My endo Doc Mike is a nice guy. But here's what happened when I saw him today.
Doc: Hi, how are you? You're looking great. How's your baby? [this is my first visit in about 10 weeks, I had a baby 9 weeks ago]
Me: Baby's fine. Growing well. She's gained nearly 3 kg now.
Doc: Don't let her get too fat.
Me: I'm exclusively breastfeeding her. She should be fine!
He looks at my results (thryoid, CBC, HBA1C). Quite a few high and low flags (high monocytes, low MCV, MCHb) the CBC, but he didn't seem to notice them and didn't comment. Maybe not important?
Am a bit hyper at the moment, with readjusting post baby, and quite a lot of weight loss. He feels my thyroid and notes that I've a tremor. Tells me to reduce my thyroid meds a bit. No problem, I will.
Then he asks if I'm still taking insulin. I tell him yes. He doesn't ask any details, but tells me that I should now stop taking insulin and stop monitoring blood sugar. "It won't hurt, because you're not pregnant any more. In 6 - 8 weeks I should do an OGTT and HBA1C to see if you still need meds and if the diabetes is going to be long term".
So I told him that I get 160 - 170+ post meal (if it's got significant carbs and no insulin bolus, and that is with basal on board), and my fasting is low 100s if I don't take insulin at night. And even if I don't eat my blood sugar will rise slowly all day. He kind of shrugged and didn't answer.
Asked me how long I intend to breastfeed and told me to be careful with breastfeeding becuase my prolactin could be high and the prolactinoma may grow. Watch out for double vision, headaches, etc. Well I've been having headaches, but I pressume that is stress and didn't mention it. Vision is fine.
Asked me how old I am now. Said 41. He said we'll have to get me ready for the 3rd baby soon, a boy! Seeing I have 2 girls now, and partner still wants a son.
I told him I'm still having joint pains [I had texted him about this a few weeks ago]. But he didn't hear me and didn't say anything.
No BP measurement, no weight checking, no asking any details about insulin doses and blood sugars, not listening to me .....
Am I wrong to be expecting something else? Why doesn't he believe I am diabetic? I don't think stopping everything for the next 2 months to see if I am diabetic is necessarily wise. When I expressed doubts and asked him further, he told me I have to stop insulin for "at least a week before doing an OGTT, to be safe". I can only assume that means to be sure the insulin won't affect the results....
Am I wrong? Should I follow his advice? This would most likely mean few months of high sugars to prove a point? And eat like a non-diabetic? Can one do much damage in 2 months? I can't beleive this is apparently one of the top guys in Philippines.
Really may be time to find a new Dr. I just need someone impartial to listen to me, to explain, to guide me a little, and encourage efforts if the going seems tough , and do all the general overseeing and monitoring and checking that one should have with long term chronic conditions. Am sure this is not easy to find. :( :( :(
But you can also find a good doctor. Maybe not one who is some top endo, but one who is reasonably competent, a good listener and someone who you can work with.
I agree about the "top doctor" thing; if anything it might give them a bigger ego. What I look for in a doctor is knowledge (of course)but also openness, compassion and the ability to listen and be flexible. A few years ago I thought I had a different medical condition (which ended up being a false alarm) and was moving to a new area, so needed a new doctor. I called a doctor's office and asked if I could speak to the doctor. I then got her on the phone and asked her about experience with that condition, but also how she feels about my reading (on the internet) about the condition and discussing things I'd learned. She said "I like having educated patients" and I of course said, great, make me an appointment please. In the mental health field it's customary to give a free first session to see if the "fit" is right for both parties. I think the same should be true for medical professionals. Well, alright, you may have to pay for it, and they may not be willing like mine was to talk on the phone first, but I still would ask similar questions at a first appointment with the eye to "interviewing" the doctor and seeing if they are right for you.
