One in black, one in brown

There’s this stereotype about women and shoes, and I’m pretty sure it exists because stereotypes exist for a reason. I’ve known women who would proudly offer to be the shoe whore, pardon the expression, poster child, given the chance. If TV and movies have taught me anything – and to be honest, I’ve gotten many life lessons via the big screen and the boobtube – it’s that these women who have a ‘thing’ for shoes, have closets lined with footwear, in every color of the rainbow, in every imaginable material from leather to fabric to plastic to reptile skin *gasp cry*. Ballerina flats, boots, clogs, espadrilles, huaraches, mules, pumps, stilettos, t-straps, wedges, you-name-it.

I am not one of these women. I have diabetes, and it was been drilled into my head from at least as far back as the time I was 6 years old that I should take meticulous care of my feet, and as part of that mission, stick to practical shoes. I have not always done the best job. I have purchased shoes because they were cute, not because they were comfortable. I got a pedicure before my wedding, although that was the first and the last one I ever got. I have gone barefoot, although I do it infrequently, even in my house. Taking care of my feet in the interest of not losing my most favorite dancing partners has certainly informed my foot care choices and my footwear purchases as long as I can remember, but more so as I’ve gotten older.

Now that I’m, well, older than I used to be, I have some kind of weird foot issue that I didn’t used to have, something about the connective tissue between the bones that keeps my feet from flexing all the way, more so in my right foot than my left. So in addition to diabetes, I have to take this flexing quirk into consideration too because I now have difficulty keeping some kinds of slip-on shoes securely on my feet, especially when I’m doing a lot of walking. Most of the sandals I own are slip-on, so as I prepared to go to Florida back in June, knowing I’d be doing quite a bit of walking, I decided I needed to find some sandals that would stay on my feet more securely than those that I already have.

I found some brown sandals in the spring that might as well have been custom-made for me, Doc Marten’s with that nice thick supportive flat sole that is characteristic of Docs, the ankle strap I sought, as well-constructed as a shoe can get, and very foot-friendly. Except for running shoes, which I should note, I don’t actually use to run, I’m very particular about having both a black version and a brown version of the shoes I buy. I won’t necessarily get the exact pair in both colors, but I try to find similar styles, one in each color because one or the other will match just about anything I might wear. I’m a little neurotic in this respect, but I’m OK with that.

Brown sandals that make me happy

Since I found the casual pair of ankle-strapped brown sandals I loved, I figured how hard could it be to find a black sandal with similar characteristics? I’m pretty sure black is the most popular sandal color, and surely, in a shoe store, a department store, or online, I would find the black sandal sister of my new brown sandals.

It was not to be though. One of the main problems I encountered was that the “in” style this summer has been gladiator sandals, and no offense to those who like and wear them, but I can’t stand them. It seems that a characteristic of gladiator style sandals is a very thin sole, and I don’t do thin soles. They’re not comfortable, even a little bit, they aren’t good for your feet, and by default your legs and back, because there’s no support. Also, thin soles mean your feet are less protected from the things on the ground that could be hazardous to your feet, such as rocks or sharp objects. Besides the issues I have with the soles, I dislike how the straps creep all the way up the foot. While I was in search of a sandal with an ankle strap, I am not a fan of these weird sandals with straps that go up the leg, or those ones with ankle cuffs which are atrociously hideous in my opinion. The ubiquitous flip-flop wasn’t an option for me either. I have a pair that I keep by the backdoor in case I need to step outside, but I know they’re crappy footwear, so I wouldn’t wear them more than that. I like what I like, and I don’t like those sandals, which unfortunately meant I had a rather limited selection from which to choose.

In June, I went for my regular podiatrist appointment. Because of the aforementioned problem with the range of motion when I flex my foot, I get an obnoxious callus on my right big toe. I try to doctor it up between visits, especially in the summer when my feet are visible, but having gotten myself into quite the pickle when I doctored up my feet in the past, I’m very conservative in my actions, leaving the real doctoring to the doctor.

One in brown, one in black

I know quite a few diabetics get pedicures to remedy unsightly problems like calluses or other dead skin, and swear that their pedicurist’s instruments are sterilized and the salon is clean, etc., but except for that single visit I made before my wedding, for which I had considerable misgivings given that I knew better, I steer clear of pedicurists. I know a woman, not diabetic, who got one at a nice, new salon a few months ago, and ended up with such a nasty infection for which she ultimately needed surgery. Leading up to that she had to see several doctors, one of whom suggested she might have to kiss her toe goodbye due to a possible bone infection. I had become pretty adamant in my anti-pedicure position before, but after hearing about that pedicure-gone-wrong, now I’m that much more opposed to them, but that’s just me, and my personal, obviously conservative approach to diabetic foot care.

So my podiatrist and I were chatting, and knowing she would sympathize and understand my footwear dilemma, I told her how unhappy I was with this season’s selection. She exclaimed, “Oh, I know!” and I felt validated, having found someone who shared my shoe shopping pain. She told me how she ended up spending over $100 on a pair of sandals, far more than she would normally spend, because she too hadn’t been able to find a decent pair. I told her how I have a couple of pairs of Skechers slip-on sandals that I love, and I had hoped Skechers might offer something similar with an ankle strap, but this year their sandals aren’t to my liking at all, except for one pair that was from their Shape-Ups line that more or less met my admittedly unspecific criteria for the perfect sandal.

Now, if you aren’t familiar with Shape-Ups, they’re a line of mostly sneakers, but also some sandals, and they have a sole that’s rounded so when you wear them, you’re never quite planted firmly on the ground. Skechers asserts that you’ll get a better workout wearing these shoes because you’ll “burn more calories, firm muscles, and reduce joint stress”. When I first saw them in sneaker form, I didn’t think much of them aesthetically, and I couldn’t help but raise an eyebrow at the claims because, c’mon, they’re sneakers, not a personal trainer hovering over you while you workout!

