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April 30, 2009

I'm in the Zone: Cortisone.

So yesterday I went to the orthopedist for this wrist mess.Frigging sting!!

I was all, "I've been wearing the brace and I stopped lifting at the gym and have generally been taking it as light as I can, but no improvement."

And he was all, "Well, we looked at your x-rays from today and your radial and ulna bones are in perfect position, so it does appear to be a tendon issue and not a bone issue."

And I was all, "That's good, right?"

And he was all, "Yeah.  So let's talk about options.  We can move with the brace for another month, or you can do physical therapy, or you can do surgery."

And I was all, "Hmm.  Well the brace isn't helping yet.  And I don't want surgery.  Let's do a cortisone shot and follow up with physical therapy?"

And he was all, "You're an educated patient.  Okay, we'll do a very small shot today and see how that works for you."

So I sat down in a chair in his office and he moved a small table towards me for me to prop my elbow up on.  He left for a minute and then returned with a small bottle, a cotton swap and injection prep wipe, and a massive needle.

And I was all, "Whoa, that's a big needle.  Do you put the whole thing in?  That would come right out the other side of my hand!"

And he was all, "But you do needles every day, don't you?  This should be okay with you."  

And I was all, "Irony, eh?  I hate needles that I'm not controlling.  And that mega-needle?  Scares me."

And my blood in my face was all draining, so I looked white as a sheet.

He was all, "You're going a little pale on me.  Are you okay?"  He swabbed my wrist and shifted my arm around until the proper injection area was exposed.

And I was all, "I'm okay, I'm just not going to watch, okay?"

He nodded.  And the needle was all of a sudden embedded into my wrist and the pressure of the cortisone being injected made me squirm instantly.

I was all, "Ow."

He was all, "Just a few more seconds and I'll be done.  And ... you're done.  You okay?  Do you need to lie down?"

And I was all badass:  "Nah, I'm good.  I'm just going to sit here for a minute while you explain what happens next and I pretend to listen fully despite the pain."  I smiled.  But winced.  Sort of at the same time. 

And he was all, "Elevated numbers for a few days ... increase basals with your endo's help ... keep wearing the brace ... it's going to hurt where I did the shot tomorrow, but you should feel real improvement by about this time next week ... if you don't, we'll want to do that physical therapy and consider maybe another shot depending on how you feel ... you'll be okay ... hey, are you okay?"

And my color was all returning, but slowly.  We finished up, and I tested.  155 mg/dl.  Okay, a little higher than the 114 mg/dl I walked into the doctor's office at, but it must have been a stress bump.  I didn't want to fool with my basals until I was sure that the cortisone would make me high, so I waited a few hours before doing some tweaking

In the course of six hours, I went from 155 to a steady stream of 190 - 240 mg/dl numbers.  I tested for ketones and - low and behold! - the little stick went light purple on me.  Small ketones, prolonged highs, and the pain from the actual shot set in around 8:45 pm.  This morning, I woke up at 213 mg/dl and even after an aggressive bolus, I'm still cruising in that general range.  Basals have since been cranked to 150% and I'm both wearing the Dexcom and testing every hour.

The ketone thing is what's throwing me for a loop.  I hardly ever throw ketones - why now?  I drank a lot of water, ate some carbs, and still had the ketones this morning.  (Poor Chris - I asked him to test himself for ketones because I was convinced the Ketostix weren't working right.  He was all, "Um, I'm negative."  And I was all, "At least I like the color purple.  Blaaaargh.... ")

I hope this was the right decision.  I'm desperate for my wrist to heal.  The doctor said this pain and the highs could go on for 3 - 7 days.   

And I was all, "This sucks."

April 29, 2009

Close Encounters With Shoes.

For the record, I like these shoes a lot.It seemed like any other day.  Little did I know, it would be a day I would remember forever.

I decided to stop home at lunch yesterday. I pulled into my parking space and fumbled with my unnecessarily enormous work bag as I opened the door to our condo building.

And then I heard it.

That steady, familiar clomp clomp clomp. I knew the cadence by heart, though it was slightly unfamiliar since it wasn't 3 in the morning.

Shoes.

I immediately panicked. OMG, Shoes. Now? Here? Now? Will she know it's me? Does she know how many times I've cursed her and her stompy heels and DogShoes and BoyfriendShoes? How many times I've wanted to banish her to sleep under the mailboxes?  

I was flooded with confrontational panic.  I'll just calmly introduce myself as her downstairs neighbor.  Maybe the bags under my eyes will serve to teach her a lesson.  I could imagine her coming home from work that night ...

"Hey, I met the girl downstairs.  She seems so nice, but she looks exhausted.  Do you think maybe it's us keeping her up?  Maybe I should take off my tap shoes after class and not practice my 80's dance moves on our hardwood floors.  You think?"

BoyfriendShoes would nod in agreement, gently setting down his cinderblock art project.  "You're right, honey.  I'll move my Cinderblocks in Repose outside near the mailboxes so I'm not making so much noise."

They hug as they take off their shoes and slip into soft, fluffy slippers.   DogShoes wanders out from the bedroom, and gestures towards his paws.  They smile and kneel before him.

"Yes, DogShoes. We'll take off the horseshoes from your feet.  You're right.   You don't need those.  It's just unnecessary noise."

... but this fantasy disappears as Shoes comes around the corner and I freeze.  She barely glances at me. 

"Hey."

"Hey."

We pass, two shoe ships in the night, me going to my apartment and Shoes moving towards the parking lot.  Her clomp, clomp, clomps Doppler away, and I suddenly wonder what the woman below me thinks about my 11 pm ellipmachine adventures.

Shoes.  You have taught me a lesson about love and respect. 

And the value of earplugs.

April 28, 2009

Grand Rounds: What's on the Menu?

Grand Rounds CafeDing.

The bells on the door of the diner near my office jangled as I walked in.

"Hey Kerri," said Lisa, the waitress who knows my morning coffee order by heart.  "Here for lunch today?"

"Yeah, I'm looking for a little snack here at the Grand Rounds Cafe."  I took a seat.  "What's on the menu?"

Lisa handed me a menu.  "We've got some great options this afternoon.  These are the house favorites today.  And did you hear about that girl who was mauled by the dog?"

"I did - remarkable, eh?  Read about it on Better Health."  I scanned the menu quickly.  "Oooh!   This looks like a fascinating dish.  The Pay to Play?  What's that?"

"That's over at HealthLine.  Employers are paying people to keep their health in top shape.  And if you look right here, we have a side dish about traveling in diabetes style from Shoot Up or Put Up.  More diabetes tidbits at the ACP Internist.  Look closer, Kerri.  We've got A Hero You Can Count (Carbs) On at My Favourite Number, JDRF T-Shirts at Candy Hearts, and a diabetes packing list at Wilson's Wanderings.  You're into diabetes, right?"

"I am.  I have it and I work in the diabetes field.  But why do you keep adding blog names to these menu items?  It's weirding me out.  I just want some food."

"Honey, this is the Grand Rounds Cafe.  We're all about medical blogs today.  So shut up and order."  She flipped open her pad and put her pen at the ready. 

"Man, you are pushy today!  But speaking of diabetes, no metformin on the menu today?  I heard from Dr. Shock that it can reduce cardiovascular disease for my type 2 buddies."

Lisa clicked her pen.  "Nope.  Thanks to Rachel's Diabetes Tales, we've decided to take it off the menu."

"Geez.  Okay, well I'll take a vegetarian route this afternoon.  How about a nice spinach salad with mushrooms and bacon?"

"Goin' all veggie on us?  Teen Health 411 says vegetarian could be the new eating disorder for those teenyboppers.  And the bacon?  Pffft.  I know you read that Berci at Scienceroll.  Swine flu, anyone?"

I threw down my menu.  "Lisa!  Stop with the blog name insertions!  You're confusing the hell out of me!"

She snapped her gum in retort.  "How exactly will people know whose blog is whose unless I say it?  Don't forget where you are, missy.  This is the Grand ..."

"... Rounds Cafe.  I know.  It slipped my mind for a sec there.  I'm sorry."

"It's okay.  I know you like me ... you really like me.  Like Medical Marginalia wrote about her doctor.  Not like Leslie and her emotionally unavailable doctor at her blog, Getting Closer to Myself."  Lisa winked as she wrote my order down and then wandered back to the kitchen.

"Gotta demand the best!  Like Duncan Cross!"  I yelled back.  Two can play at this game.

While I waited at the table, I thumbed through a few discarded papers left by previous patrons.  I caught a great article about the Land of the Screwed in the latest edition of A Happy Hospitalist.  I also got sucked into an article about drinking your way to sobriety at InsureBlog.   I found another terrific article at Nuts for Healthare about evidence based medicineDoc Gurley offered up a piece on brown fat (which I couldn't stop reading, even though it was a little graphic for lunch time). 

I even found an article at SharpBrains about the creation of a cognitive health track at an upcoming blog conference.  The reading material kept on coming, as if it were part of some big blog carnival about the best of medblogging.  At Nurse Handover's blog, I mean newspaper, I stumbled upon a post remembering the New Zealand and Australian nurses on ANZAC day. 

