The 7-Stages of RateMD

I came across this and figured I'd share it here

The Seven Stages of RateMDs:

1 - Shock and Denial

"I can't believe my doctor could be so wrong about my diagnosis. After all, when I search on Google, I find other conditions not nearly so bad that I'm sure I have. I'm going to go post a negative review about my horrible doctor who is so wrong!!"

2 - Pain

"It really hurts me that my doctor gave me such a bad diagnosis! I'm going to go post a negative review on RateMDs about how much he hurt me!"

3 - Anger

"It's all my doctor's fault that I have this terrible problem!! I'm going to go post a negative review on RateMDs about how it's all their fault!!"

4 - Bargaining

"Reading in the forums on RateMDs, lots of people there say that all doctors are wrong about everything, so they must be right and my doctor must be wrong, the internet says that there's nothing wrong with me so now I just have to "educate" my doctor about that and then everything will be fine"

5 - Depression

"My doctor wants to put me on an anti-depressant, I'm going to go post a negative review on RateMDs explaining how he just wants his magical drug company kick-back that I'm sure all doctors get every time they write a prescription"

6 - Testing and Reconstruction

"Hmm... this RateMDs place has a bunch of people who all seem to agree with me that all doctors are clueless and horrible, I'm going to spend some time there and see if I feel better about having had such a horrible doctor!"

7 - Acceptance

"Hmm... looks like my doctor was right all along... oh well, I'm having too much fun complaining about him on RateMDs so why stop now?"

If only the above wasn't so so so true...

Note: I have never personally received a negative review on this website.

Perhaps, if there were more

Perhaps, if there were more transparency and accountability by the Hospitals, Surgeons, Colleges of Physicians and Surgeons, Chief Coroner's Office, people would never have to post here. You presume that all posters are wrong in their assessments of treatments and care. My daughter had open abdominal surgery to remove a tumor and had a colon resection. All this done without antibiotic prophylaxis. No antibiotics post op when her incision became infected. The following concerns were never answered by the Surgeon, the Hospital, the local coroner and the Chief Coroner of Ontario, Canada.

My daughter bled out 12 hours after being discharged!!! She died.

How about the enlarged abdomen?
How about the foul, purulent oozing incision?
How about the fact she had no colon cleansing?
How about the fact that she did not have the anti-biotic prophylaxis given at the time of induction?
How about the fact she received no anti-biotics what so ever?
How about the fact the she remained on a liquid diet for 8 days consisting of jello, juice, tea and both withoutany nutritional supplement?
How can a wound heal without proper nutrition?
How about the fact her resting pulse rate was over 90
How about the fact that she was only receiving 687 calories per day for 8 days?
How about the many gram negative bacilli seen? And not treated.
How about the low Absolute Lymphocyte (type of white cells)?
How about the many PMN’s (polymorphonuclear Neutrophils) –? hallmark of acute inflammatory process
How about the above normal temperatures?
How about the low hemacrit, red blood cell count and haemoglobin?

American surgeons were kind enough to give their opinion. None in Canada would dare!

Why should I need, or have to go outside Ontario and Canada's Borders to get the answers I seek?
Excerpts below from experts outside of Ontario and Canada

Dear Mr. Kilby: Of course I will be happy to review your materials and give you an opinion. It is always disappointing to hear that other surgeons are not willing to take the time to offer opinions regarding cases that may have been mismanaged. ....... I would believe it to be a grave mistake to have NOT prepared a patient's bowel if there was any chance the bowel would need to be entered during the surgery. ......If indeed her abdomen was distending, and her pulse rate rising over an observable period of time, then the really important issue was why was she not rushed back into the operating room when it was clear that an intra-abdominal catastrophe was occurring?

Dear Mr Kilby
......I think there are a lot of problems with this case and you have a strong case to proceed. ......Bleeding from a stapled anastomosis that leads to hemorrhage shock and death seems a little unusual. I see negligence in this case

Dear Mr Kilby
......I find it difficult to justify what appears to be a "whitewash" of the patient's cause of death. The points you have raised are--in my opinion--legitimate reasons to question the validity of classifying her death as "natural" and would support your complaint of inadequate investigation. ........She unmistakably died of surgical complications that were arguably survivable with less flawed management.

Dear Mr Kilby

I recognize that there were serious complications, and probably unnecessary complications, with your daughter’s care. From what I have read I believe that the standard of care was not met which caused your daughters demise. .....this case which appears to be or at least border on malpractice.

Dear Mr Kilby

I have concerns that the nurses documented for Terra's abdominal exam that her abdomen was "large" for the last several days of her stay in the hospital. More importantly, they document for a number of days prior to her discharge that there was a foul smelling odor and that the wound was "oozing copious amount of purulent discharge" during this entire time as well is very concerning. .....

This doesn't happen with a superficial wound infection. These things happen when there is an anastomotic breakdown and leakage through the wound and possibly into the peritoneal cavity.

Mr Kilby
I am concerned about the description of the abdominal examination progressing from "rounded" to "large" The nutritional aspect is contributory ......supplemental nutrition should reasonably have been considered.
**********************************************************************
Mr Kilby

I am going to respectfully disagree with the Coroner.

If you take a look at the charts, it seems to me that nurses and doctors are talking about two different patients.

Doctors are talking about a stable patient who is afebril , and her wound is healing , and their plan is to discharge the patient within 1-2 days.

On the other hand, nurses are talking about a patient who has a fluctuating vital signs [particularly her Temperature], patient is refusing food while she is stating to nurses that she is hungry, and she tells nurses that she does not have pain but nurses are giving her pain medications anyway, and finally patient's abdomen is going from flat to round and large.
Don't you think, these people either did not know what they were talking about or something serious was happening to the patient? May be the thing that was happening was not septic shock but it was ileus, may it was not ileus but it was leaking from perforated site. Something was definitely wrong. It is easy to conclude that both nursing and medical care provided to patient was inadequate and below the standard of care. The definition of negligent malpractice in law is " failure to meet the standard of practice by health care professionals" and " omission of act that the fiduciary relationship of a nurses and physician with their patient, obligate them to do for their patients"

Inadequate and meaningless physician progress note. Physician must write their progress note in SOAP system [ CPSO requires that all physician's note to be written in SOAP method. S: subjective, means what patient is telling me O: Objective, what I observe , A: assessment, vital signs and physical assessment, P: Plan, what I am going to do for this patient in order to address her complaints and her abnormal physical findings]

Ultimate responsibility lies with Terra's surgeon!

