The Invisible Doctor

I have an appointment this morning.. Soon! The last time I was at this doctor, I bawled my eyes out. It’s kinda this tradition I have with the doctor’s office. Eeeeek. I hope that becomes a less visited tradition in the future. Recently, I have found that in all my spare moments–when my mind drifts at work, while I lie in bed, as I fold laundry–I have had many, many conversations with an invisible doctor. Defending myself, mostly. Telling him why I don’t need to eat 45 carbs at every meal, why I don’t write down records and fax them in weekly, why I make changes to my pump (little ones) without consulting them. I explain my personality and why this new approach is best. I talk about my life and how what I am doing fits better. I talk about all the small victories and lifestyle changes I have made! I do not want a “great” Dr. appointment because i turned my life upside down for three months, wrote everything down, and became a crazy diabetes nazi. My motivation has been a new and completely different lifestyle. I want a sustainable change. In my journey, it has not been writing everything down. It has been arming myself with knowledge and actually making changes. Finding things that work for my body and life and embracing them! I LOVE the pace I have taken. I LOVE the changes I have made. I also LOVE the results.

Today, I will be respectful. I will be composed. But I will not apologize for finally taking my health into my own hands and owning it! This is my everyday journey and I am really enjoying it! My health is not in his hands… It is in mine.

Okay, be strong Briana! You are doing things differently, but you are doing them best for YOU!

…..thanks for letting me get that out. I just needed to talk through it out loud one more time.

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The Perfect Doctor

… that’s all I need,

Someone who will answer all my questions, and care about me personally, and understand how my uniquely contradicting personality roles in diabetes care…

Yep.  He/She’s out there somewhere, and I just need to keep looking..

{We interrupt this search to bring you reality}

Last Wednesday, I drove to my NEW doctor in Willow Grove, filled with both calculated anticipation and trepidation.   This would be a step in the right direction, this would be the person who would understand me and politely listen and answer my questions.   I would have been better off hanging my hope for victory on a three-legged horse in the Kentucky Derby.  (Which I truly would love to visit for the sake of wearing a huge hat!)

I arrived early to my appointment at one of the quaintest little Dr. offices that I have ever seen.  It is part of a collection of cottage-looking professional offices set off the road surrounded by the color-stained Fall trees.  Idyllic.  THIS was the place where all my dreams would come true.  As I waited, I tried to think through a good explanation for why October was so horrendous for diabetes care… “I was SO busy, tired, etc…” “I usually do so much better, but…”

When I got sick of that, I just waited.

waited…

Finally, I was called back, weighed, blood-pressured, and what followed really doesn’t merit explanation.  It impersonal, rude, and condescending.

I bawled my eyes out in the parking lot like I have not cried for years.

Which is saying something.

So many emotions surging at once, how could I keep from crumbling under it? I had been hoping so high.  This would be the key.  The beginning of something wonderful.  But, it wasn’t.  Once again, a new doctor, and it wasn’t.

I called Ben and said things like, “I .. don’t.. want this!!” Waaa! “I feel so stupid” Waaa! “I will NEVER BE ABLE TO DO THIS.”  Waaa!  etc.. etc…

Somewhere in the middle there, I also said something like this, “I think all this was supposed to teach me that maybe a good doctor is not the answer.” (I’m still trying to hold on to the fact that good doctors might actually exist,.. but that is a conversation for another day.)  Couched in the lies I was telling myself about the situation was actually a bright beam of truth.   I thought about this truth during the days to follow, and it only became more concrete in my mind.

Who is the answer to great diabetes control?

I am the answer to great diabetes control.  I see a doctor every 3 months.  But I’m “in the trenches.” I’m the everyday go-to expert on myself–my motivations, my struggles, what helps me to be successful!  While other people join me–friends, family–the choices that I make, the food that I eat, the insulin I take, the carbs I count; these things are controlled by me.

Seriously, in the past week, I have been lovin’ the driver’s seat!  I have made intentional choices, intentional purchases, and intentional declines.

Who’s driving this thing?  This girl right here.

Hey, Where are YOU from?

