Grudging Appraisal of My Aging Situation

I've been having a lot of trouble coming up with ideas to blog about. I mean, I know it's hot, but Durango's already taken care of the weather reports.

I've been feeling old lately. At the end of August I'll go have my first ever surgery. Then I'll get to spend up to 6 weeks on crutches. Apparently 4 decades is hard on the hips. I'm having cartilage, bone and labrum stuff repaired in my right hip. I think I have to be there at 6 AM. It's going to mostly suck.

I've been watching the UEFA soccer championships. I'm rooting for Germany to win the cup although Spain are the favorites. I've kind of thought about trying to create an American European Football League where every state in the union would have a soccer team and would have a 7 month qualification time followed by a 4 month tournament similar to the UEFA Euro. Imagine an American Championship soccer game with Texas versus California. It's got me back to questioning where the popularity of American Football came from when you can easily watch 45+ minutes of action without commercial interruption with the more appropriately named Football (aka Soccer)?

Last weekend I played a new MMORPG called "The Secret World". I played because it was a free Beta. I left thinking, "You know, I think they might be on to something." I shot zombies for a few hours with my shotgun. Then I went to an old amusement park and tried to dismantle rides that had gone off kilter while ghosts and demons tried to stop me. I don't know: a haunted amusement park and an old sea town overrun with zombies. You might want to give it a try. I figure with my hip surgery coming up, I'm going to need a new game to play so I bought it.

Last Saturday, I tried, via Facebook, to help a high school friend of mine fix her television. It was something about exchanging a PS3 for a DVD player and the video was mostly in black and white with lines or what not. The description left so many of the details out that I assumed I missed something early on. I mean, what kind of connection (HDMI, component, s video, RCA)? Does the DVD player connect directly to the TV or does it go through a receiver? Anyway, it made my head spin for a couple of minutes and then I told her to drink until the picture quality didn't matter. I'm not sure how helpful I was. I may or may not have already been drinking.

I've taken up bowling. For the last month I've been bowling at least twice a week. My average has gone from a 123 to a 144. My high game went from a 160 to a 204. I think I'm a natural. Did I mention my fingers, hand and arm hurts all the time and I'm going to have to have hip surgery in August?

Gary Johnson is the first Presidential candidate who I have ever actually wanted to win. For the last 10 years or so I've always voted Libertarian. Actually, I vote Libertarian and if a Libertarian is not running then I vote for the person with the longest name. My thinking being I want fewer laws. Libertarians believe in shrinking government; and people with longer names have to work that much harder to sign bills. Barack Obama was a bad idea (name is too short). You need people like Thomas Jefferson or Abraham Lincoln. Gary should change is name to Garinaldo or something.

Anyway, for some reason, I really like him. The God thing was kind of a troll to see if I could get some people to complain about my inappropriateness. It didn't work.

God Wants *You* to Vote for Gary Johnson

I get tired of people expecting the government to babysit them. One of my pet peeves is when people only accomplish anything when "it's God's will".

If you believe in God then you must believe that he created you with the faculties to take care of yourself. God doesn't want to take care of you. He's got better things to do. That's why He created you with the ability to take care of yourself.

And if God doesn't want to take care of you he certainly doesn't want the United States Government to take care of you.

Therefore, God wants you to vote for Libertarian Candidate Gary Johnson for President. It's time we started taking care of ourselves.

The Firestone Experiment

I may have written once before about my one and only trip to "Just Brakes". I had just graduated from college, had very little cash and my pads went out on my car. I could still stop and everything, there was just an annoying grinding noise when I did.

I took my car to Just Brakes. They said I needed new rotors, new pads, do something to the brake line, I can't remember what else. They wanted $300+. I said, "Can you just replace the pads? I've only got $50." After much pressuring concerning the safety of my brakes, they finally acquiesced. Three years later, the breaks started grinding again and I took the car to the now defunct K-Mart. They replaced the pads no questions and asked for $30. I even warned them that I might need new rotors. I've never even considered doing business with Just Brakes again.

