Doctors That Are Unable to Communicate

Ouch, double ouch! When doctors and others openly criticize others is a public arena, it often is not pretty. And one mistake does not another prevent. I have followed this discussion carefully after I first read it. Often I would have offered a comment as a patient, but for once, I listened to my inner self telling me not to go there.

I do not understand the total lack of communication by the blog author. This is very evident and several of the comments point this out. I do also have a concern about several unsaid things in the blog. Was the blogger doctor waiting for the PA (physician assistant) to make a mistake? In hindsight, this may have been intended as no communication was done

It is known that many MD's have no use for PA's or NP's, but to attempt to sabotage them or put them is a bad light is no excuse. With the potential shortage coming of primary care physicians, it would seem prudent not to antagonize other professionals even though you don't respect them.

This blog has led to many comments, twists, and turns. I think we need to look past this doctor's “qualifications” and her self importance to what was she really trying to accomplish in her instructions to the patient. Dinosaur MD had to know that the physician assistant was on duty and was planning what the doctor described in her tirade about the PA.

I must blame the MD for not knowing what she supposedly knew and ask why she did not admit the patient to the hospital for observation and ongoing medication. But knowing what she did know, decided this was an excellent time to show up the PA.

Her blog is well titled and especially the name she writes under. We need less dinosaur MDs and more communicative doctors that treat patients properly. When she sent the patient to the emergency department, she should have made a call to the person on duty and explained what was about to happen and the opinion of the hand surgeon and her thoughts. This would have been the proper procedure rather than backstabbing a PA.

What Patients Desire From Mobile Apps

This is a great blog on mobile apps. Please read it at your leisure. There are some additional cautions I would add to what the author says. If you think I am on my own crusade to warn people about mobile apps, you would be right.

#1. Do you know who owns the mobile app? Unless you have carefully researched the app, read the user agreement, and know that you have certain rights only to the app, you may not know who now owns the app. Many of the more popular medical apps are purchased by medical insurance companies so that they may access the data. Also many companies cooperate to make the data available to other companies.

#2. Do you know if the app works with other apps? Why own an app if you have to manually enter everything from another app. This is one time that I can say that I turned down an app from a pharmaceutical company because I would need to enter my blood glucose readings manually and still not be able to upload the information to my computer or to my doctor. I already am able to upload my meter to my computer and print our the data, graphs, and trend analysis for the doctor, but even this is not necessary as the office can do this as well. This app was promoted by the company as being important and a time saver for me. Not. I told the representative that he was blowing smoke and that his company's app was useless for me.

#3. Will the app integrate with others apps and do it seamlessly? With the proprietary apps of today, this is very unlikely and most are developed for a single use only. Until we, as patients, demand that apps work with other apps, it is highly doubtful you will find any app working with other apps.

#4. Will the data be stored only on your mobile device or will it be available to remote apps? This is a question that needs answering. You do not want your medical insurance company to be able to access the information without you knowing it. Who else might have access to the information? This is an important consideration.

#5. Is this an app that your doctor will use for the data or will he/she just toss the data? This is a tough question to answer and even your doctor may not know.

#6. Is there a cheaper method of collecting the data? Sometimes the doctor will suggest just using a pad to write the data on and especially if it is for a short period of time. At times like this, an app may be an unnecessary expense.

#7. How often is the app upgraded or updated? This is a question to be answered. Many apps are frequently updated as the manufacturer seeks to gain market share. With the time taken to become familiar with some apps, do you want to continue to relearn parts of the app after an update. Or if you have a area that you like to have the app open to and this is changed in an update, will you appreciate this.

#8. Will the app bring advertising to you that you don't want? Some apps will flood the purchaser with advertising. If this is something you don't want, avoid the app.

#9. Will the app help reach a medical goal? This could be the most important question. If it will be a help, make sure that #1, #4, #5, and #6 above do not negate the need.

These are a few of the traps in the use of mobile apps and there are many more. I hope these will help you in not getting into the wrong app and encourage you to do your homework before getting caught in their traps.

Does Your Family Resent Your Diabetes?

Do you really know what the members of your family think about your diabetes? I certainly don't know. Yes, I know what my wife thinks, and I admit that it does not agree with what I think. Our beliefs are at polar opposites and therefore seldom a topic of conversation. My children say very little about my diabetes and this is probably a good thing since they no longer are under the same roof.

