Canada has been absorbing this week the revelation of the burials of 215 children at the Kamloops Residential Schools, many of them completely undocumented in our past, and mostly completely unknown to most Canadians. In an important sense every one of these children is a crime victim, the least of which is neglect the most serious of which is genocide. Worst of all, most of us had no clue that this burial ground even existed, although that’s just a little too convenient an excuse.
This week thousands of articles have been written on the subject, news stories broadcast on radio and television. There is much hand wringing and guilty statements about Settler privilege.
What I haven’t heard enough of, or even any of, is the genocide underway in Canada today across the country. Every day children are still being taken away from aboriginal families and forced into “care” where they are neglected, abused and abandoned, with many of these children dying while in care, or shortly after “aging” out of foster care. These kids are removed from families, single parent moms mostly, because of a system that still sees “drunken indians” instead of struggling people who have been largely dispossessed from their tribal history and context by colonial exploitation and continuing subjugation by the settler cultures.
I’m lost on a road to “God knows where.” Feeling scared. Uncertain. It’s my story right now, and I’ve good reasons for my emotional state. It’s not the first time in my life I’ve been lost or overwhelmed by circumstance. There’s no doubt my situation is difficult, and solutions to my problems seem beyond my current […]
Two years ago I wrote the above blog entry in my other blog “Out Here in Paradise” and re-examining some of the issues with which I was ensnared at that time have shown that progress is possible, even given serious and intractable problems.
Mine isn’t a new story. My health is not good, and is deteriorating over time. It is responding to my focus on trying to find a solution to my worst problems, and a way to cope with the things I won’t be able to control. My financial situation is a disaster, brought about by a series of mistaken steps, all of which seemed to be the correct decisions at the time, but have left me in serious debt, absent an income on which I can rely, and quite uncertain as to the potential for even basic survival, under my current situation.
Two years ago my health was a lot worse than now. At least it seemed so at the time. I had just got out of the hospital where I was extremely ill with pneumonia, with a new diagnosis of COPD, to go alone with my diabetes and chronic arthritic and neuropathic pain. I didn’t know it then but I also had the classic symptoms of fibromyalgia at work. I had a lot of good reasons to be depressed, just based on my health, not to mention a lifetime of fighting with bipolar depression even since my twenties, more than forty years.
So that was where I started to fight against continuing to fall down the Rabbit Hole, and started this blog, where I’ve largely focussed on discussing my attempts to improve my health and the quality of my life by taking intentional control of those things I can control.
If you follow this blog you will have read about my struggles with my medications, and coming to an understanding of how they interact with each other, and have many side effects, some of which still plague me.
You have seen my excitement of discovery when I read Dr. Jason Fung and realized that I can take control of my diabetes by making significant lifestyle changes, including intermittent fasting and radical reduction in the amount of carbohydrate in my daily diet. I came to realize that exercise every day is important, just not exactly for the reasons that I thought. I’ve lost a lot of weight on this journey, with the result being an increase in energy, a renewed sense of hope for the future, and a continued plan to improve matters further.
I’ve written about my challenges with my marriage and how we have evolved to a new set of understandings that allow for the possibility of staying intimate friends, while perhaps moving to a new description of our relationship. In our new relationship as Nesting Partners, rather than Husband and Wife, we talk far more openly about just about everything, than we even did in the past. Which is a good thing.
I’ve written about Polyamory, the state of being committed to being open to romantically or sexually loving more than one person at a time, within ethical boundaries and with full disclosure of the partners to each other and to every new person brought into relationship. We’re both struggling with our new definition but have continued to be loving to each other while figuring out how to move forward into the future.
In that Blog from two years ago I was feeling completely defeated financially as well. Things in this regard haven’t resolved themselves entirely, but I have made strides in dealing with my debts by filing bankruptcy. It wasn’t fun and it isn’t over yet, but it will be soon, and I will be able to move on into some meaningful employment or business. I’ve also learned the outcome of my problems with the Securities Commission, and while I’m far from sanguine about the Decision made, and the sanctions against me, I am in a place where I have begun to see how I can move forward from here. I have accepted entirely that I am accountable for my current financial situation, and if I am to rise again, it will be because I make it so.
Here are a few random thoughts about how I will get out of this mess.
Make a list, detail the issues including both those which seem unsolvable and those which appear to have potential solutions, no matter how unpalatable.
Take concrete steps to begin to address some of the issues. Whether or not I can solve everything, or even most things, I can do something about most things. I desperately need to break the hold that my emotional condition has on me.
Start listening better to the people in my life who care about me. At the moment they seem to believe in me more than do I myself.
Creatively analyzing my situation with a view to possible improvements in it. A little improvement is better than none. Maybe everything isn’t quite as far gone as I currently believe, maybe I can still pull myself back from the brink. Of if not, figure out how to ride out the storm caused by going over the edge.
Let go of the past, embrace the future. What is, is. What has already happened is done, over and can’t be changed. But what has not yet happened, may never happen, or may result in outcomes totally different than anticipated by my fears.
I haven’t entirely let go of the past, and I continue to work on those things from the past that still cause havoc in my life. What can say, two short years later, is that there is hope, and things have actually improved, through hard work, a renewed practice of personal discipline in following my new lifestyle, and a willingness to be open and transparent to my partner, which means a lot less anxiety of both our parts, and a better, if not a little more complicated, redefinition of our lives, both together and apart.
It’s Thursday night, and I’m sitting in an airplane, about to take off for New York. I’m heading home from Las Vegas after attending Obesity Week 2019, the world’s largest obesity medicine conference, a collaboration between The Obesity Society and The American Society of Metabolic and Bariatric Surgeons.
