On Marriage

To you this day am I wed
And to you do I make these promises:


I will love you from my deepest self
Sharing my life with you, I will be joyful
In your sharing your life with me

I commit myself to you , to a life
Of service to our marriage, and our family
And will keep my agreements with you
In a spirit of love and acceptance.

I will love you without conditions
No obstacle, no action will divide this pledge
And I will take you as you really are
And as you will become, as you grow
Into the person you shall become

I will be joined with you in a common bond
To a life of love, acceptance, and growth
To reach out beyond ourselves, and make
Our contributions to the future of our family,
Our people, and our world

I will love you without seeking to own you
Give freely of my abundance, while
Receiving joyfully from yours.
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I wrote this poem in 1984 and my wife and I based our marriage vows on it. Our marriage was my second marriage, but her first, and so far, only marriage. These words bound us together in a marital relationship for the last thirty-five years. Our marriage was always unconventional in many ways, and the way it started made it necessarily so.

It turns out that we are quite different in our points of view, on a lot of issues, including, and maybe, especially, what marriage means to each of us. For many years we chose to leave our differences unfocussed and just slightly behind a curtain of apparent and superficial conformity. To our community, and mostly to our children, our marriage appeared to be pretty much according to common community values, one man and one woman, with a raft of kids, going through the process of life. Our initial agreement to be unconventional in being polyamorous was a whisper in privacy.

It was implicitly and explicitly understood that I would be discrete in my external relationships and not bring them home, even in discussion. The policy of Don’t Ask, Don’t Tell applied because she really didn’t want to deal with it, and as long as I stayed away from her circle of friends, she was mostly fine with it. In a sense, she had been a special “friend” with me and mothered our first child while I was in an “open marriage” with my former partner.

Over the many years which followed those early times we both followed what we believed was applicable under the terms of our promises. Suffice it to say that my external relationships and experiences were kept away from the family, and never discussed with her. Any time she did bring up the issue of marital fidelity, I would always remind her of the agreement we made at the beginning. She believed that our agreement was purely a “pro forma” agreement, an agreement made purely to serve as an artifact of our original relationship.

Most importantly, she believed that I merely maintained my commitment to it to retain my intellectual independence, and was not involved with any outside relationships or sexual engagements.

And so we continued until a few years ago, when a time came when I had to explicitly introduce evidence that I had not only engaged intellectually, but had also engaged in sex with someone else. In my view, I was never unfaithful, as our promises never included any promise from me that I would not be involved with other people. In her view, when confronted with specific evidence confirming my external relationships, I’d been screwing around, and unfaithful, for all of the last 35 years.

Front Door
There’s no place like home?

It didn’t matter that we had this agreement, because she felt that it was obtained under duress, or without her full understanding of what it really meant. Over the years when she challenged me on whether or not I was seeing other people, I had always confirmed our original agreement as still being valid, and refused to specifically acknowledge when or with whom I was involved. She’d had many suspicions over the years that I was sexually active outside of the marriage, but had never felt that she wanted to push the issue, knowing that I would continue to adhere to our agreements, regardless of her fears.

The proof that I had been sexually active for years came when I took a battery of blood tests, including one for STDs, that indicated that I was a carrier of Hepatitis B, a disease that is generally contracted by an exchange of body fluids during sex. The first thing I did when this result was made known to me, was to inform my sexual partners, including my wife. Ironically, the test was a false positive, which the specialist stated to me when I went to see him, upon referral by my family doctor. So I’m not a carrier, not even remotely, but by then the damage was done, and the cat was out of the bag.

Suffice it to say, my wife decided that she no longer considers us married, and wants a divorce. I urged her to reconsider on the basis that nothing really had changed, our agreement from 35 years ago is still in place, and I still consider myself bound to its terms.

All of that took place about a year and a half ago, and we’re still living together and cohabitating. We no longer consider ourselves “married’ exactly, but we are both comfortable that we are still “partners” “nesting partners” or even just “friends” living in a common household. Sexuality has not been a facet of our marriage for a long time, so it really wasn’t an issue for either of us.

