You can lead a horse to water.....

.....and he will drink when he is thirsty.  

Ever struggle with trying to get someone to do what you want them to do?  Wouldn't the world be easier if the darn "horse" would just drink!? But maybe the horse isn't thirsty, maybe he is angry and wants to get back at you, maybe he is afraid of what is lurking in the water, maybe the last time he drank it tasted bad, maybe he can't see the water, maybe he is too tired to drink.  Whatever the reason the horse IS the one who decides to drink.   We may think we are getting him to drink, by pressure, fear-mongering, enticement, education or other means, but in the end he drinks when he chooses.

This applies to many things in my life as both the horse and the leader of the horse.  I'll share a few and maybe it will ring true to you too.

Kids - trying to get them to get ready in the morning is HARD!  They don't want to get out of there cozy beds - especially after a snow day and the last day before spring break.  We have employed many tactics: yelling, threatening, enticing, cajoling, etc.  Today I let them decide (with a few parameters) and suffer the consequences.  The car was leaving at 7:35 and they were welcome to come as they were or figure out how to get to school on their own.  It was a 50/50 successful attempt.  They got it together in the last 5 minutes and it took all I had not to prompt them to do all their morning tasks.  We left at 7:37 - I caved by 2 minutes.  But I was proud they stepped up and they were the ones stressing not me.

Husbands - In this situation, I am the horse.  I have been a little off my game lately, in a funk, blue, introspective, call it what you will, but I just want to cuddle up with a blanket, read a book and step off the merry-go-round that is life right now.  He keeps trying to "cheer me up", which I understand is well intentioned, but I feel like he is pushing my head in the water to make me drink from the happiness bucket and I am just not thirsty!  His 'cheering' actually has the opposite effect and makes me pull harder in the other direction.  No one likes to feel manipulated; we all just want to be understood.  Stop pushing.  I'll promise I will get thirsty on my own.

Diabetes - about three weeks into my new CGM (continuous glucose monitor - it is a little device that is inserted into the skin/fat on my tummy - reads glucose every 5 minutes and sends it to my pump so I can evaluate which way my blood sugars are trending and manage them more closely).  I know I should be grateful for the technology that allows this life giving information to be provided to me, but I really want to toss the thing out the window.  Because it reads every 5 minutes, I have more alarms going off (beeps, buzzes, tweets and bells oh my!) to "help" me manage.  I know this is a good thing, but it has turned the disease that I have embraced for so long into a proper "pain in my ASS"!  Before CGM, I had a routine, all was well, and I was content.  You could rightfully say ignorance is bliss.  To be fair, it isn't the device that is the trouble, it is the emotions in me it brings out - frustration, fear, self-pity, anger, and others I haven't been able to name yet.  I feel the educated side of my brain pushing me to "drink" and the emotional side saying "stop pushing, I want to go back to my safe routine".  I am hopeful this internal tug of war will play out, I can work through the emotions and get back to normal.  I keep taking deep breaths.  Let Go.  Let God.

If you are pushing your horse to drink - stop it.  Connect with their emotions, understand why they won’t drink and give them back control.

If someone is pushing your head under water – explain why you don’t want to drink,  ask them to back off and know you have the ultimate control.  Drink when you are thirsty.

Peace,

Patricia

Loving My Snake

I hate snakes!  They are creepy, crawly, slithery creatures with beady eyes and  forked tongues who crawl on their bellies with their face to the ground.  They hide away in dark creepy places ready to chomp, squeeze, or envenomate the unlucky who cross their path or look like lunch.  I hate them to the point of phobia - they just give me the willies! Gaa-Ross!

Imagine my reaction when I learned that not only had to touch a snake, but own one, care for one and keep one alive or I would lose my life.  That, my friend, is what getting a diagnosis of diabetes felt like to me. I got a snake and I had no choice in the matter.  I didn't want it, I feared it (years of nursing will do that to you - you know what it is capable of), and the thought of it repulsed me.  Yes, repulsed me.  I didn't want this.  I remember feeling pity for people I knew who had to bear such a burden and suffer with such a horrible plight.  Diabetes was creepy, scary, and treacherous, with sharp pointy parts, strict feeding habits and the potential to kill me.  How could I ever live my life with a thing I feared so much?

