Diabetes Wise

Moving On...

I feel a need to write this post, because six weeks on, I don't want heartbreak to be at the top of the page anymore. And it's also about time I thanked everyone for all your comments and support on my last entry. Your comments, as always, really meant a lot to me and brought light in to a dark place.

I've spent the last six weeks in that strange post-relationship landscape that anyone who's ever had a relationship end will surely always remember. I've certainly walked this street before. Looking back and sorting through tangled emotions whilst getting on with day-to-day life and trying to think about moving forward. But what starts out bleak, tough and upsetting eventually ends up something close to liberating.

I've cried a lot. Especially in the beginning, using countless tissues and finding myself unable to stop even though I've been aware it wasn't making me feel any better. Taking the train to Liverpool one last time to retrieve my belongings was particularly hard, despite that fact that I didn't even see Rob. The only thing that seemed different when I arrived was the absence of my cards and notes that he used to keep beside his bed.

I've gone through the helpless soul-searching 'what's wrong with me?' moments. I've felt lost and lonely, watching the 'Liverpool life' of which I'd been a part for so many months, continuing - through the photos appearing on Facebook - and dealing with the fact that it wasn't part of my reality anymore. And I've dealt with the loss of more than just my relationship with Rob, realising that certain people I'd thought were friends no longer see me that way now that I'm no longer half of a couple. It's good to find out what people are really like, but that doesn't mean it doesn't hurt. In some ways the loss of friendships - and I  include in that my friendship with Rob - and the lifestyle we had together have been the hardest parts of the whole split. The distance magnifies things. I don't go to Liverpool so I don't "bump-into" these people. I miss people.

But there is a positive slant. Last week I finally felt ready to pick up the phone, if only to try and cement some closure. Rob and I talked for three quarters of an hour and I came away knowing that the man I had loved was still inside there somewhere, that I hadn't imagined it all. Neither of us wants to exclude the other entirely from our lives, and I'm feeling positive that we've managed to break up without hating each other.

And the very distance between us has perhaps made it easier to move on. I'm not simply living the same life minus a partner. I'm living a new, different life. I've done a lot of things in the last six weeks. I've spent more nights at the pub than I should. I've gone out with friends and stayed up all all night to watch the sun rise in the morning. I've stayed out in the rain until I was soaked through to the skin, but had a good time anyway. I've had lunch with two amazing women, one in her eighties and the other in her nineties, both of whom were friends with my grandmother when they were younger than I am now. I've drunk more alcohol than I probably should on more than one occasion. I've aggressively pursued my rock climbing, pushing the grades I can climb, free of fear of not measuring up. I've made several new friends, one of whom in particular has rapidly become very close to me.

I'm making plans for the future too. I'm planning for trips abroad, I've made decisions about my professional future. Next week I'll be ditching my skis to try snowboarding for the first time.

I feel strangely free, with an incredible amount more time on my hands to rediscover my beloved city, instead of jumping on a train out of it every other weekend.

With distance, with the support and perspective of others, I can also see that there is nothing wrong with me. It was the right thing for this to end. In fact, some of the anxiety that had begun to plague me prior to the split has actually been lifted and in several ways I'm a happier person. In a way I can't quite condense into words, though, I still love Rob. Being in love is what held me with him and made the end so painful, but inside I think knew it wasn't going to be forever.

Most importantly though, I don't regret a single moment of our time together. How can I, when it was utterly right at the time and enriched so many of my days beyond measure?   

Which Way Out of Heartbreak?

This is a difficult post to write, especially on Valentine's Day.

The day after we arrived back from Italy, Rob stayed down in London with me. I had to get up and go to work the following morning. I left Rob in bed, still half asleep, giving him a kiss and a cuddle and reminding him I much I love him.

I didn't know that would be it. The end of the road.

Last Saturday, Rob reached inside my chest, grabbed out my heart and squeezed it until it broke. Or at least he may as well have done. I've been left scrabbling around on the floor, trying to fit the pieces back together.

I spoke to Rob on the phone at two thirty in the morning last Saturday. He told me, as always, how much he loved and missed me, how he couldn't wait to be with me again the next weekend.

Eleven hours later we spoke. He told me again that he loved me but then, like a bolt from the blue, told me that it wasn't enough, that he didn't want to go on with our relationship.

In that second, standing in a hot overcrowded room at a professional conference, my world began to unravel and nothing has been the same the since.

I have no idea what changed in the space of eleven hours. I'm perhaps more scared that nothing did. The love that Rob expressed to me in the middle of the night seemed as genuine and sincere as always. But Rob is a terrible liar, completely unable to hide his true feelings. Real love has no off switch, and I refuse to believe this was a snap decision, he must have already known at half past two what he planned to do when the sun had risen. If he didn't mean it when he told me he loved me then, that leaves only one logical conclusion.

He never has meant it.

The man who made me feel all this. My buddy, my rock, my partner in crime. The person I wanted to share my highs and lows with. The person who understood me and what makes me tick. The guy who was always there, at the end of the phone line, at the end of the train line. The one person who never failed to make me smile, make me laugh, make me love.

Now all he makes me do is cry. All he makes me feel is hurt. In an instant, it's all gone and I'm left wondering if it was ever there in the first place.

I can't find the words to describe how hurt I am, not simply by what has happened, but also the way it was done. Ending a long term, serious relationship over the telephone, even if you are 200 miles apart, just isn't fair. If I meant anything at all, I think he owed it to me to break the news face to face. This is the anger that tempers my tears.

I feel a little like I'm turning in an emotional spin dryer. I can't bear the thought of speaking with Rob, or seeing him again right now. I'm afraid I'd lose my dignity. I'm afraid it would hurt more than I can bear. But at the same time, the thought of never seeing Rob again, of him no longer being a part of my life at all is terrifying.

I'm still not sure that I really know how to get through this, how to find my way out of this heartbreak.

On Monday evening, I went to take my frustrations out on an indoor climbing wall. It's a hobby which, ironically, I took up because Rob loves it so much.

Halfway through a top-roped climb I found myself stuck, unable to figure out my next move, the only logical step for my right foot feeling insurmountable. I looked down, wanting to shout "I can't do it." In that unnatural position, arms and legs spread hanging on to an artificial rock face, I realised that climbing serves as something of a metaphor for life.

You can't look down or backwards. The only way is onwards, upwards, even if you have to push yourself through the pain to do it. You have to trust your belayer not to let you fall like you trust your friends to catch you when life gets tough.

And when you reach the top of an indoor climbing wall, the only way is down.

With heartbreak, the only way is through.

In One Piece... Just

I'm back in England after my week on the Italian slopes, and have finally crawled out from beneath the mountain of dirty ski clothes that needed laundering! Fortunately I'm all in one piece, if only just!

I was pleased to discover that I can still ski, although my leg strength isn't quite what it was prior to my ankle injuries, which has clearly had some effect on my technique and ability. I also earned a reputation as a cautious skier, since fear of further injury dented my confidence somewhat and I wasn't quite as keen as they guys in the group to hurl myself down any old black run at the highest speed possible!

It turns out that caution doesn't always pay, though, as I still managed to have two accidents. On the very first afternoon we set off to ski back down to the village. Unbeknown to me, someone had evidently taped a luminous "Snowboarders aim here" sign to the back of my jacket as I was hit by out of control snowboarders not once, not twice, but THREE times on the way down. The third time, just around the corner from the final drop into Sauze, a snowboarder turned across me and ran straight over my ski tips catapulting me in to the air and tearing my calf muscles. The snowboarder riding the chairlift above heard very clearly what I thought of snowboarders at that point! Thanks to wonderful friends, lots of ice and massage, I was back on the slopes the following morning though.

