Oops. The Docs at the V.A. sure are gonna read me the riot act

[Robert_Johnson]

A few days ago, I missed my evening dose for my meds. Both Metoprolol and Metformin. Next morning when I checked to see how high my BG was because I missed a dose, especially the dose that should help my waking glucose spike not be so spikey, well, it was right about 90 . But this shouldn’t be. So after breakfast, I checked it again, 96. Hrmm… Dang my blood pressue! Oh… 120/80. Hasn’t been this low in a long time, even while taking the meds.

So I decided to skip the next dose. And the next. And the next. BG levels remaining constant in the low 100’s to high 90’s. BP remaining normal levels. I’ve made one other slight life change other than Keto. I dragged my stationary bike off the back poarch where its been in the weather collecting dust, spiders, lizards, snakes… anyway, got it cleaned up and started using it again, about a day before dropping my meds.

I’m wondering what they are going to say? Should I open with I stopped all my meds? And let them prejudge my condition as it surely must have gotten worse, or should I let them say, “whatever you are doing its working, keep it up” and then slap them in the face with the truth? I’ll probably just let it go, and let it happen organically. As they ask how and what, just answer them.

Started Keto to fix my Type 2 diabetes
Went from 245 lbs. to 200 lbs. in one month, and still dropping.
High Blood pressure meds for 4 years - gone cold turkey now with perfect BP
Type 2 diabetes since 29 Aug 2017 - Dropped Metformin cold turkey
BG levels consistantly in the 100 range.
a1c was 11.7 next test in Jan 2018
My BG iphone app which has every BG reading ever taken, now shows my predicted a1c curretnly at 5.9

Maybe I’ll start asking my doctor what I can do to reverse Type 2 diabetes. I’ll be sure to have my voice recorder going in my pocket. This will have to be good.

[azviking]

Can’t vouch for the surprise tolerance of VA docs…I would tread very carefully there as I have heard MANY accounts of VA docs flipping out if patients tinker with their own meds. Be careful!

[Capnbob]

I have no first hand knowledge but I did see that VA dropped coverage for people who took non-prescribed things, specifically medical marijuana (with amazing beneficial effects) but no idea about the reverse… not taking what they prescribe. It could be nothing like it since MM is federally illegal or seen as the same issue of non-compliance.

[circesdad]

I’ll probably just let it go, and let it happen organically. As they ask how and what, just answer them.

Wow 18% weight drop in 1 month is great. BP sounds wonderful. You are armed with great change data going into this appointment. They must react, it’s unavoidable. No one can tell you what’s the best strategy for you in dealing with them. You know that better than anyone.

The strategy with no downside is to listen to their comments and questions attentively.

IMHO I would just listen and accept the praise and encouragement. Maybe share the change with the new bike exercise regime and get out of there with your newly admiring audience still smiling at you. Get my HbA1c in Jan 2018 and see where the chips fall.

Whether VA docs or not they always think improvement in a patients status is due to compliance with their brilliant advice and prescriptions. Why disabuse them of that fantasy now? You still have the meds if you think you need them again. So no real risk going forward. Just collecting more data to evaluate your personal decision.

Maybe the next appointment after more weight is gone, BP is still stable and a1C is still headed south, they will bring up dosage adjustments. That might be the “come to Jesus” appointment where you bring up the changes you have already made. KCKO

[Dipper_Actual]

I’d do what I could to avoid ‘non-compliance’ stamped on the permanent record.

You’re eating more mindfully and doing some low/no impact exercising.

[collaroygal]

Like the just answer the questions, no addition info. But you probably should at the end, mention you haven’t had meds in X days and feel so much better for it.

Freakin’ awesome results Bob, keep it up.

[Robert_Johnson]

Thanks for the morale support y’all. I’ll go on the side of caution, and play it a bit conservative. I guess it’s better not to antagonize them intentionally. Maybe just them seeing my progress will get them to ask how I did it. Then I cAn explain it in a non threatening manner

BTW: just had a scare. I cooked up some salmon in garlic butter sauce. I did a good job if I say so my self (not a good cook). An hour later I thought about it. That’s was mostly protein. Maybe I better do another BG reading. It was 134

I over reacted a bit. I threw a bunch of fat together really quick. Some coconut oil, some Rhee, some cocoa powder and some coconut flour. Added a bit of Splenda to it. Nuked it for about a minute. Started eating it. Was not the best idea. I’m not sure what the cause was, coconut flour I suspect, but it was very grainy and I choked on it. It just wasn’t going down the pipe and was making a clog just below the wind pipe. A sip of water fixed it but that entire sequence of events made me rethink my reasoning. So I went and looked up “normal” BGs. For a healthy person without Diabetes, the normal high after a meal is 140?!? LMAO. I was worried I just blew myself back into diabetic range. You know what they say, “if you can’t walk, crawl. If you can’t do that, well, then, you get somebody to carry you”. You guys are doing a great job carrying all of us newbies here. Thank you from the bottom of my heart, and my wife’s bottom too.

[NelleG]

Just to play devil’s advocate here… let’s go out on a limb and say even the VA docs want their patients to get better. Why not be upfront about what you’re doing? There’s a slight chance you may even get through to the doc and help someone else going forward. Bottom line is, no matter what they tell you to take, what goes in your mouth is completely in your control. My husband argues with his doc every damn time about statins, lyrica,and gabapentin. Just will not take them (at least I got through to one person!).

Ultimately we are in control of our own health and our docs should be trusty sidekicks.

[Robert_Johnson]

[/verbose -off] <— because I need to remind myself😬

[FYI: adding this Incase it helps someone understand their own BG levels. I believe you can never have too much relevant data.]

