Author Topic: visit to the dermatologist  (Read 187 times)

0 Members and 1 Guest are viewing this topic.

Offline nytquill17

  • Global Moderator
  • Posts: 6,523
  • It's all in the balance.
visit to the dermatologist
« on: 10 January 2018, 02:14:21 AM »
As part of moving house and getting a new GP, I have gone through the laundry list of "little things I'd like to get seen to", and I mentioned the odd patch on my leg. I then got a referral to a dermatologist which I have just been to (the upside of living in the part of the country with the highest number of HCPs per capita I think! A dermatology appointment would have taken YEARS in my old city and here it took just months!)


Anyway, the upside of it is that he has confirmed that the patch is "as classic a case of necrobiosis lipoidica diabeticorum as you're ever likely to see." So there we have it, my first official complication. As my fellow sufferer Himtoo will know (*waves to Paul*), it's supposed to be incredibly rare (not that that helps me much!) and we don't know much about what causes it. And no treatments really stand out as being particularly effective. So he said the best thing is just to leave it as is unless it ulcerates or is growing. To that end, I'm to come back in 6 months to retake measurements and see whether it's growing.


As complications go it's an ok one to have, I suppose - it doesn't do anything but sometimes itch a little and keep me from ever wearing shorts - but what with one thing and another I am feeling my mortality a bit today! It will pass though, and hopefully I can turn it into a positive (motivation to stick to my diet and testing goals a little better?)
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Online Pattidevans

  • Administrator
  • Posts: 23,988
  • It's ONLY Diabetes. It could be something worse!
Re: visit to the dermatologist
« Reply #1 on: 10 January 2018, 12:27:44 PM »
Gosh Nyt... you seem to have SO much better medical treatment available where you are now!  Is it likely you will ever move back?

I don't think Necrobiosis is that rare, we've actually had several members with it.  I recall Clare (who used to be in the preggie section) had loads of patches that ulcerated and in the end got the maggot treatment.  FWIW - and so far we are not talking about leg ulcers - a most definitely non-diabetic friend of mine had been suffering from a leg ulcer for months, GP giving her multiple doses of ABs and regular trips to the nurse to get it dressed.  Turned out it was due to her veins leaking, she suffers from Varicose flare... and she went into hospital yesterday to get the underlying problem fixed.  So it's not just us with diabetes...

These things do bring us up short though, don't they?  I was horrified to realise I had background retinopathy last year.. cos we always think we are immortal, despite the warnings. :'(

I understand that if you can keep good control it can sometimes go away on it's own.  Of course you have to balance that against your quality of life.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.


© 2015 Patti Evans

Offline himtoo

  • Member
  • Posts: 2,631
  • Prince of Protein
Re: visit to the dermatologist
« Reply #2 on: 10 January 2018, 01:05:33 PM »
Hi Nyt !!  ( big hugs lovely [[[[[hugs]]]]] )

mine did fade significantly from when it first appeared ( it took about 10 years or so ) -- and all that remains of it now is just a slight difference in colouration of the skin and sometimes it still gets a bit itchy

I guess it is worse for ladies - especially if wearing a dress or shorts.

p
x
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline nytquill17

  • Global Moderator
  • Posts: 6,523
  • It's all in the balance.
Re: visit to the dermatologist
« Reply #3 on: 10 January 2018, 01:47:56 PM »
Patti: Interesting! I was looking around yesterday and came up with a figure of something like 2% of all diabetics being affected. I guess we are just a bunch of outliers on this forum!  ;D 


As to moving, well it's all very up in the air. I am here at least until I finish my PhD, so another 3-4 years. After that, it depends if I want to continue in academia, and then you have to go where the job openings are. Of course, the Toronto area has a good number of colleges and universities so there's every chance I will find work here, although probably not any permanent or tenure-track positions, but probably plenty of contract work if I want it. Or I may end up in a para-academic field (working as an editor or writing tutor/teacher are pretty high on the list of possibilities), or freelancing or self-employed. It's really a wait and see thing...if your plans are too firm you are likely to wind up disappointed! Anyway, as to whether I will ever move back to Quebec, well I'm not opposed to the idea in theory, I mean if that's where there's a university job for me then that's where there's a job for me, you know? But definitely the state of health care will factor in to that decision in a big way!


Everyone has remarked how quickly I was able to get a family doctor though, and none of the rest of this would have happened without him referring me to this and that service. So it isn't as if the state of health care in Ontario and Toronto is miraculously better. I think I got a bit lucky with the timing, showing up right when this GP had spots open for patients. And it probably helped me being T1, skip to the front of the line and all that ;) But definitely there is a wider network of services and it is SO wonderful to be with a clinic that is used to working with T1s and calls the fear-motivated type of health care I was getting before "the old way"!


In terms of control, I haven't mentioned this yet (just haven't got around to it) but my insurance has finally approved the Libre sensors (out in Canada in September) so they are now covered to 80%. My first order arrives this afternoon  :D  So that should help a lot I think! And I have talked about possibly starting on a pump over the summer - don't want to do it during term time, and still a bit nervous about doing it at all, but it's on the table as an option now for sure, as the Ontario gov't has a program that covers pumps and a part of supplies for all ages. I have been putting it off as something that, well, put ME off, but now knowing that I do have some complications starting to show, I think the idea of good control for its own sake, as opposed to something to please my doctors, is growing on me and beginning to outweigh some of the inconveniences ;) And a pump plus Libre will definitely be the best combo for that, even if there are other elements of it I'm not keen on (having stuff stuck to me). Provided I don't get too crazy and perfectionistic about it! So baby steps, first with the Libre, see how I get on with having the sensors on and having all that extra information.