So many health articles, all conveniently left at my lunch table! 

A glossy copy of Emergiblog gave me the latest on Nurse JackieNotes of an Anesthesiologist told a tale of two disagreeing specialistsA Happy Hospitalist gave a less-than-happy assessment of the economy and healthcare.  A Paper Mask picked up the Wellsphere torch lit by other medbloggers and asked more questions.  And tucked under the salt shaker was an article from Kennedy's Tumor about the possible cloning of Russian tennis players.

"Whoa."  I was overwhelmed with information.  I rounded out my reading with an article from the Health Business Blog about the Boston Marathon, just in time to see Lisa returning with my lunch order.

"Here you go.  One spinach salad, and I brought you a diet iced tea, too."

"Thanks, Lisa," I said as I unscrewed the bottle, then massaged my aching wrist."

"that still bothering you?  Did you check out those exercises to avoid pain at the computer?  I read about it on How to Cope with Pain."

"Nah.  I'm better off creating a powerful physical space to combat this injury.  I learned about that at Chronic Babe." I smiled a bit.   "See?  I can blog-name drop, too."

"Well aren't you fancy, Miss Kerri?"

"I am.  I'm even eating this healthy ol' spinach salad as prep for pre-pregnancy.  You read that article on A Chronic Dose, right?  About pregnancy and chronic illness?"

"Of course I read it.  I'm a blog-addicted waitress here at the Grand Rounds Cafe.  But I know you'll be fine.  You have a good partner, which is important.  I read about partners who are jerks over at In Sickness and in Health."  

"True.  I'll keep myself as healthy as possible.  I don't want to end up having, or becoming, a tubby tot like I read about on Reality Rounds."

"You can also just recycle, which keeps the earth fit.  According to The Fitness Fixer."  

I stopped eating.  "Lisa, that one was just sad.  You threw that out there with barely a decent segue.  Is the Grand Rounds Cafe all about dropping link love all over the place?  Or can we actually tell a story here?" I know I said iced tea, but I'd rather have coffee.

She stopped and gave me a knowing look.  "Kerri, where else can you find a smattering of information about uninsured women fighting cervical cancer?  Yes, the Colorado Health Insurance Insider.  How about straight talk on medication mindfulness?  That's right - MedScape.  Where else will you find surgeons admitting they get in it for the chicks?  Only at other things amazni.  But here, Kerri.  Here at the Grand Rounds Cafe, you can get all this stuff in one place.  It's the best of medblogging.  And coffee."

"Wow, Lisa.  That's quite a speech.  I'm impressed."

"Yeah.  I'm impressive."  The bell on the diner door jangled again and a new customer strolled in.  "Alright, kid.  Eat your salad and I'll bring you a nice plate of Teochiu.  Courtesy of The Cockroach Catcher."

Lisa walked away and I took another bite of salad.  Then the man in the booth behind me spoke up.

"Hey.  Excuse me.  Hi, my name is Steve and I'm late.  But I have an article for Grand Rounds.  Can you add it?"

I was just about done with my lunch.  But he had a lot of heart, this guy.

"No problem, my friend.  I'll add you and your Adventures of a Funky Heart to the menu here."

I finished my lunch and left money on the table. 

"Thanks, Lisa!"

'No problem, hun!"

(Grand Rounds is served up fresh next week at Nursing Handover!)

April 27, 2009

Ding! Diabetes!

Crap happens. 

Case in point:  last week.

First off, my frustrations about diabetes are at an all-time escalation point.  The blood sugar logging, even though it is working and my averages are already in a better range, is very time-consuming and is a constant reminder of diabetes and all its trappings.  I'm logging my blood sugar tests, the food I'm eating, the exercise I'm doing, and the boluses I'm taking.  Everytime I go to jot down a result or log a carb, a little alarm goes off in my head.  "Ding!  Diabetes!  Ding!  More diabetes!  Ding, ding!" 

Secondly, I called Joslin to follow up on the photos they took of my eyes.  "Oh, hi.  Yes, you look good.  Twenty-two years, huh?  Wow.  Well you only have mild retinopathy in your right eye and barely anything in your left."

Well there's a word I've never heard before.  Not directed at me, anyway.

"Excuse me?  What's that?"

"Mild is when there are less than five spots.  So the right one is mild.  The left, too, but less than the right."  She said this like I was aware.  

"That's news to me.  I had a dilation in January and there was a little bleeding, but he didn't say that's retinopathy."

"Well did he say you had bleeding?"

"Slight, yes.  In the right eye."  Am I an idiot?  Bleeding IS retinopathy, stupid Kerri.  So since it's been there for months now, why are you getting all freaked out?  "So yes.  Sorry.  I just haven't heard that word yet."

And she explained the follow up and what would happen next, and we talked about how it might be handled if my retinologist in Stamford decides lasering it before pregnancy would be a good idea.   And the more she talked, the more I realized I wasn't getting teary or upset or sad about it.  I felt pretty damn mad.  It's never enough to really beat this thing, or at least it feels that way on some days.  After a certain amount of time, no matter how hard you work, something gives at least a little.  And in this case, it's the blood vessels in my eyes.  Now that box is checked - the one that says retinopathy - and slowly my dance card fills up.

My body feels like it's caving in a bit these days, and I'm trying to stop that avalanche from devouring my optimism.  Between the constant logging and the wrist issue and now this checked box, I'm frustrated with diabetes in general.  I need to find a little extra grace to get me through these moments.  Got any? 

And thirdly, added to this pile is the fact that my literary agent and I parted ways last week, and I'm now searching for new representation.  (If you are a literary agent or publishing house and you're reading this, email me at kerri [at] sixuntilme [dot] com.  There.  I said it.  I'm actively looking.)

So last week sucked a wee bit.

Violets on the rocks.
 
But waking up Saturday morning to awesomely warm weather and spending the afternoon with one of my best friends?   Spending Sunday cheering another buddy across the finish line and gossiping over breakfast?  And rounding out the weekend with a long hike in the woods and then taking in a movie?  All enough to pick me back up and set me straight again. 

Last week knocked me around a little bit, but I'm trying to stay positive.  I'm done bitching and moaning.  Time to move on.

It helps that in three weeks, I'll be on a cruise in the Caribbean for my wedding anniversary.  Hey, I believe firmly in the power of vitamin D.  :0)

April 24, 2009

Oscar Meyer Does It Right.

The other night at the gym, I was thumbing through People as I cooled down on the elliptical machine.  And I came across a startling marketing attempt by Oscar Meyer that actually worked for me.

Yes, it is.

Of course they're trying to target bloggers.  (Isn't everyone?)  Of course they are using a bloggy buzzword to gain traction for their brand.  And of course, I rolled my eyes when I saw it.  But damn if I wasn't so surprised by the assertion that a sandwich could be, indeed, "blogworthy" that I felt compelled to snap a picture with my KerriBerry and actually post it.

Oscar Meyer, I wanted to slap your hand for being so blatant.  But instead, I fell into your trap.

My bologna has a first name.  And it's apparently "B-L-O-G-W-O-R-T-H-Y." 

April 23, 2009

Proactive vs. Reactive: Why Good Patients Are Broke.

My health management plan is both proactive and reactive.  I am proactive by taking steps every day to not only be healthy for 24 hours, but for decades to come.  I understand that monitoring, eating healthy, exercising, and seeing my medical team often helps keep my diabetes tuned up and keeps me tuned in.  I understand that efforts now will hopefully keep me healthier later. 

I'm reactive to my blood sugar bounces, testing as often as I can and responding with insulin, exercise, food, or some dizzingly varying combination of both.  I'm reactive to any aches and pains that pop up unexpectedly, like a wrist pain or an ocular migraine

It's good for me to be both proactive and reactive.  This mentality helps keep my health, though already slightly compromised by a diabetes diagnosis that was out of my control, at the best level I can achieve.

On paper, and in my mind, I'm a "good patient."  Trying to be, anyway.

So why are so many "good patients" broke?

Being proactive with healthcare isn't part of the natural American view of health.  American patients seem to be penalized for staying on top of their conditions.  For example, I had a dental cleaning on Monday.  My second one this year.  Both my dentist, my primary care physician, and my endocrinologist have told me that good dental health is crucial not only to my diabetes management but to my overall health.  So, on their recommendation, I have three - four cleanings a year.

Yet only two are covered by insurance.  So on Monday, I paid $105 out of pocket and unreimburseable to my dentist's office.  This doesn't make me frustrated with my dentist, but with the healthcare system that would be more inclined to have my teeth drilled than cleaned.  Yet, I'll keep doing this because it's what's best for my health.

And today, I went to the orthopedist to have my wrist examined.  And the doctor - very nice guy with a good bedside manner - examined my wrist and after about a minute with me, recommended a wrist brace, xrays, a cortisone shot, and surgery.  In that order.

