#1066 External Medicine

Anna has type 1 diabetes and is an Internal Medicine physician. 

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, welcome to episode 1066 of the Juicebox Podcast.

On today's show I'll be speaking with Ana. She's a 38 year old type one who's been living with type one diabetes since she was 19 years old on and wanted to come onto the show to share her experiences at work as the type one. I don't think I'm gonna tell you what she does yet because I found out while I was talking to her, you should find out the same way. Oh, by the way, she also has Hashimotos. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. If you want to help out the show, make sure you're subscribed and following in the audio app you're listening in right now. It really genuinely helps. In Apple podcasts, hit subscribe, and Spotify it's follow and then set up your downloads so they come through especially those of you who have iOS 17 Now, if changed your downloads, go into the settings for the show and mark off download most recent five episodes that would really help.

This episode of The Juicebox Podcast is sponsored by us mid us med.com/juice box get started right now with your free benefits check at us med.com/juice box we're call 888721151. For us med is where Arden gets her diabetes supplies, and you could to the podcast is also sponsored today by ag one you can drink ag one.com/juice box. That's right using my link to drink a G one will get you five free travel packs in a year supply of vitamin D with your first order at drink ag one.com/juice box.

Anna 2:18
Hi, my name is Ana.

Scott Benner 2:20
Ana. Hi, I'm Scott. I've never done that before. I've never done that before. So nice to meet you as well. Isn't that odd? For 1000 times I've never just said back to somebody Hello, I'm Scott. Okay. And I know that you were diagnosed around 90 or 20 years old, and you're how old now?

Anna 2:37
38 years old. Okay.

Scott Benner 2:40
So that was 18 years ago, you almost are at the tipping point. Like you're almost to the I've had diabetes longer than I didn't have diabetes, but yeah, getting there. What do you think of that?

Anna 2:55
Um, I feel like I'm already there. Because, I mean, I don't you know, you don't really remember the first few years of your life. So as much memories I have. It's been more of my life. Oh,

Scott Benner 3:04
you're discounting zero to two. Yes. Oh, interest. That's interesting. You're like, I can't recall a movie I saw when I was two years old. That time doesn't count at all. Exactly. Well, that's pretty. You know, that's true. Do you have kids? I do. Okay, so you so you'll understand what I'm about to say. It's such a memory in your head of your children at that age. And then you tell them something about themselves. And they're just like, I don't know. It's a weird disconnection. Like, you've had this very deep meaningful experience together that only one of you remembers. Exactly. Yeah, it's unpleasant. It's like dating my wife who doesn't remember anything that we ever do together. So I'd be like, you remember the time wasn't that nice? And she goes, but I'm like, Ah, nevermind. So how many kids you have?

Anna 3:58
Just one just four year old

Scott Benner 4:00
are you thinking of making any more is the one good?

Anna 4:02
I hope we're good with one good for you.

Scott Benner 4:05
I agree. There are a lot of work there are a lot oh and money and time I do this thing. Your ears is only for to say girl I'm sorry. That's a little boy for your little boys for you don't know about this. I a little trick. I put my kids education on a credit card before I pay it to get the points. So if you're gonna send somebody a massive amount of money anyway, you might as well grab some points along the way. I don't know if it's smart or not. But I haven't paid for paper towels or whatever it is I buy from Amazon and quite some time. Well, by the way, I just completely paid for it. It just hasn't felt like I've paid for it. I get the check. The box often says use the points and I'm like, Yeah, use the points. But it's it's just fascinating. I wonder if Your son in 14 years, I wonder what people's thought about college will be at that point. If there'll be like, you have to go to college, or if you want to blah, blah, blah, or if it won't feel like that anymore. I think it's gonna be interesting. I'll be Yeah, probably still alive, I'll be able to find out. Okay,

Speaker 2 5:21
did you go to college? I did. And she broke up, got

Anna 5:28
at Michigan. I'm from Michigan originally. And then I did medical school in Michigan as well at Michigan State. And I came out to Colorado for my medical residency. My training you didn't

Scott Benner 5:41
you didn't lead with? I'm Ana, I'm a doctor. That's nice. Kind of physician or Yeah.

Anna 5:49
Internal Medicine. I'm a hospitalist, which means I practice internal medicine, only in the hospital. Like I don't have a clinic that you could come in to see me. I only see you if you get sick enough to be in the hospital.

Scott Benner 6:00
Can I say something that I mean, as a compliment? And other people might hear differently? You're real. You're a real doctor. That like, you know, some of those other ones. You know what I'm talking about? Yeah, people you won't talk to at work, you know, I'm saying

Anna 6:18
I get it. Yeah,

Scott Benner 6:19
who do you don't tell me the name but you picture somebody in your head?

Anna 6:23
Maybe a little bit. Okay.

Scott Benner 6:26
How long have you had to go to school for to be an internal medicine doctor.

Anna 6:29
So it was four years of undergrad, I did a post bacc program, which is like a one year program between undergrad and medical school. That was so that was a year, and then four years of medical school and then three years of residency. You're saying

Scott Benner 6:44
a dozen years you were in school?

Anna 6:47
I was in a lot of a lot of school. I didn't I didn't finish all of my training until like two weeks before I turned 30.

Scott Benner 6:55
I didn't know that sentence was going towards an age distinction. I thought you were gonna be like, I didn't get it all done. But yeah, they don't care. So I skipped ears at the end. Crazy, right. So what kind of cases do you see? Generally speaking, I'm in a relationship with ag one. This episode of the podcast is sponsored by them. So I'm going to tell you that I hang out with ag one every morning. A scoop of delicious ag one in my shaker bottle, shake, shake, shake with some water right down. And then we just talked for a couple minutes talking about the day. I don't actually do any of that. I mean, I do all the stuff leading up to the top I don't talk to the Ag one I guess is what I should say. I think about my day while I'm cleaning out the shaker. Anyway, I don't know how that came out of my mouth like that. Since 2010 AG one has improved their formula 52 times in the pursuit of making the best foundational nutritional supplement possible. All that in just one scoop every day, I get the nutrients that gut health support, and I cover my nutritional bases. So if you want to take ownership of your health, it starts with a G one. Try ag one and get a free one year supply of vitamin D and five free travel packs with your first purchase. Go to drink ag one.com/juice box that drink ag one.com/juice box. Everybody who has diabetes has diabetes supplies, but not everybody gets them from us med the way we do us med.com forward slash juice box or call 888-721-1514 us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash, the number one fastest growing tandem distributor nationwide, and they always provide 90 days worth of supplies, and fast and free shipping. That's right us med carries everything from insulin pumps to diabetes testing supplies right up to your latest CGM like the FreeStyle Libre two, n three and the Dexcom G six and seven. They even have Omni pod dash and Omnipod five, they have an A plus rating with the Better Business Bureau and you can reach them at 888-721-1514 or by going to my link us med.com forward slash juicebox. When you contact them, you get your free benefits check and then if they take your insurance, you're often going and US med takes over 800 private insurers and Medicare nationwide. better service and better care is what US med wants to provide for you. Us med.com forward slash juicebox get your diabetes supplies the same way Arden does from us med links in the show notes links at juicebox podcast.com to us Med and all the sponsors when you use my links you're supporting the show

Anna 10:00
We see we see everything. So I do basically adults that are in the hospital, not because of anything that's not requiring surgery. So let's say I just was on service or just working through Sunday and we had, oh, what do we have? Like liver disease pneumonias, lots of like bad skin infections, heart failure, and weird infections, people with like HIV and syphilis, syphilis, people still get cancer complex. They do. They do. It seems like it's an outbreak. Actually, I was I worked for I did two weeks straight. And we had two cases of it. It was kind of crazy.

Lija Greenseid 10:39
And is that not something easy to avoid? It's

Anna 10:43
actually sort of tricky, because you don't always have symptoms. Oh, and so you can easily pass it to people without knowing that you're infected. And then by the time you figure it out, or you never had symptoms, like the other people get it. Wow. Yeah. That's not great. Keep

Scott Benner 10:57
that in mind. We're just swiping left and right. Right. Yeah. Syphilis, what do we do a big jolt of antibiotic?

Anna 11:04
Well, for most people, if it's simple, yeah, you can just do that. And you don't need to go like you just go to your primary doctor and get that we saw people that had more complicated cases with what we call ocular syphilis. So your optic nerve would actually get infected. And then one case where it was like meningeal, syphilis as well. So like, the covering around your brain and your spinal cord could get infected as well. A little more complicated. Syphilis can do everything. Yeah.

Scott Benner 11:30
Back in the day blindness was very common from syphilis, right. Yeah, exactly.

Anna 11:35
Yeah. So you have to get two weeks of antibiotics to treat that. So we take care of you that was

Scott Benner 11:39
that come from? Your bits being dirty? Or where do you get that? How does that happen? Syphilis? Yeah,

Anna 11:45
yeah, it's a bacteria that gets passed. And usually, through sexual contact, you can get sores that have like bacteria in them. So when you have contact between people,

Scott Benner 11:55
I know how it works. You don't have to show off. We all understand what you're saying. I just I relate syphilis to like, West like the old west. And I thought, Oh, they must have been like, actually, what I thought was they must have been like banging in the dirt. And so that's why is the question. All they needed was a vacuum and this would have gone away. Not crazy. Not quite, not quite. Am I Am I over simplifying syphilis. Alright, so So you see a menagerie of things? Yes,

Anna 12:29
I see all different things, which is what I like, okay.

Scott Benner 12:31
Is the was the path set already to medical school when you were diagnosed with diabetes?

Anna 12:39
It was so I actually got diagnosed, like right after I took the MCAT, which is a big like entrance exam that you have to take. And so like I had already planned and going, I hadn't like obviously got my application yet, because it was that comes later. But I was like, pre med and had done a lot of stuff and took the MCAT and had issues taking the MCAT because I'd have to pee so bad that like I was barely making it to the brakes to like, run out and go pee between the different sections of this like day long test. Yeah. And then two weeks later got went in to my PCP. And that's when I got diagnosed.

Scott Benner 13:11
So so it was pretty new. Yeah, you weren't one of those people was like, I had such great nurses growing up and stuff like that, that I wanted to be it wasn't like that.

Speaker 1 13:18
No, definitely not that for me. I asked

Scott Benner 13:22
prestige or money. What draws people to medicine more?

Anna 13:26
I think both? Both definitely do. I, the people that I work with, I work in a safety net hospital. So it's more people are more not money. We don't make much money compared to other types of positions on

Scott Benner 13:40
another major Hmm. People make more not money.