This mornings BG was 158 . So crap, need to start my meds again? NO FRAKING WAY! I jumped on the stationary bike for 30 minutes (which says 7 miles and č 150 calories. 20 minutes later I checked BG again, 90 mg/dL babay!
[kinda over did it with dinner last night. Two servings of garlic butter salmon. Used ghee, because I could. It turned out really delicious.]

[Capnbob]

Remember the VA is another kettle of fish altogether than normal doctors. They (as a system) have incentives to decline coverage given how stretched they are and do so with minor excuses. If you need VA benefits you may not have the option to go somewhere else/get costly insurance so the risks are much higher than for you arguing with your doctor.

[KCKeto]

CapnBob is correct. Please be careful. Our doctors should be trusty sidekicks but that is NOT how VA healthcare works.
My husband is a disabled veteran and in our years of experience, you are NOT getting the cream of the crop in healthcare with VA doctors. VA healthcare is about covering their asses and cutting costs. Mediocrity is the best you can hope for. Please remember that in the military, you are expected to follow orders, whether from your SO or your MD, period, or there are consequences.
Even if you find a staff member who is receptive, don’t expect them to endorse what you’re doing, because you’re going outside the proscribed standard of care for the VA.
I would tread with great caution unless you have other insurance or can afford to be a cash pay patient elsewhere.

[justme]

1. Tell them you are exercising. That will make them happy.
2. Refill your drugs. That, also, will make them happy. If you don’t refill your drugs, their computer will tattle on you. Just 'cause you’ve got them doesn’t mean you have to take them. Nordo you have to tell them that.
3. If you are dependable on VA for medical care and tick them off, your records of diabetes and whatever else will haunt you in non va coverage.

[Saphire]

As @justme said, tell them you have lost weight and exercise. Ask them if they can look into reducing your medications

[richard]

tell them you have lost weight and exercise. Ask them if they can look into reducing your medications

Yup this is the conservative strategy. They can always test your BP and glucose and come to the conclusion that the weight loss is reducing the diabetes and hypertension and reduce your meds for you - even if that isn’t the mechanism

[NelleG]

I’m a DAV and a nurse, so yeah, I’ve had a little experience with the VA health care system. I’m sorry yours has not been optimal.

[Yarblek]

This just reinforces my decision to stick with buying health insurance instead of using the VA with their over taxed resources.

[Capnbob]

As I said to begin with I have no first hand knowledge but I certainly had no intention of impugning the vital work of the VA and it’s staff per se and apologize if I did so. I originally raised the opioids vs. pot issue that has led to denial of benefits to veterans who knew pot was a superior solution to their condition(s) and extrapolated from there to say that there might be some risk about brazen non-compliance with the standard of care. I’d be happy if that was definitively BS and your experience was universal.

[jrmorte63]

I am also a disabled Vet and have been in their care for over 15 yrs, anytime I have approached them with a non conventional treatment they poo poo it. In fact, I had my annual in July, although I have not lost any weight (till now) I had been doing keto since May, and it showed in my blood numbers, of course my cholesterol was a tad high, my good cholesterol was higher and my triglicerides were great! my doc squawked a little especially when I mentioned the keto thing, but, I will not change my military mind to bend to their archaic methods! lol!
And to add, my husband has lost 35 lbs and 2 pants sizes, he had taken himself off statins last year and when he had his blood done his triglicerides and cholesterol were still higher then THEIR standards BUT, lower then he has EVER HAD EVEN ON STATINS!! His doctor told him they could go lower then that going back to the drugs and he told her flat out, he was never going to take them again!
So, we both will keep doing what were doing, but I have decided to compile the studies and information from ketofest especially from Dr Westman and take them to my doctor, what she does with it is her deal. So, as others have said here, go slow, play the game(like we had to do in the military) and show your doctor by scientific evidence that you will be super healthy doing what your doing!!
Oh BTW I am also going to mention to her that the VA themselves have used the ketogenic diet on the Navy Seals to help with the effects of deep diving and seizures!! HELLO! lol
Good luck Bob and thank you for your service to our country!!!

[JayBee]

Hi @Robert_Johnson!

I’m a nurse and while I do not work for the VA, I would definitely advise you to refill meds, tell them you started LC diet, BG’s have been great, exercising, etc.
I’ve gone head to head with the VA wayyy too many times and they always win; even if wrong.

I had a Veteran on hospice and the VA kicked him off of hospice benefits because we discontinued his statins, BP meds, and metformin. Bear in mind that this poor guy was on his deathbed and he got the boot. Still makes me furious. We (my colleagues) got him a room and volunteered our time to care for him.

Please tread lightly and thank you so much for your service!!

[Robert_Johnson]

Thank you for your kind words, Jen. And thank you for taking care of my Brothers and Sisters. I’m sure the VA patient you took care of thanked you immensely. I’m also sure it meant more to him than you might ever know. Those of us that dealt with military medicine (on the receiving end) always knew we got what we paid for, and it was free. We often cringed when we would hear the doctor read out of our medical records about problems, or procedures in our past, that we never had (records mixed up, happened a lot in the 1980’s). So when we end up hospitalized, we pretty much know the drill. Don’t expect to be made any more healthy than you came in. Don’t expect to be treated anything like but cattle, as in move them from point A to point B, hustle, hustle, hustle. In that environment you know the score. We also knew we had to do what we had to do. But then… When we end up in the hands of people like you. We don’t know how to express how it truly makes us feel.

Its people like you that are our heroes. God Bless, and thank you for your sacrifice.