I don’t quite know how to express my feelings and thoughts about this event, but the words ‘anger’ and ‘hopelessness’ immediately come to mind. My anger and hopelessness are best exemplified by the first keynote speech, delivered by Dr. William Cefalu, who is chief scientific and medical officer of the American Diabetes Association.
After accurately describing our country’s spiralling healthcare costs, and the morbidity and mortality associated with diabetes and obesity, Dr. Cefalu went on to discuss the benefit of low-calorie approaches for diabetes reversal. He also highlighted bariatric surgery and medications. But ultimately, he harped on one point, that is frequently repeated at conventional obesity medicine conferences:
“There is no best diet. The best diet is one that a patient can adhere to.”
The above article by Dr. Tro Kalayjian the physician behind Dr. Troys Medical Weight Loss and Direct Primary Care is a discussion about why it is so difficult for the medical profession to accept fundamental changes in medical understanding about diabetes and current treatments for it. It is why patients continue to get contradictory advice from doctors who really ought to know better than to recommend any number of established and well known dietary strategies that simply don’t work. It’s not that they don’t work anymore, it’s that they never worked, and there is no scientific basis for any of them.
This sounds pretty revolutionary to me. The esteemed Canadian doctor is joined by a number of US based colleagues who are challenging the status quo in the treatment of diabetes, and sending a message to their profession. Just stop! Stop misleading the public! Stop lying to patients! Stop killing your clients!
Of course, they are doctors and they don’t quite put it that way. But what else can you say when so many health professionals and authorities continue to promulgate misleading information, such as “moderation is the best strategy” when clearly, based on current information that is simply not true. Moderation will kill you if by moderation you include relatively mundate advice about carbohydrates and sugar. What sciences know is that consuming carbs in excess of certain pretty limited amounts leads to metabolic syndrome, metabolic syndrome leads to insulin resistance. Insulin resistance leads to diabetes. Diabetes leads to lots of really bad stuff that can kill you, or at the least, make you really really sick.
If you or someone you love is fat, obese, or has diabetes or prediabetes follow the link on this blog entry to the above article and understand what is being said. Doctors are willfully ignoring solid medical evidence in favor of standing by old, disproved theories because they are afraid of rocking the boat. Read Dr. Fung’s book, the Diabetic Code.
Stop believing anyone who says that eating many small meals a day is ok. Stop following advice so far heard that has led you to being overweight and obese. If you want to live and healthy, long life, fire your current endrochronologist if he or she disparages the most recent research and tells you not to follow Dr. Fung’s advice. Run away from anyone who says that carbs and sugars are not the cause of diabetes, metabolic syndrome, and many many many other life threatening diseases.
Ivor Cummins is an Irish medical professional who is leading a charge to redefining the causal relationship between metabolic syndrome, insulin resistance, diabetes and a whole slew of diseases including heart disease and cancer.
In my pursuit of better health I am committed to radically reducing the amount of carbs in my diet, as well as resetting the hormonal imbalance in my liver and pancreas. Dr. Jason Fung is doing his work as a doctor in Toronto, as well as publicizing the real risks of abdominal fat.
The real crisis in today’s world is a crisis in lifestyle and diets, which is putting millions and millions and millions of people all around the world in grave danger. More people die every years in the world NOW from diabetes and related illnesses than are predicted in the worst 50 year estimates of global warming. The people dying today are dying because science has been systematically ignored by government policy makers and medical professionals for 50 years.
Dr. Fung argues that the conflict of interest between industry and medical professionals, including government agencies is at the heart of this global crisis. It is time to stop mollycoddling international business interests, and get on with the business of teaching future generations how to improve the quality of their lives, while also radically extending the length of their lives, simply by learning new lifestyle choices.
I’ve been bipolar all of my adult life. I equate being bipolar, in some ways, with being out in the weather. Some days it is sunny and bright, all things are possible, nothing can get me down. Some days are stormy, threatening lightning and thunder, and I’m afraid to get out of bed. So in addition to having to deal with diabetes, I also have to manage my emotional state. One of the best things about Intermittent Fasting is that it is another way I gain positive emotional feedback, by taking control of my health, as well as my emotional life.
Years ago, after several years of psychiatric medications, I decided that I couldn’t live with the “deadness” I felt while medicated. I felt like I was living in a fog, without any connection at all to the real me inside. I’d given up everything that made me “me” and was stuck inside a pseudo human being, without flavour, without emotions, without any reason to live at all. I don’t want to live that way, and so I’d rather live with my extreme emotional roller coaster than depend on meds to keep life in balance.
Before you decide to abandon your medications, and go it alone, consult with your doctor and make sure that you have a professional to provide you with ongoing care, just in case things don’t go the way you think they should.
Building mastery gives you a sense of accomplishment, Van Dijk said. What activity you choose “will just depend on where [you are in your] life and what will create that feeling of being productive.”
For instance, she said, this might mean volunteering, getting out of bed at 9 a.m. instead of noon or going to the gym three times a week. Or it might mean checking “the mail if that’s something you’ve been avoiding, … gardening or going for a 5-minute walk.”
Bipolar disorder is a serious illness. The illness itself along with treating it can feel overwhelming. But by taking small steps every day, you can effectively manage and minimize symptoms and lead a healthy, fulfilling life. If you’re not involved in treatment, contact a doctor or mental health practitioner. The strongest and healthiest step you can take is to seek professional support.
So, what then? I can’t rely on emotions to be an accurate guide, either for behaviour, or commitments. I can’t maintain relationships as an on-again, off-again basketcase. So I decided that my behaviour would be governed by my personal values instead of my feelings at any given moment. Whether I’m happy as a kite, manic and unstoppable, or in deep depression, I choose to respond to external input based on what I really want in the long run. This means that I’m always willing to be supportive and listen to others, whether I feel like it or not. It’s not about me, it’s about them and the kind of a man I really want to be. My actions are governed by my intentions, not my feelings.
