Three Is A Magic Number

Out of all the Schoolhouse Rock videos, this is my favorite. (I’m Just A Bill and Elbow Room are runners up.)

There is something magical about the number three. And that song (and the cover done by Blind Melon, too.)

But today, three is not a magic number. It’s the number of trigger finger releases I am supposed to have in a few weeks.

I say supposed to have, because like any empowered patient, I’m going to to do my research about having three fingers done on one hand when only one is actively triggering (although my pinky and my middle finger – hey!). I’ll ask around, look up information in medical journals and perhaps even get a second opinion by another hand surgeon. Why, you ask?

My Appointment Was Not What I Expected

The appointment itself was interesting, because if I had met the surgeon a few years ago, it would have been a different conversation. Here’s how it went (and my thoughts as it happened).

My appointment was for 12:10pm. Brought into a room by Jason with a M.A. on his name tag.

::What does M.A. stand for in this office? Master of Arts? I don’t think so.::

“So, why are you being seen today?”

::Does ANYONE read the reams of paperwork they make me fill out? Anyone? Bueller?::

I give him the lowdown. 

“How do you know that it’s trigger finger?”

::Again, paperwork. Four previous trigger finger release surgeries.::

“You’ll get an x-ray and then the doctor will be in to see you.”

From the time I saw Jason and got two X-rays on my hand, it was another 40 minutes before I saw the doctor.  He breezes in with a guy behind him wheeling a cart with a computer on it. His own personal stenographer for electronic health records.

He knows I have trigger finger. There are no questions. I didn’t get an opening statement in.

Because of my friends, Drs. Sean and Tamara Oser, who present an incredible session at Friends for Life, I know this statistic: 

In a well-known study of the survey phase, Beckman and Frankel found that physicians prevented patients from completing an opening statement 77% of the time. Those who interrupted their patients did so in a mean time of 18 seconds.

He beat this statistic to death.

“Hi, I’m Dr. X (not his real name, although that would be neat, right?). So, let’s see your hand.”

He examines it. Palpitates the area where it hurts. I wince. He keeps asking me to open and close it, telling me to make a fist.

::I can’t make a fist, dude. My finger won’t do that anymore. If it did, I wouldn’t be here.::

He pokes at it again, while I explain that I’ve had trigger release done before, but not here and not for this finger.

“O.K., so I’m going to give you a cortisone shot.”

Options

::Oh, no you aren’t.::Water Punch

::He didn’t even give me options. Ask me if I’ve ever had a cortisone shot in the FOUR other fingers I’ve had trigger finger. Explain that I could choose: physical therapy, cortisone injections, percutaneous release or open surgery release. Four options. I know which one would work for me, for most Type 1 diabetics, but HE DIDN’T GIVE ME OPTIONS.::

“Dr. X, I’m not doing a cortisone shot. It’s been proven and published that it’s not a successful treatment option for individuals like me with Type 1 diabetes. Surgery is almost always done in these cases following a cortisone shot.”

He looks at me, then turns to the steno guy, who is now looking confused.

“I’ve done the research. I am an e-patient.”

He looks at me again. He says:

“I’ve done over 10,000 release surgeries. Most people with diabetes do end up with surgery.”

The steno guy is wide-eyed. Dr. X nods to me, then tells the silent interloper with the computer:

“We’re going to do surgery.”

He turns back to me, starts palpitating my palm again and asks if there is any pain when he presses here or here.

::Yes and yes.::

“You know that you’re already showing signs of triggering in your pinky and it’s only a matter of time before you’ll have to have the pinky and the middle finger done. So, let’s go ahead and do all three while we’re in there doing the ring finger.”

::I am so over this trigger finger thing. Whatever.::

After this brief conversation, he leaves and I schedule surgery, but not before he popped his head in and told me that I would probably want to schedule it at one surgery center over the other he uses, because the anesthesia company he uses does not accept insurance at the one closest to my house.

