Thursday, July 25, 2013

Tales From the Shadows, Part II

To properly tell this story, we need to go back--waaay back, to when I was seven, and work our way up from there. (Warning: the background is 90% of this post.)

When I was going into the third grade, I switched schools. In my old school, recess was spent on the jungle gym or the swings or sitting in the grass. In my new school, we got a parking lot in the back. There were two options: sit on the side and be bored, or play tag. 

I noticed then that I had trouble breathing when I ran. I told my mother, who took me to my pediatrician, who said I was a couch potato and needed more exercise. He suggested that I start walking on the treadmill. (I hated that, by the way, because my father ALWAYS made me walk at 1 mph, which was so slow it hurt my legs to try to walk it.)

Needless to say, it didn't help. When I started seeing an allergist when I was ten, my mother made me tell him. He had me run up and down the stairs a few times. Then I came back to his office, where he listened to my lungs and told me I had asthma. 

He prescribed a bunch of different medications, none of which worked. Eventually, I got sick of trying--it was only when I exercised, anyway. And it went away no matter what I did. I got a note for gym that said I couldn't run and that was that. 

Until I started having "real" shortness of breath in the 8th grade. 

That was the first year that the changing seasons made me cough. The nurse actually sent me home so I could see my allergist that day. He gave me an inhaled steroid to be used every day. That helped, a little bit.

But I was still having trouble breathing every day. After I got bronchitis (the first of many, many bouts) at the end of the year, the trouble breathing got worse. I pretended it wasn't there, since it didn't seem like there was anything anyone could do for it. I took my inhaler multiple times--sometimes multiple times in an hour. It didn't do anything.

I saw a pulmonologist at that point. He said I definitely had asthma, and that I should keep taking my inhaler because it was probably doing something, even if I didn't know it was. 

This went on throughout high school. Something would set off my asthma and it would get worse. It rarely got better after it got worse. 

In college, the same thing happened. I got sick of it and made an appt with an allergist that my neighbor recommended. 

She put me on a slew of steroids, tried various different inhalers and even a nebulizer, but nothing worked. The steroids annoyed my blood sugar, one of the inhalers actually annoyed my asthma, and nothing helped much. 

During this time, the only thing I noticed was that I didn't get the asthma cough when I was on steroids since before the spring started. It was very nice not to get that awful deep, painful cough. 

Eventually, she said that she couldn't help me and she recommended I see a pulmonologist. So I did.

I happened to start seeing this doctor a week after I'd gotten a bad bout of bronchitis. What made it bad (other than the cold that made me more miserable than the bronchitis itself) was the shortness of breath. I literally couldn't finish sentences, couldn't walk and talk at the same time, and had to slow down my walk to school. I couldn't do stairs, I couldn't concentrate, and I was really, really uncomfortable all the time because of how bad the shortness of breath was. 

The first thing she told me was that asthma responds to bronchodilators, and that if mine doesn't then it isn't asthma. My PFT (breathing test) was normal like it always was, but my lung's ability to use the gasses in there was pretty low. 

The first thing I was evaluated for was vocal cord dysfunction, which can mimic asthma. Not surprisingly, I don't have that.

She took me off the steroids once the bronchitis got better and I had the methacholine challenge. She also sent me for an echo, just to be sure it wasn't a heart problem. The methacholine challenge came back so normal that the guy who was performing the test was begging the screen to show that I had a decrease in pulmonary function so we'd have something to go on (he liked me and he knew that if it wasn't asthma, we'd be hard-pressed to figure it out). 

The echo came back "abnormal", which was determined to be normal by the cardiologist my pulmonologist referred me to. I had a stress echo (which was the worst test I've ever had, including the EMG I had in the 12th grade), which came back normal. I had a pulmonary stress test, which also came back normal.

At that point, my pulmonologist made me get a letter from a psychologist that my breathing problems weren't caused by stress. To her credit, she accepted the letter at face value and never questioned it again.

I had bronchitis again in October of this year, almost exactly six months from the last time. At that point, I was still practically unable to finish a sentence, minor things like brushing my hair made me short of breath, and I was going out of my mind. After day two on antibiotics (the same antibiotic I'd been on the last time, in the same dosage), my breathing got infinitely better. That is where I stand now.