"Even though I'm 99% sure I'm not pregnant, I am not on the pill and am only using barrier methods of birth control.  Can the xrays wait until I'm positive I'm not pregnant?"

"Sure.  We can wait for the shot for then, too.  And we can discuss surgery at that time as well.  You can come in really quickly next week once you're sure you aren't pregnant and we can do the xrays.  It will take three minutes and you'll be on your way."

"Okay.  Thanks.  So will I be charged for a copay next week, then?"

"Yes.  Of course."

"Wait, really?  Even though it should be part of this visit?  No one mentioned xrays to me over the phone, and even if it was something I should have anticipated, I didn't.  So now I'm being charged double for being proactively cautious and protective of a potential but highly unlikely pregnancy?"

"Well, yes.  Unfortunately.  I have to charge you for next week's visit, no matter how short.  Otherwise, it would be insurance fraud.  And we can discuss surgery, as well."

Great.  So now I'll be out $50 for what should have been one visit for only $25.  I'll be charged extra for xrays and potentially a cortisone shot, but the surgery would be 100% covered.  (Yes, I already called my insurance company to find out what's what.) 

Why, Insurance Company, are you so against proactive care?  Why do I need to pay more for a brace or a shot or an extra visit when you're more content paying for a several thousand dollar surgery instead?  Not enough bang for your buck?  Why do you fight me tooth and nail against coverage for a continuous glucose monitoring device?  Is my life not worth the investment to keep my legs on instead of paying 100% to amputate them in a few decades?  I know I'm expensive as a chronic disease patient, but I'm healthier than 85% of the people I know.  I eat well, I exercise regularly, and I am on top of my disease.  Yet you deny me life insurance, you won't let me purchase a private health insurance policy, and you would rather see me on an operating table than taking up a doctor's time in an office visit.  (And it's not like I'm taking up more than 5 - 7 minutes of a doctor's time, because that's about all we get, on average.  Pathetic.)

I am ashamed sometimes to admit that the reason I don't have the money to go out is because I spent it on a dental cleaning or a follow up visit to my doctor.  I'm embarrassed that proactive patients are the ones going broke.  I hate the healthcare system, and its backwards way of punishing me for thinking ahead and celebrating any decisions to let things deteriorate until I require more "procedures" than "maintenance."  Where's the love for the proactive patient?  Our reward is being charged double?

My checkbook will be $200 lighter next week, and I'm not even "sick."  I'm trying so hard to avoid becoming "sick."

What will my healthcare cost if I ever truly am?

When Larry Bird Calls.

I tapped the Twittersphere again for some vlog ideas, and Windy came through with a ringer:  When in doubt, talk to the Bird.

I could have slapped myself in the forehead.  Of COURSE!  Larry!  My fictional personal trainer!  God knows I've been having trouble making exercise ends meet these days with my schedule and that stupid wrist thing.  I could use a few minutes with Larry

So I donned my best southern accent to bring you "When Larry Bird Calls."

(Note: No medical advice was given during the course of this video. This video barely makes sense as it is. But southern accents are, and remain, adorable - twangy or not.)

April 22, 2009

Wrist and Shout: Part II.

I can't take it anymore.  This wrist thing is making me crazy.

Since my "diagnosis" with tendinitis in February, I've done plenty of attempted cutting back on repetitive movement:

I've been trying to use the computer mouse less.  Fat chance, seeing as how my day job is extremely computer intensive, and blogging also uses - wait for it - the computer.

I bought a Bamboo.  Yet I haven't had more than 15 minutes to sit down and learn how to use it.  So it's still in the box.  Sitting there.  A waste of money and good intentions.

I took Advil for several days.  Actually, I took it for almost three weeks, and then I heard about the kidney + Advil conundrum.  But also, I didn't like the fact that once the Advil wore off, I was back to being in pain.  Seemed like a bandaid.  I want to fix this.

I sleep with a wrist brace on.  What's sexier than your wife climbing into bed, wearing a pump, a Dexcom, multiple attached sensors, and a wrist brace?  All I'm missing is the damn headgear.  And I'm wearing the brace for more than just sleep - I wear it when I'm driving, as often as possible at work, and if I ever watch television for more than 10 minutes.  (Rare, but it happens.)  

I stopped weight training.  Before my wedding, I was doing as much resistance training as possible.  I liked the effects it had on my body.  But since February,  I've had to stop weight training completely because I can't lift anything up.  I can't do tricep dips.  I can't jump rope.  I can't even hold weights while doing lunges because of the stress on my wrist.  So I've been doing more cardio than usual and gazing w(r)istfully at the free weights.

I can't carry grocery bags.  My wrist explodes with pain when it grazes my desk or the couch or the kitchen counter.  I can't even throw Siah off my chest when she's trying to sniff me to death at night.  (That cat is getting fat.)  I'm not one to complain about physical discomfort, but this wrist pain is beyond tolerable.   

I feel like a 90 year old woman. 

So I went to the Twittersphere and pinged my question out to them in 140 characters or less:  "Tough workout. Wrist issue (tendinitis) is not healing. Has anyone had this before? How did you fix it? V. frustrating."

Responses ranged from "Advil and rest!" to "Physical therapy and a brace!" to "Cortisone shot!"  Apparently, I'm not the only new media-type to have grappled with this issue before.

I called my doctor this morning and explained the situation.  After she realized that, despite my attempts to ease up on the wrist stress I still wasn't on the mend, she recommended I speak with an orthopedic practice and get an appointment.

"They may want to give you the shot that day, so be prepared, diabetes-wise."

"This could make me go high for a few days, right?"

"It depends.  They won't give you much in the injection, and it's a localized dose, so you may not see more than a premenstrual-style spike.  But you might see more than that.  It depends on a lot of factors.  The orthopedist can help answer those questions more specifically."

(This is EXACTLY why I prefer working with a primary care physician who is comfortable with specialists.  She knows that she can cover my basic needs, but she's quick to refer me to doctors who can handle specialized needs.  I like that she doesn't pretend to know everything.  Doctors who acknowledge that they, too, are human make me feel safer.)Can't dial one of these things, thanks to CRAPPY WRIST THING.

"Cool.  Thanks.  I'm tired of feeling like an old bird."

She laughed.  "Let me know how it goes."

So I have an appointment tomorrow morning with an orthopedist, and I'm sort of hoping they do the shot tomorrow so I start putting this pain behind me.  I can't wait to weight train again.  And lift grocery bags. 

And throw Siah.   

SUM Grand Rounds.

Grand Rounds Submissions - due April 26th!Grand Rounds are being hosted here, on Six Until Me, next Tuesday.  Of course, there isn't a theme because that would wrongfully imply I was able to plan ahead even a little bit.  :) 

Submissions are due on Sunday, April 26th by 10 pm EST.  They can be emailed to kerri @ sixuntilme dot com.  Please put “Grand Rounds” in your subject line and include the following in the body of your email:

Blog Name: 
Blogger Name:
Blog URL:
Post Name:
Post URL:
Short description of post:

I'm really looking forward to your posts! 

April 21, 2009

Precision LogBooking.

"So what is this one, the 236.  Did you correct this?  Is this after eating?  I can't really tell."

And I peered at the logbook, chock full of results.  Months of results, all neatly organized by date and time.  Only without food or insulin doses written in, so it was less like a diabetes assessment tool and more like the machine that spins the bingo balls. 

"Ah, I have no idea.  Damn, I have no clue, actually.  I'll assume I corrected it." 

There's not too much difference between writing in all the results the night before an endo appointment and printing out the numbers.

With last week's endocrinologist appointment being a little less than thrilling, I'm on a new game plan to get ready for my June follow-up.  Dr. Brown has asked me to keep a detailed logbook of my numbers.  Not necessarily a food journal, but more a list of blood sugars, insulin doses, and carb intake.  

"You don't need to list the kind of fruit you ate, but if you just put that it was 20 grams of carbs, that would be what we need.  That way we can tell what's causing what."

The wee ickle logbook.

So I bought a very small moleskine book to record everything. (I love these books. I have one in my purse at all times and I use it to jot down everything from blog post ideas to words I want to remember to look up to reminders that if I don't pay my cell phone bill, they will come for me.)  It's a wee little thing and it fits in my meter case.  Surely it will be covered in blood and have test strips stuck to it by the end of June, but so far it's been one full day and I'm still on the wagon.  (And that, my Faithful Readers, is saying a TON.)

I get burnt out with the details of diabetes.  The whole logging thing throws me off my creative stream of consciousness.  "You mean I have to write this stuff down and analyze trends?"  I'll wear the pump and the Dexcom and do my due diligence, but when it comes to the diabetes nitty-gritty, I often tumble off the wagon.  

It's a lack of patience.  Maybe a lack of desire to make a blood sugar testing moment last more than the five second countdown.  I don't like when I feel so much of my time slipping into the realm of diabetes management.  And I make plenty of excuses not to focus:  "I'm heading to Tucson."  "I'm going home to RI for the weekend."  "I'm having dinner with NBF."  "I'm too busy at work."  "I'm ... no."  

