Unshelved by Bill Barnes and Gene Ambaum
comic strip overdue media

Friday, October 28, 2022

I love this song

Diabetes is no fun

I hate when my blood sugar goes south. If you've never had it happen, it's hard to explain. I get dizzy and unsteady, and I perspire but my hands and feet get cold and numb, and I just feel like my brain is mush and can barely function. Just now I had an episode where I was falling fast and got the special alarm that tells me on my monitor. It went down to 47, and after a banana, a pear, a frozen fruit pop, and glucose tablets, it's 78 and finally rising. Even once it levels off, I'll feel really hungover and unwell. It's so frustrating. I didn't take extra insulin, and I ate both breakfast and some lunch [and even skipped the short-acting insulin for lunch]. It happened yesterday at work, too, while I was at the sign-in desk, and I ate nearly an entire sleeve of glucose tablets to bring it up after 45 minutes. It should pop up in about 15 minutes. I'm going to dial back on my long-acting insulin some more. I think that will help.

Thursday, September 01, 2022

I've taken the Back-to-School Reading Challenge to raise money for the Trevor Project

https://www.facebook.com/donate/402043688580684/

I'm taking on the 20 Minute Back To School Reading Challenge for The Trevor Project! Please support me as I raise funds by reading 20 minutes a day this September to help The Trevor Project achieve its amazing mission. Every donation, big or small, counts. Cheer me on in making a difference!

The Trevor Project is determined to end suicide among LGBTQ youth by providing life-saving and life-affirming resources including our nationwide, 24/7 crisis intervention lifeline, digital community and advocacy/educational programs that create a safe, supportive and positive environment for everyone.

Please consider donating at the link above.  Thanks!


Saturday, August 27, 2022

Sigh

It's been a long while. I've posted almost 12,000 times on this blog for over 20 years, but I haven't felt like writing for some time. That makes me sad. I've gotten caught up with life and I'd been relying mostly on my phone for Internet interaction, and it was just harder to do that, for one.  I have a laptop though now AND I just got a folding table big enough to write, read, do crafts, etc., on, rather than having a computer on a stool and being uncomfortable in my chair because I had to put a leg on either side.

I do post a lot on Facebook, and that's for people I'm friends with, and almost all of them are people I know personally, with the exception of a few librarians.  I guess I feel safer there in some ways than over-sharing to the great world beyond.  I know, that hasn't stopped me in the past. But I'm 55 now and a little wiser than when I started.

So let's see...I think I last wrote in February.  We got a puppy then and she was so tiny at 8 weeks that she could go between the slats of the picket fence.  Now she's nine months old, and she's nearly 50 lbs.  She finally has a big girl bark, is very tall and long and lanky, and generally is getting very big.  My roommate thinks she's part Lab (that part is obvious, as she has webbed toes and Labrador waterproofing) and part Doberman, much like the dog he had when I first met him over 30 years ago.  I'm leaning towards part Great Dane with her build, but he is probably right.  She's a joy, very enthusiastic, loving, and a good companion to the other dog, who is a Lab/Pit cross and now much smaller than her.

Healthwise I'm dealing with ageing.  I've lost 50 lbs. since early November and 28 of that was from late December on.  (I was put on a different diuretic in November and I swear 20 lbs. came off because I am a sponge.)  I'm on medicine now called Ozempic for my diabetes, but it helps with weight loss and I'm doing pretty well on it, despite early side effects.  I just went up to the maintenance dose.

I do need to lose weight because I have chondromalacia, which is a loss of cartilage in the joint.  My knees are to the point of being bone-on-bone and I need a bilateral knee replacement, but I need to lose another 40 or so pounds.  They'd like my BMI to be under 40, but 45 is a hard stop and I'm 48 now.  So I need to work harder because I'm in a lot of pain and it's very difficult to walk very far.  I do have an ADA placard for out in the community.  I had one at the university but they only gave me a temporary one as they couldn't read my GP's handwriting. I had him redo it and resubmitted it, but they denied my request.  I have a couple of weeks to submit records, which I've requested, and perhaps I can get one on appeal.  You can't just park in a spot on campus without their specific hangtag, you see...my state-issued placard doesn't do a thing.  And they're pretty tough.  One of my former co-workers used a prosthetic leg and they made him send over records, and he finally got it. I've had it all summer, though, and it's been a godsend.  Without it I'm going to have to walk probably a quarter of a mile from my car to the bus stop and back, and that is very difficult and painful.