We have had a really difficult set of discussions and for now are in agreement to stay together for mutual benefit, if not in fact in a marriage, we are still in fact deeply caring people who still love each other, if not the way either of us had wanted. She will remain monogamous and I will remain polyamorous. Where we go from here is anybody’s guess.

Couple holding hands; Shutterstock ID 33263227; PO: aol; Job: production; Client: drone


What I can say for sure, is that we still love each other, and will remain friends always.

.

Letting go doesn’t hurt, either.

Egmong, BC – Museum

Today is Canadian Thanksgiving Day. This is the day when I’m supposed to be grateful for all the good things in my life, and emotionally let go of whatever negative things are holding me back from a happy and productive life.

All of that is good. In theory.

But it’s hard to do. It’s a lot easier to list the things I’m mad about, or for which I’m resentful, than to account for all the good things in my life, for which I’m grateful. That’s not to say that I’m not, that is, not grateful.

I’m grateful for the people in my life who go out of their way to make my life better, of which there are any number, including my domestic partner who puts up with my frustrations and anxieties, and continues with me in her life, despite no longer wanting to be married to me, or believing that there is any romantic future for us. She’s probably right but still has simply accepted me as I am, despite my faults. So the two of us struggle to go forward in this fundamentally undefinable relationship and cause each other, and ourselves, the least emotional damage possible. And although this relationship isn’t what either of us imagined forty years ago, it continues to sustain me in the present. She still inspires me with her generosity of spirit towards.

I am grateful to my family, including my kids and my siblings, trying not to let resentment fill my heart for all the things I’d hoped would be, but are not. When people love me its hard when its not exactly the way I’d like to be loved. But who am I kidding? The fact that they are willing to be a part of my life is what is important, and I am appreciative when they do spend some time with me.

I’m also happy with my progress towards a healthy future. Intermittent fasting and lifestyle changes I’ve already made are making a real difference in my health, even just a few months into the process began with my decision last spring to reevaluate my medications and side effects. My son’s consistent input about carbs and sugar has encouraged me to stick to my guns when comes to fasting, and has helped me to lose 35 pounds. I do feel better, and I’m grateful for that.

But I still have a hard time not being angry about the things I’m facing in the future. It doesn’t matter really if they are a direct result of my own actions, or not. Chronic pain is very difficult to ignore, especially when it is quite severe, most of the time. I’m taking it on faith that losing weight will improve matters a little, but I’m not counting on it. Pain has become my constant companion, and it’s damned hard not to complain about it. Not that it does any good, but saying something does relieve some of the pressure of feeling so isolated and alone in the pain. Sometimes people think that I resent them because they don’t really express much sympathy, or even really seem to understand what the hell I’m talking about. Actually I don’t resent them, what I resent is the pain itself, and the fact that nothing really helps.

I’m also really resentful about the total destruction of my business and professional career, as a result of having made some stupendously stupid mistakes which cost me everything, including putting limits on my future I’m not quite sure how to endure. It doesn’t actually help to know that there were things I could have done differently that might have made all the difference. I didn’t do those things, so here I am. I’m critically broke, impoverished by the consequences of these mistakes. I also resent being ashamed of my mistakes and lack of better judgment. How can I be sure that I’ll do any better in the future?

International Symbol of gratitude

But today is Thanksgiving Day, so I’ve thought a lot about those things that matter to me. There is a better future ahead, even if I’m not quite sure how to get there. I’m still alive, and I’m in better health than for a long time, and have more energy than for probably ten years. So I grateful for that.

I’m also grateful for my blog. Expressing my deepest feelings helps me come to terms with them. So I’m also grateful for my faithful readers, who have been so encouraging to me as I have been on this fasting journey. Thank you.

bipolar living

with or without medications

Manic episodes occur with amazing regularity in my life, so I surround myself with folk you care enough to support me in avoiding the worst consequences of mania. https://www.self.com/story/bipolar-manic-episodes

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.

https://psychcentral.com/lib/10-small-steps-you-can-take-today-to-improve-bipolar-disorder/

Self Determination applies to all human beings, and ultimately we are all responsible for our own physical and mental health.

