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Patient Compliance Feed

Patient Gripe - Bariatric Surgery Suggestions

If you haven't figured it out already, I'm "morbidly obese".  As a result, medical professionals feel the need to suggest Bariatric surgery.

Okay, they don't suggest it.  They practically demand I do it and do it now.  And they won't take a polite: "Yes, I've researched it, and it is not the answer right now."  Often once I disagree with that treatment plan, I am immediately treated as a noncompliant patient.

Here's the deal.  I've met with a surgeon and I didn't like him.  Yes, there are other surgeons but I've looked at my insurance and I don't like the amount of money that will have to come out of my pocket. And that's if it is successful.  I also don't like what my body will probably look like when I'm done, and I'm talking about the sagging skin.  I also don't like the idea of opening the door to more surgery.

I don't like the mortality rate.

I don't like the complication rate, NOR am I really thrilled with the known complications.

Much less the rarer, little know complications.

I am also a very good candidate for becoming an addicted person in another way.  Yeah, food addiction is probably a problem for me, but at the current time it is much more socially acceptable (much less job acceptable), than drug, alcohol, or even shopping addiction. 

I've had long conversations with several people over several different conversations who have had bariatric surgery in various forms.  While they are happy with it, at the end of the conversation, we walk away agree I'm not ready yet.

The point of this?  My doctors, especially my primary care physician know that I am a highly educated individual, know just about every facet of the diseases I'm am dealing with and know that I research everything.  Though I will admit I often take drugs on their word alone and get to figure out the diabetic side effects 3 days later.

As a patient, I'll respect you infinitely more if you find a polite way to work it into the conversation, and then drop it when I respond intelligently in the negative.

Funny, but that works with just about every treatment plan.  Not just bariatric surgery.

What is even worse though, is when the physician who suggests it weighs about 10 pounds more than he did the last time you saw him, and he is steadily gaining weight over the years. 


Allergy medications

I am having a tough time taking Nasonex when I am supposed to. In fact, I think I forgot it again last night.

With medications, there are two problems with complanace -- making sure I actually take the drug, and making sure I don't take it twice.

With pills, it's easy. Every Saturday, I take my last dose of the week (morning and night) and I refill the pill strip. I can tell easily if I have taken the pills -- if I have, there is an empty space for that day. If not, they are sitting them and I should take them. No brainer -- I really do believe smart doctors and pharmacutical companies should provide the plastic pill containers marked by day.

Nasonex is harder. I can't tell if I took it. I've got my Treo set up with a task and reminder -- I have no idea if I took it last night, and since I didn't take my Requip, I am not sure I did. I certainly didn't tell my Treo. I also know I did not take it Monday night -- though I took the Requip.

I really do have trouble with any night time medication since I don't have a regular evening schedule.

I suspect I will end up taking Singulair as my seasonal allergy medication, since I can easily tell if I took it and can handle a missed dose fairly easily -- take it the next morning.


I think it's allergies...

I have felt like doggy doo-doo and been severly congested since Saturday night.  I'm pretty sure it's fall inhalant allergy since Marcie feels just as bad, and we were both at an agility trial that might as well have been outside.

It was so bad I skipped out JWW runs and those are the legs I really want.  Oh, and Marcie and I did qualify Saturday morning in Standard.

Here's one way that food gets affected -- every evening when the congestion, drainage, etc. is the worse, I crave orange juice and chicken soup.  To be specific, for years I've treated severe congestion with the local fast food Chinese place's won ton and egg drop soup.  I have NO idea how to properly dose, especially since the side effect of allergy problems is a rise in blood sugar.

I wasn't too far off, but I'm glad we did the blood draw for the A1c on Thursday.


Food

This is the hardest thing in the world for me to be compliant on.  In fact, confession time, I have been treated for an eating disorder.  I have been known to binge, but nothing "worse" like purging or others.  I have also had a weight problem all of my adult life.

That being said, I was also misdiagnosed and treated for another psychological problem but it was later discovered that I was suffering from sleep deprivation.  I do believe that my eating disorders are more symphtoms of sleep deprivation than anything else. 

I do know that if I go low carb, my blood sugar is better, but makes my gastric reflux worse, which bothers my sleep.  I've been learning that keeping carbs around 120-150 grams a day I overall do best. 

Doing best means to have a minimum of gastric reflux sympthoms, keeping a blood sugar around 110 fasting, and under 180 post pranial.  I have trouble doing that though.

Why?

One is the sleep deprivation thing.  When I'm having trouble sleeping, food is the hardest thing to control.  I make the wrong choices, and I tend to eat a few more carbs at night since that does help the sleep.  At the same time, exercise is difficult because sleep deprivation makes my pain sympthoms worse. 

The next thing is stress.  I've tried all kinds of things to help me deal with stress.  The first was to change my profession from maintenance programming to production programming but while that helped the sleep deprivation, the stress in that job was higher.