Perfect & Fun

These are my people–this is “back where I come from.”  On the itinerary of my “personality passport” it says, “Hometown Perfection, Frequent Visitor of Fun Country.”

Ben and I took a personality quiz a while back–we answered questions about what pumped us up, what disappointed us, what made us crazy.   We also figured out things like our top motivations in life; not necessarily what you’re good at, but what you really enjoy.  I came to a startling conclusion while reviewing the results of the test: my personality’s “home country” as the lingo of the quiz labeled it, is FUN!  I want to hear “it’s gonna be SO AWESOME”  “You’re gonna love this!”

 “WOOHOO” is one of my favorite words!

Ben’s home country was PEACE.  He spends a majority of his time here.  A huge canyon of space separates his home country, Peace, from his favorite vacation spot, Perfection.  So, he’s a steady-eddy who likes things in order.  Agreed.  This quiz nailed it for my B.

When it comes to my favorite vacation spot, there is not a canyon of space between–more like a revolving door–because I spend so much time there.  Destination?  Perfect Country.

It was hilarious when we were talking to Paul, who helped us talk about the results of our quiz because he turned to me and said, “Do you ever feel that those countries (Perfection & Fun)  are at war?  And all of a sudden, SO MUCH made sense to me!  I often feel a conflict within me of competing desires.  “The things I want to do, I don’t! The things I don’t want to do, I do”  comes to mind.  Everyone has the flesh v. spirit conflict within them, but this is not what I’m talking about here.  There is nothing inherently better or less sinful about either of these dispositions, they just don’t tango together very well.

I can clearly see how each of these sides to my personality take over at different times.  Some days, my house is picture-perfect.  Everything is neat and orderly.  Picturesque.  Other times, even days (Moments?)  later, there is chaos!  I like both because usually chaos = crafts.  :)  But some days, I just love the crazy mess.  Other days, I long for the order.

Perfect & Fun

I see this being especially frustrating in my journey with Diabetes.  I have spent some weeks recently being meticulous with carb counting, testing, meal times, and collecting data.  I loved those weeks.  It was fulfilling to put myself into something completely.  I felt great!  I had energy and strength.  I slept well, and I was happy to be doing something meaningful.  BUT those two weeks were SO HARD!  I was able to do it because I knew there was an end.  I was collecting data for a specific dr. appointment, so I knew the end was in sight.

I can live in Perfect Country with Diabetes.

As long as I can hop a plane to Fun any time I want.  But that’s not how Perfect works, is it?

It’s War.

I am currently in the process of processing this.

One-eyed, One-Horned, Flyin’ Purple People Eater!

…well, that’s what I was expecting anyway!  

The nutritionist actually ended up being a two-eyed, real, live, normal (as normal gets?) person!  She was kinda quarky and clearly much better at Math than I, and I liked her very much.  In my experience, I have not met so many encouraging, helpful diabetic support people.  Is Pennsylvania like a utopia of healthcare professionals?  Is Wisconsin a burying ground of sour-puss endocrinologists?  Maybe, just maybe, fault falls to the hearer–not the various tellers of information–for the previous negative experiences.  That hearer, of course, is this girl right here!  It is refreshing to be at a place in my heart where I can hear.  I know that this is the result of God’s loving, constant pursuit of my heart in this area.  I am truly thankful that He continues His work until it’s done!  (Phil. 1:7).  Thank you, Jesus!

Well, now that I am listening, what did I hear?  Is life as I know it done, or what?  Will I never look a chocolate cake in the face again? —- “Nutritionist” what a horribly super-negatively-charged title to have.

Dun.. dun… dun!

