medicine and technology

My history of american technology class is reading Edward Tenner, Why Things Bite Back: Technology and the Revenge of Unintended Consequences. Tenner has a couple of chapters on medicine but he makes too many points and so I confined myself in class to two. One was the obvious one that as medicine can do more things it costs an increasing proportion of our gross national product, a trend that cannot go on forever. The other came from what I have learned about diabetes--I talked about how technology (and policy decisions) determine where you draw the line of when you will diagnose a disease. If you can't measure it or identify a clear set of symptoms, you can't diagnose it. Before blood sugar testing diabetes could only be diagnosed or monitored if blood sugar was above 180, when sugar starts to appear in the urine. Now we can measure problems long before that, but when do the advantages of diagnosing a person start outweighing the disadvantages (extra cost for health and life insurance)? That depends not only on what doctors can do for people but also on whether people will be willing to change their lifestyles.

technology

Lord Finchley tried to mend the Electric Light Himself.
It struck him dead: And serve him right!
It is the business of the wealthy man
To give employment to the artisan.

Hilaire Belloc, 1911

balance

I balanced this last week and it was still up today.

C. has a policy of not having symbols visible in his office. He does have one large and three small wooden ducks as part of the decoration. I found a matching small wooden duck, and added it to his collection. When he noticed it he put it away in a drawer. I said what harm is there in another duck, and he said he would think about it. Today he said that he had decided he couldn't have the duck I had given him out. Only he had gotten mixed up and he gave me back the wrong one. When I said I thought it was the wrong one he was quite convinced that he was right and I was wrong, until I pointed out the feature that proved which one I had given him. So I could have not only had my duck in his collection, but had one of his ducks in return. But it didn't feel right to trick him.

The Roman Rule

"The one who says it cannot be done should never interrupt the one who is doing it."

That came up in a discussion of new drug trials in Australia on alt.support.diabetes as an attitude to take towards people like the diabetes educators.

Today I did a home test of my Hemoglobin A1c, which measures how well I have controlled my blood sugar the last two or three months. I was thrilled to get a result of 5.5. In October my A1c was 6.5. One explanation of what the numbers mean says:

A healthy person without diabetes will have an A1C between 4% and 6%. If you are diabetic, the closer your A1C is to 6%, the better your diabetes is in control.

The average A1c of people with diabetes in the United States is 9.

diabetes educator

I've been in contact by email with a diabetes educator at one of the local hospitals. I wanted to check the person out before making an appointment, to make sure she wasn't hostile to the approach I am following. She replied that my approach was great if it worked for me, but then she said I should be aware that everyone eventually gets complications. I asked her if she had any evidence for that, as the approach I am following results in significantly lower average blood sugar than even the intensive therapy groups in the long-term studies that have been done (who had much lower rates of complications than people following the old recommendations). As the discussion continued, it became clear that she was dubious of the intensive approach I am taking. She doesn't want to promise anyone that if they work hard to keep their blood sugar in tight control they will be able to prevent complications, and I suspect she doesn't even suggest tight control as an option. She clearly feels caught between the endocrinologists, who are recommending tighter control of blood sugar, and local doctors who still tell their patients goals that are years out of date. It is a nasty position to be in--I'm sure the first thing diabetes educators get taught in their training is never to undercut the authority of the doctor.

Update: I contacted a diabetes educator at a different nearby hospital and she said they are required to teach the Amercian Diabetes Association guidelines in order to be eligible for insurance reimbursement. She also gave me the "diabetes is progressive and incurable" message: "Diabetes IS a progressive illness, so don't deem yourself a failure if what you do this year doesn't work as well next year." The evidence is very clear that the progression can be slowed way down, but the standard advice ignores that completely.

back to work

I had a most unproductive vacation, but I guess I needed that. I feel sharper in the classroom, despite having to reconnect to where I was more than a week ago.

fake mashed potatoes

I guess that keeping my carbohydrates low to control my blood sugar is getting to me more than I realized. I made fake mashed potatoes and I thought they were great. The recipe calls for steaming a large head of cauliflower until fairly soft and pureeing it in the food processor. I added a tablespoon or two of butter, a couple of tablespoons of plain yogurt, and some salt and pepper. Next time I might add some fancy mustard. It certainly looked like mashed potatoes, but my husband thought it just tasted like cauliflower. I like cauliflower, so that didn't bother me.

forgiveness

I'm actually not uptight about where I am on the issue of forgiveness, but I got thinking about it after catching myself saying twice in the last few days that I don't want to forgive my abuser. I have trouble understanding that forgiveness doesn't have to mean saying "she did the best she could." But the more fundamental issue right now seems to be that I feel a need to see her as bad because then I am different from her. I don't feel very secure in saying I may have some of the same impulses inside me but I'm different because I don't act on them. The whole issue of the relationship between feelings and action is difficult.

spring break

I'm starting my spring break, and despite my complaints about not getting much of a break I feel the relief of tension. My daughter has the same break but her school offers daycare Monday-Wednesday. My husband and son have a different break, so I will need to continue to leave the house at 7:30 each morning to take my son to his school. I am a natural morning person, but an hour of exercise and then leaving the house at 7:30 is pushing it.