The second accident occurred on Friday while we were over at the resort of Montgenevre, in France, at the far end of the Milky Way ski area. We'd had a pretty good morning, although we accidentally took a complete beginner down a very steep red run with zero visibility due to a sudden snow storm! This was thanks partly to poor signposting and a crappy piste map - what kind of piste map shows higher areas of the resort nearer the bottom of the map than lower ones?! I skiied that run twice, but then came unstuck on another, probably less difficult, red run just before lunch where I hit unexpected ice and twisted my knee. It took until yesterday for the full glory of the bruising to emerge, so I still managed to ski out the week on Saturday.

On Thursday night we enjoyed dinner at the top of the mountain. We played football in ski boots (as difficult as it sounds) and went bum-boarding, which basically involves sitting on a plastic dish and sliding, down the bottom of the empty pistes, before eating a lovely meal. I elected to indulge in the included wine and so, rather than skiing down to the village in the dark, we rode down on a Skidoo. What I didn't realise was that the Skidoo driver was going to take us straight down the same ski run as the skiers. No quiet track through the woods, but straight down steep Red-11 in the pitch dark with  the snow cannons blowing. All I could do was close my eyes and hang on tight! I have to say this was probably the scariest experience of the whole week, far scarier than standing at the top of any black run and realising the only way is down!

Diabetes-wise it was an interesting week. My blood sugars were fairly well behaved, but there is also lots of CGM data that mimics the mountains and valleys we were surrounded by.

I discovered that the CGM alarms are pretty useless when you are skiing. They would invariably go off when I wasn't easily able to stop and deal with them, progresssively escalating to irritating sirens that distracted me from the skiing. After the first day I turned the high and low alerts right off during the day and simply checked my numbers and trends at the beginning and end of every run. I also discovered that keeping my basal rates the same, but not bolusing for food worked well. I ate a fairly standard breakfast, generally stopped for hot chocolate mid-morning and ate a fairly standard lunch. It's the first time I've tried this approach, so I think the jury will be out until I've experimented a bit more with it.

Another thing I learned this week was that keeping tubes of glucose gel in the cargo-style pockets on the side of my ski trousers wasn't a good idea. At some point I must have fallen one of these, leaving me with a very sticky, messy pocket!

The only other significant diabetes happening was when I'd obviously failed to tuck my tubing back in properly after checking my pump on a chairlift. Somehow the tubing got snagged on the chair as I skied off the lift. It twanged back pretty quickly, but not before dislodging my infusion set. I've now added "the top of a mountain" to the list of odd places I've inserted a new infusion set!

Overall it was a fantastic week, even if our hotel rep was something of a prat, the hotel food was less than gourmet and we had to up ridiculously early for both our outward an return flights. It was wonderful skiing and wonderful company, and good to spend a whole week with Rob. To the right is instructor Luciano who patiently tried to beat my bad habit of turning my upper body out of me, and helped me work on perfecting  proper pole plants, so I'm also definitely a better skier now than I was a week ago. Honestly you've got to envy this guy though - he teaches sailing all summer and skiing all winter...

Can't wait for my next snow fix!

Numbers for the New Year

Happy New Year!

Continuing on the numbers theme...

I'll be celebrating my 28th birthday three weeks yesterday.
I'll shortly reach the six year anniversary of my pump start.
This year will mark seven years of living with the stigma of epilepsy and 2 years of living with Addison's.
I will also reach my twenty-fifth year of diabetes.

Twenty-five years.

Blimey. I don't know where the time went, but I know I've come a long way.

Yesterday was also the third anniversary of this blog.

I'd have liked to have posted yesterday, but I didn't expect to spend so much of my day travelling half-way around the country on a series of different trains. I was hoping that in next year's statistics, the number of complaints made to Virgin trains would be zero. Sadly that statistic is already at one.

Strictly speaking the chaos was not Virgin Trains' fault. It was caused by Network Rail over running on engineering works. But it turned my simple, direct three hour service to turn in to a three-changes-and-a-ten-minute-route-march-through-Birmingham-city-centre service. It took six hours and I was thoroughly unimpressed with Virgin's response to the situation - they cancelled the replacement bus services, gave us no information and left this type 1 diabetic with no access to food. (Don't worry, I had snacks, but I was rather hungry without any dinner!)

And guess what? They still aren't done with the engineering work! Britain, railways and joke make comfortable companions in a sentence. Lord knows what will happen if the forecast snow arrives tomorrow...

There is one other disappointing statistic already this year: In the six years I've been pumping, I've never before had a site infection. 2008 has brought my first.

When I use my thighs for sites, I've always used Quicksets or Insets. But this weekend I had only Silhouettes with me. I've successfully used Sils in my abdomen, hips, buttocks and arms. This was the first time I'd used one in my thigh. It had grown increasingly painful and red looking over the last couple of days, winking at me everytime I went to the bathroom.

I knew it wasn't working right. The 150% basal I was running was a big clue. But my journey was bad enough, I didn't have a chance to start changing out a set on an overcrowded train. And when I got home, well, I should have changed it then. But I was exhausted. I wanted to sleep. Stubborn little me took a somewhat generous bolus via syringe, knowing it would account for missing basal, for the snack I ate before bed and went to sleep.

The syringe bolus worked. At 2am I was at 7.3 (131).

Unfortunately by 6am I was at 19 (342) and nauseated with ketones.

Pulling the old set revealed an angry red mountain with a little nodding yellow head. I only had to touch the skin nearby lightly for the mountain to erupt like a volcano.

Ewww.

So I've spent the first working day of the new year with a pounding, throbbing volcano along for the ride on my thigh.

But I have my secret sidekick antibiotics, so here's hoping he won't be sticking around for much of this brand new shiny year!

Statiscal Review of the Year

Number of...

Blog posts: 68

Caribbean islands visited: 9
Caribbean sunsets seen: 15
Photographs of sunsets taken: about 250
Hours stranded in Barbados waiting for delayed flight home: 36

Trips to the zoo: 2
Giraffes seen at the zoo: 11
Cuddly anteaters received as gifts: 2
Ants I would have eaten this year if I were an anteater: 10,950,000

Times my credit card got stuck in a machine: 2
Times my bank cancelled a card before its expiry, for no identifiable reason: 1
Hours spent on the telephone complaining to bank about mistake: it felt like about 200
Pounds received in compensation for bank error: 50 (woo hoo!)

Hours I've spent on the train between London and Liverpool: too many to count
Pounds I've spent on Virgin Trains this year: over 1200
Times I've complained to Virgin Trains about their atrocious service: 4
Times I've complained to Virgin Media about their atrocious service (theme, anyone?!): 2

Teeth extracted: about 200
Patients incredulous at the fact they cannot have their teeth bleached on the NHS: 3!!
Hours spent moaning about the NHS contract with colleagues: at least 50
Times I’ve stood my ground in a debate against someone more senior than me in order to defend the interests of younger dentists: 2

Times I have nearly been maimed by a cyclist who believes red lights and zebra crossings don’t apply to them: 5
Times I have witnessed a cyclist maim themselves doing same: 1
Teeth I've repaired as a result of cyclists going over their handle bars: 8
Teeth I've repaired as a result of a fight between a taxi driver and a cyclist: 2

Times I've been stuck in an elevator this year: 1
Times I’ve been stuck in a tunnel on an unmoving tube train for more than 10 minutes this year: 2
Times I’ve thought running up the escalators at Angel “for the exercise” was a good idea: 1
Times I’ve regretted running up the escalators at Angel: 1

Environmentally friendly "Bags for life" purchased at the supermarket: 12
Times I have remembered to take said bags with me to the supermarket to reuse: 0
Wine bottles in my kitchen waiting for recycling because there is never any room in the glass recycling bin in my block: at their peak, about 25
Times Ive had to insist to guests that I'm not an alcoholic: frequently!

