Urf

I got a phone call a few days ago about my labwork. The nurse said it was "perfect." Since they won't give the actual numbers over the phone, I didn't say anything, but I had my doubts. Anyway, my cholesterol was excellent now (although my HDL was lower), which is great. Last time I was in the normal range, but just out of the diabetic range, if you know what I mean. My A1c was much like last time: abnormally low. I don't know why this has been happening, just for the last year. The endo didn't seem too concerned about it, since we know what my A1c *should* be, and that's not really worrying. It's just confusing to other doctors who of course first want to know what my A1c is, and then I have to explain it. Not that I really have an explanation. Anyway, I just read this about donating blood yesterday in the Diabetes In Control Newsletter:

The donation of red cells does indeed have an effect on A1c levels. Since the test measures a type of hemoglobin in the red blood cell that attaches to glucose, the amount of red blood cells in the blood has a direct correlation to A1c levels.

We already know that patients who have a high turnover in red blood cells, such as those with sickle cell anemia, have an artificially low A1c, because they are making a higher number of new red blood cells. This is similar to what happens when red cells are lost due to a blood donation. A normal donation may require up to four weeks of new red cell production and a double donation may take eight weeks.

It takes about 8 weeks for new red blood cells to attach to glucose and raise the A1c to pre-donation levels.

A1c levels can actually be decreased by 4 to 8% for the first 4 to 6 weeks after a donation, and if a double donation A1c can be as much as 16% off for even a longer time.

Based on this information it is important to tell your patients that they should have their A1c done just prior to the donation, and more importantly we should ask if they have donated blood when they see us for an appointment.

Information from Practical Diabetology June 2008
Richard Benjamin, MD, CMO American Red Cross Blood Services

I don't donate blood. I don't have anything obvious, like sickle cell. I do have recurring anemia and have to take iron or it comes back, but they've never really found an underlying cause (other than the most obvious one). So it sounds like the problem could be too high turnover of red blood cells? I guarantee I am not secretly running low or anything. If anything it should be higher than any past A1c, just due to progression. Oh, and if I saw this A1c for a Type 1, I wouldn't say it was "perfect" - I'd be quite worried.

Administrivia

Someone recently asked me, "don't you ever have any good news?" Of course, that was after she called me over and told me in detail about all the terrible things that had happened to her, and then asked me a lot of questions about our (now ex-)landlord. So, I don't know.

I was supposed to see my endo on the 6th (after making the appointment six months ago), but two days before, they called me and said she won't be in that day, so it got changed to the 25th. I took a big hit for that paycheck-wise, because when you take time off, you not only lose the pay, but you lose the health insurance subsidy normally paid by the employer. It was too late to work those hours, and I'll have to take more time off on the 25th, so it was pretty significant. Anyway, I figured I had plenty of time to review my labs, so I called the receptionist (the lab at this place doesn't do copies). She said cheerfully that the doctor hasn't reviewed them with me yet, so I can't have a copy until the 25th. I asked if she was sure, because I'd never heard of anything like that, and she said yes. Okay. The more I thought about it, the more confused and annoyed I became. Doesn't HIPAA say you have to be allowed access to your medical records? I wanted to see the results before my appointment so I could get an idea of what was going on and because I'm totally anal like that.

I called back, and this time I told the cheery receptionist I thought they couldn't do that. So, she transferred me to the nurse, who made more sense, but said all the wrong things. She said it's the doctor's policy not to release labs without reviewing them. She said I don't have to wait until the 25th, just until the doctor is back in the office in a week and that normally this is never even an issue. Then she said, "unfortunately, you picked the week when the doctor is out of town." Aargh (like I picked the week). She said they do this because they had a problem with patients misinterpreting the results. Well, okay, but I think the law allows them to do that, and I don't think I'm that patient. Although now they'll probably all think I'm difficult.

I really love my endo, but I have a really low tolerance for this kind of administrative stuff. I may have to look into other options. I mean, does anyone see why this is annoying?

Meme

a. Type your answer to each of the questions below into Flickr Search.
b. Using only the first page, pick an image.
c. Copy and paste each of the URLs for the images into mosaic maker.

1. What is your first name?
2. What is your favorite food?
3. What high school did you go to?
4. What is your favorite color?
5. Who is your celebrity crush?
6. Favorite drink?
7. Dream vacation?
8. Favorite dessert?
9. What you want to be when you grow up?
10. What do you love most in life?
11. One Word to describe you.
12. Your flickr name.

#6 isn't actually my favorite drink, but it is my photo and it came up on the first page. Heh.