I'm also most likely going to have my gall bladder out soon. I go to a surgery consult the first week of September.  They'd found gallstones on an MRI of my liver but I was asymptomatic until I had fried fish and was in extreme distress for a week.  I'm a little leery of this. Even with the weight loss, I weigh about 280 lbs., so lots of visceral fat and higher mortality chances with any abdominal surgery.  Hopefully, it will be laparoscopic, as I don't want to miss much work.

Next week will mark the five-year anniversary since I moved in with my roommate.  All in all it's gone very well, surprisingly well, actually. Neither of us were particularly sure about the move and living together.

At work, headquarters took over my surgery and outpatient visit authorisations, leaving me without a position, but my boss (who's only been here a few months) really went to bat for me, and they did a lateral move into a position I've had before that is technically a few rungs down, but because of the way they did it, I didn't lose my pay, although I'm on the high end of the scale for this one.  I'm back in checkout.  One day before I moved I had a panic attack, because when I did it before, I was alone for the better part of a year, did the phone and e-mails, and generally had trouble keeping up.  Now there are two people at checkout (although my work buddy, who is very bubbly, is moving to registration, so they're trying to hire someone for the checkout position that's open), and one person who's job is to schedule phone and e-mail requests, letting me focus on the patients and families for the most part.  So it's actually been nice.  Not as much pressure and I get to interact with families and see the improvements in patients' lives. I do, being an introvert, get drained by too much interaction, but I also find it satisfying in this case.  So everything's going much better than it could have.

I've been working every day on a series of exercises to help keep my mind sharp.  There's Wordle and Latin Wordle, plus I'm studying languages on Duolingo.  I'm trying to brush up on my rusty Spanish, German, and Latin, plus I'm taking Irish and Welsh.  I was going to try to learn Modern Hebrew (I've studied Biblical Hebrew), but that wasn't going well, as the characters were very small, and it just wasn't clicking. I'm going to take my Biblical Hebrew and do some work on that instead and then go back to the modern after I get a grip on the ancient language.  But I'm getting through the ones I've studied before pretty quickly and understand more than I thought.  My grammar is actually still pretty good, it's just the vocabulary that I'm having to pick up again.  German is extremely easy, even though I haven't had it since 1985.  Latin is my most-studied language (5 semesters, including Mediaeval as well as the normal Classical, plus a little Humanist), so it's going well, although there are a lot of angry parrots in this one. (To be fair, Hebrew had a dove that liked warm wine--you can see why I was having trouble).  I've already used a little Spanish to check a person out at work without having to use the video interpreter, and I asked one of the in-person interpreters what the word for 'stickers' is and put it on my bulletin board because the kids love those.

Okay, I guess I'll sign off for now. I'm on vacation. No plans, not going anywhere, but I took the week off between now and Labor Day.  I'm hoping to get some rest and work on some new hobbies and actually do some reading.

And for some reason my neighbours are setting off fireworks for no discernable reason.



Saturday, February 05, 2022

So I missed January completely in terms of writing

I've been very busy at both work and at home.  My backup at work is leaving next week, so I'll have to do her work plus mine until they get someone else hired.  The good news is they got headquarters to help do the outpatient visit authorizations so I'll just have to worry about the surgeries and clinic treatment room procedures, as well a scheduling offsite imaging and authorising those.

The unfortunate thing about that is headquarters is taking on more and more things within our system from our local hospitals, so if they decide they can do it more efficiently, I could lose half my job when there's a replacement in her position and I go back to just mine.  That's a fear of mine. I've been laid off three times in my life (never fired), and twice have been here at work. I've always made it back because I'm flexible, but I am a little afraid of this.

