A couple of weeks ago I had two doctor’s appointments that I had been dreading for almost a year. One was with a nephrologist and the other was with an endocrinologist. While both doctors had months-long waits to get an appointment, I still slow-walked booking both of them. Dr. Gilleon referred me to a nephrologist so long ago that the doctor she referred me to has since left the practice, so I made an appointment with another doctor there. You may ask why I would put off booking such vitally important appointments. And the answer is quite a simple one:
Fear.
Since my hospitalization I have lived in almost constant fear that the lithium incident was just a prologue to a greatly shortened and painful life. I have felt that between the kidney injury/acute kidney failure that I suffered in September, nearly losing a leg to a minor injury in the fall of 2021, and the treatment-resistant diabetes that has made any injury to my legs and feet limb-and-life threatening, my health was just circling the drain. I fear that my body has taken permanent, irreversible damage. And this fear and ensuing anxiety has been disabling. I wish that I could say that my fears are totally irrational, but I know that kidney disease and diabetes absolutely could shorten my life and make my final years unbearably painful in a way that I shudder to comprehend. While I am not currently depressed, I have been demoralized by this fear so much that the desire to just give up all hope has been with me for these past several months. My initial giddy joy at still being alive after a close call has since disappeared and been replaced with a kind of resignation that these are my final days. That I have one foot in the grave and the other on a banana peel (or roller skate as Jessica my sister who’s an ICU nurse says it).
So I dragged my feet on seeing these doctors. For some reason ignorance in the face of fear comforts me in a way that definitive knowledge that may or may not confirm my worst fears does not. I know it’s irrational and wishy-washy, but I feel compelled to bury my head in the sand nonetheless. After all, I came by my avoidant personality honestly. Ignorance may not be bliss, but it does keep me from daily panic attacks. If you are frustrated with me after reading this post, just imagine the consternation going on in my head right now. It’s a war zone in there. Complete with multiple warring factions and splinter cells all vying for control. Who will win? I haven’t the foggiest notion.
Enough prologue about my fear and the battle for Jeremy’s brain. Let’s get to the appointments.
“Kidneys, man, kidneys!” Robert “Bob” E. Noah (1920-2006), the punchline of a World War II era joke: Kidneys, man joke.
I first saw the nephrologist. He told me that the top number of my blood pressure is too high. He then told me that I had to drastically lower my sodium intake (with such helpful hints as don’t add salt at the table—something I rarely do anyway, and to eat Mrs. Dash on food). I have never seen any correlation, much less causation between my sodium intake and high blood pressure, but whatever. He then suggested that I lose weight. As though every doctor I have ever seen save one has not told me that. As always I said, “Sure, find me a weight control plan that doesn’t have a failure rate of 95-97% and I’ll gladly follow it.” He then suggested bariatric surgery. I am no doctor, but with my lifelong history of eating disorders I don’t think that I am great candidate. I would almost assuredly fail the initial psych evaluation anyway. He then told me to drink a lot more water (I drink so much already that it’s like a part time job staying hydrated). He then suggested that I exercise aerobically to lose weight—I almost lol’d at that one. Aerobic exercise is about as useful for weight loss as this sign is for navigation:
I know that aerobic exercise has so many other good things to recommend for it, but weight loss ain’t one of them. Will it help to lower my blood pressure? Almost certainly, which is why I’ve been walking much more regularly for the past few months. And I will slowly raise my intensity as my fitness levels improve. So far my appointment yielded mostly useless information and limited interventions, but the doctor did give me one bit of fairly good news. I do not have chronic kidney disease. Yet. My kidneys have mostly recovered from the injury that happened to them in the fall of last year, but they are working at about 75% of what they were before. Enough to avoid any further damage, obviously, but not the 11% function or lower that calls for dialysis—thank goodness. He also wanted me to see if my endocrinologist would prescribe Jardiance, for its diabetes benefits, and because of its role in kidney protection. There is a slight chance that my kidney function will improve if my blood pressure is lowered. I know that I need to eat more fresh foods and lest packaged and processed food, but I really have to build a life where that is possible. Doing things like food prepping and making sure that my lovely fruits, vegetables, and proteins get used before they go bad. With the new job taking a lot of my excess energy, I’m just not there right now. I have a short term goal of devoting one day of the week to cooking and food prep.
If any of y’all (especially my neurospicy readers) have any tips, please send me an message to my email below.
Pretty big tangent: I am pretty easy to get ahold of electronically—my email, Twitter, TikTok, and Instagram handles are all listed below. Feel free to message me on any of those platforms. Notice that I do not have my telephone number listed. That is because I never wish to be contacted by anyone by telephone that I do not already know well enough to be considered at least an acquaintance. My number is easily discoverable online, but that does not mean that I want random texts or calls. Please don’t think that I don’t want to hear from my readers—I love to hear from y’all. I just limit my telephone contact to friends, family, and work contacts. Please respect this.
Thank you.
So the appointment with the kidney doctor went better than I could have thought, which is a big win. I will try not put off such a serious appointment in the future. I say that, but I remain Jeremy D. Nichols equally avoidant and anxious. We shall see.
Later that afternoon I went to see the endocrinologist. She comes highly recommended. My podiatrist/wound care doctor said that she is the best in the world. He was very pleased when he found out that my appointment was with Dr. Dhali. Her reviews on various sites were mixed, however. With many people talking about her lack of bedside manner and professionalism and with others citing her incredible bedside manner and professionalism. I ignored the good reviews (as is my custom) and began to spiral about having an appointment from hell where she belittled me, ignored my concerns, lectured me about my weight without any solutions etc. I needn’t have worried. She was absolutely the most approachable doctor I have ever seen as an adult—my beloved pediatrician Dr. Knapp still holds the lifetime record, but I haven’t seen him as a patient since I was seventeen. She answered all of my many questions, she talked to me like a partner in my care and she outlined very reasonable steps toward getting my diabetes numbers under control. She did bring up weight loss, but only after raising my insulin, re-prescribing the Jardiance that I had been off of for almost two years and telling why she was putting me back on it (including that it would help protect my kidneys—without me having to tell her that my nephrologist suggested it), telling me what tests and why we would be taking them at my follow-up appointment next month. While there was some talk of weight loss, she assumed that I have tried and failed to maintain weight loss many times without shaming me about it. She said, “It is nearly impossible with just diet and exercise to lose and keep off weight. Almost impossible and I am tired of other doctors bullying my patients about it.” She did not act like she was the first doctor to ever tell me about the miraculous news of diet and exercise. She then gave me a sample injection pen of Ozempic—she said, “This will help your A1C go down and you will lose weight. Many people who are not diabetic have been taking this because they want to lose weight with it—and they do, but you actually need it. It will help all of your diabetes goals.” Hopefully I can afford the medication, because my blood sugar readings are lower since I have been taking it. Hopefully my A1C will improve as well. And I have lost weight without caloric restriction—which tells me that Ozempic is working as advertised. I may have to have a newsletter fundraiser (not really) and/or GoFundMe to afford it, but I have a few more weeks of the free stuff before I have to find out. Well, wish me luck until then.
Thank you, as always, for reading.
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