And:
Antibiotics are recommended for colon surgery just prior to the start of the operation but should be stopped within 24 hours unless there are clinical indications to continue beyond the 24 hour period. These are the guidelines in the US and the goal of perioperative antibiotics is to prevent wound infections from surgery.
Sincerely,
*****************************************************************
I would have given her anti-biotic prophylaxis. I would like to know the diagnosis before the operation to be able to say if I would have had your daughter have bowel cleansing.
*****************************************************************
The antibiotic prophylaxis is used to prevent infection during and after surgery. . Please feel free to ask more questions.
****************************************************************
Both are standard practice for whoever undergoing elective colorectal surgery unless your daughter received an emergency surgery without time for formal bowel preparation. Once again the colonic surgery is a clean contaminated operation, routine antibiotics prophylaxis should have been given
Thanks
*****************************************************************
I will only say that in the US it is considered standard of care to administer IV prophylactic antibiotics within one hour of skin incision for a clean-contaminated surgical case. *****************************************************************
Antibiotics are routinely given prior to colorectal operations, whether open or laparoscopic *****************************************************************
All patients having surgery are required to have antibiotic preoperative and if there is a documented infection it is mandatory to treat it with antibiotics
****************************************************************
Yes of course a patient should receive antibiotics prior to colon resection
****************************************************************
Yes, she should have received "preoperative" antibiotics within One Hour if beginning operation.
*****************************************************************
Bowel preparation and administration of antibiotics for prophylaxis prior to surgery have been a standard of care in surgery for at least 25 years. In my opinion you have every reason to deserve frank answers about what happened to your daughter.
*****************************************************************
It is the standard in the United States to give prophylactic antibiotics within one hour of surgery.
*****************************************************************
The standard of care in the US is for patients undergoing any surgery is antibiotics within 1 hr of surgery, and for 24 hrs after surgery.
*****************************************************************
There is no doubt she should have been given pre-operative and post operative antibiotics.
*****************************************************************
I do think it is fair to say that a preoperative antibiotic dose for a colon resection is the standard of care in this country.
*****************************************************************
The standard of practice for prevention of wound infection in colon surgery is to use prophylactic antibiotics. *****************************************************************
Yes antibiotic prophylaxis prior to colon surgery is standard
*****************************************************************
We still adhere to the fact that patients should have a dose of antibiotics at the time of surgery for most colorectal procedures especially those involving a resection. Ireland
*****************************************************************
I know that it is the accepted procedure to use prophylactic antibiotic coverage for colon surgery in the hospital where I work here in Denver, CO.
*****************************************************************
The standard of practice for prevention of wound infection in colon surgery is to use prophylactic antibiotics
*****************************************************************
In the United States, it is standard of care to administer appropriate antibiotics within one hour of surgical incision for any case deemed at risk for infection. We get in trouble for any case not
administered and documented as such.
****************************************************************
The answer to your question on antibiotic prophylaxis is a clear yes.
The Surgical Care Improvement Project (SCIP) has established clear guidelines on antibiotic prophylaxis prior to all surgery (timing, type). Here in the US our hospital is literally graded on compliance with the SCIP protocols. As a department chair I am responsible for compliance on my team and have to have appropriate procedures in place to assure compliance. *****************************************************************
The big problem is apparently not cleaning the colon with laxatives or enema prior to surgery.
*****************************************************************
All patients used to receive pre-operative antibiotics prior to any colonic surgery. *****************************************************************
It is standard of care in the United States that all patients undergoing bowel surgery should receive pre-operative prophylactic antibiotics at least 20 min before the incision is made. *****************************************************************
It is standard that all pts receive perioperataive antibiotics with a goal of administering them within 30 minutes prior to skin incision. It is a well validated quality outcome parameter. *****************************************************************
The short answer to your question is that, yes, antibiotics should be given prior to colon surgery (and most other surgeries for that matter). The discharge of somebody with abdominal distention who had undergone a wound packing for infection also seems well below acceptable standards here in the US. Usually if abdominal distention arises post op the etiology of that distention needs to be sought prior to discharge.
****************************************************************
In the United States, the practice is to perform at least a mechanical bowel prep before an elective colon resection and in all circumstances perioperative antibiotics are given, usually prior to the incision.
****************************************************************
It sounds like your daughter did not receive the appropriate standard of care. Patients undergoing colon resection (if not an emergency), should receive colonic cleansing pre-op. Additionally, all patients undergoing surgery should receive pre-operative antibiotics. It does not seem that her nutritional supplementation was adequate. Finally, it seems that she was discharged while still infected. *****************************************************************
I can only say by the description here that there must have been some kind of contamination either during or after surgery most likely coming from the bowel itself based on the gram negatives you describe.

SO, YOU SEE ISLAND-DOC., YOU BASED ALL OF YOU ABOVE POINTS ASSUMING THE POSTERS DO NOT KNOW WHAT THEY ARE TALKING ABOUT. I CERTAINLY DO!!

There seems to be a big

There seems to be a big change between #6 and #7. Like magic.

island_girl wrote: "Hmm...

island_girl wrote:

"Hmm... looks like my doctor was right all along... oh well, I'm having too much fun complaining about him on RateMDs so why stop now?"

Would you prefer that ratemds " DEMANDED" proof of allegations... what would happen then?

That is so so so NOT true. Do

That is so so so NOT true.

Do you have any positive ratings from your patients? If not, maybe you spend too much time in court defending doctors like the one who treated AWK’s daughter rather than actually seeing patients.

That must give you a warm fuzzy feeling inside as you’re driving your Porsche around the island.

If patients post unfair negative reviews about a doctor I would bet a great deal of that has to do with how the doctor made them feel when they walked out of the exam room. Not for the reasons you listed.

The internet is not going away. Patients are going to use it as a resource, so doctors might as well embrace that fact and try to educate patients by guiding them towards legitimate sites to learn more about their condition.