After I kinda laid out for her my history and my self-diagnosis, she proceeded to be very helpful.  YAY!  This is what we came to.  My doctor does not yet have a proper carbohydrate-to-insulin ratio for me.  When I eat food, my body has a special “sweet spot” (pun intended, I guess) when it comes to what I eat and how much insulin it takes to cover any given amount of carbs.   Carbs are like the holy grail to diabetics.  We live and die by this number.  What Lynn (this is how I will refer to my nutritionist for the remainder of the post) said was if  I could make some changes until we get that specific ratio figured out it would be very helpful.  At this point, she lost me a little with a lot of sciency-talk.  The goal is to eliminate as many variables as possible.  I cannot necessarily control stress or other contributing factors to glucose variation, but I can control the amount of carbs that I eat.  (Sometimes, I feel like I CAN’T, but I’m going with her theory on this!)  So, the game plan is this: for the next 2 weeks to a month I am going to eat the same amount of carbohydrates at each meal: 45.  This eliminates that variable.  As I follow this plan, my doctor and Lynn will be able to find my body’s specific ratios.  Then, whether I’m eating 20 carbs or 120 carbs, the ratio will be correct (theoretically).  This is not a forever thing, but it may be an until-the-end-of-the-year thing.  Of course, I’ll probably take a few vacation days during Thanksgiving and Christmas, but for the most part, day-in and day-out, I’m going to be eating 45 carbs at each meal.  (If for some reason you find yourself in possession of some great 45-carb per meal recipes, comment!)

This will not be easy.  It seems simple enough–but, oh boy, this will not be easy.  To break it down for you, my daily eating looks like this: small, if that, breakfast.  Lunch is kinda my dinner meal with Ben.  Dinner is usually those Lipton cup-o-soups, if anything.  Then because I don’t eat or eat little, 9:30 pm is a mad (bad) dash to the pantry to find anything salty and/or sweet.  Not a perfect break down, but sadly, accurate enough.

I told Lynn this and she gave me some pointers.  Since I don’t like to cook dinner for just me, and I don’t always make lunch, (lots of soup here, people!) she suggested making two BIG meals a week that I can re-purpose later in the week.  She said, “Buy a rotisserie chicken; buy rice in the bag that you can throw in the microwave for a minute; buy those steamer bags!”  She added, “Anything you make can be dressed up the next day as a salad, a pizza, or a sandwich!”  Creative leftovers, I can do that.  The biggest concern for her is that I can go days without multiple food groups.  I stick to lots of yogurt and soup.  I went months without buying bread.  I thought the goal was no/low carb, but she said people should have 130 carbs a day at least.  I don’t want to burden you down with all the food nitty-gritty (not nutter-butter) details.  Big picture: I need to try to include 3 food groups at least at each meal and each consistent carb totals.

My goals:

– make a list of 3 breakfasts @ 45 carbs

-make a list of 3 lunches @ 45 carbs.

-make a list of 3 dinners @ 45 carbs.

~~This is a BIG one~~

ACTUALLY EAT THOSE MEALS

We are still waiting to hear back from the Dexcom representative that I accidentally gave the wrong insurance information to.  I’m sure the end of the year is busy for them because people want to purchase equipment before the new years’ deductible rolls over, but that’s exactly what we’re looking to do as well.  Would you pray with us that this could be figured out soon and I could have a Dexcom before January?

A Beautiful Mind, Indeed!

