Wednesday, April 21, 2010

And then there were four.

Yesterday was my MRI follow-up with my replacement orthopedist. (Sadly not nearly as cute as his site had suggested. He was cute, but more in a Steve from Sex and the City way - all goofy and seemingly shy - than in a McDreamy way. Sigh.)

The diagnosis from the radiologist's report: "minimal tendinosis of the rotator cuff with a tiny partial thickness rim tear at the distal infraspinatus insertion." In English, this means they found a tiny tear of my rotator cuff and some tendonitis. What didn't show on the MRI were the next words out of Ortho Steve's mouth: adhesive capsulitis, or "frozen shoulder syndrome."

I'd gone to see Ortho Steve largely because that's what I was afraid all the pain was about - I didn't want to admit I might be dealing with an "Oh, more fun stuff the tribe has to deal with" thing so I'd been putting it off. And putting it off. And putting it off. But after a number of shoulder-based tweets from Kelly - and a solid nudge from her to do so - I made the appointment.

I left the follow-up feeling a weird mix of relief (it was something, so I didn't get dismissed and now I have an action plan to make it better) and frustration (crap on a cracker, something else to deal with?!). An hour later, I'd evolved/devolved to rage and sadness - not for different reasons this time. Just two sides of the same coin.

At 2 to 3 PT sessions a week for 6 weeks, with a minimal copay of $20 a pop, I'm looking at $240 to $360 to fix something I didn't cause. I'm not out there playing extreme badminton or waving in a pageant for 20 hours a day - I work a desk job, I'm cautious about my physical health, I work really hard at keeping this rusty-old-jalopy body of mine in the best condition it can possibly be.

Cue the rage! 

It is crap that I spend thousands of dollars a year to maintain a basic level of existence that other people have without batting an eyelash. It is crap that I spend thousands of hours working at that BLE and pull from untold emotional reservoirs to have the energy to do so. It is crap that I have to have big purses, 143 specialists on call, eye exams every 8 months, black dots on my fingers, holes in my skin, and a constant background "What was that?!" monitoring of my jalopy in case something else has broken.

Cue the sadness!

After I'd seethed for a bit, all I could think about was that jalopy. How sad to have a jalopy! Sometimes I feel like the little Dutch boy plugging leaks - I've only got so many fingers, my arms reach only so far, and I worry that I won't be able to handle the next one. The D is the big leak, certainly, but I've also got the Hashimoto's, the mild retinopathy, and now the shoulder. I realize this all sounds so very defeatist, so woe-is-me, and I hate when that bubbles up to the surface. But I find it incredibly hard to keep my chin up when I keep getting whacked on my head.

Allison Blass had an excellent post today, and the following really resonated:

I spend every waking moment of every day trying to be normal, and the second I accomplish that it is taken away by the next thing that I do.

Normal, for me, is getting the jalopy to run (with duct tape and a few MacGuyver moves) like the nice sedan most people have. And that illusion of normal is shattered on a routine basis. Big things do it, like a new diagnosis or wrangling insurance, and little things too, like a CGM alarm going off in a meeting or a low messing up your sleep - the source doesn't matter. It's all about the shattering. Normal's a hard thing to achieve when the odds are stacked against you, and my body - all the blood, bones, and genes within - constantly reminds me that the odds are just that.

I don't expect this all to be rigidly under my thumb - I know it's beyond my control. Sometimes I just wish my attempts to influence it felt more effective.

Tuesday, April 13, 2010

Starbucks did it again!

I went to get my coffee treat - @Karen_mst said I could! - and wouldn't you know it, Starbucks struck again:

 I'm not Sharon this time - I was...Kathy? Karly? Whatever it was, it wasn't Karen.

I have duly logged my cappuccino (grrr) and done a bonus bolus to try to bring down today's crap BGs....

Logging, schmlogging

Logging. I've hated it my entire diabetic existence.

The whitefire hate started with those loathsome checkbook-sized BG logs in which I would madly scribble during the 45-minute drive to my endo or CDE - scrolling backward through my meter of course, and crumpling the paper and wiping my shoes on it to make it look "worn" and therefore used.

