Tuesday, October 2, 2012

For fun: Some of the stranger questions I've received

Last week while traveling I was regaling Boyfriend of SkepticRD with some of the stranger conversations/questions I’ve had over fifteen years.  I thought I would ease back into blogging this week by sharing. Of course I wish I had written them all down, because I would have had way more than ten, but here is a sample, with explanations, of course.
1)      Mr. Tight: Which is better, white or whole wheat bread?
Me: Whole wheat bread does have more fiber….
Mr. Tight: Does toasting it make a difference?
Seriously, do I need to explain this one?

2)      Mrs. Sweet: If I add water to my soda, doesn’t it lower the sugar content?
At this point I had to explain some basic laws of chemistry.  If you pour twelve ounces of soda into a glass, there is about 32 grams of sugar in the glass.  If you add water to it, and still drink the full can of soda out of the glass, you still drank 32 grams of sugar.

3)      Mr. Deafasapost:  I heard “a doctor” say that diet soda had just as much sugar as regular!
At this point I bring out the label from the soda bottle and ask him exactly where the sugar is hiding.  Then we have a conversation about how what you hear and what you remember might be different things and it’s always good to take notes.

4)      Mr. Sweet: If my sugar is really high, can I drink a lot of water to bring it down?
I basically said something along the lines of “I wish it was that easy.”  What I think he might have heard, however, is that if your blood glucose levels are very high you are more at risk for dehydration, which is true, so you do need to ensure adequate fluid intake when your blood sugars are high.  Too bad that glass of water won’t “flush” that piece of cake from your system.

5)      Mr. Inkspot:  I want to get a tattoo, but I’m diabetic, do you think that would be ok?
I included this story because it was one of the more random questions that I got on a slow clinic afternoon, but it was actually a very good question.  If you have diabetes that is poorly controlled you are at very high risk for getting a very bad infection (and possibly losing a limb or your life) if you get a tattoo, piercing, or even a bikini wax.  Once your diabetes is under control and has been for at least six months to a year you could, in the words of the endocrinologist I used to work with “tattoo your whole body if you want” but you should also take extra special care of your blood sugars and your skin while going through the healing process.

6)      Mr. Eatsalot: Can’t I eat whatever I want as long as take my insulin?
It depends.  For most of my patients, who have Type 2 diabetes, the answer is no.  These type of people are usually on a set dose of insulin every day, and if they eat too much carbohydrate one day and very little the next, their blood sugars are going to be all over the place.  And if they keep eating a lot they are going to have to take more insulin to control their blood sugars, and having to take more insulin can sometimes increase the appetite, leading to them eating more, which increases the weight gain, which makes them more resistant to the insulin, which means they have to take more insulin……so yes you could, but your health might suffer in other ways.  Now I do know and have some patients who have Type 1 diabetes and have done the work of intensively testing their blood sugars so that they can adjust their insulin based on how much carbohydrate they’re eating and still keep their blood sugars under control (quite often they use an insulin pump also).  Over-consuming anything however, can still lead to weight gain and all the problems that can go with it—poor circulation, cardiovascular disease, etc.

7)      Mr.  Politico: “Are you a conservative or a liberal dietitian?”
I was about to tell him that I don’t discuss politics at work, because I only have a limited time to spend with people, and then I realized he was wondering if I was open to new things.   We actually had a good discussion about re-evaluating one’s practice based on new evidence and not being so open minded that your brains fall out (per Michael Shermer). 
8)     Mrs. Knowitall:  I’m allergic to wheat bread.
Me: So, what do you eat instead of bread?
Mrs. Knowitall:  Oh, I still eat bread, but I just eat the white bread, not the wheat.
And what’s really sad is that I have had that conversation more than once.

9)   Mrs. Aquarius:  “We don’t eat anything with chemicals in it.”
This was the wife and chief meal preparer for one of my patients.  She spent a lot of time talking about how they wanted to do everything “natural,” but I noticed that they had no trouble asking for a prescription for Viagra.  I have also had this conversation with plenty of people who smoke cigarettes that they didn’t exactly roll themselves, so chances are they are willingly taking in some more "chemicals" than what they are willing to admit.

10)   Doctor I.M. Clueless: We think this patient is lactose intolerant, do you have a quick and dirty test for that?
What I wanted to say was “Have him drink a quart of skim milk, that will be both quick and dirty.”  But I was nice and said to have the guy remove all dairy products for two weeks and see if the symptoms resolved.

 Take home message--most of us are going to be nice no matter how odd the question.  Don't be afraid to ask and learn something.

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