That’s not to say that I don’t completely “fuck-up” everything sometimes, either in my personal or professional life. It’s especially true when I forget what’s really important to me, and don’t live up to my higher purposes.
But the other part of living is that I have to be completely accountable for my actions. That’s easier said than done, but I own my mistakes and forgive myself, rather than going over things again and again and again. Instead of being proud of myself only when manic and ashamed of myself the rest of the time, I accept myself, good and bad.
Neither be a God, (as I sometimes thought of myself when in a manic phase), no nobody, (
which is how I often saw myself during a serious bouts of depression. Instead, I’m just a human being striving to live my highest and best life. I no longer live in judgment, either of myself or others.
I feel for your pain, I really do. But live with it, and have a life worth living, regardless of temporary emotional states that come and go without any useful purpose. Ironically, over time you’ll come to be a lot happier with who you’ve become. Self respect and personal accountability trumps bipolar, at least, for me.
In an article I read today in Endocrine Web, by Kathleen Doheny
Every year, about 1.5 million Americans learn they have diabetes. However, there are more than 7 million adults who have diabetes but haven’t been diagnosed, according to the American Diabetes Association. This matters since we are learning that the best chance of reversing diabetes seems to occur very early in the onset of the disease. Finding from several recent studies indicate that the timing of diagnosis matters a lot.
If you have diabetes, your doctor may have encouraged you to consider making lifestyle changes; for many, that may include losing weight. While that same message has been discussed for years, recent evidence suggests that achieving about a 10% weight loss may be even more important than experts thought—with a payoff that is greater than previously imagined.
So you don’t have to lose all your excess weight to get a benefit from weight loss. As noted above, even a weight loss of 10% has a powerful effect on your A1C levels. This should be a great incentive for diabetics who, like me, have been identified as obese, or even merely fat or overweight.
After nearly three months I can say that fasting is making my health a little better, including reductions in A1C but also including things like mobility. I can actually reach down and touch my toes for the first time in a long time. Fungal infections have been radically reduced already. And my sense of hope for the future is significantly better.
What some authors have written about is the profound effect that fasting and weight loss have on the emotional health of a person. This may be something I’m prepared to write about in the future, but right now I feel like I’m on a roller coaster emotionally, really happy with my results one moment, and anxious about further progress the next.
My wife was diagnosed with Type two diabetes about the same time as I started my fasting program. She tried fasting the same amount as did I, but found that she simply couldn’t sustain a fast for so many hours, so she reduced the fasting to 16 hours and also continued to cut carbs and sugar in the rest of the day. Barely two months into her lifestyle change, including the reductions in carbs and sugar, she managed to reduce her A1C from 11+ down to 7.4.
She also lost some weight but not really that much. The thing is that her BMI is a healthy 24 so she really didn’t need to lose weight, as much as she needed to reduce carbs. A ten pound weight loss translated into a radical change in her blood sugars, and indeed in her medication requirements after the test.
I’m really proud of her accomplishment is such a short time, and firmly believe that if she continues in this direction that she will effectively a “non-diabetic” by spring, if not sooner.
I still hover around 215 pounds, but my blood sugars came down to 7.0 from 8.1 two months ago. My family doctor was pretty surprised and pleased with my progress. The biggest thing I keep reminding myself is that Rome wasn’t built in a day. My obesity is the result of 25 or 30 years of overindulging carbs and sugars, and it’s taking me some time to get the weight off. So be it. I already notice and now so are some of friends and family.
I started an intermittent fast a little over a week ago. By this I mean that three times a week, for 36 hours in the row, I don’t eat anything.
On the days between my fasting, I eat less than 150 carbs including sugars, but mostly avoid anything with added sugars. I do eat some fruit in the form of berries, apples, bananas, and other fruits, but no more than two servings (basically half an apple is one serving).
My plan is to do this for at least three months, or until I don’t need to do it to get rid of my diabetes. I’ve had diabetes for a long time, and have been on insulin for about 10 years or so. I’ve been told all of my life that diabetes is incurable, but treatable with diet and exercise. My doctors have always told me that it is a progressive disease. Over time it gets worse and worse. Which it has in my case. That is, gotten worse and worse.
My doctor and I decided to try the new patch and Free Style Meter, along with long lasting insulin and fast acting insulin. Basically my previous insulin regime had caused me to increase my weight to 245 pounds. I’d already been diagnosed as obese by my family doctor for more than twenty years, and I’d never weighed more that 220 prior to going on insulin. This new meter and new type of insulin is supposed to be an improvement over the previous mixed insulin (Humulin 30/70). The doctor said that he hoped that it would lower my AIC by reducing my base blood sugar to 7, and cause my blood sugar to fall to 10mml within two hours of eating, after taking fast acting insulin.
He felt that the change in metering by blood sugars and changing to two different types of insulin, might result in better A1C after ninety days.
Wow! Was he surprised when he saw me after 90 days, during which I’d only had the meter and new meds for about three weeks. My AIC was down from 9.9 to 8.1. My weight was down to 234 pounds from 244. My blood pressure was stable. This represented a major change in direction. For the first time in 20 years of having diabetes my weight was going in the right direction without me having to spend a month in the hospital. My blood sugars had also dropped so that my every day blood sugar range was then 5-8 mmls routinely, with only periodic spikes up to 9 or higher.
