Doctorly stuff

Sunday, June 17, 2007 | 13 comment(s)

I crossed paths with medical professionals three times last week.

In chronological order:
Monday, June 11th
I had my six-month check-up with my ophthalmologist
How do you spell that?
I am almost certain I have misspelled that word several times in this blog. I'm usually pretty picky about things like this. But seriously, when did they put that "h" in there?

I've always pronounced it "Op-tho-mol-o-gist", which is probably hideously wrong. Could it really be pronounced "Of-thal-mol-o-gist"? Not sure. Anybody know?

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on Monday afternoon. The eyes are holding steady. It's been about a year since my laser surgery for my diabetic retinopathy. At my first six-month check-up, the doc noticed a new microaneurysm near the center of my eye (aka, my macula). He seemed concerned about this, but not too, too much. Basically, the microaneurysm is still there and holding steady. He said if it leaked, I could notice some blurry vision, at which point I should then come in to have some more laser treatment. This would be slightly different from the panretinal photocoagulation that I had before, and be specifically targeted at this microaneurysm. But since it's so close to the center of my field of vision, he wants to hold off on doing this because of the potential small loss of vision where the laser treatment is performed.

But it's also likely that this microaneurysm could either stay stable for many years or even go away without any need for further laser treatment (which is obviously what I'm and strongly hoping for).

Tuesday, June 12th
Thankfully, my saucer-like pupils returned to normal
Damn Insurance
They used to have drops to help speed up the pupils returning to normal, but they don't provide them at this office anymore because they're apparently too expensive, not necessary, and insurance won't cover the cost of them any longer.

Not necessary my ass. Try walking or driving on a sunny afternoon with your pupils maxed out. It's not fun.

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by the next morning so I could see the most recent pictures of... the babies!! (NB: two exclamation points).

They're doing great. Baby A is now head down, and Baby B is still in a breech position (we're not finding out the genders of the babies - but more on that later). We're at 24 weeks now. It's highly likely that they can flip and flop around into new positions in there for a little while longer (before they run out of space!). But positioning of the babies has EVERYTHING to do with whether the babies will be born vaginally or by C-section (if either one is breech, most docs these days won't even consider a vaginal delivery).

So, like I mentioned above, we don't want to find out the genders of the babies. But when I say "we", what I mean is: I don't want to know, and so Megan is not going to find out either. She wants to find out (very badly, in fact), but can't come up with a reason for wanting to know other than "just 'cause I want to!" and so she doesn't feel like this is a good enough reason to over-rule my not wanting to know. (And before anyone suggests it: she can't keep secrets very well, so her knowing and my not certainly wouldn't work).

Toward the end or our ultrasound session, Meg actually asked the sonographer:
"So, do you know the genders of the babies?"
"Oh, yeah, I know."
Honestly, I'm not sure how we got out of that room without finding out.

Baby A:


Baby B (sucking his/her thumb, even):


Wednesday, June 13th
A week or so ago, I went and had my blood work done for my A1c test. When I got into the office on Wednesday morning, there was a phone message from my endocrinologist congratulating me on my A1c reading: 6.9.

If you've read this blog for any amount of time, you might know that I've been struggling, and struggling, and struggling, and struggling, and struggling to get my A1c below 7.0 for the past year. Getting this reading was so anticlimactic it wasn't even funny. I felt almost no joy, which kinda sucks.

All I'm asking for is a little internal consistancy, is that so much?
For instance:
When one's meter averages go down, their A1c score should go down, no?
(Answer: mine stayed the same)
Or how 'bout this one:
When one's meter averages go up, one would expect their A1c score to go up, right?
(Answer: mine went down!)

IT JUST SIMPLY DOESN'T MAKE ANY SENSE. Urrrrrrgggggghhhhhh.
(see this previous post for a review of my stats to see what I mean).

I feel like the A1c test has become a meaningless benchmark (at least for me).
If there's no correlation between my A1c scores and the average readings I get out of my meter, how am I supposed to interpret the results? Do I just choose to judge how well I'm doing based on one versus the other?

Clinically, it's nice if there's a single quantifiable score that can be used to judge how well one is doing (kinda like the apgar score). But there's also the pitfall
Atari rules


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of such a score being an oversimplification of one's health status. Although I've been told there's mounting evidence (I realize I should support this claim with a reference, but unfortunately I don't have one, so caveat emptor) that blood pressure and lipid profile (not to mention microalbumin concentration) are more important than just an A1c score in gauging the overall well-being of a person with diabetes, the A1c is still the industry standard.

So anyway...stick that in your pipe and run it up a flag pole.
I've reached my goal. Whoop-dee-doo.

13 Comment(s):

Blogger Minnesota Nice said...

Ok. It's done. You got a good eye report, great pics of the kidlets and a pretty favorable AlC.
I would conclude that you should continue taking care of the db just as you have been, and shove the numbers in the back closet.

Anonymous Jana said...

Re: the A1C...give yourself a pat on the back. You have to be doing something right just to be in that range. But otherwise, I agree that the numbers can be kind of deceiving. These days I just try to be within a certain range, and I figure the margin of error is pretty high.

Re: ophthalmologist...it's spelled that way because the ancient Greek word for 'eye' is 'ophthalmos' BUT the sound 'ph' in ancient Greek was really just an aspirated 'p' (the sound you get when you say 'top hat' in quick succession), not an 'f' sound...same goes for the 'th'...it wasn't the sound that ends the name 'Beth' but rather something like the sound that happens when you say 'cot hat' in quick succession. So basically I think it's fair game however you choose to pronounce it in modern English.

Blogger mel said...

Sounds like a great week of appointments! Great job with the A1C.