Therefore, it was with more than casual interest that I read about this study. Yes, it is a survey study and I discount the findings as being completely accurate. The numbers are still damming and we need to be aware that in many families, there is no support for the person with diabetes. For many, other family members still consider diabetes a lifestyle disease and believe the person with diabetes is to blame.

The statistics from the survey:

#1. 30% think their families blame them for getting diabetes.

#2. 40% say their families are not fully supportive of their efforts to manage their diabetes.

#3. 25% think their families resent them for having diabetes.

#4. 57% say their families don't make sacrifices to make it easier for them to manage their diabetes.

#5. 50% of respondents believe that their families are afraid of their diagnosis.

#6. 25% of respondents believe they are ashamed of their diagnosis.

#7. 55% believe that their families are living a healthier life as a result of their diabetes.

#8. 30% say their families join them in their exercise or physical activities.

This is the really disconcerting fact from the survey. Those who said their families did not fully support them did a significantly poorer job of managing their diabetes than those who said they had their family's support. While it is easy to believe this, I have to ask why they cannot develop good habits and show their families that they can do great management, maybe in spite of their lack of support.

Not covered in this survey is the number of family breakups as a result of diabetes. I don't doubt there are some, but for some this may have just added to the desire to end a marriage. Of the fourteen members in our peer-to-peer group, only five of us are married. Many of the group had lost a mate before diagnosis and just decided to stay single. Only one has divorced after diagnosis and has only stated that diabetes did not cause the breakup. He does admit that the stress of the situation may have been the trigger for the development of his diabetes.

HealthEngage President and co-founder Michael Slage said, "This study shows that many people with diabetes still do not feel that they get the support at home that they need. The diabetes community, both healthcare professionals and the broader industry, need to focus more resources on educating and raising awareness among the families of people with diabetes. HealthEngage has taken a holistic approach to helping users manage diabetes beyond glucose tools. It's time for diabetes efforts to also be inclusive of the families not just the person fighting the disease."

This Blog Is Again Active

I had not intended to do this, but I have so many topics that are not about diabetes per se but can often be linked. My interests are being expanded to areas that I have not done topics on before or have and I am looking for space to add them. As such, this blog will serve as an overflow for topics that may not be diabetes specific.

Please let me know if a topic appeals to you. My email address is on my profile page and I do like hearing from people. Questions I will do my best to answer and comments are welcome. I will keep this to a maximum of five days per week and hopefully bring this blog down to five days per week. This will depend on my spirits and how blogging remains enjoyable for me.

Changing the Group Format

In the last blog on diabetes symptoms to never ignore, Elaine and Jessie had asked Tim and me to stay after. I suggested to Tim that it was probably about everyone needing to help defray costs since we were using only a few homes. Tim agreed and said he had meetings scheduled the coming week with two additional churches about using their building for meetings.

When everyone had left, Elaine and Jessie said they were somewhat concerned about the costs of having snacks for everyone. Tim asked that Alan and Glen join us and Tim said that we could agree with them and that they should not bear the cost for using their homes. He explained that three churches had said no to meetings at their buildings and that he had two more scheduled the coming week. Glen asked about the meeting room at the hospital and I explained that the formal diabetes support group had use of it and the doctor advisor to the group had opposed our use of it.

Glen said he knew a few people and asked if he could see about using it. We agreed and said it would be a great place to meet. I said that with the growth of the group so quickly, homes may not be the best. Tim did state that when we started, snacks were not part of the group, but that we had quite a few meetings at a local restaurant where we sometimes had our evening meal. Each person then purchased their own food. When we started to grow above six members is when we started using homes. Even then snacks were not always part of the meeting. Jessie said that was probably why some did not take snacks then.

At that point Elaine said that maybe it was time to have a consensus of the group and follow that. Alan asked if there were any formalities that we followed and Tim and I said no. Tim said we had grown from the six last May, to the 16 this May, and really not given any thought to anything until someone suggested that if someone had an idea for the meeting to prepared something and the rest would follow. The hospice meeting was the first time we had brought in outside speakers (other than my cousin on nutrition) and Barry was really the first meeting when a member had a full program.