Anna 13:48
It's different, though. I mean, I also I do academic medicine as well. So my hospitals associated with University of Colorado and I teach medical students. And in academics, it's definitely more of the prestige. You want to be published. You want to have a national reputation. Well, you have to be polish and you have to Kevin national reputation to keep your job. But private medicine, especially subspecialties, there can be a big drop of money.

Scott Benner 14:12
Do you ever think you'll go private and have a practice? Or do you like the setting Aaron?

Anna 14:18
I don't think so. I really like working with underserved communities. That's what I love about my hospital is we serve like the city and county of Denver. And so we will find a way to make sure that you get the care that you need, no matter what your financial circumstances. I also do some work with the criminal justice community. And so I don't think the private sector is not that interested in those populations. Yeah,

Scott Benner 14:40
I see you you see prisoners in?

Anna 14:44
Yeah. So in my hospital, we have a unit that's just for people that are currently incarcerated, getting medical care. And then I do some of the education for medical students and residents around caring for people that are incarcerated or that used to be incarcerated have some

Scott Benner 14:58
history. Why are you such a good person? What's going on?

Anna 15:04
I must be the diabetes. You thanks.

Scott Benner 15:05
So are you nicer since you were 20?

Anna 15:08
I think everybody's nicer since they were 20. When you're 20 you're still kind of a teenager. Yeah.

Scott Benner 15:13
Bit of a dick usually. Yeah. All like I understand everything. And you don't need to tell me and I got it. Exactly. Yeah, that whole thing. Okay, this is interesting. But you skipped over my thing. Are your parents like super decent people? Do you remember being raised like that? Just how you are? What do you think?

Anna 15:32
I think so. Yeah, my mom was a nurse. And so I used to always like, see her, you know, going to work and doing take your daughter to work days. And my dad is a college professor teaches the New Testament in a small Midwest school. But yeah, it's always sort of important value of like giving back in our family and helping

Scott Benner 15:54
so you're seeing people help people. And is there a is there a vein of religion in your upbringing or no, there

Anna 16:01
is for sure. So my my dad teaches the New Testament. He teaches the Bible in school and my grandfather was a pastor. So our family is pretty religious. But I think that not everyone besides my dad, like kind of works out. Not necessarily specific to religion. My I have a younger sister that lives close to us. And she works in kind of like social work type situation. She works with people that have developmental delays, helping them get the resources that they need in the community.

Scott Benner 16:27
Yeah. Awesome. Nice group you got going over there. All right. So you are diagnosed as you're taking my two boys took the MCAT by the way, I remember her leaving my car with a fistful of pencils. And I picked her up like, a day later, it felt like, yeah, that was my experience with that. She's like, hobby back. And I'm like, Okay. Came back. very dizzy. She was like, Oh, my god. That was a lot worse. I guess I want to know that 18 years ago was 2005 ish. So what did you start with? As far as management? What kind of gear Did they give you?

Anna 17:07
I did Lantis and Novolog pens. When I was first diagnosed.

Scott Benner 17:12
Do you use a pump now?

Anna 17:15
I do use a pump. Now. I have a tandem pump now. I actually switched to a pump. Probably three years ago, I switched to a pump in medical school because of my medical school training. Or I was like a medical student rotating on the surgery. And it would be really hard to like know, when I was going to take breaks. And when I was using Lantus, I had to eat more regularly to like, avoid hyperglycemia. And it was like, Well, this is dangerous, but I'm like in surgery. I switched to a pump. So I had more control over my Basal rates. And I think I had a Medtronic pump. Initially, your med

Scott Benner 17:50
student is laying inside of the patient, what's happening?

Anna 17:56
It was a nice excuse if I didn't want to do something and be like, Oh, I gotta go have a snack.

Scott Benner 18:01
Wait, Who pooped themselves? Oh, no, no, no, I'm dizzy. Goodbye.

Unknown Speaker 18:07
Did you ever do that?

Anna 18:09
I definitely got out of things. That surgery when I realized that that was not what I wanted to do.

Scott Benner 18:13
Oh, I see. Maybe like, I have to say it's only twice three times in the whole, like the entire time Arden's had diabetes, but she said to me, can we just say this is diabetes? This one time, can I just can I just get out of this?

Anna 18:28
I was like, just blame it on the diabetes, or

Scott Benner 18:30
this one time, whatever. And she seriously I mean, she had it's not it's not a go to before, but there's been like once or twice where she's like, I can't like and one time she said, you know, now that I said that. I'm just exhausted because I was up all night. It is diabetes. And I was like, there you go. So anyway, when you get married,

Anna 18:51
I got married in 2008. So I'm like my first and second year of medical school. I'm from the Midwest. So I got married pretty young.

Unknown Speaker 19:00
We got to start making babies.

Scott Benner 19:03
Was that your intention to have a family or you just found it was my

Anna 19:07
family thought it was our intention because we didn't have my son until we were married 10 years. So very confusing for people from Michigan to be married for so long. And I have kids. So

Scott Benner 19:18
just a guy you just didn't want to lose. We

Anna 19:22
had been dating for a while we started dating my sophomore year in college, and we didn't get married until like a year after we graduated. But it was also sort of a time where we were freaking out. Like I was figuring out medical school. My husband was trying to figure out going to business school and like having to make decisions about where to apply and where to go. And it was sort of like well, either, we're going to be serious and get married and like figure this out together or we're going to break up and kind of just do this on our own.

Scott Benner 19:50
And so is it working?

Anna 19:53
It is our 15 year anniversary this summer. Wow.

Scott Benner 19:57
That's pretty long. Yeah, congratulate Since it's just interesting, because do you see that? Oh, you're just, there's that moment, right? Like you're too. You're too young to get married. But you found somebody that you're like, I don't want to lose track of this person. And then life's about to happen. And we're going to if we don't do something interesting, interesting, interesting. Interesting. And then you just had we're so busy, like, I'm assuming starting a family is the last thing on your mind.

Anna 20:26
Yeah, I mean, the first year, like, medical school is insane. And then like residency is even worse, or working like 80 hours a week, we spent a year apart because he was finishing business school for a year, my first year of residency. So he was in Michigan finishing school. I was in Colorado, starting my training. Oh,

Scott Benner 20:44
look at you. How did you find the distance thing? Was it testing and taxing? Or was it a thing that build up your relationship? I

Anna 20:54
think some are kind of in between, to be honest, like, I was so busy that even if he lived here with or lived with me at the time, I went to seen him that much. And I mean, I make fun of him for this now. But like business school is not that hard. It's not that busy. And so he was able to come out and visit a lot like he would. He was out until August when he started school. And then he was out for a weekend, Thanksgiving. And then it was out for like four or five weeks at Christmas. Came out lots of weekends. And when he wasn't here, I would be leaving the house at like 5am and getting back between like six and 7pm. Yeah, I mean, work and go into bed.

Scott Benner 21:31
I have thought I have thought you were gonna say like, I was glad he wasn't here. Like that. Like, where would you find the time for a person? You know what I mean? Yeah.

Anna 21:40
I actually my younger sister actually moved with me to Colorado, so she lived with me. So I wasn't all alone. But she would like make my lunch for me, because I would just be like, exhausted the day.

Scott Benner 21:52
How come? I have to ask this question to get to my thoughts. So you listen to the podcast? I do for how long?

Unknown Speaker 22:00
Months? years? No years, I

Anna 22:02
want to say probably three or four years. Okay. How can it kind of goes in waves like being super consistent, and then like taking a break? And then coming back to it? Yeah, I wish I

Scott Benner 22:12
could take a break for myself, too. So my question was, oh, by the way, for anyone listening, if I ever asked you, if you listen to podcasts, you say yes, every day, I listen to three, because we're you know, we're selling here, but I understand that I understand the reality of it. Like question wasn't around like, Hey, do you listen to me? My question was, how come you're not mad at me? If you're a doctor?

Anna 22:32
I mean, I'm going to be honest, at times I am. That was one of the reasons why I reached out and that mad, but I mean, I just I feel defensive. Sometimes when I hear some of the conversation was around physicians, although I get it at the same time, because I see a lot of the same things. And I get to see it from both perspectives of patient and physician.

Scott Benner 22:52
It's hard not to hear, like, so I'll start with this. When you hear criticisms of doctors who don't understand the thing they're helping you with, or don't seem motivated to better your health. You're not that kind of doctor, right? No, why does it why does it hit you hard, then?

Anna 23:12
I'm because it's still my community. And I and I sometimes see it where I think I have an understanding of why doctors may be doing things that looks like we're not trying or we're not listening, but like, we're in reality, maybe just bad at explaining what we're doing and why we're doing it. Okay. No,

Scott Benner 23:33
I believe that as well. I think that there's plenty that's happening that goes on said my mom went in for a blood test the other day, she had a concern. And the doctor ran bloodwork, but didn't run the thing that we were concerned about over and we My brother was with my mom now, like, you know, the same place. So he called me afterwards, he said, Hey, you know, talk to the doctor, they said this, we're gonna do blah, blah, blah, and a couple of weeks at that point, she'll get a blood test. And but he sent her for bloodwork today, but didn't test the value that we were that that has us here. And I was like, why? And my brother goes, I don't know, I didn't ask. And I was like, Well, I mean, is that on purpose? Like, would it not matter if it happened right now? Like there's just no value in doing it right now? Is it an oversight, like, you know, blah, blah, blah, and then we talked it through? And we assumed it's just I mean, she's gonna get this done again, in a couple of weeks. He probably just wanted there to be some space in between. But if you didn't know that, I can see being upset. Like like, well, this is the thing I'm worried about, why would you not look again, and my brother said there was no explanation whatsoever about why you did anything is a matter of fact, the things he said, My brother's like there's only half an explanation here. So I'm really worried about this. Before that, I my brother, and so I said to my brother, why is he really worried about that? And my brother goes, I don't know. And I was like, Why the hell did you ask and he goes, I freeze up in these situations. And so yeah, Oh, yeah. So you get in that scenario where you as the doctor know what you're thinking, and you don't explain it to the person sitting there. And because the person doesn't ask a question, just cruise right past it, that I think that happens a lot, right? Yeah, it happens

Anna 25:14
all the time. And it's one of the things I really like to do is like medical education. So I work with first year medical students, in addition to residence at the hospital, like specifically on communication. And we spend a lot of time trying to do better kind of like with a next generation of medical students and doctors are communicating more clearly. And we also know looking at like medical legal literature that people get upset with their physicians and people sue their physicians more so because of poor communication, rather than even just bad outcomes. And so it's physician kind of a communication problem that we need to improve on.

