MEDS COMPLIANCE ISSUES

MedPage is a daily (at least) subscription for doctors in an effort to keep them up to speed.  I subscribe.  Today’s blurbs included one on the management of diabetes.  http://www.medpagetoday.com/Endocrinology/Diabetes/50614

As with many other things, study of the condition becomes more specific, more detailed, more related to real world issues, which means the advice to docs is also changing.  High blood sugar is related to a zillion things.  This article mentions, for instance, the statistical fact that Asian people tend to have more visceral fat than other “races” and that it is visceral fat that is worrisome in terms of over-all health.  This is relevant here on the rez because Native Americans have an Asian basic foundational genome.  They don’t like to think about that.  (There are political issues, like the land-bridge theory of origin and WWII.)

Another new idea is that a program that effectively addresses whatever shows up as high blood sugar (not necessarily in direct relationship to insulin) should take into account the desires, abilities, and circumstances of the person -- not just their instrument readings.  This is highly relevant to all the chronic diseases now handled by frequent blood monitoring.  Researchers are universally finding that compliance is fulfilled in only 30% of cases.

I’ve been non-compliant this winter for a number of reasons.  What follows is the inevitable list, which is an accumulation of small forces that could easily, but gradually, kill me if I don’t take notice and then the right action.

1.  I’m over the first shock of being the only person in my family -- that I know of -- who has Diabetes II.  It doesn't appear to be inherited.

2.  I’m over the guilt of realizing I may have triggered diabetes II while trying to survive my nineties clerical job with coffee and brownies.  Could have been worse: alcohol.  Could have been better: exercise.  I was doc-hopping in those days (nineties).  NONE checked for diabetes.

3.  I’m over the brutal female doc here in Montana who went directly to threatening me with blindness and amputation and who is now out of medicine.  In fact, she was so outrageous that she provoked me into action.

4.  Part of it is that my first little glucose monitor was my buddy.  We learned together.  Then it was discontinued by the maker so I couldn’t get the necessary test strips.  My newer slick little machine, green and shiny as a beetle, always gave me high readings.  The strips were much more expensive.  I don’t like the way it sounds.  It has a lot of features I don’t understand and didn’t necessarily want.  In short, it is too techie for an old lady.  And those strips cost a dollar each.

Valier Clinic

5.  The little local clinic, a satellite of a county hospital of the sort that is wrestling with thinning populations and physician shortages (even more, plagued by accusations of bad ethics and negligent practices), began to send on the weekly clinic days “Physician Assistants” rather than traditional MD’s.  The PA’s are women, basically nurses, and differently normed.  They are more inclined to bully, too respectful of pharma-supplied checklists, and vulnerable to emotional dynamics.  We don’t like each other.  I don’t trust them.  Well, there was one I could believe.  She's gone.

6.  Most people are not very aware of the RAGING controversies over foods in general. They are easily hooked on dubious “diets.”  So my arrogance in reading med materials threw me into confusion over whom to trust.  As the people who seemed most persuasive presented evidence for the uniqueness of individuals and how their bodies handle food -- not all of them MD’s -- the contradictions, the assumptions of the different countries and cultures, and the constant commodifications -- made it all seem arbitrary anyway.  Confusing.  Possibly all of them wrong so far.  Today do this -- tomorrow do that.  Often contradictions.

7.  I live a solitary life.  A stringent diabetic diet -- NO sugar and as little additives as possible.  I don’t know anyone else in town who stays on this diet -- they seem to rely on meds, using insulin to compensate for sugar.   On the other hand, I don’t really know people here, so how do I know?  I don't "hang out."  The cafés and Senior Citizen meals are standard “American” meals that don’t meet my rules.  This is a great excuse for avoiding a lot of complaining, pig-headedness, and time-wasting.  (I SAID I was arrogant!)

8.  I don’t eat three meals a day.  I never sit at a table to eat.  (My tabletops are full of papers and books.)  I put the ingredients in a bowl (protein, carb, no sugars, no fruits but berries) and walk around eating unless reading or watching TV.  (Dangerous for a keyboard.)  I never have company, which is good because when I cook my way and put it on the plate in front of them, they are stricken.  (Microwaved veggies, steamed chicken breast.)

9.  Eating plenty of fresh vegetables and fruits is discouraged not by not liking them but by the inedibility of the store-supply.  Plastic tomatoes, dubious bagged lettuce, shriveled and bruised stuff from apples to parsnips in spite of genetic altering to make them stony (and tasteless).  There are not many choices in small stores that can’t afford to lose stock quickly, so depend upon frozen or canned food.  Carbs like crackers or chips are indestructible so there are always lots of them.  One whole aisle in the mom-and-pop store here is wine.

10.  As I age I become more fatalistic.  As I write with more sophistication and research, I become more resentful of anything else that takes time.  I write closer to my own key issues, which is a little like undergoing psychoanalysis and stirs up emotion from deeper, darker places which are sometimes connected to food.  How wonderful it was to go with the Scriver Studio crew up to Angie’s for "long johns"!  And it suddenly registers with me that when I was a child we were not eating that well.  Money must have been short and food was not my father’s priority since he wasn’t home.  My mother did the best she could and we didn't starve, but we sometimes had "Pioneer Night" which meant milk toast in front of the fireplace with a checkered tablecloth on the card table.

11.  I begin to realize that I’ve always been a person of considerable lassitude.  Unless there is a person or goal that pushes me, I’d rather surrender to inertia.  Esp. if it was my mother who pushed me because she thought I was fat and lazy.  Esp. if it was my father who took us on forced marches along forest paths in the belief that we were “hiking” which was a good thing.

12.  If you eat, even from only one bowl, there will be dishes to wash.  If you cook, bowls will be joined by pots and pans.  With the cats I solved this problem by feeding them off paper plates.  I like things I can eat from a can, but that means you don’t heat it in the microwave.  As counter-forces, I really like my dishes -- they're pretty -- and nonstick linings in pans are The Best.  But if I didn’t constantly use will-power, I’d be living on microwave popcorn which is bad food: carbs, plus oils, plus sugar, plus strange additives.  But you can eat it out of the bag.  

13.  The result of this experiment was at first subtle and then, over weeks, began to mean upset stomach, headache, fuzzy thought and even a little depression which for me turns to short-temper.  Also, clumsiness -- things dropped, packages that are hard to open, difficulty in getting lids back on jars, misplaced basics, and even gaps in consciousness.  Sleeplessness.  I thought it was aging, until recently I went back on my proper routine and recovered previous competence.

14.  The “experts” in all the fields including medical study will talk about “choices” and “lifepaths” and so on, but the truth for most of us is that we must live out what we meet by using what we have and for some people that means living through the night, much less the day.  Maybe living even when you don’t really much want to live.

This little fellow has far more meds to take daily than I do.

And they are nastier.

It might surprise you to know -- and will surprise THEM even more -- to know that my role models and inspiration are at-risk boys with HIV (among other problems).  They are very brave.