Battles of wills with Rob over tea making in the morning: about 100
Times I’ve won said battle: about 98
Red roses received at work this year: 24
Times I’ve realised how wonderful Rob is and how much I love him: over 1000

Blood glucose tests: at least 3650
Infusion set changes: about 115
Times infusion set ripped out on a door handle: about 6
CGM sensors used: 24
Replacement pumps: 1
Times I've thought my meter was lost: 3
Times I'd really lost my meter: 0
A1c tests with results under 7%: 4 (woo hoo!)
Times I"ve said I hate diabetes: at least 12

Times I've been grateful for all the diabetes bloggers, and the community we have: countless!
Times I've smiled, laughed and been generally happy: countless!

Anikleversary

Three years ago today, I found myself in the Accident and Emergency department of Derriford Hospital in Plymouth having a plaster cast, that reached from my toes to the middle of my thigh, applied.

And I was in total shock.

The day before I'd gone to step up on to a pavement, caught my foot inside the bottom of my opposite trouser leg, missed the curb and slipped backwards. I ended up flat on my face on the pavement. I'd also ruptured my achilles tendon and broken my ankle, although I didn't know it then.

I was so embarrassed at having fallen over in a busy street that, despite several people stopping to ask if I was okay, I actually got up and hopped home, which was fortunately only a short distance away. I didn't go to A&E until the following day, a Saturday, where one of the first questions they asked me was 'Where have you been for the last 24 hours?'

The extent of my injury, and of the plaster cast, was shocking enough. But it was a week before Christmas and I was over 250 miles away from my family in a city where I still knew very few people, having moved there just five months before.

I made a good decision to call my then boss, principally to tell him that I wasn't sure that I would be in work on Monday since I didn't see how I could do dentistry in a thigh length cast. I wasn't expecting the offer to go and  stay at his house. And when I later called my parents, I wasn't expecting them to make the 500+ mile round trip rescue mission that they duly did on the Sunday. (They probably weren't expecting to find me standing on one leg at the sink, doing the washing up, when they arrived at my flat either! But you know what it's like when mum comes round and the housework isn't spot on...!)

The last three years have been an amazing rollercoaster when my right ankle is concerned. From the initial 12 weeks in plaster, to a tendon re-rupture just a couple of weeks later, through a consultant  who badly mistreated me, three weeks in hospital due to pain mismanagement that sent me into DKA, to a re-rupture in May last year just days after starting work at a new practice. The third rupture resulted in my third surgery - a tendon transfer - the healing of which was compromised by my Addison's diagnosis one month after surgery. Nothing I write here can truly do justice to the journey I've been on. I'm just truly thankful just to be able to walk after honestly believing it would never happen again. And more than that, I can climb stairs, run for a bus and work out at the gym. The only thing I'm not able to do is walk on tip toes.

I guess that is a small price to pay.

Ironically enough, something which happened almost exactly three years prior  may have played a role  in the initial tendon rupture.

On December 16th 2001, I was celebrating Christmas with my then-boyfriend. We were going to our separate families for Christmas, so had planned our own special day over the weekend. During that day, I felt progressively more and more ill until I gave up and went to bed at around 8pm. An hour or so later, unable to rouse me properly, then-boyfriend made the decision to call an ambulance. It is hard to say that it is a decision that saved my life, since the crew that attended saw my age and a half-finished bottle of wine on the dining table and made an assumption that I was drunk, although I'd had just a single glass of wine more than six hours earlier. They initially refused to take me to hospital, and only did so at then-boyfriend's insistence.

That is what saved my life.

I was suffering from encephalitis.

Suffice it to say that my parents were given the horrifying news the following the day that I might not make it to Christmas.

Real People Sick on a grand scale.

But obviously you wouldn't be reading this now if I hadn't made it.

And as for how this relates to my ankle injury?

Firstly, one of the drugs that I was given intravenously was Ciprofloxacin. This is an antibiotic known, in high does, to be associated with tendonitis and tendon rupture.

Secondly, when I came out of the acute illness, I had lost sensation and motor control over the lower right hand side of my body. This may have been related to pressure on spinal nerves due to swelling caused by the illness itself. It may have been due to damage caused by repeated attempts at a lumbar puncture. This wasn't my first experience of a lumbar puncture. We'd already ascertained I have "unusual spinal anatomy". There is a possibility that spinal nerves were "twanged" in this attempt. Even my neurologist is unsure to this day.

Either way, I had to re-learn to walk. I was left with a foot-drop (inability to raise my foot). I walked with crutches for a long time and used a splint for much longer. My desire to wear something other than trainers (although I had killer Buffalo's for nights out!) probably led me to abandon splint usage long before I was really ready. And walking around with an uncorrected foot drop can lead to shortening of the achilles tendon. Which in turn increases the risk of rupture...

Six years on from my run in with encephalitis and three years on from injuring my ankle I'm just very thankful, both for being alive and for being able to walk.

I've learned the hard way not to take those things for granted.

I did it!

And I'm really glad that I did.

Sure, there were times when I found myself staring at a blank screen at 11pm, totally devoid of inspiration. But looking back, I'm pleased with the number of sensible, meaningful posts I've managed to turn out in the last 30 days. And overall, I've enjoyed the challenge of writing something everyday. It has been a real motivator. In the past I've let a lot of bloggable moments slip by, but hopefully that wont be the case in the future. I won't be keeping up the everyday pace, but I hope to keep to a semi-regular schedule now that I've proved I can.

Blogging everyday has also brought another, unforeseen, benefit. I actually feel more involved in the community we have here, amongst all the blogs on diabetes. It stands to reason when you think about it, I just hadn't thought about it! The importance of being part of a supportive community when you deal with diabetes should never be underestimated. I sad it was a recurring theme, so thanks again guys!

In other November news: NaNoWriMo, has not been such a success. I made it to somewhere around 24000 words, just shy of halfway. The verdict is that I've just been too busy. I hate to fail. At anything. It isn't usually a word in my vocabulary. The good thing is that I don't think I've really failed at this. I've done some good ground work on an idea I've been carrying around for a while and I do feel motivated to carry on with it. Writing is something I've never been great at finding time for so without Nano, and all my enthusiasm for it at the start of the month, that project would still have a sum total of zero words on the page.

And up for next month, a new challenge. I've made a conscious decision to return to regular logging, at least for a while. I'm still baffled by my 6.6 A1c and I want to really see how I'm achieving it. I've just spent the train journey from London to Liverpool banging my spreadsheets in to shape and manually entering the last weeks worth of data.

So onwards, to Decemeber - Caro blood sugar logging month.

And congratulations to everyone who made it through NaBloPoMo, NaNoWriMo or both!

Dans Le Noir?

Literally: In the black.

I'm talking the kind of blackness that makes you feel like you're swimming in ink. The kind of impenetrable darkness where you cannot see your own hand in front of your face.

That is how we ate our dinner last night, at the Dans Le Noir? restaurant here in London.

The idea of eating in a completely pitch dark room, guided and served by blind staff, is a novel one, at least to me. And it proved to be an experience on so many levels.

The evening began with our group forming a chain, locking on to each others' shoulders as we were led by our waiter, Graham, into the darkness. One by one Graham led us to our seats and, in a complete reversal of preconceived roles, we became totally dependent upon him.

We were asked as we entered the dark room to keep our voices quiet and warned, quite accurately, that our sense of hearing would become more acute. Deprived of vision, we quickly came to rely on our other senses. Unable to simply glance down the table to see who was seated where, we had to use our voices to map out a plan of the table. I quickly developed a need to touch anything and everything on the table, to fill in for the missing sensory feedback from my eyes.

