Your Illness is Not Your Fault.

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Your illness is not your fault.

Shared Medical Appointments

Doctor appointments are not something that most of us look forward to attending. We’re poked, prodded, weighed and asked lots of questions that we might not feel like answering. The idea of doing any of that in the presence of others doesn’t sound like something I would enjoy, so explain to me why I signed up to participate in a Shared Medical Appointment!

What the heck is a shared medical appointment? Visions of sitting in a room full of people wearing those horrid gowns, swinging their legs over the edge of the table…waiting, pop into my head. (shudder) Rest assured, that’s not what it is. It’s my understanding that the Cleveland Clinic started shared medical appointments as a way to work with larger groups of patients for their follow-up appointments. These patients all have the same condition/disease and could benefit from a group setting. Think support group/education. Here in Podunk, AZ, where we don’t even have a stop light, we have shared medical appointments! Just like in Cleveland but with more pine trees and less traffic!

Back in December, my HCP approached me about participating in their new type 2 diabetes shared medical appointments. It would start out small (6 participants) and would, hopefully, grow. She explained that each patient would have approx. 10 minutes with her to check our labs, weight and meds, etc. and the rest of the time we would be in a support group setting. Since I had tried to run a support group in our town, and failed, I was pretty excited to hear that they were going to do this. The biggest problem I had with my group was getting people to come and speak to us. Here was an opportunity to have professionals come and impart their wisdom upon our heads! I said, sign me up! I attended my third shared appointment this week and I figured it was time to tell you about the experience. It’s been a mixed bag.

The first appointment was just a chance to tell us what to expect and to ask us what we wanted to talk about. We filled out a survey and just generally chatted. We had our time with the doctor and got to know each other. There was horrid coffee available.

Second visit, 3 months later, we had a session with the dietitian. Ugh. Because I follow a lower carb diet, I knew that she would say things I didn’t agree with but she was also kinda pissy. I tried to keep my mouth shut and succeeded, mostly. She was actually spending a lot of time telling us what we can eat at fast food restaurants and which frozen meals are “good”! Thankfully, another participant spoke up and said, “I want to know what I should eat at home!” The doctor asked me what I thought and I shrugged.

This last appointment was conducted by a pharmacist and she went over the A,B,Cs of diabetes: A1c, blood pressure and cholesterol. She’s good and gave us a lot of good information. There were also lots of new people, which was encouraging. I also found out that they now have three groups! I think this is great and a much needed service.

The bad:

• They push carbohydrates.
• Not much time with the doctor. (I’m used to using my check-up appointments for everything and now I will have to have another visit to discuss lady stuff, my thyroid and fibro.) It feels rushed. 

The not great: 

• I see lightbulbs go off over some heads during the conversations (which is good) but there isn’t always time to adequately explain things and they often end up looking confused.
• While you are having your time with the doctor, the discussion continues in your absence and you might miss stuff.

The good:

• Some of the people in my town who desperately need to take charge of their diabetes are getting needed education in a group setting.

Although I feel that this is a great service that my clinic is providing, I don’t know that I’ll continue attending. It’s not really something I need any longer. My HCP wanted me to participate because I’m a well-informed PWD and I could “share my wisdom” with the others. But, my “wisdom” often flies in the face of the usual diabetes education and I have no desire to be “that woman” who argues and confuses. Even though I feel that what I’ve learned about diet and my diabetes is valuable information, I can’t exactly stand up and contradict the dietitian. Who are the others going to believe? Answer: not me. I’ve reached a point in my life with diabetes where I have learned what works for me and that just doesn’t jive with the conventional wisdom. It seems that the best place for me to advocate is right here, and not in a support group setting. Unless I could help encourage those others to take charge, check their blood sugar before and after those carby meals and see what it does to their blood sugar. I don’t hear that advice being given. Hmm, maybe I’ll go one more time.

All in all, I think that shared medical appointments are a good thing, something that’s needed. It’s a beginning. Whether or not I continue to attend doesn’t matter, what matters is that it’s happening and it may help some lost souls find their way. I give it a thumbs-up (especially since we don’t have to wear those gowns!)

Numbers: They Lie

People with diabetes live their lives with numbers; HbA1c, glucose meter readings, weight, lab results, etc. It sucks, to be honest. But I noticed something this morning that made me stop and think, that in a way, those numbers can lie to us.

Have you ever had one of those days when you just felt “thin”? I am far from thin, but sometimes I just feel skinny. I’m not bloated, I have energy, my clothes aren’t tight and I just feel good! One of the worst things I can do on those days is to step on the scale, but I often do. If the number on that scale doesn’t jive with how I’m feeling then I can begin to feel bad. My mind tells me, “Who are you fooling? You’re not thin!” Well, duh, I thought we’d already established the fact that I’m not thin! But that darn number can begin to niggle at my good mood and bring me down.

This morning I feel thin and I didn’t step on the scale! (Yeah me!) I started my coffee and stumbled into my office to check my blood glucose, like I always do. 151 WHA??? I ate reasonably last night, my fasting numbers have been slightly better than my normal lately and now this? My good mood from feeling thin today vanished when I saw that number.

“I guess I’m not doing as well as I thought. Maybe I should step on the scale and see for myself. Maybe I’ll eat ice cream and potato chips today. Why not?”

Those may not be the actual thoughts I had this morning but I’ve definitely had them before. One stupid, unexpected number on my meter or the scale or a lab report can cause me to doubt my ability to deal with this frickin disease.

Lies.

I’ve been reading a bit about depression and anxiety lately and one of the things I’ve seen over and over again from people who live with those conditions is that they lie. Depression lies (not the people who have it). It tells your brain things that just aren’t true and can cause you to sink deeper into depression. I feel as if the numbers we live with as people with diabetes lie to us as well.

These numbers are important and we need to pay attention to them, but we shouldn’t let them control how we feel about our progress. Our numbers are signposts. (Here’s where I shout out to Christel . She used this idea of numbers as signposts at the Las Vegas UnConference this past spring. Brilliant.) What does that mean? It means that the number on your meter is just a sign of how things are going this minute. It’s not a judgement. It’s not any indication that you’ve done something “wrong”. It’s just a number that helps you make decisions about your diabetes care moving forward. The 151 on my meter this morning shouldn’t taunt me and make me feel as if I’ve screwed up. It just tells me to eat low carb today and drink lots of water and go for a walk. That’s all. I still feel “skinny” and I won’t step on that scale!!

Think about this scenario: A newly diagnosed PWD has an HbA1c of 10. Three months later that number has gone down to 8. Wow! That’s wonderful news! However, if someone who knew nothing about that person’s journey saw an 8 they might think that person wasn’t doing very well. That 8 was lying to that outsider but it’s a great signpost for the patient. They’re doing a great job!

They’re just numbers; numbers on a scale or glucose meter, it doesn’t matter. Just. Numbers. Don’t let them lie to you and cause you to feel any differently about how you’re doing. Go ahead; feel skinny!