June 2, 2012

Is Diabetes Causing You Burnout?

This blog in Diabetes Health is interesting. Yes, diabetes burnout is common and happens more often than we might like. Many people have burnout and wonder why they feel like they do. Some people do not recognize this and have a difficult time dealing with this for a period of time. Others become depressed and know they have something that needs correcting, but it can take time. Some that have depression and don't know they have it. As a result, their management of diabetes takes a vacation. Some of the solutions are unrealistic for many people and others will not be able to consider the solutions offered.

The second article is from About dot com and is a little more realistic. I enjoy this analysis of diabetes burnout. Unlike the first article, the author recognizes that recovery happens, but not all at once. She says rightly so that it often takes baby steps to overcome diabetes burnout. I know this is right because even though I have been blogging consistently, I am fighting burnout myself. I am not enjoying this at all and wish I could say that I have not had depression. The depression is behind me now and I am working on correcting the areas of diabetes management that have suffered for the last two months.

No, this is not easy to write, but it needs to be written about by people that have been through the wringer. What started it, I am not totally sure. I know an argument with a doctor did not help. I can think of a lot of little things that add up and make you want to find something to take it out on. I have a couple of people that are what I term “the food police” and I see them more often than I like. I try to ignore them, but when they are constantly in my face, they are hard to ignore.

There have been other health concerns as of late and until mid June, I won't have an answer. I also know that I had about a week that blood glucose readings got higher than I like and by more than I like, and with a lot of analysis, I could not figure out what or why it happened. This may have been much of the trigger and the food police that just aggravated the situation. Now it is climbing out of the pit I have gotten myself into.

Since I am researching diabetes burnout, I have to say this makes the most sense to me so I will use the points that Elizabeth Woolley lays out and make comments about each.

Accept that you can't be perfect. Being the near perfectionist that I am, makes this almost as bad as the lesson I had to learn when I was diagnosed. What has happened can't be changed so accept it and move on. It is almost behind me and I have got to keep it there.

Remember it's all about you. Yes, I am the only one that can take responsibility and make the changes necessary. I cannot blame anyone else for my errors or shortcomings. I have to get my good habits back in control for better management. I think that a positive attitude helped me from sinking too low, but now I have to recapture this as well.

Become proactive in solving management challenges. I am hoping the fact that in dealing with the medical community I am a proactive person will aid me in being proactive in improving my diabetes management.

Connect regularly to the diabetes world. This will not be difficult, as I will have my appointment next week with the endocrinologist. The A1c will have to be what it is. Approximately two months of poor management can't be corrected in a week. In reviewing my first month’s records, I was doing so well – shame it has to be this way.

Now I wish I had the list that comes next in the article. A couple of them may have made it harder, but I am still using this list so that next time, I may be able to short-circuit some of the problems. Here is the list and my comments.

Take small steps in the right direction. Sometimes this is the best and then if you succeed you are able to celebrate a success. If you fail, you won't have lost a lot of ground. Continue with the small successes and eventually you will have your diabetes management back.

Take a doctor-guided break if needed. I will definitely give this some consideration, as this may be a way to lessen the effect of burnout. Hopefully, this will be possible, communication has been good, and this looks like something I could handle.

Find inspiration. I will have to work on this. Yes, I was reading, but reading for research and blogging. I had to work harder to write blogs and often reread some articles. I missed several of our group meetings and spent much of my time just writing and rewriting when it was not making sense.

Reestablish a connection with the diabetes community. I am hoping that just by continuing to blog will aid me in getting rid of this down feeling or energize me to be myself. According to the author, I am to reconnect with the diabetes social community.

See a diabetes educator. This is not possible. Insurance will not cover at this time and I am in no mood to have mantras shoved at me. This is me and I feel that this would put me back in depression. I know, I know, for some people this will be an advantage and serve them well. What will work for some, will not work for me this time.

Count your blessings. This can be important for many. This will also aid in getting you back to a positive attitude and feeling good about yourself. Give this an honest try.

Make peace with the diabetes police. If you are able, this may go a long way in restoring peace in a family or among your friends. Include the diabetes food police, as they can be worse than the diabetes police. I am in luck with two of these individuals, but with the third person, I am not sure this is going to be possible. I feel this may be one that has to remain at arms length.

