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How to get this baby out

18 April, 2013 in Living with diabetes, Pregnancy

Given the number of medics it took to conceive and gestate this baby, I’ve never been under the illusion that getting her out would be an all natural affair. I may occasionally dream of a candle-lit water birth accompanied by whale song or maybe a soothing string quartet, but I’ve never held out much hope.

I’ve worked on the principle that going into labour spontaneously at around 38 weeks followed by a natural birth would be my ideal. Because I have high risk tattooed across my forehead the hospital won’t let me near the birthing pool so there’s no point in packing my swimming costume. But in my dreams, a nice short labour on dry land, just long enough to be able to brag about but nothing that drags on to the point of boredom would be ideal.

On my more realistic days I’ve believed that induction is the more likely route. With a sweep at 37 weeks, followed by drugs at 38 weeks if nothing has moved by then. I’ve accepted this as what might happen, but am still concerned by the fact that being induced doubles the chances of needing an emergency c-section, which seems like the worst of all worlds to me.

What I hadn’t really considered was an elective c-section. The thought of being sawn in half like a magician’s assistant but without the spangly leotard has never really appealed. But that’s the decision I’ve just made.

I’ve had stable background retinopathy for about 5 years. In the last few weeks, that’s started to progress with cotton wool spots and some small peripheral haemorrhages developing as a result of the additional strain the pregnancy is putting on my eyes. The general feeling is that these should fix themselves after the baby is born and my eyes should return to normal. But the big question mark is over whether all the strain from the huffing and puffing involved in a natural labour would be too much for my eyes and cause additional haemorrhages. Or worse, cause my already weakened blood vessels to be weakened to the point where they don’t bounce back like a supermodel’s stomach one week after birth.

The research in this area is sketchy to say the least. No one can accurately quantify what the risks are. So after much discussion with my eye Dr, we’ve opted for the safe route. I’m going to have an elective c-section to protect my eyes. Because they’ve already withstood 30 years of battering from diabetes and despite great blood glucose control and low blood pressure, they’re starting to feel the strain. And I’d like to give them the best possible chance of lasting at least another 60 years.

I’m happy with the decision, we’ve done the research, given it a great deal of thought and are comfortable that it’s the right thing for me. I’m still childishly irritated that I’ve had to make this concession to diabetes though. It’s very rare I let it dictate what I do, but this time I’ve decided to give in gracefully.

So there we have it, we now know how this baby will be entering the world, and it’ll be some time next week!

Tags: birth, complications, eyes, pregnancy 8 Comments »

by Alison

Eye spy a gap in my care

30 January, 2012 in check ups, Living with diabetes

A photo of an eye, if no one else will share them, ShootUp will

Last week I performed my civic duty of attending the hospital diabetic eye clinic in order to reduce the average age of attendees by at least 30 years. There was also a bit of faffing round with my eyes which left me gobsmacked at quite how disjointed diabetes care can be.

My local PCT have a gem of a diabetic eye screening programme. It’s really good. And I’ve told them so. I am harassed by letter once a year to make an appointment with my choice of local optician from an approved list to have my diabetic eye check. Because opticians are businesses they have appointments outside of working hours so I can toddle along for my annual blinding session without having to take time off work.

The optician then does my regular eye test and takes photos of the back of my eye to check for any exploding blood vessels. If no fireworks show up on the photo it is archived and I’m released back into the community for another year. Several years ago a minor eruption was spotted in the far reaches of my eye so I was packed off to the experts at the hospital for them to have a look.

The hospital said it was a tiny blip, nothing to worry about, it was to be expected as I’ve had diabetes since the dark ages and everyone was happy (well not quite, but let’s not go there now).

Last week I was back at the hospital because the latest photos again show some minor fireworks. Following the obligatory let me dilate your pupils until they look like black holes and then shine a very bright light into them until you cry session, the Dr again concluded there was nothing to worry about. Being a nightmare patient I had questions. Were these the same fireworks as last time that are just simmering quietly in the background. Or have they got worse. Or are they brand new explosions on top of the old ones? Would the nice Dr please take me through the images of my eyes over the last few years so I could understand whether overall things were getting better, worse or staying the same.

You’d have thought I’d asked her to eat a live frog whilst dancing naked through A&E. Apparently I don’t need this information, I just need to control my blood sugars. I also need to repair my tongue because I nearly bit it off before I managed a polite response that I have excellent diabetes control, thank you for your concern, but I’d like to understand the long term journey my eyes are taking. Rather than just have a one off meaningless proclamation that everything is fine when there is obviously something there.

Then came the bit that did, for a little while, leave me speechless. The hospital Dr isn’t able to see the images that have been taken by the screening programme. So on the one hand the PCT have more photos of my eyes than I have holiday photos, and on the other the hospital are making clinical decisions about my eyes without the benefit of seeing their full technicoloured history.

I came home and emailed the medical director at the hospital, asking him to have a little think about how we could make diabetic eye care in our area a little more integrated.

I also popped in to see my optician and asked if he could spare a minute to access the image database and talk me through my eye changes over the last 5 years. Following numerous caveats about how he’s not as clever as the hospital Drs and I’m not to take any of this as advice or he’ll be shot, the lovely man did just that. And so I now have the information I wanted in the first place. The initial fireworks have disappeared completely. There are some other fireworks, which are no worse than the original and don’t appear to be getting any worse year on year. Thank you. Now I understand the size and scale of the problem. And I agree, no treatment required. Which means I can focus on trying to introduce primary care to secondary care and getting them to share their toys and play nicely together.

Tags: checks ups, complications, eyes, healthcare 14 Comments »

by Hairy Gnome

Pull Yourself Together!

