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My friend's son (40+) has Type 1 Diabetes . He

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My friend's son (40+) has Type 1 Diabetes. He does not take care of himself and it's prob been 10 years since he has seen an Endocrinologist (sp?). A few days ago he developed what presents like bells palsy. He thinks it will 'go away' - his Dad and I are concerned. I'm a damn lawyer - and don't even play a Dr on TV. I would very much appreciate your expertise Dr. Rynne and I thank you for your time.
Posted Fri, 1 Dec 2017 in Diabetes
 
 
Answered by Dr. Bonnie Berger-Durnbaugh 28 minutes later
Brief Answer:
Questions so that I can respond

Detailed Answer:
Hello and welcome,

Can you tell me the specifics of the neurological symptoms your friend has that has presented like Bells Palsy? Has there been any improvement or deterioration of these symptoms?

Do you know whether his glucose levels are controlled? How have his sugars been ranging? Are his blood pressures controlled?

Does he see a primary care doctor (you mentioned no endocrinologist but perhaps he sees and internist or FP who monitors his diabetes)?

Any additional information you can provide (such as medications) will help me get a better picture of the situation.

Thanks- will reply with my thoughts after hearing back.

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Follow-up: My friend's son (40+) has Type 1 Diabetes . He 33 minutes later
Can you tell me the specifics of the neurological symptoms your friend has that has presented like Bells Palsy? Has there been any improvement or deterioration of these symptoms?
According to the (40+ yr old) kid - the sagging of the right side of his face started 2 days ago. There are no symptoms indicative of a major stroke - i.e. only the face. He is blaming it on a tick bite the summer of 2016.

Do you know whether his glucose levels are controlled? How have his sugars been ranging? Are his blood pressures controlled?
I have triplets that were more responsible when they were 16 than this man is. He takes a shot when he 'thinks his sugar is high', 'before he eats/drinks' something he knows he shouldn't. Sugar drops so low that his girlfriend has to dial 911. Recently he had rectal bleeding for a 2 week period (red - not 'coffee grounds') and his peritoneal cavity was bloated/punchy when his dad called me (again - lawyer - not Dr) to come over. Closest Hospital about 40 miles.


Does he see a primary care doctor (you mentioned no endocrinologist but perhaps he sees and internist or FP who monitors his diabetes)?
No - moron doesn't see any physician unless not given a choice by 911 responders. He does not see an internist or any other medical professional unless he ends up in an ER

Any additional information you can provide (such as medications) will help me get a better picture of the situation.
Again - quite possibly he should be on some meds other than insulin, for which he doesn't need a prescription, does smoke pot.
Follow-up: My friend's son (40+) has Type 1 Diabetes . He 40 minutes later
Hi Dr. I'm not sure if I managed to get my responses to your follow-up ?s to you.

Can you tell me the specifics of the neurological symptoms your friend has that has presented like Bells Palsy? Has there been any improvement or deterioration of these symptoms?
According to the (40+ yr old) kid - the sagging of the right side of his face started 2 days ago. There are no symptoms indicative of a major stroke - i.e. only the face. He is blaming it on a tick bite the summer of 2016.

Do you know whether his glucose levels are controlled? How have his sugars been ranging? Are his blood pressures controlled?
I have triplets that were more responsible when they were 16 than this man is. He takes a shot when he 'thinks his sugar is high', 'before he eats/drinks' something he knows he shouldn't. Sugar drops so low that his girlfriend has to dial 911. Recently he had rectal bleeding for a 2 week period (red - not 'coffee grounds') and his peritoneal cavity was bloated/punchy when his dad called me (again - lawyer - not Dr) to come over. Closest Hospital about 40 miles.


Does he see a primary care doctor (you mentioned no endocrinologist but perhaps he sees and internist or FP who monitors his diabetes)?
No - The moron doesn't see any physician unless not given a choice by 911 responders. He does not see an internist or any other medical professional unless he ends up in an ER

Any additional information you can provide (such as medications) will help me get a better picture of the situation.
Again - quite possibly he should be on some meds other than insulin, for which he doesn't need a prescription, does smoke pot.
 
 
Answered by Dr. Bonnie Berger-Durnbaugh 24 minutes later
Brief Answer:
Thoughts on this

Detailed Answer:
Thank you for the follow-up information. Without being able to examine him I can say without a doubt he MUST go in to be evaluated. Without a doctor taking a history and doing an exam (testing movements associated with the facial nerve to rule out Bell's Palsy) and possibly a CT or MRI of the head (if the paralysis involves more than the muscles controlled by the facial nerve) there is no way to know if this is Bell's vs a stroke vs other neurological disease.