But I'm a woman on a mission.  If I don't ever buckle down and make my A1C my top priority, it may always hover around seven plus percent.  Even if it's a pain in the ass, and even if it's "hard," I owe it to myself and my future family to give it my best.

Poor Chris.  He thought Twitter ate up time?  Wait until he sees how often I have to logbook.  

April 20, 2009

This Is Your Captain Speaking.

Last week I had the honor and pleasure of traveling to the Canyon Ranch Institute in Tucson, AZ with Dr. Val to co-lead a workshop about social media, blogging, and the hot topic of Twitter.  It was a beyond-cool experience, talking about the impact of blogging on people's health management, and showing how the patient blogging community can improve health both on and offline. (Val has a wonderful recap of the experience on her blog at Better Health.)

After our stay was over, we went took the shuttle back to the Tucson airport and checked in for our flight. 

"We wanted to make sure we were sitting next to one another on the flight," Val said to the This was the weirdest thing that has ever happened to me.attendant at the American Airlines counter.  

"You actually aren't.  You have good seats, though.  Do you want to try and change them?"

Val didn't even have to check with me.  (She had to fly out to Tucson with me from NYC, so she's familiar with my flight anxiety.)

"We'd like to sit together, if that works."

The attendant checked the system.  "We have two seats in row 31.  That's in the way back of the plane.  Is that okay?"

"Fine with us," we said almost in unison.

"I wouldn't want to sit in the back of the plane," said a man in uniform who appeared behind the counter.  "Right near the engine?  Awful."

I was nervous.  Who was this guy was just leaping into the middle of the conversation to offer his snarky two cents? 

"Hey, I like the engine.  I'm very pro-white noise, you know.  Love it.  Soothing stuff.  It's going to be a great ride."  Tried to flash him a disarming smile, hoping he wasn't sitting next to me on the flight.

He grins and walks away.  Val and I board the plane and settle into our seats.  My seat is directly next to the engine, as advertised.  

"It's cool.  White noise, right?"  I joked to Val.  She laughed, and we prepared to take off.

Once the plane was up to cruising altitude, the PA system on the plane chimed into action.

"Good afternoon, everyone.  This is Captain Frank [Name Redacted] and me and my co-pilot will be taking you all to Chicago today." 

I tuned out a bit, still trying to feel relaxed.  Val was already almost napping beside me in her seat.  The captain continued to talk.

"So we're at 31,000 feet and we'll eventually climb to 33,000.  Sit back and enjoy the ride.  And I'd also like to welcome Valerie and Kerri to our flight today and hope they're enjoying the wonderful white noise there at the back of the plane."

Val woke up with a start.  "Did he just say our names?"

I couldn't stop laughing.  "He did! That guy, from the counter!  He's the damn pilot!"

The flight continued on without incident to Chicago, and as we prepared to land, the pilot came over the PA.

"I want to let you know that we're going to start our descent into O'Hare, and the current temperature is 72 degrees.  We hope you've enjoyed flying with us today, and we thank you for choosing American Airlines.  And we hope the white noise wasn't too much for our back of the plane passengers."

Val and I erupted into laughter again.  The captain buzzed over the intercom one more time.

"That's just an inside joke today, folks.  Flight attendants, prepare for landing."

Once the plane landed, Val and I had to reintroduce ourselves to the captain.  "We couldn't help but overhear your messages!" 

The pilot laughed.  We handed him our respective business cards.  "We're bloggers," Val said. 

"Would it be okay if I wrote about this?" I asked.  "I don't want to break any rules."

"Sure.  I'm with it.  I am on Facebook.  I don't know much about the Twitter thing, but I am pretty savvy for a guy over 50."

We actually stood there for over ten minutes, talking about Twitter with the pilot of our flight. 

That has to be the weirdest thing that has ever happened to me.

April 17, 2009

Guest Blog: Diabetics Have Healthy Babies All the Time

Baby advice for diabetics, brought to you by not-doctors. Thanks to Jessica Hickok for offering to guest post today (I'm still in Tucson with the fabulous Dr. Val).  Jessica wrote a post about something that is definitely on the forefront of my diabetes mind, namely diabetes and motherhood.   Jessica offers up her thoughts on her diabetes pregnancy and advice on managing all the emotions.

*  *  *  

Quoting a line from the movie “Steel Magnolias” for the title of this post seems only fitting when guest blogging about what it is like to have babies and type 1 diabetes. 

You see, I am type 1 and currently 31 years old.  When I was 22, my husband and I had been married 2 years and decided it was time to fulfill our dreams and have a baby.  And the biggest piece of advice I can give to everyone who has seen the movie “Steel Magnolias” … it is important to remember that life does not always imitate art.

We did the planning and really worked hard on keeping my blood sugars regulated.  We spoke to my doctor and with an HbA1c of 6.8% we were given the green light to have a baby. <insert cheesy, romantic interlude here>.

However, when I found out that I was pregnant with my first child, I was both elated and scared at the same time.  I knew it was coming, but I immediately thought to myself “what if something goes wrong?” 

When other PWDs ask me about my child-birth experiences, I feel compelled to share my story and the following advice of what you can expect or should consider: 

1.    Do not let diabetes steal your thunder.
Be happy for yourself, you’re having a baby!  Just because you have a chronic condition, does not mean that you cannot enjoy the pregnancy and anticipation of motherhood.  Nor can you let your dreams be ruled by fear or guilt of your disease.  So you have to work a little harder at staying in a healthy glucose range, big deal, you’re going to do that anyway.

2.    Be comfortable with your doctor.
Being diabetic automatically puts you in a high-risk category.  However that doesn’t mean that you should lose sight of your basic rights as a patient.  Find a doctor that is comfortable with your disease and one that is willing to work with your diabetes doctor or endocrinologist. 

3.    Expect that your baby might be big. 
High sugars can spill over into the placenta feeding the baby and causing a large birth weight.  Both of my boys were born approximately 3 weeks early and the first one weighed 9lbs 12oz and my second was 10lbs 14oz.  No, I am not looking for a prize, but I do point that out just to prove that all of my complaining during pregnancy was justified.

4.    You may have to have a c-section.
C-setions aren’t bad, they just sound scary.  Yes, it will take you time to recover, but just think with your tightly controlled blood sugars that you had during pregnancy, your recovery time should go relatively quick. I had both of my babies delivered c-section and I wouldn’t trade it for the world…I did tell you that they were big babies, right?!

5.    Expect that your sugar readings will roller coaster after having the baby. 
While my hormones were bouncing around back into place the few weeks after having the baby, it caused my sugar readings bounce along with it.

6.    Diabetics have healthy babies all the time. 
Today, my first child is 8 years old and my second is 5 years old.  They are bright, healthy and so-far diabetes free. (knock on wood).  And the good news is that my story didn’t turn out at all like the one in Steel Magnolias.

I was lucky to have my insulin pump while I was pregnant.  And because there have been so many advances in diabetes technology (enter CGM!), I know that it has only become better and easier for PWDs to have children. 
 
The moment I held that precious newborn, my fears were all washed away.  For those amazing first moments of holding my new baby, I was not diabetic … I was a mother.

Disclosure from Jessica: Please keep in mind that this post is written purely based on my opinion and my personal experiences with pregnancy and childbirth.  I am not by any means a medical doctor.  Nor do I share my story as medical advice. Please talk to your doctor about your plans to have children.

Editor's note:  Thank you for posting today, Jessica!  There are guest blogger spots I'm looking to fill, so if you'd like to guest blog on SUM, email me!

April 16, 2009

Guest Blog: Self-Diagnosis.

Adam Kaye

I'm traveling to the Canyon Ranch Institute (and spa!!) this morning to give a lecture with Dr. Val of Better Health, so I've asked Adam Kaye to guest post today.  Adam and I have been corresponding by email for a while now, and I had the opportunity to meet him last week.  He's a type 1 diabetic and in medical school - so he understands what "in the trenches" means on plenty of levels.  

Take it away, Adam!

*  *  *

First year of medical school, we learn mostly basic science: anatomy, physiology—we learn how things are supposed to work. Second year is when things start getting interesting.  We learn mostly pathology—why things don’t work. We’re finally faced with the reality that sometimes, those little twinges of pain, that mild nausea, can, in fact, be real disease. During my second year, I was convinced, at different points, that I had a brain tumor, two blood clots in my lung, and six episodes of appendicitis. You pretty much have to force your mind to write it off as what I like to call “Second Year-itis.”   

So, cue up December 1, 2005. It is my second year of medical school. I’ve just come back from Thanksgiving break. My parents had complimented me on losing weight, and made mention of the fact that I almost single-handedly took down one of their Poland Spring tanks. I’m sitting in a lecture entitled “The Presenting Signs of Diabetes.” As I’m sitting there listening to the professor’s description of polydipsia (increased thirst), polyuria (increased urination), weight loss, and fatigue, my mind begins to go into its usual “Second Year-itis” routine … only I can’t shake the feeling that this is real.

If you’re reading this blog, chances are you can fill in the rest of the story. My first diagnosis in medical school was in fact myself.

