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Fingers Uncrossing April 5, 2006

Posted by becoming in Becoming Healthy.
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No call-back from the cardiologist's office this afternoon, contrary to their promise.

I've decided that I'm going to go to work tomorrow for a little while.  Mainly I feel the need to just begin getting reoriented there. I probably won't stay for more than two or three hours.  The task of moving from my old office into the new one (which was almost ready to happen mid-March) will have to wait a few more days, though.

If all goes well, I'm planning to return to work more-or-less full time on Monday, the 10th.  I'll round up some guys with strong backs perhaps that day.

Hmmm.  I just realized, Monday will be exactly one month since the last full day that I worked.  

It's about time! 

The Needle and the Damage Done April 5, 2006

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I don't like shots. I'm a manly man, though, and so I put on my poker-face when I know I'm about to receive an injection of whatever. If there's time, a preparatory deep cleansing breath. Often I'll opt to watch the insertion rather than looking away. Still, bottom line: don't like 'em.

Therefore, the prospect of injecting insulin into myself four times a day, every day, for the rest of my days holds no appeal for me. Neither does spending well over two hundred dollars a month for insulin and syringes. Shelling out $130+ per month just for testing supplies is more than sufficient.

In short, I want to "un-diabetic" myself.

At the very least, I want to become a non-insulin-dependent diabetic.

Is that too much to ask?

Before my heart surgery, I had never been told by a healthcare professional anything like, "Your blood sugar is a little high; you'd better keep an eye on that." And as part of various blood work done for various purposes, in the last six years or so I have had blood glucose checked on average at least once or twice a year. No, so far as I know, on March 16th I was a diabetic. On March 14th I wasn't.

I've tried more than once to discuss with my endocrinologist the long-term possibility that regular exercise plus significant (maintained) weight-loss could equal insulin independence, but he does not even want to talk about it.

So I've decided that I'm just going to do it. It's something that I'm going to work at until I achieve it. And once I do achieve it, that's a very special type of independence that I'm never going to give up again.

I'm up to walking 20 minutes twice a day now, and I will be increasing that progressively. I'm struggling some with portion sizes and late night snacking to keep the weight-loss going, but right now I weigh approximately 20 pounds less than I did a month ago.

I am also looking into nutritional supplements that have demonstrated the potential to increase insulin sensitivity [e.g., chromium, vanadyl sulfate, and alpha-lipoic acid]. I have begun taking "fish oil" for Omega-3 Essential Fatty Acids, and evening primrose oil for Omega-6 EFAs. I'll discuss more my personal supplementation program as it develops and changes. For now, one little tidbit:

Keen, H., et al. Treatment of Diabetic Neuropathy with Gamma-Linolenic Acid. Diabetes Care 16(1): 8, 1993.

This was a year-old British study of 111 diabetics to whom daily doses of 480 mg. of GLA [one of the Omega-6 Essential Fatty Acids] were given. The study concluded: "Administration of GLA to patients with mild diabetic poly-neuropathy may prevent deterioration, and, in some cases, reverse the condition."

Fingers Crossed April 4, 2006

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Today could be a big day, a very big day for me.

Yesterday I went in to have blood drawn for some labs my cardiologist had ordered. He made some changes in my medications last week and I'm guessing just wanted to see that those changes were doing what they were supposed to.

Today is my first follow-up with my surgeon. Actually, I'm hoping it's with Dr. Counce, but I recognize I might be seeing one of the other doctors with whom he practices. Whatever the case, I am hoping to get a clean enough bill-of-health to return to work. If he gives me the go-ahead, I'm ready to get back in the saddle a.s.a.p.

Tomorrow, even.

More than ready.

Bad Things Can Happen April 3, 2006

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A friend who visited yesterday, after listening to me go on and on about my desire/intent to become insulin independent, asked what would happen if I just stopped taking insulin. I did not supply him with a particularly good answer.

So I did some research. Before I share the results, let me try to provide a little perspective.

The current consensus is that the formula for diabetic complications is:

Diabetes + Time = Complications.

What this means is there is a much higher potential of a diabetic becoming diagnosed with one or more complications over time. Still, the evidence to date shows that excellent control of blood sugar and the maintenance of an active lifestyle go a very long way in preventing and/or slowing down the onset of diabetic complications.

It's estimated that more than 15 million Americans have Type 2 diabetes, but as many as one third of those who do – more than five million – don't know it, and therefore aren't treating it. The consequences of untreated diabetes are bad things.

Studies have shown that up to 60% of adults with diabetes have high blood pressure and nearly all have one or more lipid abnormalities, such as increased triglycerides, low HDL cholesterol, or elevated LDL cholesterol. If you have diabetes, you’re much more likely to have: coronary artery disease; vascular disease, such as atherosclerosis (hardening of the arteries) or peripheral arterial disease (PAD); a heart attack; and/or a stroke.

Diabetes can cause kidney disease (nephropathy). High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak. Useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. When kidney disease is diagnosed early, (during microalbuminuria), several treatments may keep kidney disease from getting worse. Having larger amounts is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows. In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

The longer a person has diabetes, the higher their chances of developing diabetic eye disease (retinopathy). If left untreated, diabetic retinopathy can lead to blindness. Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. These blood vessels initially become leaky, and then may become blocked off. This causes hemorrhages (spots of blood) and exudates (proteins) from the blood vessels on to the retina. It may also cause swelling, known as oedema of the retina. People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. People with diabetes are 60% more likely to develop cataracts. (more…)

Whining Avoidance April 2, 2006

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Alright, in retrospect that last post sounded pretty much like whining.