Make sure you are not experiencing depression. Sorry, I've already been through a minor depression and have my life back. For anyone reading this, sometimes a person is able to work their way through and out of even a minor depression and at other times, it may be necessary to talk with your doctor or other qualified professional to help you. They can also determine if other means may be needed for the short and long-term.

Depression is not sometime to take lightly and sometimes professional help is the best solution. I admit that I have not needed it, but I am prepared if it becomes necessary and have talked to my doctor about just that. The doctor will give me a referral if needed.

I have several blogs about depression, but I find it a difficult topic to define and the professionals just like their technical jargon and apparently find it difficult to write about it in laymen terms. My attempt may be read here.

How you handle diabetes burnout depends on you and your attitudes. I have found that having a positive attitude about diabetes has generally served me well and made it easier to handle diabetes burnout. Not everyone will react the same. Another article on how diabetes can take a toll on our emotional health may be read here.

There is one important topic missing.  Take your medications, if you are on any.  I feel fortunate that through the burnout and depression something kept reminding me to take my medications.  Yes, often it was after I had gone to bed, but something in the back of my mind would not let me sleep and was saying insulin, insulin, until I got up and took my medications.  I guess after almost ten years, habits are good at times like this.

June 1, 2012

Friday Tidbits 06-01-12

Is this crying in the wilderness? From the comments to his blog, you would have to think that is true. Greed is the creed of many doctors and they will ride the current healthcare system to the end and take every dollar they can. At least Bob Doherty is talking about the issue on the Advocacy Blog.

There are efforts in many areas to reduce the rising costs, but little is being accomplished because of the attitudes of the medical profession. Almost every person in the medical profession believes that the current system is broken and needs to be fixed, but from the top down, they are unwilling to anything other than acknowledge the problem.

What surprises me is the opposition by many medical groups against groups that are attempting to lower costs. Two of attempts are shared medical appointments (SMAs) and concierge medicine. There are also small practices throughout the country attempting other experiments away from traditional medicine and the medical organizations are attempting to squash them early on. How backward do we have to become in our medical treatments before we have a patient uprising that will put some of the organizations out of business and demand better healthcare?

The second article is a different discussion that I have wondered about for some time. I am also happy to see this, as we need to finally sweep the low-fat mantra under the rug where it needs to be. I am not sure how accurate the research is as I am always suspicious of agendas from researchers. However, is written to show that certain fats are very beneficial for out brain activity.

This research is probably more reliable and evaluates almost 6200 women over the age of 65. It determined that consumed more monounsaturated fat than saturated fat retained greater levels of overall cognitive functioning. Those consuming more saturated fat actually had a decline in cognitive function. I do feel that there is an agenda associated with the study considering they singled out the saturated fat in butter, cheese, and red meats. These may not be the best, but in moderation should not be forbidden.

The third article disturbs me personally. Are our veterans considered second-class citizens or even third class? Veterans may be causing this themselves, but this is difficult to understand. I know when I was discharged, I was given no information about veterans benefits and it appeared like they were just glad to dump us on the street as the downsizing was already underway as the Viet Nam War was getting downsized.

Today, with a volunteer military force, this should not be happening. When discharged, those people should spend at least two days being taught about the benefits available to them. Handouts should be given explaining each benefit and the address and phone number for each local Veterans Affairs office.

It is shameful that so many veterans are without medical insurance and not availing themselves of medical services with the Veterans Administration. “It is true that the VA is “the nation’s largest health system and provides health care for many veterans through a system of medical centers, clinics, and other facilities…However, some veterans do not use VA health care services. Eligibility is based on veteran status, service-related disabilities, income level, and other factors, and even within the groups eligible for VA care, other factors, such as their proximity to VA facilities and the cost-sharing requirements, may affect the likelihood that they seek care in the VA system.””

Yes, there are hoops to jump through and some are tired of the treatment they have received by the military complex. Once you have been qualified, every year, you are required to submit a “means report” to determine your level of eligibility for benefits and the amount of your co-pay. Without this report, you may be denied benefits.