During that entire period of severe shortness of breath, my diffusion capacity (the part of the breathing test about how well my lungs use gasses) was in the mid to high 60's, when 80 is borderline low. Once I stopped having so much trouble, it went up to the low 80's. That was in December, when I last saw my pulmonologist and I assume it's been the same since.

Last I heard, she wanted me to go for acupuncture (as long as I was going for the fibro, anyway). That probably isn't happening because my insurance won't cover it. I'm seeing her in October. 

Now for the shadowing part. 

I shadowed a pulmonologist during my first month. (I now shadow him steadily, but that's beside the point). Somehow, we ended up in a discussion about how I don't have asthma.

He asked me a bunch of questions, including what sets it off. When he heard that the changing seasons, cold air, exercise, allergies, humidity, stress, laughing, hiccups, crying, etc all set it off, he said there's no way I don't have asthma. He said that negative methacholine challenges don't mean too much, and that exercise studies don't mean much, either, because you warm up when you do them for a long time. When you warm up, he said, the lungs don't overreact as much. As far as medications are concerned, there is such a thing as hard to treat asthma. 

So what, you ask, do you do to treat it, then? Allergy pills (thank you, Zyrtec), regular exercise with long warm-up periods and no exercise in cold air. Avoidance of triggers is also necessary, which would be great if I weren't allergic to common things like dust, mold, and pollen (and nuts and nickel and ibuprofen and contact lenses and lens solutions and soap and shampoo and laundry detergent and perfume and makeup and...the entire world, basically). And, you know, I love to laugh, I can't help it if I cry, and no one can prevent hiccups.

That day had been an eye-opener for me. I don't know if he's right or not, but I'd honestly rather a diagnosis of hard-to-treat asthma than no diagnosis at all.

Wednesday, July 24, 2013

It's Raining

You know that saying, when it rains, it pours? Well, sometimes it's wrong.

My blood sugars finally (FINALLY!) calmed down a couple of weeks ago. I don't know why, other than maybe the higher dose of Met finally kicked in. Maybe that was it. Or maybe it's because my body knew something else was coming.

Right around the time I started the Couch to 5K program, my fibromyalgia started acting up. It hasn't been terrible, but it's more noticeable than it's been in a while.

Sometimes my fibro's just joint pain and stiffness. Sometimes it's just muscle stiffness. Sometimes it's brain fog. Sometimes it's exhaustion. Sometimes my muscles bother me, with pain or without. Fibro is such a variable disorder with such a vast array of symptoms and so many different combinations that it can be hard to keep track of it all.

Lately, it's been my muscles, mostly without pain. I've had some on and off knee pain (my ankle doesn't count in this because it isn't fibro-related, but it's making itself known, too). I don't know if the exercise has anything to do with it--honestly, I hope it doesn't. I may not be enjoying myself, but I really, really want this exercise thing to work.

I haven't told anyone about my flare-up. I don't see much reason to. My sister would only get upset, my father wouldn't understand, my best friend wouldn't be able to help at all, and my close family friend who's the closest thing I have to a mother doesn't need to be upset.

Speaking of her (we're going to call her L here), she's been driving me home some days after shadowing. The past two times I've gone home with her, she's asked if I was up for doing the stairs before we went down to her car. She has three kids with major joint and back issues, so she understands, but I never expected her to ask. It feels strange to have someone check with me if I can do something, rather than whether I can eat something.

The truth is, no one ever asks me. My best friend takes the elevator with me if it's more than one flight up, but unless I ask, we always take the stairs down. (The one flight up thing is for my breathing.) My sister never, ever asks--to her, there's nothing wrong with me. My father is too oblivious to notice. If I'm shadowing a doctor, I don't say a word, even if they do ask.

Speaking of shadowing, I've been having trouble with that. My fingers and feet swell a little when I stand for too long, which feels a lot worse than it sounds. My knees get stiff when I stand and don't walk for a long time. It bothers my muscles, too. It's very frustrating, because I can't say a word, but I'm SO uncomfortable sometimes.

It isn't bad enough for me to consider meds yet. I'm not at the point I was when I saw the rheum in April--I was desperate then. Now, I'm just annoyed.

I'd rather the joint stiffness and muscle stiffness any day to this. This weird feeling in my muscles is awful. The swelling is annoying. I'm just so sick of this.

At least my diabetes is behaving. It's about freaking time.

Wednesday, July 10, 2013

Tales from the Shadows, Part I

These stories are in no particular order, other than what stands prominent in my mind whenever I log on. Tonight, it's about allergies.