As time went by and my pocket book became more bountiful I quit paying so much attention to people trying to oversell me. However, recently, my local Firestone has started the annoying habit of trying to sell me tires every time I walk into the store. It's kind of an ongoing joke between me and my girlfriend. I convinced her to take her car to the same Firestone to get her oil changed and they told her the same thing. But, they are conveniently located within walking distance of my house and a place to stop in for a drink so I tend to take my car there when it needs something so I can either walk home (for the long jobs) or walk to the pub (for the shorter jobs).

About 10 months ago I decided to perform an expensive experiment. I spent about $600 on four new tires, balancing and alignment at the local Firestone. These were all recommended by Firestone (in Flower Mound) for the safety of my vehicle (which was only a 15 months old at the time).

Now, my car is 22 months old and I had to get it inspected. I took it to a new Firestone (one in Irving) to get the inspection. And guess what they told me. Go ahead, guess. I'll wait. They said, and I quote, "Your car just barely passed the inspection. You need new tires and an alignment because you have uneven tire wear. Your tires had just enough tread left to pass inspection, but they won't last much longer."

I'm going to take their little write up about me needing new tires and an alignment to the Firestone in Flower Mound who did the exact same job less than a year ago. It'll be fun. I'm thinking I'm going to have to find a new place to do business. It's too bad. The guys at Firestone are pretty nice. Of course, I think what I need to find is a well qualified narcissistic auto mechanic. Someone who loves repairing cars, but won't sell a glass of water in the desert because he doesn't like the people. Wouldn't that be cool?

Choosing Your Next Pump

For the past few weeks, I've been doing research on purchasing my next Insulin Pump. My only experience is having diabetes for 30+ years, but I'll write all of this as if it's gospel without the standard disclaimers (most of the time).

I've blogged several stories about my Insulin Pump sagas. If you are interested you can do a search for insulin pump in the upper left hand corner of this page. It should show you all the stories where I mention my insulin pump. You can, of course, search for anything you want. All of my wonderful postings have been carefully indexed for ease of searching.

For those of you still reading and completely unaware, I'll give you a short lesson on insulin pumps.

Insulin
Insulin is a hormone secreted by the islets of Langerhans. Insulin's primary goal is to convert sugar into energy. You can do more research on your own, but basically, Type I diabetes is thought to be caused when your immune system attacks these islets. With Type I diabetes you are producing no insulin so you must somehow inject it. Type II diabetes is a little more complicated. It can be caused by your body's inability to use the insulin efficiently. It can be caused by the islets simply not producing the proper amount. I don't think anyone knows exactly, but suffice it to say with Type II diabetes, you're not getting enough insulin for one reason or another. Type II can sometimes be managed by diet and exercise. I have Type I.

Animas
I've tried insulin pumps in the past and I didn't like them. About 5 years ago I tried one that stuck (heheh literally). It was an Animas pump. I liked it because of the "color display" (which is riding a fine line of false advertisement -- there might be 2 colors) and because it was "waterproof" (which is also riding a fine line of false advertisement -- I've had 2 of them quit working after leaking occurred). It stuck because of the support team. I had three different nurses all calling me on a regular basis to set up what they call "the basal plan". It tries to mimic the body's natural secretion of insulin when you are not eating.

The Basal Plan
Some of this is based on fact. Some of it is based on me. A subject for another blog, but I'll summarize here for this post. I discovered the other day that I make intuitive leaps which become fact (in my mind). Over the years, I don't remember if I actually read this somewhere or it's just an "intuitive leap".

Even when you are not eating, you need energy. Your body has various ways of putting sugar into your bloodstream. Therefore, your body is always producing insulin. When getting a pump, your first goal should be establishing your fasting basal rate. If you could survive without food, how much insulin would you need?

It gets a bit complicated because your basal rate on the pump is measured in units of insulin per hour, but it can change throughout the day. Did you know your liver dumps sugar in the morning to help you wake up? My basal rate in the morning is 0.6 units per hour. During the day it is 0.375 units per hour. At night it is 0.275 units per hour.

