"It doesn't matter"

I had another weird medical situation today, really for a couple of days but it came to a head today. Maybe my second "House" medical situation in like 2 or 3 months (last one started April 6, leg injury, long story...).

I've had a lump in my armpit for a while. I discussed it w/ my PCP and Endo in Champaign (which would put it at least at 2008...maybe 07 or 06, I'm a bit fuzzy...) and they've assured me "nope, no big deal, lots of people have those, no problem at all..." About Tu/ Wed last week, I noticed it feeling a bit tender and it seemed to sort of progress rapidly. Today, I noticed it was red and figured "ok, enough is enough, convenient care..." and went off to the doc. Mrs. said "you could wait to see your doc..." tomorrow but he's great and very popular and it'd be a couple of days so I just went today.

The doc noted some streaks shooting up my arm, which immediately reminded me of Ma Ingalls on LHOTP sterilizing a knife in a candle flame, and said "I don't have any narcotics here, you need to go to the ER right now. Not just the armpit thing but diabetes makes it risky" or something like that to which I replied "oh, my A1C is 5.1..." to which she replied "it doesn't matter" which I found a bit disconcerting. I went off to the ER, had a gruesome procedure and got some antibiotics and pain relievers and a funky bandage but the whole "it doesn't matter" that I have done decently at managing diabetes bothered me. Have any of you folks run into that sort of thing?

Hmmmm, I'm not sure she was "clueless" though as I've seen some other issues, not like major complications like blindness and amputations but I've lost quite a bit of hair on my legs and occasionally little cuts and scrapes on my hands, shins, etc. will take a *really* long time to heal. I had one on my hand dating back to the marathon in Chicago last year, whacked a guy with my hand when he stopped suddenly in front of me, scraping it, and it pretty much has just got better, about 8 months later. It was on a knuckle but still, maybe my efforts to run a tight ship are a complete waste of time because the disease is bigger??

How horrid, and discouraging, and painful, and.... No, I don't think managing your D well doesn't matter. It matters a lot, though maybe isn't relevant to this situation. I also find that I heal a lot more slowly - my body is covered with little 'things' that don't want to heal for ages. I wasn't there, but what I hear her saying in your post is she had no narcotics, and healing fast could be an issue because of D? I hate to imagine what more would go wrong if you didn't have tight control.

So sorry you're having another Twilight Zone episode ;\

Glad you're okay. Your doctor's response was probably not well thought out, although there is some element of truth to it. Unfortunately, even the best doctors have very crude data to go by: PWD are X times more likely to suffer from any given condition.

It's easy to forget that D is only one part of our overall health. Some of us have had High A1C's yet been spared major problems. Others, unfortunately, have had the opposite experience.

Tight control is not a get out of jail free card. It's more like a clean driver's license.

Wait - at least on House you find out what the obscure disease was. You never said what it was? (For that matter, what's LHOTP?)

As for the "doesn't matter", I always take that as a statistical imperative - we have diabetes, therefore we have higher risk of many things. So be it. Statistics are great and worth considering, but they are not necessarily a predictor of your personal outcome. In any case, it is true that any infection (especially one that needs House to diagnose) can wreak havoc with the BG of any diabetic, well controlled or not. So treating right away is a good thing.

Hmm,

I wouldn't take it personally, perhaps it's just a case of you are diabetic therefore you are in a higher risk category as healing will argulably take longer, greater risk of infections etc.

Perhaps she just saw it as a black and white thing. I wouldn't be too discouraged :)

My internist told me that my abcess took nine (NINE!) weeks to heal because I was having "high blood sugar". Back then, I was having maybe two highs a month. My A1c was in the low 5's. He doesn't know anything about diabetes, though, so I brushed it off (with all his other comments about diabetes) as ignorance.

I get House-like diagnosis nightmare stories fairly often, I'm afraid. We should form a group and go to him together!

I think that your A1c does matter. I believe that, as a group, there are some weird little quirks that affect people with diabetes more (like slower healing), but that, overall, we're better for the better control. Slow healing is a minor issue as long as it's small cuts. I think that we're spared from the worst of the major issues by having better control.

(And for the record, I think that I heal slowly, too, even though I've never had an A1c anywhere near the "diabetic range".)

I think it matters...I have always been proactive about my blood sugar, but before the "Bete's"struck I did not see a doctor for 14 years. Anything can happen, because of my diabetes I was having a check up and they found cancer and after finding the cancer I would have to say my diabetes has became a secondary condition but if I had not been on a proactive medical plan and seeing a Doctor every 3 to 6 months my outcome would have resulted in death but by the grace of God I get to spend more time on this planet....

Everything matters...we just don't know what the big plan is...;-)

Some complications seem to be very tightly correlated with high average bg's. e.g. retinopathy, kidney disease. But you will note we still get screened by specialists for these no matter what our A1C.