Jessie then said that for such a loose knit group, there seemed to be a lot of loyalty and a lot happening. Tim commented that our goal was really education, helping each other, and helping others which he said was why he thought the group had worked so well. He said we have had meetings about studies when everyone had an interest or when some controversial topics came up making unreasonable claims. I stated that sometimes we did a lot of discussion via emails and sent URLs to help in the discussions. Tim stated that much of the loyalty may come from the questions people ask and the answers they receive. He said this is why when Bob receives a question from one member, he restates the question and gives his answer and emails this to everyone, and the rest of us do the same. Some of us will add comments to the original answer and email these to everyone. I added that we never give the name of the person asking the question to encourage questions. I also stated that early on, sometimes a person would email questions to everyone and everyone that felt they could answer would.

Elaine said that she now understood some of the reasons behind why the group worked so well and that yes, Tim had stated this in the first email, but she had not totally followed the reasoning. Tim said we wanted to talk about this and send out emails asking people for their thoughts before we brought it up in a meeting.

With that we left and Tim said he wanted to email the original six for their thoughts and then he would send me an email with what they said or he would limit it to the six of us and obtain our input before we sent information to all members. I said we are the minority now and as such needed to think about the benefits for all. We may need to change the way we handle our activities now and hopefully everyone will pull together. Tim agreed and said that was good to put in the email. With that we headed for our homes.

Diabetes Symptoms to Never Ignore – Part 2

Part 2 of 2 parts

We were having a meeting that was full of news and information. Everyone seemed to be participating or getting information. Barry read the next part of the WebMD article and said this should be of interest to many of us.

Infections, Swollen or Bloody Gums, Foot Sores Again A.J. set the tone and explained another reason he was thankful I had taken his diagnosis out of his hands. He lifted his pant leg and showed the sore that was almost healed. He said that the doctor was initially very concerned and thought about an operation, but after some discussion put him on two antibiotics, one a shot, and the second a round of pills. A.J. was thankful for that as it was almost completely healed. I could see that it looked well now compared to when we had gone to the doctor and I said so.

Jessie asked why we were concerned with swollen and bloody gums. I answered that diabetes may be associated with periodontal disease and this could be a problem for people with diabetes. With that, Jessie said she had better get an appointment with her dentist. Tim stated this is one reason to take good care of your teeth.

Elaine ask what type of foot sores we were talking about. I said everyone will need a strong stomach, but directed everyone to open a new tab in their browser and type in the search area “foot sores or ulcers.” I asked if there was a word in the upper left part of the screen saying images. Several said no, so Tim and I started circulating and helping them. When everyone had this, Tim said to click on the word images. There were several OMG's and some looking away from the screens. Jessie commented that this was too realistic. I asked if they would rather know this now, before they had problems, or later when they had this problem. Sue said most definitely now, that even if she did not like what she saw, now she knew how important foot care should be and what to look for. Even Rob said this was good to know. Brenda said now I know where you get some of the images you use in your blogs. I said yes.

Allen said that is a reason to see a podiatrist regularly and still check your feet everyday. I said yes, and I asked Max if he had a mirror that he could use. Max said he was way ahead of me and already had two mirrors that he used. Glen said to his wife Jessie that was why he kept her around. Jessie retorted that she was still getting a mirror. Jason asked where he had found the mirrors and Max said he was pulling up the URL as he was talking. He sent an email to everyone then and said they could search for other sites if desired. Tim then said that all of us should be concerned about some calluses, corns, and bunions as they could also become infected.

Eye Problems, Including "Floaters" Barry next asked how many had annual eye exams. Of the group, everyone said they had been advised to have an eye exam. Jessie said that was the standard for the doctor they were seeing. Barry went on to explain that at the age of most of us, we also needed the eye exam for cataracts, glaucoma, and macular degeneration, as well as setting the baseline for retinopathy. Barry continued that there are other problems possible as well that the ophthalmologist may discover. He concluded that for people with diabetes, it is important to have that eye exam.

I asked Barry to explain “floaters.” Barry said that if someone has had experience with them they could explain this more accurately than he could since he has never had floaters. I said okay and said that I had floaters once and at first they appeared as a bright spot when I moved by eye looking to the right. The next day I had dark floaters in my eye and a little pain. My first wife called to get me in to the ophthalmologist and then drove me there. In this case, I had a tear in the retina and was taken to the room for laser surgery. I was sent home with an eye patch over my eye to wear for two days. The third day I could try with it off, but if my eye was bothered to put it back on and call the ophthalmologist immediately. I was fortunate to have no further problems and eventually the floaters dissolved and I have not had problems since. Anytime you have floaters or dark spots when looking, get to an ophthalmologist immediately.

