Reviewing the D Buddy App

I've been using the D Buddy app for two days now. I like it, although I find some of it difficult.

It's very convenient. I was able to enter what I was eating right at the ballpark last night. I couldn't exactly find "lemonade" like they were selling at the ballpark, so I estimated, extrapolating from a store-bought version of lemonade.

This morning I ate some Kellogg's Frosted Mini Wheats, Bite-Size. I was able to find Kellogg's Frosted Mini Wheats in their database, but not the bite-size kind. Still, I was able to guess.

What I don't like about adding the food is that I can't, say, eat half a banana. So I have to enter an extremely small banana. And I can't add a quarter cup of milk. I can only add a cup (which is a lot of milk). But, when I've entered everything, it tells me how many grams of carbs I've consumed (103.4g this morning), how many are remaining since I'm diabetic, which is what the "D" stands for (171.6g), 540.1 calories, 12.3g fiber, 31.3g sugar, and 16.7g protein.

I'm not sure what all the numbers mean. How many grams of sugar should I limit myself to? Calories I understand more about -- and I'm trying to limit myself to 2,000 a day.

This app is already helping. Nutritionists have always told me to write my food down. You're more aware of what you're eating, what you should be avoiding. If you don't want to write it down, don't eat it! So now that I have to do that electronically -- it's much more fun this way -- I really am paying attention.

And I also have a calendar method of marking my weight and glucose level, as long as I remember to enter the data.

There Must Be an App for That...

I received a call the other day from my GP, Dr. Laura Miller of Lifelong, telling me that Caitlin, someone who used to intern with Lifelong, wanted to do an in-house visit with me. Caitlin was with Lifelong for a couple of years as sort of a health assistant. She set up the workshops, like diabetes and stroke, which I would attend. She was very competent, had a good sense of humor, was engaging, and seemed to have a lot of knowledge about general health matters. Caitlin is now in medical school at USF. She told me today that medical school is now emphasizing much more the patient end of health care. So, she shadows Dr. Miller a couple of times a month, and is now doing these in-house visits. She asked me after we sat down, "What would you like to talk about? Your cancer surgery, your diabetes, your support system?" I started out by telling her about the uterine cancer, how it was diagnosed, about the surgery at Alta Bates. When she asked me the question at the end, "What would you change?" I replied that there's nothing about the Alta Bates hospital care, the care I received at the hands of my oncologist or gynecologist, or even Dr. Miller. They are very caring, extremely competent doctors, with great caregivers in each of their practices. (That last statement doesn't apply to my GP; Lifelong doesn't have the resources.) For instance, Dr. Poddatoori has a scheduling person, a surgery scheduling person, someone who helps me in the examining room, etc. Dr. Stern, the oncologist, has his own assistant physician, Dr. Stephanie Summers, a scheduling person, an insurance person, ad infinitum, it seemed. I told Caitlin that I have had two cancers, I have had two surgeries, and it's gone. Twice. But diabetes beats my butt every day. I don't have a hold on diabetes, and haven't for a good, what, 20 years? I have all the information, but I can't seem to make the right choices. It doesn't help that I feel I'm addicted to sugar, and sugar snacks are the easy way to go. As are potatoes and bread. I wished -- well, almost -- I was back in the hospital. When the dietitian came by, he gave me a menu from which to choose my next three meals. After I kept checking everything -- I was hungry after having not eaten in three days! -- so he stopped me and pointed out that I was allowed only so many glucose points because I'm diabetic. Once I learned that, I could choose more optimally, and end up with a glucose-balanced meal. Ruth suggested that, just like there's a Weight Watcher's app on her cell phone, there's probably one or two good apps for diabetics. Sure enough, I just found one and bought it: Diabetics Buddy (shortened version is "D Buddy.") I have yet to use it. I hope I can figure it out and use it to my advantage.

Checking In with the GYN: My Go-To Doc

I kept my appointment today with Dr. Vineela Poddatoori, who checked on my incision today. Everything looks good. She told me the line would smooth out over time, fade, and the puncture marks on each side of that line would disappear, eventually.

She noted that I was still swollen a bit around the lower part of the incision, and that that's normal. She said it would probably disappear within the next two to three weeks.

She also gave me a lecture. It somehow came out in the conversation -- I think when she asked if I had been lifting things -- that I had been carrying the recycle and garbage out. Well, of course, I said. Who else would do it? She went on for a good 10 minutes about how I could easily hernia. And gave me examples, like a cousin who had a baby but then everything ruptured, and now, well, her intestines won't stay inside where they should be. Horrible stuff. She said it's harder to treat a hernia than my initial surgery, as the hernia never seems to completely heal. She made me promise to be more careful over the next couple of weeks until I'm completely healed, and not lift.