I obtained these numbers by fasting for 8 hours at a time and checking my blood sugar levels every 2 hours. If my sugar levels stayed normal, the basal rate was good. If my sugar levels were too high my basal rate was adjusted up for that time period. If my sugar levels were too low, my basal rate was lowered for that time period. It's a bit of a guessing game and you don't want to do anything drastic, but like I said, I always had an expert going over the numbers with me.

Once you feel confident that you can wake up in the morning with a blood sugar level of 100 and it'll be very close to 100 when you go to bed, then you can move on to Boluses. From researching various pumps, it seems that the Basal rate setup is about the same on all of them. It doesn't seem to be a big selling point. Boluses, on the other hand, are entertaining because their various implementations commit one of my pet peeves: unnecessary complications.

Boluses
Every time you eat anything with carbohydrates that aren't fiber, you need insulin to do something with that sugar. Boluses allow you to add additional insulin when eating. They also allow you to correct for times when your blood sugar gets too high.

Two important numbers come from this: the insulin to carb ratio and the insulin to blood sugar ratio. How many carbs will one unit of insulin cover (ICR is Insulin to Carb Ratio) and how many points will one unit of insulin lower your blood sugar (ISR is Insulin to blood sugar ratio). For me those numbers are 13 and 60 respectively. Except for some reason in the mornings I have to lower that first number to 10. Theories abound.

Not all insulin pumps support the above two numbers. My new pump has to. I like the feature. When programming my pump I almost never tell it to give me X units of insulin. 99% of the time I tell it that I just ate X carbohydrates and my blood sugar level was Y so how much insulin do you recommend? It does calculations based on my ICR and ISR and my IOB. IOB is Insulin On Board. I have mine set at 1.5 hours, but it's adjustable. Literature says humalog insulin (the kind most pumps use) is normally absorbed and gone in about 2 hours (give or take). IOB is a calculation of how many units of insulin are still working in your body when you get ready to perform another bolus.

Two basic types of boluses exist. Based on your entries for the amount of carbs and blood sugar level, your pump may recommend 5 units of insulin. You can choose to take it all now (which I never do) or you can tell it to give you some now and the rest over a specified duration. For example, I can say, give me 1 unit now and the remaining 4 units over the next hour. If it gives me a dose every three minutes, it'll do 1 now and then every three minutes do 0.2 for the next hour.

Every pump I've ever seen defaults to the "dumb" bolus. You scroll to the bolus option, click it and the first choice is Normal Bolus. Just enter how much you want and hit go. This irritates me to no end. They need to make these things customizable for gods sake.

Even if you get past the "Normal Bolus" and get into the "Wizard" that lets you compute the bolus, it still comes back to the dumb screen after the wizard is done. It'll, for example, say, "The wizard recommends 5 units, hit go do deliver. But, if you prefer, change this option over here to combo or expert or square or dual or whatever this particular pump manufacturer calls it, hold your head slightly to the left and carefully caress the go button".

Finally, you arrive at the "expert" delivery screen and here it gets ugly again. The Minimed pump says you can do a Square Wave bolus (give the entire 5 units over a duration) or a Dual Wave bolus (give part of the 5 now and the remainder over a duration). This is the ultimate in overcomplication.

My Animas pump specifies a percentage now (which can be 0% and a duration). It accomplishes the same thing as the Minimed but with a simpler nomenclature. 0% now is a "Square Wave", anything greater than 0% and less than 100% is a "Dual Wave".

However, let's simplify further. Let's not have normal, combo, dual wave, expert or anything. All boluses are an amount, a percentage and a duration. All of this naming and additional screens is completely unnecessary. A "Normal Bolus" is 100% now (duration would be ignored). The idea of having two bolus screens (one for the experts and one for the normal) is overcomplicated.

If they'd just make all of these devices use a well defined Bluetooth protocol I could write my own bolus app on my mobile phone.