I have beeen a patient of Doc Mike for about 10 years now, since before he was "famous". He used to better - listen, read etc. Now I guess with time concerns and so many patients, he seems to have lost sight of what is really needed. Plus he wasn't 'treating' me for diabetes - he seems to be more cutting edge and open regarding thyroid than he does about diabetes. I do have some other issues to be monitored to.
It is hard to change after such a long time (and I did try to interview some other doctors, but it was not successful), but the last few years the service has really dropped.... this last visit and this approach has really decided me, as the last straw...
I think a happy medium might be to find a GP or if that fails an Ob to help oversee everything, and I can still 'refer back to him' if ever necessary for the other conditions that could require an endo.
If only we could have doctors submit a detailed application before we became patients. "Please complete the following questions & include three references from current patients."
Oh yes! You are so right!
With a statement of their treatment philosophy for key conditions that are relevant.
This is a must do...I have done much research and then 'interviewed' my own docs whenever I move. Finding one who can treat our diabetes does not require a top dog endo. My doc is an IM doc and sees to my whole health.
I met the potential Dr. candidate today, as recommended by a friend. Quite a nice man and younger than I had expected (probably just a little older than me). He is ok that I am an educated patient. We can talk technical. And I felt I could talk to him. So far so good. :)
He knows my Endo - it was hard to explain why I was looking for another doctor. I tried to put it nicely, by explaining what I was looking for / the recent situation. I don't want to criticise one doctor too much in front of another....
We talked for over an hour - his clinic was supposed to finish at 5 - I left at 6! He took a history and we discussed all my conditions. We discussed the recommendation of Doc Mike to stop insulin and do OGTT in 6 weeks. Showed him my bs results with no insulin for the past 3 days, and explained the diet that accompanied those results (was skipping some meals). Anyway he said I shouldn't stop insulin. Agreed I shouldn't do OGTT. He is for early use of insulin in diabetes, which means he won't try to take me off insulin and put me on oral meds (though we may try adding glucophage once I stop breastfeeding - still a long time off).
I explained my BS targets and A1C (aka Bernstein). He said my targetsare too low because I'll have hypos. But I explained Bernstein and the approach to minimise lows, and he said he'd like to see my blood sugar monitoring and we can discuss further. I even broached that I may not be Type II, and he said given the overall picture that could well be true.
Said he was happy to oversee my general management and overall health monitoring as long as we both agree that he refer for anything he is not comfortable with / outside his capability, and some of my conditions potentially are.
He will see me every couple of weeks for the next little while as things are still stabilising post-pregnancy, and then probably every 3 months unless something comes up.
Now to see if the promisee materialises. I feel so much better having decided to look for someone else. Maybe a GP is going to be better and more wholistic approach.
Good for you, Sally. I'm glad you found someone you're comfortable with. I know many people have good experience with endos, but there is something to be said for a PCP for sure. Sometimes I think the personality and attitude towards patients is a more important factor in a medical professional than their certificates and even their knowledge!
I agree that a good PCP can be a key member of your medical team. It sounds like you may have found a good one Sally. I found a new PCP about 2 years ago and it makes all the difference in the world.
My endo develops my D treatment plan but my PCP does a great job of overseeing all my test results and giving me his opinion on what the other docs are telling me. Nice to have a sounding board or built in second opinion.
Very encouraging! The fact he spent this much time with you is promising.
I go to an internist because there are only three endos in my area. They're over booked, spend 5 minutes with patients & are arrogant jackasses.
And back on insulin since last night, having perfect numbers this morning! For the first time all week.
Am feeling so releived - and so much more motivated. I want to show this Dr. how well low carb with insulin (and without lows) can work.
Didn't realise quite how much this was upsetting me. I am definitely an emotional eater!
Plus I told him about the joint pains (his impression is reactive arthritis) and he told me not to hesitate to take the anti-inflammatories (had been hesitating becuase of breastfeeding, and waiting to be 'bad enough' before taking them) as prescribed (though he wants me to double check them with my baby's pedia) and so I'm feeling much more comfortable pain wise as well. :) He used to share clinic with the rheumatologist I saw 6 weeks ago... small world!