Whilst I type tonight, my brow is indeed furrowed.  I find myself on the eve of another appointment.  Tomorrow, it’s to the nutritionist’s house I go.  I was told that paperwork would be coming in the mail for me to fill out for this appointment, so I carefully observed each parcel for the following days.  No mail came.  I called the lady who said that some paperwork was coming and she said, “No, I changed my mind, you would fill it out when you come in.”  So, I stopped watching the mail–and what should arrive the next day?? Paperwork from the nutritionist.  I’m not sure who sent it, but it came.  The unopened envelope sat kinda in the open for a few days; I would glance at it and think, “what sorts of honest, unhealthy reports await to be written in there, I wonder.”  Not that I’m “unhealthy” in a buys-twinkies-and-stuffs-my-face kind of way, but I know I don’t pass the gold-star-from-a-nutritionist test.  (I’m hoping for a bronze-ish star tomorrow, actually)  I know the only way for these people to help me is if I am completely honest with them and with myself about my health, but I also know there are about five versions of myself health-wise.  Let’s see, there’s “just hand over the chocolate” Briana; there’s “Zumba is like my new favorite thing EVER” Briana; “No, I’ll pass on that soda and drink my coconut-flavored-seltzer water” Briana; there’s also “okay, that sleeve of saltines was a bad choice, now I need take insulin and make better choices” Briana —- there’s the making of one of those great movies where the main characters eventually prove themselves to be one person with split personalities in the end here.  Sheesh.  I started filling out the paperwork  and got completely overwhelmed.  WHO AM I?? What are my top 5 snack choices, and does a Caramel Macchiato count?  How often do I work out?  Does being a preschool teacher count?  There was this one time I was going to the gym–and I plan on starting that back up real soon—so how do I answer that question??   Do I need a “refresher” on diabetes management, or do I want them to start over? What are my biggest hindrances?  Honestly, when it comes to what “derails” me, it changes daily.  hourly?  like minutely. They also asked questions like “What are your top 5 questions on diabetes.”  I think that I do have many questions about diabetes, but right now I’m asking all the questions of myself–who am I, why do I do the things I do, is it possible to change, will I ever get this right?  Do I have to go to the doctor’s tomorrow?? I do get anxiety about going, even now my heart is beating fast and I’m a wee bit scared.  I really don’t want to cry, but the truth is, I often do.  I really don’t want to take an honest look at who I am and changes that need to be made —WAIT A MINUTE, YES I DO! — at least, sometimes I do.  I really, really do!  I am so overjoyed to have the opportunity to care for myself.  So many others with terminal illnesses would look on diabetes with envy.  It is NOT something to just “put up with.”  It is a gift to be embraced.  My heart knows that.  God chose it for me and me for it! But on nights like tonight I feel like the wind is out of me–heart rate up and spirits down.  As I picked up and set back down my pen tonight–uncertain how to proceed–echoing in my head was the song, “Lead me to the Rock that is Higher than I.”  I don’t always need the wind “in me,” so to speak–I have the Holy Spirit Who invites me to take each step in His strength.  (Gal. 5:25)  I don’t need to have it all figured out, because He does.  (Jer. 29:11) I don’t even need to dismiss or be ashamed of my struggles, because God longs to my strong in my weakness. (2 Cor. 12:9-10)

I am still apprehensive about tomorrow.  I’m not sure which Briana will show up at that appointment, but I do know my God.

“For God alone my soul waits in silence; from Him comes my salvation.  He only is my Rock and my Salvation, my Fortress; I shall not be greatly shaken.”

Psalm 62:1-2 ESV

**CGM**

Yesterday, I went to visit the doctor’s office again!  Before, I thought that the doctor was talking about getting a whole new insulin pump, and my week-trial would be with a new insulin pump, but it was actually for a new CGM system.  CGM is stands for Continuous Glucose Monitoring — basically, it is a small device that goes partially under the skin with a small piece of technology (for lack of a better word) above.  The small catheter under the skin takes BG (blood glucose) readings every 5 minutes.  Through this, it is more possible to accurately track patterns in BG and prevent problems in either direction.  This technology will be especially helpful for me because it will help my doctor see my body’s specific patterns.  Also, I can see where by BG is headed: if I get a reading of 105 ^ ^ I would react differently than a reading of 105 > or with an arrow downward.  I can catch highs or lows before they happen.  This will be wonderful, if I am able to get it covered by insurance.  Some people may know that I have already tried something similar to this in the past, but discontinued use—it was NOT user friendly, and that is what my doctor was so adamant about!  I have only had it on since 1:00 pm yesterday, but so far I already like it much more than the previous one.

Here is a site that  explains more about the CGM I am using specifically.

http://www.diabetespumpcgm.com/dexcom-g4-platinum-cgm/?gclid=CJmh_PbHobMCFUWo4Aodnh4A7w

Even with the positive prospects of this new technology, I find myself a little overwhelmed with all of it.  I am still testing and keeping track of everything.  I’m not discouraged.  But I woke up at 56 (LOW!) then I covered as I usually would and it spiked to 388 ^ ^ (which means still rising) about 1.5 hours later, which literally was “explainable” going off of my actions (low-carb breakfast) alone.  It’s days like these that would derail me.  I am not, I will not give up!

I need strength today.

“Be strong and courageous.  Do not be frightened, and do not be dismayed, for the LORD your God is with you wherever you go.”

Joshua 1:9 (ESV)

“Blessed be the Lord, who daily bears us up; God is our Salvation.”