The thing about fear is that you can't stay in fight or flight mode 24/7.  Fear can be a great change agent for a while, but eventually you even get used to constant fear.  You get used to your snake.  I sort of got used to mine.  Some days I was so scared I did nothing but care for the snake.  Other days I left the snake to fend for itself and took a break from carb counting, finger sticks and portion control.  Neither extreme did much to make me a happy, well-adjusted person.  Being an ER nurse during this time, I saw "snake victems" every day.  Those unfortunate souls who hadn't managed their disease well or just by sheer bad luck were blind, missing toes and limbs, on dialysis, demented, crippled by stroke or heart disease, the list goes on and on. They didn't look happy.  I feared that would be me.  

My type A self eventually got so tired of not being the perfect diabetic with blood sugars normal every time.  I beat myself up for not being a better snake handler.   I didn't want the thing anymore and thought I would lose my mind as I swung between taking care of the snake and living my life as I wanted.  By the grace of God a co-worker knew a licensed professional counselor that had helped her and encouraged me to talk to her.  I ended up learning new ways to cope, new skills, and new ways of thinking.  I think the first "aha" moment was that the snake and I were one in the same.  It was now part of my life and I didn't want to hate part of me.  Hating anything is exhausting and depleting.  I had to learn how to love my snake.  To love me.  All of me.

The first thing was to get rid of the image of a snake thrust upon me (they still creep me out) and reframe my new reality.  I now think of diabetes as a child I need to take care of; a beautiful, younger, fragile girl who needs some TLC, good food, medicine on time and a lot of understanding.  It is much easier to care for that aspect of me and love her.  That child has taught me many things, among them patience, acceptance, and tolerance.  Most importantly, she taught me that I was worth it, my life is worth living, and I can chose not to be a victim.  Life is much easier now that I am a caregiver and calling the shots (pun intended!).  I am happy to hold her hand, test her blood sugar, feed her well, and enjoy the life we live together.  It no longer feels like a burden, I don't hate anything about my life (well maybe when I don't have internet connectivity!).  I can actually say I love having diabetes, because I can't hate a part of my life.  It is just who I am and I accept that.

Patricia

Diabetes and depression is normal???

I am in the market for a new insulin pump and decided to use my twitter account to see what the world had to say about the pumps on the market and diabetes in general.  I happened across a post about the prevalence of depression and diabetes.  It suggested patients with diabetes need mental health services and more involvement with the Psychiatric community.  Frankly, it ruffled my feathers!  I was offered antidepressants years ago when I struggled with the reality of this life long ride with little chance of getting off.  I passed.  I ended up seeing a therapist who helped me build coping skills and peel back the onion a bit to understand how my life up to that point was influencing my day-to-day happiness.  Turned out diabetes wasn't my problem.  It was how I managed problems.  A lifetime of avoiding conflict, trying to please everyone and not facing some hard realities,  left me unprepared to deal with this situation that I couldn't run from, couldn't do perfectly and I was letting define my worth as a human being.  Learning that my blood sugar readings were not a judgment of my character, that I could still dream and do things I wanted, and that if my diabetes management became inconvenient for people, then so be it.  I was worth the effort.  You might call that situational depression, but I refuse to say I have mental health issues.  Who wouldn't feel a bit down when forced into a new way of life, one that you had no choice in?

I started to do a bit more research and came upon what I believe is an "aha" moment for the medical community.  When a patient is diagnosed with a chronic illness, their previous way of life dies.  It is a loss they must mourn.  It doesn't mean their new life can't be wonderful, but it will be different and to fully move forward they must come to terms with this loss.  They must grieve.  There are five stages of grief: 1- Denial (not me!), 2 - Anger (why me!), 3- Bargaining (maybe it’s just temporary, the diagnosis is wrong, I need a second opinion), 4-  Depression (this sucks - my life is over), 5 - Acceptance (this is my life and I will make the most of it).

Look at stage 4 - It's depression!  A normal part of the grieving process!  Not a mental health issue or a psychiatric problem that requires medication to placate your emotions.  Just something we all go through, but sometimes we need a little help figuring how to get through it.  What if more people went through grief counseling to understand their loss, deal with their emotions and come to peace with their new situation?  From my years at the bedside, I would say there is a large majority of patients stuck in denial, anger, and depression.  We medical folks might even label them as "non-compliant” (I despise that term BTW).  If they are stuck being mad, hating their life, feeling helpless or avoiding their reality all together who would expect them to do what is necessary to manage the day to day care that diabetes requires?