We noted that she looked like she was well along the pregnancy path, and she acknowledged that her due date is in August. I made a note to myself that I won't be able to see her until maybe Christmas, if necessary. Still, in the same breath, she suggested I call her if I had any concerns.

An important note: She said either she or Dr. Stern should be my check-off against recurring cancer. If Dr. Stern sees the June tests and pronounces me good, signs off on me, then I should come back to her. She said annual visits to one of them is important during the next five years.

Which made me think: where was my go-to doctor during the first five years after my colon surgery (also cancer) back in 2002? I didn't have one. I kept wondering whether my GP doc would know what to look for. I was just lucky: nothing recurred.

But now I have a back-up plan. I'm very happy about that.

One Month Update

It's been exactly one month since my surgery, so I thought I'd check in.

Pain. Yes, there is still pain. Pain when I walk, pain when I sleep, pain when I move. If I sit very still, I don't feel it, and can actually forget about it. Until I stand up. I'm using Aleve right now, every 6 hours. No Vicodin. The pain is certainly less than even a week ago. But according to doctors, I probably have another month to go before I feel almost normal again.

My son's grandmother wrote me to tell me that it will take me a year to get over this. "I can say confidently that it will take you longer than you think it will." She lost her uterus some years ago, and "I never missed it." Well, I know the last part is true.

As to what the area feels like, it's still a swollen mass right behind the suture line, right where the uterus used to be, and a little behind every inch of the vertical line itself. The "line" of the incision is much smoother than it has been, and doesn't hurt. It's the area where the uterus was that hurts, close to my navel, where the incision was started.

Fatigue. I still get tired quickly. I can go out for a few hours now, but when I come back I'm pretty tired. But every day brings new stamina.

Exercise. I walk quite a bit, I think, most days, but not on a flat line. I don't go for walks, normally. I need to build that into my schedule, a little bit more each day.

Diet. It's Passover now, so I'm not eating bread, which is a good thing. More salads, fresh fruit. I slipped back to some of my old habits because, hey, when you're hungry, you reach for whatever's convenient. Chips, ice cream. I try not to keep such things in the house normally, but I have slipped in the past two weeks. I am still holding at 10 pounds lost since the surgery, and I hope to improve upon that in the next few weeks.

All in all, things are going well. I have had a few set-backs in recovery (notably, nausea, bleeding from the clamps being removed, recovery from getting off Vicodin), but each of those only lasted a few days. I'm on a roll now.

Passover Challenges

I was finally able to find the time and patience to take my new glucose meter out of the package, plug in the key code wand, and get it going. It's not like the old days, when this used to be simple.

This morning, my blood sugar level was at 113, the best it's been since, well, I don't remember when. Right before the surgery, I was averaging in the 130's, which I thought was pretty bad, as before that spell, I was averaging in the mid-120's. I'm thrilled. That means that my eating regime is paying off.

Thanks to a dear friend, we have a first-night Passover seder to attend tonight. I'm not sure how long I'll last. Seders are usually looong, somewhere between 3 - 5 hours. I still get tired easily. And walking up the long, steep driveway to her house will take a lot out of me.

But I'm leaving Egypt tonight. Exodus.

The Bills Are In

Most of the bills from the tests leading up to the hysterectomy are in, and the operating bills themselves. I don't think this is the end, however. But I think this is most of it.

The total? A whopping $128,000.


COST OF OPERATION MARCH 2012

Doctors:
Oncologist OP Visit, New PT, LVL 5 $453
Gynecologist OV New PT Lev 3 $329

Tests:
MRI Pelvis $2,770
PET CT Imaging Skull-Thigh $5,900
Radiology, Supplies, Injection

Hospital:
Alta Bates Outpatient (biopsy) $26,918
Alta Bates Outpatient $289
Alta Bates (hysterectomy) Inpatient, $91,548
Ancillary

TOTAL as of 4/5/12 $128,207

I am still getting co-pay demands, and I haven't seen any from Alta Bates, although I'm sure that's next. My share will be probably around 1% of the total cost. How does someone without good health insurance, without ANY health insurance DO this???!

I feel very grateful.

Weight and See

I did not go into this great surgery with the idea of losing weight. But, hey, if they take out a uterus with really abnormally thick walls, plus ovaries, wouldn't that give minus a few pounds? Of course, they had to put something back -- I don't know what that is, and really don't want to know.

As near as I can figure, the difference in weight was about 6 pounds, as I weighed myself on my first day back. I'm not sure if that's uterus or if that's mostly I was on a reduced diet while I was in there due to the fact that I was nauseous my first few days.