During the first couple of days post-surgery, even though I did seem a bit mentally foggy (which still seems to continue to a degree, darn it!), I consciously resolved to stay positive with regard to all this new crap in my life. Already, this has proved to be not an easy promise to keep to myself, but I am convinced that giving truly my best efforts in that endeavor are crucial.

Yes, there are a heck of a lot of foods that I'm really going to miss. I'm going to miss (at least initially) the sensation of fullness that comes from eating as much as I want. I can already tell that "portion-control" is going to be something of a struggle.

What I must focus upon is that I can still enjoy cooking and eating. Many old favorite dishes and techniques are things I'm now going to have to avoid. But there remains a world of possibilities out there. I must take it as my personal challenge to find new favorite dishes, new techniques, new flavor combinations with which to reward my palate.

I can do this. I have a partner who's very open to culinary exploration. I'm a pretty darned good cook, and I love learning new things. I have considerable resources at my fingertips (i.e., in my bookcase) and know how to reach a vast wealth thereof online.

It's time to wrap up the mourning and get to work.

A Foodie’s Lament April 1, 2006

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I was talking recently with the Cardiac-Care Home-Health Nurse (who was diagnosed about 9 months ago with Type 2 Diabetes) about how frustrating and depressing it is to look ahead and think about all the many, many foods I’ve loved which I really can no longer eat.

Obviously anyone who’s forced to face a diagnosis of adult-onset diabetes is going to have to accept certain dietary sacrifices to preserve health and prevent significant lifespan shortening.

And naturally, in the case of a morbidly obese man who has recently had a heart attack and gone through quadruple bypass surgery, only a fool would expect not to have to make drastic lifestyle changes.

I am both, of course. And, yes, I know I can’t continue to eat the things and the quantities that contributed hugely [no pun intended] to getting me into these circumstances, this shape.

But for me in particular, I suspect the sense of loss, of mourning is especially acute. I’m what many people would call a “foodie” {“foody”?}. I watch the Food Network more than any other TV except perhaps for the History Channel. I own hundreds of cookbooks, each of which I cherish. I adore the act, the art of food preparation …finding the perfect, freshest ingredients possible …learning new techniques …trying new flavor combinations. It is the closest I have ever felt to “doing art”. Food is not something with which to simply stuff my gut, it’s something to be appreciated, savored bite-by-bite, in the same sense that one would approach a fine wine.

To carry that wine anology forward in an awkward manner, I feel as if I’ve been told:

Yes, you can still drink wine, but from now on Cabernet, Zinfandel, Merlot and Shiraz are strictly forbidden.

Mourning is a good word for it.

My Own March Madness – part 5 March 31, 2006

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My stay in Intensive Care was extended a day by the endrocrinologist, while he continued to tinker with dosages, trying to find a balance that suited him between two two kinds of insulin I was being given (one fast-acting, the other a 24-hour-type).

I gained a small personal victory in how I made the move upstairs to a regular room. I “walked”!! No, not up the stairs… but to the elevator, on and off there, then to my new room. The nursing staff on that third floor wing all knew where I was coming from and there were looks of genuine surprise on a few faces.

The next couple of days passed rather slowly. My cardiologist and my surgeon were both ready to send me home, but delayed my release until my endocrinologist could decide upon my “discharge dose” of insulin. He finally agreed on Sunday evening to set those the next morning.

At about 10:00 a.m. on Monday, March 20th, I called Lara at work and told her that she should probably be there in about an hour. FINALLY, at around 12:30 that afternoon, I was free.

I had been to the edge, to the very brink. I had been much closer to that precipice than I should have ever allowed myself to get. Much closer than I intended to be again until at least another fifty-one years have passed.

Now begins the long journey back. Back to health, back to vitality. Back to not merely functioning …back to living. If ever there was a time for self-examination, introspection, re-evaluation and such, it is now. I know it’s not going to be an easy road, but it is a road that must be travelled. I embark upon this with optimism reminiscent of what I felt before the surgery. I’m hopeful and curious. It’s going to be interesting to see what I’ll be becoming.

My Own March Madness – part 4 March 30, 2006

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Tuesday the 14th dragged along without further news. Finally, about 2:00 p.m., I was told that it did not appear that they’d be able to get to me that day, so I was being scheduled for first thing Wednesday morning.

I ate dinner in the room with Lara that evening feeling a sense of guarded optimism. I was absolutely glad that there was not going to be another day of waiting and uncertainty. I had never undergone surgery before and tried my best not to allow my blank expectations to be colored by what I had seen during decades of television and movies. Feeling genuinely upbeat was nice. There was no need to manufacture a brave facade to present to Lara.

Sleep came around midnight that night. I was awakened at about 5:00 a.m. by early preparations for surgery. Eventually I was taken downstairs to a large green-curtain-partioned “holding area” where I met the doctor who would be my anesthesiologist. I asked him a couple of questions about what to expect when regaining consciousness. Memories of his answers are fuzzy. There is no memory between that and waking up in a room in the ICU.

According to Lara, I evidently was evidently waking up too quickly and was given additional anesthesia. My first real memory was the awareness that I was out of surgery and that she was there. The first coherent thought I recall having was to try to demonstrate that I was capable of breathing on my own so that they’d remove that cursed respirator tube from my throat. I did, and they obliged.

Once that was out I lifted my head a bit to try and take a look at myself. It was not a pretty sight. There seemed to be a lot of blood on my gown. Multiple drainage tubes protruded here and there across the middle of my chest. I felt covered with heart monitor electrodes, and I was aware of big IV lines inserted on my upper chest near each shoulder.

And I hurt. Not a lot, no the morphine and whatever else kept things manageable, but the realization was present that all this was really going to be hurting soon. (more…)