what's new on the medical front?

My July hospital appointment turned out to be over two different days, one week apart from each other. I didn't realize this at first. The first appointment was on Friday, July 12, and was all about testing. The second appointment was on July 19, this past Friday, and was purely a doctor's consultation. Only one doctor this time: the diabetes-center doc. No stroke center, no cardiac center—just diabetes.

The July 12 visit was test after test after test, with the most obnoxious set of tests happening at the 2 p.m. appointment. I'll get to that. But first, I had to come in early to give a blood sample after fasting. So I got to the hospital around 9 a.m., went over to phlebotomy, and gave my blood and urine samples. The blood sample is done at a row of desks with transparent plastic screens protecting the hospital staff from my sneezes. A staffer, usually a nurse but maybe a young doctor, asks me to stick my arm though the plastic barrier's opening at the bottom. The staff at Samsung Hospital is usually pretty competent and professional about finding a vein in my right elbow, which is a contrast with the staffers at my local doctor's office, where the nurses have a hard time finding a vein and usually end up palpating both of my arms. Normally, the Samsung staffer quickly locates the blood vessel, warns me that she's sticking the needle in, and inserts the needle with only the barest pricking sensation. She then draws three blood samples, each sample in a different vial that she labels and writes information on. She then hands me a special urine-sample cup with a screw-on top and bids me go to the nearby restroom to provide a sample. The first time this happened, the nurse explained the urine-sample procedure in rapidfire Korean, and I didn't catch most of what she'd said because it was so far outside the range of the Korean I normally use every day. But with difficulty, I eventually figured out what to do, and now, I'm an old hand at providing urine samples. Take the special cup, go to the nearest restroom, pee into the cup (and if you pee too much, just finish in the toilet), then take your sample to a special window inside the restroom. Open the window and drop your sample off there, trusting that someone will collect it and run it through occult machinery to gets stats on things like your urine glucose.

But blood and urine were only the beginning. At 10:30 a.m., I was scheduled to have a vascular exam, but I also had to eat something, wait an hour, then go back to phlebotomy to give a second blood sample. I'm pretty sure this was to check insulin resistance: when you eat, your blood sugar goes up, which makes your insulin spike in response. For those of us with insulin resistance, coming down from that spike takes a long time, but for normal people, their blood sugar and insulin return to baseline within an hour or so. I asked a staffer whether I needed to give my second blood sample before my vascular exam, and I was told yes, so this meant going to the first-floor concession stand right after my first visit to phlebotomy, buying a modest salad, eating, waiting an hour, then hitting phlebotomy again—a different set of desks this time—and giving a second blood sample.

Does all of this sound confusing? Are you having trouble following the chronology? Then you're following my own state of mind quite well. At the time, I was pretty confused about the order in which to do things; the directive, on my schedule, to eat and give the second blood sample didn't have a specific time listed next to it, so I had to figure everything out on the fly. This ought to be easier next time. In any event, here's the order of operations for clarity's sake:

9:00 a.m. Arrive at hospital. Go to phlebotomy. Give blood and urine samples.

9:15 a.m. Go to the concession stand and grab a salad. Eat. Wait an hour.

I finish my salad a bit after 9:20 a.m. and walk over to the vascular center to get the "reception ticket" (접수표, jeopsu-pyo) for my 10:30 a.m. appointment. This ticket gets presented to a nurse to verify you're you and to permit you to see the doc.

10:20-ish a.m. Back to phlebotomy. Give second blood sample.

10:30 a.m. Vascular tests. I don't even remember what happened during this session.

Now, I had thought that I had an 11:10 a.m. appointment with the diabetes-center doc, but I had misread the schedule. When I wandered over to the diabetes center and tried to use the automatic kiosk to get the reception ticket for my appointment, the machine told me the appointment didn't exist. Confused, I went over to the staffed desk and asked another young lady (you're always interacting with young ladies) what was going on. The staffer looked at my schedule and pointed at the page, showing me that the 11:10 appointment was for Friday the 19th—i.e., the following week. I hadn't read closely enough. So all I had left to do was my 2:00 p.m. appointment, and I would be home free.

With nothing to do for a couple hours, I found a seat and spent time either napping or reading Jack Carr's seventh and latest Terminal List novel, called Red Sky Mourning (review pending), which felt like a swan song for the James Reece character. When 1:30 rolled around, I strolled over to the diabetes-testing center for my 2:00 session. This turned out to be the worst part of the day: the doctor was terse and somewhat rude, never allowing me to finish any of my questions as he constantly interrupted me. By the end of my time with him, I wanted very badly to slap the fucker, but I kept my calm and stalked out. The tests had to do with things like blood pressure and nerve conduction; at one point, I was flat on my back with four blood-pressure cuffs on all of my limbs. The cuffs inflated and deflated in sequence. During the nerve-conduction test, I could tell that my feet had gotten pretty numb. That final test by Dr. Rude involved electrodes on my feet through which the doc ran currents, asking me to raise my hand when I felt the tickle of electricity. I honestly couldn't tell whether any current was running through me, and I'm pretty sure that, from his point of view, I was raising my hand at totally random intervals.

With the 2 p.m. session over with, I went back to the office to work. I was a little later than usual (I normally pop in a bit after normal people's lunchtime), so I was able to work almost a whole day. The boss is pretty lax about work hours; he's more of a project-oriented guy than a "you must work X number of hours per day" kind of guy. Just get the work done, and he's happy. I realized, though, that I had walked out of the hospital without having paid for my tests, so I told my boss I was going to leave, go back to the hospital, pay up, then come back. He grunted his permission. It was a lot of tests, so I ended up shelling out a bit under W340,000 (about $245 at the current exchange rate). Good thing I'm rich, eh?