The last item is more for the political types and is indicative of what is happening in our government. If a sitting president can fund a campaign with government funds, then it is time to bring these funds back under an oversight committee and end the handouts.

May 31, 2012

Problems for Diabetes Patients

As I research diabetes and the related occupations that treat those of us with diabetes I keep making small discoveries that are upsetting to me at least. I read several medical blogs by doctors and read some of the blogs by diabetes educators and a few other blogs by other professions related to the treatment of diabetes topics. With a few notable exceptions, many doctors, all diabetes educators, and all dietitians want us to be complaint and stupid, letting them tell us what to do and what not to do.

I am reading about more people on diabetes discussion boards and diabetes forums who think like I do and are tired of being treated this way. Even those in my local diabetes group are now echoing these feelings. Although we tend to all go our own way and have differences of opinion on many topics, we are all in agreement that the current atmosphere for people with diabetes is a lose – lose situation. While we are doing exceedingly well as individuals, all of us have learned to ignore anything from the USDA and the medical groups that promote and advocate following this way of eating and nutritional advice.

Yes, we all want nutritionally balanced meals as much as possible, but we know that we cannot depend on our medical and related diabetes professionals to give us good advice. They constantly repeat the same thing – whole grains, low fat, and they will not budge from this mantra. This is what the USDA preaches, the American Diabetes Association trumpets, and the American Association of Clinical Endocrinologists follows. Then you add the American Association of Diabetes Educators and the Academy of Nutrition and Dietetics and you are hammered again and again and again with the same boring meaningless mantra.

Fortunately, some of us have friends or relatives that are nutritionists that are not under threat from the Academy of Nutrition and Dietetics (AND), and they will work with us at various carbohydrate, protein, and fat levels to help us balance our nutrition. Their only concern is seeing that the balance of nutrition is present. For this we listen and thank them. We also promise to support them and stay in touch with our state legislators to prevent the AND from slipping something through without a fight. And they have tried, but thankfully nothing came of it this year.

The other common item most of our group agrees about is all the studies that insist that we eat certain foods if we have diabetes as we have decided that most of these studies are misleading and not for us. Most of the time these studies have a specific agenda and nothing to do with balanced nutrition or even fair nutrition. We are tired of studies claiming red meat is bad for us, that a specific vegetable or fruit is a super food that benefits people with diabetes. What they do not even consider is that more and more people with diabetes are figuring out that what works for one person does not always work for another person. We are downright tired of this one-size-fits-all advice that we know probably does not work for us.

Another common agreement is the studies that are done to prove that one medication on top of another medication, plus additional medications added to these is the only way to treat type 2 diabetes; we know this is not for us.. We are disappointed that our researchers have a very limited ability to think for themselves and that they jump to the tune of Big Pharma every time the bell jingles. We are disgusted that our researchers are incapable of thinking outside the box to give us something to hope for and solutions not requiring medications stacked one on top of another. This is one of the reasons most of us are using insulin. We obtain better diabetes management results and have none of the side effects associated with the oral diabetes medications.

When the researchers start calling the tune and telling Big Pharma that their ideas are unworkable, then we may see some innovation and meaningful studies where study participants are everyday people and not those that fit the strict criteria to slant the study in the direction desired. We understand age ranges and people with other chronic diseases being eliminated from some studies. What we disagree with is studies where people that might be concerned about testing their blood glucose on a frequent basis are automatically eliminated because the researchers and the funding agencies are looking for people that do not care about testing so that they can show a reason for limiting testing supplies for those that want to test and maintain excellent diabetes management.

When we think about all the money funneled into poor and useless studies, we have to think about how much closer we might be to an actual cure if the money had been utilized more efficiently. Efficacy in our studies and their usefulness should be a priority. Another topic that is a sore point with us is universities that have results from research that is on the cutting edge of a breakthrough and this is purchased by a pharmaceutical corporation and that is the last we hear about it. These are things that need to be exposed and if the research is useless, the American public should be told. While we may not always believe the results, because we are suspicious by nature, we deserve to know whether it was purchased to be buried and nothing more done with it or if it was indeed only a minor piece of the puzzle.