Now I teach, which means I get almost total control of my hours (except for next week, but that's another post).  My biggest problem though, is that I really take my job to heart.  I know that what I do may affect my students' future.  Last year was the worst year for dealing with that, and I'm still not completely over that.  Before their major tests I don't sleep.  I also don't sleep when I worried about individual students, etc.  I know that I shouldn't let it get to me, but it does. 

Most of the time, I can look at a food item and decide that it is't worth the extra insulin, but sometimes I don't.  Most of the time I can handle the binging, but every once in a while, I just have to sit down with a bag of potato chips and just deal with the stress that way.

It's a hard balancing act.


Not Sleeping

So here's an example of how I don't sleep.  I got in from dog agility last night about 10:00 pm.  Forgot to take my Requip so it was about 10:30 before I took it.  About 11:00 pm I finally got to bed.  However, every time I laid down, I choked and coughed.  Note:  This does not work with a CPAP very well, especially with a full face mask.

For those wondering, there is a bit of a concern with full face mask that the patient will aspirate if they cough or reflux.  (Yeah, and I have that)

I got up and started fooling with a broken computer I have, which I have finally declared dead.  I also took some Tylonel PM so that the choking would stop.


Forgetting to Test

So not 20 minutes after I post, I forget to do my afternoon test.  I made a run down to the office and they were handing out free cookies from the Men's Warehouse.  Grabbed one, it was good, I usually eat a small snack this time of day anyway, etc.

However, the food was downstairs, the blood sugar meter was upstairs.

Smith's Medical (Cozmo) idea of attaching the meter to the pump is a good idea, until you want to jump into the pool (my argument against the Cozmo idea).

Carrying the meter around would be a good idea, but a pain.


Blood Sugar Monitoring

For me, because of my Animas pump, remembering to test my blood sugar is pretty easy.  I have it set to remind me two hours after my last bolus.

HOWEVER, I often forget to test in the morning.  Almost every weekend and occasionally during the week, I'll figure that important, first test of the day.  I need to find a better way. 

I've learned to keep a spare meter in my purse, as I will occasionally forget my regular meter.  Once I even dropped it as I loaded up the car for agility.  I also keep spare meters tucked in places where I might need one.  The car, one in my gym -- and I would keep one in my gym locker if I had one, and I even have a spare at my desk at home.  If I thought I might lose my spare one, I would keep one in the classroom but so far I haven't.

Find a meter you like.  I really like the Freestyle meter (Therasense, Abbott Labs), but Medco didn't like covering it.  I took home several different types that they did like covering, and tried them for several days.  I would test off the same drop of blood.

Remember meters are NOT equal.  For example, the Freestyle meters and the One Touch meters use an almost opposite approach of putting blood on the test strip and the Freestyle method fails when you use the One Touch strip/meter and vice versa.

Also they tend to give different ranges of results.  My CDE once told me that the Freestyle average more closely matched the A1C than any other meter.  I believe, but can't prove it, that the individual types of One Touch meters read similarly, but I haven't performed an individual experiment.

By the way, one of the reasons the average Type 2 isn't compliant on testing blood sugar, is that the insurance companies do not like paying for strips.  To stretch money, I was told by my first CDE (when I was on medication), do to a testing schedule such as this:

Test fasting on Monday
Test before lunch on Tuesday
Test before dinner on Wednesday
Test at bedtime on Thursday
Test fasting on Friday
Test before lunch on Saturday
Test before dinner on Sunday

I'm not sure that is real smart, as it really doesn't tell you what is going on, but remember the common approach to diabetes in Type 2's is to throw a daily pill at it and cross your fingers and hope it works.

I personally think the "Patty LaBelle" method is good, but getting the insurance company to pay for the strips is going to be hard.  Basically eat the same meal several times and see what it does to the two-hour blood sugar.  That will open some eyes!


Exercise

Okay, I'll be honest. I really don't like physical activity. Well, dog agility is my exception. I don't know why I like it, but I do. I do enjoy just about any type of dog training, so you'd think that walking my dogs would be pleasant, but nope.

My parents were not into playing sports, though they did take us places like roller skating or bowling. We just never did any regular physical activity.

I hated gym class as I was growing up. I'm left handed and awkard which meant that I got picked last, plus I had never really learned any gym skills. I hope PE teachers have quit the team picking thing, by the way.

When I have been successful exercising it has been extremely convenient. I joined a gym which I enjoyed until it shut down precisely because it was less than 1 mile from the house and on the way to school. I felt guilty if I didn't stop by either on the way home or to school. Plus it was close enough so I didn't have an excuse in the summer. Heck it was on the way to about 80% of my activities. Plus it was clean, the staff was friendly and they had good personal trainers.

