Saturday, July 21, 2012
I am still steaming. And it's been four days since I went to the doctor's for a "routine" physical. She insisted, since I hadn't been there for a complete physical in two years. OK, that seemed fair, so Tuesday I went.
Back story to my visit:
I had needed a prescription for new CPAP equipment and had my doctor give me one. I was really annoyed that the company would not just give me what I needed, since the condition is stable, and has been since my diagnosis of obstructive sleep apnea six years ago. If you're fat enough (I am) chances are good that you may have this. I can't tell you how many people I know that do have it. Sleeping with a mask and continual pressure to keep the airway open through the night is a rough thing to get used to (success rate runs at only about fifty percent), but it sure beats stopping breathing 40 times an hour. That's not a typo. My sister one holiday event noticed I fell asleep in the lounge chair and stopped breathing. Some wakeup call (no pun intended). As bad as that sounds, I had a friend who stopped breathing 72 times an hour. Another friend of mine, a physician, told me it was a good ten years before he was diagnosed. That got me to thinking how long it took me to find out why I was always feeling so dopey (I always attributed it to an intense working environment and thought it was par for the course when one works 80 to close-to-100 hours a week): For me the diagnosis came after about 15 years. That's pretty shocking, that a major illness can go undetected for so long. Part of that is (I feel) the medical profession simply did not know about this disorder. I clearly have a memory of seeing a pulmonologist with a sick relative and as a "by the way" on our way out, mentioned to her that sometimes I wake up gasping. She told me she could give me medicine for that. This was in 1991, and she was a specialist. Looking back on it is simply shocking that she did know about sleep studies, or at least that's what it seemed. But little truly was known in the late 1980s and early 1990s about this condition. Sleep apnea is not a "silver bullet" diagnosis for all the ills that being overweight brings, as one friend sarcastically said (non-physician) until she reexamined her own situation. And she had already been diagnosed with obstructive sleep apnea. The condition is linked to heart disease, high blood pressure and an assortment of other "goodies".
So this was the road that led to the doctor's visit now. Before I went, I was waiting on a prescription refill for an elderly relative at Rite Aid. They have one of those blood pressure machines to occupy you while you wait. I went for it. I got a blood pressure reading of 171/96 and a heart rate of 85. The heart rate is fine, but the blood pressure results sent me positively reeling. I started to calculate it in my mind: The systolic pressure put me at Stage 2 hypertension and the diastolic pressure at Stage 1. If this were true, this was definitely not good. Now I really wanted to see my doctor four days hence.
As it turns out, even off the CPAP machine for several days, my blood pressure is fine: 128/80. It hadn't been when I first started seeing my doctor some five years ago. It was stuck in the 140 to 155 range. Other things, besides the morbid obesity, lead her to tell me back then that my body was "starting to complain". I seriously needed to lose weight, and I needed to do it then. A realistic initial goal is to lose 10% to start to see results with high blood pressure. I did. It's that dramatic. My doctor was proud of my efforts. More so, I was pretty proud of me.
But after awhile, complacency sets in. You know the drill: You lose some weight, then you get stuck. It's not a true plateau for many, because the old stressors and the bad habits really want to get it on again. They are fighting the new lifestyle with everything they have, they have been together for so long.
As relieved as I was that the blood pressure reading at Rite Aid was false, I was not going to be let off the hook that easily: Bad news was still on the horizon. It came the next day with the lab results. While at the doctor's, I signed up for the new patient portal. Whoever thought of this, is pure genius. It allows you to communicate with your doctor without having to leave incessant messages, missed call backs, new phone calls, ad infinitum. I was surprised that the very next day after the visit, I saw in my e-mail box a note from the doctor. I figured it was a "welcome to the patient portal" kind of message. I was dead wrong. Some of the lab results were already in and she wanted me to know that I was now "pre-diabetic". She was very blunt. My head started to spin, "How can this be?" Two years prior, my blood work results were so incredibly pristine, I wanted to frame them. I started to reexamine what lead to this moment. I've kept off a substantial weight loss of 35 pounds over the last four years. Yes, I had gotten down to 46.6 pounds gone, but that couple I just mentioned to you that want to get it on again, they are fierce competitors for my general good health and well being and they do not tolerate well anyone wanting to come between them in their love life. [They are not married yet, so help me, so there is hope.]