I am confident the therapy I have done over the years to learn about what makes me tick has done more to control my A1C than any amount of diabetes education ever could.  I have grieved and long ago accepted this gift that is diabetes (yes I said gift - more on that another day).  It has taught me more than it has ever taken.

Be happy

Patricia
#copingskillsnotdrugs #emotionalsupport#cheerleadernotcritic

Where does your truth live?

This morning I had “monkey mind”.  You know when you have a zillion thoughts bouncing around your head and it makes you anxious?   I was trying to slow down my thoughts, focus on something, and relax.  Somewhere in that process, I had a little epiphany and have to share.  It is this: We see in our minds.  We feel in our heart.  But we know in our guts.

As my mind wandered, ideas bounced around, and thoughts floating by, I realized I was watching them as I tried to slow them down.  I suppose I think in pictures and “see” my thoughts in my “mind’s eye”.  I even had a choice of which I honed in on, which came and went, and they constantly changed.  Heck, I can even think opposing thoughts at one time and believe in both!  If I am seeing them, then they can’t be me – right?  If they come and go, they can’t be my truth – right?  This is the scary part, I pride myself on making good decisions based on what I think about something!  Don’t we all make decisions every day based on what we think?  And those thoughts can change moment to moment.   Our vernacular even illustrates it with “fleeting thoughts” or “mind games” or “I changed my mind”.  Ummmm,  maybe I don’t want my mind calling all the shots.  So where else?

Going a little deeper - what about my heart?  When I feel things like love, joy, sadness, guilt etc.,  I literally feel them and experience them in my chest.  Are these feelings my truth?  Should my life be about what my heart feels?  I have less choice on what I feel as it tends to relate to the people, places and things going on around me - external things, but there is a choice.  One can have a “change of heart” or “get their heart broken” or literally be “heartless”.  Thinking the heart may not be such a reliable guide.

So one-step deeper and we are in the guts.  Way down in the belly where we can’t change the truth and there is no choice.  You have a “gut reaction” and there is no time to study it.  It just is.  When you “know it in your guts”, there is no denying it.  Have you ever said “I knew in my gut it was the right/wrong decision” and it was?  I think our hearts and our minds spend a lot of time and energy trying to keep us from “following our gut instinct”.  There are a few things” I know in my gut” that I am going to spend a little more time on.  And a lot of things flitting in my head that are going to have to take a back seat!  Maybe your gut is telling you something – something true that you have been avoiding.  Maybe you should listen?  You know the saying “No Guts, No Glory”.

Patricia

There has to be a better way!

So I just returned from my quarterly visit to my endocrinologist and I am frustrated - again!   There has to be a better way!   

I have been a type I diabetic since I was 26 and I wear an insulin pump.  I am a freak of nature, as to my knowledge I am the only one in my large extended family ( 6 siblings, 16 cousins, and too many second cousins and cousin’s kids to count) that developed type I.  I was working in the ER when it all came down.  Most likely related to something viral I picked up.  I had a weird rash and fever about 6 months before I became symptomatic and the “boom” there I was doing injections.  Diabetes has taught me many lessons and good lessons.  It is not something about my life I hate.  That is a bitter emotion, so instead I embrace it, hold it close, and care for it as it were another child.  It is my responsibility.

As a registered nurse, I fully understand the impact of diabetes.  In my career, I have worked on a med/surg floor caring for diabetics, in Medical ICU caring for diabetics at their worst and in the ER caring for the newly diagnosed, those who poorly managed their illness and those who had accidents when low blood sugar got the best of them.  I have literally seen it all.  So I get it.  I go to the endocrinologist every 3 months, get my eyes checked annually, and do all those other things on the "Check list for Diabetics".  I test my blood sugar 4-6 times a day or more if I feel weird.  While we were trying to conceive, during the pregnancy and while nursing, I was super careful and checked my sugar every day at 7, 9, 11, 1, 3, 5, 7, 9 and 3 am.  My numbers were equivalent to those without diabetes and my kids had no complications.  Yeah!  We eat pretty healthy without being obsessive.  I probably could work out a bit more than I do but I have gotten myself back in the yoga studio the past few months.  And I am happy to say, So far, So good, No complications!!  I hope I am what doctors would label "compliant", one of the good ones.  