We all learned a lot sitting there in the dark. We learned how to do familiar things, that we  normally take for granted, without visual feedback, such as pouring wine into a glass without spilling it. Placing food in our mouths without being able to see what it was. In this respect, it struck me that we had one important advantage over a truly blind person. We were all blinded. Many of us resorted to picking our food apart wit our fingers and putting it in our mouths, perhaps being quite messy along the way in what might normally be deemed a socially unacceptable manner. But then, no one could see us, so it was easy for us not to let it matter.

We learned about communication and the role that sight plays. In the darkness you cannot read visual clues or body language, but this actually makes it easier to be a little more spontaneous in what you say and makes behaviour more free without the pressure of conforming to accepted standards.

We learned, too, about taste. You do not order specific dishes at Dans Le Noir? Instead, you select a 'surprise' menu, with a choice of meat, fish or both or a vegetarian option. It is only afterwards that you see the actual content of your dishes. Not knowing what food is in front of you forces you to concentrate on taste and texture and removes preconceived ideas about whether you will like a particular dish based on how it appears or what it is called. Without sight, we weren't very accurate at identifying our food. I was completely stumped by an item on my plate that felt like a bird's nest and tasted fired - it turned out to be crispy noodles. Of those who selected the menu containing Guinea Fowl, none identified it correctly. Rob ate cold Parma ham that he would normally have not given a second glance to.

Of course the evening presented particular challenges to me. All objects that can produce light, such as mobile phones, are banned from the dark room. Whether to take or leave my little Freestyle meter was a difficult decision. I actually ended up leaving it in the outside locker, knowing I could get to it at any time if I needed to. My pump, on the other hand, I kept on. But I  then found myself faced with a very difficult problem. I did actually hit the backlight button at one point, ready to perform the preconditioned reflex of bolusing before my food. I left the light on for about 3 seconds, instantly mortified at having introduced even a tiny bit of light in to this experience, and suddenly realsising that without being able to see my food, there was no way at all for me to assess the carbohydrate content.

Looking back, I probably could have arranged with staff to view my meal beforehand, but I'm glad I didn't. It would have ruined somewhat the experience that I've already outlined. I'd had a good reading going in to the meal and so elected to bolus immediately after leaving the dark room with what is a fairly average amount for a restaurant meal for me. Something worked, because by the time we got home, my blood sugar was 4.0 (72).

I learned though, how vital a tool sight is in the management of diabetes. We use it each time we test our blood glucose, each time we bolus and, most difficult of all to find a replacement method for, we use it to count carbohydrates.

I truly discovered the irony of diabetic vision-loss.

And perhaps this principle was the biggest part of the night. That we all learned things about ourselves. Each of us had fears to face in that room. Some were claustrophobic, simply afraid of the darkness. Some had a fear of eating food they could not see.

For me, it was like facing my fear of blindness head-on.

And it was scary.

For several minutes all I could think was that this was what it would be like to have that ultimate fear realised. And for several minutes it seemed overwhelming. I wanted to shout for Graham and have him take me back outside to the light. But then it hit me that if this were for real, I wouldn't have that option. There would be no returning to the light. Rather than freak me out more, that thought made me more determined to stay, to work through it. That was the point at which my hands went in to overdrive, seeking out the missing feedback. Learning. Discovering.

By the end of the evening I realised that yes, being totally blind, living in a world devoid of colour and faces would be awful. But we still had good food and wine. We still had voices and laughter. We found new ways of doing familiar old tasks. I felt safe with the support of others - Graham our guide, and Rob sitting to my left, holding my hand and reassuring me it would be ok.

I learned that if it ever happens, I could find a way to cope. And my little daily worry knot loosened just a little.

I Will Still Give Thanks

If you've read my blog for a while, it will surely come as no surprise that I'm a bit of an Americanophile.

It might be because the first time I ever left the UK, as a three year old, the US was our destination. It might be because my Dad is a self confessed Americanophile too. It could be more banal - the influence of TV shows, movies and indeed the internet.

My brother has been making a life for himself in the San Francisco Bay Area for the last three years, and I have no doubt that if it weren't so difficult for me to convert my UK qualifications in to a license to practice in California, or pretty much anywhere in the US, (for difficult read lots of exams and thousands of dollars, nevermind the normal immigration procedures) and if I didn't have very positive reasons to stay right here in the UK, I'd move in a heartbeat.

But that is not the way that things are meant to be, and I'm really alright with that too.

If I could choose just one aspect of American life to import in to the UK though, Thanksgiving would surely be high up on the list.

Sure, it has something to do with the fact that we currently have no public holidays between the end of August and Christmas. The months stretch out long and depressing with ever darkening days and no respite. In addition, the fact that there is really nothing much to celebrate in the autumn months (we've already established that Halloween isn't such a big thing here) means there is no buffer and the commercial powers that be see fit to start Christmas at the end of September.

It's more than that though.

The spirit of the holiday is impossible to miss even just by reading around blogs today. The idea of a holiday dedicated simply to being with the ones that you love, in person or in spirit, and giving thanks has got to be a good thing. Much as I might wish that Christmas would fulfill the same functions, it doesn't.  As Rachel pointed out to me yesterday, Christmas is a very stressful holiday, not to mention a commercial goldmine.

Perhaps the thing to remember is that I don't actually need the public holiday to follow the sentiment and give thanks and, with good timing, that was shown to me today.

I may have had to work today, but I was reminded very starkly this morning of how, despite that fact that working in such a close knit group in a stressful environment causes us to get stressed out with one another frequently, I am blessed to work with a wonderful group of people who will always be there when they are most needed. For that I am very thankful.

I also have a wonderful family, who keep me in mind always, friends I can rely on and a partner who shows me every day how very much he loves me even though we are so often far apart.

I'm also thankful for the community that I am a part of here. The connections I have made with people from across oceans who I have never met in person, yet understand intimately what it is often like to be me. This is a recurrent theme this month.

I hope everyone in the US has a wonderful Thanksgiving holiday. I hope that everyone else is able to remember that we don't need the holiday to observe the sentiment.

Seven from me

I've been tagged by Pearlsa and also by Vivian to share my seven random facts.

1.     I have an obsession with giraffes. Seriously. I think they are incredibly amazing animals, so elegant and so well adapted, but yet so... daft. I recently saw a giraffe drinking at London Zoo and the memory of its sloppy drinking never fails to make me smile. I have dozens of cuddly giraffes and other giraffe related objects too.

2.    I cover my ears when I'm scared. It doesn't matter what the source of my fear is, it may be entirely visual, but I have to cover my ears to feel safe. I also sleep with my ears covered up, even in summer (although I do leave the rest of me uncovered when it is hot, I'm not completely mad!) 

3.     I can't say the word anemone. I just can't do it. Countless people have tried to teach me, but it never fails to make me sound as if I'm completely drunk!

4.    I only eat cooked cheese. This is partly because I don't like the texture of almost any cheese when it's not cooked. I much prefer the flavour reduced to a stringy, homogeneous blob first!

5.    I grew up in a village where all the houses look the same. Obviously not exactly the same, but each row of houses contained identical houses, each small neighbourhood had houses of very similar style and the entire village had a united look. I think it is this that has influenced my life long desire for uniformity and things that match. All the furniture in a give room of my house has to be in the same type of wood, for example.

6.    I regularly read things backwards. I don't mean prose, or when I 'm reading for an extended      time at normal pace, but when I see a title, or an individual word, or a sign or a brand name, I automatically reverse it in my mind. So Coke automatically becomes ekoc and diabetes is setebaid. I do occasioanlly do it with entire sentences too. I have no idea when I started doing this as I don't remember ever not doing it.

7.   Rob and I make  kissing noises down the phone to one another in lieu of the real thing. He won't, unsurprisingly, do it if anyone else is in the room on his end of the phone, but it was his suggestion that I include this as a random fact!

I'm pretty sure everyone has been tagged, but if you haven't and you want to be, you're it.