::In my next life, I’m coming back as an anesthesiologist.::

If this had been a few years ago, I would have blindly accepted the cortisone shot, then floundered for weeks dealing with super high good sugars and staggering amounts of insulin to bring it down, eventually ending up in his office again, this time to schedule surgery.

I have done a lot of research, talked with my friends in the DOC, and had this done four times already, I didn’t go in blind. I just came out angry.

Angry that I wasn’t offered a choice. Angry that I had to state that I was going to have the option he didn’t initially present to me. And then I am angry because I am not even sure I should have three fingers released when I know only one needs to be done right now.

Questions

So, for those of you who have had trigger finger release surgery, has anyone had THREE fingers done at once? What would you do?

And maybe the other question I have is this: Is it wrong to expect doctors to have a conversation with you about options, because right now, I’m as confused as the poor steno guy?

 

 

 

 

 

Accu-Chek To: Program – Saving $ on Test Strips & Getting More

logoIt’s little things like this that I love to share.

Accu-Chek has a new program that gives a fantastic discount on blood glucose monitoring strips and a little something extra to feed the soul.

It’s called Accu-Chek To: and I’ve signed up this week because I believe that they’re doing something right. (A great price. A great idea. A great program.)

It’s a monthly subscription program and they describe it like this:

Every month you’ll receive a box filled with the ACCU-CHEK® essentials you need, plus amazing items for you to discover – all delivered right to your door.

You’re given two options: Accu-Chek Essentials or Accu-Check Essentials + Discovery. It’s a five dollar difference between the two and here’s the reason why: with the Discovery add on, they surprise you each month with samples that help to nourish your body and soul (and aren’t necessarily diabetes-centric).

When you to to the website, you are given the option to view a quick video (but here it is, because you know…)

and then as you scroll down, you’re presented with two choices to start:

Do you have an Accu-Check blood glucose meter?

(If you don’t, you have the option to choose a meter. While I do have a Nano, they’ve now come out with a designer version and it’s.so.cool… Ahem.) You can choose a Nano or Aviva Plus…

Then you choose your monthly subscription option… and here’s the cool part.

50 strips = $20.00

100 strips = $40.00

(If you want the goody surprise box, it’s $25.00 and $45.00.)

You are getting the strips for almost 50% off what you would pay at a store. 

I went to a big name store (rhymes with Ball-Mart) a few days ago just to see what the shelf price of strips were. Even the cheap-o strips don’t meet that price when you use the Accu-Chek To: program. And you get a meter for free. And you don’t have to go to the store. And the strips are accurate. (After all the work that’s been done with StripSafely, I know which strips I feel I can trust. My personal opinion.)

I’ll get strips sent to me every month and a box of goodies. This month’s samples could include lip balm, body butter, tasty treats… and I’m all about that. If you like what you get for samples, you can purchase more at the site. (And you can also purchase more diabetes testing supplies. I’m going to check that out, too…)

The boxes are sent out on the third Wednesday of every month. Tick-tock. Get yours for this month. 

So, if you are looking to supplement your existing strips every month (which I am doing, as my insurance won’t pay for the number of strips I blow through each month) or you are trying to figure out a way to keep costs down and take care of yourself, this is the program we’ve all been waiting for.

The Fine Print

Here’s the deal: you cannot use this program and get the cost reimbursed through Medicaid or Medicare. It’s for individuals who either do not have health insurance or you have health insurance but will not seek to get reimbursed from your insurance using this program.  It’s only available for U.S. residents right now. 

For individuals like me on a high deductible insurance program and strips are part of that high deductible, while I can’t get the strips I receive through the monthly subscription program as part of my deductible, every bit helps.

I am not an employee of Roche. I am not compensated for this post. My opinions are my own. I just think this is an amazing program that does two things: saves me money on things that are expensive for my diabetes and gives me a little lift with the samples they send. 