I have one set of tests to grade and two papers to finish writing, one on a woman scientist and the other on discernment in spiritual direction (for the spiritual directors training program I am in). After that I don't know what the next priority is.

change

I don't deal with changes in schedule well. My day got turned around today, and it really threw me. I was gearing up to let some stuff out, and now I have to wait several more days. I should have decided to do something for myself with the time, but the small idea I had wasn't absorbing enough to distract me from thoughts of all the things I need to get done.

mammogram followup

I got a call last week that there was some question about my mammogram and they wanted me to come in to have more xrays taken. So I went in today, and had two more views taken, then the radiologist looked at those, then they took two more views, then the radiologist decided they needed to do an ultrasound. They did the ultrasound and then the radiologist told me they didn't see anything suspicious, just some normal fibrous tissue. After going through so much it is hard to absorb the word that it is nothing.

When I first got the call to come back, my first thought was at least I have done everything right. This mammogram was just a year after the last one (and I haven't even quite hit 50). My thought was "If there is a problem I won't have to blame myself for what I didn't do."

post-tenure review

One week later, my post-tenure review package is done. It actually turned out to be less painful to have it come up a the last minute, instead of having it hanging over me for months. I'm very grateful to my friends who wrote letters for me quickly.

It is an example of the worst of the current emphasis on assessment. The process is like being back in elementary school--various documents must be in a notebook in a given order. I resisted the temptation to decorate the notebook. So we jump through this extra hoop, and what is accomplished? I asked a couple of people and everyone thinks that no one has yet been fired at this institution as a result of post-tenure review.

mountains

We went to Kanuga for our church's annual retreat and were there for the first spring weather. We took a family hike to Wolf Mountain, which has a view back toward Kanuga's lake, with a cross on the far side. The downside of the beginning of spring was that the gnats drove my daughter crazy. They didn't bite, but they were very persistent face flies. I think the black spots on my picture must be gnats in front of the lens.

it's not about me

Working on issues about my father's death a month before my third birthday, I went further into what I have inside me about what my mother felt at the time. And I realized that a lot of her confusion came from issues she had from when she was a child and her parents divorced. I've felt that I was as a child terribly caught up in her confused feelings, because I didn't have any other role model of what I might feel about my father's death. But now I see her feelings came from her past, they had very little to do with what was actually going on. All that confusion and guilt is her stuff, it doesn't have anything to do with me. It is a weight I suddenly don't need to carry any more. My first reaction is shock at being less important and my second reaction is to feel confused and out of balance. It isn't easy being freed.

balance

The weather has turned spring-like here and the days are longer.

research areas

For a post-tenure review I need to write a description of my current and future research, and I decided I wanted to write about the past as well. I have done history of the space program, history of women in science and engineering, and history of forestry (environmental history). Amazingly when I try to put that all together it actually looks not like random wandering but like a a coherent story. I'm asking very much the same questions about forestry that I was about the space program, about the intersection between research and everyday practice. The history of women in science weaves in and out of that.

white flour

I put the bread I make for the kids in the bread machine last night on the timer, so it was ready just before we got up. It is made with a cup of old-fashioned oats and three cups of bread flour. I don't eat that bread any more, I make grown-up bread with oatmeal, barley bits, coarse ground whole wheat flour, milled flax, and vital wheat gluten. But today I was tempted by the smell and decided not to make a big deal of denying myself, so I ate one piece. I did check my blood glucose more often, curious what the effect would be. I spiked briefly to 150, though by 1 hour after eating it I was down to 135 (my goal is to be under 140 at one hour). At two hours I was at 95, which suggests that my body reacted to the spike by producing too much insulin, too slowly. It shows how careful I have to be if I want to keep my blood glucose from swings, which if nothing else make me feel hungry at the strangest times.

trusting the process

I have recently subscribed to a daily meditation that I like very much: the Almost Daily eMo's from Geranium Farm. Today Barbara Crafton writes:

Spiritual grown is usually not thunderous; it is usually incremental, in tiny steps, a little at a time. It is the direction of all the creatures of God--we are all hard-wired for growth. Diminishment is not our vector; our vector is toward greater depth. We are made that way.

That is particularly what I needed to hear today as I struggle to bear facing some difficult stuff in me.