Medical aids and the future?

In my opinion which some may argue is not humble. I argue it is.

Medical aids restrict care for patients as well as shoot themselves in the foot when it comes to downstream costs.

Particularly in an environment like south africa where we have this tsunami wave of a diabetes epidemic. Approaching things holistically (as CDE which originated in Joburg and is now all over RSA) is the only way to manage the finances we have. Yet the push back from some medical aids is interesting to use a word so as not to offend.

I am merely a GP – general practitioner. I have made it my mission to stay up to date (as well as the most qualified I can be) regarding diabetes at large. I am passionate about it. I am even more passionate about the best care for my patients. This largely could translate to the best money spent for medical aids but alas it does not turn out that way 9 times out of 10.

There are medical aids who are open minded and practice preventative care like Discovery and medications and appliances are provided with insight and good application.

I wish this were across the board. Alas not in our beautiful country.

Patients vote with where they pay their money.  The next few years are critical as to both the direction of medical aids and whether the money will be spent effectively saving downstream costs or whether the whole thing just implodes. Every day another massive wave of patients are added to this problem. It is soon to hit that critical mass where devastation occurs.

We have to become more preventative, we have to manage what we have to the best of our abilities with what we have.  That is best done with more brains. Team is key. Technology is key and unfortunately not everyone is on this boat.

Think before you drink before you drive, think before you eat that cake and you don’t survive.

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Death Oh who art thou?

To lose a loved one is one of the hardest things for me. I am so unsettled by it, especially if it is someone my age or younger. Because I am young. And Death is so definite.

At someone’s memorial or funeral one expects to gain closure and to get some kind of “feeling” that the world is upright again. But alas it is not always so.

My “friendus” Mark Reynolds was a larger than life person who was always going to defeat death until he didn’t. I met Mark on the “kleuterskool” play ground in a small town called Tzaneen where english speakers were in the minority. There were 3 of us : Mark, Vivienne and myself.

We played on the “baantjie” and said ” get away, get away” a lot. We forged a friendship right there and then that lasted an eternity (I hope). Death confuses me and many of the things I hope for (faith) elude my desire for confirmation thereof.

Throughout junior and high school we played, we learned, we experimented. Mark was the first to offer me a cigarette -menthol nogal. I tried it, hated it and it convinced me lifelong that I would not smoke. We hiked in the gorgeous agatha forest, slid down the rocks. We laughed so much mostly our sides split.

We rode horses in Sabie – galloping into eternity together.

More recently Mark attended my sister and my wedding. I will never forget Mark giving my bemused husband-to-be a flower as was his custom.

Mark’s laugh was one of those that triggered others to laugh and not stop. His smile captivated. His heart was one the most beautiful I have ever seen. He sacrificed so much for others – his important others.

In love I believe he was let down so badly it still hurts me. He painted out of that and gave up on romantic love – which is so so desperately sad but I believe he was trying to self preserve. For me this is so tragic as he was a gorgeous soul and the love between 2 people – true romantic love as it were is something that can take one to heights that nothing else can- and it did – only it dropped him too (as it does many).

He had so much to give – in life and love.

Taken way way too soon, I just don’t understand and I guess never will.

What I know is that we must live here now, and make each minute count. We must cherish each other in the moment. Be present in the moment and live each as if the last.

 

To Mark – my “friendus” ignite heaven as I know you will with your soul. Devastate them with the joy that radiates out of it. The deeper the sorrow carves into your being the more joy it can contain. I love you and I always will.

Celebrate and live each minute

Our time on earth is limited by a number none of us know. The quality that we experience depends almost entirely on us – each one, in our own capacity.

Life is very short for some and interminably long for others. The enigma is that there is no way of knowing.

Where does that leave us each, individually?

Life is a strange bag of tricks and boils down to little more that about 40-60 years on average of a daily slog : waking, working, paying for things, sleeping. And yet it can be so much more. It can be.

It depends entirely on your own self. The quality of each minute. The minutes add up and create memories. But essentially if you are not present in the present and enjoying that very minute wholeheartedly it may be a wasted minute, hour, life.

I wish we knew in a way. The hours we each had and the moments that we should make count.

But we don’t.

Perhaps only when you lose a loved one do you re-evalute life on a minute to minute basis.

Today actually counts for more than you think and if you understand that in the realm of time and space we are each such a small inconsequent speck that may or may not live another day, surely it’s worth making this very minute worth it.

Sorrow and sadness fill my being for the loss of a life so huge at some moments and so full of the very essence of life. He lived indeed and took the time to make it special. I so hope that one day I will understand the reason we have a this life and a “death” or after life. I certainly don’t today.

Tidal wave required

Ok so life is interesting in south africa. I would like the kind of money that Manyi  has, 450 million? was it. I would use it to “fund” my patients needs.

Diabetics, type 1’s in particular have many needs. Most of these are not taken care of by their medical aids and despite the fact that patients pay a LOT of money for the privilege of being on one.