Tandem t:slim
I had high hopes for this little guy (the t:slim). However, last week they released a video of someone giving themselves a bolus and my dreams were crushed. It's odd being excited and then horribly disappointed by an insulin pump (medical device), but I was. I am still in line to get one because it does seem to be a little ahead of the curve. At least it looks more like a smartphone than a pager.

Ah, the video. Basically, it shows someone doing a bolus. The t:slim came up in the "Normal Bolus" mode and you have to touch a little slider button to switch to "Combo". And I reiterate: Normal and Combo are exactly the same things! Don't make me hit a slider button and then adjust the percentage when adjusting the percentage is the only thing that is necessary. It's utterly stupid. Some other people who actually were given a chance to play with the pump have commented on its customizations. You can probably change the colors. If they'd let me unnecessarily make all Boluses default to Combo that would be something.

None of the pumps allow you to have two "Combo Boluses" active at the same time. You have to cancel the previous to do a new one. This should be customizable. I can understand the safety risk of over medicating yourself, but for those of us who know what we're doing, it's just a pain. Pizza, for example, can take an hour or more to digest. If I eat a slice of pizza at 20 carbs and do a combo bolus for an hour, then, thirty minutes later, I decide I want another piece I'm screwed. I'd have to do some kind of miraculous calculation about how much of the previous insulin was given and how much of the previous pizza was digested so that I could cancel the previous bolus and do another one. It should just allow me to do another bolus over time (BOT is my new acronym)!

Maybe I should get into the Pump Programming business.

T:slim advertises less buttons to accomplish the same task which is obvious because there are no buttons. It's a touch screen. I think there might be some marketing folks who need to be shot. It's also "rechargeable". I'm kind of curious if I'm going to have to sit next to an electrical outlet for an hour while it charges... That would be fun.

Where Have You Been All Week?

No, I wasn't cruising. Well, not on a ship.

This has been my darling eldest child's last week of "mandatory education". I have high hopes for her "voluntary program", but it's interesting watching the kids squirt out on their own like an unsquishable jelly-like thing. Anyway, it keeps ones mind on things that aren't necessarily for the viewing public.

Her mom and I bought her a laptop for her birthday, which happens to coincide nicely with her graduation (birthday is May 26, last day of school was May 24).

I was going to get her a DSLR camera for her photography dreams. But, I've decided not to purchase one until she's enrolled at a university. Yes, I learn from the federal government. I hold back on necessary funds until my demands are met.

On Monday, I went to get my "gum surgery" to keep my teeth from falling out. Before the surgery I had to go get 3 prescriptions: a mouth wash, pain killers (with Hydrocodone) and antibiotics. The surgery was at 2:30 PM. It lasted until 3:30 PM. It was mostly uncomfortable. At about 5 PM, I popped my first pain killer. At about 6:30 PM, the "cute doctor" herself called me to ask how I was doing!

Being on pain killers, I quickly replied, "I'm fine, thanks, how are you?" It's part of my instant response training to alleviate my social awkwardness. Of course, I assume she was really calling to make sure I wasn't bleeding or any of that nasty stuff that can happen after open mouth surgery. However, the pain killers were encouraging me to think that maybe she thought I was cute!

Next morning, after the drugs had worn off, my paranoid personality disorder took over and I began to wonder if she called everyone or just the ones she messed up on.

Nurses and Doctors and X-Rays, Oh My!

An odd thing happened today.

It started Wednesday.

Actually, it started several weeks ago, but if you've been following along, you'll know this.

My ongoing hip drama has taken a wincing turn to the left.

Yesterday, that day being Wednesday, also known as the day after Tuesday. I should probably pause here and mention that I've recently hired an attorney to do my will. I've been reading legal documents for a few days now so some of this may sound kind of legal (like that first sentence). I don't know why I tend to mimic my current reading assignment. I'm like a mockingbird.


Yesterday, I decided to be a squeaky wheel and try to determine why no one had called me concerning my imminent Labral Repair and Osteoplasty.