Scott Benner 25:48
That's very interesting. I think that in the end, like for me, in this position, making the podcast, I can't worry so much about how we got there, I have to worry about where we are when we're talking about like somebody saying, Well, I don't know. You know, I don't know anything about my insulin, nobody's ever explained it to me, I didn't understand fat impacted my blood sugar. When I went back and talked to my doctor, my doctor said, No, they No, it doesn't, it doesn't have carbs in it like, so there's levels of incompetence, right. And, and but in the end, if you're going to ask me to take someone side, I'm almost always going to take the side of the patient, because they're the one that goes home and then lives with the thing. So they get the short end of the syphilis thick, no matter what happens. Right? You know, like, maybe the doctor did it for a good reason. But my brother and my mom, had we not all spoken would have spent the next three weeks worrying about something. Because because of poor communication. So yeah, yeah. And they're and I hear from doctors, like I hear like you, what do they call it doctor bashing, or they call it doctor bash? Yeah. And I've also had, there's a great episode of this podcast, where an endocrinologist comes on here, and talks about how this podcast literally changed the face of the way that she treats people. Because she started out listening and being angry at me, and then found her way to the other side of it. I don't know if you've ever heard that one. But it's really kind of amazing, right? So. So what do I do that? What I do that makes you mad? And what do I do that makes you happy?

Anna 27:25
I mean, the education people, part of it makes me happy. I think I've learned more about like more advanced management of diabetes, who listened to this podcast, then I learned as like a patient and being taught by doctors, like diabetic educators. And it's more close to home. Like when we talk when I hear conversations around, like inpatient management of diabetes, people get hospitalized in the frustrations of dealing with their diabetes in the hospital. I think that's where I kind of want to be like, not necessarily mad at you. But like, I want to explain kind of the back side of it now that it's always done. Right. And there clearly are errors. And it's not always managed to well. I see that with at my hospital, too. It's not always done well. But I think there's kind of background that just isn't explained. Well. Yeah. About why why we approach diabetes different in the hospital than like, what you'd want to do on your day to day. Yeah,

Scott Benner 28:19
yeah. I would love to hear you. Tell me more about that. Go ahead, please.

Anna 28:24
Sure. This is what I talk with. Like when I teach medical students and residents in the hospital, it depends on what your patient is there for, like how closely and how aggressively we manage diabetes. And so I'm an internist. So I see people that are not there for surgery, surgery is kind of a different category for hospitalized patients. But we try to go by evidence in my studies. And so there's a study that's actually called nice sugar. That looked at patients that were hospitalized and categorize them as either really tight control trying to keep blood sugars, and the low one hundreds verse, moderate control, looser control, where their blood sugars could go up to 180. And seeing how outcomes were. And what they found was that there was no benefit to keeping people tighter controlled in the hospital, the only thing that they found that it did was really increased rates of hypoglycemia in the hospital, and so like negative outcomes, and so for hospitalized patients with diabetes, we allow more hyperglycemia we're really not worried about the blood sugar as long as it stays at 180 or less. And then we also know that people eat differently in the hospital because of the food that we have available to them. They tend to be NPO in the hospital, they tend to be less active in the hospital. So blood sugars are going to be different. So we allow more ups and downs, especially the upper part of it. Of course, yeah. And so I think yeah,

Scott Benner 29:47
okay. Why is the food terrible in a hospital? It makes no sense. It feels like

Anna 29:53
I don't know. It is really terrible. Yeah, it

Scott Benner 29:55
would be like if I went to yoga, and they gave me a high ball on the way and I'd be like the These things don't seem like they go together at all. Like, like, What do you mean? Like what health hospital? And then the food is like, and how do they not seem to understand what a diabetic menu is either.

Anna 30:11
It's very, it's all very old school. Yeah. I just say my hospital has really, they're trying to be better the food is not any better, but they're trying to be better about, like specialized diets like for diabetes, where we used to just like put people on a super, super low carb diet, and it's like, you have no choices as all you get. We try not to do that as much anymore. We have amazing diabetic educators who I think are just as good for our patients that need to talk to diabetic educators. But also like in teaching the physicians like the residents and the nurses and like everyone else more as well,

Scott Benner 30:47
our our lower, more stable blood sugar's not more conducive to healing.

Anna 30:51
They are but only with a cut off of 180 really been been lower have been like closer to 101 80 doesn't show that much of a benefit for medical problems. Now, when you look at surgery, patients who have maybe like open wounds that need to heal, there is a benefit to targeting blood sugar's more like 110 rather than 180. So you do have to take care of patients differently. But if you're like in the hospital with pneumonia, there isn't any healing benefit, no mortality or morbidity, meaning like you're not going to have higher rates of death or higher rates of poor outcome. If you target a bunch of group one ad rather than one time. The

Scott Benner 31:26
study that you spoke about, was there any look at what happens to people when they leave? Like what happens when you subconsciously put it into somebody's head that their blood sugar can be 180? And it's okay, do they go home and continue that trend instead of doing what they were doing if they were shooting for lower and having success?

Anna 31:45
So that study, no, it only looked at morbidity and mortality for inpatients. It didn't follow them at home. And I mean, that definitely could happen. And that's where it's like on the providers to be educating their patients to Hey, things are different in the hospital, we're going to do it different. There was another interesting study that came out, I think two years ago now that looked at does it matter if we change insulin in your in the hospital? Once you get discharged? Like Are there benefits to us trying to adjust your insulin to give you with ideally tighter control? And that study showed also that no, but would you go into the hospital and somebody tells you how to change your insulin or to increase your doses? You probably shouldn't listen to them because it didn't make any difference in your control. Once you got home. All it did was increase your rates of hyperglycemia without actually changing your agency at all.

Scott Benner 32:31
Yeah, so I understand the hospital looking at that that small slice. But I think it ignore it ignores a lot of like important issues. First of all, people who end up in the hospital whose blood sugar's are higher to begin with, don't seem to know how to manage their diabetes to begin with, you know, so maybe that's why they're finding themselves in the hospital with frequency. And then, and then you show them a higher number and you say it's okay, and they go, Okay, well, that's okay. And you say, Well, you know, you should educate them, but somebody has already tried to educate them a couple of times, and sort of left them for, I was gonna say, left them for dead. But I don't mean that I meant, like, we kind of left them adrift. You know, like, somebody shows up and says, Hey, here's diabetes, and you're a one C seven and a half or eight, and you go to the doctrine, like that's not bad. It's good. Like, you're doing great. Like now you're like, Oh, well, this is okay. And then you go to the hospital and hospitals like, Oh, it's fine. If it's higher. And by the way, you can have peach cobbler. It's on the diabetic menu, and then you go home and backslide in an amazing way. And then somehow this the survey thing that the hospital just like, oh, works great. So yeah, I just feel like it's bigger picture, like, and I'm relating it to pregnant women who I've spoken to, who will say like, you know, it's interesting, my blood sugar's were. But then I wanted to get pregnant. So boom, I put it in the fives, like it was nothing. And then a lot of them say the minute they have the baby, it goes back again. And so it's easy to say like, because there's an example where the person knows what to do, and, and can do it. And still, when given like the tiniest out, we'll just take it, you know, and I don't know, I think it ignores that kind of stuff. I mean, I'm not and by the way, I didn't just pull peach cobbler out of my butt. My mom had, you know, a significant amount of cancer removed was recuperating in a hospital prediabetes on her chart, and I go into visit her one day and she's got a big piece of pie. And I go Hey, Mom, whoa, we don't want to die. And she was that they brought it in and I said you tell me if die you know diabetes. She goes yeah, they said it's on the diabetic manual allowed to pick one thing from this. I was like, Okay, I got I don't even know what to do. I give up so it's and I get and I but I take your point of the other side of it. There's a lot going on if you can reduce hyperglycemia in the hospital. I mean, amazing. I just that and then there's the last piece of it that I think For the people coming in, who already know how to like, I use my daughter's example if my daughter had to go to the hospital, and somebody suddenly said, Hey, you can keep her blood sugar at 180 all day, I'd be like, That's 100 points higher than we tried to keep her blood sugar. And not only that, but she's 18. And so for the last 16 years, we've been endeavoring to keep her blood sugar, lower and stable. And now I go to a place again, that says health to me, and I get there and they say, Hey, do something unhealthy. And I think that might be the bigger leap for people who are already in better control. So I see the downside of people who are struggling for the people who are struggling, and I see the downside for the people who are within themselves. So I understand how it is, but how should it be, like perfect world, what should be happening, it

Anna 35:49
should be patient dependent, because it's so variable, like people, like you're a doctor, most, I feel like that most type ones have a better understanding of their disease and what they need. And that should be continued. A lot of the people that I take care of have type two diabetes, who just haven't had the education, and don't have as tight control and as kind of aggressive management of their diabetes, where, yeah, that's where we tend to kind of have looser, I think, goals, and we tend to manage it more. And they're just better education. Overall, I remember having my kid in the hospital and I was on an insulin pump at the time, and there was like, sort of panic around like, how long I could wear my insulin pump and what blood sugars were okay. And who was going to manage it. And I end up having a C section and like, when does it come on? When does it go off and I had to have my endocrinologist basically had to like write out like, it's okay to do what she wants. So it was very nerve racking for them. And a see kind of the privilege that I have is also being a physician that I get to do a little bit more of what I want with it, and that not all patients who come in even if they have better control than I do, and understanding than I do don't have that ability to have that kind of control over their health

Scott Benner 37:05
care nerve racking for them because your level of understanding is not the level of understanding they're accustomed to from patients.

Anna 37:11
Yeah, that they were much use much more used to being like, Okay, well, now we're gonna do a C section. So you're gonna go on an insulin drip and a glucose drip, and we're gonna take your pump off, and we're gonna manage your diabetes after that, and I was like, I would rather keep my pump on until I absolutely cannot and then go back onto the pump. And I'd like to keep my ducks come on and manage my blood sugar's that way. Yeah, like, your husband help.

Unknown Speaker 37:34
During the birth.

Anna 37:35
He was there. Yeah.

Scott Benner 37:38
That was he was there.

Anna 37:46
Madison is not his forte. So he was managing himself. You

Scott Benner 37:51
went to so much effort not to go? No, not at all. He did not help me one little bit. So the idea of like, I want to leave it on until I absolutely can't means unless I get unconscious, and then four or just where I just I'm unable somehow, cuz Yeah,

Anna 38:05
cuz that's, that's their concern. That's a concern we have if you get so sick, that you can't manage it yourself. And I was at Omnipod at the time that I gave birth. And my my care team was not familiar with Omnipod. Not a lot of people in my whole system use it. They were just worried like, well, what are we going to do if we don't know what you're doing?

Scott Benner 38:23
You think if I had to put you under in that scenario, the last thing you would have yelled is he's a business major.