(I just had a horrible flashback from Catholic school where the nuns told us not to read the Bible or ask questions....just believe what we tell you. Let the “experts” study and interpret the Bible and tell you what to believe.)

It would be nice if more doctors had the balls to stand up to the few bad doctors instead of supporting their negligent medical practices. I guess there’s not a lot of incentive to do that other than one’s honor and dignity.

Hmmm......I’m feeling the need for another animation video.....let’s see...I-doc vs Ratemds....Evil

gagal wrote: That is so so so

gagal wrote:

That is so so so NOT true.

Do you have any positive ratings from your patients? If not, maybe you spend too much time in court defending doctors like the one who treated AWK’s daughter rather than actually seeing patients.

That must give you a warm fuzzy feeling inside as you’re driving your Porsche around the island.

If patients post unfair negative reviews about a doctor I would bet a great deal of that has to do with how the doctor made them feel when they walked out of the exam room. Not for the reasons you listed.

The internet is not going away. Patients are going to use it as a resource, so doctors might as well embrace that fact and try to educate patients by guiding them towards legitimate sites to learn more about their condition.

(I just had a horrible flashback from Catholic school where the nuns told us not to read the Bible or ask questions....just believe what we tell you. Let the “experts” study and interpret the Bible and tell you what to believe.)

It would be nice if more doctors had the balls to stand up to the few bad doctors instead of supporting their negligent medical practices. I guess there’s not a lot of incentive to do that other than one’s honor and dignity.

Hmmm......I’m feeling the need for another animation video.....let’s see...I-doc vs Ratemds....Evil

My PCP absolutely hates educated patients & especially internet educated ones. I had to diagnose my own diabetes (type 2). I have a family history so I always randomly checked my glucose. After getting a 240, I told the doc who did a finger stick that came back within normal. He says I do not have diabetes. My fasting results at his office have been high normal or just above for years. I really believe I should have been on Metformin for a long time. Anyway, our old family doc always told us all that over 200 was diabetes. So I began a regular check of fasting which was always too high & a drugstore A1C which was 7.5--also way too high. When I took this to my PCP he instantly told me the drugstore tests weren't reliable but he did one that was 7.2.

So, on to Metformin & my last A1c was 6.2 which is good, but I'm having quite a few highs and every afternoon a low. I told the doc this & he kept telling me the A1c was fine. I said yes, I know but it's an average & it doesn't reflect what's happening to me. He kept telling me the same thing. Got angry when i said that I had read that over 140 was damaging--which I'm having over that almost daily--didn't deny that it is damaging. Said he was going to refer me to a specialist who would tell me the exact same thing he had.

He was really huffy & I'm trying to find someone else but our good doctors are never taking new patients.

Strangely enough, my PCP has pretty good ratings here.

impatientpatien wrote: My

impatientpatien wrote:

My PCP absolutely hates educated patients & especially internet educated ones. I had to diagnose my own diabetes (type 2). I have a family history so I always randomly checked my glucose. After getting a 240, I told the doc who did a finger stick that came back within normal. He says I do not have diabetes. My fasting results at his office have been high normal or just above for years. I really believe I should have been on Metformin for a long time. Anyway, our old family doc always told us all that over 200 was diabetes. So I began a regular check of fasting which was always too high & a drugstore A1C which was 7.5--also way too high. When I took this to my PCP he instantly told me the drugstore tests weren't reliable but he did one that was 7.2.

So, on to Metformin & my last A1c was 6.2 which is good, but I'm having quite a few highs and every afternoon a low. I told the doc this & he kept telling me the A1c was fine. I said yes, I know but it's an average & it doesn't reflect what's happening to me. He kept telling me the same thing. Got angry when i said that I had read that over 140 was damaging--which I'm having over that almost daily--didn't deny that it is damaging. Said he was going to refer me to a specialist who would tell me the exact same thing he had.

He was really huffy & I'm trying to find someone else but our good doctors are never taking new patients.

Strangely enough, my PCP has pretty good ratings here.

Thank you for the perfect example of what's wrong with "internet educated patients"

You did such a wonderful job of proving the point that I'll throw you a bone:

Type II diabetes is diagnosed by measuring fasting INSULIN levels, not glucose levels.

Unless the fasting insulin level is out of range, Metformin is both not indicated and potentially harmful.

Maybe you need a referral to an endocrinologist instead of just diagnosing yourself with google?

impatientpatien wrote: After

impatientpatien wrote:

After getting a 240, I told the doc who did a finger stick that came back within normal. He says I do not have diabetes. My fasting results at his office have been high normal or just above for years. I really believe I should have been on Metformin for a long time. Anyway, our old family doc always told us all that over 200 was diabetes. So I began a regular check of fasting which was always too high & a drugstore A1C which was 7.5--also way too high. When I took this to my PCP he instantly told me the drugstore tests weren't reliable but he did one that was 7.2.

So, on to Metformin & my last A1c was 6.2 which is good, but I'm having quite a few highs and every afternoon a low. I told the doc this & he kept telling me the A1c was fine. I said yes, I know but it's an average & it doesn't reflect what's happening to me. He kept telling me the same thing. Got angry when i said that I had read that over 140 was damaging--which I'm having over that almost daily--didn't deny that it is damaging. Said he was going to refer me to a specialist who would tell me the exact same thing he had.

An A1C of less than 6.5% is regarded as being within normal range, and *anything* above that does not necessarily indicate Diabetes Mellitus Type 2. The diagnosis is generally made when an A1c reads >6.5%. It is the average coverage of your hemoglobin by glucose, which is what leads to the damage. Glucose causes hemoglobin to clump together, it displaces oxygen and it also chokes the blood supply in the blood vessels, most notably the capilliaries. Loss of muscle and nerve function follows, and eventually, tissue necrosis.

When reviewing A1Cs which are less than three months apart, keep in mind that it is a [i]moving[/i average, so changes in it lag behind those reflecting daily glucose levels.

