Monday, August 28, 2006

How to annoy your friends (and ruin your evening)

We were having dinner with some old friends. The friends, I should clarify, are longstanding rather than elderly. I was telling them about the painful ankle and my female friend said something about having to learn to live with it. My husband said we'd just add it to the list of stuff I have to live with and that's where things went rapidly downhill.
Like what, they wanted to know, like diabetes said my husband, who at this point had decided that he was my spokesperson. Once in a while you have the chance to sit back and see what people think of you, I decided this was one of those times. So I shut the hell up and watched the drama unfold.
The female friend was upset because she thought we had hidden this from them. When I say before every meal we have eaten together over the past ten years "I just have to go shoot up", what did she think I was doing? Did she think I had a bad heroin habit?
Her husband, one of my husband's best friends, was close to tears because his great uncle had died of diabetes. Turns out his relative was ninety-one and this was thirty years ago but it obviously traumatized him. At this point I thought I'd better interject but maybe my comment about being lucky to live nearly two decades past the normal life expectancy wasn't the most diplomatic thing I could have said. For the remainder of the evening he kept holding my hand, and shaking his head. He obviously thought I was about to expire at any moment.
Of course that was the only topic of conversation the whole evening. I actually apologized for not telling them, but although I've never hidden it (I inject at the table, I tell people if I need sugar NOW) I don't introduce myself as "Jane, and I have diabetes." I could only say that I tell people when it comes up and I was amazed they didn't know.
I was completely pissed at my husband who decided that he would stress his role as the martyr in this relationship, having to be aware of food, injections, testing etc. As the one time I let him carry my emergency candy because we were kayacking and he had a zipper pocket in his shorts, he forgot to do up the zipper and, well you can guess the rest.
And then came dessert, which I passed on. Oh, they said, that's why you don't eat desserts, because you are a diabetic. Aaagh. No, that's why I don't tell people, because they would make that assumption and maybe offer to make a "special sugar free" version that I still wouldn't eat.
I'm not sure how this will affect our relationship with this couple. Maybe once they get over the shock we'll be four friends bitching about work and politics and house prices again. Maybe.

Friday, August 25, 2006

Gym Hogs

I'm sneaking into the gym at the moment to avoid the personal trainer. He wants a note from my doctor to say I can work out with my sore heel/ankle. I haven't provided a note to anyone since I started secondary school and forged a get-out-of-gym note:
"Dear Sister Marie-Therese
Please excuse Jane from netball practice today. If she has to play Goal Defense one more time she is going to bounce the ball off someone's head so hard She is not feeling very well.
Jane's Mama"
As I'm not twelve anymore I am doing the mature thing and going to the gym after he has finished his shift.
One thing I've discovered is that different types of people work out at different time. Early morning (when I used to go) is busy with people who work up a sweat. They run on the treadmills and ellipticals and grunt when they lift weights. Now I'm going later I'm running into a whole new (to me) group of people. Those who go to the gym to socialise and even relax.
These are perfectly tanned and toned women (always) who wear cute pink and white shorts and tank tops and who never, ever sweat. I suppose it's quite difficult to work up a sweat when you're predominately using the equipment to rest your butt while you make calls on your cell to arrange the rest of your under-productive life. It's not that they are doing nothing, they are listening to their iPod Shuffle through one ear, while the other is glued to a pink or magenta Razr cellphone. They are usually skimming a magazine at the same time. Multitasking. What they are not doing, is actually using the machine. And I'm noticing because either they are next to me and I can hear their one-sided phone conversation over my iPod or they are occupying the machine I want to use.
My gym isn't cheap but it does include a bunch of services such as a creche for the kids. I wonder if I could suggest they provide a lounge where people could go hang out, read magazines and make calls and thus free up the machines for the people who actually use them?
I don't know if it's the sore foot or the sore muscles but I an aware that I'm getting very intolerant. And cellphones in cinemas, restaurants and gyms are top of my rage list right now. Maybe I should try yoga to help me relax. They wouldn't use cellphones in a yoga class, would they?