Anna 38:32
You would have gotten it my mom, as I mentioned before, is a nurse he would have just been like it my mother in law, which is essentially what he did right after I had my son. Because my son had some hypoglycemia immediately. And then I was hypotensive and not really with it. And he basically told him I need my mother in law here to help please

Scott Benner 38:47
I don't know what to do. I so many vacations don't look to me, please. I just imagined your your measurement for all that. It's just like he was a business major. Okay, I'm sure there are plenty of like very with it. Business majors. And I'm sure your husband is one of them. It's just, I just want to know, I'm in a good mood this week. For some reason. I've been laughing through most of my interviews the last couple of days. Hopefully that won't get irritating to people. I think so. I mean, one lady was from Canada. Oh my god. Fantastic. She told such a scary story. Anyway, I don't want to ruin it for anybody. And the scary story wasn't about living in Canada, there's something about diabetes. Okay, so, so we understand how it works in the hospital. People should people should, you know, I think do what you did, like go in with a plan. Tell them like, you know, here's my intention. Like if it becomes emergent, you have to take it away from me okay, but up until then I want to do it like this. I Arden had an exploratory surgery once that was only like 45 minutes long and they ended up taking out some like a cyst near her ovary or something. But actually, they call it a pocket of fluid went off as assessed. But they were like, hey, just turn the algorithm off while she's in there. And I was like, okay, and I like flipped my finger around on the phone a bunch. And I left the algorithm on and sent her. I was like, That thing is her best chance not to go low while she's in there. And yeah, and so, but they put her like her phone in a bag. They understood the connection between CGM and the pump and the loop in on the phone, they kept the phone near the whole time. And it's a matter of fact, I remotely adjusted her Basal while she was in there. Again, the hospital and I and my wife's like, they said not to do that. And I went, Yeah, it's okay, I'm gonna, I'm gonna do this anyway, they don't care. So they did. They just they just wanted, they said the thing. They're good now, and we're, you know, let's get past this kept her blood sugar super, during the procedure afterwards, the whole thing. But I also get that there are plenty of people who don't know what they're doing. But I kind of want to like, shift for a second to type two, if you don't mind, because of your experience. What is it? Like really like being honest? Like, people can't adjust what like, why can't they do something for themselves? Like, why are there so many people in the hospital where the hospitals just like, listen, they don't seem to know what they're doing. Let's get him out of here for this emergent problem. Like, like, Why? Why isn't it like, what, what's my point? If I came in with like a fractured finger, but that's not why it was there. I was there for something else. And I kept telling you, oh, my finger hurts and you're like other fingers fractured. You wouldn't ignore it, you'd fix my finger. But how come people don't know how to manage their type two diabetes, and we just act like that's the cost of doing business? That makes sense.

Anna 41:53
Yeah, it makes sense. I think it's kind of two parts. I think the biggest reason why we don't intervene in the hospital and try to like, fix that understanding around diabetes and improve outcomes. Probably number one, to be honest, is money, that it costs money to be in the hospital, we need to be reimbursed for what we do, the best thing you could do to intervene would be to educate and spend time educating around like, what the disease is, how do we treat it? Why do we make these adjustments? Like how can they self manage better, and we don't get reimbursed for that. So we don't have time to do that. Can I think that's one of the big Yeah, okay.

Scott Benner 42:31
It's a question based on that. And it's gonna sound argumentative, and it's not. Yeah. Do you think people don't know they shouldn't eat Twinkies as an example, or that they shouldn't not exercise? Or that when someone tells them, they are insulin resistant, that they, you know, couldn't do this? I'm not saying that, you know, there are plenty. There are plenty of people who get type two diabetes for, you know, reasons that aren't about how they eat. I'm not saying that. But for the people who that is the situation. Like, I don't understand what education is going to do for them. Like, I feel like they know the thing already. Like, is it? Is it just, I'm just trying to get to the point of like, somewhere in the back room? Is Doctor going like I could say this, but they're not going to listen to me? Is that a big part of being a doctor, the frustration of being a doctor? Some

Anna 43:20
of it, some of that is very frustrating. And I think there are, I think a lot of people don't understand the intricacies of like, what it actually means, like what a carb is, like, how do you change your diet, what kind of exercise is important, and I see a lot of hits.

Scott Benner 43:35
On I just want to wait for a second, sorry, you're gonna come back

Anna 43:38
and you need to eat healthy, what is healthy mean? Like this, and people are saying, well, I'm eating healthy. But when you talk about diet, maybe they're still having a lot of noodle, they're still having a lot of tortillas or other things that are carb heavy, but in their culture aren't viewed as bad. So that can be one of the issues. Yeah,

Scott Benner 43:56
that's I find that fascinating, too. Like, there's a significant rise in type two and the Indian culture, like on the East Coast, I don't know about the rest I'm aware of around me. And that if you talk to them privately, like the Indian people that I've met, that I've spoken to, they're like, We I know, like, you know, the food we eat is not great for this. And, but this is what we eat, like, okay, like, I don't know, like Jenny and I just got done doing an entire type two series, where we were, you know, I mean, it felt important to us to be respectful that not everybody gets to diabetes through poor diet and no exercise, but it's a big factor. And, and that whole idea of like, well, they need to be educated. That always seems like a way of saying, Look, we'll say it to everybody, but not everybody's gonna get it. It doesn't seem like a cop out. I do actually think it's the right thing to do, but it's so contingent on the person receiving the information then following through and that's how hard, really difficult to do, you know, and I, there's no shade for me on that like it just to like go home one day and decide I'm going to eat differently. And not just for a day or a week or a month, but forever and ever. Like, I don't think that's a very difficult thing to do, especially with how food is produced and packaged and moved around. And you just said something that I find frightening, not that I haven't thought of that before. But there are people eating things that are really bad for them. And they actually think they're having like a healthy meal. It's fascinating, you know, the lack of understanding, I guess, and it could be cultural. I don't know why I'm saying all this just that. It seems. It seems like a very impactful situation that we don't seem to have any luck impacting whatsoever.

Anna 45:49
Yeah, and I think education fails when it's like this prepackaged of here's a handout of the food you should eat and the exercise you should do. And you don't know who you're talking to, and what food they enjoy eating and what their day to day looks like. How do they make those changes if it doesn't actually look like what their life is? And that's where I think we fail where we're like, just just eat healthy. Here's a handout, here's the food, make sure you exercise, you know, 30 minutes a day without actually talking to people to figure out what those barriers are,

Scott Benner 46:19
ya know, Jenny, I have been talking about a lot lately, because I'm going to tell you something that I don't know that'll be in the public for a while, but your episode will come out later. So actually, today was my third injection of weak Ovi. So, three Tuesday's ago I started taking like almost a non therapeutic level of we go V it's the they start you off. Very low point two five milligrams. Micro mg. What's MJ go on?

Anna 46:49
milligrams.

Scott Benner 46:50
Thank you. I had alright. So I would tell you, I think I need to lose 30 pounds. But my body holds all my weight my midsection, like, like, no lie my arms, my legs, like all like, look like I weigh like 175 You know what I mean? Like, I'm I'm five, nine, I look like my arms and legs look like I might my butt too. I'm sorry to say they all look like I met my weight. It's all in. Not even as much in my chest. It's mostly in my stomach. Like there is I don't. Anyway, it's significant. But my eating habits are not terrible. Like my body just doesn't manage. Well, like if I eat anything. I gain weight, like a, like a pregnant lady retaining water. But like No, no lie. It's terrible, like, my whole life. So I went to the doctor, to an integrative endocrinologist and I said, Look, kids are gone now. Like they're ones working once in school, I have a little bit of time to focus on myself. Why? Why does my body do this? She gave me bloodwork, like, like so much, you know, she came back and said, Listen, people would pay for your bloodwork. And I was like, I'm like, Well, that's what like what the fuck, like, that's exactly what I said, I was like, well, then, this doesn't change anything. I've said it a bunch of times in the podcast, I'll say it here. I am the fattest person who doesn't eat much food that you're ever going to meet in your life. Like, it just doesn't make any sense. You know, and it's not like the little bit that I eat is just like a bag of sugar. Or, you know, like, I'm just a piece of chicken, I have an egg, I put it wrap in it. I have a scoop of yogurt once in a while I like a sorbet. Sometimes in the early evening, I make it myself on. Like, like, you know, you mean like I'll eat a banana once in a while. Like it's not. It's not it's not a crazy existence I'm living through. So she says, Well, let's try this. And she goes, you know, your insurance covers it, I think you should try it. So I shoot the week over you on a Tuesday. And by in the first four days, I lose a pound every day. And I'm like, that's gotta be like, I did change my like, like, I was very careful about the fat, right because they kept saying like, you might get nauseous or feel over full and like, I don't want that. But I was just eating like a couple of eggs in the morning with some turkey cut into it or some chicken cut into it or some steak. I started having it with a wrap, you know if something like for lunch and you know, a sensible dinner like you know, just like I'm just going along, eating a pound a day, first four days, the next three days. My weight stays exactly the same. It won't go up and it won't go down. On the second Tuesday, I shoot the we go V I lose a pound for the first four days. Now I'm on the phone with the doctor, she's checking in with me. And I tell her this and she goes that is not normal. Like that doesn't happen to people. And I'm like I'm like okay, like so. Then I get like a scientist or my version of a scientist in my mind right now I'm starting to eat things like what will happen if I eat candy like or it was Easter so I eat more food. And I was like limit nothing. Those three days I did not gain any weight even even one day, like had a big bowl of popcorn at dinner like, you know, etc. Now as this medication ramps up and I get more milligrams, that's going to become less and less possible because for the first three days, I did have that like, overly full feeling in my stomach, which has gone away now, but the feeling is gone away, but I still can't eat very much like if I tried to overeat, it would be difficult. So I'm like, Alright, so I was now excited to inject it today. I was like, get let's get to the next four pounds. Maybe you don't like if this is what's going to happen? I don't know. Like, maybe that won't happen this week. It might have been all very anecdotal. But what I can tell you is not anecdotal, is my appetite. Like I have to remind myself to eat, I feel full sooner when I'm eating. And that's from this medication. Like it's not it's nothing that I've done differently. But had I had I eaten like this for the past two weeks without we go via I would not have lost eight pounds. That I'm I'm very confident of. And I don't know if it's because it's limiting my intake. Or, you know, there are some studies that are preliminary, that say that we go v ozempic. You know, those drugs, direct your body to burn fat instead of muscle when you're in a deficit. And they I don't think that's been substantiated completely to the point where they say it out loud. But it's, I'm hearing those rumblings that that that might be it. Anyway, I'm sharing that because I think that there are a lot of people who we can educate till the end of time and tell them what to do. That's right and point them in the right direction. But in the end, because of the way the food system set up, I don't think they're going to be able to do it. I don't see any reason not to help them along the way. Like, like I'm being helped, because I'm like, as we're talking on it, like, I don't know if you've ever seen a picture of me. But for context, when I went to the endocrinologist, before my initial appointment for this, I stood up and I said, in your mind right now, like, how much do you think I weigh? And I'm like, I'm gonna get on a scale soon. So be perfectly honest, because you can't hurt my feelings. And she looked me up and down and said, I think you weigh about 175 pounds, and I was 233 that day. So I just, it's all in one place. And it's, I hide it well, and like I've broad shoulders, like I think part of that, like kind of just draws people's attention away from it. But for me personally, it stopped me for all those years from looking in the mirror and thinking, Oh, my God, I have to do something. Because I don't look like I have to do something, if that makes sense. You know what I mean? Yeah. So yeah, anyway, I don't know how to help these people. But I don't think educating them is gonna help not based on my experience for the last two and a half weeks, like, Well, I