It's come a long way in the past 16 years - lots of automation, with graphs, charts, and spreadsheets, oh my! - but it's (supposedly) no less an important part of D management. And I would sooner eat dog poop than do it.

I hate it. With every fiber of my being, I hate it. I hate writing down these intimate things for near-strangers to examine. I hate getting feedback on my life from people who don't know me, don't know my disease, and certainly couldn't follow the rules they put out for me time and time again. I hate seeing my life - from a stressful meeting or beloved friend's birthday outing to my love of all things peanut butter or a long walk in the park - reduced to numbers and food entries on a page.

Endos and CDEs so often see the output of my life and its attendant numbers rather than what drives it - they wear blinders that conceal my living and show only the ways in which, health- and diabetes-wise, I'm doing it poorly. And so, as usual, my response is to lash out at the number-recording itself: the logging.

The bonuses of being so digital is that I can download my Dex and pump with very little effort. I can see the graphs and charts, the wonderful daily logs of bolusing and blood sugars, and I can pretend it's not a log. That these are clearly computer-generated numbers and, as such, have very little to do with me. Sending it along does not become a source of guilt because of this wonderful disconnect: "Sure, CDE, here ya go! Enjoy fiddling with my paperwork! La la la...." Analyzing data makes me feel like less of a failure - it becomes a math problem, a riddle to solve. A trend is just that - a trend to fix! - not me missing an opportunity to tweak a basal level.

But the food logging can't be automated. You can see my boluses and carb counts, but that's meaningless data without knowing what the food was. If I have an MFE for dinner, how would anyone know its effect if no one knows it was an MFE? Like the zen koan: If a nacho gets eaten in the forest but no one's around to identify the nacho, does the nacho cause a spike?

I understand the value of a food log. I still hate it. Passionately. So I've been tricking and treating myself into the undertaking:
  • I have gaps in all the entries of my little a-hole notebook (I am very aggressive toward this poor little notebook), but am ignoring them to reward myself for making any entries at all.
  • I'm using the little a-hole because I've found physically writing it down with a nice pen makes it more likely to happen than entering it electronically into a spreadsheet.
  • For now, I'm giving myself weekends off until my weekdays show no gaps.
  • I haven't been sending them to my CDE yet. I need to get my loathing under control, my entries more consistent, before I do that - baaaaby steps to thorough logging!
Time will tell if these are all the machinations I need. I have a feeling stickers and cappuccino rewards might be incorporated in the near future....

Thursday, April 8, 2010

Wednesday, April 7, 2010

And the award goes to...

Me, courtesy of my husband:

Am I a basketball player? Do I still do intramural sports? If you're asking those questions, you probably couldn't see my very special trophy inscription:

Most Responsible Diabetic: Karen A. Hoffman

The reason:
  1. Last week I bought my first bottle of Ketostix in, oh, say a decade.  Maybe longer.
  2. After a friendly little shove from @diabetesalic, I finally made an appointment for an orthopedist so I can get my burning, seething shoulder pain checked out.
  3. I tried (hard!) to make an appointment with a cardiologist (who still hasn't returned my call, the rat fink). But I've left 3 messages.
Having done all those things I've been loath to do, I told B I wanted a reward. He said "Yaaaay!" I said no, an actual, physical reward I can hold in my hand.

I'd expected a Reese's peanut butter egg or a batch of colored pens - something silly and stocking-stuffery. Instead, I am now the proud owner of this trophy. My first goal as owner is to try to to figure out what I'm doing on said trophy. Might it be an omen of PT to fix that killer right shoulder of mine? Is that a giant glucose tab I'm holding up? Am I symbolically chucking the D out the window? I'll figure it out. And maybe some representational arts-n-crafts are in order...

As for the little plate? I don't know that "Most Responsible" is accurate, but it's good to shoot for the moon sometimes. And while I'm trying for "most," I'm just hoping for "more."

Tuesday, April 6, 2010

Gold Five: "Stay on target."

Geek out with me! (And I'm talking about something other than the quotation title of this post.)

Aside from a little blip in the middle, I've been between my Dexcom lines for my 24-hour graph. Not too shabby considering my lines are 70 and 160! Now I just need to get that sucker smoothed out a bit....

Side note: WTH can I never get a reflection-free picture of Dex?! I blame my office's inferior lighting.