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.

Fast Changes

At the end of another week of three 36 hour fasts, I’m contemplating how much my life has already changed, and how much it may still change, as I continue my fasting and attack on diabetes.

Changing your lifestyle is the first key to beating diabetes

First of all, I currently weigh about 30 pounds less than when I started on the low carb high fat program. Fasting started about two weeks later, after I took the time to consult with my endocrinologist about how to manage my blood sugars during my fasting. We had already switched to two different types of insulin, long acting and fast acting, and I’m using the new meter that tests all day long, so he felt that the risk of a dangerous low could be managed.

Secondly, I now know that fasting isn’t really all that hard, for me. I suspect that motivation is a huge part of this, but fasting seems pretty straightforward to me now. Take care of my insulin and blood glucose levels, otherwise just don’t eat. Anything. Instead of it being hard, it’s been pretty easy, and the results so far are gratifying.

Weighing myself every day has become a lifetime habit. Getting my weight to a better levels is one of the keys to improving my diabetes, blood pressure, arthritis, and many other inflammatory problems and diseases.

I made the change to my lifestyle on July 10, and began fasting near the end of the month. It’s now the end of the first week of September so I’m approach two months into the program. My insulin levels are lower than ever as are my glucose readings. I take half of the prescribed dose of long acting insulin these days, and no fast acting insulin at all on my fasting days, and about three quarters of the previous prescibed dose on my non fasting days.

The biggest concern is keeping my blood sugars high enough not to end up in a coma from hypoglycemia from having too much insulin in my system and lowering my blood sugar too much. In more than 20 years of trying to manage my diabetes low blood sugar was never ever a remote possibility, even after being on insulin, as my blood sugars were always higher than desireable.

I recently made two new holes in my belt to keep my pants from falling down, after moving from the last belt hole at the other extreme. I didn’t measure my waist when I started because I was too embarrassed to admit how big I had become. Now I wish that I had because I’m shrinking fast.

When I started this fast, I told myself that I would stay the course for three months, and then re-evaluate where I’m at then, from a health perspective as well as general feeling perspective. I also said that I would be happy if I were to get my weight under 200 lbs or 90 KG by the end of the 90 days of fasting. Today I weigh 217 lbs, down from 244 lbs on July 10th. I believe that I will achieve both goals, at which time I will commit to the next phase of this program.

I wish I could say that there have been no negative effects of fasting. It’s a little early to make that statement. What I can say is that there haven’t been any, so far.

The Diabetes Code

Prevent and Reverse Type 2 Diabetes Naturally

I’m reinventing myself again. My goal is to eliminate or radically reduce prescription medications for diabetes, and a whole host of inflammatory diseases caused by the same thing that causes diabetes. 

Change doesn’t come easily when one is used to surrendering autonomy to the medical profession and simply being the obedient patient. It is NOT SAFE to simply trust that doctors know what is best for us. We already know this, but it is no surprise when we obediently follow their advice. Like everything else in life, you need to check the information out for yourself, and ask a lot of questions.

It seems that diabetes is actually caused by the thing that is supposed to cure it – insulin. In his book, The Diabetes Code, Dr. Jason Fung has coined the word diabesity – combining the words diabetes with obesity, to indicate that diabesity is caused by excess glucose in the body stored as fat, particularly in the internal organs, particularly the liver. There is a cycle in the body, controlled by the liver, that triggers the production of excessive blood sugar and results in insulin resistance.

Too much sugar and the body develops insulin resistance because the body simply can’t absorb any more sugar into the cells. To make matters worse, the medical profession prescribes increased insulin, or even just metformin, which helps the body to try to consume even more sugar.

Dr. Fung’s prescription for the elimination of diabetes is contained in a book called the Diabetes Code. Read it and weep, but understand that it calls for regular fasting to reset the diabetes cycle. 