Now fast-forward to third year of medical school. Third year is easily the toughest year for medical students, both intellectually and physically.  You leave the cozy confines of the lecture hall for the sterile floors of the hospital to practice your newly-learned skills as a diagnostician. The work can be, at times, very rigorous physically, as well as intellectually. I am lucky enough to be at a school where our “overnight call” (read: staying up all night) is kept to a minimum, but the demands of many of my rotations meant very long, odd hours. On my surgery rotation, for example, I would be at the hospital around 5:30 am to round on patients. Surgeries would begin at 7:00 am, sometimes lasting well past lunch. Surgeries could be scheduled in the afternoon, too, meaning we would have to wait until the late evening to round on patients again. With so much to do, and so many hours at the hospital…well, not much time built in for diabetes management. As opposed to the regimented, strictly scheduled second-year routine I had spent 6 months getting accustomed to (my only 6 months as a diabetic, mind you), I was now flung into the chaotic, regiment-less world of a hospital.   

Our fellow Type 1’s can relate to the fact that the world doesn’t wait for us. The rest of the world doesn’t want to wait 15 minutes to eat—they want to eat quickly and get right into the next patient’s room to keep the patient queue in check. The rest of the world doesn’t want us to scrub out from a surgery to check our sugar, they want me to keep holding traction so they can see the whole operating field. The patient will be alarmed, even in a noisy hospital setting, by the BEEEEEEEEEEEEP of my Dexcom, and will be even more confused when I have to excuse myself in the middle of a physical exam to check my sugar.
   
Reading other Type 1’s experiences on sites like Six Until Me, I know I’m not alone. I know we all deal with the frustrations of a world not waiting for us, of a world that just doesn’t get it — a world full of “real people.”  As a medical student, however, I’ve been given a crash course in how to deal with them.

I can only hope my experience has helped me become a better doctor — to understand my patients’ diseases and how frustrating it can be to deal with “real people” on a constant basis.  As doctors, we ARE the “real people”—we don’t know, for the most part, exactly what our patients are going through—but I at least have a head start in my training towards understanding the patients’ side of things.

Editor's note:  Thanks, Adam!  And more guest posts coming in the next few weeks!

April 15, 2009

Deflated.

Yesterday didn't go as well as I had hoped.

The nurse came in first and took my blood pressure (fine), weight (slightly higher than last time but I can deal), and my A1C.

(Yes - Joslin is finally giving their adult patients A1C results day-of!  I was abnormally excited.  "You mean I'll know in 15 minutes?  Really?"  The nurse looked at me like I was new to the planet.  But for a minute, I was ecstatic.  I hate waiting.)

While the results were being spun, my endocrinologist came into the office and she and I spent almost two hours together going over numbers, plans for improvement, and the specifics of pre-pregnancy appointments.  While we were talking, the A1C result came through.

"Okay, so you're just where you were four months ago."  

And I felt like crying.  It's overly-dramatic and pretty sad to feel so affected by this number, but it has always been the standard I judged everything against.  It was the number that defined my health. It was the only number in my diabetes world that mattered, and a result that was too high tarnished my spirit.

It spoke to my success, or failure, as a person.  

Or at least that's how it's always felt to me.  

So I felt very teary and felt totally deflated.  And my endo kept talking, moving on past this number and instead trying to isolate patterns in my blood sugars that could be contributing to this result.  We went over my January lab results, and she was very happy with my cholesterol and my heart health.

"You're exercising how often?  Five days a week?  That's great.  I wish more of my patients were into their cardio that way.  Your resting pulse is very low.  That's good."

I couldn't stop thinking about the A1C.  Even though we're not actively trying for a baby, I wanted to get the green light, at least diabetes-wise.  I want to be a mom, and I don't want diabetes being anything that makes me decide to wait.

"Yeah, but the A1C.  I mean, that's the same as last time.  I felt so sure that I was doing better."

She looked at me.  "7.5% is not where we want you. Under 7, if we can, and even closer to 6, if possible.  But it's time, isn't it?  You feel ready?"

I nodded.  A little afraid to speak because this is something I've always wanted.  To be a mom.

"Okay, so it's time to schedule the pregnancy clinic.  Let's get this in motion and we can make everything fall into place.  And I want you to meet with Doctor Boston because she's the leading high-risk maternal fetal medicine ob/gyn out there, and she'll be able to handle your type 1 diabetes, Factor V, and hypertension.  You have more than two decades of diabetes under your belt, so I know you're feeling vulnerable.  We'll schedule this for June?  Does that sound okay to you?  Between now and June, you and I will work together to make this A1C happen."

"So the three of us will be together on this appointment?  And she'll see me through my pregnancy?"

"She'll actually be delivering your baby.  She's the best.  You'll be in very good hands, Kerri."

I had this moment where I clearly pictured this moment of delivery, when I will go from Kerri to "mom" and Chris becomes "dad" and in that instant, diabetes won't count.  It will be about me, and my husband, and my baby.  I felt hopeful that maybe, with enough help, I could really do this. 

"June.  And if I'm good in June, we can actually decide if Chris and I are ready to get pregnant?"

"Some mommies, I worry about.  I worry that they won't be willing to give it the best try they have in them.  But you, I don't worry about.  We can get you there.  You aren't going to do this alone."

"Okay.  I can do better.  I really need to do better.  I'm ready." 

She printed my prescriptions.  They took photos of my retinas to send to the pregnancy clinic.  I paid my co-pay.  I asked Chris to wait for a minute while I ducked into the bathroom.

I closed the door behind me and cried.  I'm so afraid that I can't do this.  I'm so afraid to do this wrong.  I'm almost afraid to try.  I'm afraid to hope.  But I'm so sure that I can overcome these obstacles, just like other women with diabetes have done before me, and become a mom. 

Cried so hard I thought my heart would break because I think this can really happen. 

Hopeful.  Damn it.
 

April 14, 2009

Joslin: I'm So There.

Thumbs up for, um, blood!I'm driving my little Honda up to Boston today for my endocrinologist appointment.  I spent part of last night printing my blood sugar logs from the end of March and the bulk of April (I have been keeping up with The Log Book, as promised - many blue stars on my chart).  I noticed that while I've been feeling like my control has been relatively good, I've had some zinger highs and a few trenches in the last 90 days. 

For whatever reason, I'm not dreading this appointment.  Oddly enough, I'm looking forward to spending the day in Boston, even if I will be at a hospital for much of the day.  Going to Joslin forces my brain to realign, and it always makes me feel hopeful.  I've been a patient there for over twenty two years, and it feels oddly like home.

They'll take an A1C, and I hope it's finally ringing in at NHB Range.  But my doctor has expressed more interest in having my numbers stable, instead of "good" as a result of averaged highs and lows.  She'd rather see me holding strong at a 140 mg/d as opposed to pinging from 300 mg/dl to 40 mg/dl. 

I'm not sure how I feel about an A1C result being the definitive measure of my diabetes control.  (Apparently Lindsey at Blogabetes has had the same thoughts.)  Is this a state of mind I've decided upon as a result of a result over 7%?  People talk about the estimated average glucose (here is a dizzying article including lots of math and here is an online calculator that keeps the math hidden where it belongs), but is it a true indicator of how I'm running?  And what is this fructosamine test I keep reading about?  What is the best way to tell if my body is healthy?

I'll have these tests today and I'll run through my list of questions (including, but not limited to, what can I do about this relentless tendonitis, is my blood pressure well-controlled enough for pregnancy, and do I really need to cut out ALL the coffee from my diet as I move forward here?)  I feel like I'm in excellent hands at Joslin, and I'm ready for whatever today has to throw at me.

(In the meantime, this had me mesmerized for quite some time yesterday.  I wanted to dive into the middle of that couch and snuggle every last one of those furry messes.)

April 13, 2009

A Little Pick Me Up.

Today was a bad day at work.  Not that anything particularly crappy happened, but I feel like I'm under several deadlines at once and not able to keep my head on completely straight.  Frustrations and to do lists keep piling up.

I returned from an iced coffee adventure (Yes, the iced coffee runs have already started.  No, I can't stop.) to find a priority mail envelope on my desk.  Return address looked a little familiar, but I couldn't place it.

"Who do I know in Minnesota?" I wondered, opening the envelope.

And out spilled three magnets, the first of which made me laugh out loud so hard that people at the Westport train station must have heard me.  Holy bad hearing flashback!!

Holy funny magnet.

Oh you wily Scott Johnson ... you know my affinity for puns, coffee, and hey, something shiny!  Could you be a better bloggy buddy?  

Thank you for such a thoughtful, hysterically funny, and completely unexpected care package!

Easter Eggin' It.

I have a lot of traveling going on this week, so Chris and I decided to stay in CT this past weekend instead of thrashing the roads.  

We spent a wild Saturday night spent coloring Easter eggs. With the little cups lined up and holding a Paas egg coloring tablet, I poured an unfortunate smelling combination of water, vinegar, and lemon juice into the cups and watched the colors fizz.