Traditional diagnosis using an FFG (fasting plasma glucose), a 2hPG (2-hour plasma glucose), or random glucose test with symptoms are still recommended for diagnosing diabetes, as A1C can be misleading in certain ethnicities and is not recommended for diagnosis in children, adolescents, pregnant women, or people with type 1 diabetes. Age, too, affects A1C values, which can increase by up to 0.1% per decade, however, further studies are required to determine if “age-adjusted A1C thresholds are required for diabetes diagnosis in the elderly,” write the study authors.

Anyone *can* experience a spike, owing to a variety of things, most notably what was recently eaten. Certain scenarios can even fool the liver (a producer of glucose) into thinking one's level is too low, causing it to produce and release more glucose. Basically, you're diabetic when your A1C is >6.5%, it's not falling, and normal glucose meter readings are the exception.

My afternoon glucose still reads 12 mmol/l (216 mg/dl) on oral medications and my last A1C read 11.4%, down from 11.8% three months previous. One more oral medication and then I'm almost certainly onto insulin (diabetic clinic staff are strongly recommending insulin *now*). Diabetics are advised to aim for a glucose level of 5 to 8 mmol/l (90 to 144 mg/dl), a little above the optimum range of 4 to 7 mmol/l (72 to 126 mg/dl). Generally, a non-constant glucose level under 10 mmol/l (180 mg/dl) is considered "not dangerous". Morning glucose can sometimes be quite high, in anyone, especially those who have a habit of skipping breakfast.

If you returned to normal from 240 mg/dl, you may well be non-diabetic, or possibly, pre-diabetic. Some mornings I awaken to 17 mmol/l (306 mg/dl), before taking my meds. You may also have tested too soon after consuming food high on the glycemic scale. Lack of exercise can produce high numbers, as well.

If you're checking your glucose with a meter, try waiting four hours to ensure that your glucose has completely fallen. Check your glucose. Then, go for a brisk walk. Check your glucose again. You may be surprised at the results.

Are you symtomatic?

* Please disregard my earlier

* Please disregard my earlier post *

impatientpatien wrote:

After getting a 240, I told the doc who did a finger stick that came back within normal. He says I do not have diabetes. My fasting results at his office have been high normal or just above for years. I really believe I should have been on Metformin for a long time. Anyway, our old family doc always told us all that over 200 was diabetes. So I began a regular check of fasting which was always too high & a drugstore A1C which was 7.5--also way too high. When I took this to my PCP he instantly told me the drugstore tests weren't reliable but he did one that was 7.2.

So, on to Metformin & my last A1c was 6.2 which is good, but I'm having quite a few highs and every afternoon a low. I told the doc this & he kept telling me the A1c was fine. I said yes, I know but it's an average & it doesn't reflect what's happening to me. He kept telling me the same thing. Got angry when i said that I had read that over 140 was damaging--which I'm having over that almost daily--didn't deny that it is damaging. Said he was going to refer me to a specialist who would tell me the exact same thing he had.

An A1C of less than 6.5% is regarded as being within normal range, and *anything* above that does not necessarily indicate Diabetes Mellitus Type 2. The diagnosis is generally made when an A1c reads >6.5%. It is the average coverage of your hemoglobin by glucose, which is what leads to the damage. Glucose causes hemoglobin to clump together, it displaces oxygen and it also chokes the blood supply in the blood vessels, most notably the capilliaries. Loss of muscle and nerve function follows, and eventually, tissue necrosis.

When reviewing A1Cs which are less than three months apart, keep in mind that it is a moving[/i average, so changes in it lag behind those reflecting daily glucose levels.

Traditional diagnosis using an FFG (fasting plasma glucose), a 2hPG (2-hour plasma glucose), or random glucose test with symptoms are still recommended for diagnosing diabetes, as A1C can be misleading in certain ethnicities and is not recommended for diagnosis in children, adolescents, pregnant women, or people with type 1 diabetes. Age, too, affects A1C values, which can increase by up to 0.1% per decade, however, further studies are required to determine if “age-adjusted A1C thresholds are required for diabetes diagnosis in the elderly,” write the study authors.

Anyone *can* experience a spike, owing to a variety of things, most notably what was recently eaten. Certain scenarios can even fool the liver (a producer of glucose) into thinking one's level is too low, causing it to produce and release more glucose. Basically, you're diabetic when your A1C is >6.5%, it's not falling, and normal glucose meter readings are the exception.

My afternoon glucose still reads 12 mmol/l (216 mg/dl) on oral medications and my last A1C read 11.4%, down from 11.8% three months previous. Given that level combined with being fully symptomatic, I was diagnosed with Type 2 immediately, with confirmation coming with the second test. That's when there's an exception to having to undergo a [i]fasting glucose test.

One more oral medication and then I'm almost certainly onto insulin (diabetic clinic staff are strongly recommending insulin *now*). Diabetics are advised to aim for a glucose level of 5 to 8 mmol/l (90 to 144 mg/dl), a little above the optimum range of 4 to 7 mmol/l (72 to 126 mg/dl). Generally, a non-constant glucose level under 10 mmol/l (180 mg/dl) is considered "not dangerous". Morning glucose can sometimes be quite high, in anyone, especially those who have a habit of skipping breakfast.

If you returned to normal from 240 mg/dl, you may well be non-diabetic, or possibly, pre-diabetic. Some mornings I awaken to 17 mmol/l (306 mg/dl), before taking my meds. You may also have tested too soon after consuming food high on the glycemic scale. Lack of exercise can produce high numbers, as well.

If you're checking your glucose with a meter, try waiting four hours to ensure that your glucose has completely fallen. Check your glucose. Then, go for a brisk walk. Check your glucose again. You may be surprised at the results.

Are you symtomatic?

island-doc

island-doc wrote:
impatientpatien wrote:

My PCP absolutely hates educated patients & especially internet educated ones. I had to diagnose my own diabetes (type 2). I have a family history so I always randomly checked my glucose. After getting a 240, I told the doc who did a finger stick that came back within normal. He says I do not have diabetes. My fasting results at his office have been high normal or just above for years. I really believe I should have been on Metformin for a long time. Anyway, our old family doc always told us all that over 200 was diabetes. So I began a regular check of fasting which was always too high & a drugstore A1C which was 7.5--also way too high. When I took this to my PCP he instantly told me the drugstore tests weren't reliable but he did one that was 7.2.

