Shoot Up or Put Up

Dearest darling GP,

I moved my healthcare to your business a couple of years ago because my previous GP was failing to deliver. He was medically mediocre and administratively hopeless. I like your surgery because you take in a lot of trainee GPs. Terrifying as this may first sound, they’re actually rather good – they’re young and enthusiastic, they haven’t heard it all before so they actually listen to what I say and when they don’t know something they run off and check with a grown up, rather than just making stuff up. I find all that quite endearing in a doctor.

Overall, you’ve been doing very well. Medically you’re performing. You developed a worrying interest in delivering my diabetes care but I managed to steer you away from that and we’ve agreed that you won’t meddle in things that you don’t really understand. We’re getting along just fine.

Administratively you’re above average in my experience, although my benchmark for good GP admin is pretty low. If I ask for a repeat prescription you normally manage to issue one within 48 hours. And most of the time it’s more or less correct. You also get extra brownie points for not accidentally giving my medical records to a little old lady to read whilst she was in the waiting room as one of your predecessors did.

It’s not all good though. We’ve been having a little issue for a while now. You understand that I need blood testing strips and you’re happy for me to have as many as I need. You’re not misinterpreting any silly PCT guidelines about rationing strips like some of your less bright colleagues. More brownie points there. Sadly, while your intentions are good, your delivery is a little random in this area. If I request blood test strips sometimes I get them, sometimes I don’t.

We’ve talked about this and you explain that the nasty PCT won’t let you put blood test strips on my repeat list in case I order too many, start selling them on the black market and the NHS isn’t left with enough money to buy biscuits with. I explain I’m happy for people to put sensible measures in place to manage budgets, but we still need a process that works. At the moment if I order blood test strips I sometimes get them and I sometimes don’t.

You say that I should ask my pharmacist to check my prescription when he collects it for me. I say it isn’t his job to double check your work. You say I should highlight when I’ve requested blood test strips. I say the list I sent in only had 5 things on it and blood test strips were in bold size 14 font and you still managed to miss it. Short of sending a singing telegram I don’t see what else I can do.

For the love of god this shouldn’t so difficult. Please put a process in place that means I get blood test strips when I ask for them. I’ve spent a couple of years training you to deliver my healthcare and you’ve been doing it well, I don’t want to have to start all over again with someone new.

Lots of love

Alison

Well, this week I had my annual diabetic MOT up at the Royal Infirmary. Sadly, for ghoulish readers, there’s nothing much to report. Everything is going fine, no limbs have rotted off, I can still see and hypo awareness is good. Even the goldfish in the fish-tank in the reception area were looking good – no fin rot, white eye or anything.

After the regulation armful of blood was taken by a very pleasant, chatty nurse and a bladder-full of pee donated (eugh!), I sat down in reception and read my book for a bit before being summoned by the Prof. for my annual review proper.

As expected, everything was fine with my HbA1C clocking in at a very satisfactory 6.7% (feel free to bathe in my munificent glory, you know you want to!) We had a brief discussion about a better way of avoiding hypos at the weekend (which tends to be a bad hypo time for me) and then the rest of session chatting about this and that, with me plugging my web site and the Prof. plugging his (www.hypodiab.com – a great resource if you want incredibly in-depth information about hypoglycemia).

So, all in all, a good time was had by all. This is how the annual MOT should be.

I must be brave. I must face my fears. I can’t keep avoiding it. I’ve been busy at work. Its the wrong phase of the moon and the dog ate my homework. All good excuses but I’ve run out of road. I have to take the giant leap.

GP studying hard to learn about diabetes

My GP surgery have been harassing me for months. One of their chaps has now read his full quota of articles about diabetes in Womans Weekly, Men & Motors and Fishing Today and is now kindly going to share that knowledge via the medium of a diabetic clinic. (Note: all speculation on the potential qualifications of said GP to deliver diabetes care is based on nothing more than too many bad experiences with Dr’s who like to pretend they know more than they do which have led me to be very wary of people claiming to know about diabetes).

I’ve been stalked by the Drs receptionist for the last 2 months, begging and pleading for me to make an appointment. This naturally makes me wonder quite how much money the GP gets paid for every patient who uses this clinic because I haven’t felt so wanted since a spotty 13 year old had a bit of a scary crush on me in high school.

Previous experience of GP diabetes care hasn’t been good. Anyone who starts a conversation with a young woman with ”do you take tablets for it” is off my list. “Diabetics can’t have their tonsils taken out” and ”you should expect to have complications if you’ve had diabetes over 20 years” were also uttered by GP’s who supposedly had their Brownie badge in diabetes. The highlight was definitely the incredibly useful “if your blood sugar is high, you need to take more insulin” . Proof indeed that they’d read the first chapter of “Diabetes: The blindingly obvious” but sadly hadn’t progressed to “Diabetes: It’s not quite as simple as it may first appear”.  Little gems like that tend to undermine your faith in the system.

I already attend a great hospital diabetic clinic. I’m struggling to see what I’ll get out of this – all my numerous test results are up to date, I’m muddling along quite happily and I really don’t need any more help. Sadly, I’ve put this off long enough. I know from previous avoidance tactics that eventually my dealer will start withholding my insulin fix until I go and see them.

Ironically, I am quite a supporter of GP based diabetes care. I’ve met incredibly knowledgeable GPs delivering top class diabetes care to (mostly) type 2′s. I just haven’t been lucky enough to experience it personally and seem to have spent every diabetes related GP appointment over the years providing free education on living with type 1. I’m quite happy to do that and even throw in a free insulin pump tutorial at the same time, just let’s not pretend its you doing me the favour by letting me be there!