So why is it after every visit to a provider, I feel so beat up and defeated?  I leave feeling like I am failing at my diabetes management, that I must be the worst patient ever and I am doomed to suffer all the complications that are just waiting to pounce on me.  

It starts with the waiting.  In my corporate world, if I had an 8:30 meeting, it started at least by 8:40.  It would not be acceptable to be 60 minutes late.  I feel devalued when I am made to sit for no good reason.  I was the first appointment!  How could you be that far behind?  Nevertheless, in healthcare it is the norm.  Patients wait.

I eventually get back to the exam room and answer the required screening questions (Thank you Meaningful Use).  Today they added Ebola risk along with verification that I haven't started smoking in the 3 months since my last  visit (LOL!), my flu shot is up to date, my BMI is recorded and many other important tidbits that have no bearing on how I feel or what I need, but they are required.  Meanwhile, the clock is ticking, I have a list of things that I need from my provider and I have to make sure we cover it in my allotted time.  1) My insurance no longer covers the brand of insulin I have used for the past 20 years - need a new Rx.  2) My insulin pump is out of warranty and I need a new one - curious about new pumps on the market.  3) I need some labs drawn for another doctor - any way we could do it together?  4) Anything new on the diabetes front I should know about?

But first, we do the obligatory review of all my blood sugar readings that have been downloaded from my pump.  "What happened 2 weeks ago on Thursday - your number was a little high?"  Hmmmm, I really can't remember.  (Can you?  What were you doing 2 weeks ago on Thursday?  Who knows this?!!!)  When I say I am not sure, they eyebrow of my NP goes up as if to say, "Aha! We caught you!  And you have nothing to say for yourself".  It proceeds as she points out all the "wrongness" in my numbers.  Never mind that most of them are good and my overall average says I am within target range, only those out of range are addressed!  On my last visit, I created a log of everything I ate, activity, mood, glucose readings, carb intake etc for 2 weeks, so I could answer her questions.  She still only circled the numbers she didn't like and commented she “Didn’t know what to make of all this information".  Sigh.......

So we complete the review she asks me if I want to change my pump settings.  "Sure" I say, "what do you suggest?”  She counters with "What do you think?" In my head I say “What I think is that I am here for your opinion and advice.  You help me!”  We end up doing nothing and when I get to the parking lot - I adjust them based on what I think will work.   Frustration #1.

So on to my list of stuff!  She hands me my new prescription.  "What should I know about this?"  I say.  "It is just the same," she says,  "Nothing new".  Well to me it is new as I have been on the other brand for a long time.  So I will google it when I get home and see if I can find others who have switched and noticed a difference.  Frustration #2.

Now to new insulin pump.  She hands me a packet of literature from the manufacturer (same as what I have already read on their webpage) and tells me to read it and call the company rep who can answer my questions.  I ask for her opinion about her other patient's experiences and she says she isn't allowed to share that, as it would be unfair to the pump companies to promote one over the other.  Really?  Being fair to the pump company is more important than sharing real life experiences among your patients?  She tells me not to worry, as the pump reps will be fair.  Yeah - right and I have some swampland you might be interested in!  I told her I would try to find some info from other pumpers online.  Her advice "Don't believe everything you read online".  Once again, I am left to my own devices to figure this out.  Frustration #3

Finally my lab work.  I have several specialists in my medical arsenal and my wellness doctor likes to have my labs done in advance so we can discuss during my visit.  (Brilliant idea BTW!).  I need to get them done this week, so let's get two providers tests done with one needle stick - right?  No such luck,   My NP wasn’t willing to add the wellness labs to her lab slip and wanted me to move some of the duplicate labs to her lab slip (which would require me to contact my wellness doctor for a new order sheet).  Suffice to say I had 2 separate lab draws 45 minutes apart at labs that were 2 miles apart.    Frustration #4

As far as anything new in the world of diabetes management, she had nothing.  I go every 3 months, it is always the same, and nothing is new.   Sigh...........I will keep checking online.