While I was sticking sheep stickers onto hard-boiled eggs and using egg real estate to sell our cats, Chris made the world.

Rows of eggy goodness.
 

Best I could do was make a rather bunny-looking Siah Sausage.

The egg arsenal, 2009.

She was not amused. 

Chris tolerates me.  Siah does not. 

Chris humors me.  Siah, however, doesn't.

April 10, 2009

Color Comparision Chart.

As I mentioned yesterday, I stumbled upon some diabetes relics at my dad's house the other day.  Now I'm totally in memory lane mode.  :)  I found this staple of my early diabetes management:

The Red Diabetes Book

The "Red Bible."  This book was given to my parents by the Joslin Clinic when I was diagnosed, and it held the supposed answers to any diabetes questions.  (You can see on the cover there where I was practicing spelling "restaurant" many years ago.)  I thumbed through the book and found plenty of recipes and snack ideas, all using the old food exchange philosophy.  Pages and pages of things I couldn't eat, and small sections of what my lunch options were. Half a cup of spinach, one sugar-free popsicle, rice cakes with peanut butter, those peanut butter nab things ... places to buy food scales and measuring cups ... countless pages focusing on food.  I always hated that assumption that a healthy diabetes life was achieved solely through my dinner plate.

There were three pages on handling diabetes in school settings.  No mention of 504 plans or testing in the classroom or anything about how my fellow students would react.  A short description of the symptoms of low blood sugar and how to treat it, but that was about it.

The pages on blood sugar monitoring and management brought me back to my diagnosis days.  When I first started testing my blood sugar back in 1986, we used a machine that took 120 seconds to produce a result and the strips were color-comparison ones that had to be wiped with a cotton ball and then plugged into the meter.  The color comparison chart seems so remedial compared to the UltraLink on my desk or the Dexcom on my hip.   Here's a screenshot of what we'd compare the color pads to:

Chemstrip color comparison chart

Not much to go on.  (And the numbers were too easy to manipulate.  I remember wiping the color pads on the strip with rubbing alcohol to make the results seem lower.  I wasn't the most responsible kid.)

The thing that kills me is the lack of focus on the emotions of diabetes.  There were only TWO pages on "living with diabetes."  How stress can affect blood sugar management.  How important the impact of a support network is for acceptance and dedication.  I want to rewrite this Red Bible and flesh out more of the parts that count.  Support groups, diabetes blogs, communities ... this is the future of diabetes management.  Meters have improved a little, insulin has improved a smidge, but our methods of support have leapt by such enormous margins that my future health is already brighter.  

My Joslin appointment is next week.  And believe me, I'll be talking about you guys there.

April 09, 2009

Old Photos.

I was at my father's house this past weekend and ended up poking around in some old photo albums, and these snapshots from decades past made me smile.  This is a before-diabetes photo.  I'm probably about three in this photo, and I also appear to love butterfly cakes:

Three year old Kerri.

This photo was taken two months after I was diagnosed with diabetes.  I'm at my first post-diagnosis birthday party (my friend Jill, the birthday girl, is on my right), and that box of sugar-free peanut butter cups were my answer to birthday cake.  It's weird to look at that photo and see how big my mother's responsibility was, because I was so small.  

Kerri at Jill's birthday party.

(Also, if you look closely, you can see Kitty crammed into the crook of my arm.  I brought that thing everywhere, and she still currently lives in my closet.  I waved to her this morning.) 

But out of all the photos I found, this one of me at Jill's birthday is one of the very few that brings any memory of diabetes.  I remember my mother coming to dinner at the party and giving me my shot, then coming back again before bed to test me and give me another shot, and then waking me up in the early morning hours as she returned to test and shoot me up again first thing in the morning.  

I have a clear memory of my mother and Jill's mother in the kitchen that morning, as we all toddled downstairs after our sleepover, and they were drinking tea.  It didn't dawn on me until later that my mother probably didn't sleep much that night, running back and forth between our house and Jill's house to monitor my diabetes.  I had barely been diabetic for two months, yet my mom made SURE that my childhood wasn't compromised, even when her life was.

My mom is my greatest diabetes asset.  She worked hard to make sure that my life was still mine.  And now that I'm an adult and on the cusp of my own motherhood, I am deeply appreciative of everything she has done for me.

Even now, when I need an ear, I call my mom.  

Who else you gonna call?

Who you gonna call??   Me?
 
(Sigh.  The sad thing is, there are more pictures of me in costume than anything else.  And barely any of those costumed moments fell on Halloween.  Like this one.  And this pirate one.  I am a proud product of my environment.)

April 08, 2009

The Guy with the Heart Pin.

I.  Said.  HEART.(This has nothing to do with diabetes, but I had to tell this story at a dinner a few days ago and it made me blush all over again.)

When I was in college, I met my mother for dinner at a town halfway between her office and my dorm.  We decided on an Italian chain restaurant and asked to be put in a corner booth.  

"We're kind of loud," my mom said.

So we settled into our table and ordered our food from the waiter, who was wearing a white button down shirt, a red vest, and a black apron.  (And pants.  Don't get all crazy on me.)  After our waiter walked away to place our order with the kitchen, my mother noticed that a bus boy, clearing tables, was wearing a bright red  heart pin on his collar.

"Mom, do you know what that pin means?"

I always notice pins, ribbons, and other awareness jewelry. 

"No.  Our waiter didn't have one.  Ask him, he's right over there."

So I leaned across our table a bit and said, pretty loudly:  "Excuse me?  Why do you have that heart on?"

The tables closest to us stopped chattering and turned to stare, a shared incredulous look on their faces.  But I had no idea what was wrong.  So I cleared my throat and tried again, only louder this time.

"I'm sorry - excuse me?  Why do you have a heart on?"

The busboy stopped dead in his tracks and a bright red blush took over his cheeks.  "Um, what?"

(Oh.  My.  God.  What did I just say?!)

"No, no - oh my God.  I said a heart.  Like the heart pin on your shirt.  The heart.  Not hard.  No, no ..."  I'm crying, laughing, and trying to forget that the rest of the dining room heard something decidedly less appropriate than "heart on."  He shuffled over, about to burst into flames.

"Um, I'm wearing this pin because I made a donation from my check to the Heart Association and they gave me a pin to wear on my uniform to show what I did and okay?  That's why I have a heart on.  A heart PIN on."  The words came out of him in one steady stream, like a firehose.

"I am so sorry!!!"  I buried my face in my hands, laughing.  My mother was almost out of her chair, cackling, "You're asking him about a heart, not his manhood!  Not his manhood!"

The dining room errupted into laughter, old ladies dabbing tears from their eyes. 

The busboy shuffled off to call his therapist. 

And dinner arrived shortly thereafter, with a seven waiter escort because they wanted to see the perverted patron who accosted the busboy.  I could barely whisper a word, I was so embarrassed.

"I said HEART."  

April 07, 2009

Diabetics Running Amuck in New Haven.

I'm a road warrior ... or at least I was this weekend.  And it all started on Friday night, when I met Manny Hernandez for dinner in New Haven, and we were joined by Adam. 

Manny, Adam, and Kerri in New Haven.
 
Plenty of wine, beer, and coffee later (coffee was me - had to drive to Rhode Island after dinner), the three of us were knee-deep in discussions about Dexcoms, diagnosis dates, and our first low blood sugars.  These guys are true kindred spirits and excellent dinner dates. 

One thing that came up was our "before" and "after" with diabetes.  For Adam and Manny, they were both diagnosed in their late 20's, early 30's, respectively.  For me, I was diagnosed when I was in second grade.  Their "diabetes before" included decades of memories and a certain sense of self, not to mention memories without the disease.  My "diabetes before," for better or worse, doesn't include more than a handful of childhood memories without the disease, and my sense of self is coiled around some aspects of diabetes.

"What's better, though?  I mean, there are pros and cons to both and I don't see a definitive 'yay' to either, honestly."  I drank my second cup of coffee and let the caffeine spin around in my brain.

A lot of the people I'm in contact with that have diabetes were diagnosed in their childhood years - Howard at dLife, Christel, most of the Fairfield County dinner ladies - so they are dealing with the same "lifelong" diabetes as me.  But I've also met many late-onset type 1s - the LADA crew, as I fondly call them and then subsequently picture a fire engine - and their life-altering diagnosis must be so jarring, coming into their lives later.  Adjusting to diabetes wasn't much of a challenge for me because it's almost always been there.  I only had a year or two of elementary school before I was diagnosed.  I can't imagine finishing college and then being forced to change everything midstream. 

But I will admit to a bit of a pang of envy as I tried to remember my first low blood sugar while the guys described the recent memory of theirs.

"I'll have to ask my mom," I said.  "She'll remember." 

It's not a debate, believe me.  It's not a question of "Who has it worse?"  Type 1 diabetes, regardless of it's arrival date, is its own cyclone of discovery.  But the discussion made me realize how long I've had this and how old I'm not.  And when people talk about cures, how lives will be changed when a cure for diabetes is found, and even though I don't often think about a cure, I can't help but happily muse about "diabetes after."

