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Constant Progress, However Small.

Paging Doctor Awesome ... Doctor Awesome?It has taken me a long time to find a new primary care doctor. For a good span of time, I was at the Joslin clinic preparing for pregnancy and then actually being pregnant, and in tandem with the pregnancy care team, I had a kick-ass doctor in Connecticut (where I was living at the time ... and yes, I was driving from Norwalk, CT to Boston, MA for endo appointments. Joslin is worth it, in my opinion. But that was when gas was $4.65 a gallon, so it was an expensive adventure in pancreas pandering.)

Over the last two years, I've seen a few different primary care doctors that are local to where I am now (in Rhode Island), but I hadn't found a good fit yet. Every patient is different and has different needs (same goes for docs), but I wanted a doctor who was at least familiar with type 1 diabetes care, even though I still see Joslin specifically for my diabetes care. I wanted to have a doctor who was comfortable discussing diabetes stuff, and who would be okay with shuttling information back and forth with my endo at Joslin. And I really, really hoped that their staff would be kind, because as a patient, the doctor's staff can make or break your desire to be seen by that practice.

Lastly, this person had to be a woman.  (Nothing wrong with doctors who are men, but I can't comfortably talk shop with a guy. I don't know why. I've always felt most comfortable with female practitioners.)  So with that "wish list" in place, it has taken me a few tries to find a good doc/patient fit.

But I think I found her. And she's awesome, because she threatened to 'break up with me' during the course of the first appointment.

As I mentioned last week, during my first appointment with her, she wanted to run the full gamut of labwork to 'establish the baseline."  But we reviewed my last few lab work ups (I brought the older results with me - I'm a creepily-fastidious paperwork person), and she, like me, wasn't happy to see the higher A1C values over the last six months.

"This isn't where you want to be. I can tell," she said, watching my face as we discussed my health history. "And I don't want your numbers here, either."

"Definitely not," I agreed, trying to look like an adult capable of making my own medical decisions, while sporting the awkward paper johnny. "I'm really unnerved by those A1Cs, and I'm working to bring it down. It just seems to be a really slow process for me. I don't know why. I've always had trouble with my A1C, even as a kid when my mom was fully in charge of things."

"Did they call you that old-school name? The 'brittle' kind of diabetes?" she asked.

"Yes! That word is written all over my old Joslin charts. Always made made me think about fancy tea cups. Or really weak fingernails."

"Exactly." She smiled, and closed my chart. "But the fact remains that your A1C is higher than it should be, considering all the complications that come as a result of maintaining that kind of number. You know the list - I'm not going to run through it for you. But we've discussed the things you're doing to make changes, and I think that's the right path.  I know the lows scare you."

"It's less the fear for me, personally, and more about dealing with them when I'm home alone with my daughter. I'd rather be 150 than 80, because I seem to drop so quickly."

"I understand that. I have a little one myself." She grinned at me. "They're fast, aren't they?"

She opened my chart again and reviewed one of the labwork slips. "So do you want to be my patient? Because I'm happy to take you on."

"Yes." (It felt strangely like a platonic date. I should have brought her flowers?)

"Great. The only condition I have is this: your diabetes is not in the control that you or I want it in. I know you see Joslin for your endo appointments, and that's fine, but I want to make sure that you're continuing to pursue tighter control. I like what you're doing to move forward, and I want you to stick with that. I don't expect you to have perfect results the next time we meet, but we need to have constant progress - however small - towards that goal that you have set and i agree with. Does that work for you? Because anything less than that doesn't work for me."

"More than you realize - yes."

She smiled. "Welcome to the practice, then! I'm happy to have you with us."

"Can I put my clothes back on?"

She laughed.  "Of course! I'm sorry - such a strange conversation to have in a paper johnny, I know."

Constant progress, even if the steps are very small? I love that. And understanding how freaking awkward it is to meet someone for the first time and then have serious health discussions while sporting a paper dressing gown?

Even better. 


I am so glad for you that you seem to have found what you were looking for! It took me a while to find a doctor I was comfortable with, too. Attitude (and a sense of humor) can make a world of difference.

I really like that your PCP is holding you accountable, and not just brushing it off on your endo, while at the same time not trying to control you. It's a delicate balance with PCP's sometimes. Did you fill her in on #bananarama, because I think that's an important detail. :) Also, please remember that a few a1c's slightly above "control" are not going to cause your feet to fall off tomorrow.