Type 1’s require tight control of glucose above a certain range and below a certain range and everything including the weather impacts on blood sugar. Thus continuous monitoring is a tool that can make a very very big difference in a patient’s life – it can also make such a difference that the medical aid is spared costs of admissions for highs and lows, for amputation, renal dialysis, heart attacks as well as costs attached to being blind.

However medical aids at large do not seem the slightest bit interested in saving themselves money.

Far rather milk the patient for all they are worth and at the same time provide the minimum service and complain about any request made by the health care provider who has studied long and hard and has a passion to save the medical aid costs.

Yes I am angry, perhaps at this time of day I am even h”angry”.

I am tired of begging, pleading for minimum standards of care.

I am tired that overseas things get “accepted” years before they do in south africa. Are we really 3 rd world? Despite having the “Manyi’s” ???

We require a tidal wave of protest in the form of intelligent debate with the stakeholders that matter in the realm of diabetes. I am just so tired of fighting.

Please from far and wide across  this beautiful country we call home join me, join the debate, write to your medical aid. Email me : drleethegp@gmail.com.

Please.

Continous monitoring is available in 4 forms in south africa : dexcom G5 and G4, libre flash abbott, medtronic standalone CGM and most new to the scene : ever sense.

Coming in at the lower end is the abbott flash R990 once off and R990 every 2 weeks. Dexcom is a cost upfront more than about 25k and then monthly around 4 k, medtronic around 15 and 2k per month and ever sense brand new so not too sure but in the ball park for the last 2 mentioned.

What is boils down to is MARD and quite frankly this is the bottom line with CGM is accuracy. The lower the MARD the more accurate. There are really only 2 in the market that a great on MARD : dexcom G5 and ever sense, however for the cost the libre is actually a very good value for money.

The other thing that helps me as a practitioner is a trend and all of the devices are good for this.

What we need is for the medical aids to realise that CGM is a tool they their patients can NOT afford to be without! FOR THEIR own sakes – the medical aid’s sakes.

Please tsunami arrive and let’s flood the medical aids with the truth.

Alternatively could the guptas or the Manyi’s or maybe Grace Mugage give me 450 million to spend on my very deserving patients.

Thanks ;).

The injustice of medical aids

 

So I have applied for continuous monitoring for a type 1 patient who has multiple hypos affecting daily living. He is on a top plan of momentum (I have other patients on this plan who fund continuous monitoring). I then appealed and put in a second appeal to their DECLINE.

We have been told in writing that they have declined it a third time but with no reason and that they are withholding their criteria from us.

This is common garden crime!

I say this is bullshit! to put it mildly.

In south africa where we have human rights we have a very progressive legislation and law. We have so much and yet we have nothing.

Medical aids keep moving the goal posts and now we don’t even know what they are in this case.

NO transparency. NO patient care. NO clear communication.

I believe that there needs to be a tide by both patients and doctors against this kind of bullshit decision and policy.

Let me know if you are in and we can go to the ombudsman.

Diabetes does not have to be

To be or not to be – TYPE 2 I mean. Lifestyle induced diabetes. This is a disease that we hardly saw 100years ago. It’s a new thing really.

A question of quality of life I believe. Both to prevent it and to “cure” it. Type 2 diabetes is essentially “toxicity of life” disease. Too much sugar, too much bad stuff, mainly sugar that causes inflammation generally but is specifically bad for the pancreas and the reason being it is like flogging a horse. Every time YOU demand insulin of the pancreas (every time you eat sugar or carbs) it has to produce it. Only it only has so many b cells to do this and the harder you flog it the harder those cells work and you literally flog your pancreas. At some point – once you have lost 50 % of those cells you become diabetic.

Now here ‘s the interesting thing. At 49.9% you are not diabetic but at 50% you are – go figure. Like with a lot of things there is a spectrum. So, surely you understand that one can “pick up ” this continuum BEFORE you qualify for type 2. SO why not find out??

Once you have type2 for real it is a matter of time before you flog those last 50% and then need insulin to save eyes, heart, limbs etc. However IF you take it seriously and “recruit” dying cells that are about to become apoptotic you can actually turn it around a bit, not back to 100% but you can slow the progress and retard the disease. So why not do that?

To be or not to be ? The choice is yours and the decision in your hands for the grab or not?

 

How Bell Pottinger can get away with this??

I know that we have a lot of interesting things happening in the banana republic of south africa. You gotta love our pres and one of his wives looking so sauve at the G20 as if all is just peachy (not to mention dressed to kill).

But hells bells Bell Pottinger please could you go on a quick course on how not to screw over a “cowntry” in a few short months unethically purporting shit.

What I am battling to get my head around is how this happens? And they are just going to get away with it????

I guess in a world where Donald Trump is the US president and making “deals” with Russia (his new/old best friend) and Brexit goes forth with all those shenanigans I should not be surprised by a PR company that is able to purport shit that affects everyday normal multi-coloured (rainbow-nationed) people.