Psalm 68:19 (ESV)   

Doctor, Doctor, Give Me the News…

As I sat in the waiting room, I began to rifle through stacks of “Diabetes and You” pamphlets.  “The New You!,” “Controlling Diabetes!” –emphatic declarations of hope like that.  And I started to shrink just a bit. I’ve sat in waiting rooms like this before; I’ve read stuff like this before; AND I’ve walked out discouraged.  Why should today be different?  Because I have a diabetes blog? Because now I have an audience that can be disappointed in me?  NO! NO! NO!  Something I realized more clearly today is that I attach a fair share of guilt to my diabetes.  Many of the resolutions I have made to “Do Better–or else!” have been because of a tremendous weight of guilt.   I have not resolved because it is the best decision, or the right thing to do, but because I feel guilty.  But really, is any resolution made out of guilt going to stick or be accomplished joyfully?  “Motivated by guilt, that person accomplished great things!” —said nobody. EVER.  So, motivation is the problem, eh?  What is proper motivation for diabetes management?  I have “fringe” motivations: energy, quality sleep, avoidance of future complications, future additions to the Frei house (doesn’t the whole world want a little Benny Jr.?), to prove to myself that it can be done.   But, my chief motivation must be a love for God that compels me to obey Him.  Notice the BIG difference between a love that obeys v. a guilt that reacts.

“For the love of Christ controls us because we have concluded this: that One has died for all, therefore all have died; and He died for all, that those who live might no longer live for themselves, but for Him who for their sake died and was raised.”

 (I Corinthians 5:14-15 ESV)

So, I can’t live for myself. I can’t live to fulfill that burning desire in me to “do this perfectly, or ignore it, so you don’t have to face the guilt of imperfections.”   I can’t do it to satisfy any selfish desire.  Because I can’t do it. I am incapable of it.  I think at the beginning of a journey like this, I have lots of steam–the Briana’s-motivated-and-gonna-do-this-thing train pulls into the station and chug-a-lugs into the future–until I get derailed.  It doesn’t take much when you’re going off of a self-motivated desire to improve.   God doesn’t bless a self-proclaimed, self-energized search for improvement.  He does promise to satisfy those who “hunger and thirst” to be more like Himself (Matt. 5:6).  So, the question is, if I am not satisfied–in my pursuit of anything–am I looking to be more like Him in the outcome?

This will serve as the excellent transition from “journaling Briana” to “here’s what happened at the appointment…”  

I started trying to schedule this appointment last July.  (As I was informed today, that’s a shortage of endocrinologists in PA.)  Finally, in October, they were able to “squeeze” me in!  I must say, it was well worth the wait!  I have had a variety of personalities care for me over the years, everything from a sympathetic, but mostly unhelpful grandfather type, to a militaristic “if you don’t take care of yourself you’ll go blind, lose your eye sight and your limbs and die” type.  This fella was a “let’s figure this out” type.  I told him that I think one of the reasons I have struggled in the past is because of attaching personal guilt to it and he said, “Diabetes is a disease–you can’t cure it, but you can control it.”  He encouraged me to not think of blood sugar readings as “good” and “bad” but as information.  He said that my body won’t always be perfect and I can’t tie myself to perfection.  I’m sure I’ve been told that before, but today, I heard it.

Okay team, here’s the game plan:

* Give the process a chance–Keep with it! (Dr’s orders!)

* Go for blood work (fasting–yikes!) on Saturday

* Test 7 times a day

*Write everything down for the first month or so

* Meet with a nutritionist (TBA)

* New Dexcom Insulin Pump (Dr said it’s worlds above Minimed)

“For it is God who works in [me!] both to will and to work for His good pleasure!” 

(Philippians 2:13)

My doctor also made some big changes to my insulin pump today.  He said that  many of my settings were too complicated.  He wants to simplify, and I’m all for it, but I’m wondering how my body will react.  The biggest struggle for me personally in this will be the need to write everything down and test 7 times.  I consider it an accomplishment when I test 4 times.   I’ll keep you posted on how that goes.

This was a long one, if you made it to the end, I commend you! Thanks for all the encouragement.  It’s a huge blessing to me!