Wednesday, August 23, 2006

Instant Internet Diagnosis

Frustrated by the thought of waiting another three weeks for a diagnosis of the ankle/heel pain I did a little web research last night. What a fascinating hour can be spent by typing "ankle/heel pain" into google and trawling through the results.
I rejected gout because the pain hasn't flared up and gone away but gradually increased. I also rejected it because the cure involves giving up beef, shrimp and most importantly alcohol and it's the gin martini that is getting me through this at the moment.
I also rejected arthritis because it hasn't behaved like the arthritis in my wrists or hands: it's just one ankle and the lump is red and tender. The ones on my hands don't hurt, it's the joint itself that hurts and the lumps are symmetrical. Likewise I dismissed tendonitis because that is supposed to flare up and, in most cases, disappear after a couple of weeks, and because of the nasty hard lump. I liked bursitis better, well actually I hated it but it seemed a better diagnosis. And then I found this article and it was a perfect match for my symptoms. The clincher was this sentence: "Another possible contributor to Haglund's deformity is a tendency to walk on the outside of the heel."
Always, all my walking life. When I was a toddler I was sent to an orthopedic surgeon and one of my earliest memories is walking up and down his huge mahogany desk so he could examine the way my foot "rolled". My other early recollections involve falling down flights of stairs because I couldn't bend my leg in the steel calipers he had prescribed. Eventually my mother decreed that given the choice between a child that couldn't walk straight and one that was brain damaged due to the number of times she knocked myself out falling down the stairs, she'd take the deformed child. After that it was a dozen years of built-up shoes to try and correct the problem. Hey Mom, I think you wasted your money!
Of course, I'll wait and see what the doctor says but I pretty sure even if the diagnosis is different the cure will be the same. I already ice it (although not 20 minutes out of each waking hour, I mean I have a life to get on with) I've been using the heel inserts and lifts for a month now, and stretching and Advil are part of the daily routine. I guess what remains is physio and ultrasound. I certainly won't be going down the cast and surgery route if I can help it.

Tuesday, August 22, 2006

Limping Along

Just when you think things are going along swimmingly someone pulls the plug. That's what happened this week while on an enforced but very pleasant vacation in Canada. One day I'm happily walking around the Vancouver seawall from Gastown to Stanley Park and the next I'm hopping on one foot because the pain in my ankle is excrutiating.
Of course there was no public transport and no taxis at that point so I hobbled the last kilometre or so. And then being an extremely cheap type, I refused to take a taxi the few blocks back to the hotel. So I hopped and hobbled and wimped until we got back and received zero sympathy from the husband who was mad because I wouldn't let him get a cab. A bucket of ice later I examined the foot and there seems to be a large, hard lump on the back of the heel at ankle height and it hurts like crazy.
Full disclosure: the heel/ankle has been making me aware of its existence for a while now but I thought diet and exercise would fix it. It gave me grief in Boston because we were walking a lot so I wore trainers all the time but once I put my stilletos on, the tenderness disappeared. I stretched it and iced it and if I walked around on my tiptoes I didn't know I had a problem. How's that for denial?
Well, now I'm back and I dragged myself to the doctor with my diagnosis: plantar fasciitis and he wasn't impressed. He thought it too high on the foot for that and sent me for an xray. The xray revealed no broken bones or fractures but did indicate evidence of an old injury. What? Did I break something and not notice? How old an injury? Maybe when I was in my bassinet. I sure don't recall anything.
I have an appointment with the orthopedic surgeon in September. I'm hoping it will resolve itself before then. I can deal with the pain but not with filling out another bunch of forms and signing one of those "privacy notices".

Friday, August 11, 2006

Citrus Shrimp

I made this for supper yesterday, it was so easy and delicious I thought I'd share. (The recipe, not the food - that's long gone). It was totally my own invention as I was trying to use up the stuff in the refrigerator before we go out of town.

Citrus Shrimp
Half a packet of frozen shrimp
1 lime
Half a lemon
1 tbls orange juice
Shake tabasco
Salt and Pepper
3 tbls V8 juice (low sodium)
2 tbls chili oil with garlic (or olive oil, a shake of dried chili flakes and I clove garlic, crushed)
Half a vidalia onion sliced
Half a tomato

An hour before you want to eat take the shrimp from the deep freeze and lay in a shallow dish. Cut lime in half and squeeze over shrimp. Put limes in with shrimp (adds extra flavour). Squeeze lemon over prawns. Add orange juice. Give a shake of tabasco (three to five drops depending on how spicy you like your food). Season with salt and pepper. Place somewhere cool for an hour. The juice will "cook" the shrimp.
After 45 minutes heat the chili oil and saute onion until soft and lightly brown. Drain shrimp and pour marinade into pan with onions. Discard lime. Add V8 juice and tomato to marinade mix. Cook until slightly thickened, about five minutes.
Throw the shrimp into the hot sauce and cook two or three minutes. Serves two greedy people or three with normal appetites.
Serve with rice and a green salad.