OK not great black sandals

My podiatrist, who I absolutely adore because she takes wonderful care of my precious feet, scoffed, and told me to stay away from Shape-Ups. She said that of the patients she had seen who were experiencing foot problems that seemed to be related to wearing Shape-Ups, all of them were diabetic. Most of her patients are older, as you might imagine, and I think it’s a fair assumption that most of her diabetic patients are type 2, so they’re more susceptible to foot problems than the typical younger people with type 1 for whom peripheral neuropathy isn’t a pressing issue, but regardless, I thought it was telling anecdotal evidence that Shape-Ups aren’t all Skechers would like consumers to think they are. As it turns out, the American Council on Exercise did a some research, and it doesn’t think much of Shape-Ups or comparable lines of footwear either.

While the Sketchers sandals I had eyed were the closest I had seen to meeting my structural and aesthetic requirements, minus the Shape-Up sole, my doctor’s recommendation knocked them off the list of contending sandals. That left me with no sandal candidates though, so it was back to searching.

Jason, who is an eternally good sport, accompanied me on several shopping trips to find a pair of sandals I liked, and as if channeling Goldilocks, not a single pair was quite right. He’d point or pick a shoe off a shelf, holding it for me to inspect, and he’d get, “Too dressy, too dainty, the sole’s too thin, the straps are too thin, the heel is too high, the toe is too narrow, too enclosed, too 1983, I don’t like that metallic decorative thing, too shiny.” I had a reason for dismissing every pair. Eventually, he gave up trying to help me, although we did find a new pair of sneakers for him.

The day before I left for Florida, I schlepped back to the mall, determined to get a pair, even if that meant getting sandals that didn’t quite meet my apparently impossible expectations. Having reached defeat by the stylistas who decided ugly sandals should be the rage this season, I settled on a pair that I like for the most part. They’re not as sporty or casual as I was hoping to find, and sole isn’t as thick as I would like, but I’ve been wearing them on occasion nonetheless, and will continue to do so until next season when I dearly hope cute sandals are in style again.

Long time, no blog! Last week I returned from a rather eventful trip to Orlando, FL where I attended the ADA Scientific Sessions, the Roche Social Media Summit, and the Children with Diabetes Friends for Life Conference. It was a whirlwind trip during which I met some fabulous people, and caught up with many people who, dare I say it, are feeling like longtime friends now. I have so much to tell you about all of it that I’ve been a little baffled about how or where to start, but the most logical starting point is no further than arm’s length.

This pink cast, which as Karen suggested, is begging to be bedazzled, is making everything you can imagine, including typing, slow and tedious. As much as I want to unload a torrent of anecdotes and information that has been taking up vital cranial real estate, it looks like the posts might be slower to emerge than I would like. However, in an effort to put a positive spin on the blog break I’ve been taking, which it seems was much needed, slow posts will actually be a vast improvement over no posts at all.

Not So Gripping...

If you’ve already heard the story about my hand, then feel free to move ahead to the next blog in your Google Reader queue, but for those who haven’t heard how I injured my hand, the short version is that I tripped and fell. Amongst anyone who has spent enough time with me, it is a well-established fact that I am notoriously clumsy. Last weekend, we went to our friends’ to help their youngest spittle out 3 birthday candles. Upon seeing my cast and learning that it was the end result of tripping and falling, the birthday boy’s dad chuckled, and said something to the effect of, “That’s not too surprising.” So my two left feet are why I’m now fending for myself with one left hand. P.S. I’m right-handed.

The long version of the story is more than just another-day-in-the-life-of-Lee-Ann clumsiness though. While at the ADA conference, I stumbled upon the booth of the Center for Hope of the Sierras, an eating disorder treatment facility in Nevada with a program designed just for people with diabetes. It is, to my knowledge anyway, one of only two such in-patient programs in the country, which is a sad state of affairs for all the people in need of specialized treatment. I had sent the Center for Hope a resume some time back, but as is the case with many art therapist positions, they would have only been able to use me for a few short hours a week at best, and who can realistically justify moving cross-country for a job that doesn’t amount to one day a week, as cool as that job might be? I have been in occasional contact with Rachel Harriman, the Professional Relations Coordinator of the facility though, and since she travels quite a bit, we had made non-specific plans to meet up if at some point her travels coincided with my whereabouts.

Our paths never quite crossed though until I discovered she was in Orlando wo-manning the Center’s booth in the ADA conference exhibit hall. This was an especially great surprise after fielding the blatant disinterest of countless pharmaceutical and bio-tech reps that either didn’t know or didn’t care that I could read their disappointment in learning I wasn’t a physician like I can read a nutrition label. However, the Center for Hope reps were happy to chat with me about how the program is going a year and change into its inception, and how interest in the program has been slowly but steadily increasing.

Rachel suggested we meet up for dinner or lunch, so on the last full day of the conference, I stopped by to see if she wanted to grab a bite to eat. Having spent too much time in the frigid convention center, we decided we’d get out of the caverous convention center for a bit, which meant relief for my frost-covered extremities. We made the trek to the other end of the facility towards the parking lot, and stepped into the much welcomed heat.