I do remember eating that big, orange popsicle they gave me on my second day. I promptly threw it up. But it sure tasted good for a few minutes. They then, I think, figured out I was diabetic, and I never saw a popsicle again. But everything, once I was able to eat again on the third day, tasted great. A little tin of fruit. Some chicken soup. I really didn't have an appetite and wasn't at all hungry while I was recovering from the nausea in the first few days of hospitalization, but then my appetite came roaring back. I almost wished I could have stayed to see what the evening meal was like on Tuesday. But I was discharged around 2pm.

I weighed myself this morning, and I've lost 11.2 pounds since I went into Alta Bates. I'd like to continue eating small, frequent meals, fewer carbs, more healthy choices. I don't know if I can keep it up, but I have so many reasons to try.

So, for the young adults out there contemplating surgery for one reason or another: don't go into the procedure thinking you're going to lose weight as a goal. But if you do happen to lose some pounds, maybe it's a new beginning for you to start on healthy habits.

A Miserable Day off Vicodin

I can't lie: the day I came off the Vicodin was a miserable day. I'm not even sure why.

Yes, I felt more pain but it wasn't unbearable. I think it might've been a matter of blood sugar. When I ate lunch -- an Asian salad -- at noon, things straightened out a little bit. But I still had a stomach ache and a bit of nausea. I felt so bad the rest of the early afternoon that I just sat in my chair even though our son was over visiting. I didn't feel like talking.

We ate dinner quite early, at about 4:30pm. I was actually able to drive for the first time, which was part thrill and part almost terrifying (the car was going too fast and I wasn't used to it). At the diner, I ordered a small dinner salad and a bowl of fruit. And I felt immensely better after that. Ruth suggested that my body needs frequent nourishment because it's still dealing with healing.

This morning when I woke up, I immediately noticed the lessening of the pain around my mid section. I have felt some of that same nausea this morning, but it appears to be lessening, especially after breakfast.

(A small interlude for the Jews among my readers. Friday night is the beginning of Passover. I was eating some of the last of my cereal for breakfast this morning at 9am, being careful to put the mini-wheats gently in the bowl and not spill any. After all, the cleaning crew had come yesterday, and I didn't want any of the forbidden chametz, or grains, over everything in the kitchen. Wouldn't you know, I sneezed -- and several pieces went everywhere. On my pants, on the chair, on the tiled floor. But, thankfully, I had a little toy poodle who likes to eat spilled chametz. So I think I'm safe.)

I was going to go to a movie this morning, but I'm a bit tired. Maybe tomorrow.

Off the Vicodin

I came off the Vicodin last night. Mainly it did it because I felt the pain was manageable. And I did it because I'm tired of being a prisoner -- unable to drive, go to lunch or dinner with friends, even pick up groceries. Tired of having to take naps after I take the next pill.

Yes, I have a little pain this morning, but it's not bad. I also have a stomach ache. I have no idea if it's because of the (lack of) Vicodin.

Just to recap, I went through surgery (hysterectomy with removal of the ovaries and a sampling of the lymph nodes because of cancer of the uterus) on March 9th. I have been recovering ever since. That's three weeks-and-a-half, almost three weeks since my release from the hospital.

They had me on a dilaudid pain drip, intravenously, while I was in the hospital, but that induced low-level nausea, and I couldn't eat, which delayed my release by a few days. Once they figured that out, they put me on morphine. Once I was released from the hospital, they gave me a prescription for Vicodin and Motrin (Motrin is just 600mg of Ibuprofen). I went in for a check-up and to have the stitches removed a week later, March 20th, and they gave me another prescription for Vicodin.

The pain is getting less and less each day. I was able to start really reducing the Vicodin about a week ago, going from two Vicodin tablets every six hours to one, and then one every seven hours, every eight hours, etc., until I got up to every 12 hours on Saturday. And then, on Sunday, I figured I could come off it that night.

I hope those days are over for me now. They told me initially it would take 6 to 8 weeks for everything to heal and for most of the pain to subside. When I think about it, I'm only half-way through that process. There is some more pain to come. But it's nothing compared to the first few days.

Cancer Breakthrough

Big, big article on the cover of the San Francisco Chronicle yesterday: "In a potential breakthrough for cancer research, Stanford immunologists discovered they can shrink or even get rid of a wide range of human cancers by treating them with a single antibody." You can see the article online here.

The researchers are understandably excited, saying that "the data is indeed exciting, and the effects are significant." What seems even more joyous is that the treatment doesn't cause "major toxicity," i.e., horrible side effects. Mild, temporary anemia is cited as the only one. And, perhaps more importantly, "the antibody offers hope as a weapon against a broad range of cancers -- breast, ovarian, colon, bladder, brain, liver and prostate."

Tests have only been in mice so far. Researchers are hoping to move it quickly to human trials.

It's called CD47, but more informally, the "don't eat me" molecule.