In the past I would have been ecstatic with these results, but reading Dr. Jason Fung’s “Diabetic Code” has taught me that not only can diabetes be controlled, it can be beaten altogether. But only by following a regime that allows the liver and internal organs to cleanse themselves of internal fat, will I get rid of diabetes for myself. And that regime is intermittent fasting. As the doctor indicates in his book there are many ways to achieve the results desired by different fasts but he recommends the fasting schedule and routing I’m following.
Starting eleven days ago, I have been fasting, and following Dr. Fung’s advice. And yes, it’s been a bit of a challenge. But mostly convincing my family and friends that I’m not out of my mind and am endangering my life with such a radical change, and so quickly.
This is my fifth day of fasting, and I couldn’t be happier with my results, even after such a short period. My blood sugars have gone down and down, now typically in the target range of 5.8 to 7.8 every day. I now control my insulin, reducing the amount given to the amount needed to maintain my blood sugars in the optimal zone. On fasting days I take a 20 unit shot at midnight, and during the day watch my blood sugar coast along at 4.5. I’m almost ready to cut it again. But before I do that I think I will cut out one of my oral medications first, and set what effect this has on my sugars.
Diabetes is controllable and probably to a degree that it is no longer evident at all. But even if all I could hope to achieve was my current results, I would have been very satisfied with myself.
But I’ve just started.
So, my faithful reader, keep reading. I keep shrinking, and getting healthier.
Healthy people consult professionals before implementing significant changes in our medications or lifestyle choices
Healthy people are patient and persistent in overcoming health or lifestyle challenges.
Healthy people accept total accountability for our own health, without taking on blame for things beyond our control.
What can you do to improve your AIC when you’re feeling terrible from a variety of symptoms and conditions, many of which are either a direct result of your diabetes, or at least are indirectly impacted by persistent high blood sugars.
There are any number of things you need to deal with in order to make real change. The most important of these things is probably NOT your diabetes. At least not directly.
I’ve been a type two diabetic for many years. Diabetes probably started with me in my twenties although my first symptoms didn’t start to show up until I was nearly forty. I’m now in my sixties and I’ve been on insulin for more than fifteen years. That means I’ve been pricking my finger at least once a day since I was fifty years old, and injecting myself with insulin ever since.
The one thing I can say about my diabetes is that it has progressed in a predictable way, gradually causing negative effects to my body. All the way along the road various doctors have given me a lot of prescription medications, as well as a lot of advice. I’ve been to diabetic clinics where nurses and dieticians have attempted to teach me how to control my blood sugars through diet and exercise.
When I was first diagnosed with diabetes I even received counselling, to try to make sense of Why Me? I think everyone feels victimized by negative health conditions, whether it’s COPD, Heart Disease or Cancer. The answers to Why Me? are both existential and practical.
There are two parts to the answer. First, there is the part of Why Me? over which you have no control, never did, never will have and makes no difference anyway. Whether it’s fate, God, a cruel universe, DNA or the conditions of your life (including a bad diet, smoking, poor or no exercise, etc.) leading up to becoming diabetic none of them actually matter in coming to terms with the emotional fallout of Why Me?
Truthfully, there are many things I could have done differently in the past that might have made a huge difference in my experience of diabetes now and in the future. But for whatever reasons I had, or gave myself, I did what I thought was within my capacity to change in my habits and behaviors.
You can check your blood sugars regularly with you meter tests, get your AIC blood work done in the lab and consult with your doctor as often as she thinks is useful or necessary. You may make changes in your diet and exercise program, and do your best to lose weight and keep it within certain boundaries. And if you do all these things from the beginning, your diabetes will be stable and you will reduce the consequences of this disease.
For most of us, however, no matter how much we say we care about our health, we’re not really willing to do whatever is necessary to fundamentally change our outcomes. We do some of it, maybe ever some of it every day with serious intentions.
This is the Second Part to Why Me?
This is the part of Why Me? you can control if you choose to do so. So how do you change what you do and how you act, to have a real impact on your own health? This goes back to me saying that it’s not actually about diabetes, or even about your physical health.
It’s really about becoming conscious about who and what you want to be in your own life. We’ve all been beat-up by life along the way. Parents, friends, lovers, partners and even strangers have both positive and negative impacts on our self esteem. Why is that? Why do we let anyone else impact how we feel about ourselves, and how we make positive or negative choices about our lives, including those choices about dealing with negative health outcomes resulting from poor choices.
I hate to say this but “Who cares?” It doesn’t matter what happened in the past, or how you allowed yourself to be negatively influenced regarding healthy living. It really doesn’t matter, but only if there is some way you can turn your life around and ultimately take control of those things that you can control.
How to take control and like it.
The first thing is to understand what it is you need to do to make things better. If you don’t know what you need to do, it’s pretty hard to decide what to do. So find out. See you doctors. Read everything you can find out about current treatment alternatives, and inquire from other people their experiences. Read blogs. Get new referrals to diabetic clinics and resources. Talk over alternatives with your specialist. Make a plan of action with on a few, specific steps, done regularly and persistently.
Don’t try to do everything all at once. Set limited goals with realistic objectives. For example: Don’t try to lose a lot of weight in a week or even a month. Lose weight in amounts that can actually be achieved. If you find it too hard to do by yourself, join a club or a weight loss program which comes with monitoring and emotional support. But don’t blame the program if your weight loss isn’t happening. Be totally honest with yourself, and reset your goals. Weight loss is fundamental to improved diabetic outcomes and lowering blood sugar.
If it isn’t happening, then look elsewhere for support, but don’t give up on necessary change. Remember that whatever happened yesterday is no longer relevant unless it results in change today. Guilt is useless unless it is accompanies by a renewed sense of personal accountability.