 

The Wrong Finger

1283953_23864084One of the lovely little complications that you can get from having diabetes is stenosing tenosynovitis, affectionately known as “trigger finger”.

What is Trigger Finger?

À la Wikipedia:

a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the “triggering” phenomenon. The label of trigger finger is used because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun.

Let me add on:

The pain of trigger finger can become so bad that it wakes you up in the middle of the night. The locking of the finger in a curled position to an open position can make you see stars and clench your teeth and make you lose your breath. The inability to flex the finger renders it useless.

Trigger finger is not one of those items on the list of complications that you learn in your quest to understand what diabetes does to your body. Kidney disease, blindness, cardiovascular issues… they get all the attention. Those get hammered home in all the media and resource information.

Trigger finger isn’t even on the first page. In fact, until the first time it happened to me, I had no idea it was a complication at all.

Ain’t My First Time At This Rodeo

About ten years ago, I got “hitchhiker’s thumb”, which is trigger finger… except it was… yeah. My thumb. Both of them at the same time. (Long story. You can read it here.)

After The Kid was born, it was my index fingers. Both of them. Repetitive motion can trigger (sorry for the overuse of the word) trigger finger, and I was changing a lot of diapers. By the time I dragged myself to the orthopedic surgeon, I couldn’t change a diaper or move them much at all.

Well, it’s back. Just one finger this time. My ring finger on my right hand. And it’s the wrong finger. (I’d much prefer not to have it at all, so any finger is the wrong finger.)

How Do You Fix Trigger Finger?

First line of defense that many people try is: NSAIDS (anti-inflammatory meds), splinting, and steroid injections into the tendon.

While for non-diabetics, the injections of steroids can help and make this issue go away, it’s not a successful course of action. Surgery is recommended to most people with diabetes: percutaneous release or open release. (The first is done via a needle inserted without cutting open the hand.) Open release surgery has been my only option, where the surgeon opens up the sheath surrounding the tendon and as it was explained to me: “the gunk gets cleaned out so that the tendon can smoothly move back and forth”.

So, right now, I’m splinting it and taking NSAIDS. I’ll most likely have surgery as soon as I find one I trust in the area (I moved last year…).

In the meantime, my typing is slow and a little very painful and I am apologizing to John about the level of cleanliness in the house. Unloading the dishwasher is a joke that isn’t funny. I can’t cut my own meat. My right hand is becoming less useful. I am having problems typing, which is why I haven’t written a blog post recently.

This has happened over the last few weeks. No warning. But I know the ending. And that it will most likely happen to other fingers in the future.

I’m hoping next time it’s one of my middle fingers. Because that’s what I want to give this complication.

Ouch.

 

In No Particular Order – Diabetes Neat-o News

1199767_63019393Sometimes, I’ll see something diabetes related that interests me and I file it away in my inbox, saying: “I’ll share that…”

Today, I’m cleaning out my inbox. You’re welcome.

In no particular order:

But here’s the interesting tidbit:

“…the clinical data demonstrated that the two meter systems exceeded the minimum accuracy criteria for the new, more stringent ISO 15197:2013 performance requirements for accuracy.”

You know how I feel about blood glucose meter accuracy. We need it. Better accuracy from our blood glucose meters, better accuracy for our CGM readings, better dosing and food choice decisions = better days.

This is from a company that offers relatively inexpensive meter and strips. The devices will be on shelves by Q4 of 2014.

  • Close Concerns/diaTribe has it going on all over the place. I strongly encourage   demand that you take a moment to check the following out:

Kelly Close, the woman I swear never sleeps because she’s so busy doing amazing things for the diabetes community, presented this at a recent FDA meeting a few weeks back. (Click on this link to get her insightful slide presentation… so worth going through… it totally surprised me, and I’m pretty jaded these days.)

And then, there’s the work that DiaTribe is doing for #dstigma (diabetes stigma). Those of us who live with diabetes have probably felt unreasonably stigmatized at some point, whether it’s with friends, colleagues, strangers… and they’re showing this to the public in hard numbers. They did a study, and here are the results… and I love the fact that they’re not just satisfied with dumping the results on our lap. We’ve got work to do, people.