So, now I’ve delayed the inevitable a bit longer by blogging rather than making an appointment, I’d better get on with it. Although my office is looking very messy, I might just give it a bit of a tidy first.

Swine flu - these guys started it!

Later today, you’ll be thrilled to hear, I’m off to the doctors to go and get my swine flu jab. I mentioned in my earlier post about seasonal flu that last year I did manage to successfully contract flu (proper flu I mean, not “man flu”; no, honestly) and I vowed never to miss a vaccination again. The sweats, weakness, aching, misery, despond and despair caused by flu were just far too horrible to contemplate ever having again.

So I’m therefore looking forward to an injection given by someone else for once (ohh, luxury!) and a slightly aching arm. This is clearly more than fair recompense from protection from the oinking disease.

When I was a small child, many, many years ago I would occasionally have philosophical moments (well, as much as a seven year old can have philosophical moments) and wonder what the future would be like. Say in 2009. Hovercars would be pretty cool, entire meals in a pill would be great but, even then, I thought the traditional silver space suit would be perhaps a little impractical and perhaps somewhat dull.

Sadly, none of the things I imagined have come to fruition – we don’t holiday on the moon or travel through time like Doctor Who (which is probably a good thing, given the scrapes that can result from inadvertently opening worm holes in fourth dimensional black holes and messing with the space-time continuum (apparently)). So maybe we’re just living in a stagnant technological backwater of the early 21st century with little to show for the last 25 years.

Then I thought about swine flu for a moment. Back in April swine flu was a brand new strain of influenza that hadn’t been seen before. Now, by November, that new strain has been isolated, genetically sequenced, a vaccine has been engineered, thoroughly tested and is available in my local surgery. When I think for a moment about that I’m utterly amazed. That vaccinations can be made available to the public within 6 months of them turning up on the virus-scene is utterly flabbergasting.

Similarly with diabetes, in merely 90 years we’ve moved from the single option of slow, unpleasant death (never ideal) to having a choice of a whole range of artificially engineered insulins which work extremely well and give us pancreatically-challenged hoards pretty much a normal life. Similarly blood testing equipment and other accessories having moved on massively in recent years – tiny blood samples, three second results and so on. It’s genuinely amazing.

We might not live on the moon, like I imagined at 7, but – by crikey- when you think about it for a minute we’re living in the future right now. Cool!

Generic pictorial filler

Well, it’s that time of year again – today was time for my seven-month review at which I’m poked, prodded and vampiric amounts of blood removed from my arm for analysis. My feet were jabbed and I was blinded by the flashes of the retino-eye-camera-blindy-thing-whatsit (I’m sure it’s got a slightly more formal name).

Anyway all that aside, the figure we care about is, of course, the A1C – the roughly three month average of how good, or bad, a diabetic you’ve been. This time, mine was 6.3 – down from 6.5 in March. And all done on MDI – none of this pump malarkey. As Alan Partridge would say, “Back of the net!” Top right hand corner! I give you permission to bask in the glowing glory of my personal A1C magnificence!

While I was there, I also had a chat with the doc about my peaky mornings (I start at about 5, put in 8 units of humalog 20 minutes before a small breakfast and still end up at 13 two hours later). So we’re having a crack at using the slightly newish Apidra -  which is made by the same chaps as everyone second favourite long-acting insulin Lantus.

Apparently Apidra kicks in a bit quicker than Humalog (which is pretty quick in itself) so it might be useful for trimming the top off the morning peak. Anyway, I’m going to give it a go and see what happens. Rest assured, beloved readers, I’ll report back with the results in due course.

You'll just feel a little scratch

Well it’s that time of year again, the time of year when I usually ignore my letter from my doctor reminding me to go and get my winter ‘flu jab.

But not this year, oh no. No, this year I’ll definitely be subjecting myself to the joys of a slightly achy arm for the day. I’m not particularly worried about swine ‘flu (oink), as from what I can see it doesn’t seem to be much worse than usual seasonal ‘flu. I suspect it’s been, perhaps, blown a little out of proportion. After all the British press absolutely loves a health scare – especially rancid rag The Daily Mail, which seems to be made up of little else. If I’m wrong, however, please feel free to crow over my cooling corpse saying “we told you so…”

Anyway, I’m just terrified of the usual plain old common or garden ‘flu. Why? Because last year I actually got it and I have to say that it was far from being a week-long chucklefest. I picked it up at a family birthday in France from my brother – yeah, thanks Ben – and on the return trip spent a merry afternoon in Gatwick airport waiting for connecting flight  steadily feeling more and more awful (and, coincidently, probably passing on said ‘flu to 30,000 passers-by who were flying to every corner of the world – go me!)

The next five days or so were spent in bed, sweating, shaking, coughing, spluttering, checking my BG every hour, injecting extra insulin and generally wishing I was dead. Everything hurt and I could hardly summon the mental energy to get up and do something as simple as visit the bathroom (I did eventually go, you’ll be pleased to hear). It was the second most miserable five day period I’ve ever had. The first most miserable was the last time I had ‘flu – at boarding school in Northern Ireland. What fun that was!

So, never wishing to experience the misery of proper ‘flu again (man flu’s fine – I can deal with / put that on any day) I’m ignoring the inevitable health scares concerning vaccines and I’ll be at my doctor’s next Saturday at the front of the queue for the jab.

I have to confess that despite all that, I probably would have ignored the doctor’s reminder as usual. But after consistently disregarding her advice to “go and get your bloody ‘flu jab” last year, Katie very sensibly just made an appointment for me yesterday. I have been told.