Anna 52:49
would say when I say educate, I don't just mean like diet and exercise education. I think part of the problem is type one diabetics, I think we learn how to manage our diabetes by having more control over like how much insulin to inject, and when and how to use insulin. I don't think type twos are taught that part of it. And so like, when I talk to him about type two diabetics, they don't always understand how the insulin works like, and how it can be related to what you're eating and, and how it might need to be adjusted based on what you're eating and what your activity is. And so like, teaching people to be better advocates for themselves and to take control with other things in medicine, like, if you have hypertension, like we sort of defer that to your provider to like, take your blood sugar and tell you what dose of blood pressure medication you need. But diabetes doesn't do well when it's managed that way. You need that like daily, those daily numbers and knowing your activities, and you need to know how the medications work so you know how to adjust them and how to advocate for yourself to get those adjustments. Neat done. To

Scott Benner 53:51
some degree, my contention to is that it can't kill you right away, type two. And that's why they don't they don't like, like, viciously learn about it in the beginning. Because it's just

Anna 54:02
it's different to like your pancreas like kind of works at first. So you don't need Bolus Basal insulin at first, you can do basil at some point, you're going to need Bolus maybe, like you can use oral medications. It's not as clean cut kind of where it's like, well, now you're in charge, you're on insulin.

Scott Benner 54:19
Yeah, it's a great point, like not everybody's type two is going to be exactly the same. Whereas everyone's type one needs insulin or, or you're you're gonna die. So like, you know, like we have to, but I really do think that's part of it like that feeling in the hospital like Okay, so if I don't give the insulin, the blood sugar goes up coma death. All right, well, I'll do that. And so you never question that ever again. You're like that, that has to happen. And you know, and so with type two, it's like, Well, why don't we try you know, could you go for a walk in the afternoon and like, alright, let's cut out a little bit of this and that we'll see where we are six months from now. Do you think there's the lack of like, I don't know immediacy. See that? That's lost. I do wonder if you weren't told more directly like this is going to lead to a significant health concern. Like I don't even I, you know, I talked about it in the type two series that we made. I met a person who got put on ozempic. And they had type two. And I said, Oh, how was that? Because I hadn't done this yet. And I was just listening to people and person said, it's great. I lost 25 pounds, I had no appetite whatsoever. I was like, Oh, wow, that's great. I'm like, you know, do you expect to lose more? And they said, I stopped taking it. And I said, why? And they said, Well, you know, I wasn't hungry. I like eating. And I thought, why? Like, like, all the good stuff that came for this person's health they weren't concerned with I don't even know that they understood it. Like, if all they saw was I injected this stuff in Yeah, last week, and that part was good. But I'm the kind of person who enjoys blah, blah, blah. And it took all my enjoyment away from my food. So I stopped taking it. Like, wow, like, can you imagine if, like, somebody said to you, like, oh, no, you like, if you stop taking your insulin, you know, you won't die. But, you know, you'll have all these other health implications over the years. And you're like, Yeah, but at least I get to do this now. Like, it was such a strange, but I thought, yeah, telling, like interaction, like, this person was not concerned, as much with their long term success as they were with their short term things. It's, it's very

Anna 56:42
interesting. It's, it's hard to understand, like you don't, you know, a lot of times you don't feel that terrible. And if you don't feel bad, and you think you're just taking his medications, maybe to look better, but that doesn't, that doesn't hold as much value to you. And nobody's talked to you about how uncontrolled diabetes can affect every organ in your body. And this is what you can expect if we don't manage it. And

Scott Benner 57:04
right, right. I mean, from your perspective, that story, it freaks you out as much as it freaked me out, right? Like, because you like, like, a doctor did the thing that got him to do the thing, and it was working. And this person was, I would big, strong person, like, like, big, strong person. And I think that's part of it. Like their identity is like, I'm a big person. That's how people see me, that's how I see myself, like there was so much more to it than just me, because if you would have said to me, Hey, Scott, here's an injection take it you'll lose 25 pounds. By the way, a once he got better, blood sugar's were lower, like, we were having all of the, you know, expected benefits from the ozempic. Not taking insulin, like it was really working for them. And I don't know, I just I didn't know I didn't, I'm a person who interviews people with diabetes for a living. I didn't know what to say after, after they said that. I just I didn't know where to go from there. But um, but I'm looking at also now talking to you today, I'm kind of thinking of it again, because I'm looking at it from your perspective, like, wow, like, look at all the work that doctor put into getting 25 pounds off this person lowering their agency lowering their blood sugar's and they didn't, they just said, I'm not going to do this anymore. Like that must be demoralizing for that person's doctor, I would think

Anna 58:24
it just makes you wonder, like, their understanding as well like was this medication sold to them? As Hey, we're going to help you lose weight and get your agency under control, which maybe the doctor cared more about the the person, or the reason that we're doing this is that we can help you live longer and be healthier in all these other aspects. That's my point. Yeah. And type two diabetes. That's the goal. Like, yeah, we can make your numbers look pretty. But ultimately, I want to treat this so I protect your brain and your heart and your kidneys. And you don't die young and end up on dialysis with only like half a leg left.

Scott Benner 58:57
Yeah. And that's so that's my exam standing in the doctor's office. And she goes, Why are you here? I'm I don't want to die. That was it. Like, I don't have another explanation. Like, why would I be here? I don't want to have a heart attack. Like I'm carrying weight in my front. I can Google that's not good. So like, I want that to go away. So I don't die. Like I don't care what I look like, I don't care what people think of me. I don't none of that. But I don't give a crap about any of that. Like, I just don't want to stand up one day and go hmm, what? Like, I'm not. I don't want to do that. Yeah, I think I need to get this weight off. And I've tried 19 different ways. And my body doesn't want to do it. So like, I'm tired of what I told her was I'm tired of doing things that work or don't work or work a little bit and the outcomes are different. I'm like, Tick Tick, like times ticking away here. Like I'm out of time. Like I like we need to we need to do this right now. And she's cool. She's like, Yeah, right on let's do it. And I was like, okay, cool, right. So, so is it more about how people see Eat. Like I bring this up sometimes. But there are parts of the country we're getting Type Two diabetes, for example is almost like a, it's like a family tradition like, Oh, I got the sugars. You know, it's it's here like I expected it to be. And yeah,

Anna 1:00:14
I think we all think it's inevitable. Like my mom had it, my grandma had it and some of it is genetics that we don't fully understand. So like, yeah, you might not have complete control over it. But if you just see your whole family went through this, and if you and your family and your culture, you guys really value being together and sharing meals together, and why would you value then doing things to lose weight or to change things that might make you not feel as connected with your family? Your culture? Yeah,

Scott Benner 1:00:43
like even understanding that I might get it one day like say, I say it's a that's an inevitability for me. Now I've seen it through my entire family, change it to, hey, everybody in our family catches fire in their 50s Do I just then I don't keep water around. And when the fire comes, I don't like douse myself out. I just go here, this happens, everybody. It's such an odd an odd decision in that moment to me, like like, Oh, I'm having this significant health crisis that is going to poorly color the rest of my I don't like maybe we should be more clear with people, most of the causes of death, right? Like when you die, and they say like, oh, this person died from complications to type two diabetes, but it was a heart attack, or they died of complications that but it was a stroke, or it was like, I think that people need to understand that you don't gracefully die at 96 with type two diabetes, that you're not doing anything about, like they're gonna have like a major catastrophic incident that's going to end your life. And no, maybe they don't know. I'm not sure.

Anna 1:01:49
I don't think people realize that. I mean, I take care of patients that have heart attacks and strokes all the time. And it frequently is news to them that will your diabetes with your agency of nine is one of the big risk factors that led to you having a stroke. Yeah, like, that's something that we need to fix. How does that

Speaker 3 1:02:07
happen, though? How does somebody get diagnosed with something and not be told, my mom got cancer? And the doctor sat down with her and said, Bev, you're gonna die in four months, if we don't do a surgery. He didn't say, oh, tough luck. What do you want to do?

Scott Benner 1:02:24
What do you what are your thoughts on this? Because my mom would have been like, I don't want to do anything. Because that's yeah, I don't know. Like, and it's, I really don't think it's the I don't think the fault lies on the patient. Like, there are plenty of things about life that I don't understand. But they don't try to, they don't try to kill me. So it doesn't matter. But if I walked up live, I'd never seen an alligator before and I started walking towards this enclosure, I'd expect someone who knew better to go, Hey, don't go in there. That's a killing machine. You know, like, good. I don't know what I don't know, like, so there's a disconnect somewhere. Because it seems to me like you get type two diabetes. And the machine writes you off is lost, unless you go home and figure it out for yourself. And then we love to say, oh, when people do the right things, it all works out great for them.