I leave somewhat dejected,  defeated and very frustrated.  When I could have used a cheerleader or an advocate, I get a critic.  If you look for a person's missteps, they are easy to find, especially if you have a chronic illness.  I really want someone to tell me, "Keep on going!  You are doing great!  There is hope!”  But not today.  So, as I have done many times in the past, I try to shake it off, take matters back into my own hands and be my own cheerleader.  Take a deep breath and try to rise above my frustration and disappointment.  Because at the end of the day it is my responsibility, my “child” to care for, and I will do what I can.

But what about all those people out there who haven’t really accepted their situation, who don’t have 30 years of nursing under their belt and aren’t comfortable enough to take matters in their own hands when it is necessary?   It seems our system has become broken, fractured, siloed and frustrating.  Even though we have the best medical care in the world, it has become less and less about helping a patient to live their best life and to be well.  It is now about data collection, checklists, finding physical symptoms that can be treated and billed among a sea of specialists.  There is little concern about the overall quality of a patient’s life, their ability to deal with the emotional toll that is paid, or the how the nuances of their life affects their ability to manage illness (or wellness).  The body is assessed for symptoms of brokenness and disease and thusly prescribed treatments, but the mind and the soul are not included.  So many people walk around "Band-Aided", but really not whole.  Struggling, when they shouldn't need to.

There has to be a better way!  Could it be possible, that there is a way to coordinate a plan that includes not only medicine , lab tests, and traditional western health practices, but addresses emotional health, nutrition, family considerations, work/life balance, discovery of inner strength so you can do what needs to be done, and peace in your spirit to minimize the ever present effects of stress in our lives?  I am not sure of the exact recipe to make this happen but I think it is a quest worth pursuing.   And it doesn't start with education.  If so, smokers wouldn't smoke,  no one would be overweight and we would all exercise 30 minutes every day.  We all have been educated about these things.  So why don't we do it?  Personally, I know having someone cheering you on who thinks you are "worth it" is far better medicine than having someone pushing you down and making you feel "less than". 

I am interested in connecting with anyone who has interest or expertise on this topic.  I think it is a service that people need.   Feel free to share my blog or send them my way!

Patricia

Merry Christmas and Melancholy??

Did you ever notice those words share many of the same letters?  During the season when we are supposed to be joy-filled, why is it that I sometimes feel blue?  I love the planning, the anticipation, finding the perfect gift for someone on your list who won’t expect it, the feel of my house decorated and cozy, the glow of the lights on the tree etc.  It is like living in a little surreal bubble for a while (I would say snow globe, but I live in Texas!). But the actual event itself leaves me a little blue and disappointed no matter how hard I decide this year will be different.

My reasons are not hard.  My father died when I was 13 and holidays were never the same after that.  The traditions just a little different, the locations changed, and always something missing that would never be there again.   Don’t get me wrong, we celebrated, there was laughter, family get-togethers and lots of fun, but somewhere deep in a corner of my soul it hurt. 

I did a good job of avoiding the holidays for over a decade.  Being an unmarried nurse, it was easy to work those holiday shifts so my colleagues could be with their families.  So for all but two Christmases from age 21 – 35, I worked.  There is something sacred and special about sharing a holiday with docs, nurses, patients, police and firefighters.  It actually gave me peace.   One of the ER docs I worked with used to write “LOC” as a diagnosis on some of the patient’s charts.  No, it didn’t mean Loss of Consciousness, Laxative of Choice or any other medical abbreviation.  It meant Lonely on Christmas.  It was for those folks who were seeking a warm touch, a hot meal, a bit of human connection to ease whatever pain it was they suffered.  That pain was unlikely from an ailment (and they typically had many) but more often from a place in their soul that hurt a bit more on a holiday.  I could relate.  

When I left the hospital and started working for a healthcare IT shop I found myself with 2 weeks off nearly every holiday.  No diversion now!  I met my husband a year or so later and the holidays became filled with other people’s traditions, memories and stories.  So fun to hear it all and I was welcomed to be there, but I couldn’t truly experience any of the lore and “good ole days” they spoke of.  Somewhat like watching slides of someone else’s vacations perhaps? 