The Road Taken

This month marks ten years since my interviews for a place at dental school. It was a dream I cherished and worked towards. It was what I really, really wanted to do. Although I had a very clear idea of where I wanted to end up, I applied to five schools, to give me the best chance of getting a place somewhere. Because anywhere doing dentistry was better than nowhere at all.

My first interview was in Birmingham, and I was offered a place. The second interview that came up was in London - where I wanted to be.

I remember the day clearly, from getting on the train to ending up in a McDonalds, the closest place to hand, drinking regular coke because my blood sugar was low but I was too nervous to eat anything, including glucose tablets. I remember meeting my brother, already a student in London, afterward. We went up to Regent Street, where the Christmas lights were in full blaze and I remember thinking how this was the city I wanted to call home. I didn't want to be a faceless stranger in the crowd, I wanted to be a Londoner.

Two weeks later, a frosty morning in early December, I was woken up by my parents waving a letter bearing the university stamp. I didn't waste time in considering whether the envelope was thick enough to contain an offer. Without even getting out of bed, I tore it open.

And that was the first moment that shaped my future.

The offer of a place at my preferred school meant the interview trail was over. The grade offers I might get elsewhere could not reasonably be expected to be any lower, so I withdrew my outstanding applications and accepted my London offer, examination results pending.

The next decisive moment in shaping my future came on August 20th 1998, the day I received my Advanced Level Exam results. For the first time in my over-achieving life I didn't care about the actual grades. All I cared about was meeting the grade requirements set out for my dental school place.

My dad summed it up nicely six years later when he recalled how I'd phoned him and, rather than telling him my grades, I'd simply said "I'm going to be a dentist."

In retrospect, it's a poignant statement. I didn't have any idea on that day how hard it would actually be to get there. I had no reason to. I'd never struggled academically and although I'd been ill, it had somehow never got in the way of me achieving what I wanted to.

Now, ten years on, I can't help but reflect on the path I chose. The road I took.

Not dentistry.

I love dentistry. It is a job that you can't do well, if at all, if you don't love it. It's too intense, too involved. And I never did really struggle, either academically or clinically, as a dental student either. I emerged from six years of university with an enormous debt, and two degrees. I don't regret any of that.

What I wonder about is how life would have turned out if I'd not chosen London.

Don't read this wrong. I also love London. The seventeen year old on Regent Street is still alive and well inside me. I adore this city, with all its history, its winding streets, its icons of architecture and transport. I'm so glad to have called this place home for so many years, and enjoyed all the opportunities this nation's capital has to offer.

But this month also marks eight years since my life changed.

Being diagnosed with epilepsy had a profound effect on my life. Frequent seizures bring real life to a stand still. I became afraid to go out. My seizures brought out the very worst in some other people, whose lack of understanding and treatment of me drove me deep in to depression. The cruelty I endured is difficult to think about. Impossible to put in to words.

But most of all, I could no longer be sure of becoming a dentist.

I'd taken it for granted, since the moment I opened the brown envelope containing my exam results in my high school car park in August 1998. The thought of not achieving my dream, of failure, was devastating.

You know the ending to this story. You know that I did make it through.

It's looking back on the struggle, all the extra effort, the cruel treatment I received, that makes me reflect on the path I took.

If I'd gone to study dentistry somewhere else, what might have been? Would I have avoided catching meningitis, and so avoided developing epilepsy? I know I can't answer that. No one can. But since, unlike with diabetes, I can trace my diagnosis back down a path of specific turning points, it's natural to question it.

Epilepsy is a tiny part of me now. It remains engraved on to my medical ID bracelet. I still don't hold a driving license.

I still meet people who question. Critcise. Discriminate.

The stigma is still firmly attached.

What if? I can't help but wonder...

 

A Long Week

This week feels as though it has been going on for at least a month.

It may be the double whammy of an important personal anniversary on Monday with World Diabetes Day on Wednesday.

It may be because my blood sugars have been carrying on a ridiculous dance.

It may be down to a professionally draining week.

I've sedated a number of patients for treatment this week. I've discussed before about how routine the delivery of injections in patients' mouths has become to me. The conscious sedation technique, however, has more parallels to pumping insulin than injecting it. It involves placing a cannula in to a vein through which a drug is delivered to relax and sedate the patient.

The cannulas themselves are similar to insulin infusion sets in that they have a guide insertion needle and a teflon tube. I'm used to sticking this kind of equipment into my body every three days, but putting it through the skin of someone else's arm or hand, trying my best to hit the vein first time and spare them a repeat performance, is something that I still find slightly tough, no matter how many times I do it. And positioning something in a vein is far harder than just positioning it sub-cutaneously.

I also know what it feels like to be on the receiving end.

Despite a good first time success rate this week, and only one "Oh eek, third time lucky" moment, these procedures still have the ability to take far more out of me than my more routine dentistry.

To finish up the week, I was faced with a six year old child who'd fallen at school and cleanly knocked out his front tooth. He seemed quite happy about it, proudly showing me his gap. Since I spend a considerable amount of time each week taking teeth out, putting them back in is a novel variation. Sadly, the young patient didn't seem that impressed with my efforts, bursting in to howls after we reinserted his tooth and restored his cheeky grin.

I was still happy to know that I may have made a real difference to that kid, even if he doesn't know it yet.

It was a welcome end to a very long week.

Going The Distance

For the last year, every other Friday, or perhaps every third Friday, I've rushed from work to Euston station to board the overcrowded Virgin Trains service to Liverpool, approximately 200 miles north west of London. And each corresponding Sunday, I've done the journey in reverse. In short, I've been a weekend commuter.

I hate the journey. The rush to make it to the station on time, the fight to secure a seat, the terrible food and lack of WiFi, the delays and the overpricing.

I do it because I'm in love with the man who meets me at Liverpool Lime Street Station.

It was a year ago today that we took our first, tentative steps on this journey. It's been a winding road of discovery, with highs  and lows along the way. But when I look back, I can hardly remember where I started out from .

Rob, I love you.

Facing life, diabetes and other challenges, with you is infinitely easier than facing them without. With you, the world seems brighter in colour and richer in texture. You make me feel beautiful, special and adored. Until I found you, I never knew what was missing from my life. Now, I can't imagine being without you.

But I am. Every weekday. And although the distance, and saying goodbye every Sunday night, threaten to break my heart, you also make me strong enough to handle it until we're both in a position to make a change.

There so many moments from the last twelve months that stand out. The fun times: The week we spent in San Francisco. The restaurant meals. You squeezing me tight when I was afraid at the cinema. Indulging my passion for giraffes and taking me to see them twice. The things your friends said you'd said about me. The not so good times that you somehow made good: One of the first nights we ever spent together, you got up in the middle of the night to find me sugar. The time you sprinted down the road to find cranberry juice for me. The time you held my hair back as I was throwing up.

I remember the time I couldn't bear to say goodbye, so I got on a train and came all the way back to Liverpool with you, because I didn't have to work the following day.

I remember the moment you told me that you loved me.

I remember realising that I already knew, because you'd already shown me.

Thank you, Rob, for being there for me, even when we're far apart. Even when I'm in a bad mood, stressed out or exhausted. Thank you for understanding. Thank you for going the distance with me and making this work.

Thank you too, for the twelve red roses you sent me today at work. Even though they arrived in front of a waiting room full of patients, I cried. They stood in my surgery all afternoon and I was proud to tell every patient, when they asked, that they were a gift from my boyfriend.

Because he loves me.

I love you too.

iHas iPhone

What can I say?

I'm weak. Very, very weak. But the prospect of replacing my battered 2-year-old-dinosaur-of-a-phone with the super shiny, brand-new-on-the-UK-market-yesterday iPhone was too much. I know I've got no patience and I know I'm like a child wanting the next new thing now. I've heard all the arguments about waiting for the larger capacity model, waiting for 3G and just waiting for a newer iteration where the kinks have been ironed out. But I still couldn't wait.