Remember when I blogged about how the Disabilities Center refused to let me bring my epi-pen into the testing room? I now have a story for them (and my doctor, which will get me a note of consent to bring my epi-pens in).

One morning, we shadowed in pediatric hematology/oncology. There was a room in the back of the clinic for the doctors and residents to log information into the computers, consult with each other, and just rest between patients.

My partner (whom we will call A from now on) and I were sitting at one of the desks together, whispering just to have something to do before we started seeing patients.

I heard the word "walnuts". My head whipped around so fast that I swear I could've gotten whiplash. One of the doctors was telling another doctor about the topping for her yogurt. I turned to my partner and whispered that I'd go wait in the hallway, and that she could come if she wanted but she didn't have to. I told the doctor we were shadowing where I was going and I left.

My partner came about five minutes later. I was grateful that she'd come, and that she didn't make fun of me. (She did say something about how hypersensitive to my surroundings I am, but considering my history of severe reactions from airborne allergens, I don't feel weird about it at all.)

After about twenty minutes of standing outside and leaning against the hallway walls, we decided it was safe for me to go back in. I sat across the room from the garbage can and from where she'd been sitting. I didn't feel safe, but I didn't feel threatened, either.

We saw a few patients, then we came back. We sat for another hour or so with a resident, who was explaining to us and a med student how to read a chest X-ray. We were then given permission to leave early, so we did.

Around the time we left, my palm felt very, very itchy. I figured that it was nothing, given the fact that, well, skin itches sometimes. But it refused to go away.

We walked all the way back to the office before I noticed that my right palm was bright, bright red. The redness from an allergy is so red that it almost glows, and it's immediately recognizable to people who know what they're looking for. If you've ever seen a skin infection, it looks something like that.

I knew I should take a Benadryl, because that's the first step I take for ANY allergic reaction unless I can't breathe or can't swallow. However, since I wasn't 1000% sure that it was, in fact, a reaction, I was hesitant to take something that would make me sleep. And I couldn't take Zyrtec because I'd been taking it every, single day for months. (If it isn't a bad or rapidly progressing reaction, I'll take Zyrtec sometimes because Benadryl can have weird side effects for me. But I also take it for seasonal allergies.)

I went to the bathroom to wash my hands before lunch while I decided. And about a minute after I'd washed my hands, the itching completely stopped. The redness took about an hour to subside.

My theory is that this doctor had touched the yogurt or the topping (it happens) and touched the desk afterwards. HOURS later, I must've put my hand down in the same spot, which caused the reaction.

Honestly, I'm lucky. I've had one very severe reaction from airborne walnuts and several smaller ones from airborne tree nuts or peanuts. I'd imagine that touch reactions should be worse, but I think that the nightly Zyrtec was what saved me.

This has never happened to me before, and it had me a bit spooked for a few days. Life goes on, but the memory of what could happen remains. When I see my doctor next (he's a neighbor--I can just ask the next time I'm at his house), I'll tell him that I need a note permitting me to bring my epi-pens into the testing room. The risk of someone else eating a peanut butter sandwich and using the keyboard before I do is too great--and if I'm not taking Zyrtec at that point...I don't want to think about it.

The funny thing is that my FA is rarely on my mind. Oh, it's there subconsciously--I always, always check food labels before I eat, I always, always ask what's in the food, but I don't think about it all the time. My epi-pen is just there, like my wallet it--loaded into my bag with no thoughts. It makes me feel safe, but that isn't a conscious thought, either. It's more like the song stuck in your head for days--you find yourself mindlessly humming it, but you don't bring it up in a thoughtful kind of way. It's the first thing my mind jumps to if I'm itchy, or if I can't breathe. It's the first thing on my mind if I feel dizzy or my heart rate is fast. But it's not a constant presence.

In fact, I'm happy this happened--now I have proof that this CAN and DOES happen. The Disabilities Center won't know what hit them.

"They've had eons more time than we/ Is it possible could it be/ Am I watching you watching me?" ~The Chromatics (Astrocapella)


And just as an update, I was high (140's and 150's) from dinner for nearly three hours. Yay.

The Ballad of the Repeat Highs

Sometimes I make "bad" food choices. It happens. Sometimes (read: almost always) it causes problems for the rest of the day.

