I have a past history of diabetes that was originally treated with oral
hypoglycemics, then later with a gastric bypass.  At this point in time I am on
no meds.  My last HgbA1C was in the 6.5 range IIRC but it was done about three
years ago.

I recently visited the surgeon who did the gastric bypass and he had many labs
drawn.... but not a HgbA1C.  My only abnormal lab was a low Vitamin D level.
The experience cost me $200 out of my pocket.

I have a few molars that had broken and had a crown installed last year on one,
which effectively spent my annual dental insurance allotment.  This left me with
two broken molars on my lower left side.... the most aft and the one next to it.
I was going to have them worked on early this year but in the meanwhile, I
developed a painful abscess where my wisdom teeth were erupting.  It became the
priority.

I put the wisdom teeth off until the new year began with my dental plan, then
had them removed by an oral surgeon about three weeks ago.  So far, so good.  I
appear to have healed without complication.

Then last week I'm chewing on a pork chop and I spit out a little bit of tooth
with a big hunk of filling.  No pain; no sensitivity to cold or heat.  I went
back to the dentist and he said that while the most aft lower molar was probably
beyond saving, the next one inboard still was.  We made a plan to have the one
removed and the other crowned for next Monday.

He asked about who my MD was.  Well, I haven't seen my primary physician in
three years 1) because I had no issues and 2) I've been dissatisfied with his
services.  (As an example, not once did he ever show his face in my room during
one of my four surgeries at my hospital... although he was up on my unit every
day.  I worked with him as a floor nurse and I don't think it would have hurt to
pop in for a 1 minute social call... particularly since every surgery began with
him giving a consult as a condition of the HMO.  More to the point, I've seen
him on the floor in action.  He has the reputation of ordering unnecessary tests
to pump up the bill.)

Anyway, I told the dentist I hadn't seen him in three years but I had seen my
gastric surgeon about a month ago.  I thought everything was set.

Apparently not.  Today his office called up demanding that I go back to my PCP
and get another HgbA1C.  I refused.  The surgeon said he was just my surgeon and
not my doctor.  My insurance isn't going to pay for any of this... and my PCP is
likely to order a bunch of unnecessary labs while he's got me there.  He charged
me $35 for a finger stick the last time I was there. (I could have done it for
free if he'd just said he needed one).

The dentist's office person said that he wouldn't be able to treat me in that
case.  I asked if my records were mine.  I'll be picking them up tomorrow.
Since I've got to pick up the total cost of the crown and extraction, I don't
think I have to constrain myself to the dentists on the plan's list.... I can go
to anyone.  I mentioned all this and asked her to convey to the dentist the
reason he wouldn't be seeing me after all.  I'm not convinced he will be told.

There is a difference between "need to know" and "nice to know".  My HgbA1C
would be nice to know but I question what he would do if it were high?  Refuse
to see me?  Frankly, I think I've demonstrated normal healing ability with the
removal of my wisdom teeth three weeks ago.

I've already been in contact with the dentist I used to see before I had that
dental plan.  They insist upon a cleaning/exam for about $89.  The crown will be
$1100.  I don't know what she'll charge me for the extraction.

So what's the deal with the HgbA1C?  Would you agree this is "nice to know"
rather than "need to know"?  What is reasonable for me to do in my situation?  I
was pretty pissed this afternoon but I've cooled off since.  Now it's time to
decide what I should do.  Input?

Jay Hanig, RN