I want to preface this post by saying that I have the highest regard and the upmost respect for our doctors. They show a remarkable dedication to their discipline while facing a mountain of stresses and strains that most outside the medical community never know about. I have a lot of doctors in my family, and I’ve heard many stories of the trials and tribulations that those possessing an “MD” at the end of their name face long after the many grueling years of medical school and residency. So you may think it odd that today I’m going to suggest that you stop listening to them.

Well, let me clarify. I don’t mean to completely stop listening to your doctors. Rather, I want you to listen differently and more carefully to what they are saying. Sometimes we look to our doctors for all the answers, expecting them to fully and accurately solve all of our medical problems. We don’t want to engage in any self-analysis or have any responsibility placed on our shoulders, so we place the full burden of our bodies on our physicians.

But sometimes we forget that medical science is imperfect and that diagnosing and treating many conditions isn’t as easy as diagnosing and fixing a car’s transmission problems. Sometimes we forget just how infinitely complex the human body is and how many possibilities our doctors are contemplating with each recommendation they make.

After years of schooling and certifications, a CPA still makes accounting errors. A master-level auto service technician misdiagnoses a problem sometimes. And our best financial advisors don’t always make the best stock picks for us. Sometimes we forget that a medical degree does not imbue a doctor with infallibility.

Sometimes we forget that our doctors are human.

 

A Call for Self-Evaluation

 
A couple of years ago I watched my cell phone scoot slowly and randomly on my desk as I worked. Once again, I had left my phone on vibrate after a movie, or church, or some event that strictly prohibits an audible notification that a call is coming in. After enduring a few seconds of this peculiar activity and that annoying, rapid, buzzing-insect-like pulse, I answered the phone and issued a somewhat dubious, “hello.”

A minute later I hit the “End Call” button on my phone and stared at my desk in total dismay. It had been a nurse at my general practitioner’s office, calling to give my latest test results. “Overall, your labs came back fine,” she said. “However, there were a few numbers that were off. Creatinine and BUN levels were high and EGFR was low. It could just be dehydration, but the doctor was concerned and wanted you to know. You are welcome to come back in and take a new set of labs if you would like.”

Aided by my ego, I quickly came to the conclusion that it had to be dehydration as the nurse had suggested. I mean, what else could it be? I thought with growing indignation. I had a solid 23-year track record of normal numbers. Only some temporary abnormality could account for the out-of-range variances. And if that was the case, there was no need to go back and take more labs. Everything would just naturally work itself out down the road.

Although I tried to dismiss the lab results and push the news to the far recesses of my troubled mind, I couldn’t get that call out of my head. I was used to issuing broad grins at the end of those calls—calls that just confirmed that everything I was doing in my diabetes self-management was working. Now my perfect track record had been broken. Something wasn’t right, and in my heart I knew it. Dehydration? Well, it was certainly possible, but not probable. I wasn’t sold on that theory. I needed answers.

Because it can be a primary indicator of impaired kidney function, the elevated creatinine level had been the biggest of the doctor’s concerns. So I went to the Internet and started researching its possible causes. Yes, dehydration was one. But there were many others that either directly affected creatinine levels or could indirectly cause them to rise by damaging the kidneys. The list included diets high in meat and protein, high blood pressure, creatine and dietary supplements, NSAIDs (Non Steroidal Anti Inflammatory Drugs), high potassium levels, strenuous exercise, an enlarged prostate, a muscular physique (bodybuilders, e.g.), and, of course, diabetes.

I didn’t like the look of that list because outside of high potassium and high blood pressure, nearly every single one of those offenders could be checked off on the Tad Roberts list. Now the big question was whether my lab results were just a one-time biological fluke or showed I was heading in the direction of chronic kidney disease.