Last time I went to the eye doctor they didn't offer me the reversal drops (which I thought was odd), so I asked for them and the assistant asked if I was driving (I was) and then asked the doctor if she could give them to me. He asked if I was driving and then agreed to. I found it odd, but now I know why--they're just cheap :)

Blogger Major Bedhead said...

Babies! Those are great U/S pictures.

Congrats on the good a1c, even if you are totally underwhelmed by it.

Blogger Scott K. Johnson said...

Wow Kev, maybe the A1C result is like, delayed or something...? Hmph.

I can really feel you on your frustration with it. You worked so damn hard, and then nothing. Now you back off a little bit, and there it is. Wow.

Awesome baby pics. They look so big already (yeah, like there's a quarter in there for scale or something...)!

Nice Atari reference. That's hardcore gaming right there!

Take care man!

Blogger Kevin said...

Kathy: I kinda think you're right. If I can keep my numerical tendencies in check, I might be better off!

Jana: Thank you for the etymology/pronunciation help!

Mel: Get those drops while you can!

Julia: Thanks!

And Scott: I am so not a video game player, it's not even funny. I just have vivid memories of my friends trouncing me in these games as a pre-adolescent and have never been the same since.

Blogger Kelsey said...

Kevin, congratulations on the A1c, and more importantly, the babies! How exciting!!

We're expecting just one baby this winter, and my husband was hoping for twins... I'll have to share your news with him!

Blogger Bernard said...

Kevin

Yours is the second recommendation I heard for Gary Sheiner in the last 2 weeks.

I'm going to give them a try and see if it helps flatten my sine wave sugar readings.

Congratulations on the twins. Start banking up those sleep hours now! :-)

Blogger Bernie said...

KP,

The U/S pics are amazing! In the process of moving we haven't had 'the internets' (a series of tubes, btw) to check out the little yins. So exciting!!

Hang in there, KP. I just can't believe that it's been a year since your procedure. And hearing that you've found A1c stability (despite the starvation) offers you more information for that data-seeking self of yours.

B&K

Blogger Lyrehca said...

I'm way late to the party here, but congrats on finding out your wife is pregnant with twins. Hope everything goes boringly well.

And as a fellow comrade in diabetic eye issues, I hope you get to avoid more laser stuff too. But hooray on the 6.9, even if you aren't feeling it--it's a great A1c.

Blogger Chrissie in Belgium said...

Kevin, those photos are amazing. I cannot get over how clear they are. Ultrasound had just begun when I was pregnant with Eric - and they said I had twins. That was b/c he moved around so quickly! See how advanced science has gotten. They thought I had twins until they did an x-ray. Back then x-rays could only be done in the final two weeks before delivery. Kevin, and Meg too, I am really happy for you both.

You know, what does a number say?! You can only try your best. I really think it is wrong how everyone grades diabetics by their HbA1c. Try your best and forget the HbA1c value. Yes, a good HbA1c does make us happy and we should suck up all the good moments! Nevertheless, science really doesn't understand all the factors that influence our HbA1c level. What happens in our eyes can be seen as a mirror of what is happening in the rest of our body. That your eyes are now stable says ALOT! Keep up the good work. Kevin I like my logsheets SO MUCH and every day I want to thank you / send you a hug for them! Every day.

Anonymous doxdox said...

Some things to think about (maybe they are worthwhile or maybe they don't mean much).

-You figure if you measure 10-20 times a day, are they are pretty staggered intervals?

-Do you measure more when you have lows (skewing your meter average lower)? Also, you figure when correcting lows that you move your BG up faster than moving highs lower (but your meter doesn't know that -- it just moves your n value up one tick at a time).

-Do your night numbers go up? If so, I am assuming you generally don't measure these, thus they are not factored into your meter numbers? You figure all of those hours you are sleeping and no meter values to show for it.

-Lastly, I haven't read your blog enough to find the answer, but I did read you use two meters. Which ones? I use a Freestyle Flash. Interesting enough the technology in the meters is different and namely the enzyme technology in the strips themselves. For instance, the Freestyle uses glucose dehydrogenase as the detecting enzyme whereas some other brands use glucose oxidase. From my reading (and personal experience), the GDH technology is more accurate. When I got my pump, the meter that came with it always gave me LOWER numbers than my Freestyle Flash. Interesting, to say the least. Your meter (if this is the case) just might be naturally skewing your numbers lower than what your BG might actually be. I know that meters are technically not supposed to be off by more than 10% from actual value, but when I was taking dual measurements, the two meters were definitely off more than that...

Some food for thought. Take from it what you will...

Blogger Ed said...

I found your comments about the A1C results very interesting and intriguing. I was diagnosed with Type II diabetes in April 2007 when I showed up in the ER with atrial fibrillation and, unknown to me, a glucose of 280. My A1C came back a week later at 8.4, which supposedly computes to an average glucose of 186 or so.

I immediatly embarked on a self-imposed "diabetic" diet which for me mimics the Atkins diet except for a MUCH* higher intake of low carb vegetables and salad. It took me about 2 weeks to get readings below 160 and another 2 weeks to get below 140, so I had a month mid April to mid May) of readings which should have pulled my A1C level up compared to the readings I would achieve thereafter. From mid May until my A1C test in early July, I was getting a lot of readings in the 110 to 118 range and wound up with an A1C of 6.0. Not bad for 2.5 months of work.

Since then, I have continued to lower my readings, and for the month of December, 2007 my average reading was 104. November was a bit higher but not by much - 108.

Ok, cool, I should get a really gaudy A1C of 5.7 or 5.8, right? Wrong! My A1C this week was 6.1- higher than my reading when I still had lots of 140's to 160's "cooked" into my A1C. I'm dumbfounded. I'm confident my less than 1-year-old glucometer is working well. So, how does someone average 110 or below and get an A1C of 6.1???

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