And to be honest, so far there aren't really any major kinks. The user interface is gorgeous, navigation very straightforward and the speed really doesn't seem that bad.

It was actually remarkably easy for R and I to get our hands on them too. Not only were there no queues this morning, but we were the only people in the shop buying them. Activation caused a couple of minor headaches, but I already have a contract with the UK provider, O2, and when it got to it my number was transferred across in seconds.

My only gripes are that I wish the portrait mode was available in all applications, particularly since this makes the keyboard easier to use. Not that the keyboard is any more difficult than a standard, tiny-keyed smartphone keyboard, mind you. A percentage battery indicator would be nice too, but since that really is all I can find to gripe about at present, Apple have definitely triumphed, at least in my eyes.

It's a masterpiece of design. I only wish the user interface on my pump, which now grates against my eyes in comparison, could be as beautiful.

It's definitely love!

Christmas, Anytime of Year

Okay, okay, I'll admit it. It doesn't matter how many rants I have, via twitter  or otherwise, there is one place (or more accurately something like 48 bazillion places worldwide) where I would be quite happy for it to be Christmas every day. Every. Single. Day.

The place?

Inside a branch of Starbucks.

I know it's bad. I know its oh-so-NOT diabetes friendly, but so long as they have Gingerbread Lattes, Peppermint Mochas and Cranberry and Orange Muffins, they can hold Christmas every single day of the year.

Stepping off a bus outside Borough Station earlier on my way home from a hospital appointment, I couldn't help but notice the snow flakes etched on to the windows of a fairly recently opened branch on the other side of the street. The promise of Christmas inside acted like an invisible hand, guiding me to the crossing, over the road and in through the front door in a blast of cold air.

They had the red cups, the turkey feast panninis and a list of festive food and drink. I was like a kid at, well, Christmas! For a minute, it didn't matter that we're only just out of the first week of Novemeber. It was Christmas and all I cared about was what I could have. New for this year includes Creme Brulee Lattes and Skinny Cranberry and Orange Muffins - does that mean I can eat twice as many?

I know I shouldn't have, but with a healthy 5.3 (95) blood sugar and a morning spent at the hospital behind me, I convinced myself a treat was in order. Who am I kidding? I didn't really need any convincing.

One grande Gingerbread Latte (minus the whipped cream) and 3 units of insulin later, I'm cruising  in the 6's (110-125) range.

Yeah, secretly I can't wait for Christmas. Or at least, I can't wait for Starbucks' Christmas!

A Small Rant

Diet coke with added vitamins and antioxidants? WtF?

This makes me really mad. It's the kind of marketing crap that perpetuates the myth put about by the junk food industry that it's perfectly alright not to eat a properly balanced diet because you can get all the vitamins you need from a bottle of coloured, flavoured and carbonated water instead. As if it really amounts to the same thing!

Seeing this advert again, for probably the ninety-ninth time, on a full building height bill board on my way home tonight has caused this rant t re-surface after a couple of weeks of suppression.

Don't get me wrong, I'm fond of Diet Coke for all kinds of reasons. But I also recognise that it is a completely nutritionally worthless item and, as a dentist, that when drunk frequently the acid content will lead to erosion of tooth enamel and loss of tooth surface.

But if you're really too lazy to get a proper balance in your diet, you could just try swallowing a couple of multivitamins with a regular can of Diet Coke. It amounts to the same thing!

Sunday Working, Sunday Blogging

If I thought a 9-6 day yesterday was bad, imagine the prospect of 8.45-4.30 on a Sunday. I may occasionally blog on a Sunday, but I very rarely do anything work related. Dragging myself out of bed at an ungodly hour this morning, I was very glad that I'd modified my plans last night. Instead of the scheduled night out, I ended up heading back in to Greenwich with my practice principal (i.e. the dentist who actually owns the practice where I'm an associate) where we ate noodles before heading up to Blackheath to catch the fireworks, which were pretty cool.

The second half of our conscious sedation update today went pretty well. You'll be unsurprised to learn that my veins weren't used for any cannulation practice! I was the example of a difficult patient! The session also included good, accurate coverage of diabetes, which is always refreshing to hear.

And no, I still didn't make it back to the scene of the crime.

I've spent a chunk of this evening attacking my NaNoWriMo project. I'm more than 10% of the way there, at 5331 words. I'm a little behind where I should be at the end of day 4, but I'm still hanging in there and finding it an excellent motivation to get writing everyday.

Hope everyone had a great weekend!

Returning to the Scene of the Crime

Today's post, for NaBloPoMo, was always going to be a challenge to write, not only because I rarely, if ever, post on a Saturday, but also due to a hectic schedule. I had a full work-length day attending a course to update my knowledge and kills in sedating patients followed by plans that would take me directly out this evening with no time to stop to make much of a blog post.

What I wasn't really expecting was to hit on a subject I wanted to write about that in itself would present such a challenge. I've been mulling it over on my journey home, and can only hope I don't come across sounding ridiculously emo.

The course I was attending was based at Queen Mary's, University of London in Mile End. QMUL is the university attached to the Royal London Hospital at Whitechapel, in which I spent some time last year, about 10 minutes away.

It only struck me when I was waiting for a train on the northbound East London Line underground platform at Canada Water, that this is the first time I've used the East London Line since that day. It's not hard to let to let 16 months pass without using this particular line. It's currently the shortest on the network, serving just seven stops between Whitechapel and New Cross. But realising that this is the first time I've re-made that journey made my stomach lurch. I can't find the words to describe it properly. It made me catch my breath for a second. It just made me feel weird. I knew it was irrational a daft. After all, it's not like the day was going to have the same ending. But sometimes you just can't help the way you feel.

Arriving at Whitechapel station, I found myself hot footing it up the stairs to the District Line platforms above and jumping on a train to go one single stop eastbound to Stepney Green. True, I was several minutes closer to my destination, but it was beautiful, clear and sunny November morning, I was running a little early and the extra walk would have made a great start to the day.

Instead, I found myself in Whitechapel station, my heart pounding crazily in my chest and totally unable to accomplish the simple task of walking out through the ticket hall. I found myself physically unable to revisit of the scene crime, of which only a brief and sanitized version is really described here, the truth hidden and excused by my unconsciousness at the time.

I don't ever have much reason to visit Whitechapel these days and could quite probably go through the rest of my life avoiding it.

But sooner or later, I need to make myself go back there.  Life after all did go on, no matter how close it came to being a different story.

A Halloween Confession

I have a confession to make.

I don't 'get' Halloween.

This isn't actually as much as a biggie as it may sound to my US-based friends. Amongst my UK friends, I'm definitely not alone.

When I was a kid, Halloween certainly wasn't a big deal. We may have made ghoulish masks in school art classes and tried our hand at writing a ghost story in English. A few hardy souls might have braved the cold for a trick-or-treat outing that consisted of knocking on their neighbourhood friends' doors. Knocks that had already been planned and agreed by parents in advance. And everyone was safe and warm at home by 7pm. I certainly don't recall any dressing up or parties, and the involvement of adults didn't appear to extend beyond supervising their kids. Halloween candy was never as much of a challenge to my diabetes control as Christmas, and the event itself definitely paled in comparison to the excitement of Guy Fawkes' Night five days later.

It's certainly picked up a little as an event these days. I've still not seen any pumpkins on porches or in windows, but the shop decorations and themed candy are certainly abundant.

But there's a big difference in how we do it.

The morning starts with reports on breakfast television of what measures different police forces are taking to handle the mischief caused by Halloween including limitation of sales of flour, eggs and shaving foam and placing extra community support officers on duty (paid for by the taxpayer, I must add). I don't know anyone who dresses up to go to work - costume parties are very few and far between too.