This week I’m seeing my endocrinologist, and am going to be seeking support to follow Dr. Fung’s program. I’m curious as to what he will say.

Will he continue to prescribe insulin, Janumet, and Invokana to address my extreme diabetes? Or will he support a major lifestyle readjustment along with a fasting program to eliminate the disease altogether, eventually? I have already started to substantially reduce my carbohydrates and sugars in preparation for the revised program, and have already lost over 10 lbs in just under ten days.

I started writing about my diabetes and this journey several months ago, when I decided to review the prescription medications and their side effects, as a result of finally getting fed up with being sick, and seeming to get worse and worse and the years roll by.

With the encouragement of my middle son, Don, I began to look at diet as a major issue in my illnesses, as well as my diabetes. Sure, I went to many diabetes dietician clinics years ago when I first became aware that I was a diabetic. They always talked about reducing carbohydrates and sugars, and using diet and exercise to control my weight, and therefore help control my blood sugars.

As noted by Dr. Fung in his book, diet and exercise programs have been a massive failure, all over the world, in controlling or preventing diabetes or obesity. There are many reasons for this failure, but the medical professional continues to support this old and tired cant, that doesn’t actually work. I think the real reason that nobody wanted to actually examine diabetes and obesity with new eyes is that the old views are very profitable, to the pharmaceutical industry, the vegetable oil industry, even the health and diet industry itself.

But you’d have thought that somebody would have noticed that it didn’t work. And finally somebody has.

Anyway. Wish me luck on this new direction in my journey to solve my diabetes, and eliminate the side effects of so many medications by eliminating my need for them at all.

Finally, my wife Katherine has been diagnosed with Type 2 Diabetes in the past month, and has begun the journey through this ugly territory as well. Hopefully we can solve the riddle of the disease for both of us, and she never has to go through the years of pain and agony I am experiencing as a result of having poorly controlled blood sugar for the past twenty five years.

How to improve your health when your blood sugars are out of control.

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  • Healthy people are proactive about our health
  • Healthy people seek out more information
  • 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.

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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.

Why Me?

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.

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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.

Don’t hang around waiting for someone else to improve your health.

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.

TU UM EST!

A Critical Medical Self-Analysis

Purpose of this exercise

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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.

Current Symptoms

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  • 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 difficulties breathing.
  • 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 memory
  • 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.
Rain coast blogger
Rain Coast Review Blog author

  Conditions and/or diseases

  • Diabetes
  • Slightly elevated cholesterol
  • Sleep apnea
  • Asthma and bronchitis (borderline COPD)
  • Diabetic Neuropathy
  • Evidence of diabetic damage to my eyes
  • Fatty liver
  • Obese
  • Arthritis in hips, hands, shoulders, lower back
  • Tendonitis in hands and wrists
  • Eczema
  • 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
Photo by Tim Gouw on Pexels.com

Discussion

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 so often.

Diabetes blood sugar and neuropathy management

Endocrinologist

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
  • constipation
  • diarrhea
  • difficulty speaking
  • drowsiness or tiredness
  • dry mouth
  • nausea
  • vomiting

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

Other diabetes Medications

In addition to the two new forms of insulin, and the gabapentin for treatment of the diabetic Neuropathy I also take two other diabetes medicines.

Jentadueto

2.5/1,000 MGs – taken twice daily prior to morning and evenings meals.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 08/28/2017

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:

  • cough,
  • sore throat,
  • sinus pain,
  • stuffy nose,
  • upset stomach,
  • weight gain,
  • pancreatitis,
  • diarrhea, and
  • low blood sugar (hypoglycemia).

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.

Invokana

300 MG – taken once daily prior to the morning meal.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 11/12/2018

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:

  • urinary tract infections,
  • increased urination,
  • yeast infections,
  • vaginal itching,
  • thirst,
  • constipation,
  • nausea,
  • fatigue,
  • weakness,
  • skin sensitivity to sunlight,
  • hypersensitivity reactions (including skin redness, rash, itching, hives, and swelling),
  • bone fractures, and
  • kidney problems.