Other complications, especially macro-cardiovascular and general-inflammatory, seem to be very loosely correlated with average bg's.

I myself had frozen shoulder last year, and when I looked at several research papers, it appears that frozen shoulder is anti-correlated with A1C's. Those with frozen shoulder had a lower A1C than those without. This seems to fall into the "general inflammatory" thing.

Some dimestore docs just want to send all diabetics to ER and refuse to listen. I think you just found one of those. A dimestore doc is not going to be doing surgery on you anyway.

Given the season, and if you live somewhere with ticks... could this particular red spot be a tick bite?

Thanks for the answers and support guys!!

Re Jag's questions: LHOTP= Little House on the Prairie

The dx was an abscess and cellulitis. Unfortunately, I had to miss out on the ADA 5K today too, which is sort of a drag as it would have been fun to run with "the team"! I don't think it's a tick bite as it seems unlikely one would leap up to my armpit.

Re the "dimestore doc" issues, this was "convenient care" and she said "I could get it out but with what I have here, it'd take me an hour and a half to root around in there and we don't have any narcotics" which also made me blanch a bit. Although certainly not as much as while the guy at the ER was rooting around with the proper gear.

Everyone also assured me that it would have been a ***REALLY*** bad idea to try to drain it myself, with a syringe (maybe a CGM needle? *shudder*)

Tick bites definitely don't cause cellulitis. And yeah, cellulitis REALLY hurts! (I'm actually jealous that you got narcotics, because I had cellulitis in three different places at the same time earlier this year and I lived on Aleve and Tylenol, which barely took the edge off. Ditto to the abcess I had two years ago.)

I think your doctor did the smart thing sending you to the ER to have it drained--they're better at it.

Now that I think about it, is it possible that that's where the "it doesn't matter" comment came from? Is it possible that that comment wasn't about your A1c, it was about having the abcess drained in the hospital?

Little House on the Prairie--a TV show based on the books of Laura Ingalls Wilder.

I am vigilant about by blood glucose numbers and have an A1C that has stayed between 5.1 and 5.6 for many years, and I have had D over 50 years. I do find that some things are not totally controllable. I have very little hair on my legs anymore. I took a tumble on our driveway in February and it is in the very final stages of healing. I bruise fairly easily,, and that is not medication related. There are other small things, too.

I think the point is that no matter how hard you work at it, you will never achieve a truly non-diabetic blood glucose.

However, it DOES matter, because the hard work will extend your life and help ward off those risks. Hope you feel better, AR!

The ER doc used a local for the procedure and almost got it deep enough, although there were a couple parts during the rooting around where it seemed as if the knife/ scissors/ tongs got a bit below the numbness and into some raw meat and was quite painful but I caged some Norco as well as I had to sit around for a while before I left and it was starting to throb and, since I have two weeks off, I figured I'd rather be as pain free as I can.

Thanks Spock!! I love hearing reports from crafty veterans like yourself. Slow healing is better than no healing.

I get tired of doctors using diabetes as an excuse not to delve further into a problem. Sometimes I ask, "what would you say if I weren't diabetic?"

Man....where do I sign up for those hairless legs...us women are getting a bum deal here.

Actually,one of the speculative causes of the armpit thingy may have been shaving my armpits, although no cuts/ slashes were evident on it. The nurse also speculated that if you apply deodorant bidirectionally, it can get sort of impacted into the follicles and recommended one-way application.

I think that they sort of do each case individully? The last time I had an issue (2011, ran 33 miles but the last 7 it was 7 degrees out and 2x pairs of socks were too tight and my toenail turned black and surrounding toe got a bit red and puffy...), I saw the same doc @ immediate care who rx'ed antibiotics and referred me to a podiatrist. Slightly different but a bit less "eek" in the outcome. I'm sure there is an element of "if you aren't 100% sure of the outcome, send them to the hospital. They also voiced a bit of concern about clearing me of MRSA and both had the same story about "we have a case with a family and the dad gets it and then the kids and the mom, then they clean everything with bleach...and come back and have it again..." so I was pleased to learn that it wasn't that.

In this case in my opinion it matters but it doesn’t matter. No matter how good your control is prior to the infection your body’s stress response to the infection in combination with the diabetes puts you at higher risk for complications or poor healing going forward than someone without diabetes. That’s just physiology. Your risk is much lower than someone who’s sugars are already high and yes you know how to deal with being sick all of which should have been acknowledged but to be honest that wasn’t the primary concern right then. Getting that abscess taken care of ASAP was.



Having diabetes may not have been the primary reason she sent you to the ER. Those sorts of infections are emergent whether or not people have diabetes. It’s not at all unusual for something like that to be sent off to the ER. I’ve seen people without diabetes admitted with infections like that or needing the abscess drained in the OR too.



Hope you feel better soon.