When I graduated many years ago from UBC my school motto was TU UM EST. What I didn’t realize was how powerful an idea that really is.
Yesterday I began a critical review of my current health situation, with a view to improve my future results by making some new decisions based on the current facts and trends.
Here is a recap of the situation as I see it now. I am taking the symptoms I listed yesterday and discussing each of them in the context of my current method of dealing with them, and/or discussing the cause of each of them as best I can, given that I’m not a doctor or scientist trained in this.
Frequent urination – especially at night, interrupting my sleep.
The whole issue of urination and bladder control is interconnected with so many of my other underlying issues so it’s probably a good place to start.
Problems with urination are a little bit like the canary in a mine that warns of trouble. One of my earliest indicators that I had a problem, (and it might be diabetes) was having a need to urinate frequently, both during the day and at night. This started in my thirties, almost thirty-five years ago.
Diagnoses of the problems with my urination were complicated by a discovery, in my thirties, that I suffer from a relatively mild form of spina bifida, which despite it not being debilitating does have some significant neurological effects on my lower body, including sexual response and bladder control. This wasn’t great news to hear when I was only in my thirties, but everything the doctor told me about the possible side effects of spinal bifida occulta has surfaced from time to time since then.
Like many other men with any problems with their genitals and urinary systems, including urination or sexual performance, I generally tried to ignore the problem as much as possible. After discussing the potential effects of the problem with my lower spinal column with the back specialist I tended to ascribe any problems to the back and nervous system, including periodic difficulties with both urination and sexual performance.
In the spring of 1985, when I was 32 years old, I also exacerbated the problem, by choosing to undergo a vasectomy, without understanding in advance that the operation could have unintended side effects. Unlike what I had expected, the operation resulted in swelling of my prostate and my testes and an infection in my urethra and bladder. For more than a year I suffered severe pain from both urination and sexual expression, and my soreness persisted for several years before fading away completely. A prescription was given to me to reduce the swelling of my prostate, but it took some time to take effect, and as it was significantly swollen, there were physical effects on both sexual function and urination.
As one might expect, given the pain, there were also emotional effects and a significant impact on my intimate life, in ways I would not have normally expected.
My reasons for having a vasectomy still seem as valid today, as they were at the time, however, part of the decision to go for it turned out to be less true than it is in most cases. My medical results included significant pain, reduced enjoyment of life, and a much higher level of anxiety about the whole subject than was probably warranted.
The argument for having a vasectomy is that it is generally considered a relatively benign surgical procedure, done in the doctor’s office as a day surgery. For a woman to have sterilization surgery is much more invasive, not to mention that it results in huge hormonal changes. My wife and I both thought a vasectomy would be less problematic, and we were probably right, despite how frustrating and painful it turned out to be.
It continues today, as so I suppose I’m used to it. However, continuing declines in muscles and nerves is also contributing to further problems, which require a certain fastidiousness to avoid embarrassment because of weakness in bladder control. It’s not promising for the future, because if it continues to decline I can see a future including adult diapers. It may be already as bad as it is going to get, at least that’s my current hope.
So my problems with sexual function and urination really started then, and it was only somewhat later that I realized that my need to urinate more frequently as I was getting old might have a relationship to diabetes.
Poor sleep – several things wake me up at night, variously including frequent urination, frequent cramps in my feet and calves, pain my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and difficulties breathing.
I’m not sure that I’m doing this analysis in the right order, but this is the order I listed my symptoms yesterday, so I will follow this list and get to the underlying stuff as it comes.
I have a lot of trouble sleeping through the night. I have a CPAP machine to help me deal with my sleep apnea, with which I have been having problems. The problems with the CPAP machine aren’t really with the machine itself, but with on again off again sinusitis that makes it almost impossible to sleep with the device forcing me to breath through my nose. So when I’m congested I don’t put it on. So it doesn’t do anything if I don’t use it.
So one of the new decisions I’m making as I do this analysis is to start using the damned CPAP every night possible. When I was using it, it did improve my blood sugars and I suppose it improved my sleep, although I didn’t feel much more rested then that I do now. In other words I’m still exhausted most days, regardless of the CPAP.
The problem with cramping in my legs and feet is another thing that wakes me up in the middle of the night fairly frequently, although not every night. When it first started up a few months ago, I asked a doctor and she advised me to use Magnesium and Calcium together to help. I started taking them every day, and my cramps in my calf muscles has been reduced to once or twice a month, instead of every night. However, this remedy has not improved the cramping in the arches of my feet, or the muscles in my toes.
Other body pain and neuropathic pain are also problematic in getting a decent night’s sleep. Arthritis and rotator cup problems wake me at various times in the night, and make it difficult to get back to sleep. Neuropathic pain which is merely irritating during daylight hours seems far more painful when I am at rest. Ergo, more interrupted sleep and more pain.
Chronic pain during waking hours – moderate to severe pain in my feet, neuropathic pain as well as mechanical distress, including pain caused by walking on supersensitive soles of my feet, as well as my toes.
I am taking Gabapentin, an anti-seizure medication which has shown to help with neuropathic pain. It may be providing me with some relief from the neuropathic pain, but the benefits are still uncertain to me. Would the neuropathic pain be worse if I were to wean off of Gabapentin, due to the numerou side effects cited in the literature?
Also… periodic moderate pain in my back and shoulders, and more serious pain in my lower back and hips when walking more that 1,000 to 2,000 steps.
Various types of chronic pain plague my waking moments, including arthritis in my hands, shoulders, hips and legs. Tendonitis has my hands bound up with pain. Inflation combines with ongoing pain.