This past Friday, July 19, I had my appointment with the diabetes-center doc. It was the only thing on my schedule. Consultations with Korean doctors (and I've heard the same is true in Japan) don't usually last very long; the wait is often longer than the consult itself. I got to the hospital about 40 minutes early and used the electronic kiosk to scan myself in and get a reception ticket. It worked this time. I again waited in a chair in front of the diabetes center; large monitors on the wall tell you about how long you have to wait before it's your turn. When your time is close, your name becomes visible and slowly rises in the ranks. When there are only two patients in front of you, the normal thing to do is to move from the outer waiting area to the inner waiting area. A nurse comes over and checks your reception ticket, then she calls your name when it's time to go into the doctor's office. There are eight or nine different doctors' offices; I always go to Room 9, with Dr. GY Kim. As I waited, a little boy started whining loudly while in his father's arms; he didn't stop for a long time. I fantasized about shooting him with a tranq gun or telekinetically inducing him to faint. The kid looked over at me at one point and saw me staring daggers at him. Little shit.

It was finally my turn to see the doc. Our consult didn't last long. The first thing I learned was that my nerve-conduction test showed me to be severely numb in my right foot. This was not news since I'm the foot's owner. Dr. Kim didn't give any recommendations as to what to do about such profound neuropathy, so I guess I'm on my own. She then told me my A1c was 7.5, which was a big improvement over my previous 10.2 and 9.2, but still disappointing: my own calculations had me at a 6.8. But that datum, too, is useful because it gives me an idea of how much I'm off by. So from now on, as I'm measuring my own A1c, I'll add about 0.7 points to whatever my own estimates are. I asked the doc about triglycerides, insulin, and HOMA-IR, measures of fat in the blood and insulin resistance, but she didn't have those numbers, and since I'm taking exogenous insulin, my insulin numbers would be skewed, anyway. Or so she said. I told the doc about my constant, relentless diarrhea for two months, and I asked her to please, please consider lowering dosages. She dodged the dose-lowering issue and said she would change my meds to something that wouldn't provoke any more Noachide flooding. She asked random questions about pain and discomfort; I forgot to tell her about my one-time use of nitroglycerin, and how the angina seemed to go away after that single use.

And that was pretty much it. I left Dr. Kim's office and waited for the nurse to print out my schedule for my next visit. She wanted to schedule me for Friday, October 25, but I told her I would likely be doing a cross-country walk at that time, so could we please reschedule for either earlier or later? We settled on Tuesday, October 15, about three months from now, minus a few days. Despite my awkward, stumbling Korean, she complimented my language skills. People's experience of my interactions with them varies: if I'm having a good day, and if we're talking about topics for which I have the vocabulary, I might sound almost fluent, but quite often, if we're talking about things for which I lack the words, I may come off sounding like an idiot. In this case, though, I've learned a lot of medical vocabulary from having to communicate my various conditions to doctors and other hospital staff, so I can express myself in simple terms when talking about diabetes, chest pain, blood pressure, etc. Nerve conduction is new to me, though, so I'm still learning terms like numbness.

With all of that done, I went over to a first-floor kiosk to pay the day's bill and receive my prescription printouts. The kiosk allows you to select which local pharmacy will prep your meds, so I of course selected my usual Blue Bird Pharmacy. A solicitous, young attendant came up to me as I was making ready to use the kiosk. I told him I was a veteran with these things, but instead of leaving, he switched to English and asked me where I was from. I told him Alexandria, Virginia, and he lit up, saying he'd spent several years in the area. He had friends in the States as well... I nodded politely while he talked, finished my transaction, waved goodbye to the assistant, and ambled out of the hospital.

It's a shortish downhill walk of only a few hundred meters from the hospital to Blue Bird Pharmacy. By the time I got down there, my meds were pretty much ready to go, and I was shocked to see how few meds there were. While I think it may be a bit too personal and confessional to lay out all the meds I've been on, I can say that I had been on twelve different medications, and now, I'm down to only three: all for blood-sugar maintenance. No anti-stroke meds (anticoagulants), no heart-failure meds, no metformin, nothing.* I still have insulin shots, though, and I'd like to get rid of those. Now, at this point, a normal person would rejoice because getting free of meds is a cherished goal of the chronically ill, and most of my meds were now gone. But like the old farmer in the story about the horse that runs away (sae ong ji ma/새옹지마), I'm looking at my sudden change in fortune with a kind of cautious equanimity. Why? Because I suspect the radical reduction in the number of meds is a test to see whether the meds are being supported by good dietary and exercise habits.

This is actually a fairly motivating thought. I discussed my October 15 appointment with my boss, and we agreed that I should go on my Nakdong River walk on October 16. So there's now a concrete reason for me to truly buckle down, diet, and seriously exercise. I'm no longer taking meds to manage my blood pressure, so that's totally up to me now. This means I have to overcome my fear of angina and get back into staircase training. I think I also need to get back to full-on Newcastle; my attempt at a half-ass Newcastle ended with my not losing much if any weight at all: I've been wavering between 114 and 118 kilograms this entire time. So I'm going to craft a more specific exercise plan to carry me over the next three months so I can have good numbers when I next see my doc.

Oh, yeah: I've been on the new meds for two days, now, and there's been no sign of whatever the male equivalent of Aunt Flo is. Uncle Enos Rivers? Cut the meds, and boom—like magic.

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*Metformin, about which I've ranted before, is a blood-sugar med, but it was also the likely cause of the diarrhea. The metformin tablets I'd been using had the brand name of Diabex. I'm now on Galvus, whose active ingredient is vildagliptin. Read more here.