9 May, 2011 in Living with diabetes

The Slough of Despond; shortly after consuming yet another diabetic.

ShootUp’s resident Type 2 Terry gives a personal insight into the complication of diabetes we often forget…depression.

How often has that been said to you? Maybe not very often, because people have learned to avoid using this somewhat patronising phrase when people are suffering from depression. There, I’ve said it, the big ’D’ word; depression.

So what does depression have to do with diabetes? That’s probably a stupid question; I would be very surprised if everyone that lurks around on ShootUp hasn’t suffered from depression at some time or another. If you’re a T1 who’s been unfortunate enough to be diabetic from childhood, I’d be willing to bet that your teenage years were punctuated by bouts of it. Periods when you rejected your treatment regime and tried to believe diabetes did not exist. I still get them even now.

If, like me, you are a T2 who was diagnosed in middle age, the crunch didn’t really come until the words, “We’ll have to put you on insulin,” were uttered. I’m not trying to elicit any sympathy here, just explaining where I was in my life when depression first hit me.

I was particularly unlucky, a long term relationship had just ended in the October of 2005, I was put on insulin in January 2006, and my mother died in the February, not a great concatenation (Damn! I love that word!) of events, and depression welcomed me with open arms. The night my mother died I started smoking again after fourteen months nicotine free.

I’ve just re-read that last sentence and realise I’ve imbued depression with anthropomorphic attributes. (Try saying that after a Shoot Up Night Out!) Wasn’t it Winston Churchill who called depression his ‘Black Dog’? Maybe this monster really does seem as if it’s alive in its malevolence, though Chaucer’s inanimate Slough of Despond works well too, now there was a man before his time! However you visualise it though, depression is an evil thing.

It’s the side effect of diabetes that’s never mentioned, everyone talks about neuropathy, macular degeneration, and nephritis, but nobody mentions depression. Just the symptoms are depressing, so instead of trying to remember all that I felt, here’s a list of symptoms as provided on the BUPA website:

“If you have depression, you may have a number of different symptoms including:

a continuous low mood, which may be worse in the mornings
feeling irritable
crying a lot
a loss of interest in your social life
a loss of self-confidence
a lack of energy
tiredness and poor concentration
difficulty in making decisions
feeling helpless, worthless or hopeless
feeling guilty
thoughts about death and suicide
anxiety
a loss of sex drive (libido)
trouble sleeping – possibly taking one or two hours to go to sleep or waking up earlier than usual
disturbed eating patterns – either loss of appetite or eating too much
unexplained or worsening aches and pains
physical slowness.”

I have to say that sadly, I recognise quite a number of those symptoms, maybe you do too.

If you do recognise any of those symptoms, but you’ve done nothing about them there are two things you need to do. The first is to believe that you really do suffer from depression. The second is to talk to someone about it! When you’re depressed (we’re talking real clinical depression here, not just feeling sad for some reason) one of the first hurdles is actually admitting to yourself that you have a problem. The second, and often the most difficult, is talking about it.

So, once you’ve admitted to yourself you have a problem, who are you going to talk to? If you look on any of the websites they’ll always tell you to talk to your GP, but my (very unprofessional) suggestion is to talk to the one you love, the one who is nearest and dearest to you, and has been suffering the fallout from your problem. If they tell you that you aren’t depressed, and to “Pull yourself together!” then maybe you should be looking for someone else. In reality, they’ll sympathise with you, and tell you how worried they’ve been.

It’s not easy, I know, and unfortunately I didn’t really have anyone close enough to make a difference, one of the downsides to living alone. I did talk to my GP though, and got a lot of help, my DSN at that time was a rock, and I could always talk to her, at one time I was seeing her every week. Some of that help was chemical in the form of Fluoxitine capsules, (if you look it up it’s a generic form of Prozac)

There are indications that Fluoxitine shouldn’t be used if a patient has diabetes, but there are other drugs that can be prescribed, and anyway, the contra-indications may not be for you, your doctor will know. If you do go onto medication, there may be a period in the initial few weeks where your doctor wants to see you every week anyway (I saw my DSN by choice, but the doctor saw me regularly too). The immediate effects of anti-depressants can be a slight worsening of the situation. Your doctor may recommend counselling as an alternative to drug therapy. Personally I think counselling is widely overrated, but it may work well for some people, I only know, that having done the first year of a counselling course, I’m not one of them.

I don’t know if any of my fellow ‘Shoot Uppers’ are old enough to remember, but there used to be an advertisement on TV for a headache remedy, I think it may have been Anadin, but I could be wrong. The tag line for the advert was, “Leave me alone, I’ll be all right soon…” Sadly, many people with depression say the same thing, hoping it will go away. Depression though is much more insidious than a headache, and it won’t just go away; in really bad cases it may even need psychiatric help, so don’t dismiss it out of hand.

Don’t feel as though it’s something to be ashamed of either! Part of the depression is to feel as though one is less than a person for admitting it, don’t be fooled! If you can relate to any of the symptoms mentioned above, you need help, it’s not ‘being silly’, it’s not ‘wasting the doctor’s time’, you have a real illness that needs real treatment, believe me.

Me? Well, I’m much happier now; I’m off the drugs and have been for a couple of years now. I still get problems with sleeping, but that’s often more to do with the neuropathy than depression. I never really have got back into the swing of doing housework, so I have to ask the spiders if I’m allowed open a window. Overall though, my life is good, but I keep my eye open, looking over my shoulder for Churchill’s ‘Black Dog’!

Terry Ozbourne

Tags: attitude, complications, depression 22 Comments »