August 23, 2018, 2:45 p.m.
I liked it that my appointment with my new PCP was only 2 miles away from home (instead of 10+ miles to Alameda). I did not like it that there is no wi-fi or cell phone coverage inside the Kaiser building.
I checked in a half hour early, anticipating that I would need to fill out paperwork. I didn’t, but a medical assistant ushered me into Dr. Prabaharan’s office after taking my weight (132.0 lbs) and blood pressure (107/67). She asked me all the routine questions, including, “Do you have any tingling or numbness in your feet?” I said, “Yes, as a matter of fact, I do,” so she told me to take off my shoes and socks. She also told me to take off my top but leave my bra on and put on the paper jacket with the opening in front.
Dr. Prabaharan was pleasant, as I expected he would be after seeing his picture online (when I selected him for my new PCP). He speaks Tamil as well as English. Of course, he had my complete medical records on his workstation, as well as my pharmacy account. I told him about the Lyrica and I couldn’t afford the copay, so I was planning to just use my acquired pain management tools when my current supply of Lyrica ran out. But I was still planning to pursue a way to get it.
He asked if I still took Humulin, and I said, “Yes,” and somehow felt compelled to tell him that I had been on 95u a day but now was down to 25u, and that I had worked with Dr. Michelle Poon, PharmD, and learned how to “titrate” my insulin based on my numbers.
We talked about my feet (since he asked why I had my shoes off). I told him what I told the medical assistant, that the outer side of my left foot felt numb and the third and fourth toes on my left foot had a tingling sensation that I noticed especially when I put my feet under the bed covers. I told him about my arthritis flare in January and how I had lost feeling in my fingers and thumb and I was sure it was peripheral neuropathy. He stopped me. “You don’t have diabetic peripheral neuropathy in your hands or your feet,” he said. I was stunned! He continued, “Peripheral neuropathy is never unilateral. And it will start with toes or fingertips, and progress from the extremities inward, like putting on a glove or a sock.”
Since we were talking about feet, I told him that my physical therapist (Francis) is very strongly encouraging me to walk as part of my treatment plan for my chronic neck pain. “So I am aiming to walk more,” I told Dr. Prabaharan. I told him I averaged 3,000-4,000 steps a day, following quickly with, “I know that’s not nearly enough. But it’s better than not walking at all.” He did agree that walking is one of the best exercises that a diabetic can do.
He also could see my last lab work which was in February of this year when I had a 6.6% A1C. I told him about my chronic pain and that I thought the pain was a factor in my higher blood sugar. He agreed. I told him I’m on a low-carb diet, focused on meat and vegetables, no grains or potatoes. He didn’t bat an eyelid! And he said those words that every low-carb diabetic wants to hear from her doctor: “Whatever you’re doing, just keep doing it.”
He asked about the colon cancer screening and I said I usually get it around this time of year but I haven’t yet. He checked my chart and saw that I had done it last year in September. “You’ll probably get it in the mail in a couple of weeks.” And then he talked about the lab tests that I needed to get. “You’ll need to have a full lipid panel, tests for liver and kidney function, TSH, and I’m adding A1C.” I expected that.
He asked how my general health was, aside from the chronic pain. He said, like digestion. I said, “Fine, since I no longer take metformin but take berberine instead.” Again, he did not show any concern. But then when I said I take Prevacid, he asked when I take it. “Morning,” I said. “And when do you take your levothyroxine?” I hesitated. “Um, morning. Why?” He explained that Prevacid inhibits absorption of levothyroxine. “In fact,” he said, “you should take your levothyroxine an hour before you eat or put anything else in your stomach!”
Finally, I got brave enough to ask him about the c-peptide test to determine insulin levels. “What is your medical opinion?” I asked him. “That it is virtually useless,” he answered, “because it will not make any difference in your clinical management.” I understood. I was not expecting any different answer. So I now know that if I really want a c-peptide test, I will have to get one from a third-party source.
Overall, I felt the appointment was positive. Dr. Prabaharan’s experience and competence was obvious, and I appreciated that. It was only after I left his office that I remembered I had forgotten to ask him about a new glucose meter. Well, there’s always email.