Anna 1:03:13
Yeah, I mean, a lot of that is on doctors, we diagnose people. And I think sometimes we feel free to overwhelm people with so much information, and then it just gets lost. Where? Yeah, you know, my first priority is to like, get this under control now. But my next priority, which I totally forget about is I need to make sure you understand why this is such a priority. Like why do we care so much, that your blood sugar is high and that you're not at goal. And

Lija Greenseid 1:03:40
yeah, and then in fairness, I also think a

Anna 1:03:44
system that isn't set up to manage like diabetes needs intensive monitoring, it needs intensive treatment, and it's the long game, right? It's not like you have diabetes. Now, next year, you're gonna have your heart attack, I mean, you could, but it probably is going to be yours for free of outcomes. But you need to have an established primary care that's, you know, really invested in you and has the time to, like, help make sure everything is managed well, and our health system is it's hard to navigate hard to get consistent care and not great at teaching people about their illnesses and how they can manage themselves. The best one

Scott Benner 1:04:17
of my brothers has type two, and I've been for years, like, trying to, like, educate them slowly, like I don't want to put them off and everything and I think he's finally getting it. But, you know, he didn't know like, he's like he first got and he was like, okay, and then the valley like a year or so later, a doctor like tried to scare him. And that worked on him a little bit, but he still didn't have enough information. Now he was just scared. So he was properly scared that he could die, but didn't know what to do about it. And so I kept saying like, I think you should try this like try this like and he's like, Oh, I did like I you know, and he would for a while like he he like significantly changed his eating habits. He lost some weight is going in the right direction. And then I don't know What happens like, whatever the way people's brains work like why I use this as an example, my father told me when I was a kid, my father told me he started smoking cigarettes when he was like a child. Like 1110, like 1011 years old, like the first thing my dad smoked was a cat tail. Do you know what that is from a field? I do. They rolled that up and smoked it like because they were looking for something to smoke as children. My dad smoked unfiltered cigarettes his whole life. And like something called Chesterfield kings, like they were like, vicious cigarettes. Like if you back in the day, like Pall Mall, like something like those kinds of things. And strong like strong tobacco unfiltered, and my dad would always say like, I'm fine, I'm fine. I'm fine. He had coughing fits like you wouldn't believe. And he would smoke two and three packs of cigarettes a day sometimes. And he'd be like, Oh, the doctor says I'm fine. Doctor says he can't even tell I smoke. I heard that my whole life. And then my dad died of congestive heart failure. But he told himself his entire life, that this thing that he knew was hurting him. He told himself his entire life. It wasn't. It was just, I don't know. It's fascinating. Really? Do we all need therapy on? What do you think? We do?

Anna 1:06:20
I mean, but it also gets into addiction, too, and how things affect your brain prevent you from making good decisions? Yeah.

Scott Benner 1:06:29
And maybe the food and the sugar, and all those carbs? Like, maybe that's got a lot to do with it. I mean, I kind of believe it, you know?

Anna 1:06:38
Oh, for sure. I mean, some of the medications that we use for addiction can also be used for weight loss. It's all like that pleasure center.

Scott Benner 1:06:46
Yeah, that's fascinating. I mean, honestly, I just said I'm using we go V for people who don't know we go v is the exact molecules as Empik. Like so ozempic was made for type two diabetes, because they people said, oh, people lost weight, and their Baba boss got better, etc, that you know, and it's because they couldn't eat as much. And they I think it goes right to your hippocampus and tells you you're not hungry, which is, you know, the story about the GLP ones and the healer monsters. Not that well. Okay, but GLP ones GLP twos were discovered in the saliva of Hilah monsters in the beginning of the 80s by a Canadian researcher. And that's what this this is what this drug is, like. I think the, the researcher noticed that he'll, uh, monsters are like vicious eaters, but once they've eaten there, they don't eat again. So like, you could put a goat in front of one, it'll swallow a goat, but then you put another good in front of it. It's like, No, thank you and fall, whereas other animals, yeah. And I think he noticed that they were very muscular, didn't carry any fat, and seem to be in control of their hunger. And that's where that all kind of began. So I'm telling you, it works. Like I in the first couple days of the injection. I told you, I had to remind myself to eat it was worse than that. Like, like, I got dizzy. That's how I knew I was hungry for the first couple days, because I had no physical signs of hunger whatsoever. And

Anna 1:08:12
did you did you like that? Like, that would be?

Scott Benner 1:08:16
No, I immediately was like, why am I woozy? Like, not just woozy, but tired. Like, I was like, am I shutting off. And then I said, Oh, I have to remember to eat on a schedule. So now I just get up in the morning. I used to not be a breakfast person I eat every night, every morning now. And on purpose. I eat every morning. And then I usually make the podcast and late morning. And then I as soon as you and I get done, I'm gonna go eat something else. And I'm not hungry. I have no desire to eat whatsoever, but I'm gonna go eat something else. So to avoid that, so it took me like three days to figure out how to avoid Oh,

Anna 1:08:50
weird, I was raised in a very, like, clean your plate clean plate club type of family. In with our son. We've been very intentional about trying not to do that and do that, like listen to your body to try to like develop more healthy eating habits. And it's interesting to like to see kind of what the next generation and I feel like. I mean, I hang out with a lot of other physicians as well who have similar ideas to me if the next generation of kids will have similar issues around eating and overeating that I think especially people that grew up in the 70s 80s and 90s with a culture of fast food, have fun Easter,

Scott Benner 1:09:27
I went to a family member's house on Easter. There were 10 people there. There was a spiral ham, a pulled pork that was smoked a couple of different casseroles, mashed potatoes, rolls to different kinds of roles. At the end, there was chocolate cake and Rice Krispie treats and people were drinking the entire time there was beer and soda and wine and like everything right? And so the it came time to eat and I Put my food on my plate. And I was like, I wanted to try a little bit this little of this. And I, I even recognized as I walked away, this looks like I don't know, it looks like they gave me a certain size spoon and said I could only fill it once, you know. And, and I went and sat down, I thought, I wonder how much more food would be on this plate if I wasn't taking this objection. And I think the honest truth is more, I definitely would have had to have the rolls, like and I had one, I had a very small scoop of potatoes. And I tried both of the like, I tried the pork and the ham, I didn't like the ham. And instead of just eating it to be polite, which is what I would have done. I was like I'm throwing this out. And then I had a little bit of a chocolate cake later. And I had a rice krispie treat at the end of the night. And I woke up the next day and I weighed the same exact amount that I weighed the day before because I was in the last three because of my theory that I was in the last three days of the shot, right. But I I know myself if I would have went there on Easter prior to this. I would have come back I would have gained weight I would have been retaining water the next day. So I don't know what's in the magic. Like he'll a monster juice. But I said to Jenny the other day while we were recording a type two, with the state of food. And the way we like, by the way, my point about Easter was that I walked away with my food some the amount of people said are you not hungry? When they saw my when they saw my plate was really interesting. Are you not hungry? And I'm like, No, I am. Thank you. Are you sure? Yeah. Like the idea was like more? There isn't enough food there for 50 people. Yeah. And it's not like no shade to them. Like they just put out a bunch of options. And like it was lovely. It just, I looked over at somebody else's plate while I was eating. They had a little bit of everything on their plate. The plate was full. Like it was there's no way anybody needed that much that many calories in a whole day. And this was just like dinner. But anyway, so the Jenny I was like, you know, to your point earlier about like generational stuff. I said the way this week Ovie seems to work so far, if my experience continues, I'm saying, we take a whole generation of people who have children, and inject this in them, and their kids, their kids are gonna grow up with a completely different idea of how much food is the right amount of food to eat. Yeah, like really, because you just

Anna 1:12:14
affected your enjoyment of food when you do eat. Interesting.

Scott Benner 1:12:18
I am not a food person to begin with. In my perfect scenario, I wish that ever eating was like the Jetsons, like, you know, they would get a pill. Remember the beginning of the Jetsons they got a pill, they'd cut it in half with a knife and fork and eat it and they were done. Yeah, I don't love food. But I also think my stomach would get upset my whole life too. And I wonder how much of that makes you not want to eat, really. And that I've addressed before this. So before I tried to be goofy, I did try other things. And one of the things I did very successfully was I watched Arden like Arden was clearly having trouble. And I don't know if you've heard that episode, but we added a a digestive enzyme to Arden's like meals, and that and that got her digestion going well, and then we added a magnesium oxide, which got elimination going really well. And we put a probiotic, and she's been doing very well with that cocktail. And I was like, I'm going to do that. I did that it changed my like, changed my life. Like just taking a digestive enzyme when I don't have that. Like, that's not sitting well feeling ever again. Like I don't you know, and I'm doing I'm doing the whole thing. So I'm eliminating every day on a schedule, eating, you know, I used to have to take fiber, I don't have to do that anymore. And so I tried that. And then once I got it rolling, I was like, I wonder if I'll lose weight because I don't eat very much. Like I'm not overeating. And it just didn't touch my weight at all. Nothing like I felt better and everything was working better. But I did not lose a like an ounce. So I tried that. That didn't help. By the way. I've now I've become like a heroin dealer with digestive enzymes. Easter my niece was like, oh, like there's dairy here. I'm not going to feel well later. Like all this stuff. And I just kind of heard around the corner, Matt. I took these two little like tablets or these capsules I dropped in her hand. I was like, take those. I felt like I'm like I knew if I was 10 years older, it would have been the crit I would have. I would have been like that old lady like dropping like pills out of a tissue. Take this like, anyway, she's like, really I'm like, Just take them she was what are they? I'm like their digestive enzymes are gonna help you digest your meal. And she popped them in her mouth. She had her food. I don't know what shade I didn't pay attention to her. And hours later she said to me, you know, usually by now my stomach's upset, my stomach's not upset. And I was like cool. It's great. I said here's a couple more time for a few days see what's up. Obviously for art and she has type one and your pancreas also helps you digest food and you know, stops working and stops doing other things besides making your your insulin but the way I saw it help art and then when I set it on the podcast, the amount of notes I'm getting from people like that like 111 was like, my stomach is hurt every day for 30 years. And I've been okay for a week now because of this. It just like super excited, like, I think the foods just, I don't know, like a lot of what we eat is garbage. It's just I don't think, I don't think it belongs inside of you. You know, I think I think it's kind of amazing that your body does as good of a job with it as it does, to be perfectly honest. So it is, yeah. Hey, so anyway, you have type one diabetes should have probably brought that up at some point. I mean, I could ask you all the boring questions about like, how do you do that at the hospital? And you'll be like, Oh, I make sure to stop and get snacks. And all the nurses know, like, I know those answers already. So I'm very just much interested in, in what type one, having it having gone through 12 years of, of medical school, how has it impacted how you treat people,