Heart Disease Symptoms (Not Just Chest Pain) Barry said the last part is the hardest to explain. He said anyone with diabetes should know that heart disease and the risk of an heart attack or stroke increases. He did share this link with us.

I asked how many people were on blood pressure medicine – only two, Max and me. Next, I asked who was on cholesterol lowering medicine – three of us only. I told Barry that we have a healthy group of people with diabetes. Granted, Max and I are the only two overweight and Rob said he has a history of heart and cholesterol problems in his family so he was not surprised to be on a statin.

Alan, Elaine's husband said he was on a statin, but as of yet does not have diabetes was the reason he did not say anything. He said he was aware that people on statins could develop diabetes, so that did not surprise him. We finished with some other discussions and Jessie and Elaine asked Tim and I if we could stay for a while after the rest left.

Diabetes Symptoms to Never Ignore – Part 1

Part 1 of 2 parts

Warning – are you aware of problems you could have with diabetes? Many people think they know, but from the information presented in many articles and on different places on the internet, many people with diabetes seem to think that they are not vulnerable to these things happening to them. This is one thing our informal group does do for us and this is a great help. The group does keep us humble and we always have someone asking the right questions when we need reminding of problems we could develop.

This article in WebMD was a topic of discussion recently and there were quite a few valid questions raised. I will list the symptoms to never ignore and then cover some of our discussion points. Please read the article for your own comparison and information. Because Barry felt this topic was important, he asked anyone that had a portable computer to bring his or hers to the meeting. Elaine had hers setup and her husband had his desktop available.

Frequent Urination, Extreme Thirst or Hunger, or Blurry Vision. A.J. started us off and commented how important he found them to be for him. He said if I had not rattled them off when he thought he did not have diabetes, he would have trusted his doctor and probably gotten into more trouble. He thanked Barry for requesting this topic be discussed and this was good to have this type of article handy when discussing diabetes with people like him that did not think they had diabetes. Ben commented that the statement about how uncontrolled type 2 diabetes can lead to "dehydration and altered consciousness ... which could be fatal if untreated.” Ben said in the research he was doing, this might have been part of what started his depression. He continued that if Tim had not insisted on taking him to the emergency room, he does not want to think about what might have happened.

Acting Drunk. Ben said this was another reason he was happy that his brother had agreed to move back and live with him. One of his recent, but very few, lows (hypoglycemic episodes) happened and Barry checked his blood glucose and had him drink about 6 ounces of juice. Ben said he was acting (according to Barry) as if he had had too much to drink, yet he knew there was no alcohol in the house.

Brenda said this was good, and asked how many had medical alert jewelry that they wore. Only six of us did and she suggested that we talk about my blogs here and here. Allen asked us to include this blog of mine. Brenda said this is why she reads my blogs. I know she does not like every blog, but to hear her on this really is a support for me. I told her so and A.J. said that he needed to do more reading as he had not read these. He also asked why we were so concerned with a piece of jewelry.

Brenda took up the challenge and explained what could happen during a hypoglycemic episode. She said if we were driving a car during a low and happened to be stopped by a law officer, we could be arrested for drunk driving even though we had not been drinking. She explained that not getting treatment for the low soon, we could pass out, and then the officer could just think we needed to sleep it off when we could be near a coma. She explained that with a medic alert bracelet, necklace, or other piece of jewelry, it might be seen and then with diabetes on it, they might act to save our lives. Allen said she was right and hypoglycemia was not to be ignored. We needed to test before we started the car and develop this habit when we are on insulin.

A.J. said that now it made sense and John asked if this applied to those on oral medications. Tim said that for the two he was on, yes. Sulfonylureas could cause a low and while metformin by itself would not, the two together could increase the chances of a low. Tim stated that the new medication just approved could not be evaluated yet, but that all other oral medications could cause a low. Insulin was known for this, but oral medications could cause lows. If the person did not take the medication because they did not feel like eating, then a low could be avoided. Also taking too large a dose for the food consumed could also cause a low. He stated that this was something everyone should be aware of and alert for this happening. Tim concluded by saying that if we were unsure, to talk to their doctor.

Barry had bookmarked several sources of medical jewelry and said he would send this out to everyone. Jessie asked if this was what we did at every meeting. Sue said we are getting better now that everyone that has an interest suggests topics for the meetings. She then stated that the help is the emails that are generated, normally by Tim and others now to summarize parts of the meetings and provide URLs that might be of interest for all. She said that these are also sent to those not attending which she said has helped her. Elaine then asked why when she was not on medications she would be interested in the meetings.