I've kept the tags on for 22 years, just in case I need to make a return.  ;)

April 06, 2009

Bertalan Meskó: Of Genetics and Johnny Cash

Berci Mesko:  The Guy 2.0When it comes to Health 2.0, Web 2.0, and other Stuff 2.0, Bertalan Meskó is The Guy 2.0.  Berci and I have been bantering back and forth for the better part of the last two years, and I'm continually impressed by his dedication to improvement the landscape of health online and also his ability to be a normal guy. 

Kerri:  Berci, you've been a star in the medical blogging community forever (and a friend of mine for several years now), but many patient bloggers may not be familiar with your work.  Can you tell us a little about yourself, on a personal level?

Berci:  You're the first one who didn't start with a question about web 2.0 and medicine. So I will graduate from medical school in Hungary this August, then I plan to start PhD training in genetics because I've been dreaming about becoming a geneticist for almost 18 years now. But in my second life, I work online and try to help patients, medical professionals how to enter the web 2.0 world. That's why I've been running Scienceroll for 2 years and I also launched the first web 2.0 guidance service at Webicina. This service is totally free for patients. Anyway, I love playing football, squash, I'm a movie fanatic and try to learn to play the guitar in order to sing Johnny Cash songs properly.

Kerri:  What is ScienceRoll and what made you start blogging?

Berci:  Scienceroll is a medical blog where I focus on personalized genetics, which is my research topic, and the role of web 2.0 in the future of medicine. I launched this blog because I wanted to share my thoughts on science news and articles with people from around the world. Later it turned out it became my best channel so people with the same interest could find me easily and invited me to give presentations at several conferences and beautiful places (e.g. University of Yale or the centre of World Health Organization). Actually, I can travel a lot due to my work on Scienceroll so I feel quite lucky to be involved in the health 2.0 movement.

Kerri: What is your role in Health and Medicine 2.0?

Berci:  I feel I'm somewhere between medical professionals and e-patients. I think my job is to help them find reliable medical resources and useful web 2.0 tools from quality medical podcasts to educational Second Life sites. Through Scienceroll and Webicina, I really hope I can provide doctors and patients with tips on how to be productive online, which medical blogs to read and which medical communities to join. To achieve my aims, I created free packages for patients such as the Diabetes 2.0 or Depression 2.0 package in which I list the best blogs, blog carnivals, wikis, podcasts and many other web 2.0 tools focusing on a specific medical condition.Diabetes 2.0 package on Webicina

Kerri:  How can patients and doctors use the web to their collective advantage?

Berci:  Doctors can save time and effort by using RSS so they can keep themselves up-to-date in their fields of interest quite easily. Following hundreds of medical journals and websites takes only a few minutes a day. They should also build an online image for themselves as patients tend to do a search for the name of their doctors in search engines. So their practices should be represented online properly.

Patients can find support information about their medical conditions, or can find doctors via the internet. They can meet each other virtually in Second Life, or share their health stories through community sites. I could also mention the personal health records systems that are also going to revolutionize healthcare.

Kerri:  How is it that you are in your early 20's and yet one of the most influential health bloggers in the (dare I say it?) world? What's the key to achieving success as a medical blogger, in your opinion?


Berci:  I have 3-rules: openness, consistency and commitment. You have to be open to new things, that's why I try to answer all the e-mails I receive. Consistency is important, because if you blog regularly, readers will come back to check your content. Commitment is the No.1 rule as if you believe in what you write about, sooner or later, it will work. But to be honest, I think I spend too much time online (mostly at night) so I can be involved in several different projects from Wikipedia through medical blogging/microblogging to organizing medical events in Second Life.

Kerri: What do you see as the future of health and medicine on the web?

Berci:  I believe e-patients will change the way medicine is practiced and healthcare is delivered. E-patients are patients who find information online, want to communicate with their doctors via webcam or e-mail, blog about their health or just share their stories with other patients dealing with the same medical problems.

According to Pew Internet Research, the number of e-patients is exponentially growing, while the number of web-savvy doctors is not, so there will be a huge gap. I try to close this gap by launching the first university credit course focusing on web 2.0 and medicine for medical students. Now it's in the second semester and I hope no students in Debrecen will graduate in 5 years without finishing this course.

Today's physicians and medical students must meet the expectations of e-patients whether they are open to it or not.

Kerri: I know you don't just sit around all day banging away on your computer keyboard - what else do you do, besides shape the medical blogosphere?

Berci:  From morning until the afternoon, I do clinical rotation at local clinics as a part of my last year duties in medschool. In the afternoon, I spend all of my spare time in the genetics lab I've been working in for 2 years. I hope I can publish my research findings this year (my thesis: gene expression patterns of chronic inflammatory diseases). I'm a sport-fan and I like being with my friends so I try to live as normal and full life as possible.

Kerri:  Thanks, Berci!!  See you for tea sometime this fall.  :)

April 03, 2009

She Makes Packing Difficult.

Yes, Siah, we're going to be in RI this weekend.

Foolish Sausage.
 
No, silly cat, you cannot come with us.  Get out of the suitcase.

Friday Six: Linky Stuff.

The Friday Six:  April 3, 2009 editionI'm overdue for a Friday Six, and I have received a lot of information lately from the diabetes media maven and their rapid-fire emails.  So I will drink the majority of a pot of hazelnut coffee and try to wrap my head around the day.  You click, if you want.  :)  

1.  SymCare (a company I had not heard of until I received an email from their media contact) has just received FDA approval for their cleared the new inTouch™•diabetes program.  inTouch is a diabetes management system, like online logbooking.  According to the website, "The system collects blood sugar readings from a glucose meter and wirelessly transmits them to a secure web site."  The system provides personalized educational content from Johns Hopkins University, diet and exercise programs from e-Diets, and an incentive program in partnership with amazon.com, so they're tied in with plenty of big companies.  I can't tell exactly how this program will work (it sounds fancy and involved, judging by the press release), but I'm hoping for more details in the coming weeks.

2.  Looking to take some small steps for you, and some giant leaps in your commitment to diabetes management?  David of Diabetes Daily and Manny at TuDiabetes have collaborated once again for Simple Steps for Health. Here's the blurb:  "Its life-changing goal is to promote small things that someone with diabetes can do to live a healthy life. We invite you to teach others how to take simple steps to improve their health - without spending a lot of money or time."  Submit your ideas on how to make simple, effective changes and win some cool prizes!

3.  Medtronic, with Dr. Fran Kaufman, is holding two webinar sessions about making use of current technology to better control diabetes.  On April 15th, Dr. Kaufman will offer up her thoughts on insulin pumping, CGMs, and other technologies, and then there will be a live Q&A.  Sessions are at 6 PM EST and 9 PM EST, respectively, and you can sign up through the "Real Diabetes Control" Medtronic website.  (Also, Medtronic, I'm looking to speak with someone from your team.  Please email me at kerri (at) sixuntilme (dot) com.  Thanks!)

4.  dLife (hat tip to my employer) has a new community space that's gaining traction and also keeping me very busy at work.  The network was built to help bring together dLife's active forum boards and give members a place to call their own.  I realize this is a big plug for my office, but if you haven't joined the dLife community, today is a good day to check it out.  Why, you say?  Because social networking improves office productivity - ABC says it is so!

5.  Even though World Diabetes Day isn't until November 14th, it's on the top of many lists these days, including the people at Boston Scientific.  They've come on as a sponsor of WDD and have launched a big ol' campaign to raise awareness, tapping the holy social networking trinity of YouTube, Twitter, and Facebook.  As the email from their campaign outreach coordinator stated, "Boston Scientific’s WDD social media campaign is designed to help spread information about diabetes to as many people as possible, in support of WDD’s current theme of education and prevention."  I'm into that.

6.  And lastly, this video made me laugh.  Out loud.   "I don't particularly appreciate that," may be the line that put me over the edge.  It's nice to start a Friday with some Brimley cat.  :)

More site updates being done this weekend, so if you have any problems accessing, it should be solid again by Monday. 

Now I need to get more coffee.  Mmmm ... coffee ... 

April 02, 2009

Readers in Need?

The D community comes together.Quick outreach post this afternoon for you guys: 

I received an email from a very generous reader who mistakenly received 550 Freestyle strips (instead of Freestyle Lite strips), and their insurance company doesn't want the strips returned.  This reader wants to offer these Freestyle strips up to a PWD in need. 

So if you are a Freestyle user and you are having some trouble making ends meet on the diabetes financial front, send me an email at kerri (at) sixuntilme (dot) com and I can put you in contact with this kind reader.  They're willing to pay shipping to get the strips sent out, and they would really like to help a fellow PWD in need.

Thanks!

UPDATE:  We found a home for these strips.  Thanks, guys!

Employee of the Month.

Yesterday at lunch, I was browsing at one of my favorite stores and picking through a pile of spring sweaters.  (Buy one, get one 50% off!  I'm a sucker for a good sale.)  So I find two sweaters that are pretty and springy and have that nice, soft cottony feel that you want to rub against your cheek.