Now, decades of diabetes has resulted in what I’ve understood to be a common eye issue for veterans of type 1. My eyes are slow to adjust to drastic changes in lighting conditions. When I transition from a bright environment to a dark one, it’s initially so dark that I can’t distinguish objects and my depth perception is shot. For instance, while some people are fine arriving at a movie during the previews, as long as they don’t miss the start of the feature presentation, Jason and I try to arrive in advance of the lights being dimmed because otherwise, I can’t see anything. I stumble on steps or down ramps or over seats or over people, and if I’m carrying popcorn or a drink from the concession stand, there’s a good likelihood that I’ll spill on something or someone. When you’ve been extorted for $10 of popcorn and diet soda, it’s aggravating to see half of it falling between seat cushions onto the icky floor.

Darn Curbs

Conversely, when we leave the theater and step into the daylight, which is how it unfolds more often than not because matinees are our movie time bracket of choice – less money, fewer people – I am blinded by the daylight. As if through a special effects filter, everything glows bright white, so I can’t distinguish things, my depth perception is shot, and again, I am more likely to stumble and trip. It is what it is and it’s been like this for coming on 15 years or so.

In both scenarios, light to dark, or dark to light, give me a couple of minutes and my eyes adjust, but it’s those first few minutes that converge with my clumsiness to make me an accident waiting to happen. Just as the solution to the dark theater is arriving prior to the lights dimming, the easy solution to stepping outside into daylight is a pair of sunglasses. It’s simple and effective… as long as I have them on my person and wear them when it counts.

The movie theater is an easy example, but anytime I go from a dim setting to a bright one, the same principle applies, be it the mall, a restaurant, or in the case of the day in question, a convention center. Once out from under the overhang at the parking lot entrance, the sunlight radiated. I started to reach in my bag for my sunglasses, but remembered they were buried under a bunch of stuff in my tote bag that made them less than easily accessible. It seemed that by the time I fished them out, we’d probably be at her car, so I took my hand out of my bag, deciding the short walk to the car wasn’t worth the time it would take to find my sunglasses.

Moments later, I walked right into a curb that I didn’t see because the sun was blinding me. I fell forward, my knees landed in the soft grass, completely unscathed, and my hand automatically went out to keep my face from meeting the sidewalk. Falling like that is embarrassing, falling like that with someone you’ve essentially just met is that much more embarrassing. The moment I recovered from being momentarily stunned, and it registered that I was sprawled on the ground after tripping on a curb I likely would have noticed had I been wearing sunglasses, I jumped up, dusted myself off, slipped my beloved bracelet, now broken, in my pocket, and assured her I was OK. We kept walking and chatting as I surreptitiously inspected my hand. Some minor scrapes, so nothing overly concerning upon visual inspection, but man, oh, man, it hurt something fierce.

Me, Cherise & Kelly R.

Since it didn’t appear to be too badly injured, and since I could still mostly move it, I decided I just needed to rub some dirt on it and walk it off, so to speak. We had a lovely lunch, discussing various aspects of the program, how it came to be, how they’d like to see it develop, and some potential collaborative ideas which I’ll happily share if they come to fruition in the future. Then we headed back to the convention center and bid farewell so she could get her colleague and supervisor to the airport in time for their flight back to Nevada.

I went about my conference agenda, and then met up with Kelly Rawlings of Diabetes Living Magazine and Karmel Allison of A Sweet Life to head over to the site of the Roche Summit for dinner with the early arrivals. My hand didn’t hurt any less, and was starting to swell and turn colors, but I stubbornly clung to my rub-some-dirt-on-it-and-walk-it-off intervention of choice, knowing that the alternative, a visit to an Orlando emergency room to pay a co-pay that I didn’t want to shell out on top of an already pricey trip, to be x-rayed and prescribed some kind of orthotic, be it a brace or a cast or a sling, sounded far worse than the pain I was experiencing.

I talked to Jason, who started to get a little cranky when he heard my flimsy reasoning for not seeking medical treatment, and I consulted with my DOC buddies who generously shared their opinions. After Kelly Kunik insisted I get it checked out, after Cherise graciously offered to go with me, after Sarah graciously offered to join us, and after Jason went from cranky to angry because I was “being stubborn and stupid”, I reluctantly accepted my fate, and relented. Kelly Kunik tracked down the address and phone number of the nearest ER, and I said my goodbyes with Karmel and Kelly Rawlings, before Cherise, Sarah and I set out on a most memorable adventure.

I know this story is as powerfully gripping as my current weak right-handed grip, but to hear the conclusion, which does include some impromptu video, you’ll have to stay tuned. Not sure if I’ll put it all together in time to post tomorrow, but if not, check back early next week…

Every time I learn that another friend is about to start a family, I tend to pull away. Call it selfish, call it insensitive, call it what you will, but I call it preparation for the inevitable and self-protection. When it’s been people I know in real life, it equates to less time spent with them. When it’s been people I know remotely, staying in touch via Facebook or similar means, it’s equated to less visits to their profile, fewer wall posts, less interaction. Then it seemed to become the theme of the DOC, and I didn’t know what to do. There’s been a lot of baby talk in the D-blogosphere for quite a while, and this post is my response to that. You might not need to read it, and if that’s the case, I hope you won’t, but please understand, I felt like I needed to write about it.

When I was a kid, having babies seemed like a given, an inevitable fact for everyone except a few random souls who either couldn’t conceive for medical reasons or stumbled into unfortunate life circumstances that precluded conception. From what I had gathered by observing people, reading books, and watching TV and movies, parenthood was inherently joyful, the ultimate life accomplishment. I understood that there was an element of choice involved, but it never really occurred to me that people would purposefully choose not to become parents.

I first thought that perhaps I should skip the whole motherhood thing when I was about 20 years old, a sophomore in college. I don’t remember what precipitated this revelation, whether it’s something I’d heard or seen. Maybe it was a sign of maturity that I could self-reflect on the circumstances of my life and have such an insight. I’d been treated for depression for about 5 years by that point, and my eating disorder had gotten worse with no end in sight. It seemed glaringly obvious that I had absolutely no business procreating since I clearly couldn’t even take care of myself.