Anna 1:15:56
you know, it's sort of evolved with me. As I think I learned more about Thai politics, I got it, you know, not too long before I went to medical school, and just also sort of matured as a person. I remember being a resident, so just out of medical school, still doing training, and we rotate through a diabetic clinic at the VA hospital. And at that time, was only a few years, and I was mostly recruited type today, medics, and I sort of realized I did not want to be an endocrinologist, because it was all it was too much to like, deal with diabetes, like all day long, and then also have to manage my own. And I think I mean, a part of the medical system training, I didn't have a great understanding of what type two diabetes at the time and really felt like, well, if you just did all of these things, right, like you could get rid of your diabetes and upset but like, I can't get rid of mine, if I can do all of these things, definitely now has led me to have more compassion with my patients and understanding of like, the frustration of like, knowing all of these things about diabetes, that we don't talk to our patients about, knowing that there's better ways to manage that we can't do or don't do. I'm very selective, I think I've only told two patients in my entire time of practice that I have diabetes as well. I like we're a pump in a glucose monitor. So like some patients pick up on it when they see it. But twice, I've actually shared with that, like, oh, you know, I was diagnosed diabetes, or I have type one diabetes and kind of share my story with them to help connect. And I think that has been helpful in a couple of instances. Once with a young woman who is about the same age, I was just 19 when she was diagnosed, and that's what got her hospitalized. And she was really struggling and very tearful, very upset about it. Her family only really knew about type two diabetes, her mom like, had pulled me apart. It was like away from her. I was like, Well, you talk to her about losing weight, because that's what she needs to do. And so I had a talk with her and her mom be like, that's not the issue right now. Like, right now, let's talk about what diabetes is and why you need to take insulin. And this isn't just that you need to lose weight, you know, losing weight with type one diabetes is not going to change the fact that you have this disease. But this is frustrating, it's stuck, that it's going to change your life. And I get that. And I think I mean, that seemed to be somewhat helpful for her. It's also really led me to try to work with my hospital and provide some like collaboration with our diabetic educators just to provide better care. For our diabetic patients. residents know when they work with me that I'm not going to let them get away with like, let's just console endo to like figure out this that I feel very strongly that internist need to know what diabetes is and how to manage it. And they need to know how to manage their patient's diabetes. So that's something that we always talk about how many

Scott Benner 1:18:38
people type one type two combined, do you see that have diabetes? A lot, I would imagine,

Anna 1:18:43
we see we see a lot more type two, just because the nature of people that get hospitalized tend to be able to have multiple medical problems, and mostly older, but it's not infrequent for us to see type one diabetics hospitalized either in our hospital is pretty good. We have a whole protocol if you're like on a pump that you can stay on your pump more. Our nurses are more familiar with Dexcom, which actually came out of COVID Dexcom donated a bunch of supplies to hospitals with COVID Yeah, mostly. Yeah, so our nurses didn't have to go in the room. But now it's been awesome because our nurses know how to like set up Dexcom and we have access to them. And we can use it for a lot of our patients and you can use it as education. A lot of our patients have glucose monitors now. And so it's always a good way to kind of introduce those topics to our medical trainees to show them and I usually actually try to use our patients to educate our residents in our bed. So you have a libre on like, how's that working and like, try to like role model for my medical students and residents that our patients can teach us about their disease and like how they're managing and what their understanding is. Yeah,

Scott Benner 1:19:50
I thought when COVID happened and Dexcom was like we're getting these into hospitals because it was keeping nurses from having to go in and check people's blood sugar's right they could do it from outside. And I was like, Oh, this is brilliant because it's going to teach a whole generation of medical people about the glory of like, continuous glucose monitoring, and people are going to wear it and see, like, you know, geez, I have diabetes. And like, I didn't know that this impacted me. Like, it's such a simple conversation, but like the CEO was on here years ago of Dexcom, Kevin, and he said, I wear a continuous glucose monitor, you know, trying the products and making sure I understand the, you know, the experience and everything, because he doesn't have type one. And he said, I remember him telling me like, three distinct foods that he's like, I'm never going to eat these things, again, just for seeing what they did to my blood sugar. And you get that, that that's an education. Yeah, you know, like somebody's telling you don't eat, like, eat? Well, I use, you said it earlier. Like, people say I eat great, but like, they think of mashed potatoes is like healthy. They're like, that's a vegetable, like, exactly, you know. And so they're like, Well, I'm where let them see one time, let him see their blood sugar, go to 160 and sit there for two or three hours after a meal. And be like, Oh, I am tired right now. And they don't feel well. And you know, I didn't like you know, for generations, it was just a joke, right? Like, everybody falls asleep after Thanksgiving dinner. And people would be like, it's tryptophan, um, I was always like, your blood sugar is high. Like, you're way too much food and your body is trying desperately to get rid of it right now. So, yeah, maybe that maybe that's what education looks like. And I don't see anything wrong with that, like, whether it be this GLP one. We're somewhere we're in a glucose monitor. I think that's terrific. I think that if that's what gets it through people's heads, then great. And we just don't do, we don't do a good enough job of teaching anybody. It's just a human. It's a human problem. Like, even like this whole thing, whether you're on the side of the patient, or you're the doctor, people are just at some level are limited in how much they can manage and handle and understand and put into practice. And it's just always gonna be this way. But some things are just, I don't know, some things just seem so obvious. It's baffling that we can't pull it together. As a society as a society. I mean, and to be honest, that that statement could have been for politics or health care, you know, anything really like how was it? How was it so obvious to everybody? And yet, we just go like, Oh, okay, well, I guess this is all right. Yeah, I do anything,

Anna 1:22:33
can improve diabetes, we will have as many people on dialysis people will be dying of heart attacks, people won't be having strokes, they won't be losing limbs won't be losing their vision. And

Scott Benner 1:22:43
they won't be spending their life dealing with this stuff. You know, like, it's just a it's just a it's a net positive. Like every everywhere, everywhere is positive. And I don't, it's not it's not as simple as you know, eat better or just don't have a potato chip. Like, it's not that easy. You know what I mean? It just, we pretend it is. And we pretend that anybody who doesn't react to it and do the quote, unquote, right thing is a lost cause who doesn't care about themselves? And I just don't think that's true at all. I think it's just too easy

Anna 1:23:18
disease to blame the patient, right? If that all comes? It's because you didn't care enough? Yeah,

Scott Benner 1:23:24
I am not lying to you. I have not eaten differently in the last two weeks than I ate the two weeks before that. And I've lost eight pounds. So who cares why I honestly don't care why. Like, I'm not embarrassed, like, I'm not like, I don't want to die prematurely. I don't want my joints to hurt. I don't want my knees like we we've gotten to the point where people are overweight, and they're saying like, I'm tired all the time. And my knee hurts. I wonder what's wrong. Like you're carrying too much weight on your frame. Like it's like it's a but we look for other reasons. As fascinating. Like, you don't mean like you skip over, like step one. And you go to step two, oh, you know what it could be? I don't know, what could it be? All can be this very rare thing where people students? Or how about just like I shouldn't, like I shouldn't be carrying this weight around. It's just I don't know, it's become very confusing to me as time passes.

Anna 1:24:20
Well, we're better at fixing the like, problems that come from the way or the problems that come from diabetes, and we are fixing the weight and fixing diabetes.

Scott Benner 1:24:28
know for sure what's easier? Yeah, that we seem to be on top of no problem. I mean, even me, like I'm a fairly reasonably intelligent person. I know when I'm doing something I shouldn't be doing. Like I'm not unaware of it, you know? And, I mean, what are my eating troubles? I don't eat vegetables. And I've discussed this with Jenny and the type two series like I just grew up with people who like came from that clean your plate generation two, and I didn't like textures of some foods. mostly vegetables. And then my parents would sit me in front of them until they got ice cold and make me eat them. And like I I spent evenings of my life sitting in front of green beans for examples. And I've had them brought back to me for breakfast. I don't know what, what lesson my mom was trying to impart in May. But she was a complete parenting failure. Like, I'm sure she was just doing what she thought was right. And I don't, I'm not mad at her. But like it was a it was a parenting failure. And now I can't stomach vegetables. I can't bring myself to do it. And yet I try some sometimes I'm like, this is fine. Like, but it would never occur to me to go back and eat it again. Because it is so far out of my food lexicon at this point, that when I'm thinking to eat, I don't think Oh, I did like XYZ. Last time I had it. I should make this now. Yeah,

Anna 1:25:50
and it's that same thing that leaves you to probably think of green beans and feel nauseous or not want to eat them. That makes you want to finish your plate. So you can have dessert afterwards. And even if you're not hungry,

Scott Benner 1:26:03
yeah, no, yeah, we have to keep eating. It was all about like, also, we were broke. And and like growing. Yeah. So it was like if somebody bought something you're like, Oh, holy hell look what's in the house, like, eat it. It's never coming back again. You know, like there was that there was that kind of like scarcity mentality of like, Oh, my God, there's cake. They'll never be cake again, eat all the cake. Because I won't be able to have it again. Anyway, my point is that that's true. I mean, that's my story. It doesn't mean I should have to have a heart attack. Like, you know, and just because somebody else grew up in a way that's got them in a situation, it doesn't mean that they lose. Do you know what I mean? Like if your life's not perfect. That doesn't mean you don't get to live. So I'm for what, um, for whatever helps. Anyway, I'm sorry, did. Why didn't you want to come on? The podcast is probably a little late to ask you that now. But we got all that right. Like, is there anything we didn't like? Go over? You wanted to?

Anna 1:27:02
Know, I mean, that was I think I forgot which episode it was exactly. But talking about in patient management of diabetes of like, but it's not just that we don't care that we have these other motives, these other thoughts behind it, like that nice sugar study that I mentioned. Yeah. Wanting to explain some of that. And just the kind of being on both sides of it, having diabetes, being how diabetes is managed? Yeah. Yeah, the one thing I would say that sort of nice is my colleagues, I work with a group of, I think there's about 60 of us, between our MD group and our eight VPS, which are physician assistants and NPS, they sort of know that if they have diabetes questions or management questions that they can come to me and ask questions, and we try to do better, help manage better in the hospital, knowing that we've failed at it in the past.

Scott Benner 1:27:51
I mean, it's nice to have like a person there who might have a deeper understanding. And, you know, you can go to, then you find them doing it, like they actually come to you. Yeah, that's excellent. That's very cool. No, I mean, it's nice to you know, to hear younger doctors talking the way you are. It's actually very exciting. It's just, I don't know, my, my experience with my mom. And, you know, it's just been a little shaky, like, you know, you meet some people who are just right on top of it, and other people just, you know, don't care. Like I've said on the podcast before, the first oncologist that my mom saw, was absolutely happy to let my mom die. Was he was a he actually said to me, I'm not going to kill your mom in surgery. And, and then you, you know, you start hearing about things like doctors have scores, and they have to keep their scores up, or, you know, like the hostage and you're like, oh, okay, great. So you're not going to help my mom in case she dies. Because then that'll look bad for you. And I was like, cheese, that's crazy. The next doctor is just like, Yeah, I'll do it. And now it's two years later, and she's still alive. Like, it's amazing, you know. And that's an example of, you know, that's not going to leave me like I'm not gonna be able to shake that example. I'm not going to be able to shake the, the amount of times that when Arden was younger, and she went to, you know, a very good Children's Hospital, like a very good very popular very, like, you know, competent Children's Hospital, where we'd go there. And even as a small child, Arden would say, why do we come here? What are we doing? And I had to tell him, like, Well, we're here to get your prescriptions, you know, in the hospitals acting like they're doing all this stuff, and I'm just like, look, you're just the guy with the prescription pad at this point. And you know, it's lovely to see you wonderful people. I love visiting with them and everything. It's all really nice. But the amount of time something's been said to me that I was like, Oh, um, that's actionable. I need to remember that is an You could argue that's because Arden was doing so well. And we had a good grasp of it and everything. I'm sure other people were getting other direction. But for us, like, it's, you know, there was still a time when Arden was going there, and our agency was eight. And it was, you know, in the mid 80s. And nobody was saying anything that was like, here's how you can fix this. Like, it was just like you're doing great, keep going. It's always how it was, you know, so I don't know. It's just, it's tough. Like, it's tough to be sick. And it's tough to know that the thing that you're fighting with doesn't go away. And that you're going to be with it forever. Like but I think it's a leap you have to make in your head, you just have to say this is just part of who who we are and you know, add it to your added to your cycle of things that you think about. I don't know, might end up missing a couple Netflix series this year, because you don't have time, but they should be

Anna 1:30:56
healthy. Anyway, while your limbs and organs

Scott Benner 1:31:01
I think that's a damn good trade. I am also I apologize to him. A guy spoke too much today. But there's nothing I can do about that. All right, good, like motivated, and then it's hard to set off. Also my energies coming back. I just got my iron infusion recently. So I'm jacked back up again. Hey,

Unknown Speaker 1:31:22
other stuff.