If he had a stroke (and a stroke doesn't have to involve the entire side of the body) it is important to have this documented and address underlying health problems that can lead to another stroke. These include controlling blood sugar, blood pressure, tobacco cessation if that applies, lipid control, weight management, etc.

It is important to know if this was a stroke to start rehabilitation as soon as possible. Early physical therapy leads to better outcome in most cases.

So while this might be Bell's Palsy, it might be something worse that needs attention now.

If it was a stroke, and nothing is done to control risk factors or efforts to prevent it from recurring, another stroke could be his last one.

I don't know him, so I don't know his reasons for avoiding care of his health, but I have seen people with Type I diabetes just be so overwhelmed by what their disease means and what miserable things they believe they would have to do to monitor and control it. So they escape or are in denial or avoid dealing with it. But perhaps you can share that there are new and improved ways for managing Type I where a person doesn't have to be frequently poking themselves for a sugar reading or shooting themselves with syringes full of insulin. There are subcutaneous devices that take care of all of that and allow a little more flexibility in diet compared with the "old days" too. So he might feel better overall with little effort.

I do hope this information helps. Please let me know if there is any additional information I can provide that would help.
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Follow-up: My friend's son (40+) has Type 1 Diabetes . He 34 minutes later
Thank you Dr. Berger-Durnbaugh for your advice, and I do understand that he's not your patient and you only have a 'banking compliance atty' trying to formulate a question that makes sense to you. I am hopeful that your advice will help his Dad and I convince XXXXXXX to seek medical care.

Can you provide any suggestion as to how to tell XXXXXXX that it "might not be a tick bite" that is causing this "temporary partial facial paralysis" and that maybe a "real" MD should be consulted". Promise Dr - if the little sob were a client - I would fire him. Thought about med school for a minute - law school was a better fit. Smile. Thank you for this and any psych suggestions that may get the 40 yr old child to a doc.
 
 
Answered by Dr. Bonnie Berger-Durnbaugh 30 minutes later
Brief Answer:
Thoughts on this.

Detailed Answer:
It might be that he doesn't think that going in to see a doctor will result in anything but reminding him that he has health problems that he doesn't want to think about.

But there is now way to know, without going in to be seen, whether this is from a tick bite. And if it is from a Lyme carrying tick bite, that needs treatment too. Lyme is caused by a spirochete like syphilis is, and like syphilis, it has stages and can lead to arthritis and major organ impairment.

I find most success with skeptical patients if I can offer something hopeful. Where I can explain that the benefits outweigh the risks. For example, if he understands that if this is a stroke related to uncontrolled diabetes, then there are ways to prevent future and possibly even more debilitating strokes with an insulin pump or other ways, and rather than misery, he might feel better in many ways.



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Follow-up: My friend's son (40+) has Type 1 Diabetes . He 17 minutes later
Thank you Dr. One of my boys just graduated from Emory and is considering med school. Your thoughtful responses to a stranger (me) convince me that this is the profession that XXXXXXX should pursue.
 
 
Answered by Dr. Bonnie Berger-Durnbaugh 33 minutes later
Brief Answer:
Thoughts on this.

Detailed Answer:
I do recommend a career in medicine if your son likes to solve problems, is open minded about symptoms that medicine doesn't have answers for yet, and has a heart for people who may be quite different from him in their life choices. Some doctors get frustrated by these things and then don't enjoy their career.

The field of medicine has changed, in both good and bad ways, since I first trained in XXXXXXX in the late 1980s. Medical training is less brutal in terms of hours, workload, expectations, and a highly authoritarian chain of command. There is actually consideration that the med student and resident are humans that need sleep. This has made things more humane all around. On the negative side, the field of medicine is largely now run by corporations and the downside of that is that people who are not trained as doctors are making decisions that while financially profitable to the organization in the short run, are not necessarily in the patients' best interests. For example, there isn't a lot of understanding in some HMOs that physician's assistants and nurse practitioners are not trained as doctors, or that some patient's have complicated chronic health problems that need more time than the 15 minute time slots the doctor is allowed in their schedule.

But the field of medicine is evolving and I think some of these problems will be ironed out over time. Millennials as a generation, in my opinion, have a knack for creating things that are new and cooperative rather than adhering to what they are given, and so I am hopeful that they may find solutions to these limitations.

I am signing off for the night but will be happy to discuss any further questions in the morning if you wish.

Best regards -
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