Paul: Thanks :D I have had other "skin weirdnesses" that have faded with time...in fact they may have been NLD too, now I think about it. Hopefully this one will too, but as you say it takes years. I don't mind too much having it showing in terms of my looks, it is what it is, and anyway "no body" is perfect! But I worry that people will think it's contagious or otherwise "gross" and I don't really want to have to face that sort of reaction, so I just keep it covered. Anyway in Canada it's only really shorts / short dress weather for 3-4 months of the year!  ;D


I mentioned to him also having had the pilonidal cyst, and he said how odd it was for a woman to have one. So yep, got the rare diabetic skin condition and the cyst I wasn't "supposed" to get either, plus all the other weird skin stuff I've had in the past. I'm just a weirdo, me!  ;D  And the past year or two I've noticed I've been scarring more easily from little things (cat scratches mainly, as we've been raising a kitten in that time!) plus I have mild edema in my lower legs...I guess skin and vascular conditions are going to be my weak point. Bring on the fatty fish, I suppose!
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline himtoo

  • Member
  • Posts: 2,631
  • Prince of Protein
Re: visit to the dermatologist
« Reply #4 on: 10 January 2018, 02:41:03 PM »

haha -- join the club -- I've always considered myself a weirdo too !!  ;D


that is fab news on the Libre -- it really is an amazing bit of kit - so helpful in seeing patterns and seeing hypos before they actually happen
( the straight down arrow )


also really cool you are considering a pump -- it is a big decision -- I know I wrung my hands over it for many years before finally deciding to go for it !



T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Online Pattidevans

  • Administrator
  • Posts: 23,988
  • It's ONLY Diabetes. It could be something worse!
Re: visit to the dermatologist
« Reply #5 on: 10 January 2018, 03:07:38 PM »
Quote
it is SO wonderful to be with a clinic that is used to working with T1s and calls the fear-motivated type of health care I was getting before "the old way"!
;D ;D ;D
Quote
In terms of control, I haven't mentioned this yet (just haven't got around to it) but my insurance has finally approved the Libre sensors (out in Canada in September) so they are now covered to 80%. My first order arrives this afternoon  :D  So that should help a lot I think! And I have talked about possibly starting on a pump over the summer - don't want to do it during term time, and still a bit nervous about doing it at all, but it's on the table as an option now for sure, as the Ontario gov't has a program that covers pumps and a part of supplies for all ages. I have been putting it off as something that, well, put ME off, but now knowing that I do have some complications starting to show, I think the idea of good control for its own sake, as opposed to something to please my doctors, is growing on me and beginning to outweigh some of the inconveniences ;) And a pump plus Libre will definitely be the best combo for that, even if there are other elements of it I'm not keen on (having stuff stuck to me). Provided I don't get too crazy and perfectionistic about it! So baby steps, first with the Libre, see how I get on with having the sensors on and having all that extra information.

What incredibly good news all that is!   You will find the Libre invaluable.  Don't spend too much time worrying about it being a few mmol out with your other meter (which in any case isn't guaranteed to be 100% correct as you know),  concentrate on the trends and patternsIt tends to get further out to blood samples at the extremes i.e. low and very high.  Make sure you stick the sensor in a place where you won't knock it off on door frames i.e. not on the outside of your arm, more to the back (some people get on well with it on their thigh and some on their hip).  I always secure the sensor with a circle of Opsite.  I first cut a circle of paper or card the same size as the sensor to place in the centre of the Opsite, so it covers the sensor, then if the Opsite peels you can remove it without pulling the sensor off with it.

I think that once you get your head round the idea of good control for your own sake, and given the tools to do it, you will be incredibly motivated. 

As to the pump... well, I forget about it most of the time.  That is, you get to the stage where it's subconscious i.e. I don't think about it, but naturally grab my pump to prevent it swinging on the end of the tubing under circumstances where it might.  You learn to manage situations naturally. e.g. if I go to try on clothes I usually leave my pump in the pocket of my trousers and detach it from the cannula for ease of trying garments on.  In bed I let it roam free as my PJs don't have pockets, but you could knit a little pouch and attach it to a lanyard worn about your neck etc etc.  Whatever is comfy for you.  Mind you, Paul speaks well of the patch pump, but I've not tried one.


I am so very very pleased for you!  Welcome to diabetes care in the 21st Century!PS my friend's daughter recently suffered a Pilonidal cyst - she's about the same age as you.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.


© 2015 Patti Evans

Offline sedge

  • Global Moderator
  • Posts: 13,969
Re: visit to the dermatologist
« Reply #6 on: 10 January 2018, 03:47:06 PM »
I think Moby either has or had NLD too? - or am I mixing up my Martin with my Paul here?

I think you've hit the nail on its head with your pumping sentiments but you are still not expressing it how I would, Nyt.  Yes yes it's absolutely all about control - but ONLY because good control is good for ME in that 'they' forever tell me - to the extent that I totally believe it and I've never found anything I can believe to the contrary LOL - that this should stave off complications as far as is humanly possible for me, personally.

Whatever I do now or have ever done with my diabetes is always 99.9% for ME! The fact that it also keeps HCPs happy is more than somewhat incidental - but there again it simplifies matters for all of us - and therefore tends to make my relationships with them so much more comfortable across all medical specialities I encounter along the way - they all know upfront I'm very 'engaged' with my own health IYSWIM - which pays dividends! - less 'talking down' to by most of em these days.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline himtoo

  • Member
  • Posts: 2,631
  • Prince of Protein
Re: visit to the dermatologist
« Reply #7 on: 10 January 2018, 10:40:44 PM »
deffo agree with sedge-- what i choose to do ( like going on a pump ) is all to do with me and how I feel about me -- not to please any HCP's
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014