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

Spiriva HandiHaler (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:

  • dry mouth,
  • constipation,
  • upset stomach,
  • vomiting,
  • cold symptoms (stuffy nose, sneezing, sore throat),
  • nosebleed, or
  • muscle pain.

Tell your doctor if you have any serious side effects of Spiriva HandiHaler including:

  • difficult or painful urination, or
  • fast heartbeat.

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

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 1/22/2018

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:

  • headache,
  • throat irritation,
  • nausea,
  • vomiting,
  • stomach upset,
  • diarrhea,
  • back pain,
  • stuffy nose,
  • muscle or joint pain, or
  • changes in your voice.

Tell your doctor if you experience unlikely but serious side effects of Symbicort including:

  • white patches on tongue or in mouth,
  • signs of infection (such as fever, persistent sore throat),
  • mental/mood changes (such as nervousness),
  • trouble sleeping,
  • vision problems (such as blurred vision),
  • increased thirst or urination,
  • muscle cramps, or
  • shaking (tremors).

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

Salbutamol 100ug – two puffs as required

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 2/7/2019

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:

  • nervousness,
  • shaking (tremor),
  • palpitations,
  • headache,
  • mouth/throat dryness or irritation,
  • cough,
  • hoarseness,
  • sore throat,
  • runny or stuffy nose,
  • nausea,
  • vomiting,
  • dizziness,
  • sleep problems (insomnia),
  • muscle pain,
  • changes in taste, or
  • diarrhea.

Seek medical help immediately if you have rare but serious side effects of Ventolin HFA, including:

  • chest pain or
  • irregular heartbeat.

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 10/24/2018

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 adult patients.

Common side effects of Protonix include

  • injection site reactions (redness, pain, swelling),
  • headache,
  • nausea,
  • vomiting,
  • abdominal or stomach pain,
  • diarrhea,
  • gas,
  • dizziness,
  • joint pain,
  • weight changes,
  • drowsiness,
  • tired feeling, or
  • sleep problems (insomnia).

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 4/23/2019

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:

  • constipation,
  • diarrhea,
  • nausea,
  • fatigue,
  • gas,
  • heartburn,
  • headache, and
  • mild muscle pain.

Contact your doctor if you experience serious side effects of Lipitor including:

  • muscle wasting and muscle breakdown (rhabdomyolysis),
  • confusion or memory problems,
  • fever,
  • dark urine,
  • increased thirst or hunger,
  • drowsiness,
  • loss of appetite, or
  • yellowing 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:

  • dizziness or faintness due to low blood pressure
  • cough
  • dizziness
  • chest pain
  • nausea
  • vomiting
  • diarrhea
  • weakness or tiredness
  • Serious side effects

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:

  • low blood pressure. This is more common when you’re starting the drug or increasing doses. Symptoms include:
  • dizziness
  • lightheadedness
  • allergic or hypersensitivity reaction (angioedema). Symptoms include:
  • swelling of your face, lips, tongue, or throat
  • trouble breathing
  • stomach pain with or without nausea and vomiting
  • liver problems (jaundice). Symptoms include:
  • yellowing of your skin or the whites of your eyes
  • stomach pain
  • fatigue
  • swelling (edema). Symptoms include:
  • swelling of your feet, legs, or hands
  • low white blood cell count. Symptoms include:
  • sore throat
  • fever
  • purple spot on your skin caused by internal bleeding (purpura)
  • fast or abnormal heart rate or palpitations. Symptoms include:
  • feeling like your heart is fluttering
  • high potassium levels. Symptoms include:
  • weakness
  • arrhythmia (irregular heart rate)
  • worse kidney function. Symptoms include:
  • nausea and vomiting
  • decreased urine output when urinating
  • fatigue
  • loss of appetite

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 and older)

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.

Special considerations

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 years)

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.