Trick or treating happens though.

Groups of kids running wild like packs of feral animals until well past what should surely be their bedtimes. Most of these kids haven't even made an effort at a costume and trick-or-treat becomes a misnomer as these kids brazenly demand their treat, or worse, just demand money. If the phrase 'trick-or-treat' gets mentioned at all, it translates as "give me a treat or I'll play a horrible trick on you" where the trick may range from an assault on your house with eggs and shaving foam to windows being broken or even a lit firework being shoved through the letterbox flap on your front door - a side effect of the proximity of Halloween and Guy Fawkes.

So no, I don't 'get' Halloween, or the hype that surrounds it across the pond. Here, it seems to be a defining celebration of the antisocial behaviour plaguing chunks of Britain's youth.

As a reflection of society, I guess I really see it as a pretty sad day.

On your marks...

The end of the week brings the beginning of November.

And November brings NaBloPoMo and NaNoWriMo.

There are plenty of D Bloggers joined up. Bernard has even started a Diabetes Bloggers Group on the NaBlo site. I've discovered at least a couple of other diabetes bloggers, besides me, who are also insane enough to attempt to write a 50,000 word novel during the month.

Come on guys. It'll be fun!

I'll be writing chick-lit for the first time ever for Nano, in the hope that it is as easy to write as it is to read! The plot revolves around two friends making a pact to marry each other if they haven't found anyone else suitable by a certain time. When the time comes round, he quite likes the idea. Trouble is, she can think of nothing worse.

See...fun, I tell you!

(And you bet both dentistry and diabetes will feature in the story. Write what ya know, and all that!)

If you're planning on Nanoing too, you're very welcome to buddy me. My profile is here. 

I'm off to enjoy some of the last of my freedom. Good luck to everyone else!

The Nature of Fear

Twenty years ago last night, England was hit by its biggest storm  in living memory. The storm that wiped 15 million trees off the face of the country, cut electricity and telephone communications for days and claimed no more than 23 lives only by virtue of the fact that it struck at night when most people were safely tucked up in their beds.

Growing up in the far south-eastern corner of the country close to the Kent town of Sevenoaks, famously reduced to One Oak by the storm, my family was right in its path. The picture here is of nearby Emmetts Garden.

Listening to the then-director of the National Electricity Grid talking on a television documentary tonight about making the monumental decision to flip the switch that would throw the entire south east including London into complete darkness, that would make us literally powerless in the face of the onslaught and that would lead many people to believe Armageddon was truly upon them, I felt the fear. Looking right now at the brightness of the lights just over the river in Canary Wharf and comparing it to the CGI of London that night on the television sends chills running down my spine. Use of the music from the soundtrack of '28 Days Later' was in no way out of place.

I remember that night as though it were much more recent than twenty years ago. Beyond spending the early hours huddled together in my parent's bedroom, our cat rescued from the garden by my dad and celebrating with my brother that there would definitely be no school tomorrow, the biggest thing I remember is the initial total lack of fear.

Back then, I was the kind of kid who wouldn't move from my bed during a thunderstorm that struck at night. Paralysed by fear, I'd stay buried beneath the covers no matter how hot I got, no matter how desperately I wanted to use the bathroom or how low I thought my blood sugar could be. But lots of people were afraid of thunderstorms. I perceived there had to be something to be afraid of.

Waking up that October night in 1987, the noise was like a washing machine reaching its spin cycle with a vacuum cleaner running at full speed over the top. The wind roared and growled around the house. Leaves, twigs and other debris battered the windows of my bedroom and the curtains flapped in the whistling breeze that seeped around their edges.

But I got out of the bed and headed for the bathroom without a thought.

I didn't know what was happening around me and with no preconceived ideas, I didn't realise how very much there really was to fear.

The big storm taught me something very powerful about the nature of fear. I didn't fear it, because I didn't know there was anything to fear.

I didn't fear diabetes either, when I was diagnosed. I didn't know then how much there is to fear.

The Verdict?

That exam that I took: I PASSED!

To say I'm happy would be an understatement.

I spent yesterday afternoon at a revision session for the next part - the practical part - of the exam. In addition to five face-to-face grillings with examiners the afternoon included the bizarre experience of or a mocked-up patient encounter with a female character played by a man! The feedback for this scenario? I was told that I was "too aware that I was being watched" and "seemed to be acting." No kidding! It wasn't exactly reality!

I also had to smile when during a generic advice session we were told: "If in doubt about a medical condition say diabetes. Diabetes is somehow related to everything!" I guess I couldn't argue with that.

In other news, it is a good job that I'm not entered to sit this exam at its next sitting in November. Somehow I've found myself signed up for both NaBloPoMo and NaNoWriMo and have therefore kissed goodbye to my November!

I've tried all the excuses:

"It wasn't me."

"I was just holding the computer for someone else when it signed me up...."

"I didn't mean to do it" (This one is true, I really didn't. Well, not both anyway.)

I'm actually hoping NaBloPoMo will help me cement a regular blog writing routine and possibly expand my subject matter outside of diabetes. As for NaNoWriMo... Well, it'll be fun.

Go on, you know it will. Come and join me!

And finally, October 15th is Blog Action Day. One Issue. One Day. Thousands of voices.. In its inaugural year Blog Action Day will be coordinating bloggers to tackle the issue of the environment. Check out the site, and join in.

Going for the Jugular

Today I went for a hydrocortisone day curve analysis, to check whether the levels of steroids I'm taking for my Addison's are correct. This is the first of a number of protracted tests I'm having over the next month or so, to check up on the Addison's and my waning pituitary function. My body certainly failed the 'endocrine' part of the 'how to be a great human body' course!

I have notoriously difficult veins to find for blood tests and cannulation. I've known anaesthetists to curse in frustration in the face of my tiny, wiggly veins and a junior doctor to hurl his equipment down in defeat.

So getting the cannula in my vein was the only part of today I was dreading. It turned out to be with good cause.

Several attempts by several members of staff later, I was getting anxious. This is a long test that I wanted to get underway, and having taken a day off work specifically there was no way I wanted to abandon the attempt.

"We'll have to go for the jugular then" said the doctor attending to me.

I'm not squeamish - I'm a dentist after all. And I'm not even unduly squeamish about procedures carried out on me - I've even let them use my feet before. But somehow the tears were escaping before I could even fully get my head around the idea.

Having a three inch needle shoved into your neck is, I can confirm, not the most pleasant experience in the world. But two fantastic nurses and a very gentle doctor make all the difference in the world.

And here's my reminder:

The good part? It didn't have a negative effect on my blood sugars and neither, so it seems, did a day of lying in bed! (The upper line = 9mmol/162mg/dL, the lower line = 4mmol/72mg/dL. Yes, that is my MacBook the pump is resting on, and yes it needs a clean!)

The bad part? I've got a repeat performance to look forward to in three weeks time.

Updates - Exams and Pumps

1. My new pump has arrived.

Yay!

And, it arrived on time as promised. Double yay!

In fact, even Medtronic were impressed at their own efficiency. On Friday morning, when I already had the new pump attached and pumping the telephone rang.

"Hi, I'm just calling from Medtronic. I understand that you have a pump that needs replacing" came the chirpy greeting.

"Well I did. It's been replaced though, thanks" I replied.

"Oh no, the American technical assistance line isn't able to replace them direct, so it hasn't actually been replaced yet" she said, with the patient manner of someone who has had to explain this point before.

"Erm... I can assure you that it has. The new pump arrived this morning and I'm wearing it now!" I responded.

"Oh, I'm terribly sorry..."

"No problem, it was already dealt with yesterday."

"Well, that's great..." I don't think she knew what else to say, caught off guard that the job had already been done. I'd definitely rather they tried to replace it twice than not at all!