This morning, I had a bowl of cereal for breakfast. It's an oatmeal-based cereal, and I'm well aware of the fact that it makes me high. I usually combat this by eating a half serving, which, with milk, is about 30g of carbs.

This morning, I was sick of seeing the bottom of the bowl through the cereal. 1/2 cup of cereal really is enough, but the plastic bowls my father buys are very wide, so it doesn't look like much. (I know the solution to this problem--use a plastic cup.)

So this morning I had a full serving, plus maybe a drop extra, plus milk. We're talking something perilously close to 60g of carbs here. Not my usual AT ALL and it's a number of carbs I never, ever eat. With good reason.

About a half hour after finishing breakfast, I was 179. I deserved it, I know. I felt it, though not too much. It was more like an ache behind my eyes that I could ignore if I wanted to, and a slight feeling of dizziness. Was the cereal worth it? Probably.

I didn't sit up high for long at all, and I was coming down within ten minutes or so. My guess is that I came all the way down, since that's how my body usually works on Metformin as long as it isn't time for another dosage change.

Not even an hour later, I made myself a coffee. Since I don't really like coffee itself (just the caffeine and the milk and the fake sugar), I have a very specific coffee recipe that includes a TON of coffee grounds, very little water, a lot of milk, a lot of Splenda, and ice. Occasionally, when I have half and half in the house, a splash of that goes in, too. (It did today.)

Well now wasn't I surprised to see a 147 before I'd even finished the coffee? (Okay, one or two Madelines might've gone in there, too.) Usually, coffee and Madelines aren't enough to bring me above 130. Especially since Madelines are mostly fat and coffee is mostly milk, which doesn't usually bother me.

I'm back to 99 now, which is about 25 minutes after the 147. I feel fine, which is great, but I'm seriously pissed off.

This is a phenomenon that's been bothering me for a while. If I overdo it on the carbs on any given day, it's like my body runs out of insulin for the rest of the day. Sometimes if I'm really unlucky, the repeat highs stick around for a few hours before going back to normal. Today might still be one of those days, since I haven't really tested the waters yet with the repeats.

This is one of the reasons I'm so sure insulin is a better bet for me than Met or any of the oral drugs. It's clear  that my body is insulin deficient. I'm clearly pretty insulin-sensitive if I drop so fast after highs. (No, I do not think it's a result of oversecretion, because if it were, I'd probably drop slower, and I'd end up with reactive hypos at the end, which I do if I don't eat for hours and hours after a high. If it were oversecretion, I'd steadily drop until I'm low, not drop to about 120 and hang out for a few hours before going low.) But if I'm experiencing repeat highs like this, it means my body is running out of insulin and it can't make up the deficit fast enough.

Tonight I'm supposed to be going out to dinner. Though I wasn't intending to order an entire plate of pasta, I was intending to go a little more carb-heavy than I usually do. I guess I should've thought about that before I had a nice bowl of cereal this morning, but that's easier said than done.

Emotionally, low-carbing is hard. People like to see lots of food on their plate, even if it's too much. Often enough, people eat more than they should just because their eyes are bigger than their stomachs. In the case of carbs, they're often hungry again 3-4 hours later. I find that the more grain carbs I eat, the hungrier I am. (Except in the case of this cereal, which has awesome powers of filling.) Protein and salt seem to be the key to filling me up.

But even if I know, intellectually, that 1/2 cup of cereal is enough, it looks so sad to have a huge bowl with nothing in it. And eating cereal in a cup isn't eating it from a bowl. I don't really miss eating all carbs all the time, but I do miss the freedom that it used to afford.

"So you've made a lot of mistakes/ Walked down the road a little sideways...You can do what you think is impossible/ Keep on believin' don't give in/ It'll come and make you whole again" ~Rascal Flatts

Monday, July 8, 2013


And pissed off and many, many other things.

Warning: This is a post about how much I hate my body. I don't usually get like this, but MAN, am I annoyed.

So today I decided to do my second day of Couch to 5K. So, all geared up in a pony tail and sneakers, with a pre-workout BG of 95, I was all set to go. I even brought my Kindle for company through the walking parts (and as encouragement for after the running parts).

The first running bit went okay. And I thought that this might actually be as easy as the last time. Ummm, maybe not.

