To say that 49-year-old Liz Groepler lives a full and busy life is an understatement. In addition to her 9 to 5 job in Human Relations at Lookout, Inc, she has a sideline making clay prototypes for a Sausalito design company, designs decorative planters, helps her parents run the Homeward Bound ministry at their church, and cares for a friend who is struggling with breast cancer. As if that were not enough to keep her busy, Liz also gardens and loves surf fishing at Ft. Cronkite/Rodeo beach, where she once caught a 30-inch striped bass!
It’s hard to believe anyone could stay this busy while living with three kinds of arthritis and diabetes. Liz deals with a daunting combination of autoimmune rheumatoid arthritis, psoriatic arthritis, and osteoarthritis and is being treated for all three chronic conditions by Arundathi Malladi, MD, a Rheumatologist at North Bay Rheumatology.
One Thursday in August of 2016, Liz noticed what she thought was a painful insect bite on her abdomen. Neosporin didn’t help and the area was warm to the touch. By Saturday evening, it had turned into an abscess. Liz was so alarmed she went to the Marin General Hospital Emergency Department (ED). There, in the course of draining Liz’s abscess, the care team made a startling discovery: her blood sugar was more than four times the normal level!
Prior to her ED visit, Dr. Malladi had warned Liz that her blood sugar was in the pre-diabetes zone, but Liz did not have a Primary Care Provider (PCP) at the time and had ignored the warning. Now, her blood sugar had shot straight up from pre-diabetes to dangerous levels. The ED team sent her home with heavy-duty antibiotics and instructions to come back if the abscess grew. They also encouraged her to see a Certified Diabetes Educator as soon as possible.
By the following Monday, Liz had returned to the Emergency Department. The abscess was now a large colored area. She was immediately hospitalized and put on intravenous antibiotics for the infection and insulin for the uncontrolled diabetes. Her blood sugar was so high, she began having vision problems.
It’s not uncommon for people with diabetes to be diagnosed during a hospitalization and thanks to Marin General Hospital’s groundbreaking Keys to Control program, Liz received two in-hospital visits from a Braden Diabetes Center Certified Diabetes Educator (CDE). Keys to Control was developed to begin diabetes management training immediately, and then help transition that training after leaving the hospital.
What’s more, because Braden Diabetes Center and Marin General Hospital’s Wound and Ostomy Services are in the same location, Liz was able to have both her wound care and her diabetes education in one place. The first time she went in as an outpatient, it took 17 inches of gauze to pack and bandage her abscess! She also had to have a wound pump. Liz calls out Wound and Ostomy Services Director Victor Alterescu for his expertise and compassionate approach. “Victor knew exactly what he was looking for and how to care for me as my abscess healed.”
Liz began seeing Braden Diabetes Center’s Medical Director and Co-founder, Endocrinologist, Dr. Linda Gaudiani, as well as Certified Diabetes Educator, Carrie Dorsey–Higdon, NP. For the first two weeks after hospitalization, she went in every 3-5 days. Liz felt immediate confidence in her team. “I was impressed that they made a point of beginning diabetes counseling when people are still in the hospital,” she recalls. “I knew nothing about blood sugar control, but I was educated from the start. I felt like I was getting an hour of personalized care. I never felt pushed, I never felt like it was the end of the world. It was great to listen to Victor and Carrie discuss the drop in my sugar levels and how quickly my wound was healing. Under the care of this exceptional team I knew that I was on the right track. “
After each meeting with Carrie, Liz would go home and make small adjustments to her diet and exercise routine. One change that made a huge difference was simply walking for 15 minutes after each meal. Carrie took a down-to-earth, hands-on approach, using visual aids and an activity checklist, as well as helped Liz set dietary goals to strive for in between visits. Liz said, “I really appreciated having those realistic, measureable goals so I was always clear on my own path and just how much I was progressing.”
Liz’s hospitalization made her realize she needed a PCP. She has been very impressed with the collaborative relationship the team at Braden Diabetes Center maintains with her PCP, as well as with her rheumatologist. “I experienced a serious rheumatoid arthritis flare in my right hand and elbow and had to take Prednisone for several days,” Liz recalls. “My blood sugar numbers had been looking great since August, but the Prednisone made those numbers shoot way up. My rheumatologist, Dr. Malladi, advised me to contact Carrie immediately. After a couple of days and a few tweaks to my diabetes medications, she had me right back on track.”
Today, Liz sees Dr. Gaudiani every three months. She measures her blood sugar religiously four times a day, before and after she eats, and she takes a walk after every meal, even walking around the house if the weather is bad. She has dropped 90 pounds and her eyesight has improved.
Liz remains delighted with her progress. “As a long-term resident of Marin County I never imagined what an important role Marin General Hospital would play in my life. Because I received both the wound care and the diabetes counseling together in one place I feel like this is a team effort. My rheumatologist is thrilled that my inflammation is way down. My PCP is pleased that my A1C numbers look great, and I have dropped a good deal of weight since getting my blood sugar under control. I couldn't be happier because I have better control over my autoimmune issues and have the physical strength to do things that I haven't been able to do in years.”