We had a fairly mild ice/wintry mix event on Thursday and Friday. I was off work on Friday because I had an appointment with my liver specialist in person and a longish teleheath (getting everyone on the call plus the actual appointment was about an hour) with my weight loss doctor.  I changed the in-person appointment to next week as a teleheath, and we moved up my other appointment from the late afternoon to late morning because the doctor was stuck in Louisville and was going to try to get back to Lexington that afternoon, I think.

Anyway, as a result, I didn't get to talk to the liver specialist about my MRI, but I have gotten the report through the patient portal.  While I do have fatty liver, stage 2-3 (which is moderate, I think), there is no sign of cirrhosis.  That means diet can really help (and being a little more active).  Also, since November 1st I have lost 25-30 lbs (my weight fluctuates...the other day I was 8 lbs less than yesterday, but might be down tomorrow, who knows). I usually weigh weekly, but because I was seeing my physician, I went ahead and weighed.

We had a good appointment.  Since portion control is a problem for me, and I don't have much time to really do meal prepping, she suggested frozen meals, which aren't ideal, but may help, and that way when my roommate isn't able to cook, I still have something.  He hasn't been able to lately because we have a new puppy (11 weeks old now)  he's house training and he's just been exhausted with watching her so closely and getting up with her at night.  But she is so adorable.  I'm helping when I'm home so he can get some rest, but I've never been in a house with that small of a dog before.  She is just about the size of both cats now, but was smaller when she came to us, and only about 9 lbs at her first vet visit.  She's grown some already.  We're not sure what she is.  I'm thinking Labrador/Boxer.  The shelter had her as part pit bull, but the vet said her bone structure is far too delicate for that.  She has sort a of a little jowl thing going, so maybe she is part Boxer.  But she loves to be held.

So I went out yesterday and got some vegetarian Lean Cuisine/Healthy Choice meals, pluse some Boost to try, as she thought meal replacement might be good for breakfast or snacks.  I'm willing to try.  She said to keep it to Boost, Ensure, or Glucerna because she can prescribe them so they're much cheaper, like $10 for 24 instead of 6. I bought some chocolate and strawberry Boost packs to try that are the blood sugar control ones.

Okay, my friend wanted to sleep a bit more, but it's time to wake up. I have to go get medicine, puppy food, and pay a bill. I couldn't do them yesterday, even being off, because I 'lost' the method of payment, and actually backtracked to the bill place to see if I'd dropped it on the ground.  Turns out it was in the closet with the dog food on a shelf.  I'd taken a picture o the puppy's food so I'd know which one to get and left it there.  I'd been so stressed out with all that because it was a full book of cheques, and I was looking at almost $500 to stop payment on them, and I couldn't find them anywhere. I hadn't had my ADHD medicine in days as I'd misplaced that.  I have some today, but it's not the full dose but an earlier prescription.   Sigh. I make life so much harder than I should due to messed up brain chemistry.

Anyway, I should go now.  I'll try to write more.

Tired of seeing this misused

I was perusing the news this morning and found several opinion pieces regarding the removal of music catalogues from Spotify (one called Neil Young's actions 'righteous censorship' but also Spotify's removal of about 100 Joe Rogan podcast episodes. All referred to these as censorship.)

I think there is a fundamental misunderstanding of the word censorship in this country.

Censorship is the action of the GOVERNMENT to remove information. An example is when elected officials such as those serving on a local school board vote to ban books at the public library, or a body of government votes into law a bill that does basically the same time.

Do you know what censorship is not? An artist's use of his control over his own product so that a platform whose actions he does not agree with does not profit from his work. Censorship is not when a business chooses to distance itself and remove content when it violates its terms of conditions. Censorship is not the removal by a private business of customers who violate those terms of conditions, such as Donald Trump being banned from Twitter. Censorship is not when subscribers or customers leave or boycott something to do with a business because they do not agree with some action or aspect of the business. For example, the CEO of Jimmy John's is within his right to go big game hunting. However, I do not want him to use even the small amount of money I might contribute to that activity for something I feel strongly is wrong (I have no trouble with hunting if it's for food, etc. But hunting endangered animals for sport is reprehensible, in my opinion. I just wouldn't hunt, say, deer myself.) So I don't go to Jimmy John's. Just like I don't go to Hobby Lobby or Chik-fil-A due to some of their practices regarding employee treatment, and in the case of Hobby Lobby, the purchase of illegally obtained artefacts. That's a matter of personal choice, but it's part of a free marketplace and supply and demand. Companies do not have a right to profit.. People spewing hate do not have a right to have a platform. Artists should have control over their work. Simple as that.

