Inside The Endo's Office

Tuesday may be gone with the wind as Lynyrd Shynrd says, but remnants of my most recent Endo Visit still loom large in my mind and we're already preparing for the next one in the regular three-month cycle.

Coming from work on a Tuesday morning last week, I had an already-busy morning and was trying to clear my head briefly for would likely be about an hour-long visit scheduled for 11:10 a.m.  That day, I had a few different missions: Waiting Room Observations, Big Picture D-Management Discussion, and a Look Ahead at where we want to be and how to get there.

Checking in, the receptionist quickly checked her computer screen and informed me about the co-pay of $50, almost asking as if it was correct.

Me (voice dripping with sarcasm): "I suppose, if Dr. P considers herself a 'specialist.'"

Receptionist: "Well, of course she does. Her work is specialized and her time is valuable."

I smiled, and handed over my Insurance Flex Card without argument. Thinking to myself that my payment doubled in the past few months though my visit times seem to decrease. I concluded that if my co-pays and costs rise, then my visit times should go up accordingly. But, I didn't raise that point and decided this wasn't the time or place for that Insurance Co-Pay/Provider-Reimbursement discussion.

Turning to the waiting room, I scoped out the room for a seat. That's when I saw the flatscreen TV on the wall airing the most recent episode of D-Life. On the screen at that moment was Manny Hernandez, the esteemed founder of TuDiabetes and the Diabetes Hands Foundation, talking about social networking among diabetics and the newest HealthSeeker game on Facebook. I thought this was pretty awesome, to have such a key Diabetes Online Community leader right there in the waiting room with me (and any other person who might be waiting)!

Only one other older gentlemen was in the waiting room with me, but he was hidden behind a middle-of-the-room wall post from where I grabbed a seat in the corner - a spot where I could both see the door where I'd be called in to and the outside door where new visitors would enter. This also gave me a key view of the room to snap some pictures of the room, for George's Waiting With Diabetes challenge. With that, one part of my Endo Office Mission was complete!

The wait-time was only about 10 minutes, meaning I was accompanied back by the nurse about five minutes past my scheduled appointment time. We did the weight routine right around the corner, and then started the walk back to the visit room. That's where I ran into Ryan Sellers, the local Minimed Sales Rep who was chatting it up with a doctor in the office. We said hellos and shook hands, then briefly touched base about his recent Lake Tahoe D-Bike Ride and how he was going to be writing a guest-blog about that soon. In about 15 minutes since arriving, I'd already encountered two members of the DOC!

Once doing a blood test and retest on the office Accu-check Aviva meter, I mentioned to the nurse that was a fine result in the low 200s because it was actually coming down from the post-glucagon 450 a few hours earlier. Her face went white and I thought she might fall over in disbelief, but she didn't say anything and just wrote a note on my chart. Then, she scooted out and I sat waiting for about five minutes before there came a knock on the door.

Dr. P entered the room, with a young blond girl in glasses and a white lab coat trailing behind her. Greetings revealed the stranger to be a Resident Observer who was just along for the ride for a week or two. She was keen on taking notes, but didn't say much and certainly liked to nod - like that one guy in Office Space who stood listening to the boss talk and visibly agreeing with everything that was said.

We started off with small talk, delving into generalities about how things have been and any huge changes that should be noted. I reminded that I'd been back on the pump for about three weeks, and hadn't yet made any changes in order to make sure I was used to it again before doing so.

At some point, it became clear she didn't have my BG readings that had been uploaded the night before onto Minimed Carelink. I'd phoned and left a message earlier that morning, and so she left in search of someone to print off those uploaded results.

Resident Observer stayed behind. I asked how she was liking everything, and she noted that Dr. P was very knowledgeable but quite busy with so many patients. I mentioned we Patients With Diabetes generally don't get much time and that's an issue, but that we take whatever we can get. She nodded in agreement.

Dr. P returned a few minutes later and we started going over the BG results she'd located. She observed my Lows and the trends of hovering in the 60s, but noted generally I was doing better.

But my inside-the-office A1C came back at 7.8, a tenth of a percentage point higher than the last result back in June. This wasn't a surprise to me, as I'd seen higher BGs in the August from my last month of MDIs. Actually, with the more recent Lows in the past few weeks since reconnecting to my pump, I actually expected an artifically deflated A1c. With this final result, I concluded that my A1c is actually hovering somewhere near 8%.

We acknowledged that and knew some work was ahead. Really, this doesn't change my goal of getting down to 7% by year's end. I know it's possible, and think that the basal changes we made will help tighten up the control.

Dr. P determined that my trends of hovering in the 60s at various times of day and the even lower Lows that have led to glucagon-injecting and paramedic visits meant we should adjust ALL of my five basal patterns each day. We lowered them, if even just a tad. I'm to fax my results in a week, she said.
I observed that there was a benefit of having the paramedics come out to the house.

Me: "On a positive note, at least I'm getting my tax dollars' worth and getting to know my paramedics by name."

Dr P: "That's NOT what we want... I am not prescribing that."

The Resident Observer laughed at that, and I agreed we indeed didn't want that.

After all the trend talk and basal adjustments, we discussed my need for Lab Work and I agreed to get that done before long. Then, she proceeded to do the Eyes and Ears check, heart and breathing checks, and see if I could feel the metal brushes in my toes and feet. All good.

When all was said and done, I got about 25 minutes out of Dr. P this time. Which of course, was half of what I'd paid in my newly-revised co-pay amount... But again, not the time or place for that one.

My Endo appointment wasn't the only in the DOC - several others also had visits the same day or week. There was some discussion about this being a coincidence, but I don't buy that. I think it's simple planning: going every three months or so, we've all orchestrated our visits to be timed so that our next one, the fnial one of the year, comes just before Christmas. That way, we can get some results from our Endo just in time for the holiday!

Checking out with the scheduler, I mentioned this scheduling was perfectly planned because it meant I'd either be getting a wante Christmas gift or a lump of coal from Dr. P on my next visit. She chimed in that her impression was that it was perfect timing for me to bring them a gift. Well, of course!

So, we in the DOC have our work ahead for the next three months as we prep for our likely year-end visits just in time for Christmas! Hopefully, we don't put off our "shopping" until the last minute and give ourselves the chance to avoid those lumps of coal!