Knowing that it would be at least several years before I might potentially be at a place in my life when I would want to reconsider having children, I decided to scrap birth control pills in favor of Norplant, the implantable birth control that lasted 5 years. I. Loved. It. I went to the doctor’s office, they inserted it under the skin on my arm, and for 5 years I didn’t have to worry about getting accidentally pregnant. Until Norplant, I was neurotically paranoid about getting pregnant, occasionally buying home pregnancy tests despite having absolutely no concrete evidence that I might even be pregnant.

When I was 25 and Norplant #1 expired, I signed up for Norplant #2 because I still wasn’t ready to have kids. My boyfriend at that time and I were living together and barely scraping by financially, and I was preparing to go to grad school, so between life circumstances and continued ambivalence about having children, another 5 years of foolproof birth control seemed like a sound decision. I figured by the time the second one expired, I’d be 30, and I could revisit the issue of whether or not my life was conducive to making a baby assuming I’d had a change of heart about poopy diapers and spit-up. Although I was fairly certain I didn’t want to have kids, I wasn’t ready to definitively say “never ever”. After all, people change, maybe life circumstances would reveal themselves to be perfect for making a little Lee Lee.

Of course, there was a lot more to consider than whether or not I’d found a man with whom I wanted to share the rest of my life, or I’d finished school and started a career, or was financially stable enough to raise a family. There was the diabetes. When I was about 24 years old, it seemed my diabetes which I’d mismanaged for 10 years had started to catch up with me when the endo put me on blood pressure pills to protect my kidneys. Being on “old people” medication certainly poked a hole in my inflated sense of invulnerability. Soon thereafter, the ophthalmologist started doing laser treatments to protect my retinas from ever-increasing and worrisome microvascular changes. Despite the treatments, I still developed a hemorrhage in my right eye and needed a vitrectomy that very nicely reversed what would otherwise have left me blind in that eye, but served as a reminder that my body wasn’t taking too kindly to the way I had been treating it.

That my eyes were affected was difficult, but not completely out of the clear blue considering my lack of dedication to diabetes care. It was a most unexpected complication that left me feeling truly defeated by diabetes. At 27, I found a lump in my right breast that went from pea-sized in July to plum-sized in November. The surgeon, who was considerably concerned that it was cancerous, talked to me about removing the lump, and wanted to know if I had any concerns about being able to produce milk in the future because the surgery would compromise the internal structure of my breast. I told him to do whatever had to be done and not worry about whether or not I’d be able to breastfeed when it was all said and done since I was still about 90% sure baby-making wasn’t for me. A week or so after the surgery, the pathologist’s report came back with a diagnosis of sclerosing lymphocytic lobulitis, also known as diabetic mastopathy. Thankfully, it wasn’t cancer, but the cosmos was rightfully punishing me for being more concerned about my weight than my BG’s. Three months later, I found a lump in the other breast. Another lumpectomy later and diabetes had officially left me with permanently diseased breasts. No part of my body was safe apparently.

During those years, the list of prescriptions I took became increasingly lengthier. In addition to the blood pressure meds, there were cholesterol meds, heart meds for the autonomic neuropathy, a diuretic to shrink my marshmallow ankles that swelled because my kidneys weren’t quite what they used to be. It seemed like having a baby would be tempting fate, asking to have thus far minor problems escalate into major problems, the kind that lead to disability or even death.

There was also the matter of the depression. Whether or not my antidepressant would be safe to take during pregnancy, I don’t know, but not taking medication had consistently proven to be a bad idea for me. Beyond that issue was the question of how pregnancy-induced emotions and hormones could potentially worsen my depression. Ultimately, that seemed like an unknown risk that I wasn’t anxious to take, and further weighted the scale in favor of not attempting pregnancy.

With depression and diabetes come obvious hereditary risks. I questioned what I would do and how I would cope with the increased possibility that I could end up with a diabetic and/or depressed kid. My experience with both has been pretty hellish, and the possibility of contributing to that in my children was hardly a selling point for parenthood. I’ve seen the discussions, so no need to tell me that the risks are low. I’ve also seen diabetic parents randomly checking their children’s BG’s, obsessing when they seem unusually thirsty, expressing fears that the past would repeat itself in the next generation. I can understand why they’d react that way because I think I too would constantly worry that my kids might develop diabetes, and I didn’t want to live with that hanging over my head. It wasn’t a risk I was comfortable taking because I know I wouldn’t be able to live with myself if the worst of the what-ifs came to fruition. Mind you, I’m willing to entertain the possibility that there’s probably plenty of awesome in my genetic material, but I believed there couldn’t possibly be enough to outweigh the potential fail.

That brings up the risks of pregnancy to both me and a baby. There are all kinds of diabetes things that can blow up in one’s face during pregnancy. Besides the chore of trying to manage BG’s which is a constant battle on any given day for everyone with diabetes and obviously that much more difficult with a baby on board, there was preeclampsia, retinal issues, and kidney issues to consider. I also had what I thought to be valid concerns about miscarriages, dead fetuses, still births, premature babies, and any and every conceivable kind of internal and external deformity and abnormality. Then there was the prospect of losing my own life in the process of trying to create a life which led to thoughts of leaving a husband to raise a baby that essentially killed his wife. While the risks might be low compared to the probability of having a normal, healthy baby, I figured the risks were inherently greater for a woman with type 1 than the average healthy woman, and that totally freaked me out. I was clearly coming up way short on the pro side of my pros and cons list.