I'm also pleased to find that Medtronic no longer demand that I pay the cost of shipping and insurance to get the old pump back to them. This was an aspect of their customer service that really bugged me a few years back. I once had two pumps to ship back to them at once where the total cost would have come to around twenty pounds. In that case I dropped the pumps off at my hospital and let the rep pick them up from there, but glad I can simply send this one off at the Post Office.

2. The exam went pretty well.

Went well, insofar as there were a decent number of very straightforward questions that I definitely knew the answers to.

Went well, insofar as nobody batted an eyelid about my pump, clipped visibly on my waistband, or  my test kit laid on the desk and called in to service twice during the three hour paper. After all my panicking it turned out that I actually knew the exam coordinator from when I was an undergrad!

The exam did not go so well with regard to my actual blood sugars, which hovered between 10 and 13 (180 - 235) throughout, failing to respond to corrections.

It must have been stress, because the minute I left the exam hall, it started falling nicely.

Examination Questions

Next Monday I'm sitting an exam that will count towards my first post-graduate qualification.

And I'm nervous.

The English school's examination system, coupled with my high desire to achieve and my choice of degree programmes means that I'm no stranger to exams. In fact, they were a summer ritual for eleven straight summers in a row. The moment the weather started warming up and the scent of fresh mown grass and barbecues started drifting in through the windows, I'd know it was time to get my head down into my books. I'd emerge pale, pasty and blinking like a mole several weeks later to enjoy the rest of my summer.

This, though, will be my first exam in three years and that is definitely a contributor to my nerves. The ritual of revision and preparation seems strange, alien almost.

But there is more to it than that.

There is diabetes.

Being diagnosed at such a young age, diabetes has undertaken every exam with me. I'm glad to say, it has rarely been a problem (the odd French and German spoken language exams aside). But then, I've always been in a secure environment. At school my diabetes, and the adjustments that may be necessary to accommodate low and high blood sugars, were common knowledge.

Even at university, where some of my exams were sat in vast, impersonal halls with a thousand other students, my diabetes, my pump, my need for testing supplies and snacks were all listed in my record. Even if an over zealous invigilator should question what the little silver device - my Freestyle meter - on my desk was, as normally happened, I knew it would get straightened out without problem. I never felt that my sitting an exam would be jeopardised by diabetes.

Diabetes being an unregistered candidate for this exam didn't occur to me until I received the candidate information letter.

There it is, towards the bottom:

"mobile phones or any other electrical device are not permitted in the examination hall... Use of any electronic device is not permitted during the examination and regular checks of the hall will be made."

My pump, CGM and testing kit are suddenly prime candidates for getting me kicked out. Even after putting in a call to the examination office, I still feel uneasy.

As if the stress of just trying to  pass the exam won't have a deleterious enough effect on my control!

So the question is, will trying to hide my pump, given that I may want to pull it out to deal with CGM alerts, end up drawing greater unwanted attention than having it "out-there". And would I be foolish to try and rely on CGM alone for the 3 hour paper? Your thoughts are welcome and appreciated.

Book Meme

What could be better than writing about reading books? Following on from Kerri, Nicole, Rachel and Allison I absolutely had to jump in on this one.

Total Number of Books Owned:

I honestly have no idea! New book shelves (along with new DVD and CD storage) has been high on my list of things to sort out for a very long time. As I write this, I can see the book shelf in the corner of the room where the books are stacked double-depth. The Harry Potter's and Roald Dahl's have found a precarious home on top of my speakers, my growing collection of travel guides is squashed beneath the magazine rack and an enormous pile of recent purchases teeters on top of the stereo. In my bedroom, a stack of at least five books sits on the floor by my bed, and there are countless books stashed under the bed as well. All this is without mentioning the half height bookcase in my second bedroom-cum-study that houses nothing but dental, medical and sociological books! In short, we're talking in the hundreds.

R's book collection is just as vast and un-contained. If we ever end up living under the same roof, I dread to think where the books will go! If all else fails, we could always build the house out of books.

Last book bought:

That will be books, plural.  Whenever I start clicking on Amazon, or walk I in to my local Waterstone's book shop, I don't seem able to stop myself ending up with at least 3 new purchases! The most recent bundle included a guide book for Brugge, ahead of a trip in December, a book with a very un-scintillating title about the National Health Service and The Story of You by Julie Myerson.

Last Book Read:

Depends if we're talking properly read, like from cover to cover. If so, that would be The Story of You. But I've also been dipping in to a lot of dental stuff, as I have a post-grad exam looming in less than two weeks and completing my 06-07 Tax Return over the last couple of weeks has lead to furious double checking of several chapters of The Financial Times Guide to Personal Tax. Exciting times!

Five Books That Mean a Lot to You:

Difficult to pick just five, but:

1. Happy Like Barnacles by Karen Testa.
I discovered this book as a 14 year old in the grip of my first bout of depression. It made me cry solidly from around mid-way through (and still does, to be honest). Yet I came away from it feeling that I valued life just that little bit more. At that time in my life, in terms of its impact,  there probably couldn't have been anything better for me to read. I'd recommend it to everyone but it's long been out of print.

2. Say Goodnight Gracie by Julie Reece Deaver.
I read this the same summer. Again it manages to sadden and uplift in almost equal measure.

3. Hideous Kinky by Esther Freud. Helps me reconnect with my inner child every time. I still refuse to see the movie, because nothing can top the book.

4. Catcher In the Rye by JD Salinger.
A cliche perhaps, but it has long been one of my mum's favourite books. When I left home, a battle even ensued over ownership of our dog-eared copy! I've read this at least half a dozen times, but I still discover a different slant at each re-visit.

5. Curious Incident of  the Dog in the Night Time by Mark Haddon

This was the book that got me back in to reading for fun following months of nothing but study for my final dental exams. It is also a book that is inextricably linked with the year I spent away from London, living in Plymouth.

Best Five Books You Read in the Last Year:

I just can't whittle this down to five. I read with a voracious appetite, often going through more than five books a week! So I have cheated slightly, and grouped these into related titles:

1. Harry Potter and the Deathly Hallows
Absolutely it's on my list. I forced R to stand with in the pouring rain on Bold Street in Liverpool, waiting for our midnight copies. Torn between wanting to make it last and wanting to reach the end, I finished it by 3pm on the Saturday! I've also re-read all the books this year, and although the final installment has replaced Goblet of Fire as my favourite, they are all still up there.

2. Philip Pullman's His Dark Materials trilogy.
I can't believe I waited so long to read these! Go out and get them!

3. One Unknown by Gill Hicks, Out of the Tunnel by Rachel North and One Morning In July by Aaron Debnam
These all focus on the London Transport bombings of July 7th 2005. By virtue of including them all here, it may almost appear that I have a fascination with the event. But these people, who were intimately involved in the attacks, have a story they wanted to share. Each of them has done it in an honest and moving way. As a Londoner, July 7th had a profound impact on me. So did these stories.

4. Books based on blogs - Blood Sweat and Tea (London Ambulance), Wasting Police Time (Police Force), Its Your Time You're Wasting (Teaching) and In Stitches (A&E Doctor)
All brilliantly crafted tales of life within each given profession - perfectly blended gritty realism and political rant.

5. The Jodie Picoult collection.
My Sister's Keeper was the first Jodie Picoult book I read, almost exactly one year ago. I began it on a early morning train in Italy and was almost done by the time our plane touched down back in England that afternoon. My travelling companion remarked "That must be really good, you literally can't put it down." More favourites include Salem Falls, The Pact and The Tenth Circle.

If you want to play, I'm keen to read.

P.S. Does anyone here Library Thing?

Reflections on Practice

From the moment I tossed my mortar-board hat in the air and spun around beneath it, laughing giddily, on graduation day, I've had the importance of professional development drummed in to me.

To me, at least, it's