04 November 2006

Shock and...uh, more shock

I'd start at the beginning but which beginning? To write good fiction, the writer should never start with a flashback but find the part of the story that should be told first, not too early and not too far into the story.

I could interview myself - take a history with chief complaint and its seven dimensions , review of symptoms with significant positives and negatives, past medical history, current medications and allergies. That's what I would do with my patients but I specialized with providing services for minorities and so was never surprised when the story would start with, "My family offended a spirit when we escaped to Thailand."

All I can start with, for myself, is "I always knew that it would happen." When I worked as a Physician Assistant in a health center in California, most of my patients were diabetic. I read a lot on endocrinology, attended continuing medical education programs on diabetes and the new drugs that were coming out (this was in 1996). I tried to convince my patients to follow their diets, take their pills and to exercise.

Reality was otherwise. For Asian people, being heavy after generations of deprevation, was a sign of good health. Medications should be taken for a short time - they are strong and they are supposed to cure the patient. Take medicines daily for a long period of time? What kind of poor medicine is it? And exercise - a Hmong woman laughed when I suggested it. "In the neighborhood where I live, it's more dangerous to exercise."

So, I digressed. I wanted to write about me, not about the people who were not me. Only to say, "I would never get Diabetes." I ate properly (mostly vegetarian), exercised and for a long time, watched my weight. However, I've been living in SE Asia for the past ten years. People entering prosperity - big wedding parties, dinners with friends, alcohol flowing like a tsunami.

In 2002, I visited the US. As usual, I bought too many books and trinkets I could not get in Asia. Hefting around the suitcase hurt my back, so I decided to get a physical and back x-ray. I learned I had spondylolthesis, a back condition where one vertebra slips against the one below it. Now that I had a reason for my back pain, I went into kind of a slump. Didn't exercise very much, but on the plus side - I let other people carry my bags for me. I gave up my trusty backpack for a trusty roller bag (and thereby entered middle age).

I gained weight and at my next physical, I was stunned to learn that I had a high blood sugar. A doctor was about to put me on a medication that I didn't want to take, so he referred me to someone else (Thai doctors are not accustomed to having their patients ask questions)

The endocrinologist was cool and decided that since my HbA1c was normal, that it was probably impaired glucose tolerance and we'd try diet and exercise. So I joined a gym and got myself back into running and bicycling. Strangely enough, I started to feel better; in fact, even more hopeful. But during a long trip in October last year, I gained ten pounds and returned home feeling down. In between some eye lid infections and meetings, I got down to Bangkok several times and started an overdue physical exam.

In January 2006, I worked for a month in Vietnam. When I returned home, I had to go to the field so it was full month before I received the results of my blood tests from November. My fasting blood sugars were above 250 and my HbA1c was 7.5, kinda high.

The real shock was the recheck. My fasting blood sugar was 359 and my HbA1c was 11.2! So my doctor started me on Glucophage 850 in the mornings and 500 at night.

We'll jump over the past six months. I just returned from Bangkok and my fasting blood sugar was 110 and my HbA1c was 5.5. I've been consistent with medicines and checking my fingersticks both fasting and several times a week, 2 hours after a meal. I've been fanatic about execise and I've lost 30 pounds since January.

So that's the background. There's a lot more. And there will be a lot more. There always is.

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