To this, I would say that if nothing was forth coming in three years (or maybe longer), but no more than five years, then rights would return to the originating university for continued research and development. Only if some checks and balances are put in place can we be sure that good research will not be put in mothballs because a large pharmaceutical company wants to make larger profits by burying promising research.

It was a little surprising that while we have been discussing the above; a study would be published adding to our perception of what happens. This study published in the Journal of the American Medical Association on May 1, 2012, declares that the majority of clinical trials are small. The study points out there are significant differences in methodical approaches including randomizing, blinding and even the use of data monitoring committees. This is the largest comprehensive analysis of data in Clinicaltrials.gov and finds that clinical trials are coming up short of producing high-quality evidence needed to guide medical decision making in a clinical setting.

This evidence points out the problems we a patients will continue to face in obtaining informed information and proper treatment of medication usage, clinical care with application of the latest techniques and possible best treatments. If our doctors are unable to rely on proper evidence, how are we going to have confidence we are obtaining the best in care.

Our group does agree that there needs to be an independent agency (or committee) that oversees all of the study applications before they receive a penny of funds. This agency should be independent of any pharmaceutical company, university, or government. Where they would obtain their funds to make a modest living is a point we have not solved. We do agree that the number should be an odd number, but no more than fifteen members, and that if someone is absent, an alternate could be selected. We also agree that the members should be from retired researchers, patients, and some non-pharmaceutical or related CEOs. Term should be limited to five years and some replaced every year on a rotation.

May 30, 2012

The Importance of Peer Mentoring

I like blogs like this one. First, they let me know that there is a strong need for this to fill the vacuum left by the medical and related organizations. With the increasing numbers of people being diagnosed with type 2 diabetes and approximately 50 million people with prediabetes, other professional organizations will not be able to keep up with the need.

The group of us with type 2 diabetes is basically an informal peer-to-peer group with no formal diabetes training. I am not sure that we have the same low A1c average that we had at one time, because we have added members rather rapidly. Of the current group of ten, eight of us are using insulin and another is considering insulin. We do work with each other, offering encouragement, advocating for better health and doing research and reading to help each other. This may not be an ideal peer group, but so far, it has worked for us.

The study was done with African Americans at the Philadelphia Veterans Affairs Medical Center who had not been successful at lowering their A1C. What the researchers are not sure about is if the veteran camaraderie helped more that it might in other groups.

Of the ten in our group, five of us have served in the military. I am surprised that there is not a lot more talk about our service time, as all of us served during the Vietnam era. This seems to have been replaced appropriately by our need for conversation to help each other with diabetes.

In the Philadelphia Veterans Affairs Medical Center study, the peer-mentoring group had the best results among the three groups. Among those in the peer-mentoring group, A1C was reduced from 9.8% to 8.7%. Not that the results that are excellent, but it is an excellent start for the group.

Perhaps the most obvious attraction of this type of peer mentoring is that it is virtually free, almost certainly enhancing its cost-effectiveness relative to more expensive interventions, such as nurse care management, telemedicine, and group medical appointments,” state the study authors.

You may read the press releases here and an article by David Mendosa here.

May 29, 2012

Even Nanotechnology Has Safety and Ethics Issues

This is a topic that is due and much needed at this time. While I am in favor of nanotechnology for the greater good that it can do, some issues could cause more harm than intended. Kathleen Eggleson, a research scientist in the Center for Nano Science and Technology (NDnano) at the University of Notre Dame, provides an example of a nanotechnology-related safety and ethics problem that is unfolding right now.

She realizes that nanotechnology is here and there are some ethical and problematic sides to our new found and potentially great tool for treatment of diseases. Not only will they affect people in real ways, but nanotechnology may also become a harm to people. This is why she is in charge of the Center for Nano Science and Technology last year to study and prompt discussion of problems involving nanotechnology.

"NDnano is expanding its scope into studies of the societal impact of nanotechnology," explains Wolfgang Porod, Frank M. Freimann Professor of Electrical Engineering at Notre Dame and director of the center. "This is the background for bringing Kathy on board."