Persistent breathing problems – mild to severe asthma on a continuing basis, almost always somewhat symptomatic but much worse when exercising or physically stressed. Sometimes exacerbated by emotional stress or conflict. Of all my symptoms my breathing problems are the most intrusive, making ordinary activities difficult or impossible. I am currently taking three separate inhalers to remediate the asthma and borderline COPD. All of them have side effects which make my sinus and throat problems worse, and while they help me breathe, they make my singing voice harsh.
Chronic physical exhaustion and fatigue – comes and goes during the day but is worse during periods of relative inactivity (sense of exhaustion) and during periods of exercise (weakness and muscle fatigue).
Addressing these symptoms is something I haven’t really been able to address, yet.
To close the blog for the day, I’ve decided to stop here and pick it again tomorrow or Friday. All of this thinking is making my head hurt, but I realize that I haven’t really given enough thought to the role of the many drugs in my system, and how their many potential side effects may be effecting me.
There can be no time more suitable than the present to make
better choices for my future health and well-being. New choices mean reviewing and carefully
considering alternatives not previously pursued, or if previously pursued,
inadequately. In some respects, this
analysis reflects a continuing and necessary re-evaluation based of my current
state of health, not as a snapshot, as it were, but rather as a streaming and
changing set of conclusions and actions based on them. However, this analysis is specifically about
now and the immediate future, with a clear understanding that nothing is ever
completely settled in these issues, and there is new information available on
an ongoing basis.
More simply put – This self-analysis is about resetting how
I go about living my life with due consideration to what I have learned about the
conditions and diseases that currently plague me. How to do better and improve my health for
the future – this is my object.
Much of what will be expressed here rests on certain
persisting patterns of behavior which require significant modification. In other words, I must change if there is to
be any real improvement in my health reality. And based on what I know about
achieving anything of consequence in my life, it will need to be outlined in a
program of specific steps, which depend upon my own actions rather than on
others. My physicians can only provide
me with information and treatment within what I’m willing or able to do
myself. My partner, as supportive as she
has tried to be over the years, is not responsible for any part of this,
despite my tendency to try to lay responsibility at her door particularly for
my dietary habits and lack of blood sugar control.
Frequent urination – especially at night,
interrupting my sleep.
Poor sleep – several things wake me up at night,
variously including frequent urination, frequent cramps in my feet and calves, pain
my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and
Chronic pain during waking hours – moderate to severe
pain in my feet, neuropathic pain as well as mechanical distress, including
pain caused by walking on supersensitive soles of my feet, as well as my
toes. Also… periodic moderate pain in my
back and shoulders, and more serious pain in my lower back and hips when
walking more that 1,000 to 2,000 steps.
Periodic breathing problems – mild to severe
asthma on a continuing basis, almost always somewhat symptomatic but much worse
when exercising or physically stressed.
Sometimes exacerbated by emotional stress or conflict.
Chronic physical exhaustion and fatigue – comes and
goes during the day but is worse during periods of relative inactivity (sense
of exhaustion) and during periods of exercise (weakness and muscle fatigue)
Dizziness upon standing – it is sometimes acute
and sometimes minor
Mental fatigue and a sense of a loss of acuity
and sharpness – I am finding it difficult to concentrate on mental tasks which
require the application of my intellectual skills and professional skills. I still feel capable of creative work for
relatively brief periods, but fatigue quickly overtakes me, and I must put
things aside, while I attempt to recover my energies and focus.
Forgetfulness and feelings of anxiety regarding
Visual deficiencies – lately I can only read or
work on the computer for a certain period before my eyes begin to become less
effective, making it necessary for me to interrupt my work or reading, and brake
completely from work that require visual acuity. Eye fatigue contributes to my overall sense
of fatigue and exhaustion. Note: I probably need new glasses, something
I will discuss with my ophthalmologist on Friday when I next visit her.
Conditions and/or diseases
Slightly elevated cholesterol
Asthma and bronchitis (borderline COPD)
Evidence of diabetic damage to my eyes
Arthritis in hips, hands, shoulders, lower back
Tendonitis in hands and wrists
High and low blood pressure
Allergies to a broad band of common allergens
including pollens, animal dander, dust and others. Anaphylactic reaction to Cipro and Penicillin
I have had recent visits with my family doctor, my Endocrinologist
and my Respirologist (Pulmonologist), plus an upcoming CT Scan in early June at
Burnaby General, and an eye exam this Friday.
I’m clearly a heavy draw on the medical system with all these frequent
appointments to deal with various ailments.
Clearly I’d like to see less of them, and they would like to see less of
me. All we have to do to accomplish this
feat is to improve my health sufficiently so that they wouldn’t need to see me
Diabetes blood sugar and neuropathy management
My most recent visit with my Endocrinologist, as usual, thorough,
with a significant discussion about changing my medications, in particularly,
moving to two different types of insulin every day, with a long acting insulin
injected in the morning with design purpose of bringing my premeal and fasting
insulin down to ideally 7.0mml or below and then having me take fast acting
insulin with each meal, dividing up the insulin between the meals, more or less
based on the prorated amount of food being ingesting at each meal.
In order to manage this much more intensive insulin regime,
it will be necessary for me to check my Blood sugar levels first thing each
morning, as well as 2 hours after each meal.
The goal of the fast-acting insulin is to return my blood sugars to
10mml or below within the two hours.
In order to maintain such a frequent reading of my blood
sugar levels, I need to have a new form of monitor with a patch blood reader
that sends the information to a monitoring device, either my iPhone or one that
comes with the patch. I submitted the
request to Blue Cross two weeks ago and am currently awaiting approval. Note: I
should follow up with them before Friday to make sure they are working on this.