Small steps lead to great progress. The Japanese call it "kaizen." Robert Maurer (a therapist, I belive) wrote a great book about it. It sounds like an apt description of your diabetes journey!

That doctor/patient relationship is so important! It's empowering to have a team of doctors that are intertwined with your care and not just shuffling patients in and out the door. WAY to go! Small steps is right - I take a few back now and again but as long as one keeps hoppin' back up - that is progress!

Wow - I thank you for this post. Why? Well, there are so many similarities in our lives that I do not feel so alone.

My little guy turned 3 the beginning of February, and my A1C's over the last year have not been where I, or my doctors, want it. Actually, they've been the worst ever! (And not because I have ignored my care) I have suffered tremendous anxiety over having a low while alone with my son, so I felt more comfortable, as you mentioned, running at a higher number than a lower on. Especially out in public! Who will take care of him if I am too weak to? That's been a constant thing for me. So much so, I started to isolate myself. Once I was able to finally articulate why I was isolating, I discussed it with my pump nurse, and she and I discussed temporary basals as a solution. Once I became familiar with how to use my temp basals, it became less scary, and I suffer less lows. I am so happy that I no longer have the constant feeling of a lurking panic attack or low while I am out with my son. I feel more comfortable, and confident that I will not go low.

As for the small steps (My Blood sugars measure in MMOL) My A1C levels can go down by mere points. I'm talking ___.4% to ____.2% and I would feel so disappointed because it wasn't the full numbered percentage I was looking for. But, it is a slower process. We have to cautiously go about it this way, to protect our sanity, and our children. And the small steps downward are progress, even though small. So, for now, I am happy. And I am thrilled for you that you found the doctor you were looking for. Sometimes all it takes is a great team to make you look forward to better caring for yourself, well, going without saying that the long term benefits are there too...but who thinks of that when we are just trying to get through THIS day. Take care...

SO happy you've found someone you feel good about. My appointment with a potential new endo is Friday morning. I just had my old doc fax copies of my last few lab results and the figures are staggering. NOT looking forward to starting off fresh with this new guy, trying to explain my rapid decline in the control arena from when K was born to now. All while wearing a paper gown, of course. :)

I love my endo, mostly because I know I'm one of the first people he saw at the practice, so he KNOWS me and he's an encouraging, understanding doctor. But he's not my go-to doctor when I have all kinds of health questions.

My PCP is this young, smart, funny woman who makes me see myself as a whole and not compartmentalize. I'm lucky.

I'm glad you found someone you feel can help you figure out what's going on. I hope your next A1C makes you smile.

So glad that you've found a doc you feel good about and who cares about your progress! And I can completely identify with feeling waaaay more comfortable with women doctors than men doctors.

Best wishes for the A1c-lowering! I'm fighting that battle as well.

I love my PCP, and I love my end in the pre-pregnancy clinic at joslin - so much so that I need to figure out a way to have her keep being my endo after we're done with this whole baby thing, because I like her much better than the other person I was seeing.

I wish someone would creat and APP for the smart phones that would allow you to track your numbers! Now, THAT would be awesome!

Wow! Wouldn't you know it? As soon as I wrote the last comment, about there being an APP for diabetes logging, I went to look, and low and behold there are several! I've downloaded two of them. Can't wait to see if they help in my logging, because frankly, I hate to do it!

I had that same sense of relief at finding the right doctor. The fit is so important. I wish you luck in getting your A1C where you want it.

I always appreciate someone who speaks frankly. Just cut to it, and I like you.

This post really struck a cord with me. Ever since I left home for college (8 years ago) I have not been able to find an Endo that is a good fit. My PCP is wonderful, but I really want a Endo that can be part of my medical team and help me to get the control I strive for. Not just someone who tells me whats wrong and then kicks me out of the office. My problem is how to go about finding a new Endo? How did you go about looking for a new PCP?

She sounds hard-core, but in all the right ways! Hope all goes well with the new relationship!

I completely understand where you are coming from. It is difficult to find the right healthcare team. I have a 7 month old and I really relate to the thought process behind being more comfortable at 150. I have had a few grand mal seizures in the past 13 months while the dexcom and omnipod showed higher numbers it is the quick drop that my body can't seem to keep up with. I know all the complications of having a higher A1c but I also know how unsafe things can be for myself and my 7 mnth old right now so I tend to run higher. My endo is known for pushing very tight control but I'm at a point where that's not realistic for my situation so thank you for posting that. It's a relief to know someone else understands the desire to run higher for the sake of our babies.

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