Sue laughed and said because she has type 2 diabetes. She explained that because of the support she received from the group, she was able to get off all medications and hopes to stay off for quite a while. She said because of the new members, she would repeat what a pain she had been for a few of us before she was diagnosed. Brenda said if they had not heard of the diabetes police, this is what Sue was talking about and she was one of the worst at getting under our skin. Sue said that she expected to be paid back, but she was accepted into the group and has not had this thrown in her face once.

Sue's husband, Bob, then said that he was the one that outed her to the group and had tried to have them give her some payback, but that none of us had. He said we had just accepted both of us and given Sue encouragement to get off medication and continued to support her. Then he said that when her brother Ben needed help they were there for him and have been very supportive of both he and Barry. He then said this on one reason we want to stay with the group and learn about diabetes as they felt there was more to learn and he felt this as well.

Then he dropped a bomb on us. He stated that he had been to the doctor the week before and that he now had prediabetes. He was on metformin and now both he and his wife were doing more exercise together. He said because metformin is so inexpensive now that he feels that the group has been a help for him and asked if he could be considered a member. The vote was unanimous in favor.

Apparently, this was the day informing the group of diabetes news. Jessie's husband, Glen, was next and he said his diagnosis was type 2 diabetes as well. He admitted that he was not over his anger yet, but that because of his wife and the group, he felt he had a home with support without looking for it. Glen said to me that he was reading some of my blogs now and this was helping him. He was happy that I had encouraged his wife to join, how much my cousin had helped them get off on the right path for nutrition, and he said that my encouraging his wife to use spices was what brought back pleasure in the meals. He was asked to be a member.

Next, we turned to Elaine's husband. He said he hoped not, but admitted that he was using his wife's meter for fasting blood glucose readings and that he had a few fasting readings above 100 mg/dl, but that after meal readings were generally under 100. We told him to keep checking and get to the doctor if there was a trend upward. He said he would and asked to keep coming to the meetings.

Jason said his wife was not having any problems and was normally under 90 mg/dl and I said my wife was normally under 85 mg/dl but was having some problems of readings in the upper 50's and feeling very shaky. With this report, our membership has grown to 16 with about 17 attending.

Tim said we are now limited to four houses and that so far he had not found another meeting place. Both Elaine and Jessie said that their houses were available. Bob and Sue said their house was also available. Jason said he would have to talk to his wife now and Max said his house would not have room. We were then ready to continue, but this will need a second blog.

Diabetes and Depression – CDE Style

At last, a certified diabetes educator that is willing to talk about depression. Although I am not sure I completely agree with everything she says, at least she has opened a dialog. Where it will go from here remains to be seen. Will the American Association of Diabetes Educators (AADE) make it a topic of interest? This could be interesting if they would.

I am admittedly tired of explaining to other people with diabetes why CDEs seem to close out sessions with diabetes patients when the word depression is mentioned or when CDEs are asked for help. The instance, what I talked about in a previous blog seems to hold true time after time. It is like most CDEs are afraid to talk about depression and don't want to be around people with any level of depression.

Talking about depression and obtaining help for people with depression is becoming more difficult as many programs are being cut by lack of funding and qualified people to handle depression. In my state, mental health facilities are less than one quarter of what they were 15 years ago and finding doctors willing to refer you to professionals capable of assisting people with depression is almost non-existent. Those that do have a practice are so busy they do not have time for new patients.

Most medical providers today just attempt to help by prescribing antidepressants for a period of time. Even with all the discussion about mental health care because of school shootings and obtaining guns has not been looked on with favor because there just is not provisions to handle this potential influx of patients. Most of the governors in the surrounding states have stated that this would be ideal, but with the lack of facilities and professionals to handle this, it is unrealistic to support mental health care for persons needing this.

That is the main reason for my surprise that a CDE would even blog about depression since her colleagues seem to walk – no, run away from people even mentioning the word depression. Clearly they lack the training to deal with depression. What stops them from talking to the patient's doctor about this still has me puzzled as this seems the least they should to do to assist the patient.

This behavior by CDEs says they don't know how to assess diabetes patients for depression and are not interested in helping people with depression. I can only hope that the dialog opened by one CDE does not die for fear of having to deal with diabetes patients and depression.