The Endocrinologist wrote me prescriptions for the insulin
and the device, as well as had his assistant prepare the forms for Blue
Cross. Once I have approval, I will need
to deliver these forms to the Pharmacy for processing.
The Endocrinologist and I had a fairly long conversation
regarding various aspects of my diabetes including the need for me to have my
eyes re-examined, thus an appointment this Friday with Chui Luca, my Ophthalmologist. We also discussed my weight gain since being
diagnosed with diabetes with him expressing some thought that while weight loss
would be desirable many type two diabetics in my circumstances find it very
difficult to lose weight while taking insulin.
Not only does insulin contribute to weight gains, but so do Jentadueto
and Invokana my other diabetes treatment medications.
In addition, gabapentin, which has been prescribed for my
neuropathy due to diabetes, also leads to weight gain along with other symptoms
I am experiencing.
The more common side effects
of gabapentin include:
abnormal eye movements that are continuous,
uncontrolled, back-and-forth, or rolling
clumsiness or unsteadiness
drowsiness or tiredness
Talk with your doctor about
precautions you can take for side effects from gabapentin:
Ask your doctor for advice on diet and
exercise to help manage your weight if you are concerned about possible weight
gain from gabapentin.
Don’t drive or operate heavy machinery until
you know you can function normally while taking gabapentin.
Talk to your pharmacist about
over-the-counter medications that can help relieve some of the more common
digestive system side effects.
Gabapentin side effects may
make you want to stop taking the drug. However, don’t stop taking it without
first talking to your doctor.
Stopping gabapentin suddenly
can cause serious problems, such as withdrawal symptoms or the return of
seizures. Your doctor will help you stop taking the drug safely.
Medically reviewed by Lindsay Slowiczek, PharmD on December 20,
2016 — Written by University of Illinois-Chicago, Drug Information Group
In addition to the two new forms of insulin, and the
gabapentin for treatment of the diabetic Neuropathy I also take two other
2.5/1,000 MGs – taken twice daily prior to morning and evenings
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Jentadueto (linagliptin and
metformin hydrochloride) is a combination of two 2 oral antihyperglycemic drugs
indicated as an adjunct to diet and exercise to improve glycemic control in
adults with type 2 diabetes mellitus when treatment with both linagliptin and
metformin is appropriate. Common side effects of Jentadueto are:
Get medical help immediately
if you have severe side effects of lactic acidosis (symptoms include muscle
pain or weakness, numb or cold feeling in your arms and legs, trouble
breathing, dizziness, lightheadedness, tiredness, weakness, stomach pain,
nausea with vomiting, or slow or uneven heart rate.
Jenadueto is available in the
following strengths: tablets containing 2.5 mg linagliptin and 500 mg metformin
hydrochloride or 850 mg metformin hydrochloride or 1000 mg metformin
hydrochloride. The maximum recommended dose is 2.5 mg linagliptin/1000 mg
metformin twice daily. Jenadueto should be taken daily with meals, with gradual
dose escalation to reduce the gastrointestinal side effects due to metformin.
300 MG – taken once daily prior to the morning meal.
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Invokana (canagliflozin) is a
sodium-glucose co-transporter 2 (SGLT2) inhibitor used to control blood sugar
in people with type 2 diabetes mellitus, in addition to diet and exercise.
Common side effects of Invokana include:
sensitivity to sunlight,
reactions (including skin redness, rash, itching, hives, and swelling),
The recommended starting dose
of Invokana is 100 mg once daily, taken before the first meal of the day. Doses
may be increased to 300 mg in patients who are able to tolerate Invokana at 100
mg doses. Invokana may interact with rifampin or digoxin. Tell your doctor all
medications you use.
Asthma and Bronchitis Medications and treatments
After spending 10 days in the hospital in 2016 with severe
pneumonia, when I was discharged my Respirologist at Centrio Medical Centre diagnosed
me with COPD and prescribed three different inhalers to treat the disease.
Spiriva 2.5 mg
Spiriva 2.5 mg – two puffs with morning medications
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList 2/12/2018
(tiotropium bromide) Inhalation Powder is an anticholinergic drug used to
prevent bronchospasm (narrowing of the airways in the lungs) in people with
bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease). Common side
effects of Spiriva HandiHaler include:
Tell your doctor if you have
any serious side effects of Spiriva HandiHaler including:
or painful urination, or
The recommended dose of
Spiriva HandiHaler is two inhalations of the powder contents of one Spiriva
capsule, ONCE DAILY, with the HandiHaler device. Spiriva may interact with
atropine, belladonna, cimetidine, clidinium, dicyclomine, glycopyrrolate,
hyoscyamine, mepenzolate, methantheline, methscopolamine, propantheline, or
scopolamine. Tell your doctor all medications you use. During pregnancy,
Spiriva should be used only when prescribed.
Symbicort 200 mg – two puffs with
morning medications and two puffs with dinner medications
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Symbicort (budesonide and
formoterol fumarate dihydrate) is a combination of a steroid and a long-acting
bronchodilator used to prevent bronchospasm in people with asthma or chronic
obstructive pulmonary disease (COPD). Common side effects of Symbicort include:
joint pain, or
Tell your doctor if you
experience unlikely but serious side effects of Symbicort including:
patches on tongue or in mouth,
infection (such as fever, persistent sore throat),
changes (such as nervousness),
problems (such as blurred vision),
thirst or urination,
For patients 12 years of age
and older, the dosage of Symbicort is 2 inhalations twice daily (morning and
evening, approximately 12 hours apart). Symbicort may interact with
antibiotics, antifungal medication, MAO inhibitor, antidepressants,
beta-blockers, or diuretics (water pills). Tell your doctor all medications you
are taking. During pregnancy, Symbicort should be used only when prescribed.