It’s amazing how a perfectly balanced mixture of fear and denial can stop you dead in your tracks. Despite my newfound knowledge, I waited until my next office visit to get that all-consuming answer. However, this time before donating more blood to the lab, I made sure that I was fully hydrated so that could be completely ruled out. I prayed more times than I can count that hydration would be the culprit and that my numbers would return to their normal in-range levels. Then the past three months could just be chalked up as a nightmare I finally woke up from. But that didn’t happen. This call from the nurse echoed the previous one. The same numbers were still off, and it was now clear—something was wrong with my kidneys.

 

Unsettling Realizations

 
When I learned about the DCCT (Diabetes Control and Complications Trial) and its results in 1993, I knew it revealed that good, tight diabetes control could dramatically reduce the possibility of diabetic neuropathy, retinopathy, and kidney disease. But I also knew that good control didn’t guarantee a complication-free life as a type 1 diabetic. However, as long as my lab results came back normal, it was an outcome I didn’t really have to consider. After 23 years, I thought I was home free. In some illogical way, I had developed a somewhat cocky sense of invulnerability.

Now that I had been brought back to reality, I kept replaying the words of Luke Skywalker to the Emperor in Return of the Jedi: “Your overconfidence is your weakness.” That pointed declaration really got the Emperor’s blood boiling, but for me and my sometimes overly-sweetened blood, we were humbled by the thought.

Yes, my overconfidence was my weakness.

I hadn’t felt that low and that terrified since the day I was diagnosed with type 1. I felt like a failure. It was as if all those years of good A1cs, working out, watching my diet, and learning the strategies of successful diabetes self-management were all for nothing. I know that assessment is also far from logical, but that was the way I internalized everything after getting those lab results. My heart was broken, and I grieved in the only way I could.

 

Corrective Measures

 
I knew something was wrong with my kidney function, but I didn’t know exactly what or how bad it was. I figured this was beyond the scope of my GP, so I got a referral to a nephrologist (a kidney specialist). When the appointment day came, I was nervous as hell. The nephrologist would have been too if he had known what he was in for.

I walked into the exam room with a stack of papers and notes detailing my lab results for the past fifteen years. I had charts showing the absence of any odd trends and my own analysis of behavioral factors that might be responsible for my kidney problems. Out of the mountain of paperwork provided, the doctor’s attention fell on a short handwritten list of possible reasons for my impaired kidney function. This was the list:

1. 20+ years of creatine monohydrate (a supplement I had been taking for weightlifting)
2. 20+ years of weightlifting
3. A long-term high-protein diet, including up to 1/3 gallon of milk each day
4. The intentional elevation of blood sugar levels for exercise and other strenuous activity.
5. Anti-inflammatories such as Ibuprofen (taken for some disc problems in my lower back)

As the doctor went down the list item by item, he pretty much shook his head, dismissing each one until he came to the final option. Suddenly, he perked up and looked at me and asked for more information on the NSAIDs I had been taking. I told him that I had been taking Ibuprofen pretty consistently for as long as I could remember for various sports aches, pains, and injuries. Then I had him turn in my chart to the list of medications I was taking, and I pointed to a pretty powerful prescription painkiller for my lower back problems. He asked how long I had been taking the painkiller, and I told him that my back doctor had prescribed it a couple of years ago.

Then we switched gears for a while to talk about me, my lifestyle, and my diabetes self-management. He asked a lot of questions and listened carefully to my often-lengthy answers. I’m sure he could tell I was scared. Every response I made possessed a subtext that proclaimed it loudly. Nevertheless, he was patient and compassionate, and it was probably the longest doctor’s appointment I’d ever had.

After I had fully spilled my guts, he assured me that good days were yet to come, that I hadn’t reached some dire point of no return. Some adjustments would need to be made. In his initial assessment, he believed that although the other items on my list could certainly contribute to my kidney issues, it was the NSAIDs that were of greatest concern. Apparently the dosage I was taking would be stressful on a non-diabetic’s kidneys, but for a diabetic already facing extra renal stresses, the high doses were way too much. So, we made a small adjustment to my blood pressure medication, and he instructed me to stay away from the NSAIDs for now. All in all, it was a very positive appointment with one exception: I had now been classified as Stage 1 CKD (that’s Chronic Kidney Disease).

