I want you to have a great colonoscopy

On July 4th (no fireworks that day, sorry I'm Canadian) I finally got around to my 2^nd colonoscopy (I have them done due to my Dad having colon cancer).  My previous one that was done back in Quebec was an easy process, with doing that usual day before clean out, liquid diet (yes, beer counts as it’s a clear liquid).  When it was done (I wasn't on the pump then just my "poor man's pump" ), I was hooked up to an IV with a slow drip of insulin, no sedation, and got to watch the whole show of my squeaky clean A-hole on a screen.  Easy peasy – though they wouldn’t give me a copy of the video to share with friends on the big screen as we all ate popcorn!  I remember being so hungry, that a greasy breakfast was a must for me, and I was able to resume back to work the next day.

When I’d left Quebec last summer, I was still waiting to be called up for my 2^nd colonoscopy which already was going into year 3.  Ontario seems to be alot better with wait times as I was referred  after going to a local walk-in clinic.  Night and day over Quebec health care system where the waiting game can go on for years.

This time, totally different, starting with the prep the day before.  It was a day of not being  actually able to work, despite sitting on my behind for the majority of one of my jobs I do.  Perhaps due to being a wee bit younger last time, what I'd used to "process" the goop out of me, who knows.  All I could do the day before was be a slug and I now understand why people don't like the prep bit - I feel for you all now.

The other difference this time, I was to be sedated aka " conscious sedation ".  I was told that I could not wear my insulin pump for this 10 minute procedure – but to give ½ my usual dose that AM (this was stated on the hospital form – obviously insulin pumps haven’t been updated onto the form).  I had planned on just giving a unit of rapid insulin in my pump, and then disengaging, but with some of the comments on my Facebook posts of how they'd kept them on during this procedure,  I convinced the RN that by lowering my basal rate of my pump by 50% things would all be good.  I decided at the last minute though, with my blood sugar showing 7.1 mmol/dl / 128 mg/dl – that I’d leave it be, and not reduce the basal.

I didn’t tell them this …

After a weigh in, that I insisted on them doing since they asked me what my weight was, and I told them I really didn’t know  (they wanted me to guess … it’s like … WTF?).  I found I'd lost 15 pounds (maybe the previous day of fasting helped shed some?) - and now I understand why my pants keep on falling down.  I figured the amount of sedation would be based on my weight (I have later found out since, that there is a limit to how much they give a patient (Versed and Fentanyl were used on me). 

Then came the " let’s find a juicy vein ".  Two RN's tried to find one in my forearm (and they're commenting on how tough my skin is … hello … diabetic of ½ a century … we have tough skin). They give up despite my saying my hand is the best bet but the clock is ticking for the next patient to be processed and they're understaffed.

So, it’s wheel the patient, moi, into the OR.  Where the doctor takes over in the game of finding a vein in my hand, and even better, he uses a butterfly needle, which just glides into that juicy plump vein in my hand (I sound like a junkie don’t I? LOL).   Then its lights out, night night Pussy Cat … despite being told by RN that I would be awake during the procedure.  No watching the screen like  the classic 1960's movie The Fantastic Voyage  ... I'm out ... cold ... no seeing the bowels of the Earth.

I awoke, wondering WTF, ½ an hour had passed since being wheeled in, and I was being asked if I wanted any biscuits and water.  It’s like, yes please.  Sadly, within 5 minutes, I was trying to be polite about requesting a … fetch me a bucket Garcon … and just about hopped out of the bed to go searching.  At that point, after the hurl session or two,  the RN brought me my clothing and I wobbly got dressed, texted my DH to come and fetch me.  I'm still amazed how I  managed to get myself out the right door to where he picked me up, I was that out of it and wondered why no one was asking if I needed a wheel chair.  For the next 3 days that was how I was, the effects of the sedation making me feel like I was having a hangover from Hell going between hurling, coldness, nonstop sleeping, and eating was a chore, but wait … this isn’t the end of the story yet of my anal probe.

