Yesterday I visited my endocrinologist. It was an eventful appointment for a couple of reasons:
- I am down 4.3 pounds since my last visit a few weeks ago.
- He has trimmed my diabetes medicine to a single medication, a single pill, once daily.
- The real possibility exists that I could be prescription medication free in 2016.
The weight loss was simply stunning. I have purchased a replacement scale for my bathroom but not yet deployed it so I had no idea where I was on the change scale. In my ignorance I was mentally braced for the disappointment of the reading to be the same or even up a few pounds, an emotional reaction so typical I was mentally resolving to return the newly purchased scale at home while I waited for the reading to appear in the display. The range of emotions I ran through while awaiting rendering of judgment from a piece of machinery reinforced why I do not set goals, why I do not like measurements of progress, and why I should run over that scale with the big truck with its big tires and heavy Tommy lift apparatus to ensure I completely obliterate it. I was so preoccupied with visions of scale destruction that I failed to notice the final answer until the nurse remarked on the 4.3 pound loss since my prior visit. I asked if she was sure the scale was right and she laughed, saying it’s usually when people gain weight that she gets asked that question.
My more cynical side wants to point out it could be water, I could be wearing lighter weighing clothing, different scales provide different results, etc., etc., etc. Nope, not going there this time. I am fully and completely owning that I have moved the scale downward in just a few weeks time since my last visit. And rather that indulge myself in scale-destruction mayhem, I will simply return it for a refund. I honestly do not need such a negative influence haunting me in my own home. The gym has several available to me if I feel the need to torment myself in that way.
This endocrinologist is a super happy, upbeat guy; he radiates enthusiasm when he walks into the room and instantly makes me feel like everything is great and going to be better than okay.
He had released my lab results to me earlier in the week and directed me to schedule an appointment to discuss them in further detail, so there was no looming happiness surprise coming for me. To say he was delighted is an understatement – he was absolutely thrilled and jumped up from his chair to shake my hand and congratulate me on my progress. With my A1c was down to 5.8, putting me just outside or just inside of normal, depending upon the scale utilized (former doc told me > 5.7 is normal, this doc says 6 or lower is normal). This is after my former doc halved the remaining 2 orals diabetes medications I was taking about halfway through the 3 month cycle. It’s been years – YEARS! – since I have been this normal when talking about blood sugar. I am delighted.
We talked about my other readings – cholesterol and everything else is stable and well within the normal range even after taking me off the cholesterol lowering drug – and I am basically a very healthy person. He was very happy with the weight loss and actually asked me if I was eating enough, which made me laugh out loud. Trust me, I eat PLENTY of food, but I have cut back significantly on my junk consumption and am trying very hard to eat regular meals at regular time intervals. The system remains hit-and-miss, but it’s better and I am trying.
I had to laugh again when he was reading through the dietician’s notes about me being “resistant” to logging food and calories as suggested to get a baseline on my nutrition. I explained that I took exception to the term, because I do not feel I am resistant so much as realistic about what I will and will not do to empower myself to better health. I will not weigh and measure food or try to count calories or carbs. I am a hyper-responsible person and being forced to perform such activities would stress me to the point of obsessing over accuracy and being at the judgmental mercy of an app or another professional who will likely find me wanting. Any accurate, meaningful data is questionable under such circumstances.
Okay, put like that, I am resistant. But it is only because I know such protocol will not work for me. I am not going to lie outright or by omission about my shortcomings, especially not to healthcare professionals only trying to help me with a chronic condition.
He agrees that whatever I am doing is working very well for me, so just keep up the good, hard work and maintain my improvements.
We talked about exercise and weight loss, and again I am probably the patient anomaly from Hell. I refuse to maintain a food log for the dietitian. I refuse to track my progress by weighing myself regularly between appointments. But at least I am completely honest and transparent about my rebellion.