Then that feeling hits.  The one where my jacket felt warm and heavy against the spring chill but suddenly made me feel like it was a fabric tanning booth - too hot, too heavy, and like the sleeves were thick with mud.

"Excuse me?  I know it's a weird question, but do you have any juice or candy in this store?"

The pregnant woman behind the counter gave me an odd look.  "I don't ... hang on ... um, I have half of a mini Milky Way bar?  Is that okay?  You just hungry, sweetie?"

"No."  My tongue was too big for my mouth, making it hard to talk.  "Can I just leave these here for a few minutes?  I'll be right back."

Walking with determined, focused steps, I went outside to where my car was parked and unlocked the door.  Leaning in the passenger side, I grabbed the bottle of glucose tabs from the center console.  

"Damn it, two?  Only two are in here?"  The bottle was almost empty, save for two lonely glucose tabs.  I poured them into my hands and ate them at the same time, the glucose tab dust coming out and snowing all over the passenger seat of my car.

"Gee whiz," I said.  (What's that?  Not kidding you on that one?  Fine.  I dropped an F bomb right there, outside of Ann Taylor.  I have no class.)  I noticed a Panera Bread next door so I slammed my car door and walked over there, listening to the Dexcom blaring from inside my purse.

There was a line for lunch.  Four cashiers were working furiously, but the low was creeping up just as fast and my legs were beginning to buckle.

"I need orange juice.  I'm diabetic and having a low blood sugar.  Can you please help me as quickly as you can?"  I stood there in my work clothes and my coat, with my grown-up purse over my arm and started to cry because I couldn't function properly and I was becoming more and more confused.  Not sobbing, not whining, not outwardly breaking down, but big tears rolled out of my eyes without permission and headed for my jawline.  

The boy behind the counter was taken aback.  "Stay here.  Stand here.  I'll be right back.  Don't move."  He ran and returned with a glass of juice.  I moved toward him like goldfish in a pond going for crumbs of bread. 

He watched as I drank the entire glass without stopping, knowing that people in line were watching me and staring and I couldn't bring myself to care.

"You good?  You seem better already, right?"  CounterBoy answered his own question.  "You're good.  You're fine." 

I fumbled with my wallet.  "How much do I owe you?"

"Miss, it's okay.  I'm happy to pay for that orange juice myself.  Please."

"No, I'm diabetic but I have a job.  And I appreciate your help."  The novocaine of the low was starting to wear off a bit, just by knowing the juice was in my system.   "I'd really like to pay."

"Okay, let's just call it a small, okay?   That's a dollar.  A dollar is fine."  He punched the keys of the register.  "$1.05" came up on the digital screen.

"A dollar five.  Okay."  I handed him a dollar and dug around in my pocket for a nickel.  "Here you go.  Exact change.  We'reHe should be employee of the month, damnit. good."

He put the money in the register and wiped his forehead with his wrist.  "You sure you're okay?  Do you want to sit for a minute?"  A guy waiting in line mumbled something about 'flirting on your own time.'  CounterBoy raised an eyebrow.  "Sir, this is a medical emergency.  I just saved her life.  Your sandwich?  Little less important at the moment, okay?"  

He turned back to me.  "You good?"

"I'm good.  Thank you for your help.  I really appreciate it.  You saved the day, man."

"I did.  I saved the day."  He squared his shoulders.  "I'm going to be employee of the month!"

April 01, 2009

Charlie Kimball: Can I Drive Your Car?

My father taught me how to drive and I distinctly remember being afraid to go above 25 mph.

"Kerri, you need to speed up," my father warned as I crawled along the road, passed by angry drivers who were in a hurry. 

"Dad, I'm scared."  I hugged the white line in my old Volvo, chugging along.  But I eased my foot against the gas pedal and pushed a bit.  Then a bit more.  Then I hit 40 mph and felt like I was traveling at warp speed.  And ever since, I've wanted to drive a race car.

So imagine my surprise when I met Charlie Kimball, race car driver and type 1 diabetic, at last year's World Diabetes Day event in NYC.  Outwardly, I said, "Oh, it's nice to meet you!" 

Inside, I was yelling, "HEY!  CAN I DRIVE YOUR CAR!" 

Charlie Kimball and Kerri Sparling

Kerri:  Charlie, you're recently diagnosed, right?  Tell us about your diabetes diagnosis and how that all went down.

Charlie:  October 17, 2007, I was in England and went to the doctor in Witney (near Oxford) for a skin rash.  After he had given me some cream to clear up the rash, he asked if there was anything else going in with my health.  In my high glucose addled brain, I nearly didn’t say anything- the typical mid-20’s guy response, “Nope, nothings wrong. I’m 10 feet tall and bullet-proof.” Then I said well I have been kind of thirsty lately. To which he responded, "Lost any weight?" "Maybe a little..." (thinking I had been training and eating better than normal). Jumped on the scales and was down 25 pounds from normal. I had gone from 10%-6% body fat and was so dehydrated my lips were cracked and infected.  He drew blood to confirm, but was convinced I has type 1 diabetes.  I didn’t know what that was. I thought only old people got that!  Boy was I ignorant! I spent the whole next day at OCDEM (Oxford Center for Diabetes, Endocrinology and Metabolism) at the Churchill Hospital in Oxford and my ‘diabetes’ life began.

Kerri: How was your learning curve?  Were you overwhelmed?  Pretty chill?  A mix of both?

Charlie:  My learning curve was pretty steep but I definitely pushed hard to get on top of it.  From early on, I was pushing my doctors for more information, alternate treatment methods, better insulins, less painful injection methods.  There were moments when I was so overwhelmed all I could do was sit and shake my head.  Then there were moments of strength when I was determined to ‘beat this thing’ and show it I was still the boss.  As time went by, I found I was having more strong moments and fewer moments of denial, bewilderment and fear.  I gave myself 10-14 days to ‘get over myself’ and get back to being me.  My friends helped with that as they wouldn’t let me get away with feeling sorry for myself either!

Kerri: What is your job and how has diabetes affected how you work every day?


Charlie:  I am a professional Open-Wheeled racing driver.  I have raced on 4 continents and won as far away as New Zealand, Europe and here in the States.  I have competed at speeds up to 185 miles per hour and my passion for motorsports and racing is a huge part of who I am.  Diabetes has affected what I do tremendously.  I remember the moment when I asked the doctor if I could race again soon after diagnosis.  It was a moment where the whole world seemed to stop moving while I waited for the answer.  I almost didn’t want to ask in case the answer wasn’t the one I wanted!  When he said, ‘of course, there is no reason why not,’ my world stopped spinning out of control and righted itself.  Then I had a road to start walking down to get healthy again and get back into a race car.  In racing, I have always sought the best advice I could find and my diabetes care was no different.  I saw Dr. Anne Peters of USC Medical and her educator and nutritionist as soon as I could.  I though I had an idea of what diabetes meant for me and my career, and then I met Dr. Peters, Donna and Meg ... now I am a carb counting machine and diary keeping fiend!

Charlie behind the wheel.


Kerri:  Have you ever had a diabetes emergency behind the wheel?

Charlie:  Luckily, I have never had an emergency behind the wheel.  I have a lot of protocols in place to keep myself from getting into trouble.

Kerri: What kind of tools do you use to manage your diabetes?

Charlie:  I manage my diabetes differently when I am going to be in the race car compared to when I am not.  In the race car, I have a ‘Camelbak’ type drinks bottle full of orange juice or Gatorade with a tube into my helmet.  That way if I am headed towards low, I can drink that and get back to good numbers.  I also use a DexCom Seven Plus to keep track of where I am both in the race car and when in every day life.  I don’t use a pump yet as I am still a baby when it comes to diabetes.

Kerri:  How has diabetes changed your perception of what's "healthy?"


Charlie:  Diabetes has actually made me stop taking my health for granted and become proactive.  Before my diagnosis, I hadn’t had my eyes checked for years and took my license physical for granted.  Now I work hard on my health and my nutrition is better than it ever has been.  I am a better athlete and while I have diabetes, I am probably healthier now than I ever have been in the past.

Kerri: What kind of advice do you have for others who are recently diagnosed with type 1 diabetes in their "grown up years?"

Charlie:  I think that my biggest piece of advice for people diagnosed later in life is not to let diabetes rule your life.  It is a big change, don’t get me wrong, but it is manageable in the long term.  And you are not alone. (If you are reading Kerri’s awesome blog- you probably get that already- but don’t ever forget it!)

Kerri: And Charlie, where can we catch your next race and cheer you on?

Charlie:  My next race is the first of this season and my first race back in the US for 5 years.  I will be racing for Team PBIR at the Honda Grand Prix of St. Petersburg, April 3-5.  And then I will be in my own personal neck of the woods and racing at the Toyota Grand Prix of Long Beach April 17-19th.  You can keep up with me on my website, blog, and Twitter.

Kerri:  Thanks, Charlie!  ... and, um, can I drive your car? 

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