By the second running bit, the very, very back of my throat started burning/hurting. That's THE sign that my breathing's flaring up when I'm already out of breath. (Being out of breath is okay if you're running, it's not okay if you're going up the seven stairs in your house. In Normal Life, my breathing is fine unless I'm being "strenuous", but when I'm exercising, the only way to tell what isn't normal is gauging with pain.) It subsided by the end of the walking stint. And then it happened again. And again. And again. Through the last five running bits.

Once I'd gotten off the treadmill (with a BG of 81), I felt okay. Tired, and hot, and thirsty, but okay. I took a shower, and I figured the steam would help open my lungs some more.

For the next hour I was fine. And then, out of nowhere, while sitting on the couch watching TV and minding my own business, out comes a deep breath I just can't catch. I tried a few times, then gave up. But I felt like I Needed to take a deep breath. And I couldn't.

At some point, my pulmonologist tried to misdiagnose me with sighing dyspnea (where you can't take a deep breath and you end up yawning or sighing all the time because you're trying to). That's caused by Stress. After that, I actually had to get a letter from a psychologist that my breathing issues are not caused by said Stress before she'd consider anything else.

Now, Stress does annoy my breathing. The same way running does and laughing does and crying does and not getting enough sleep does. All are forms of stress, but if this were caused solely by emotional stress, I wouldn't have had so much trouble breathing ALL NIGHT. Nothing different happened tonight more than any other night. I was, in fact, more relaxed than I have been in a while, considering the fact that the MCAT is over. If you want to call it Stress, I will not agree with you.

On top of my inability to breathe tonight, my ankle hurts, which I expected. (I foresee an MRI in my future, which my podiatrist suggested, along with orthotic inserts for my apparently flat feet). My knees hurt at some point during the running, but that was transient. I'm suppressing a cough, for fear that it starts and never stops (a fear that is justified, considering my years and years of experience in the matter). The bottoms of my lungs ache, which is from the strain of trying to breathe (another explanation for another time). I'm annoyed and sick and tired of my body. I have a few Choice Words to say to it, all of which are four-lettered at base and none of which involve the word "love".

The cause for my breathing difficulties? Probably the A/C, because the treadmill is in the coldest room in the house. That is a problem that I will need to experiment with, considering my propensity for exercising where the treadmill is. Good luck to me.

Who Would Believe

My story with diabetes is tangled, complicated, and not over yet. It started with my father being diagnosed with reactive hypoglycemia years ago--probably about nine or ten. Then I was diagnosed with Hashimoto's Disease when I was fourteen, which forced me to go see an endocrinologist.

The pediatric endocrinologist I saw denied my reactive hypoglycemia symptoms, insisting that if I had it, I'd have fainted several times. I didn't like him in general, and I was very, very happy when he stopped taking my insurance a year later.

A year after that, when I was sixteen, I went to see my father's endocrinologist. My father pushed me to tell him about my symptoms (shaking, irritability, starving hunger, severe headaches, whenever I hadn't eaten for a few hours), and he offered me a meter. I documented my blood sugars whenever I felt low, and three months later he sent me for an oral glucose tolerance test.

The OGTT didn't show anything really significant, except a high fasting insulin level (which I'm not entirely sure was accurate). My doctor diagnosed me with reactive hypoglycemia, and that was, supposedly, that.

A few months later, I started seeing numbers in the 140's and 150's in the week before my period. These were accompanied by paralyzing fatigue and headaches, as well as a feeling of just not feeling well. My endocrinologist assured me that they were hormone-induced.

At that point, the worst experience I'd had was a 160 at a school weekend retreat. I missed some of the program on Friday night--specifically meant for seniors, which I was. And I was 60 an hour later. Needless to say, I felt awful that night.

This continued through my first year of college. I also had extremely stubborn lows during finals that year. My endocrinologist tried to convince me that I had insulin resistance that May. I was 18, 5'2", 142 pounds. Not ideal, but certainly not a body-type (or lifestyle) for insulin resistance. (I walked two miles a day, minimum, just for my walk to and from school.) I asked for, and received, antibody tests for type 1 diabetes. They came back negative.

The next year, I started seeing an allergist/asthma specialist. She tried to control my asthma with steroid inhalers, which didn't work all that well.

I don't remember which inhaler did it, but one of them drove my blood sugars up, up, up. The day I hit 200 in class from one slice of thin-crusted whole wheat pizza, I had enough. (I fell asleep in class and was 50 a half hour later.)