Thursday, August 10, 2006

What about the insulin?

The latest terror threat means that international flying is going to be extremely trying for a while. The media is reporting that no liquids will be allowed on flights, except in checked baggage, and a reporter said the TSA screeners had confiscated her eyeliner.
I have to fly to Canada on Saturday (another year, another visa in the passport) and I'm wondering if I can carry on my Lantus and my Humalog pens. I normally don't let them out of my sight because no one can guarantee that both myself and my luggage will arrive at the same place at the same time.
Even during the extreme airport security after 9/11 no one stopped me carrying a pack of syringes. When I asked what I should with the sharp objects I was carrying, the check-in attendant told me to hand them to the screeners and they would ensure that I would be given them back on the plane. That made zero sense to me. If I was planning to take out someone with a syringe full of insulin, I would surely be doing that on the plane, not in the airport terminal. Then it occurred to me that they would stand over me while I took my shot and then confiscate my stuff for the rest of the flight. I didn't fancy that idea either. In the event the screeners searched my hand luggage and didn't say a word about the pen or the syringes and I never asked the question again.
I guess I'll just make sure that I have the prescription slip for the insulins with me and hope for the best. And I'll pack my liquid eyeliner in the check-in bag.

Tuesday, August 08, 2006

Of course you can

Finally after I had left messages on every voicemail at the endocrinologist's office I got a call back. They wanted to know how many testing strips I needed. As the number times I test a day depends on
i) what I'm doing
ii) what my last BG result was
iii) how I'm feeling: low, high or just plain weird
iv) my mood: can I be bothered to test or should I just wing it
the number of test strips I go through per day varies from a couple to ten. I guestimated eight which is what we applied for last time and the insurance paid for no questions asked. The nurse was about to call the Rx through when I reminded her I hadn't had my bloodwork results yet.
Well score for me 'cos the A1c was down another .5, making a drop of 2.8 since February. Pretty cool, I thought, because I live in fantasy land where the magic number is <7. Apparently in the new real world the number to aim for is <6.5. Is this like when they raised the perfect score on the SATs to 1600 making those who took the exam years ago look stupid? Or when the medical profession dropped the LDL for diabetics to <70 and I became a bad person who needed another drug overnight?
Obviously I'd like it to be <5.9 but that isn't going to happen. So <6.5? If I can get it there without keeping my control so tight I go hypo every day, and without huge swings in the amount of glucose running around my bloodstream, I will. But a word of encouragement wouldn't have gone amiss.

Please can I get my results?

It's a week since my last endo appointment and I've been trying to pick up my results since Friday. I've been leaving messages on their answerphone (press 20 for the results service) and at the switchboard but no one phoned me back. Then yesterday afternoon I phoned the refill service (5) and left a list of meds I needed. This morning they left me a message to say they had a couple of questions. I'm going out of town on Saturday so I want to make sure I have adequate meds. I have phoned back five times (extension 11) but no-one is picking up. I'd go to my PCP but his office is shut for a week.
I guess I have to sit on the phone and call every five minutes until I get a real live human being. I wonder what would happen if I had a medical emergency? I certainly wouldn't bother if I had a casual query.

Monday, August 07, 2006

Training myself

The third of my reduced price personal training package was early this morning and I've learnt another thing. My right upper arm is much stronger than my left. The Trainer is keen that I work both sides equally so I'd don't exacerbate the problem, which means that, at the moment, I'm working well inside my comfort level on one side while the other arm hurts like crazy.
Since I gave up doing stomach shots a while ago I seem to have used my left arm as a Humalog pin cushion. Actually, more of a bullseye. I do the Lantus injection in different places on my upper legs every evening, but without giving it any thought I jam the pen needle in the same spot in my arm three times a day. I have definitely bruised the muscle.
So from now on I will make an effort to switch arms as well vary the injection site on each arm. That's in addition to figuring out the carb ratio and correction bolus. I think maybe I need a diabetes personal trainer as well.