Additionally, I felt legitimately worried about how my diabetes would affect a child, regardless of whether or not that child ever developed any health or mental health issues. Kids whose parents have serious medical problems have a strike against them. Diabetes is a family disease as I always say, and it’s a burden for a child to have to learn to cope with a parent’s illness. Short term, I worried about a child being embarrassed about having a diseased mom. I worried about a kid being in a caretaker position, having to get me juice, fetch a meter, check my BG and understand the readings, or heaven forbid, call 911. I worried about a child’s needs becoming secondary to my medical needs, a hungry baby or an over-curious toddler colliding with a paralyzing low BG. Then there were the longer term issues of whether or not my health would remain stable long enough to parent a child until they could be self-sufficient, whether or not I’d live to see them graduate from elementary school, let alone high school or college, or see them get married or meet my grandchildren. I know no one who has children, health problems or not, is ever guaranteed those things, but let’s be real, people. Having diabetes, increases the risks that those expectations people who start families have won’t necessarily be met, and I feared the emotional toll that could take on a child. Is it paranoid, overly cautious, worst-case-scenario thinking? You might think so, but to me it was the reality of the circumstances that had to be considered.

At 29, I met Jason, and from the start, I made it clear that I was reasonably certain I wouldn’t have children of my own, and if I did decide I wanted to raise kids, I’d be more inclined to adopt. During the couple of years I’d been dating leading up to meeting him, I’d discovered how much it sucked to meet a guy I liked, and then discover on the 2nd or 3rd date how much they wanted kids. Once I figured out what a deal-breaker that was, I was totally upfront about it. Obviously, Jason was fine with that. When we’d discuss it, he’d essentially tell me his con list was also much longer than his pro list, and while he conceded curiosity about what it would be like to father a child, he wasn’t curious enough to be willing to relinquish his freedom. We both seemed to be at the same place on the issue even though we’d arrived via different routes.

Norplant (from: http://www.healthsquare.com/fgwh/wh1ch21.htm)

About a year into our relationship, it was time for Norplant #2 to expire. Having done my research, I had learned that Norplant had been taken off the market. Extraordinarily displeased that my birth control of choice was no longer an option, I studied the choices that were available. Condoms weren’t an option for countless reasons. The pill had been OK, but when I’d used that, I was never good about taking it at the exact same time every day, and during times when my love life was, well, less loving, I’d been known to take 4 or 5 days worth of pills all at once when I remembered I’d forgotten to take them. Granted, I’d been quite a bit younger, but still, I’d been spoiled by Norplant which did its thing without any action on my part.

Since I was in a quandary about what to do, I thought maybe it was a sign that I needed to finally commit to either becoming a mother in the future or foregoing parenthood altogether. Maybe it was time to get my tubes tied and be done with it. In search of answers, I went to a neonatologist who specialized in high-risk pregnancies just to find out what I might be getting myself into if I opted to bear children. They weighed me, took my blood pressure, collected my history, and told me about the risks. He talked a lot about big babies, little babies, preeclampsia and extended bed rest, but felt confident that despite my diabetes history, I could successfully deliver a healthy baby. The doctor was an older man, and was clearly operating under the assumption that I was definitely planning to get pregnant, even handing me a prescription for neonatal vitamins with instructions to start taking them some length of time prior to when I wanted to officially start trying to get pregnant. I took the script, and left feeling torn. Part of me didn’t trust him. Of course he was going to tell me he could help me carry a bundle of joy home since that was his job. Part of me wanted to believe him, figuring he’d been doing this long enough that he must know what he’s doing. All of me thought it still sounded like a lot of work with no guarantees of a happy ending.

Still feeling like I wanted to keep the option open, just in case, I decided to try the Depo-Provera shots. Well, I hated Depo-Provera. The glorious benefit of no periods on Norplant were replaced with incessant periods on Depo-Provera. I also hated that I had to pay a co-pay just to have them give me the shot at the office every 3 months, on top of the co-pay of the injection. Once, I tried to give the shot to myself, but that big-ass needle towers over a little insulin needle, and giving an intramuscular injection is a whole different experience than a little subcutaneous shot. I nearly passed out trying to give myself Depo-Provera, and then I was paranoid for 3 months that I hadn’t done it correctly, and would end up with an unplanned pregnancy. I had to find an alternative.

The options were sparse though. When I chatted with the doctor about just going back on the pill, I was 31 years old and Jason and I had been married less than a year. She and my endo decided the cardiac risks of taking the pill as a type 1 diabetic woman in my 30’s were too high. No pill, I was done with Depo-Provera, and the other miscellaneous choices didn’t suit me either. Jason and I weren’t ready to have kids, and neither of us thought that was likely to change, but we agreed that if it did, there was always adoption. My body simply didn’t need the wear and tear of supporting another life.

I decided to get my tubes tied. Although I didn’t ever really feel 100% committed to not having a baby, I certainly wasn’t even 25% committed to having one which meant I had no business doing so. I knew if I was going to have one naturally, it needed to be sooner rather than later because the longer I waited, the less likely there would be a favorable outcome. However, if we were ever going to be ready, it was going to be far enough into the future that there was no sense in doing it the old-fashioned oh-I-know-what-you-were-doing-9-months-ago way.