I got to see this in action at the AADE conference in Orlando and was blown away. While I use a pump that does the calculations for me, if I didn’t, this would be the meter I use. Imagine not having to do the math when you want to inject:

“If my blood sugar is 196 and my target is 100 and I’m going to have 48 grams of carbohydrates but I took a correction bolus an hour ago so I’ve got insulin on board….how much insulin should I take?”

It’s easier to ask what time the train will arrive. The answer may be just as elusive. But this meter will do it (but don’t ask what time the train will arrive).

It’s not available off the shelf – you will need to ask your medical team to get you one, but if you’re on MDI… whoa. Get one of those in your hot little hands.

  • National Medical Device Curriculum – Stop whining about how complicated the FDA makes the process of getting a device approved and start figuring out why. (Look, I used to whine. Not anymore.)

What is it? It’s a learning pathway for anyone who wants to know what it takes to get a medical device approved by the FDA, starting from scratch.

The National Medical Device Curriculum is a series of fictional case studies designed to help academic institutions and science and technology innovators understand FDA’s medical device regulatory processes. The FDA believes that better understanding of regulatory processes will accelerate the delivery of innovative medical devices to patients.

Regulatory pathways, PMA, 510(k), acceptable risk… it’s all covered with case studies. So worth your time if you are using ANY medical device to manage your diabetes.

Take a gander. Bookmark it. Share it. Discuss it. The more educated we get as a community about what the FDA does, the more we can help the FDA and device manufacturers with the process.

Thank you for helping to clear out my inbox. I feel so much better now. Do you do windows, too? 

 

Diabetes UnConference Scholarships Available NOW!

un-diabetes-conference-fullcolor-iconI quietly announced Sunday on The Diabetes UnConference’s website that scholarships to the conference are available, thanks to our generous sponsors and The Diabetes Collective, Inc., a Florida not-for-profit corporation. Everyone was on vacation or not looking at the Internet, so I got to ease into this wonderful announcement.

Are you an adult with diabetes? Do you want to be a part of the only conference where all adults with diabetes can talk about the psychosocial aspects of living with diabetes? Do you want to come to Vegas? Do you want to have fun?

Then you need to apply. Now. The scholarship deadline will close on September 30, 2014. 

What type of scholarships are available?

There are scholarships for Medicare recipients, Type 1s and Type 2s. There are full and partial scholarships. There is something for every adult with diabetes.

I want everyone to come and I’m so glad that these scholarships are possible. Even if you aren’t awarded a scholarship, I hope you’ll be able to come.

A lot of very cool announcements will be made this week about what’s going on at The Diabetes UnConference. If you’re interested in keeping up to date on the latest news, then you can subscribe to the newsletter (which is awesome, but I’m biased).

The early bird full registration of $139 per person will end on September 30, 2014. If you are on the fence (or applying for a scholarship), you can still register and if you receive a full scholarship, you will be refunded your registration fee.

Wait. What do I get for my registration fee?

  • Entrance to the Friday night Special Event
  • A spiffy t-shirt
  • Breakfast, lunch, and snacks on Saturday
  • Snacks on Sunday
  • Non-alcoholic beverages for the Saturday and Sunday conference (coffee, tea, soft drinks, etc.)
  • An exclusive special event on Saturday night from one of our sponsors that will make you feel like you’re on top of the world
  • Intimate access to certain companies who want to hear what you have to say about products and devices made for us
  • The feeling of safety and connection with others, knowing you can say just about anything related to living with diabetes and someone else “gets it”

Is it worth it?

Yes. Yes. Yes.

So, register. Apply for the scholarships. Get signed up for the newsletter. Tell your friends who have diabetes. Make it a “friends weekend”. Make it an “about me” weekend.

You won’t be disappointed.