Are you wondering about the highlighted bit above “I didn’t tell them this …”?

Stay tuned for the 2^nd part of this blog, and be ready to be as surprised as I was …

Psst,  remember, if you don't follow me on Blogger, maybe now's the time to get cracking ... so you can keep up with my occasional blogs that come forth from my sponge brain!!!  I always aim to make them both educational and entertaining!

I Wanna Be a Pole Dancer

Yes, I do like to joke about taking up this hobby when I retire in some of the places I post at in the social media world for diabetes, I'm looking as this being one way to be able to afford my diabetes gadgets that help me to stay in control when I am no longer working (retirement is fast looming up after 35 years as a 9-5er).

So come into my dream world, and dance away with me ..... 'cause  "I wanna be yours" ...

Three weeks ago, I had a second go with an MRI scan that had been delayed from a previous visit when I found out ... a Dexcom sensor cannot be worn, even if it's not placed anywhere near where the portion of your body is being scanned (my knee has been acting up over the last 3 years).  The problem was the day before I had only placed a new sensor on my upper body, which usually lasts an average of a month.  No insurance coverage for the CGM (and I'm not alone in paying out of pocket) meant I wasn't about to rip it off.  So my file was left open, and viola, 4 weeks later ... I was back without any piece of metal on/in my body (I didn't know tattoos can react to MRI's as well - and I have one). The things you learn, but in reality, these questions should be given to the patient prior to making an appointment, not on the day you arrive.

So, after the 2nd MRI (I twitched alot even though I tried to be still during the 20 minute scan), I went back home to place a new sensor on.  This time, it wasn't going to be on my regular real estate  portion on my body which is either my stomach, upper back, upper thigh or arms.  I had seen a post from JeVonda Flint who was diagnosed with Type 1 diabetes (T1D) 6 years ago.  She places her sensor on her calf, and finds it works well for her there.  So between myself and another T1D here in Canada, I decided I'd give a try.

Yes, I was abit terrified about placing it into what is abit of a muscular portion of my leg (actually I think there's alot of fat, if I was a chicken or a turkey, I'd feed a family of 4 easily).  The good thing, I felt nothing when inserting it.  If any of you have seen the introducer needle for the Dexcom sensor, it looks abit scary.  I felt nothing at all, and even thought to myself, "did I do it properly - did it go in?".

Two hours later, calibration done (you have to take 2 blood tests to get the CGM going) ... I was all set to see if the sensor would work as well, and as long on my body as the other sites do that I place it in.

Sadly, it didn't ... by Day 3,  I was seeing gaps on the trend line or 1/2 hour here and there, along with a few other warnings (e.g. having to restart sensor due to sensor failed warnings - and I tried twice that day to restart).   I realised it wasn't worth continuing to try to keep it on.

The only three factors that I can come up with:

1. When coming back from a walk as well that day, had my boot cuff (yes, it was still cool here in Canada 3 weeks ago), did I perhaps rub on the sensor too much since it's advised not to have anything bump up against it).
2. The sensor was expired and this time my luck ran out?  The majority of the time 2 out of 3 sensors I use are expired and work fine  (I can only afford to buy new sensors a few times a year due to cost, once in a blue moon I get a lovely package of expired sensors from American diabetics who do have insurance coverage).
3. Is my receiver starting to maybe go (I haven't had any warnings yet that should say it's on going to stop).  It's getting close to being 2 years, again, the receiver was gifted to me, and I really have no idea of how much it was used prior to my receiving it.  I have already replaced the transmitter portion that is inserted into the sensor, and so far, it's gone past the 6 months time frame. So eventually, this will go as well and I'll have to buy a new one.

I'm now approaching into my 3rd week without a sensor, and in the beginning I did miss it, but one thing I didn't was how it affects my sleep at night with alarming (combine that with menopause hot flashes, etc. I don't sleep like a cute little kitty).  The same goes with my insulin pump as well, that I'm still not reattached to since the end of January when I went on my holidays to Cuba.