Sunday, December 26, 2021

Please send good thoughts

So the sensor to my glucose meter is expiring in a little over an hour, but I can't replace it, even though I do have others, because Tuesday morning I have an MRI and I can't wear it (it has metal in it), and I don't want to waste a ten-day sensor for just a little over a day's time. So it's back to pricking my finger for about 36 hours. Not bad, really, in terms of the timing.

I am nervous about the MRI for a few reasons. One, I'm claustrophobic. They've given me hydroxyzine to take a little while before to take the edge off. Second, it looks like I'll have to lie flat for about 45-60 minutes. I sleep with a CPAP. I'm a little iffy on breathing while flat for that length of time. I may ask if they can put the fan on. Third, it's an MRI/elastography of the abdomen to measure the pliability, of lack thereof,  of my liver. Back on the summer, I had an ultrasound/elastography and I had to spend some amount of the time exhaling all my breath out (in a mask) and then holding without breathing over and over, so my abdomen would be still. It made me light-headed. I'm thinking this might be the same, and that's why she didn't want to sedate me. (An open MRI was not an option, as the images would not have been clear enough). Lastly, this is to see just how damaged my liver is. I know it's enlarged. The ultrasound indicated cirrhosis due to non-alcoholic fatty liver disease. If that's the case, it's very serious. It could mean liver tumours, advanced liver disease, paracenteses (drawing fluid off the abdomen that had built up with a long needle), encephalopathy from a build up of toxins (think loopy as someone dealing with dementia--my mom once put a lighter in the microwave, and my stepfather caught it before she turned it on...she'd thought she was making soup), even an eventual wait for a transplant. If it isn't full-blown cirrhosis, but a milder stage, that's great, and there are things I can do to reverse our stabilise it. I've already lost 25 lbs., although that was mostly from being put on another diuretic. That's one thing I can do, along with lifestyle changes and exercise. So it's good to know exactly what we're dealing with. But I'm nervous and a little scared. My mom died of this, and it was terrible. If you wouldn't mind, send some positive thoughts my way Thanks!

Sunday, December 05, 2021

Argh!!!

 I'm pretty technically-savvy.  I may not be able to do much with the smaller components on a laptop or build a whole computer, but I can change out periphery device cards and upgrade memory.  I know a lot of Windows and Android tricks, and I'm proficient with both.  I used to program in three older computer languages, so I know the basics of coding. And I've always been able to troubleshoot things to do with my computer or phone, eventually.


Enter the Amazon Fire.  This tablet (the latest generation of the Fire 10, which is the 11th generation) is so good in so many ways, and I'm actually able to use it as a min-computer because I have software compatible with Office and a keyboard.  I did the game notes entirely on it yesterday because my roommate was using my laptop (as a kind of desktop, as all sorts of things are plugged into that). But one trouble I have had is the headphone jack.  Right after I got my Fire this summer, the headphones I'd bought specifically for it that were wired, didn't work when I tried them.  I tried another pair, with nothing. I tried all the things I'd found on Google, including a factory reset, to no avail. I contacted Amazon and they couldn't help.  It hadn't even been a month, so they replaced it.


I usually use wireless Bluetooth headphones anyway, but sometimes I don't want to use up the battery, such as on Sunday mornings, when the wireless ones are better for my chores.  So I tried wired ones again, and lo, on the replacement tablet, it was the same.  The headphones didn't work. I tried everything short of a factory reset to no avail. As a last ditch effort, I tried a pair of headphones that I'd never used before, one that came with my last phone, the Samsung S7 (I'd preferred the ones from the S5, until they'd finally died, and the S20 has a USB-C jack instead of the 3.5 mm one).  I plugged in those, so frustrated with how my morning was going...and they worked, unlike two other headphones.  I checked the one set for any kittly nibbling and didn't find any.  I guess they were just somehow incompatible, even though they work on other devices.  So sending the other back didn't need to happen.