I called my allergist, who told me to call my endocrinologist. He put me on Januvia, which evened out my blood sugars. No more highs, and, oddly, no more lows.

About a month and a half later, my new pulmonologist (who my allergist recommended I see), pulled me off the steroids so she could run a test called a Methacholine challenge, which is used to prove or disprove a diagnosis of asthma. When I went off the steroids, I went off the Januvia.

A month later, I started seeing highs like I'd never seen before. Nearly everything I ate sent me above 150. Even though I came down within two hours (usually), the damage was done and I'd often be out of commission for the rest of the day.

After a full summer of this, I saw my endocrinologist in October. After seeing my high c-peptide, he told me that he thought I had an enzyme deficiency and told me to stop eating grains.

So I did. And even after stopping all grains, I still had problems. In fact, the more carbs I cut out of my diet, the more I had to cut out. It came to the point where the only carbs I could eat were uncooked fruit, non-starchy vegetables, and milk. And even then, I needed to start cutting out milk.

Highs at this point started within ten minutes of eating and lasted for three to four hours. During the first month of that spring semester, I hardly got any schoolwork done because I was always so tired and feeling so sick. When I saw my endocrinologist that February, he finally, finally stuck me on Metformin.

The Met 500mg worked well for the first week. Then I started seeing highs again, though I'd stopped feeling them. I was so happy about that that I didn't care what numbers I was seeing.

When I started feeling highs again, I called my endo. He pushed the Met up to 500mg twice a day. During that phone call, I asked him if I was the only one who thought this was strange. He asked me if I'd ever heard of a disorder called MODY. I had, but I let him explain it, anyway.

The last time I saw him, I asked him to re-run the antibody tests. He did, and, of course, they were negative. He also pushed the Met up to 500mg three times day.

I'm back to pushing for MODY testing. My insurance claims they'll cover it if there's pre-authorization and the medical necessity for it. I tried to get tested through the Kovler Diabetes Center in Chicago, which runs a MODY research center. They'll test you for free if you fit certain guidelines. They didn't want to test me because I don't have a linear three-generation history of diabetes.

I called my endocrinologist's office today for the pre-authorization. Is it sad that I'd rather battle it out with my insurance company myself than let me endo's office do it? Because I don't really trust them to get it done and get it done right.

I'll keep you updated. This feels like it'll be a long haul.

"You feel like a candle in a hurricane/ Just like a picture with a broken frame...You get mad you get strong/ Wipe your hands shake it off/ Then you stand" ~Rascal Flatts

Saturday, July 6, 2013

Catching Up

I've been away for a long time. Like I said it would be, the last month or so has been crazy. 

I went to Maryland with my friend. I ended up being fine AND I had fun. I made sure to keep hydrated, I didn't sleep much, and though I had a few slight highs, there was nothing awful and nothing that kept me out of commission. (The biggest reason why? Their pizza has twice as much cheese as dough.)

I spent a month shadowing doctors. For the most part, it was a wonderful experience. I ended up buying a Tummietote to keep all my supplies in so I wouldn't bring around a backpack (which the patients and doctors don't like) and so I wouldn't bring around a fanny pack (which I don't like). It works wonderfully. 

During that time, I got almost no sleep because I was studying for the MCAT and getting up early to be in the hospital by 8 (most mornings). That part wasn't fun.

I took the MCAT this past Tuesday. My blood sugar behaved, but the test itself wasn't too great. Basically, my brain freaked out about halfway through and turned off, at which point I could no longer concentrate. I'm NOT happy about it. I get the results in about a month.

I've finally started the Couch to 5K program--tonight. It wasn't as torturous as I expected it to be, though it did bother my lungs more than I expected it to. We'll see how this works out as it goes along. 

Pre-workout blood sugar: 101
Post-workout blood sugar: 123

In other news, my latest set of antibody tests was negative. Back to MODY testing, which will be explored in a later post. I'm now on 1500mg of Metformin per day--one pill during every meal. The most annoying part of that is that I'm forced to eat three meals per day instead of snacking all day. I can't tell if it's actually working or not because it wasn't at first and then it started to--the opposite pattern my Metformin increases usually run. 

I'll be posting the highlights of my shadowing experiences over the next few weeks. 

"Summer nights/Everybody are you with me/Let that Igloo cooler/Mark your piece of paradise" ~Rascal Flatts