The one thing with not having the sensor on,  I'm not constantly obsessing about the trend of my blood sugars during this period, and from others I have spoken to who wear this device, they can be checking it alot compared to my once in an hour check up.  Along with comparing it against my blood meter (and with the calf placement I was doing check up alot due to how it was not as close to the real thing from the blood meter).  I'm very fortunate that I can still detect when I'm going low (though I think wearing the CGM has made me abit lazy since I woke up to a few in the 2 mmol/l range ... which I never used to do).  Also, I know for some die hard CGMS wearers,  it can be dangerous due to their not having hypoglycemic unawareness!

So, yes, I will be placing a sensor on again, probably next week, and I will probably not be placing it back on my calf again due to the results I had with first placement.  I'll stick to my usual spots, and know that I will hopefully get my 3-4 weeks out of the sensor.  Maybe if I had coverage, I'd be different with not being so anal about keeping the sensor in place, but when you're not quite a pro a pole dancing, well, a cat girls gotta do what a girls gotta do.

Oh, and the outcome of the MRI, despite my twitching knee during the whole process?  I had been trying for past 3 years in Quebec with no success of seeing a specialist (I tried but kept on being told to call back in 6 months and there might be an opening) and  GP who looked at my MRI in the beginning, said it was my age and  arthritis.   Finally, I've been diagnosed by an orthopaedic surgeon  -  with a torn meniscus  - and am now on waiting list for surgery - whoo! whoo!.  It'll be nice to have a knee that doesn't go wonky on me - but at least I finally got to see someone who knows their stuff (and they're interested in what I do within the DOC as well)!

The pros/cons of diabetes costs in Ontario

I am fast learning 6 months after my move from Quebec, that though we may pay less in provincial taxes, some costs are higher.  Though the one pro so far here in the small town I live in … when I go to walk in clinic (wait time is far less than in Quebec but for surgical procedures about the same according to 2014 statistics).  This is where things excel, along with referral to a doctor being quick when going to the clinic here in my town.  So I guess it all depends on what is more important to the individual.  For myself though at the moment, seeing my salary and eventually savings when I retire go towards funding the pharmaceutical companies due to my type 1 diabetes, is getting me abit down.  Luckily, my Dad taught me early on in age, whatever I was making, even at $7/ – to save for a rainy day - though I don't know if he meant it to be used on medical expenditures).

I’m finding that prescription costs in the small town I live in are much higher than  in Quebec.  Most of my prescriptions costs are up by $10-$20 more, along with a prescription fee being tacked onto that price as well.  It doesn’t help, living in a smaller town, as my pharmacist explained when I switched the brand of pen needle I use to one that is $25 less.  It’s all about how much they, the pharmacy buys for their clients to use, that controls the prices we pay due to volume.   It’s like really?  So, maybe moving my prescriptions to a bigger city (making a trip every 3 months) – is the way to go while I still have wheels. 

So, some of my little tricks I’m learning in order to feel like I have some sort of control as to how much the big pharmaceutical companies/pharmacy makes from me is to shell out for 3 months supplies of my prescriptions here in Ontario.  This makes the prescription fee less expensive (ohhh and I earn more travel rewards faster on my credit card BUT just have to pay it off in time before I get hit with interest).  Prescription fees in the town I live in can range from $8.41 up to $20.  The reason for the variance floors me to no end and sadly to make the drive to Ottawa, where Costco only charges $4 (remember – you do not need to be a member there to use the prescription service).  I did try to see if the current pharmacy I go to could match Costco’s … but nope … not possible.

Now, if I wasn’t making enough, then it would be a different case with being on the Trillium prescription plan here in Ontario.   I’ve been working on/off over the past 40 years, so I’ll never qualify unless I declare bankruptcy or some other way.  So there’s no win win situation – as one retired person put it to me– if they had to pay out what I do for my diabetes health – they’d not be able to go on their holidays.  That sort of hit me hard with that remark, and even worse was being told that having the insulin pump and CGM would be something they wouldn’t have in order to still do what they want to do.  Yuppers, I can see some of you stunned at that too.  If only they knew what these devices we now have to keep us well controlled can do to make our lives more productive (hey – we’re paying taxes to help pay for their pensions, etc.).  Now, if they’re reading this, maybe my they’ll rethink their comment.