Fast forward a few years and we have a child; time to establish our own traditions.  The first of which was that Santa came to our house.  We weren’t going to haul kids anywhere on Christmas night.   I love that decision; it was a step towards creating a “new” holiday that was “ours”.  Those mornings we have shared have been the best part of the holidays for me.  We get to weave what our traditions will be; we have a bit of his, hers and ours; and watching the kids’ excitement is genuine joy for me.  Christmas eve, Christmas day, Christmas week – we cram the rest in with those friends and family who are near.   I listen to other’s stories, raise a glass with their traditions, attempt to relive some of mine, unwrap the gifts that abound; and try to put on my happy face.  Those times are always a hodge-podge of joy, pain, happiness, sadness, closeness, severe distance, worry, fear that my kids will not behave as expected and sometimes still, even disdain that I still don’t have “mine”.

But this year I have changed.  I am trying to find my own truth and calling.  Going through the motions of the season seems flat and that deep pain in my soul seems closer than ever.  But the pain is not for my childhood holidays or memories, but for authenticity.  Perhaps the commercialism and the abundance have worn thin?  Would all this “joy” of giving (things to people who need nothing) be better served with something more important?

The best part of this holiday season for me was in "presence" not "presents".  My younger brother and I decided our kids did not need to rip though another set of the endless gifts they receive.  We gave up lovely presents, wrapped in beautiful paper that would be cast aside within minutes of being opened, for an evening of bowling, laser tag and pool!  I am 100% confident that they have no idea who got them what in the past 5 years for Christmas, but I have that same confidence they will remember blasting their cousins, aunt and uncle, and mom in laser tag; they will remember learning how to play pool (even if my lovely, perfectionist daughter hated that she wasn’t a pro on her first shot!);  they will remember video motor cycle races with their cousins; they will remember learning some pool tips from my brother; and they will remember who had the highest bowling score!  They will remember that JOY!

And on that night my heart didn’t hurt, I didn’t feel melancholy, and I felt connected to those I was with.  It felt real. There were others in my family whose holiday’s were spent in the ER, on bed rest, getting medical procedures, with a spouse who was home for just a brief stint, on a beach, missing their spouse who was working a shift, suffering their burdens silently, having a Christmas dinner with most of their family absent and more I am sure I don’t know.   For all of these situations, no gift can make it better. 

So, fondly remember the days of yore, consider less commercialism, and perhaps find your joy in authentic moments with those you love.  I know that is my plan from now on.

Patricia

Practicing what I preach

It is funny how life teaches you lessons if you only pay attention. Last week my daughter was raking me over the coals because I was "annoying her" and "making her mad".  To my defense, I wasn't doing much of anything, but apparently my singing, my jokes, my rules, my lack of response when she wants it and occasionally my sheer act of breathing are the source of her angst. We had the talk about how I can't make her feel anything (if I had that super power everyone I know would feel wonderful all the time!), that her feelings are her own.  She decides what she holds on to, what bothers her and what doesn't.  She can chose to wallow in her own victimized, self pity or she can just let things go, accept what is, change what she needs to or decide to act if necessary.  The power is all hers.  There was no light bulb moment that day, but hopefully over time those insights stick with her.  The point: people will always do things that you dislike, but don't take them personally - 99% of the time it wasn't aimed at you.  Only you suffer when you cling to them. 

As luck (or life) would have it, a few days later my husband raised my ire - just the normal stuff married couples deal with: kids, how to parent, how to discipline, communication, etc.  I found myself mad, brooding, blaming, wanting him to change so I would feel better.  Of course it was he who was guilty of this foul mood I was in- right!?  

You see where this is going, I am sure.  It didn't take long for my conversation with my daughter to tip toe into the picture and change my perspective.   I ended up apologizing to him.  Not because I felt I was wrong in my opinion, but because I held onto the anger and put distance between us.  That simple act closed that distance and eased the positions we were clinging to.  Good lesson for me and for all of us; we chose which of the millions of moments we experience each day will stick to us, which of them we decide we want to suffer for, which of them we assume are to hurt us, which of them we believe expose something we are trying to hide, and which of them sail past without a thought.  However, in the end they are just moments, things that happen, mostly other people just living their life. We are caught in the crossfire and not the targets.  We can choose to pause and take a moment before we get angry.  We really do have all the power, if we only chose to step back for a moment to see it.  It's a lesson I continue to learn.  

So Merry Christmas! In all this crazy, holiday madness - stop and appreciate a smile, a joke, a hug, a secret, a sharing, a toast and enjoy the simple act of forgiveness if you need to. It is the best gift you can give yourself.