It’s been 5 years since my tubes were tied, and not much has changed for us. I believe it was the right choice for me considering all the circumstances, and since it’s the choice I made, it’s the one I have to accept. Like any major life decision though, there are lingering doubts, times when I wonder if I chose wisely when I came to the fork in the road. Sometimes I get the what-ifs. What if I had gotten pregnant, what would that have been like, what if we had a kid, what would he or she be like, what would a mutant Jason-Lee Ann even look like, what kind of parents would we be, how would our lives be different or better or worse? The questions are as asinine as asking what my life would be like if I didn’t have diabetes though. There are no answers, only postulations that can’t be verified either way, and sadness because there is a sense of loss. Maybe it would have been spectacular and I missed something great. On the other hand, maybe it would have been awful, and I’d be dead or I’d be forever mourning the death of a baby who never grew up or I never even met. That’s not a heartbreak I ever want to know.

Lots of people take the leap of faith and jump into parenthood, or tread cautiously and thoughtfully, regardless of health issues, financial concerns, or other life circumstances that are worthy of consideration. I’m in the minority though since I’m not one of them. I’ve surrounded myself with friends who can go out on a school night or at the last minute or until 2AM, who aren’t reliant on childcare or babysitters, who enjoy being aunts and uncles, who appreciate the joys of “parenting” pets. I’m at a point where I don’t know what I’d do without them because I consistently experience it as a loss when a friend outside of my childfree friends group becomes a parent, and the older I get, the longer the list of friends I lose to parenthood grows. Not that I’m not friends with them, but obviously, having a child is a life altering experience, and it drastically changes people’s priorities, interests, and schedules. Not that I can’t be friends with parents and parents can’t be friends with me, but it changes once they move onto that phase of life, and there’s what feels to me like an irreconcilable disconnect. Their lives are filled with new experiences, new people, new responsibilities, lots of newness, but I’m pretty much the same old boring gal I was last week, last year, years ago.

In the end, I have to feel good about what my life is, what I’ve made of it, and who I am because what’s the alternative? It’s hard to be reminded that I opted out of parenthood, regardless of whether or not I had perfectly valid reasons, regardless of whether or not it really was the best choice. You can’t choose to be a parent, decide it wasn’t a good choice, and undo it, so I stayed with what’s safe and familiar to me based on what evidence I had. Maybe I’m just a horrible, selfish person for discussing this in light of events with which I have to cope if I’m going to actively participate in the DOC, but why should I stay silent when my emotions are in a tailspin? I’m happy to see my friends are happy, achieving their goals, building their lives to their specifications, but sorry, I’m having a hard time with it. The perpetual reminders of look-what-you-could-have-had can sting. Am I allowed to be sad that I didn’t better manage my diabetes when I was younger so I could have felt I had more options? Am I allowed to be sad that I didn’t have life experiences that might have molded me into “parenting material”? Am I allowed to openly talk about it and express it, or do I have to zip my lips, or lock my keyboard? Am I stuck tip-toeing around the DOC, limiting my participation because the over-exposure is eating at me, not sure in whom I can confide, feeling isolated and burdened with guilt, ashamed of the way I feel?

Whether or not being childfree was the absolute best choice for me, I’ll never know because I have no point of comparison. It’s the choice I made, so I try to make the best of it, and actually, I think I’ve done pretty well with that. I don’t deal well with the reminders that there was another option that I forfeited though, so frankly, I don’t like to be reminded. I’ll tell you, I’ve loathed myself for feeling like this. I want to feel less conflicted as I watch my friends reach such a unique milestone. I like knowing my friends are happy, and I wouldn’t want anything less for them. Mostly, I’m sad though. I’m sad that I feel like I can’t relate to their lives anymore. Their lives will be much different, and if I’ve learned nothing over the last 5 years or so watching one girlfriend after another having babies, I’m sad that it will affect those friendships. I’m sad that their lives are filled with new meaning and purpose, and by default, my life might lack meaning and purpose, and I’m sad because I have lingering doubts that whatever meaning and purpose I’ve assigned to my life really does pale in comparison.

I try to stay positive about diabetes, I really do, but the thoughts about the bad stuff are always there. I put a lot of time and energy into managing my diabetes now so that I can hopefully prevent or delay some of the scarier things, but some of the things that worry me have little or nothing to do with how well I manage diabetes. Of course, death scares the tar out of me, as I’ve previously expressed. It doesn’t do any good to dwell on this stuff, I know, but maybe putting it out there and talking about it will make it a little less scary.

The things about diabetes that scare me the most:

1. Dying from heart attack or stroke. Hopefully, if I ever do suffer one of these, I’ll have some kind of symptoms and be able to get myself to a hospital for treatment. I’m scared there won’t be symptoms, or I won’t recognize the symptoms, and just like that, I’ll be gone.

2. Dying from kidney failure. From what my nephrologist has said, I really shouldn’t worry about this. Since I’ve gotten my diabetes managed, the protein in my urine has dropped significantly, and now hovers just over the normal threshold. If it stays there forever, that would be ideal, but I do get freaked occasionally that my kidneys are going to go, I’ll be on dialysis, maybe I’ll get a transplant if I’m lucky. All of that would suck, and while a transplant might buy me a few more years, I would never fool myself into believing it was a permanent solution.

3. Not having health insurance. Going without health insurance wouldn’t be such a big deal, relatively speaking, if I didn’t have a chronic illness. No insurance with a chronic illness is about as craptacular as it gets. Paying out of pocket for pump supplies, insulin, and test strips would mean…. well, I don’t know what would happen to me and Jason, but I think it would mean financial ruin for us, especially because I also take several prescription meds on top of needing basic diabetes supplies. This is definitely a big fear of mine, especially since my COBRA expires in 6 months.