The average person is worse off Bell Pottinger because you sided with a bunch of criminals and chose to spit out trash.

You are the devil along with Donald Trump and all the other role players quickly killing this world. And I guess in this world where the one with the most money gets to be a bully and get away with it this kind of thing will continue to happen. How you sleep at night I do not know.

Wouldn’t it be nice if one could get paid large sums of money for a more mandela like society in Mandela month. How I think he would cry at the likes of you and what you have done.

Why holistic management?

Why is it important to see a team when you have diabetes?

Well because complications are preventable. Dialysis, amputations, blindness, heart attacks and strokes are sequelae to sugars above 10.

Why? This is like pouring coke on the floor, the vessels stick to each other and everything else – creating a sticky stuck mess. Hence blindness, renal failure, amputations etc.

The answer is to be vigilant. See your team every year at least once a year and some of them twice a year, some even 4 x like your doctor if you are a type 1.

The team : dietician (1-2), the podiatrist (1), the educator (1-2) -essentially also the co-ordinator, GP (2-4), or endocrinologist, ophthalmologist (1). Additional benefits : psychologists, biokineticists, nutritionists, life coach.

Libre flash monitoring

The patient driven and marketed libre has arrived in south africa.

R990 for a reader once off which is a meter for both glucose and ketones.

R990 for a sensor that lasts 2 weeks and so i.e. cost per month if worn every day is R990 x2

You scan your button and get a reading every 5 minutes. The device has functions like worked out a1c (3 month average) as well as about 100 more. See the website.

https://www.freestylelibre.co.uk/libre

You need to fill in a form, pay the amount and it gets couriered to you.

Contact me for forms

26 hilton avenue 033 343 1826

😉

Diabetes Ball

Innate hilton is hosting a diabetes winter ball : 26 August 2017. All welcome (i.e. you don’t have to be diabetic). It will be at La Rose Des Vents in Hilton. http://www.larosedesvents.co.za

We are hosting it in aid of one child not on medical aid who is type 1 as well as to raise awareness regarding both type 1 and type 2 diabetes.

Tickets will be on sale shortly.

Please contact Sarah : 0845450848 if you would like to sponsor or buy tickets.

We will kick off the evening at sunset with Tanya Nicholson and St John Haw and canapés and drinks. Followed by a mediterranean dinner and dancing.

Innate

http://innatehilton.wix.com/innate

Holistic integrative medicine

Diabetes still on the rise

Whilst the world (rightly so) is horrified at the current state of zuma/zupta/corruption in south africa to the absolutely insane attacks in the UK but ALSO the ongoing terrible and unacceptable carnage in syria, iraq, afghanistan (this list is way longer and way worse than most of what the “west” has seen).

I would like to bring all of your attention to something that is “silently” killing way more people. Diabetes. Don’t believe me – look at the horrendous stats. They do speak for themselves. In both the west as well as the east as well as the poorest of the poor.

Diabetes is a scurge that is on the surge. And with no even small little sign of stopping.

What is type 2 ? A disease of wealth but also of abnormal eating. There is no reason to get type 2 diabetes unless you have actually “abused” your body OR if you have had cancer or a tumour of your pancreas.

It is a disease of too much sugar into the body. Too many simple carbs stuffed into a single body and the pancreas says ok well enough is enough and all of a sudden once you have lost 50% of them pancreas cells you find yourself diabetic.

Type 1 however is a different story. This is a case of severely unfair dishing out of disease. Mostly children and young adults who out of the blue have total pancreas failure. And become dependant (i.e. you die without it) on insulin.

Type 1 is NOT avoidable by anything you do or do not do.

Type 1’s rely on insulin, without it they die.

Diabetes is killing and causing loss of quality of life for many many people.

Educate yourself and be aware of what you say. Prevent yourself from getting type 2 and help others understand the difference.

The blooming of a womb

I am privileged to watch womb’s bloom. From a tiny teeny little bud of a being to filling up the whole womb with no space to move. From a dot of a heart beat with unfolded heart to a racing raging beating beast of a heart from which the life force flows.

It is a miracle before my eyes and plays out in different ways each time. The fusion of an egg and a sperm that happens so easily sometimes and with so much pain and difficulty at other times.

Life unfolds literally. It starts as and egg and a sperm which merge and then divide and divide and divide until the trophoblast bursts forth a little heart (unfolded) which then takes up the fold. The embryo tucked into itself almost like a little sea horse which then spirals in on itself to further divide and subdivide until by 12 weeks all the organs are formed. Poetry in motion.  A privilege to witness. An 8mm miracle at 7 weeks that grows steadily and miraculously until the birth thereof.

Life, the life force, the presence or absence of a new life. It is a strange beautiful mystery of a miracle and it gets me every time.

Death Oh who art thou?

Source: Death Oh who art thou?

Tidal wave required

Source: Tidal wave required