Thursday, November 30, 2006

Endo appointment

Today I had my endo appointment. He thinks that my management is so good that we only need to set up appointments twice a year. I can live with that, as I get the appointments I need with Alice, my fabulous diabetes nurse in the day-hospital unit. In my eyes, Alice is the health care person in my D-team, who knows the most about me and my diabetes when it comes to management of this disease. She has done more trying to get my sugars in control, working with me to reduce the number of morning highs and subsequent severe lows (they were more or less an invariable rule for the last couple of years with Insulatard® [NPH] as basal insulin), assisting in the switches to Lantus and the pump, respectively. That she is the one to turn to when it comes to fine-tuning of insulin and use of the pump in general, was confirmed beyond everything else today.

I started seeing my current endo, when I moved to Odense almost 6 years ago and needed to find a new diabetes team here. My first impression of him was a bit mixed. He is Egyptian, and although he has been living in Denmark for many years, he still speak Danish with quite an accent, so I had to focus on every word he was saying to make sure I understood him right, which also caused me to doubt his medical capabilities a bit. This is not a problem any longer, as I have gotten use to his accent in both Danish and English (he was my co-supervisor during my master’s, and because his research unit is international, the common language in the lab and at meetings was English), and I have gained confidence in his medical capabilities too. Like many other doctors, however, he too has a tendency to focus on the overall results of diabetes care, i.e., the A1c-value. Thus, it took me quite some time to make him realise that a change in my regimen was needed 4 years ago, when I was having large issues with Insulatard® and BG-levels overnight. My A1c was around 6.0, so he couldn’t see any problem.

Sitting in his office today, I almost felt like back then. He asked about, whether I had decided to stick with the pump or not, and I told him that although I am still not convinced, I am being a bit more positive towards it than I was 6 month ago, so I felt I had to give it a bit more time to make it prove its worth. Jimmi and I do want to have kids within the next few years, and as much as I know that the hospital will not approve Lantus for use during pregnancy, I absolutely do not want to go back to Insulatard® and its unpredictability, so, as I told my doc, it will probably be wise to try to make pumping work. I told him about the issues I currently feel I have with it, but he didn’t really have any suggestions as how to solve those. As these issues are specifically related to the sports activities I like to join, he asked if the adhesive on the infusionsites would stay put when I was sweating. I told him that I would usually secure the site with an additional adhesive, because I had experienced unintentional detachment of sites due to sweating. I also mentioned that I had started swimming again, and he immediately asked me how I managed with the pump during swimming.

“I take it off”, I replied

Doc: “So you take out the whole thing?”

Me: “No, I just disconnect like this (showing him how to disconnect the pump), put a couple of pieces of Tegaderm® over the site to seal it, and go swimming”

Doc: “Let me see that again (referring to the disconnection procedure, carefully inspecting the infusionsite). It is so much smarter than those old butterfly-needles that were used with pumps 20 years ago.”

Me: “Yeah, I guess so….” (thinking to myself: Haven’t he kept himself informed about the new advances in diabetes treatment at all for 20 years?!!! He too recommended the pump 4 years ago, when he finally realised that we needed to exclude Insulatard® from my regimen if I was to regain decent control – and now he reveals that he actually knows nothing about pump therapy!!).

I am so happy that I got Alice to turn to in these matters. My endo is apparently helpless when it comes to pump therapy. What surprised me even more today was that he didn’t even wanted to look at my log sheets. Essentially, what he did today was to measure my blood pressure, hand me a lab-sheet for blood work to be done before the next appointment in 6 months, reminding me to schedule an appointment for eye check-up at the same time (the eye exams are done by specialists in the ambulatory too), and then ask me if there was anything else (not specifically related to pump therapy, as he stated that it was probably better to let Alice handle that) that I wanted to discus with him.

I've got an appointment with Alice in two weeks :-)


Kelsey said...

I think many endos do not stay current on new diabetes technologies like pumps. I've told my endo plenty of things that he was unaware of. Kinda scary!

Chrissie in Belgium said...

Heidi, I KNOW what you are talking about! On one hand one can rationalie the issue and say that at all endo appt, time is limited, the doctors cannot know really understand b/c each diabetic reacts so differently. BUT that is their JOB! That we cannot rely on help from our doctors STINKS! Thank God you have Alice. When i want to ask anything it must first be directed to my CDE. If he cannot reply, he refers my question to the Professor. I cannot contact my doctor directly! In the last month we have gone through this procedure and I have yet to receive a reply from the Professor. So just last week I commented to my CDE that "I do not think the the Professor intends on replying to me!I do not think the Professor is at all interested in patient-doctor communication." The CDE just simply did not reply, he just looked at me ...... So we D's are left to manage on our own!

Scott K. Johnson said...

Alice is a true gem.

It's scary sometimes when we are unsure of our endo's knowledge level of the details and the day to day "nitty gritty" of management.

And Chrissie! That sounds like quite a frustration!

Chrissie in Belgium said...

It certainly is - but I do not think I am alone. Other D are in exactly the same situation. I have had so many doctors after 45 years - it is rare to find one who really has the time to prioritize patien-doctor communication. My general physician does, but he is not a diabetic specialist.