However, when it closed, they moved me to a gym that was not on my way, was about twice as far away from the house so I had lots of excuses, plus the dressing room was on a different floor from the showers. And the workout room. I got more time on the stairs than on the equipment.

Right now, I have the best solution for me. I have a gym at the house. If it is in disrepair it is my fault (it isn't). I also have all the tools I need to be successful -- I use iShape as my personal trainer, I have a TV setup with a DVR, and I tape shows I like to watch. It's at the foot of the stairs so it is hard to avoid -- most of the time I leave the doors open even though the dogs make a mess in there.

I also get repetitive stress injuries on a regular basis. I've had carpel tunnel repair, I've had heel spurs, and I have been diagnosed with tarpel tunnel syndrome. Plus I've gone through P.T. twice now for a bad knee. Any one of the foot problems can sideline me for a while, especially when I have to do physical therapy.

I'll share some of my unsuccessful exercise attempts.

When I first started teaching school, I started walking the dogs every morning. Good plan, accept a) there were dogs that attacked MY dogs, and b) that's when I discovered my grass and tree pollen allergy. Man, I only walked about 3 weeks and I got a major ear infection. Plus my stress level was high over the attacking dogs.

I signed up for an expensive gym on the other side of town -- great place and cheap for teachers -- the Landry center, super trainers, BUT it took an extra 30 minutes to drive there, and it was an hour trip when I didn't go to school.


Sleep

Sleep is my hardest area to be compliant. I've ALWAYS had sleep issues.

Some are genetic/environmental. My father's family has not been good sleepers, and my mother says I've always had problems with sleep. Part of the problem, I believe is that it was considered a treat to be able to stay up with my father.

Other item that leads to that was my choice of profession -- I became a maintenance programmer, and I was on call literally 24/7. The only way I got off call was to go out of town -- and even then I would often get calls. It was not unheard of for me to get a call at 2:00 in the morning, go in and then stay at work until quitting time the next day.

My medical team has conjected that my sleep apnea was caused by an automobile accident when I was 20. If so, I went over 15 years without being treated for sleep apnea. I would often wake up in worse shape than I went to bed, so I often decided to not sleep, as what was the point. Before being treated for my sleep apnea, I would typically sleep 2-4 hours a night.

That has changed since I got my CPAP machine. I checked this morning, and I have logged an average of over 8 hours a night on my machine over the past 30 days. I still have trouble going to sleep, often have trouble getting to sleep, and even worse, have touble staying asleep. Then when it is time to get up, it's hard to wake up.

This is something I would really like to fix. The Requip helps, the CPAP machine helps, and eating sugar before I got to bed helps. Few other things help significantly.

I do know the better my sleep, the better my blood sugar, and the better my eating habits.

I do try to keep my sleep as stable as possible.


Pill Compliance

Some pills are relatively easy but some are difficult. Here's what I've gone through recently on a difficult pill. I'll put some suggestions for helping ALL patients at the end.

I was recently prescribed Requip. You take it 90 minutes before you go to bed. Also, you are not supposed to drive until you know how Requip affects you. By the way, it makes me drowsy.

Here's the problem. I try to go to bed at 10:00 pm every night, but two nights a week I have dog class and they end about 9:00 and I have a one hour drive afterwards. I also found that Requip does make me drowsy. A good thing if I am at home.

The first problem was remember to take the pill at 8:30. The good news is that I can set my pump to remind me to do something (though it doesn't tell me what), at a certain time. So I set my pump for 8:30.

On the nights I have to drive, I take the two pills on the exit I take to get to my house. There are enough ways to get home from there, that even if there is some type of road block I can get home before I get drowsy.

First problem -- sometimes I couldn't remember if I took my pill. Knowing that it makes me drowsy and that taking it twice would be a really bad thing -- I did it once it was not good -- I was skipping taking it.

Unfortunately those pill containers marked by the day of the week have a problem -- one they are too big for my purse. However before my last trip, I found some lovely little plastic bags that can be marked by the day of the week and time of the day. I used some of those, but they are hard to handle and you have to work at figuring out if you took the pill.

The good news, is that I came across a smaller container that is marked by the day of the week.

So here's how I ultimately solved the problem -- first, I use an alarm that is present and with me at all times to remind me, and second was the smaller container to hold the pills.

For ALL patients:

I recommend those day of the week pill containers. I use a seperate one for morning and evening. The best thing about them is that they prevent overdoses as you can tell at a glance if you took it.

For traveling, I recommend the little plastic bags. The above pill containers do come open. Yes you should take something to indicate that they are prescription drugs. I print out the pages from the mail order pharmacy I use.

Finally for weirdly timed pills, use some type of alarm to remind you. It needs to be with you at the time you need to take the medication.

A smart pharmacutical company, pharmacy, or doctor's office would purchase them and get their name imprinted on them and give them free to patients. This would even be a good thing for the ADA or DLife to produce.