So, on to Metformin & my last A1c was 6.2 which is good, but I'm having quite a few highs and every afternoon a low. I told the doc this & he kept telling me the A1c was fine. I said yes, I know but it's an average & it doesn't reflect what's happening to me. He kept telling me the same thing. Got angry when i said that I had read that over 140 was damaging--which I'm having over that almost daily--didn't deny that it is damaging. Said he was going to refer me to a specialist who would tell me the exact same thing he had.

He was really huffy & I'm trying to find someone else but our good doctors are never taking new patients.

Strangely enough, my PCP has pretty good ratings here.

Thank you for the perfect example of what's wrong with "internet educated patients"

You did such a wonderful job of proving the point that I'll throw you a bone:

Type II diabetes is diagnosed by measuring fasting INSULIN levels, not glucose levels.

Unless the fasting insulin level is out of range, Metformin is both not indicated and potentially harmful.

Maybe you need a referral to an endocrinologist instead of just diagnosing yourself with google?

I have NEVER, in the year & a half of having diabetes been told any test was for a fasting insulin level. Only glucose stick & HA1C were ever done. At any rate, are you saying, with A1c over 7 that I don't have diabetes? And with fasting glucose levels sticking in the 140 range with some over 200 are you saying that I don't have diabetes? Are you saying my bringing this to my PCP"s attention was a mistake? Did you note that I have a long history of tests above normal? Also, I'm not stupid enough to not consider carefully any source on the internet. Actually, I still read actual books, too.

I have escorted my mother (diabetic for years) to her doctor who never in my knowledge took a fasting insulin level. Nor in my brother & SIL's many yrs as diabetics. If it's commonly done don't know why we never had it. Of us all, only Brother had a glucose tolerance test. Even at VA where they do every test known to man, he's never had it. Is there a specific name for this test?
We're all taking Metformin--are we in danger from our medication??? They were all diagnosed because of repetitive high glucose except brother who was diagnosed after glucose tolerance test. As I said, our old family doctor said over 200=diabetes. Can we have all these high readings (some over 400) & our insulin NOT be out of whack?

My PCP did a finger stick glucose, an A1C & diagnosed me with type 2 diabetes & prescribed Metformin. Are you actually saying this was not correct procedure.

Also, since A1C is an average, can you imagine this scenario--person arises with fasting glucose at 220. afternoon glucose is 80. Average is 140--still damaging (yes or no? over 140 damaging????) Scenario repeated with variations usually not as sharp difference but often over 140 even several hours after reasonable meal. The average may end up being in the 130's but what about the extended highs?

Is it acceptable for my PCP to become angry when I wanted him to answer some of these questions?? Especially the one about damage from levels over 140? Read carefully and see that he would not answer that question. Told him I have a diabetic friend who just had two amputations & I was worried. I wonder what you think about these actions.

Looking for a new PCP and old one said he would refer me--hasn't in the two weeks since. I will soon call again & risk more wrath. Anyway, if you are willing, I would love to have your answers & recommendations.

MicOnTheNorthShore wrote: *

MicOnTheNorthShore wrote:

* Please disregard my earlier post *

impatientpatien wrote:

After getting a 240, I told the doc who did a finger stick that came back within normal. He says I do not have diabetes. My fasting results at his office have been high normal or just above for years. I really believe I should have been on Metformin for a long time. Anyway, our old family doc always told us all that over 200 was diabetes. So I began a regular check of fasting which was always too high & a drugstore A1C which was 7.5--also way too high. When I took this to my PCP he instantly told me the drugstore tests weren't reliable but he did one that was 7.2.

So, on to Metformin & my last A1c was 6.2 which is good, but I'm having quite a few highs and every afternoon a low. I told the doc this & he kept telling me the A1c was fine. I said yes, I know but it's an average & it doesn't reflect what's happening to me. He kept telling me the same thing. Got angry when i said that I had read that over 140 was damaging--which I'm having over that almost daily--didn't deny that it is damaging. Said he was going to refer me to a specialist who would tell me the exact same thing he had.

An A1C of less than 6.5% is regarded as being within normal range, and *anything* above that does not necessarily indicate Diabetes Mellitus Type 2. The diagnosis is generally made when an A1c reads >6.5%. It is the average coverage of your hemoglobin by glucose, which is what leads to the damage. Glucose causes hemoglobin to clump together, it displaces oxygen and it also chokes the blood supply in the blood vessels, most notably the capilliaries. Loss of muscle and nerve function follows, and eventually, tissue necrosis.

When reviewing A1Cs which are less than three months apart, keep in mind that it is a moving[/i average, so changes in it lag behind those reflecting daily glucose levels.

Traditional diagnosis using an FFG (fasting plasma glucose), a 2hPG (2-hour plasma glucose), or random glucose test with symptoms are still recommended for diagnosing diabetes, as A1C can be misleading in certain ethnicities and is not recommended for diagnosis in children, adolescents, pregnant women, or people with type 1 diabetes. Age, too, affects A1C values, which can increase by up to 0.1% per decade, however, further studies are required to determine if “age-adjusted A1C thresholds are required for diabetes diagnosis in the elderly,” write the study authors.

Anyone *can* experience a spike, owing to a variety of things, most notably what was recently eaten. Certain scenarios can even fool the liver (a producer of glucose) into thinking one's level is too low, causing it to produce and release more glucose. Basically, you're diabetic when your A1C is >6.5%, it's not falling, and normal glucose meter readings are the exception.

My afternoon glucose still reads 12 mmol/l (216 mg/dl) on oral medications and my last A1C read 11.4%, down from 11.8% three months previous. Given that level combined with being fully symptomatic, I was diagnosed with Type 2 immediately, with confirmation coming with the second test. That's when there's an exception to having to undergo a [i]fasting glucose test.

One more oral medication and then I'm almost certainly onto insulin (diabetic clinic staff are strongly recommending insulin *now*). Diabetics are advised to aim for a glucose level of 5 to 8 mmol/l (90 to 144 mg/dl), a little above the optimum range of 4 to 7 mmol/l (72 to 126 mg/dl). Generally, a non-constant glucose level under 10 mmol/l (180 mg/dl) is considered "not dangerous". Morning glucose can sometimes be quite high, in anyone, especially those who have a habit of skipping breakfast.

