Young adult preventive exam — prediabetes and allergy follow-up

DRDelana? I am Dr. Reyes. You can put the phone away or keep it, no judgment — some people like to take notes on it.

PTOh — sorry. Notes, actually. My aunt texted me a whole list of things to ask you. She made the appointment, honestly.

DRThen your aunt and I are already on the same team. What is on the list?

PTUm. The sugar thing, from the letter last year. My gums, because she noticed. And she wrote get your shots in capital letters.

DRA thorough woman. We will hit all three, and a few things of mine. First, tell me about you — I have not met you before. What does a normal week look like?

PTKind of a lot? I take classes — I am partway through my associate degree, trying to get into the nursing program eventually. And I work at the grocery store, the early shift some days. I live at my aunt's place with her family, there are six of us in the house. It is fine. It is just full.

DRFull house, classes, early shifts. Where do you fit in friends, rest, fun?

PTHonestly... I do not, really? Like, my friends from high school all kind of went different directions, and my classes are half online, so it is not like campus where you meet people. Most days it is work, class, my room. My aunt teases me that my best friend is my headphones. She is not wrong.

DRDoes the aloneness bother you, or is it comfortable?

PTSome of both? Like, I am okay being alone. But lately it feels less like a choice, if that makes sense. Sundays especially. Everyone in the house has their people, and I am just... there.

DRThat makes complete sense, and thank you for saying it plainly — I am going to write it down as a real thing, because it is one, and it affects health. We will come back to it. Now the sugar thing. Last year you were told your blood sugar was in the prediabetes range. What did you make of that?

PTKind of nothing? Which I know is bad. It scared me for like two weeks, and then life happened. My grandma has diabetes, the real kind, with the finger sticks, and I do not want that. But nobody really told me what to actually do.

DRThen that is today's job. We repeated the test this morning — the hemoglobin A1c, the three-month average of your sugar. It came back six point two four. That is still in the prediabetes range — under six point five, so not diabetes, but above normal. Your sugar today was ninety-nine, which is fine. So: real, but very fixable at twenty-two.

PTFixable how? Because my schedule is chaos and the store discount is mostly on the wrong foods.

DRHonest answer: small, boring changes that survive chaos. Swap the sugary drinks first — that is the single biggest one. Walking after your shift, even twenty minutes. And building meals around the cheap boring staples, beans and rice and frozen vegetables, which conveniently are the ones on discount everywhere. I can also refer you to the nutrition class here — it is free with your coverage.

PTFree I can do. Soda... I can try. I am mostly a juice person, which I assumed was healthy.

DRJuice is soda with better marketing, I am sorry to say. Trade it for the fizzy water and your future self will be smug about it. Related, and I will be straight with you because you are heading into nursing and can handle numbers: your weight today is ninety-four point four kilos, height one seventy-three, so your body mass index is thirty-one point four. That crosses into the obesity range, and it is connected to the sugar picture. I am not saying it as a judgment — I am saying it because it is the lever you control.

PTNo, I — I knew. My clothes have been telling me. It helps hearing it like a fact instead of a lecture.

DRFacts and levers, that is the whole visit. Now, allergies. The chart says mold, dust mites, animal dander, grass and tree pollen — basically the outdoors and half the indoors — plus the aspirin reaction. You take the cetirizine, five milligrams?

PTEvery morning, yeah. Spring was rough this year, my eyes were a mess through April, but the pill mostly keeps it livable. I still have the EpiPen, too. I carry it in my backpack.

DRNot expired? Checked the little window lately?

PTMy aunt checks it, honestly. It is good until next year, she has it on the calendar.

DRYour aunt is running a tighter ship than most clinics. Keep the cetirizine daily through your bad seasons, keep the pen within reach always, and remember — no aspirin, and be careful with the related painkillers, the ibuprofen family; check with a pharmacist before anything new for pain.

PTThat one I knew. It is written inside my backpack flap, in her handwriting.

DRNaturally it is. Standard screening questions now, everyone gets them, answer honestly and skip any you want. Feeling down, depressed, hopeless in the last two weeks?

PTNo. Bored sometimes. Not sad.

DRLittle interest or pleasure in things you usually enjoy?

PTNo, when I have time for them I enjoy them.

DRNervous, anxious, on edge?

PTBefore exams. Like a normal amount? It goes away after.

DRFits your scores — basically nothing on the depression screen, one point on the anxiety one. Safety questions: in the past year has anyone humiliated you, made you afraid, forced you into anything sexual, or hit or kicked you?

PTNo. Nothing like that. House is loud but safe.

DRGood. Alcohol?

PTRarely. A cousin's birthday, maybe one drink. I do not love the taste, and it messes with my allergies anyway.

DRAny vaping, smoking, weed, pills?

PTNone. Never smoked anything. Grandma's oxygen tank was a very effective advertisement.

DRVivid and effective. Quick exam now... heart is regular, a touch quick at ninety but you mentioned the walk from the bus. Blood pressure one twenty-one over sixty-two — good. Lungs clear. Now open up for me. Mm. This is what your aunt spotted. Your gums are puffy and red along the edges, and they bleed at a touch — that is gingivitis. Do they bleed when you brush?

PTYeah, kind of a lot lately. I thought maybe my toothbrush was too hard.

DRIt is the gums, not the brush. Early stage, completely reversible — but it needs a real dental cleaning and daily flossing. When were you last at a dentist?

PTMiddle school? Dental was never a thing we could fit.

DRThen I am sending a referral to the dental clinic downtown — they take your coverage, and the cleaning will not cost you anything out of pocket. That plus flossing and this is gone in a couple of months.

PTOkay. She is going to be so pleased with herself.

DRRightfully. Also, your blood count from this morning looks fine — no anemia, nothing alarming. Now the capital letters item: shots. You are due for several. Flu, a tetanus booster, hepatitis B — and because your program will eventually put you in clinical settings, that one matters — and the meningitis vaccine.

PTAll of them today? Like, all?

DRAll of them today, two per arm, and then you are done and gloriously up to date. Sore arms for a day or two.

PTFine. But I am telling my aunt it was heroic.

DRI will co-sign that. Last thing, the loneliness piece, because I do not want it to just sit in the chart. The community center by the transit hub runs a study group and a walking group, both free, both full of people your age in exactly your situation. And when you apply to the nursing program, their student association is famously welcoming. One small thing this month — pick one.

PTThe walking group would hit two birds, honestly. Sugar and Sundays.

DRExactly the right math. So, the plan: dental cleaning through the referral, floss daily, juice swap and walking for the sugar, we recheck the A1c in about six months, cetirizine and EpiPen continue as they are, four vaccines today, and one Sunday walking group before I see you next.

PTThat is... a lot of list. But okay. Yeah. I can do the list.

DRYou can. The nurse will be in with the vaccines, and the front desk will print the dental referral and the nutrition class times. Any questions from you — or from the aunt list?

PTThe list is all checked off, actually. Thank you. This was less scary than I built it up to be.

DRThey usually are. Take care, Delana — and tell your aunt the clinic says she should run for office.

PTShe would win. Bye, Dr. Reyes.