Scott Benner 1:31:24
Do you have other stuff? Do you have thyroid or anything else?

Anna 1:31:28
Oh, do I? Yeah, yeah, I have Hashimotos as well.

Scott Benner 1:31:33
You take just a T three supplement? Or do you take T three T four is a just Synthroid and you don't have any trouble that that works for you.

Anna 1:31:43
No, no, it's been fine. My thyroid is sort of weird. I've never actually been very symptomatic from it. And my endocrinologist just caught it because when you're my TSH went from like, I think just under two to just under four. And she was like, well, technically, you're still within the normal range. But we like doubled. So let's check your antibodies and everything came packed, like very, very elevated. So I just started Synthroid, before I even really had true symptoms.

Scott Benner 1:32:09
I think, yeah, that's terrific, actually. Yeah. Can I ask you a couple more questions? Sure. Yeah. When you hear people all the time, say everyone, like the whole population is deficient in vitamin D, do you think that's very impactful?

Anna 1:32:24
Vitamin D is a tricky one, like my physician perspective, is the evidence has gone up and down. Like I feel like it for a while, it was like vitamin D will fix everything. Everyone needs to be on vitamin D to make everyone's life better. But then when we actually study it, and see what outcomes are it, it probably doesn't make everyone's life better. It's probably a little bit overdone. But it also is not going to hurt you.

Scott Benner 1:32:48
What about anemia? And like low ferritin? low iron? Do you see that with people very often?

Anna 1:32:56
We do I personally think that that is definitely under recognized. And it has a big effect on how you feel because we normally don't think about it until your hemoglobin your blood counts are actually dropped. But your ferritin can be low wait before that. I've had problems with that when I was younger I did. And then even my son was sort of interesting, he had this whole big workup because he was a terrible sleeper, which is common among a lot of kids. But low ferritin levels can be one of the causes and kids because they can get restless leg syndrome. And his pediatrician told us when we like brought him in, we were talking about it like well, you know, his hemoglobin is fine, so it's probably fine. But we should check his ferritin and it was like crazy low. So he was on a lot of supplements for it and we saw a big improvement with his sleep. So because of my personal experience, I definitely believe that we probably are not as aggressive with chemotherapy tends to be too reliant on waiting for like the bigger down the stream outcome of low hemoglobins before we address it as the

Scott Benner 1:33:53
person who it happens to I can't tell you like like it would be difficult for me to explain how turned off my body and brain becomes when it gets lower. Because of the the insurance system I am set up in that situation where I'm like, I have to almost turn off so they'll give it to me again. And we're trying right now to get them to just preemptively do it. Like as we start seeing numbers fall like why can't I just have Excuse me? Why can't I just have more now so they don't get to the part where I'm like, fumbling around. Yeah, terrible and like exhausted constantly. And I just wondered if that's something Did you see it with people who have other autoimmune issues? Or is it just kind of across the board?

Anna 1:34:36
Yeah, I've seen it across the board. Lots of people for lots of different reasons. Not always specific to autoimmune.

Scott Benner 1:34:43
Now it's interesting it just really is like I changed my it changed my life like getting a an iron infusion and bringing my fire to and back up again. Like it really like I was in trouble and and then hindsight showed me that this was happening to me most of my adult life and I didn't even realize said, I actually have an episode going up tomorrow or the next day with the hematologists, who came on to chat. I joked with him in the beginning, I was like, this is the only time you're going to hear somebody say how excited they are that a hematologist got type one diabetes, because now I have access to you on my podcast. But he came on was terrific and like shared all about it. And I just think it's something people should be more aware of, because a lot of doctors, like, I guess I'm gonna ask you this last question. I'll let you go then. Because you brought it up with your own thyroid in range, your labs are in range. Why does that stop many physicians from caring about your symptoms? You know what I mean, you know what I mean by that, I think because

Anna 1:35:44
we're so taught to treat to a goal, we give medicine, we check labs, you want to get to a goal. And so it looks like hey, we got there. And it's so much easier to be like, well, I can see an exact number than to have to sit and listen and to what she's saying. It's it's easier to, you know, target that certain goal than to listen to symptoms and see if this fits for hypothyroidism. I mean, it's, it's not good. And I don't want to make excuses for that. But it's, I think it's just easier to do that, you know, you see a patient you check their labs, you can call them and be like, don't worry about it. I don't have to think about this anymore. For thyroid though, argh, are in range goal is like really outdated? Isn't what we know about when people have symptoms. And when it says of it as well.

Scott Benner 1:36:31
No, it's fascinating. Like, I you just, I mean, over 2.1 You probably need medication. And yet the range goes up to 10am. I right about that.

Anna 1:36:43
Um, normally No, it's for most adults. It's five on we think like geriatrics we give a little bit more wiggle room up to 10. But most labs will say under five is technically normal.

Scott Benner 1:36:56
Yeah. So us people who are like dragging themselves, they're like a puddle. Their hair's falling out. They're gaining weight, nothing, nothing. They do help anything. And a doctor is like, well, your TSH is only four you're in range. And then that's it. And then it happened to my wife where we were just like, Just give her the medicine. See what happens. It's the reason we were able to save Arden so early because when Arden's TSH went up originally, the hospital said that's in range. And I was like, oh, no, you might I don't care what you say about range, she gets it immediately. And then still, Arden is interesting because Arden can't function without teeth for NT three. Like she needs she takes point two five micrograms of Saito mil a day. Yeah. And if she stops taking that for more than about four days, she starts to shut off. It's fast. It's fascinating, like into a into a puddle. And there's real really something else like How interesting. It is that just the tea for alone will not help her. It does. It takes away all the other symptoms, but her energy is shot. It's ridiculous. It's interesting.

Anna 1:38:05
Everyone's so different. Yeah, I think, you know, there's some concerns I know that some physicians have because I know milk can be abused, especially when we think about young woman with like eating disorders. So it's I think, in general this is very cynical, but medicine tends not to believe especially young women write about their symptoms that are more difficult to quantify. And so they are taken less seriously and thyroid autoimmune diseases are more common in women auto mean like thyroid disease or more is more common in women. These symptoms that we describe are that you have from your thyroid disease are are hard to quantify and really make people who don't have the disease understand what it's like. And so I think they're just taken less seriously and so it's harder to get appropriate treatment. Well

Scott Benner 1:38:52
my wife was dying from it when we were younger and she was told like exercise lose weight and you'll feel better. They told her that for sleep like seven years at 70 I guess sleep but can you sleep with the sun so when the sun goes down close your eyes and when it comes up open your eyes. Oh, thank you.

Anna 1:39:10
That's it. That's how easy

Scott Benner 1:39:12
Should I try a cold plunge to so so I just um not that cold plunge can help you with things I'm just saying like it's you know it's interesting where the where they'll go and where they won't go Yeah, you know and and I take I take your point about the thing with young women and by the way, who was on here Chris Freeman. Did he share this with me while we were recording her afterwards? He said athletes will cut weight with cider mill and that was one of the things I he might have said that off anyway. It wasn't Chris nevermind. But but but I but Arden like for sure like Arden will start gaining weight and she gets really tired. Like right away and nothing changes. out about her intake or anything like her life doesn't change she just without that T three she, I mean, we went through so many things. She might have pots that that was one that was fashionable to yell about for a while like for I don't know for people got pots. Now all of a sudden everybody tired has pots. And that went on for a while. And then does that happen? Is there like a psychosis that goes through doctors? They're like, You know what I've been hearing lately. Let's test for this. Oh,

Anna 1:40:26
for sure. Yeah, the popular diagnosis. Yeah,

Scott Benner 1:40:29
yeah, I figured, because I right away, I put a stop to that. I was like, she doesn't have pots stop it. Like, I'm like she has type one. And she's got this and the type ones managed, like let's focus on the thyroid. And they actually got away from it for a while. So she struggled for like a year and a half to the point where and I know I've said this on the podcast before. But in Arden's yearbook from high school. We did like a page like that with photos of her and her yearbook and if that's something everybody can do or not. And Arden's page is in the center. It's her it's a really nice photo of her that we had taken when she was graduating. And around her picture in the middle are nine images of her asleep on various hard surfaces in our house. And the caption says if you see our daughter sleeping in college, please wake her up like like something like that. And it's very funny by the way, but but that was so much of her life before we figured out cider mill was like she just power through come home pass out like I mean on the floor in the fetal position head down ass up asleep with a blanket over top of her or passed out forward on a hard countertop sitting in like a like a barstool chair, like with her face just on a piece of stone just unconscious to after school. Like just really, really crazy stuff. So anyway, I don't know what the answer is. But I think the answer is fight for yourself. Learn as much as you can and and stick up for yourself. So thank you so much Ana for doing this. You really were terrific. And I'm going to have you back sometime where I don't talk as much. Hold on one second for me.

A huge thanks to Ana for coming on the show today and sharing her story. And I also want to thank us med U S med.com/juice box or call 88721151 for the podcast was also sponsored today. By ag one. Drink ag one.com/juicebox links in the show notes links at juicebox podcast.com. Last little bit if you're listening. It doesn't matter where you're listening. If you subscribe in Apple podcasts, Spotify iHeartRadio wherever you're listening and whatever app you're listening in. It helps the show immensely. Subscribe and follow and make sure you set your downloads to download the most recent episodes.

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