So everything works now. Now to determine why my Bluetooth earbuds are not pairing with each other (i.e. only the right one works).  But that is for another day.

Saturday, November 06, 2021

I know it's been awhile, but here's an update

Had my long-awaited liver consult today at the University of Kentucky. I took my roommate (who is also my medical surrogate) with me because I had a lot of trepidation and I knew he would ask any questions I forgot to). He said I was his emotional support animal. :) Met the nurse practitioner, who took a detailed history and was rather impressed by my ability as a medical historian regarding my personal health history, my medical terminology understanding, my (theoretical) knowledge of nutrition (I have a lot of that, it's the putting it into practice I have trouble with), and my willingness to work on my health.

I don't have definitive answers yet [they took a lot of specific bloodwork designed to give a better idea of my liver function, as opposed to just the enzymes--shout out to Miss Benita in the lab at UK Kentucky Clinic, who literally took my blood with the barest sensation of a needle stick] I need to have an MRI to get a better sense of the damage, as at this point it could be fatty liver disease, fibrosis, or Nonalcoholic steatohepatitis [NASH].  the latter is eventually what killed my mother, although she went through all the stages first.   I was a little reluctant to do an MRI because I do hate closed-in spaces and they didn't really want to sedate me, and open MRIs are not as good and often have to repeated anyway on a regular scanner, but she agreed to give me something to take the edge off and we'd go from there.  Since I hadn't eaten or drunk anything, there was another test they could have run today, but the MRI would be better, she said.  She is also sending me to a consult with an obesity doctor at UK who works with patients by helping keep them accountable for changes they're making in their lives.  She didn't think going to a dietician would really help, as I know what I'm supposed to do, but coming up with a plan and sticking to it by having to report to someone would be beneficial.  She did not give me the 'lose 30% of your body weight' talk.  She said it would help if I lost 10%, which for me is a little over 30 lbs, although even getting down the 25 I've gained over the last year would help.  I eat very healthy at home, rarely get take away or go out to eat, so my main nemesis is empty sweets from the vending machine, so that's an angle to work on.

They also got me set up on the patient portal so I could message her and get lab results, some of which have already come in.  I see her  in three months,  after the MRI and obesity consult are completed.  I feel better about where I am now.  We had a very detailed discussion (down to taking small amounts of acetaminophen vs. the large amount of ibuprofen I've been taking for my musculoskeletal pain (she'd prefer the former to protect my kidneys  even though acetaminophen isn't usually considered the best for the liver.  We have a plan in place.  It's a start.

Sunday, August 08, 2021

I've been processing some news rather than writing about it

For years I have been concerned that my bloodwork always shows my liver enzymes as very slightly elevated, because my mother had the same thing happen to her. It eventually progressed to fatty liver disease secondary to diabetes, then NASH Syndrome (non-alcoholic steatohepatitis), then cirrhosis, then to liver cancer, and then to liver failure, and it finally killed her.  It was terrible. 

I'd expressed this concern for some time with my PCP, but it was only a very little elevated, and so we took a wait-and-see tack, but I finally said something about my concerns to my endocrinologist. She ordered labs and sure enough, the values were higher than they should be. So Tuesday before last I had two liver tests: a regular liver ultrasound and an elastography, the latter of which measures the elasticity or rigidity of the liver. It wasn't a particularly painful test, it's just an ultrasound that I had to fast for, but it was difficult in that you had to (for the elastography) let out all your breath and then not breathe for awhile before letting in some air again. I was a little dizzy afterwards.