If you returned to normal from 240 mg/dl, you may well be non-diabetic, or possibly, pre-diabetic. Some mornings I awaken to 17 mmol/l (306 mg/dl), before taking my meds. You may also have tested too soon after consuming food high on the glycemic scale. Lack of exercise can produce high numbers, as well.

If you're checking your glucose with a meter, try waiting four hours to ensure that your glucose has completely fallen. Check your glucose. Then, go for a brisk walk. Check your glucose again. You may be surprised at the results.

Are you symtomatic?

You sound like my brother's case. He is now on insulin & found it not nearly as hard as he thought it would be but his levels are still far from what they should be.

I'm not symptomatic other than more frequent urination & getting shaky in the afternoon when the level gets below 100 or so. Also very cold feet which I'm afraid may be circulation problem starting. I've seen a podiatrist (for an unrelated problem) & sensation is still normal. Eyes ok, too.

I've never returned to normal levels on a regular basis. I have lost 20 lbs but seem stuck there--at least I'm not gaining.

I'm worried by the lack of concern by my PCP when I first told him I'd gotten a high reading. My blood draws (from arm for all my stuff) always were just at the top of normal or slightly over--126 or so. He was aware of that although he ignored it even when I reported a 240 glucose. I think it should have been investigated farther than a finger stick glucose. He is also supposed to be aware I have a strong family history of diabetes as well as having high cholesterol, high blood pressure & overweight with several chronic autoimmune diseases.

Even if he were right & nothing matters but the HA1C reading, he still should have been concerned because his patient was concerned.

Best wishes for you getting better control of your diabetes. Are you suffering from eye problems, etc?

impatientpatien wrote: I have

impatientpatien wrote:

I have NEVER, in the year & a half of having diabetes been told any test was for a fasting insulin level. Only glucose stick & HA1C were ever done. At any rate, are you saying, with A1c over 7 that I don't have diabetes? And with fasting glucose levels sticking in the 140 range with some over 200 are you saying that I don't have diabetes? Are you saying my bringing this to my PCP"s attention was a mistake? Did you note that I have a long history of tests above normal? Also, I'm not stupid enough to not consider carefully any source on the internet. Actually, I still read actual books, too.

As I said, our old family doctor said over 200=diabetes. Can we have all these high readings (some over 400) & our insulin NOT be out of whack?

My PCP did a finger stick glucose, an A1C & diagnosed me with type 2 diabetes & prescribed Metformin. Are you actually saying this was not correct procedure.

Also, since A1C is an average, can you imagine this scenario--person arises with fasting glucose at 220. afternoon glucose is 80. Average is 140--still damaging (yes or no? over 140 damaging????) Scenario repeated with variations usually not as sharp difference but often over 140 even several hours after reasonable meal. The average may end up being in the 130's but what about the extended highs?

Is it acceptable for my PCP to become angry when I wanted him to answer some of these questions?? Especially the one about damage from levels over 140? Read carefully and see that he would not answer that question. Told him I have a diabetic friend who just had two amputations & I was worried. I wonder what you think about these actions.

The A1C is a measurement of the glucose coverage of red blood cells. As those cells live an average of 2-1/2 to 3 months, the "average glucose coverage" represents your average glucose level over that period of time.

Anyone's glucose level can spike during the day. Lack of exercise can allow it to rise. Your liver can produce a little too much at times. Ingestion of alcohol and some foods can cause a delayed increase. Averaging glucose meter readings is virtually meaningless in the absence of discrete information pertaining to food intake and energy expenditure.

An A1C <6.5% is "healthy". However, a value above that is not necessarily unhealthy, as other factors need to be considered. Is the situation temporary? Is it due to a change in diet or exercise? An A1C of >11% is a virtual diagnosis, as any average that high would not likely have many lows within the normal range. Readings >6.5% and <11% are indicative and require confirmation, such as a fasting glucose test or a second A1C.

An average of 130 or 140 is not exactly life threatening. When you go low, your blood vessels undergo repair. It's when the near-constant lows hit 130-140 that you are risking problems or 180 that you have trouble. The glucose meter is best used for estimating meal portions and fast action medication (insulin) dosing. At 140, your level may come down on its own after walking to the bank (normal) but will require medication if you need to eat before going out. Take a glucose reading in the morning, *after* you are up and around and had some water, but before consuming anything else, and one before dinner. Keep a food diary. If you are consistent in diet, exercise, and testing, the results *may* be indicative. BTW, some medications can play havoc with blood glucose.

Ask for a referral to an endocrynologist, and don't take no for an answer. S/he will order the requisite A1C, fasting glucose, electrolytes, and cholesterol labs, etc. and render a definitive diagnosis. You could be pre-diabetic, diabetic, or it could be something else affecting your glucose. If you are diabetic, your endocrynologist will want to determine, among other things, whether you are insulin resistant, cannot produce insulin on demand, have a low baseline, etc. It's never as simple as recording a string of highs and throwing metformin at it. That medication helps your body utilize its insulin better ("insulin resistance"), but it doesn't serve to raise its availability.

Your cholesterol figures prominently as well in the overall scheme of things for diabetes. The labs may also indicate whether you have inflammation, which is one of the signs of potential damage. The endocrynologist should also spend some time with you explaining the tests themselves and the results. In some areas, clinics are held to educate diagnosed patients as to care needed in managing the disease.

A doctor gets a negative

A doctor gets a negative rating because he/she EARNS it. The positive side of my complaints against Dr. Victor Mak’s malicious surgical errors and his cover ups is to have alerted potential victims of such a dangerous doctor and expose to the public the corrupt manner of the CPSO’s many investigations. The well-being of our citizens depends upon the integrity of our healthcare system.

So I hope you did you mean the following points of complaints against Dr. Mak and my long fight with the CPSO to have the truth revealed are results of my “having fun”.