The magic age of 65 is still abit of a ways away, but the main earner of the family after 35 years of working is giving the heave hoe to his work place, since if he stays on, he'll still be paying into a pension fund that won't mean he gets more if he leaves later.   So, while we both have good health, hoping to take advantage of some time off before we are sitting in our rocking chairs watching reruns.  I'm also  hopefully still alive and kicking to take advantage of the services my parents boast about.  

Yes, I’m freaked out about getting old (I can live with the aching knee joints and taking naps in the afternoon sun on the porch) – it’s all about the cost of staying healthy with my diabetes and trying to enjoy the golden years!  Anxiety over this is something I have to keep on pushing away and telling it to F-off!!  

The other option is to move to another province to get more bang for our bucks ( New Brunswick has been calling me for a few years and we are going there in June to check it out - compare it's medical coverage - cost of living in that part of the east coast of Canada ).  

NB:  If you’ve never applied for the Disability Tax Credit that I’d written about in the forums at Diabetes1.org … then check out how to go about it, along with other tips on how to save at the Diabetes Advocacy website link that you will find here. 

Falling through the cracks of a small town hospital

Falling through the cracks of the Cornwall Community Hospital (CCH) system … that’s the only way I can come up with an explanation of what happened with my insulin coverage last week during a 4-5 hour period when I was asked to stop my insulin pump from delivery insulin during surgery.  I put Ziggy into 0% basal rate for 4 hours – but now think I should have lied and just left him on. 

The Womb With A View

I think due to the diagnosis 2 weeks after my initial visit to ER for heavy bleeding and I was in menopause stage of life, along with the fast turnaround of 2 weeks after that for a spot on the slice and dice table this may have resulted in mistakes being made in what occurred that day with Pre-Op / miscommunication with the CDE’s / gas woman aka anesthesiologist, etc.  

Was pre-op done to close to the surgery date?

In past surgeries (e.g. mastectomy done in 2007 for diabetic mastopathy ), the Pre-Op, meeting up with endo team, was all done within 2 or more weeks of the surgery date.  In my case at CCH, pre-op was done 2 days before the surgery day  ( DH came along ).  The RN didn’t say anything about whether pump would be allowed or not, but took down that I wore an insulin pump,along with my total basal rate, average basal rate (this same information was given to the Pharmacist from the CCH the next day who said it was unusual for them to be left out of the loop for pre-op).   The RN was fully aware that I was being seen by the Diabetic Clinic within CCH and I “assumed” they would be contacted for any help (they were already aware of my upcoming surgery by an email I’d sent to them).    

Was any blood sugar testing taken during the surgery and didn’t

my CGMS alarms make them aware?

Sadly, I didn’t think of the CDE statement from an email earlier during the week when I’d asked her about wearing the insulin pump during the surgery …  

“do you have a protocol for not wearing pump during surgery”

Her response to my query, with no suggestions,  made it obviously clear to me I was on my own with handling my diabetes control in the hospital (I have since learned she expected me to respond back with my answer). 

I assumed that when the anesthesiologist (gas woman) firmly told me that she would not continue if I kept the pump on, that insulin would be at least provided in the drip.  This was told to me as I was already being strapped down to go to la la land of no pain and she meant business (she wasn’t happy with where the RN had set up the drip, but my veins are sparse and RN didn’t go to my hand which has LOTS of plump veins and has been used in the past by the blood takers).  So, basically, I had no time to say, “ let me get my overnight bag and shoot up with Lantus “.   Yes, I was in a tough position at that point, trying not to panic.  I had come prepared, but not at the last minute when the surgeon’s clock is ticking for his other scheduled patients that were behind me!!  Gulp!!