Friday, August 04, 2006

Not depressed, just paranoid

I love (note the sarcasm) filling out forms. Especially the ones sent by my Health Insurance Provider. Especially the ones that are targeted at me, a person with diabetes. Especially when the questionnaire is being read to me over the phone by my Healthcare Provider.
Generally if asked, I describe my health as good. Sometimes I am then asked to list any other conditions or illnesses that I have and I usually get the giggles at some point and clarify my first comment with "Well generally good, taking into account the chronic, life-threatening nature of these conditions." Most people laugh along but my health provider has been taking Diabetes and Depression very seriously so they followed up with a whole bunch of questions like "Do I ever feel sad?" "Do I get depressed?" I have a real hard time answering these because I don't think they are asking the right questions. I mean I felt sad when my cat died. I feel depressed when I look at the situation in the Near/Middle East or when I can't come up with a answer to the healthcare crisis in this country that doesn't involve the words "Universal Healthcare".
Somehow I don't think that's what the health insurance people had in mind. But I am leery of answering yes to these questions because I fear someone will tick a box on my records that suggests that I suffer from depression and that will form part of a database that one day will be published showing that 98% of people with diabetes suffer from depression.
So I always answer no to these questions. Which leads me to a new fear, that there is a box on the paper that says "Is this person an unfeeling, uncaring bitch?" and where there will be a check next to my name.

Thursday, August 03, 2006

Blame Game?

Introductions at a party:

Friend: "This is X, she's a diabetes educator"
"This is Jane, she has diabetes"

Diabetes Educator: "Type I, I hope"

Me: "???????"

Type I, I hope! What the heck does that mean? Did she mean a lifetime of insulin shots is preferable to pills? Or does she think that Type II diabetes is just a result of poor lifestyle choices?
Of course what I should have replied was "Diabetes educator? Medical doctor, I hope". But I'm not that obnoxious.

Wednesday, August 02, 2006

Not so much a breeze, more a complete washout

I finally overcame my antipathy to the surprise package this morning, at least enough to open the carton and check out the meter. But first I did a little research on Bayer Healthcare's website.
Here's the claim:
Studies show the new Ascensia® BREEZE® meter is preferred by patients and professionals: Ascensia(TM) BREEZE(TM)
And here's their data to back that up:
* 9 out of 10 healthcare professionals and patients say that the Ascensia® BREEZE® system fulfills a need in blood glucose monitoring
* 3 out of 4 patients were successful running a test with the Ascensia® BREEZE® system the first time
* 2 out of 3 people would recommend or switch to the Ascensia® BREEZE® system for its effortless handling

Well that sounds great, but a closer examination of the website and a thorough testing of the meter reveal a few problems.
Claim #1: 9/10 say the system fulfills a need. I'm sure it does. It takes a sample of blood and displays its glucose level. Sometimes that's all I need to know. But both my healthcare professionals and myself are looking for a little more information here. Like whether I had been exercising before the reading, how many carbs I had eaten before the last reading, how many I ate after, if I had been ill. This meter tells me the date and time and BG and that's it. Everything else I have to record in a logbook. How very 1980s. What's worse is the length of time that it takes to deliver the reading - 30 seconds. I could go crazy waiting. Meters have been getting faster, I could trade up to one that delivers the number in three seconds. Why would I trade down?
The second claim that 3/4 patients successfully ran a test the first time? It took me three goes. The machine is bigger than the one I'm used to and much more difficult to handle. I actually dropped it the first time I tried to use it.
The Breeze came with a wheel of 10 strips. I have had two correct readings out of six strips. Maybe I am very clumsy, maybe its the arthritis but, wait a minute, "the Ascensia® BREEZE® is so easy, it's the first meter to earn the Arthritis Foundation's Ease-of-Use Commendation". So it must be me.
Claim #3: 2/3 patients would swap their machine for this. Not this patient. This is a cheap feeling, flimsy, basic machine. It stores only 100 readings. My Lifescan Ultrasmart allows for 7, 14, 30, 60 and 90 day averages, by times of day in numeric or graph form. My Ultrasmart lets me test on my arm as well as finger. If I wanted to do that with the Breeze I would have to buy an alternative lancing device, although Bayer will kindlt reimburse $25 of the cost.
And here's my final worry about the accuracy and rigour of Bayer's data collection methods from their website "Based on interim results from Asecia Breeze evaulation tial. Final results may vary.". I want to know what this machine was preferred over. Urine testing perhaps?