    1. Dr. Mak failed to dissect the lymph nodes but only fatty tissue was cut out and he lied about it;
    2. Dr. Mak failed to remove the whole prostate gland and left cancerous cells in Mr. Ching's body;
    3. Dr. Mak severed Mr. Ching's 3 veins and bled more than Mr. Ching's total body blood volume in less than 45 minutes;
    4. Dr. Mak did not explain the cause and the nature of the traumatic bleeding;
    5. Dr. Mak perforated Mr Ching's rectum during the prostate surgery;
    6. Dr. Mak prescribed a bowel injury antibiotics 1 day after the prostate surgery but this doctor’s order was removed to cover up such treatment;
    7. Dr. Mak “doctored” his operative note to cover up everything;
    8. certain party/parties broke the law by removing incriminating medical documents to spare Dr. Mak;
    9. the CPSO made up non-existing facts to acquit its peer assessor Dr. Victor Mak.

BLOOD TESTS FOR

BLOOD TESTS FOR DIABETES

Fasting Insulin

The best test is your fasting insulin level. The normal range is considered to be 5 to 25 uUnits/ml, but a chronic fasting insulin level over 10 uUnits/ml is probably too high, and anything staying over 15 uUnits/ml on repeat testing should be considered hyperinsulinemia.

Beta cells in the pancreas produce insulin. Insulin stimulates uptake of glucose (sugar) from the blood to the cells in the body. When the body's cells are resistant to the action of the insulin, it is called insulin resistance (IR). As a result of the insulin resistance, the pancreas produces much more insulin than normal. This is called hyperinsulinemia. As an example, in a normal person, 1 unit of insulin might be needed to help 10 mg of glucose go into the cell, but in a hyperinsulinemic person, 10 units of insulin might be needed to get the same 10 mg of glucose into the cell.

Hemoglobin A1C

In the blood, glucose binds irreversibly to hemoglobin molecules within red blood cells. The amount of glucose that is bound to hemoglobin is directly tied to the concentration of glucose in the blood. Since red blood cells have a lifespan of approximately 90 days, measuring the amount of glucose bound to hemoglobin can provide an assessment of average blood sugar control during the 60 to 90 days prior to the test. This is the purpose of the glycated hemoglobin tests, most commonly the hemoglobin A1c (HbA1c) measurement.

Note that while this test is useful in a diabetic patient, where the stability of glucose levels is (attempting to be) controlled by diet and/or medication, a random A1C test in an untreated individual can be as much a reflection of their food choices, timing of meals and intake of high glycemic index foods as anything else and is typically NOT diagnostic of disease.

Again, a little bit of knowledge from the internet without actually spending years and years in school understanding WHAT IT ALL MEANS, probably does more harm than good.

If you think you have diabetes (including type II) YOU SHOULD SEE AN ENDOCRINOLOGIST. Almost any GP can do a good job of managing diabetes but diagnosing it can be a lot more complicated and yes, there are actually other things to be ruled out and investigated before just jumping on the "it must be diabetes" diagnosis without actually even checking if the patient has high fasting insulin levels (which is what type II diabetes actually IS, hyperinsulinemia due to insulin resistance).

Yes, there actually is a differential diagnosis for high blood sugar levels and out of whack A1Cs, in a previously undiagnosed and uninvestigated patient, wow big surprise!!!

I'm tired of this place again... didn't take long.

impatientpatien wrote: gagal

impatientpatien wrote:
gagal wrote:

That is so so so NOT true.

Do you have any positive ratings from your patients? If not, maybe you spend too much time in court defending doctors like the one who treated AWK’s daughter rather than actually seeing patients.

That must give you a warm fuzzy feeling inside as you’re driving your Porsche around the island.

If patients post unfair negative reviews about a doctor I would bet a great deal of that has to do with how the doctor made them feel when they walked out of the exam room. Not for the reasons you listed.

The internet is not going away. Patients are going to use it as a resource, so doctors might as well embrace that fact and try to educate patients by guiding them towards legitimate sites to learn more about their condition.

(I just had a horrible flashback from Catholic school where the nuns told us not to read the Bible or ask questions....just believe what we tell you. Let the “experts” study and interpret the Bible and tell you what to believe.)

It would be nice if more doctors had the balls to stand up to the few bad doctors instead of supporting their negligent medical practices. I guess there’s not a lot of incentive to do that other than one’s honor and dignity.

Hmmm......I’m feeling the need for another animation video.....let’s see...I-doc vs Ratemds....Evil

My PCP absolutely hates educated patients & especially internet educated ones. I had to diagnose my own diabetes (type 2). I have a family history so I always randomly checked my glucose. After getting a 240, I told the doc who did a finger stick that came back within normal. He says I do not have diabetes. My fasting results at his office have been high normal or just above for years. I really believe I should have been on Metformin for a long time. Anyway, our old family doc always told us all that over 200 was diabetes. So I began a regular check of fasting which was always too high & a drugstore A1C which was 7.5--also way too high. When I took this to my PCP he instantly told me the drugstore tests weren't reliable but he did one that was 7.2.

So, on to Metformin & my last A1c was 6.2 which is good, but I'm having quite a few highs and every afternoon a low. I told the doc this & he kept telling me the A1c was fine. I said yes, I know but it's an average & it doesn't reflect what's happening to me. He kept telling me the same thing. Got angry when i said that I had read that over 140 was damaging--which I'm having over that almost daily--didn't deny that it is damaging. Said he was going to refer me to a specialist who would tell me the exact same thing he had.

He was really huffy & I'm trying to find someone else but our good doctors are never taking new patients.

Strangely enough, my PCP has pretty good ratings here.

I am very fortunate to have a great primary care doctor. In the past he has referred me to the internet to get more information and call if I had any questions about what I read.

Just this past year I needed to see a specialist. After some of the comments from doctors on this forum I was a little apprehensive bringing up some things I read on the internet.

I said, “Can I tell you what I read on the internet or would you rather not hear it?” Then I smiled.

He smiled back and said, “Ah, Dr. Internet!" We both chuckled then had a great discussion about what I read. He corrected a term I used saying that wasn’t really used anymore. He never talked down to me and wasn’t afraid to use technical jargon.

I have been so lucky with my experiences with doctors…..in the real world.

impatientpatien wrote: You

impatientpatien wrote:

You sound like my brother's case. He is now on insulin & found it not nearly as hard as he thought it would be but his levels are still far from what they should be.