4. Losing Jason. We said our vows, for better or for worse, through sickness and through health. The thing is, it wasn’t until we were already married that Jason started to grasp just what it means to live with diabetes. I do what I can to manage it, I try to not bother him with it too much, but it affects him, whether it makes us late because we had to turn around and go home to get my meter, or he loses sleep because he’s pouring juice down my throat, or the stress of worrying about me and what diabetes will eventually do to my body. I’ve written on this topic before, but I worry that all of it will become too much for him someday and he’ll decide to leave. Maybe it’s not a realistic fear, but it’s my fear nonetheless.

5. Not getting a job. While I think having diabetes has made me more empathetic, an essential quality for therapists, and since I want to work with diabetics, having diabetes is a pretty obvious asset, most employers have to look at their bottom-lines. Is it possible I’ll miss more days from work? Statistically speaking, it’s likely. Will I take full advantage of healthcare benefits? Of course. I’m not one of those lucky folks who pays for insurance “just in case”. I pay for it because it’s essential and I use it. Would any cost-conscious employer choose me over a more or less equally qualified candidate without diabetes? Probably not. I had always hidden it before for fear of discrimination – discrimination that’s obviously illegal, but happens anyway since no one can really prove it isn’t happening – but now I lay it out there. I figure most potential employers do internet searches anyway, and it’s not like they won’t find my blog. I keep hoping it will work in my favor, but I keep fearing it won’t.

6. Gastroparesis and GI tract autonomic neuropathy. I’ve already had a little of this, and honestly, it’s one of the few things I don’t see myself ever sharing publicly. My experiences have been very sporadic, occurring once a year or less, but when it happens, it’s pretty rotten. I worry I’ll develop worse problems with more frequent occurrances. When eating and digesting become ongoing problems, I imagine quality of life will fall precipitously. This is definitely a bad complication that can make life miserable, and after having had a taste of it, I don’t want any part of it.

7. Amputations. At least I could still live my life, but it still scares me to think about this and how my life would be different. I don’t even know what else to say about it. Like anything terrible that happens to anyone, I would adjust and learn to live with it, but I’d rather not ever be in that position.

8. Hypoglycemia, especially dying from it. We can all talk till we’re blue in the face about the what-if’s of long-term complications. Hypoglycemia, on the other hand, could take any of us just like that. Go to sleep one night, don’t wake up, ever. Luckily Jason has been here and has woken up when I’ve had issues, but I’m afraid he might not wake up one time, or maybe he won’t be here or I’ll be someplace else so I’ll be by myself. I know death from hypos doesn’t happen very often, but it can and does happen, and I’m scared it will happen to me.

9. Would you believe, being cured? I’m sure a bunch of people won’t believe that, but diabetes is all I know. This is who I am. Mind you, I don’t expect to be cured. I know that kind of outlook angers, or at least disappoints some people, but for the sake of my mental health, I gave up on that pie-in-the-sky. I have to invest my energy in living with diabetes, and that’s how I survive with it. Other people survive by working towards a cure, and I’m glad those people exist and do their work. I’m just not one of them anymore. I guess I would accept a cure if it existed, but I’m scared of the identity crisis I would have. Waking up without diabetes, for me, would be like waking up as a man, or waking up as a different race in a different country speaking a different language. This is who I am, and it’s taken me a long time to learn to love and accept this part of myself. Taking it away would completely disrupt my world in ways I can’t quite fathom.

10. Losing my drivers license. The cause is irrelevant – vision-loss or hypoglycemic unawareness. If I couldn’t drive, that would just about kill me. In reality, I know I’d learn to cope, but it would put a greater stress on Jason, and would make things like doing grocery shopping more involved projects. I’d obviously have to depend on others to pick me up and cart me around, and I would lose my freedom to just get in the car and go. I like driving, I like being able to get where I need to be and where I want to go. I’d adapt if that changed, but man, would that suck big time.

How would your list compare to mine? Do you think about these things or is it easy for you to put it out of your mind?

I haven’t had an encounter with The Fear in a while. I actually can’t recall the last time I had it or what might have triggered it. I do get pretty spooked before my bi-annual nephrologist appointments, but not to the extent that I used to get freaked, expecting to be told I’d slid a little closer to dialysis and the transplant list, nothing the gracious donation of an organ couldn’t fix. However, she’s assured me things are stable, and that based on her experience, she expects my kidneys to stay stable. While that hasn’t completely alleviated my pre-appointment anxiety, it’s made a big difference.

Monster Under My Bed (from: Cedric Hohnstadt Illustration)

The Fear, of course, is the shadow lurking in the corner, the monster under the bed, the boogeyman waiting to lunge out of the closet just when I’m feeling safe and secure in the bed of diabetes life, which is hardly the most comfy, pillowy mattress ever, but I’ve come to tolerate it enough to catch a decent night’s sleep on occasion. The Fear is what I feel when I think some complication of horrific magnitude has come to snatch me from safety and tote me off into scary uncertainty.

I used to live with The Fear because I didn’t understand that I had a choice. How much to teach kids about complications is fodder for another post, but I had learned about them as a kid at camp initially. I don’t know if the caveat that I could avoid them if I took care of myself was ever offered or not, but I, with my infinite child logic (see yesterday’s post…), took away the message that blindness, amputations, kidney failure, and premature death were essentially as much a part of diabetes as taking insulin and exchange diets. I was wrong about everything except the insulin, but for years, as certain as I know insulin stinks to high heaven, I was certain that I would be dead by age 30. That prophecy didn’t come to pass though. There was a point maybe in my mid-20’s, when I updated the prophecy to age 40, but as I stared down the barrel of my 30th birthday with my sexy new boyfriend, Jason, on my arm, it occurred to me that maybe I’d been mistaken to think such an early death was inevitable.