However, despite my refusal to be one with the Kaiser diabetes program, I am making progress. I exercise regularly and nearly every day of the week, and while it is a relatively new habit (about 3 months now), it is becoming a pretty ingrained habit for me. While I tend not to do the recommended 30 minutes of cardio, the pace of my typical 75 to 90 minute weights and toning workouts thus far this year have been noticeably peppier and my heart rate monitor is reflecting that. I have also made better choices about cutting the junk from my diet and will continue to tighten up on my eating.
Thus far, my endocrinologist wholly agrees what I am doing is obviously working, and he is sensible enough not to try and tinker with a system and a patient who is not broken in typical ways. He said he usually spends far more time coaching patients to try and get 30 minutes of walking 3 or 4 times per week to help with their diabetes management and suggesting someone with my numbers may be doing something incorrect is simply wrong. Thus far he has no issues with me or my lifestyle, except to ask if I feel I am pushing/being pushed too hard with too heavy of weight or if it might be too much sometimes. No such problems exist in my universe, and he was satisfied. I really wish everyone could have a trainer like J to help them get up off the couch and into the gym or at least out on the street to take a walk around the block.
During our conversation I thought he said he was going to leave my medication levels the same for another 3 months, which was just okay news and completely understandable. I had hoped he might switch it up to something that would protect me from the now less frequent low blood sugar incidents, because they are both annoying and frightening when they happen. But he is the doctor and I trust his judgment in this realm. However, when I went to the pharmacy to pick up the pills in the lower dosages (versus continuing to try and split the last of the pills I have), there was only one bottle of pills and the label indicated to take it once daily. I emailed when I got home to ask if there had been a misunderstanding, and apparently there had been on my end. One pill daily for the next 3 months. However, if I have low blood sugar incidents, I should email him immediately to decide whether or not further tweaking is in order between appointments.
I was overwhelmed. Happy dancing in the streets!
He had said that if I continued this progression forward and brought my weight down further, the next step would be to discontinue medication completely to see what happened. I am to continue to test throughout the day, probably the only monitoring habit I have completely adopted and maintain, but being medication free with diabetes controlled by diet and exercise has become a real and tantalizing opportunity for me. More than anything else, the idea of being medication free motivates me to stay focused on my practice and continue to clean-up my diet.
“Are you following a diet plan?” he asked me at one point, somewhere after telling me the dietician noted my resistance to food logging and before our discussion on medication. I told him about reading Scott Abel’s anti-diet book, and not only was I not following any particular diet plan, I may soon escalate to scale destructing vandalism. For me, it is the correct route to improving and enhancing my health, and he agrees that the science supports my conclusions. I actually cancelled the second appointment with the dietician, because he a resource I do not need right now and would be better served meeting with someone who is not resistant to his advice and tools to improve their diet and nutrition.
I am realizing that I know a lot about feeding myself and that it is primarily when I get bogged down in thinking about the minutia of details with food and nutrition and the “eat this, not that” advice that confusion and disappointment and anxiety start creeping into my consciousness about food. In the last 6 months I have wondered if I could hire a diet coach to help me figure it all out, and then I realize that J, as my volunteer diet and nutrition gatekeeper, has already stepped up and filled that role as well.
Personality quirks, biases, and nut-ball craziness aside, I am in a good place and on a positive pathway with my health and now have the results to prove it. Thinking about it at the gym this morning, I am far from he poster girl for success, because my results do not show – yet. Yep, I went there, challenging myself to start moseying along and thinking about what I might like to see next on the outside, if I can bring myself to allow that thought out of its box. (Maybe later … much, much later … like never.) In 3 months if I have backslid, gained weight, have blood glucose or cholesterol or other critical factors skyrocketing or even creeping upward I may have to rethink and reconsider my actions. But right this minute, I am getting better on the inside, where it truly does count the most.
And damn! I am overjoyed.
And just to keep it real – still hating this rain and all the havoc it wreaks on my hair. But oh well. Big hair will keep my princess tiara in place.
Happy Saturday one and all!