Doctor Scheinberg's "assistant" answered my original squeak and exclaimed, "We haven't received any referral concerning His Excellency's, The Great and Powerful Gar's imminent hip repair." To protect the innocent, we'll call this assistant Wanda. I picture Wanda as a brunette with long hair and even longer legs.

Anyway, Doctor Evanich's "assistant" answered  the second squeak and exclaimed, "They haven't received it yet because we haven't sent it yet. The transcriber has been on vacation." What I heard was, "We kind of forgot about it and now I'm going to describe something that makes no sense so you'll forgive me and my lovely blonde curls." We'll call this assistant Becky. I've met Becky. I think she's blonde.

My last appointment with Doctor Evanich involved Becky calling Wanda to setup my appointment. I was standing there and remember Becky telling me that Wanda couldn't setup an appointment until Doctor Scheinberg reviewed my files and considered me a candidate for the procedure. Thus, the reasoning for my two weeks of patiently waiting for everything to get mailed to Doctor Scheinberg.

This morning, or the day after I made my squeaks, Wanda called me! She said, "We've received your files and I'd like to setup your appointment. The first one I have available is June 11 at 8:30 AM."

"Sounds good to me," I say. I figure the first appointment will just be a fifty dollar consultation so I can ask the doctor if we can delay the surgery until late autumn.

She then gives me instructions on their website and how to fill out the forms and get them sent to the correct place, etc.

Then she says, "Could you make sure and bring all your radiology discs including the X-Ray."

It gave me chills. I told her I didn't have the X-Rays, that Becky wouldn't give them up. Wanda said they'd make more.

If you don't understand, you'll have to go back here and read a bit. It's short. The post is short. Jeez. I mean the blog is not very wordy.

Now I'm not worried about the surgery at all. I'm worried about the X-Ray! And what did Wanda and Becky discuss which made my X-Ray so important? I feel like a cheap porn star.

Update on My Deterioration

I've had a host of concerned citizens ask me about the status of my ongoing physical deterioration.

Okay, not really.

Today, I've got an appointment with a Periodontist. Her name is Dr. Hsu and she comes highly recommended. She's also rather cute. I don't know how I feel about a nice looking woman poking around in my mouth. It seems like that should be a job for some wicked witch type person who heckles and has a lazy eye. Or perhaps a nondescript man who doesn't laugh and has a steady gaze.

My cool doctor has determined, via a trip to the radiologist for an MRI Arthrogram, that I have a labral tear. I think it sounds worse than it actually is, but apparently I've got a little bump on my hip bone and over time the bump has torn my labram.

A couple of months ago I was going to physical therapy and my physical therapists said, "I think you've got a torn labram. You should probably make an appointment with Doctor Robert Scheinberg. He's one of only two surgeons in the Dallas area who can fix that kind of thing."

I, of course, mostly ignored her and made an appointment with my own hip doctor. Two months, an MRI and $100 dollars later, my cool doctor tells me, "Well, it looks like you have a labral tear caused by a bump on your hip bone. There are only two surgeons in this area who have experience with that sort of thing and I would recommend Doctor Robert Scheinberg."

From doing Internet research, I believe the procedure is called: Labral Repair and Osteoplasty. Feel free to look it up. Recovery involves lots of physical therapy. Four weeks without putting weight on the leg. Two weeks no driving. Six weeks on crutches. I'm not at all happy about it.

I am wondering how fast it will degrade. I'd probably prefer to get the surgery done at the end of the autumn rather than the beginning of summer. But, if they recommend surgery ASAP, then what to do? I've been doubling the amount of pushups I do every morning to strengthen my arms for the coming crutch fest. I've never had to use crutches before. I may beg for a walker. I'll have to remember to get one of those temporary handicap mirror hangers for the car. And tennis balls.

They sent the MRI results to Doctor Scheinberg and basically said, "He'll call you after he determines that you are a candidate." I haven't heard from him yet, but it's only been two weeks. I don't know how long I should wait before calling. I don't think I've waited long enough.