I started to look back at the motivators that kept me going on an even keel for so long: One was my old health insurance. My policy gave me back $200 every six months if I went to the gym 50 times during that period. It's a sweet deal (and other insurance companies I have seen, carry the identical policy), because if you join a "Y" or another gym that is cheap, this deal then virtually pays for itself. Another thing back then that I did to keep me going was to mix up the exercise, and with an SP buddy, we created together a challenge to virtually walk from one end of Cape Cod to the other -- close to 80 miles, by Thanksgiving. We finished that endeavor, and almost right on schedule. So what changed since then? My insurance policy changed and I am no longer offered a monetary incentive for my good work at the gym; my SP buddy and I finished that challenge, and I began another, but alone, that I have not been tracking as closely as the original one. These are not excuses, just an honest answer to myself as to why I am not working optimally on my weight loss progress as, of course, I should.
As a health professional I know the consequences of diabetes. I do not want to get there under any circumstances. What immediately popped into my mind was a young patient I had some years ago who was hospitalized for its consequences [WARNING: What follows is going to be graphic, but I feel necessary for the purposes of my writing all this. If you've come this far in the reading, congratulations, this blog is long. Feel free to stop reading now.]. He was about 25 years old at the time, and just flat out refused to acknowledge that he was diabetic. Even in the hospital environment, he would order fast food to be delivered. He was not heavy, and if I remember correctly, he was a Type 1 diabetic. The rules for the diet component, are the same for both types of diabetes. He refused to acknowledge that, and it was heartbreaking. He was in the hospital for an above-the-knee amputation of his leg. It just could not be salvaged, having suffered the ravages of the disease. He was refusing the above-the-knee surgery which was required, wanting to save the knee so he could have a better prosthesis for walking. It was too late. And here was the heartbreak in the story: He only gave permission for a below-the-knee amputation. When the surgeons went in, they saw, as they knew they would, that it was too gangrenous to be stopped at below the knee, but because of his limited consent, they were forced to respect his wishes. So they closed and concluded the surgery for the time being (hopefully). We, the medical staff, were then left with the task to convince him to go back to the OR and proceed with what was necessary to save his life. He only acquiesced, but literally allowed a slow progressive remodeling. He was still refusing what he needed, and only allowed piecemeal surgery in multiple steps, while still consuming the takeout food that was literally like putting a gun in his mouth. It just broke my heart. And his family was so incredibly unsupportive of this young man.
So now here I am, literally fighting for my life. With my hemoglobin A1C of 5.2% two years ago, to the current value of 6.3%, which is clearly in the pre-diabetic range (6 to 6.4% is pre-diabetic) I am in serious trouble here. The doctor's note was terse and there was no mincing with the words (and I do appreciate that, it was necessary to be said just that way): Any value over 6.4% is clearly diabetic.
So, I have three months before the recheck of the HbAIC. I've given myself until October 9th (the time around which I need to reschedule the doctor's visit -- and she does not want me to just schedule the lab work, she wants to see me as well) to lose 20 pounds, a realistic goal. I'm going to watch my diet very closely, and this time around I just cannot afford to give myself any treats (so long ice cream, goodbye gooey cakes, you will be missed). I really would like to keep all my attached parts, those that were given to me at birth, and those that I want to keep until the end.
That brings me to you folks: I'm reaching out for support to keep me on track for the next 80 days to ensure that I reach my October 9th deadline with a 20-pound loss. I want to lose the pre-diabetic "Scarlet Letter". I will post my progress, one way or the other.
What's your wakeup call?