I'm not symptomatic other than more frequent urination & getting shaky in the afternoon when the level gets below 100 or so. Also very cold feet which I'm afraid may be circulation problem starting. I've seen a podiatrist (for an unrelated problem) & sensation is still normal. Eyes ok, too.

I've never returned to normal levels on a regular basis. I have lost 20 lbs but seem stuck there--at least I'm not gaining.

I'm worried by the lack of concern by my PCP when I first told him I'd gotten a high reading. My blood draws (from arm for all my stuff) always were just at the top of normal or slightly over--126 or so. He was aware of that although he ignored it even when I reported a 240 glucose. I think it should have been investigated farther than a finger stick glucose. He is also supposed to be aware I have a strong family history of diabetes as well as having high cholesterol, high blood pressure & overweight with several chronic autoimmune diseases.

Even if he were right & nothing matters but the HA1C reading, he still should have been concerned because his patient was concerned.

Best wishes for you getting better control of your diabetes. Are you suffering from eye problems, etc?

I was extremely symptomatic by the time I presented (in the ER), but only because I ignored it for five years. Occasionally blurred vision, weight drop from 205 to 145, excessive thirst and frequent urination, recurrent loss of dorsiflexion, cold hands and feet, pain in lower legs and feet, numbness eventually reaching my waist, and a few nasty infections requiring IV antibiotics, and that neverending fatigue. Many mornings I'll test at 17/306 and others, at 4.5/81. It can be at bit bizarre. What's important is doing everything you can to maintain an even keel. I have a cholesterol problem (low HDL emitter) and transient arrythmia, which requires that I try to maintain my glucose as carefully as possible.

As soon as the ER gave me a dose and Rx for metformin, my eyes cleared up. My GP increased the dose, and my endocryinologist added glyburide (pushes beta cells to excrete more insulin), increasing my metformin. My eyes have returned to normal, the numbness is restricted to my lower legs though the pain has increased, the dorsiflexion is better, but it's still hard to walk at times. The fatigue is still a killer. Staff at the diabetic centre are trying to nudge my endocrynologist to initiate insulin. He just wants to try one more oral medication, even though he expects it to be ineffective. I'll try to convince him to prescribe the insulin at my next appointment.

Get to that endocrynologist as soon as possible. They'll get your situation figured out and a good therapy working for you. This is a disease which is progressive, but one in which we can exert some control of how fast it progresses and how it affects us.

gagal wrote: He smiled back

gagal wrote:

He smiled back and said, “Ah, Dr. Internet!"

Did you remind him that Dr. Internet still makes house calls at 3 am? Laughing out loud

.

.

MicOnTheNorthShore

MicOnTheNorthShore wrote:
gagal wrote:

He smiled back and said, “Ah, Dr. Internet!"

Did you remind him that Dr. Internet still makes house calls at 3 am? Laughing out loud

Of course, as a matter of fact I am going to request a house call right now. Maybe he can give me something to help me sleep. Evil

The Seven Stages of RateMDs

The Seven Stages of RateMDs for Canadian Posters

1 - Shock and Denial
I can't believe the College doesn't care what happens to patients. I can’t believe they didn't even look at the evidence in the charts, and simply accepted the doctor’s misleading reply as fact.

2 - Pain
The doctor was dishonest in his response to the College. The doctor took no accountability for his actions, and the medical expert accepted his lies as fact. Nobody cares.

3 - Anger
I wanted an investigation into what happened; I wanted to learn exactly what happened and why, and help prevent this from happening to other patients, but there was no learning. The doctor’s negligence was defended.

The doctor’s response to the College was deceitful; I can see that. Why can’t the College’s medical expert see that? The College investigator should not be allowed to call herself a nurse. The investigation was biased.

Doctors like that Idoc make a lot of money giving biased medical expert opinions. I wonder if the "I" stands for "Idiot". The truth doesn't matter to doctors like Idoc. People don't matter; all that matters is money.

Random Thoughts is a member of the CMPA; so is Twain. He’s no Rabbi Baskin! That pain doctor causes pain! Emotional pain is pain, and secondary harm is painful. That doctor in London calls himself a Christian? What did Jesus say was the most important commandment??? Riddle me that!

4 - Bargaining
I will appeal. I will organize all of my information and share all of the facts, and show that the doctor was negligent in his care and the College was negligent in their duty to do a proper investigation. A proper investigation can still be done.

5 - Depression
The panel upholds the College’s decision because they believe the doctor’s lawyers. Patients are no match for experienced lawyers, hired by the CMPA. The doctor, the College and the two CMPA lawyers against the patient; there is no justice. Nobody will see the truth; this doctor will learn that he can lie and the CMPA and the College will support his lies. There is no justice.

6 - Testing and Reconstruction
RateMDs is a place where I can share the truth. I can post the truth here and help patients. There is still a chance that learning can be done – even if it’s just to save patients from the secondary harm caused by the College and the CMPA.

7 - Acceptance
It may be true - there is no justice. Doctors can harm a patient and if that patient or their loved one complains to the College or starts a lawsuit, they are very likely to receive additional unnecessary harm from both the College and the CMPA. Doctors and their organizations can’t see the forest for the trees. They don’t have an understanding of what secondary harm is.

The CMPA is a Goliath, and patients who have been harmed are David, and through Ratemds, we can try to fight the good fight, but we’ll never win. Doctors and their organizations must join us in becoming “David”, and fighting for a “Just Culture of Safety” for all.

Rabbi Baskin states: “After our time on earth we carry nothing away except the memory of our character, our good deeds, our good name.” Doctors and their organizations need to see what they are taking away. One day, they will clearly see. I must have faith. I must have hope.

Hope- Paul Brandt
http://www.youtube.com/watch?v=5O_RAaleOhk&feature=related

God knows the hearts of doctors, nurses, patients and their loved ones. God is merciful and loving. There will be justice.

Bravo!! I really like the "I"

Bravo!! I really like the "I" for IDIOT! Big smile

coldbloodsurgery

coldbloodsurgery wrote:

Bravo!! I really like the "I" for IDIOT! Big smile

This would be an example of the "Anger" stage. Eye-wink

From my experience with the CPSO, and Margaret Obermeyer, I believe it is definitely justified anger.

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