That’s about the time I got serious about getting myself together and figuring out how to manage my diabetes the way it was meant to be done. Of course, I’d been screwing with it – and dragging my poor body along for the ride – for so long, that it took me a couple more years to slay the demons who eventually had to concede that I was leaving them for good. Living without those demons has been an awesome experience thus far, but The Fear still stops in for a visit on occasion.

I like to have a treat at night, so around midnight last night, I broke open the cellophane wrapper of a 37g carb pastry. My BG was sitting at 105mg/dL, so I did a combo bolus to account for the fat and keep my BG from dropping before the sugar hit my bloodstream. At about 1AM, Jason went to brush his teeth, and I would’ve done the same, except I started to feel a low coming over me. The pastry carbs were MIA. I thought about a cup of milk, but opted for a sugar-free pudding instead because that’s the same number of carbs. In retrospect, maybe that wasn’t the best choice, but I knew I had pastry sugar waiting to charge through my system, so I didn’t feel the same sense of urgency that would have steered me towards the juice carton otherwise.

I ate my pudding and waited. At some point, I started to not feel so good, like kind of nauseous, an odd symptom I get with lows sometimes, so I checked my sugar. 61mg/dL. I really wanted to go to bed, but I needed my BG to not be low. It had been about two hours since I’d eaten the pastry, and maybe an hour since I’d eaten the pudding. Why the heck wasn’t my BG coming up? I was getting frustrated, especially since the nausea wasn’t lifting, so I got some cookies out of the cabinet. I didn’t measure or weigh or count. I wanted my BG to rise enough so I could go to sleep, so I just ate until all that remained were crumbs. I checked my BG. 55mg/dL.

Just Crumbs

That’s when The Fear arrived. I’d eaten all this carby food, and my BG had been hovering too low for almost two hours. I had bolused for the pastry, but never bolused for the pudding or the cookies, which had to have totaled at least 70g carbs. The only logical explanation was that my food wasn’t digesting. Gastroparesis ?? Could it be? There are times when I suspect I have some delayed digestion. Before meals, if my BG is low or within target range, I bolus after I eat more often than not, and I don’t typically get dramatic post-prandial spikes. I also use the combo bolus feature with almost every meal. If I took my entire bolus before I ate, I’m pretty sure I’d end up with a lot of post-meal lows. If I have slowed digestion, that doesn’t even really upset or worry me. What worries me is if it progresses to full-blown gastroparesis with the nausea, vomiting, weight and appetite issues – and the unpredictability of how to bolus for food if you don’t know if or when it’s going to be digested.

Although this one instance of carbs that aren’t kicking in is flimsy evidence, I do already have autonomic neuropathy. It’s affected my heart. I’ve had some unfortunate incidences of diabetic diarrhea. One of these days, I might cover that topic if I can figure out how to write about it without embarrassing myself or completely grossing you out. I’ve also had some sexual function/lady parts issues that I can only attribute to diabetes, yet another sensitive topic I’ve skirted. And these are issues that started close to 15 years ago, so would it be a surprise if my stomach also wasn’t functioning optimally, especially in light of having been bulimic for 18 years? Honestly, if last night was a sign of gastroparesis, it’s a wonder it hasn’t developed sooner.

By the time I went to bed, about 3AM, I wasn’t feeling low anymore, but I wasn’t sure how to bolus for the food I’d eaten over the course of the previous three hours. I told myself that perhaps I was just having one of those fluky nights when no matter what I do, I’m low. Even people without gastroparesis get days like that because sometimes diabetes just does it’s own inexplicable thing. If that were the case though, and I fully bolused for the carbs I had consumed, I might be facing some fierce early morning lows. I erred on the conservative side, assuming that at least some of the carbs were going to hit me eventually, and I took a small bolus of 1.5u. Then, I brushed my teeth, crossed my fingers, and got into bed.

The Next Morning

Naturally, I spent most of the morning being awoken by the CGM siren, periodically silencing it, and hoping it wasn’t bothering Jason too much. At 6:30AM I bolused 3.5u, hoping that would bring me down. Jason got up, got ready and left for work, and the siren was still blaring, kindly alerting me to the RISE RATE and the HIGH SG. I checked my CGM, and my BG was maxed out. Not good. Not good at all. I bolused 4u, and hoped that would do the trick and I could sleep in peace for just a little bit longer.

A few minutes before 10AM, the siren was still ringing out from under the covers. I looked at my CGM monitor, I looked at the clock, and decided that even if I tried to salvage any more sleep, it wouldn’t be peaceful. I felt like crap, I had a headache, and I felt like I’d licked the lint filter in the clothes dryer, so I trudged downstairs to see what my BG was, and take yet another bolus. 245mg/dL. Not horrific, but obviously not good. I tried not to think about what my BG had been 7.5u of insulin ago, while I programmed another 2.9u.

The Fear is gone, but I’m concerned. As I ate lunch a short time ago, I panicked for a moment, wondering if my food was going to digest. Was I over-reacting last night to assume this was a sign of gastroparesis? Do I wait and see if I have more incidents like this? Do I assume it’s just diabetes being diabetes, or do I follow-up and make sure it isn’t anything more foreboding? Maybe I was jumping to conclusions. Maybe I was being irrational because my BG was low. Having had diabetes for 31 years, and having already experienced problems as a consequence of not managing it well in the past, it’s hard to not let The Fear get the best of me sometimes. The Fear doesn’t need a reason to intrude though. If I listened to it every time it crawled out of the woodwork, I’d spend my life in and out of doctors’ offices and medical testing facilities, chasing every little hiccup and twitch like they were signs I was dying. I know I need to be cautious and proactive when it’s justified, but I also know I can’t let The Fear order me around. The problem is distinguishing when I should pay attention to it, and when I should know that The Fear is only trying to scare me.