As part of her duties, she has established a monthly meeting group, called Nano Impacts Intellectual Community. This taps into Notre Dame researchers from the campus, visiting scholars, and others from outside the university to probe nanotechnology topics in depth. Some of the issues on the table have been ethics in nanomedicine, the commercialization of nanotechnology products, and the interdisciplinary nature of nanotechnology research.

Eggleson has some excellent thoughts about nanotechnology and its usage. She is concerned about how nanotechnology may affect our own beneficial and internal bacteria needed to synthesize vitamins and aid digestion. Some bacteria are needed to maintain appropriate levels of nitrogen in the air.

She discusses at length a potential good and potential harm from one use of nanotechnology. This is the nano-sized particles of silver that are used in hospitals and clinics. Silver is an element that is known for its antimicrobial properties. These nano-sized particles are being applied to hard surfaces, like bed rails and doorknobs, and to fabrics, such as sheets, gowns and curtains, by a growing number of medical supply companies. These new materials are proving effective.

"Nanosilver coatings have made life-saving differences to the properties of typical hospital items," Eggleson says. "Just this last December, a textile made by a Swiss company was the first nano-scale material approved as a pesticide by the EPA."

“The possible new danger is that the vast majority of bacteria and other microorganisms are actually neutral, or even beneficial, to human life and a healthy environment. So overuse of nanosilver products, especially outside of clinical environments, could pose a danger to needed microorganisms, and enable resistant strains to flourish.”

"Under most conditions, the preservation of microbial biodiversity is a benefit,"  explains Eggleson. "In fact, those who would use these potent new antimicrobial technologies for frivolous uses, such as for odor control, work directly against the U.S. National Nanotechnology Initiative's goal of responsible nanotechnology development."

This is the purpose for Kathleen Eggleson and I do not envy her and the tasks she has ahead of her. Read the article here.

May 28, 2012

Concierge Medicine Is Not Understood

Concierge medicine is not well understood. As Dr. Centor states, “Policy wonks have ignored this movement for too long. Retainer medicine is a fast growing start-up industry. It grows because it fills an unfilled niche.” Many people and companies are beginning to utilize concierge doctors more frequently and it will continue to grow as our current system continues to languish in its broken state of greed and corruption.

There are some questions that need answering and I will strive to give some answers.  There is an organization named the American Academy of Private Physicians (AAPP), which encompasses the physicians operating in the concierge medical community. The American Academy of Private Physicians and was founded in 2003. Some areas on the site are for membership only but most are viewable by the public.

Within the concierge community, there are a few large groups serving people on a regional scale. What is unique is that when combined with a high-deductible medical insurance policy to cover hospitalization and some other high dollar costs, the model is significantly more cost effective for the patient. At present, there may be some setbacks in coverage, but eventually the medical insurance industry will innovate and cover more of the present holes. I am sure that there is talk between the AAPP and medical insurance to do this.

The one item I have not found that may be a total out of pocket expense for some is prescriptions. High deductible insurance policies will not fill this gap at present. For some with chronic illnesses or diseases requiring expensive medications like diabetes, this could be expensive.

To this point I have been using one term for roughly four types of service. Dr. Centor defines the first three and Dr. Matthew Mintz talks about the fourth. I quote both of them for maintaining clarity.

We need to define terms:
Concierge medicine – paying a large (>$3000/yr) fee to contract with a physician (usually an internist) to provide same day appointments, phone access, email access, comprehensive and continuous care

Retainer medicine – paying any fee to receive the same access as concierge medicine. Generally concierge practices have smaller panels, i.e., the more you pay, the less patients the physician has to follow

Direct primary care – retainer medicine for a lower fee

Boutique medicine - I think the key words in this definition are “specialized” “stylish” and “elite.” The first word is something commonplace in medicine, but the later two words are something usually not associated with medical practice. “Luxury” is also implied in the word “boutique.” Thus, in my opinion, a boutique doctor is one that specializes in unique, often luxurious services, that are not offered by others and which will therefore cost a little extra. Read the full blog here by Dr. Mintz.