 

The Difference a Year Makes

 
I’m not one for half measures. As instructed, I stopped taking all NSAIDs outside of a low 80mg dose of aspirin as a preventative for heart attack and stroke (The nephrologist had said that the dose was so low that the benefits far outweighed any risk.) But I went several steps further. I stopped taking creatine monohydrate and all athletic performance supplements. I started monitoring my protein intake more carefully and reduced almost half of the milk I was drinking each day. And, I learned a way to reduce how much I had to elevate my blood sugar level prior to intense exercise.

I saw the nephrologist a few times over the next year, and my numbers had begun to trend in a positive direction. Toward that 1-year mark, I sat down in his office for the results of my latest labs. Once again I was so nervous—I was seriously edgy at all of these appointments.

Looking up from my chart, the doctor smiled at me and said he had good news. All of my numbers had returned to normal, and my A1c was just about the lowest it had ever been. For a moment I was paralyzed, unable to move, speak, or do anything but watch a few tears drip down on my Dallas Cowboys T-shirt. Once I regained my mobility and composure, I thanked him several times for everything he had done in helping me turn this thing around. Then he gave me more good news. He said he didn’t need to see me again for another year.

I walked out of the office that day sporting a broad grin, but it was a cautious one. I had achieved victory for now, but I knew that one set of labs didn’t make any guarantees for the future. The NSAIDs had likely done some permanent damage to my kidneys, so as a diabetic I knew that I would have to guard them well for the rest of my life. I learned an important lesson from my earlier overconfidence, and I vowed never to fall into that trap again.

 

Taking Responsibility

 
You might think that I should have felt betrayed by the back doctor who prescribed high doses of NSAIDs to a type 1 diabetic. Shouldn’t he have known what that could do to my kidneys? Well, maybe, but that’s an arguable point and, honestly, not worth arguing. I knew (yes, I knew) that anti-inflammatories were hard on the kidneys. I had read of the effects more than once in various articles on diabetes self-management. I failed myself by not asking more questions and not doing the requisite research.

I wanted relief from my back pain, and when the doctor said the medication would help, I heard what I wanted to hear. I combined that selective hearing with my brazen overconfidence and decided I could do whatever I wanted with impunity. That was my mistake, not a doctor’s.

And this brings me to the whole point of this post. As I said in the introduction, we have to realize that our doctors are human. They took an oath to do no harm, and I truly believe that is their honest intention. But they didn’t take an oath promising perfection. I’m not perfect, you’re not perfect, and neither are our doctors. We ALL make mistakes and oversights. It’s a reality we have to acknowledge.

So what does that mean for us diabetics? Just like we can be our own worst enemy, we can also be our own best diabetes advocate. We have to listen carefully to our doctors, and if something doesn’t sound right or we just don’t understand, we have to probe deeper. We can’t be lazy and just accept. Do some research, get a second opinion, but don’t just blindly accept something that might appear unacceptable. The success of our diabetes self-management depends on it.

Part of working with our diabetes team is acknowledging our responsibility and taking time to fully understand each action and step of our self-management. That understanding endows us with a powerful self-confidence and keeps us safe from falling into a dangerous overconfidence.

Incidentally, I was able to solve most of my back pain problems without additional or kidney-damaging drugs. My back doctor (yes, the same one) was able to perform a fairly simple procedure called a rhizotomy that brought me a lot of relief. So, sometimes we have to go in search of better options. Very often, they do exist.

And now when I watch Return of the Jedi with the kids, I smile when I hear that line. Lesson learned. Plus, it feels pretty good not sharing character traits with really really bad guys.

–Tad

——————————–

The audio version of this blog post is now available below: