Friday, June 16, 2017


Lichen, seen close-up

When I was first diagnosed with diabetes 2, which I did not expect and only came to light because of an eye exam, docs and researchers seemed confident of what was happening and what to do about it.  Since then, medicine in general and diabetes in particular has had what used to be called a “sea change,” meaning that there is a massive shift, partly due to research and partly because of social change, esp. that which is economic and partly because of demographic shifts in age and origin.  Some would call it a “paradigm shift”, one that far exceeds changes in the field of medicine and its associated institutions.

I’m reading “Boundary Layer” by Kem Luther because I asked to review it for “The Goose,” the official publication of ALECC (Association for Literature, Environment, and Culture in Canada).  I’ll post the review later, but it is an exemplar of the change in thinking among scientists, including the “soft” sciences of psych and sociology, though advanced physics is part of the shift.  One way of describing it might be that we are challenging the idea of “thingness.”  That is, what we consider to be a circumscribed concept and give a name, like “diabetes”, is really a complex interaction of how people live, how molecules react, and what the emergent consequences can be.  “Disease” itself is a category that morphs all the time.  No longer do we think of invasive bugs/germs to be countered with magic meds.  Peoples’ very “being” is a matter of constant adjustment to everything.

“Type 2 diabetes is a progressive disease.”  This is the information that has been the missing link in my planning.  I thought that if I were conscientious and stayed otherwise healthy, I could freeze diabetes 2 where it is, indefinitely.  So when the new doc told me that it might be time to go to a different set of meds plus a weekly injection, I was shocked.  

The implications are not medical so much as logistical.  If I must have a weekly injection, I must either get to an injecting person or they get to me once a week.  In winter Valier roads are often impassible.  I can cope with grocery shopping because intervals happen, but they are unpredictable.  I can get pills and catfood delivered, but no one delivers nurses.  If I really MUST have weekly injections, I will have to move to a larger town, but this house is probably unsaleable.  It stood empty for three years before I bought it.  The outbuildings are seriously deteriorated.

I had expected my eyes to deteriorate.  My glaucoma scores are going up slowly, but are still not to the point where I need medication for that.  For decades I’ve gone to the Great Falls Clinic for eye care, but the third opthalmologist of mine just quit them.  I suspect it’s because they have a practice manager charged with increasing profits, aggravated by the expense of the fancy structures they have built.  Doctor support has been cut back, removing the transcribers traditional for opthamologists and imposing time limits on examinations.  They emphasize computer records, which is not comfortable for some older docs.  

What used to be a slow crawl across my retinas with a big specialized machine is now not much more than a recent high school grad filling out a questionnaire and the doc standing in the doorway to ask me how I am.  Maybe a quick glimpse with a hand lens.  I suspect the big dominant medical corporation, Benefis, is competing with the clinic, but I see that the docs who are leaving are establishing independent small offices.

A few summers ago my eyes became so painful and enflamed that I forced my way into the eye doc, insisting that he see me.  He was flummoxed by the symptoms and kidded me about wearing too much fancy eye makeup, which I wasn’t.  We finally decided it was irritation from field burning.  Then this year he stood in the doorway and said I had ocular rosacea and dry-eye syndrome.  My mother was diagnosed with that many years ago, so it’s not a new medical breakthrough.  Now I control it with a hot washcloth compress and lubricant eye drops.  I got this advice off the internet.  The doc wanted me to go to the clinic dermatologist.  There’s a new pill for dry eye syndrome, a systemic.  

When this doc left the clinic, he joined an earlier doc who had left, one who has established a reputation as the lens-replacement go-to doc.  He sees the world in terms of cataracts.  That’s his “thing” and he lines up surgical assembly lines.  I don’t like that.  I resist specialists and always have.  Much of this is driven by money, as those watching the versions of federal health care law are acutely aware.

If I lose my eyesight, I can compensate to some degree with speaking programs in the computer, but I can’t drive.  There is no regular commercial bus service to Great Falls.  I suspect that the various initiatives for aging services and others will not be sustainable in this government climate.  This is a "family" town where most people have relatives with cars. 

The other consideration besides eyes is the need for exercise to maintain vascular health.  Back in my clerical days one leg developed a tendency to swell and that continues now.  I must remember to stand up and walk every now and then.  I think I might be having “microvascular” accidents, but maybe this forgetfulness is just standard aging:  where did I put my car keys and all that.  But again, a more major accident might mean no more driving.  The Strachan hereditary tendency is strokes.

This summer I’m thinning out my books, reducing the furniture which is easy since it’s all Good Will stuff anyway, but on the other hand hard because today’s Good Will won’t accept furniture as shabby as mine.  I can no longer afford to buy Good Will furniture either.  I would not be able to personally and physically load up a U-Haul to take the basics to a new place, which is how I’ve managed in the past.

This book I’m reading is about lichens which are symbiotic with algae.  “A lichen is a composite organism that arises from algae or cyanobacteria living among filaments of multiple fungi in a symbiotic relationship. The combined lichen has properties different from those of its component organisms.”  One of the messages from Kem Luther is how resourceful this partnership can be.  The organisms can separate, go through stages in which they are quite different, establish new relationships, include other organisms, exchange nutrients, and compensate in many other ways.  They are exquisitely prepared to survive.

Right now we are wrestling with the “thingness” of the government, of the presidency, of the citizens and the whole nature of democracy.  We want uniformity of entitlement and prosperity, but at the same time we want exceptionalism in our leaders.  These are not frozen, stable, eternal phenomena, but rather time-arts that can adapt to new situations.  This is what I’ll do with my diabetes 2, not without inconvenience and a certain amount of pain.  It is what the medical profession must face.  

The message from thoughtful people is that the only way to sustain survival is through adaptation, NOT through clinging to the status quo.  But if we change too much, who will we be?  It’s a time to survey the options and generate new ones.  Lichens are the literally lowest life form and could probably survive on Mars.  That thin layer of adaptable small units is called the “stegnon.”  It is not a THING, but a relationship.  So is diabetes.  How do I find a new eye doc who doesn't think I am a thing.

1 comment:

Mary Strachan Scriver said...

This is an update. First, I was horrified that my A1C results were DOUBLE what they should have been and always have been. It's hard to know how much was progressing disease and how much was bad attitude and noncompliance on my part, partly neglect and partly defiance. I do NOT want my life to revolve around testing my blood. I resent how much the pharma people are exploiting the testing issue. I've always been suspicious of the claims that Diabetes 2 can be "cured" or "reversed" by any means, let alone the ridiculous ones.

But I'll be making a lot of little changes. The doc suggested injectable drugs and gave me the names of three kinds. I looked at them all online and was repelled. I didn't feel their claims were well-documented, I resent depending on equipment which is always mysteriously going "obsolete" and I'm suspicious of the whole concept of "epipens", the spring loaded gizmos for the faint-hearted to give themselves shots. If a kid can learn to shoot up heroin, why can't an old lady learn to use a syringe?

In the meantime, I'm moving to a time-release form of metformin because I always forget to take the second pill of the day.

Prairie mary