The next day, the results showed up on my patient portal and I read them. A couple of things were easy to understand. My liver was enlarged and I had asymptomatic gallstones. There was a mention of the wave result being correlated to a Metavir score of F4. That I knew nothing about, so being a former librarian, I looked it up, being congnizant that you shouldn't panic based on Google results. But the Metavir Scale goes from F0-F4. F0 is a normal liver. F1-F3 are various degrees of fibrosis in the liver. F4 is consistent with cirrhosis. That was a bit to make me think about panicking. I've had diabetes for aver 20 years with obesity and other risk factors. I thought there might be some damage. But cirrhosis is not good. Not at all. Fibrosis can be reversed in some cases, particularly in the early stages, as the liver has a great deal of resilency, but cirrhosis is another matter entirely, and can lead to liver cancer and liver failure.

I called my doctor's office to speak to her. Her nurse wasn't there that day, but they'd said they'd give her the message. The next day I hadn't heard anything, so I called back and spoke with the nurse. I explained what the score was supposed to mean and the nurse was like, oh, I didn't know that, let me get the doctor to call you right back, which she did. The F4 score is certainly concerning. She said she wanted to refer me to a specialist at the University of Kentucky, as they were the best ones in the area for this and if I went somewhere else, I'd probably wind up there anyway (I think she meant if it came to a transplant, as they're the ones who do that). So that was definitely hard news.

Fast forward to this Thursday and I hadn't heard anything about the appointment. I have the Informed Delivery from the US Postal Service that emails you scans of the mail you're getting that day and saw that I was getting something from my endocrinologist's office. I asked my roommate to open it in case it was the referral. It was just a copy of the results plus the intent to refer, so I went ahead and called her office and the referral clerk called me back. I do have an appointment with the University of Kentucky's Gastroenterology office (apparently that's where Hepatology goes under), but after reviewing my records the first available appointment was October 8th, when I'll be seeing a doctorate-level nurse practitioner. So maybe they didn't think I was as urgent as my endocrinologist's office thought. Or maybe, being a major univeristy teaching hospital, they just don't have the availability. I don't really want to make any assumptions. So it looks like I won't really know anything about my condition until then.  I have to admit, I'm pretty disappointed and more than a little scared.

I know that it often takes big things to scare us into making even small changes.  The best thing for fatty liver is to lose about 30% of your body weight.  For me, that's about 100 lbs.  Yeah, that's a lot.  I saw my rheumatologist the next day and told him about what was going on.  He asked me what I planned to do.  I told him I was cutting out the processed food in the vending machines.  I was trying to find ways to walk a bit each day beyond going to and from work (I get about 6200 steps in on average.  I'd like to slowly increase that to 8000.)  As far as losing weight, 100 lbs is too much to tackle.  My plan is to try for 15-20 lb. weight loss and then add another goal after that, taking it smaller bites.  He thought that was good, and he offered to get me to a nutritionist if my endocrinologist didn't.  I appreciate it.

I haven't eaten anything from the vending machines in over a week. I ordered and tried out some walking poles to help with my balance so I can walk around the neighbourhood, and some walking shoes are being delivered today (my New Balance work shoes, which look like black trainers, are actually steel-toed, and not flexible enough).  I went and spent $100 on things like large bags of nuts, raisins, craisins, jars of sunflower seeds, cheese I can cube, baked crackers, yoghurt, etc., so I have snacks and breakfast at work.  Here's hoping this helps.

UPDATE: My appointment has been pushed back to November 5th! Arrrgghhhh!

Sunday, July 25, 2021

Feeling a little better than last week

I had about a two week period in a funk, maybe longer, where I was depressed, irritable, and somewhat labile. It's unlike me at my norm. My lamotrigine had been upped about a year ago for some lability and more hypomanic issues. I was stable for years on my original dose, but my mood is still subject to my Bipolar II disorder. I spoke with my psychiatrist on Tuesday and he upped my mood stabiliser, lamotrigine, as well as my ADHD medicine, as I've been having trouble focusing lately. That puts me at the highest dose of Strattera, a non-stimulant, non-addictive medicine for ADHD. I'd recently walked off with a sink running at work (which half our sinks are automatic, but still), had a minor fender bender, and lots of little issues that were adding up to a bigger one. I've only taken it for a couple days (the pharmacy had to order it), but I think it's helping. I was able to up the lamotrigine immediately, and I feel a little better and think that it will help. Anyway, that's why I haven't been writing.