My hospital gown had the washy washy instructions to ensure no evil germs develop!

Granted this was my first major operation using an insulin pump.  Previously, I was on MDI, and with pre-op it was always determined that I do my regular long acting insulin shot and that after surgery that I took over my diabetes control.  Did my being on an insulin pump throw off the pre-op and pharmacist?  This is where both my husband and I wonder …

was any insulin drip given during the 4-5 hours I was under their care?

My darling husband (DH) had been contacted at noon time as I was being wheeled into my room after being in recovery (surgery had started between 0730 – 0800 ) and he arrived about an hour later to hear my story about the blood sugar reading of 22 mmol/l (396 mg/dl) and how the staff had determined I should be given 10 units of rapid insulin.  I vaguely remember all this happening, and again, have no time reference.  I hope I didn’t yell, but I told them it was too much.  I remember being asked what they should give me and in my state of mind was calculating 1 unit of insulin would be lower me down 3.5 mmol/l (63 mg/dl) and told them to give me 3.5 units (if I’d been more with it I should have said 5 units).  I don’t even recall them giving me the injection. 

I was having to rely on someone else to take care of my diabetic care at this point that

had wanted to inject me with 10 units of insulin

My DH at that point looked at Bowie my CGMS and it was alarming like crazy (we are wondering now if the trainee RN who was holding him during surgery noticed this).    Bowie does not like being high, and was still registering at 22 mmol/l (395 mg/dl).  At this point, having my DH by my side, I was more with it and did my own finger stick test which showed I was around 14 mmol/l (252 mg/dl).  Obviously the insulin was working (maybe they did an intramuscular injection (IM) into my arm to make the insulin work faster … which is what I do when my BG is that high – but due to no time frame of injection I’m unable to figure it out). 

With insulin coverage for a T1D it’s all about what TIME insulin is giving … 

method of injection ... site it`s injected into …

This is where even more confusion starts is that the RN that was speaking with my husband didn’t realise that my pump was functioning.  Again, either I did not explain myself properly to the gas woman / RN when turning my basal rate off for the 4 hour surgery time.

So, even now as I compose this blog, trying to put together what occurred, it seems like a dream

So, DiabetesMine ( @samanthachan at Instagram)  … I told you the true story would come  with the picture that you asked permission to use at the Diabetes Innovations Summit at Stanford in November.  Even though the trainee RN who held Bowie during surgery had been warned about what would occur if my BG’s went up or down with him alarming.  I think he was ignored OR even worse case scenario when he was finally looked at, they assumed that that was the correct blood sugar number.  That is even after I  had told her and various staff earlier and during my 2 day stay that the CGMS reading HAS TO BE verified by a blood meter.  The fingertip NEVER LIES when it comes to real time blood sugar number. 

Victorious thinking I`d be allowed to use pump during OR ... NOT

It’ll always be a mystery to me … and personally I will not return to CCH for any surgical performance if I cannot go another route (see note below).  This is after speaking to other residents where I live, they avoid it at all costs.  Though if it’s a situation where I’m not able to drive to the next closest hospital ( Winchester District Memorial Hospital has been recommended to me by many people in Cornwall ), I just hope/pray that I have someone on my side (my DH or another T1D) able to ensure that my diabetes health care does not get lost in the cracks like it did with this hospital experience.

NOTE:  The one thing I have learned out of this experience is that hospitals in Ontario have different ratings (and probably in other provinces of Canada).  A few members from the CCH Diabetic Clinic came to speak to me due to what had occurred the day before with surgery.  They had stated that CCH is a #1 hospital (I have tried to find anything pertaining to what they had told me online but have come up empty handed so this is “my version” of the “rating system”).  If my surgery had been performed at either Kingston or Ottawa, which are larger populated areas, then  insulin pumps would be more accepted and understood by the medical staff members, and perhaps allowed to remain on in the OR. 

Day after the surgery - attempting to drink a Timmy`s