Saturday, January 06, 2007


Off I went to the doctor in Great Falls, confident that I was going to be praised for my good work, and for keeping my blood sugar and blood pressure stats diligently. I thought I had only one weak spot: not enough exercise, since it mostly consists of my two-block jaunt to the post office and back. I resisted all Christmas indulgences related to food, feasting on the Montana Nutcracker Ballet instead.

Instead of a happy visit, I walked into a buzzsaw. She began with my lack of exercise, went on to my terrible crime of eating beans for lunch (“most people do not eat baked beans for lunch and anyway they are high in sugar”) and when I began to argue about my decisions, she jumped me for “being defensive.” She didn't like having my file so fat with statistics, saying they were useless -- then criticized me for scores back in October when I blundered. It was as though she were provoking a fight. I’m never one unwilling to oblige, though --as usual -- I ended up in tears. “I’m just trying to keep you from going blind and having your feet sawed off,” she said. “Most people have blood sugars in the 130’s!” Mine have been close to 100, which is normal. I think she thought I was lying. I think she considers me arrogant and denying reality. (She’s not the first.)

Then she was on, asking me about “wheezing.” I don’t wheeze. “Retaining fluids in the lower limbs.” I don’t do that either, now that I don’t fly anymore. I tried to move her to discussion of this new discovery about mice cured when capsiacin was used to prune back the pain nerves knotted around their Isles of Langerhans. She didn’t know about it, pursed up her mouth, said, “You’ll always have diabetes and you’d better get used to taking meds.” (I don’t take any meds except for my blood pressure.) I was just stunned. She has NEVER been like this before.

This is a small community and everyone knows everyone else’s business. Distances are long so I had an hour-and-a-half drive to ponder on all this and try to get a handle on it. What it sounded like to my counseling ear, more than anything else, was a marital argument, with the old refrain of “you’re being defensive.” I might have reacted badly, but the battle was on from the minute the door opened.

I have at hand a pretty informed Internet community. My cousin: “Could you try to convert your outrage into compassion for whatever is the problem with her?” My NEW cousin, who was a medical librarian for years: “The last time I checked, doctors were human.” My Montana niece, “Yeah, I’m picking up rumors about marital troubles.” It’s a second marriage to an older man, also a doctor.

Nevertheless, it took me overnight to get back confidence in my ability to manage this Diabetes 2 stuff. This morning I stood paralyzed in front of my oatmeal saucepan, wondering whether I dared throw in the usual frozen unsweetened raspberries. I’d already figured out that the news about the mouse pancreas treatment was NOT that capciasin is a wonder drug I ought to run out to buy -- the important part was that they were able to prune back those knotted-up autonomic nerve cells that were throttling the insulin producers. And the important part of THAT was that it suggests a whole new way of of figuring out Diabetes 2, which is really a metabolic syndrome problem, probably with a strong emotional component. (I raised this with the doctor but she didn’t address my blood pressure or lipids -- just hammered away on diabetes. Has someone related to her or maybe even herself developed the problem?) Is it wrong to be hopeful, to try to understand what scientists and doctors do and why? I say, resoundingly, NO.

This punishing, threatening approach to motivation can only encourage lying. Also, it assumes a rather old-fashioned view of diabetes, the little sugar-pig theory. The more enlightened folks are talking about the glycemic index, stress as a fundamental cause (which ties right in with the autonomic nerve factor), and the synergy among protein/carbohydrate/fat mixes. The Australian counselors, who seem pretty advanced to me, will say, “If you have toast for breakfast, why not add a bit of low-sugar jelly and an egg?” I’m finding that it’s the unbalance of JUST the carb that’s not good. High fat alone will also make high sugar.

The Aussies say, “If you really love mashed potatoes (which converts almost direct to glucose), why not mix them with mashed lentils, which are high-glycemic, go well with potato, and slow down the need for insulin?” They encourage the learning of a list of foods in order of glycemic impact on the pancreas, always working to find the highest glycemic, slowest digesting, foods and include them in one’s diet. It’s not just that sugar is sugar, it’s that sugar demands insulin right away or else loads up the blood.

Even smaller portions of forbidden foods -- like REALLY small! -- might be all right. But I don’t even LOOK at them, for fear of eating too much: a tablespoon instead of a teaspoon might be too much. I’m looking back at my old Weight Watchers lessons and thinking about weighing portions. When one looks at a can or package for “serving size,” it’s often startlingly small. Especially for a single person who feels obliged to eat a whole canful of food once it’s open. Little bowls of saved stuff often turn into mold.

But -- live and learn. I’ll keep eating beans for lunch, but I’ll mix a serving size with the same amount of baby spinach. Or I might get out the old slow cooker to guarantee sugar-free beans. Why shouldn’t people eat beans for lunch anyway?

I'm not supposed to go back until July.


Brett said...

What an unpleasant meeting with your doctor! Whenever people act out of character like that, I try to imagine that something unrelated to me is happening in their lives. This doesn't excuse her for acting this way, but it might explain it.
Good luck finding the right combinations of foods.

Connie said...

Ouch! That's not the kind of treatment one should get from one's doctor? That must have been rough. Sorry you had to deal with that!

As for going back in July, I saw ditch the doctor! Why even bother to ever go back? Find another doctor who shows compassion and warmth and who takes a more humane approach.

FYI, your blog came up because I have Google alerts for "SUGAR SHOCK," which is the name of my new book.

Connie Bennett

Anonymous said...

No beans?! I don't know, but given their GI it sounds to me like your sawbones was really stretching for something to hit you with.

Re: her behavior, I'm reminded of an incident many years ago when I worked behind a counter in a store. My partner was having some personal woes, and when a customer came in exchange something he'd bought, my friend got surly with him. The customer took it for the first few minutes, then said, "Sir, I run a business. And there is no way my customers would ever allow me to speak to them in the way you are speaking to me now. If this is going to be beneficial for either of us, you will have to change."

I watched my friend take a few deep breaths. Then he said, "Alright," and performed a complete about-face.

But it's an exceedingly rare sawbones who realizes they are in the business of customer service, and not parenting, or some other presumed greater authority.

prairie mary said...

What's upsetting about this was NOT that the doctor was authoritarian and not up-to-date on diabetes, but that she was never anything like this before and has a reputation for always being able to come to where people are and be supportive. There are women who will drive halfway across the state (and this is a BIG state) to come to this doctor. At my last visit she read my stats carefully, said she enjoyed my letters, and patted me on the shoulder. Something was badly wrong and we certainly "hooked" emotion in each other.

Prairie Mary

Anonymous said...

I think the rumors about marital troubles are correct. Something is bothering this doctor, big time, and unfortunately she's taking it out on patients.

Iron Rails & Iron Weights

prairie mary said...

There's another more sinister possibility than problems at home. This community has been in a huge money-powered power conflict over medical care, a gold mine. Out of state corporations have bought the hospitals from the religious orders that ran them for a century. They are whipping doctors into line, making them conform, while the doctors themselves are defiantly founding their own hospital. Already my eye doctor and the only Native American doctor in town have been driven out. They do NOT like women doctors. The newspaper takes in a great deal of advertising money from both doctors and hospitals -- remember when it was considered unethical for professionals to advertise? The result is that the public never gets a straight story about all this.

Prairie Mary