Derek has again tried to decrease his meds from 10mg HC at lunch time, down to 7.5mg.
It doesn’t seem much of a difference but it’s a bit running your car on a 1/4 tank of gas all the time. You just never know what is going to happen during the week, and he needs to be working at a level where he doesn’t have to climb into bed at every turn.
When he is on 10, he has some reserve left in his tank the next day, when he is on 7.5 at lunch, it seems he is running on the smell of an oily rag the next morning. He can keep up (just) but he can never get ahead by having a little in reserve.
You are given a budget for petrol, you are paid daily, so you have to fill your car with gas before you go to work each morning. You have enough money to fill your tank to 1/3, or you can fill it to 1/4 and have a little cash in the bank for a rainy day.
You know that 1/4 of a tank will get you to and from work, on a flat straight road every day without a problem. You will even have enough to get you to the petrol station the next morning to fill up for the day again.
You know the route to work, but you don’t know what the driving conditions will be each morning.
4 days out of 5 you can take that straight flat road, with no traffic holding you up. The problem is, on that 5th day, there is a hold up. Something very minor has happened, but it adds 10 minutes to your journey, and there is a very slight hill that you have to go up to get there.
It WILL use more gas. You look at the tank and think, OK, I can do this, just take it easy, “drive to the conditions” and you will make it home fine. No need to stop at the expensive petrol station to top up.
The problem isn’t that you can’t get home, you can even get to the gas station the next day to fill up again, but there isn’t quite the same reserve in the tank. The next day is a smooth run again, but we all know that if there is less gas in the tank, you seem to use more. If you don’t top up, by the end of the week you can’t make it to the petrol station to fill up.
Perhaps you should have put the 1/3 tank in, and had enough reserve for the little blips that ALWAYS come along. Those Blips WILL come along, every week, there will be something that takes that extra gas you put in the tank.
This is what Derek’s decisions are all the time, does he put that little extra in his tank so he can get over the little blips without having to fill his tank completely (because it’s dangerous to run the car on full for more than a couple of days), or does he run it to almost empty each day, in the hopes that he doesn’t need any extra, and then have to top up just to get to the end of a week, or does he put that little extra in each day, to have enough in reserve for the little blips.
A major traffic snarl up is different. You will always have to fill up when there is a major traffic jam and you have to drive over the high hills. Thankfully most of the time, there is a petrol station on the way to help you. If not, then there is a pick up truck and a mehcanic (read ambulance and hopsital) to help if you completely break down.
If you put only a 1/4 of a tank in each time you filled up are you short changing yourself. Given that Derek is only 9 days into the new reduced meds and he is starting to show signs of insufficient cortisol, then no, he should do the 1/3 tank each day as those little blip aren’t enough to warrent extra HC at the time, but there is definately a gradual reduction over the days, to a point where he runs on empty.
Thankfully we see the Endocrinologist in 3 weeks so we can discuss matters with him.