Budesonide passes into breast milk. It is unknown if formoterol passes into
breast milk. Consult your doctor before breastfeeding.
Salbutamol 100ug – two puffs as required
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Ventolin HFA (albuterol
sulfate inhalation aerosol) is a bronchodilator used to treat or prevent
bronchospasm in people with reversible obstructive airway disease. Ventolin HFA
is also used to prevent exercise-induced bronchospasm. Ventolin HFA is
available in generic form. Common side effects of Ventolin HFA include:
dryness or irritation,
Seek medical help immediately
if you have rare but serious side effects of Ventolin HFA, including:
The dose of Ventolin HFA for
adults and children for treatment of acute episodes of bronchospasm or
prevention of symptoms associated with bronchospasm is 2 inhalations repeated
every 4 to 6 hours. More frequent administration or a larger number of
inhalations is not recommended. For exercise-induced bronchospasm, the dose is
2 inhalations 15 to 30 minutes before exercise. Ventolin HFA may adversely
interact with diuretics (water pills), digoxin, beta-blockers, antidepressants,
MAO inhibitors, or other bronchodilators. Tell your doctor all medications you
are taking. During pregnancy, Ventolin HFA should be used only when clearly
needed. Discuss the risks and benefits with your doctor. It is unknown if this
medication passes into breast milk. Consult your doctor before breastfeeding.
Other Medications Prescribed or recommended
Tecta 40 MG
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Protonix Delayed-Release Oral
Suspension and Delayed-Release Tablets (pantoprazole sodium) is a proton pump
inhibitor (PPI) used for short-term treatment (less than 10 days) of
gastroesophageal reflux disease (GERD) and a history of erosive esophagitis in
Common side effects of
site reactions (redness, pain, swelling),
or stomach pain,
The recommended adult dose of
Protonix is 40 mg once daily. Protonix may interact with atazanavir,
nelfinavir, ampicillin, blood thinners, digoxin, diuretics (water pills),
ketoconazole, iron, or methotrexate. Tell your doctor all medications and
supplements you use. Protonix is not expected to be harmful to a fetus. Tell
your doctor if you are pregnant or plan to become pregnant during treatment
with Protonix. Protonix passes into breast milk and may harm a nursing baby.
Consult your doctor before breastfeeding.
APO-atorvastatin 40 mg
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Lipitor (atorvastatin) is a
statin used for the treatment of elevated total cholesterol, LDL,
triglycerides, and to elevate HDL cholesterol. Side effects of Lipitor include:
Contact your doctor if you
experience serious side effects of Lipitor including:
wasting and muscle breakdown (rhabdomyolysis),
or memory problems,
thirst or hunger,
of the skin or eyes (jaundice).
The recommended dose of
Lipitor is 10-80 mg daily. Erythromycin (E-Mycin), ketoconazole (Nizoral),
itraconazole (Sporanox), cyclosporine (Sandimmune), indinavir (Crixivan) and
ritonavir (Norvir) decrease elimination of Lipitor. Lipitor increases the
effect of warfarin (Coumadin) and cholestyramine (Questran) decreases the
absorption of Lipitor. Lipitor should not be taken during pregnancy because the
developing fetus requires cholesterol for development, and Lipitor reduces the
production of cholesterol. Lipitor passes into breast milk and could harm a
nursing baby. Breastfeeding while taking Lipitor is not recommended.
Ramapril 10 MG
Ramipril side effects
Ramipril oral capsule doesn’t
cause drowsiness. However, it can cause other side effects.
More common side effects
If these effects are mild,
they may go away within a few days or a couple of weeks. If they’re more severe
or don’t go away, talk to your doctor or pharmacist. The more common side
effects that occur with ramipril include:
or faintness due to low blood pressure
Call your doctor right away if
you have any of these serious side effects. Call 911 if your symptoms feel
life-threatening or if you think you’re having a medical emergency. Serious
side effects and their symptoms can include the following:
pressure. This is more common when you’re starting the drug or increasing
doses. Symptoms include:
or hypersensitivity reaction (angioedema). Symptoms include:
of your face, lips, tongue, or throat
pain with or without nausea and vomiting
problems (jaundice). Symptoms include:
of your skin or the whites of your eyes
(edema). Symptoms include:
of your feet, legs, or hands
blood cell count. Symptoms include:
spot on your skin caused by internal bleeding (purpura)
abnormal heart rate or palpitations. Symptoms include:
like your heart is fluttering
potassium levels. Symptoms include:
(irregular heart rate)
kidney function. Symptoms include:
urine output when urinating
Disclaimer: Our goal is to
provide you with the most relevant and current information. However, because
drugs affect each person differently, we cannot guarantee that this information
includes all possible side effects. This information is not a substitute for
medical advice. Always discuss possible side effects with a healthcare provider
who knows your medical history.
Senior dosage (ages 65 years
As you age, your kidneys may
not work as well as they used to. This can cause your body to process drugs
more slowly. As a result, more of this drug may stay in your body for a longer
time. This increases your risk of side effects. Your doctor may start you on a
lowered dose or a different schedule. This can help keep levels of this drug
from building up too much in your body.
Kidney problems: 1.25 mg once
per day. Your doctor may increase your dose to 5 mg taken once per day if
needed for blood pressure control.
Renal artery stenosis or
dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your
doctor may change your dose as needed.
Dosage to reduce the risk of
heart attack, stroke, or death
Adult dosage (ages 18–64
2.5 mg taken by mouth once
per day for 1 week. Then 5 mg taken once per day for 3 weeks. Your doctor will
increase your dose as tolerated to 10 mg taken once per day.