I am bothered a little with Dr. Mintz and his concern for ethics and word association. The current medical system is broken and needs overhaul. If I could afford any of the above, I would be there in a heartbeat. I say let the patient decide what level of service he/she desires and can afford. If a doctor establishes excellent doctor patient relationships, he will have a great practice. If a doctor is this concerned about the meaning and connotation of a word, maybe medicine is not where the doctor should be.  Many doctors writing about this topic are stressed about ethics.  I think too many decades of fighting with the insurance industry and government has addled their thinking.  I remember the 1940s and 1950s when this would not have been a concern.  Even before this, we had fee for service, but not the term concierge.  Some doctors were paid with produce and other patients paid with currency.

We as patients cannot always afford the best in care now and are seeing too many cases of government euthanasia because they won't pay for the treatment. See my blog here about the treatment of kidney transplant patients being denied immunosuppressants by Medicare. I predict that if the current system does not have a jolt soon, many patients will not have a place to get care, regardless of the cost.

Our medical insurance industry needs to change and if these types of services can exist without insurance, we may be better off. Hospitals are better able to demand more money from the insurance companies and major medical will become more affordable as some companies are forced out of business for their greed. Insurance executives do not need million dollar plus salaries. As a patient I feel that changes are coming and the patients may do better as a result. Will everyone be happy? This is highly doubtful, and some will suffer as a result of these changes.

Another helpful article on concierge medicine can be read here. This article highlights some of the professional jealousy by doctors and specialists unable to make the change. Insurance companies are angry and have dropped doctors. HHS is also warning doctors. Some states are investigating whether under the insurance laws in their states this is even legal. Read this article with care.

"If Medicare continues to tighten the screws on doctors ... some will react by saying, 'I'm just fed up with the whole thing.'" And if more doctors shift away from traditional practices to concierge medicine, it could exacerbate the physician shortage because there will be fewer doctors to go around. I hate to say this, but this may get action, both good and bad, from the voters when our congressional people refuse to act to get government out of medicine.

Patients have had it too good for too long and will become militant if Congress refuses to act and wait times for appointments become longer and longer.

I must add this Medscape article of May 27.  This is what we need, doctors that are not afraid to speak out and are not intimidated by doctors that are striking out because they think the "system" is the only way.  I found this article very good. 

May 27, 2012

Some Explanations and Venting

I like comments on my blog from others. I also appreciate the emails I have received from those that email me from my profile page even more as this allows for a better interchange of ideas. I do become annoyed by most of the advertisers that attempt to sneak comments through. Some are becoming very adept at this until I back check the link provided or back check the name on the post. I like that the delete key works as easy as it does at times like this.

Unless I use the product or have reliable information about at particular product, I seldom promote a product in a blog. I may promote a type of product without a specific brand being mentioned when there is good evidence of relative equality among brands. I do this because then it is an individual preference as to which brand a reader chooses. Most also go with what the doctor recommends if a prescription is required.

Most of the comments I have received lately have been spam. Saturday, I had one that looked authentic; however, upon further examination and a little correspondence, I found out that the site is a dummy site operated by a public relations person looking to make a sale for some of his clients. I have no idea about the product and whether it will work as advertised. Plus, under the circumstances of the exposure to the product, I will not even try it. Too good to be true – usually is. Plus these products most often do not deliver what their advertising claims. I will keep my money thank you.

Do I like receiving all this spam? Not a chance! As long as the delete key continues to do its thing, I will not hesitate to use it to keep spam off my blog.

Then I receive emails that are what I consider the ultimate in poor taste. They are from people that I term “ambulance chasers.” They want to know if a family member or I have used a medication or a list of medications. If we have, they want to help us obtain compensation for possible injury received from the medication. I will never use them as to-date; I have not used any of the medications on their lists. Plus I will never use a firm that comes looking for work, as they generally want a greater percentage of any amounts received. I prefer talking to a local attorney and having a recommendation for a firm. Occasionally, the firm of record is the only firm that may be used and then you may not have options.

I have also been receiving requests for guest posts. I may as well say it now. I will not allow guest posts from commercial companies or firms looking for business. I will not allow guest posts of any type because I like what I am doing. If a product or service is one I have used and like, I will blog about it. If a product or service is something that I don't like, I will blog about it. I know I cannot please everyone, and it is not my intention. I want to inform you about diabetes and related issues. Occasionally, I find something that I have an interest in that is not related to diabetes.