that are able to control their diabetes with nutrition and exercise, they should go for it. This along with the stage that they are at will determine how much they have as a possibility of delaying the progression of diabetes. A good thing for those that are able to to control their diabetes early on.

Another attitude of diabetes is depression. This often arises after you, the patient, realizes what the daily routine is and the time, patience, and education this disease requires from you. Diabetes is a disease that will not go away, constantly makes changes to confuse us, and at times seems to have a mind of its own. One of the hardest parts of depression is not letting it take control as this will help diabetes get the upper hand and then the problems really multiply.

Yes, there is anger, denial, acceptance, but these are all stages of the process of coming to terms with your diabetes, and not attitudes.

And last is Tom's attitude, of “get it done” - let's see what can be done to maintain tight control and manage my diabetes instead of it managing me. His attitude takes determination in addition to effort and dedication. This is the attitude of a person that is proactive in their health care. This attitude also requires the best attitude - a positive attitude which is often lacking with the other attitudes.

There can be a multitude of other attitudes, but none of them matter unless you can cultivate an attitude like Tom's. Everyone can have this attitude regardless of the point they are at with their diabetes. Read his blog of August 10, 2010 for his answer of what moved him to do what was necessary. This is Tom at his best.

August 15, 2010

Sleep Apnea CPAP Nasal Mask Liners

Disclosure – This is something I purchased for my own use, but since I have been very satisfied with it, I wanted others with sleep apnea and using a CPAP machine and nasal masks to be aware of some of the benefits. I am receiving no compensation for this.

Have you had problems with air by-pass from your nasal masks? I have had many problems with air leaks, especially with certain masks. These are normally the ones that I mistakenly let the the local supplier talk me into. I had finally found a mask that was comfortable and very seldom had caused air by-pass or air leaks. Wouldn't you know it, next time I needed to replace a mask, they no longer had it in stock. Not that the new mask that replaced it does not work, it just has too many air leaks.

Even after adjusting it several times and working with different strap adjustments, it still allows too much air to leak around the mask. When you add in the facial oil build-up over the night, it was not a pleasant experience, I would often wake up with air blowing in my eyes. How I found these liners, I am not sure of, but in looking at some sites that sell different CPAP masks, I know that I saw something that I passed over the first few times.

Since I had stopped using the current mask and returned to the comfortable one, I started looking in earnest. This time I saw the ad and decided to check it out. Still I was not impressed, so I went searching and found the manufacturer's site. After reading much of the site information, I sent them an email and asked a few questions.  Since this was after hours for them, I did not expect an answer until the next day.

An hour later I had an answer. I did not order then, but I should have. A couple of days later, I did order a sample of six nasal mask liners. When I received them the following week, I tried one that night. I needed to readjust my straps and found that I did not need as much tension on them. It still needs to be firm, but the air leaks stopped. Yes, if I turn while sleeping, some air will escape, but normally by adjusting my mask it stops. Since then I have ordered the 30 day supply.

Now before you tell me that there are other options like nasal pillows, or other appliances, I will only say that they do not work for me. Yes, there are other nasal masks and I may try others in the future. I will also be investigating full-face masks in the future, but for now, I have my solution. The nasal mask liners cost less than a dollar per day if used the way it is recommended by the manufacturer.

Disadvantage for me is that at present Medicare does not cover these liners. So now I am working on several experiments to see what can be done to get more use from the CPAP nasal mask liners. The manufacturer strongly recommends using a new liner each night. I have found that if I am careful and turn the liner over and carefully lay it out, I can use it for two nights. I have tried using it for three and four nights, but then there are problems of the air leaks happening again. The facial oils have filled the pores of the liner and it looses it's effectiveness.

Washing the liners in my wife's delicates bag in the laundry does not work. The liner basically disintegrates as it does not have a sewn edge holding it together. So I took eight of the used liners and soaked them for about four to five hours in a mild laundry soap. After rinsing them carefully three times to remove the laundry soap, I carefully laid them out on a sweater rack and laid a couple of paper towels over the top using a couple of large bamboo spoons to anchor the paper towels and let them dry.

They have worked well for another two nights. Now I will need to see if they will accept another washing – doubtful. Even without washing them another time, my effective cost per liner usage for four nights will be less that 25 cents each. While this is not recommended by the manufacturer, I had to see what could be done. Am I satisfied, very definitely yes. Will I do this for each liner? I may. It has just been interesting learning what can be done and finding out how well the mask liners hold up.

So if you are one that has problems with air leaks or air by-pass from your CPAP nasal masks, check them out. Now to make sure that my supplier has the nasal mask that I prefer in stock the next time I need a replacement. Otherwise, it will be time to replace the supplier.

I have learned that each face has a different requirement in size of mask and one mask does not fit every face. There are normally two or three sizes for each mask and the mask that works for you may not work for me. Thank goodness for the RemZzzs nasal mask liners! Take time to explore the site.