The Grass Is Always Greener

A lot has been said about the Affordable Care Act lately. All political opinions aside, I'm terrified of what it means for those of us with diabetes. Of course, it all sounds good in theory; however, in practice, I'm afraid that it will be a huge mess that we will all suffer for.

Bottom line, you NEVER get something for nothing. Someone ALWAYS pays for it.

Now before someone gets angry and tells me how politically incorrect or socially irresponsible I am, let me say this: I believe in helping those who are less fortunate. However, I believe in giving a hand up rather than a hand out. The system in place now does not promote individual responsibility; rather, it perpetuates a cycle of dependence that is incredibly hard to break. Yes, I absolutely believe that the current health care system needs some change and insurance companies have to be held accountable for the cost of their premiums, but I don't think this is the way to achieve it.

My fears are these:

• According to local news stories, young doctors are now planning to retire early. If the doctors believe this law is going to impact them negatively, I don't have much confidence in their motivation/ability to provide adequate care...and I fear that finding the ones who go above and beyond will be exceedingly more difficult.
• "Free" preventive care? Just like most everyone I've talked to, I believe that we'll be paying for these benefits in one way or another...there might not be a co-pay at the time of the visit, but I'm almost positive that the cost will be accounted for through higher premiums.
• Similarly, moving toward outlawing discrimination due to pre-existing conditions is a great idea; however, I do not believe for a second that people with pre-existing conditions will be paying the same rate as someone without them.
• Even if it turns out that I'm wrong, what price will we have to pay? Even if we're charged the same as everyone else, I find it hard to believe that our needs will be adequately covered. Right now, I pay 20% of my diabetes supplies (after I meet a $3,000 deductible...that's a whole different story); in the future, who knows what kind of coverage we'll be settling for...if we'll be able to jump through the inevitable hoops to get some things covered at all.

So in summation, I'm afraid that this law, which was passed with the intent to lower health care costs for everyone, will actually end up costing us more in the long run in one form or another. I don't know what the ideal solution is, but I have a sinking feeling this won't be it.

During my first American Diabetes Month back in 2010, I wrote about how health care issues affect people with diabetes, and me specifically. I correctly predicted back then that my dream of staying at home once we had children wouldn't be possible due to my need for insurance. This adds an entirely new level of suckiness (yes, I'm making it a word) to an already sucky disease...not only do we have to suffer from the disease itself, but we also have to quite literally pay for having it. Let me break it down for you:

• Test strips--$1/piece; at the current rate I'm using them, $300/month or $3,600/year without insurance; $60/month or $720/year with it.
• Insulin pump supplies (reservoirs and infusion sets only)--$652/3 months or $2,608/year without insurance; $492.80/3 months or $1,971.20/year with...Before the maternity costs of last year, I never meet my $3,000 deductible. Because of that, I never get my supplies covered under the 80/20 plan, and have to pay them at the contracted insurance rate instead. But hey, at least I get that 20% insurance discount...
• CGM Sensors--$420/3 months or $1,680/year without insurance; $327.90/3 months or $1,311.60/year with...although I don't use sensors all the time, partly because I don't feel I need to wear them 24/7 and need a break from the skin wreckage caused by the adhesives from the bandaids I wear to cover them, and partly because not wearing them all the time means I can stretch my supplies out longer.
• Endocrinologist visits--$473/quarterly or $1,892 without insurance; $50 copay or $200/year with.

That comes out to $9,780 without insurance or $4,202.80 with for strictly diabetes-related medical costs, which of course is not including premiums, glucose tablets, or other miscellaneous expenses that I incur thanks to this disease.

Since I work full-time (as a CAD drawing technician for the family business), my employers (aka, my parents) pay 75% of all the employee's insurance premiums. I'm blessed that everything worked out so that I had insurance coverage upon diagnosis and have been able to keep the same policy since then, but I wish so, so badly that we were able to afford private insurance so I didn't have to work full-time. Unfortunately, though, it just isn't feasible for us to forgo my salary and lose my benefits. I realize I'm incredibly lucky to be able to bring my baby to work with me (and have a flexible schedule), but most people don't realize how hard it can be. I don't think I could ever leave her at day care, but it's definitely not easy trying to juggle being a mom and working at the same time (and that's without all the lovely d-related stuff I'm dealing with 24/7). While I'm at work, I have two (/three with the d) jobs going on virtually all the time, and they inevitably interfere with one another...the phone rings, baby wakes up. I need to be working on a drawing, baby is crying. Oh, and by the way, your blood sugar is low...now! It never ends...

Sometimes, like yesterday when I saw a new mom walking with her baby in a stroller on my way to work, I can't help but mourn what could have been if it weren't for this disease and all its related implications for my life. If I didn't have to work (full-time) just so I can keep affordable insurance coverage, I could...

• Spend more time just enjoying my baby, rather than being frustrated by trying to give her the attention she needs without abandoning my job.
• Keep up with her baby books, which are currently in a woefully neglected state. Oh, the things I've missed already...Thank goodness for the iPhone, because without it we'd have no proof of her milestones and day-to-day cuteness!
• Have a clean(er) house, because then I wouldn't have to wait until I got off work to conquer the mountains of laundry and dishes that are always waiting for me at home...If I were at home all day, I could at least throw some loads of laundry in the washer during naptimes/breaks.
• Similarly, I'd actually be able to have more time to enjoy on Saturdays, which have unofficially become "Get Everything Done That I Couldn't Get Around To During The Week Because There Aren't Enough Hours In The Day"-days, during which I get the floor sweeping/mopping/vacuuming, general cleaning, and other organizing done. Ditto for any days off...
• Be around for "playdates" and other social occurrences that are a virtually impossibility for working moms...Especially since every one of my mom friends (and all but one of my in-laws) are stay-at-home moms, it's hard for me to miss out on that stuff all the time! "Let's get together tomorrow afternoon and the kids can play!" Yeah, I don't think I'll be able to get off work for that, unfortunately...oh, and that last-minute baby shower/Pampered Chef party/whatever you invited me to? Sorry, I'd love to come (really, I would!) but if I take the time out to go, I'll be catching up on laundry and assorted housecleaning duties for the next week.
• All of that crafty/artsy stuff I used to do? I haven't had time for any of it in oh, about six months! Working and taking care of the baby (and house) is all I have time for every day, and even at that, something usually gets left out. I have a quilt for my baby girl that I started long before she was even conceived that is still sitting on my sewing machine, about 75% quilted and needing to be binded, but who knows when I'll ever have time to finish it. Oh, and I can pretty much write off any hope of ever doing anything on Pinterest!

Yes, I know you don't spend all day doing fun activities you saw on Pinterest, but that's the way I like to imagine my future life as a SAHM...

I know that being a stay-at-home mom is hard work too (I got to do it for a couple of months, let me remind you!), but right now I have to manage doing everything a SAHM does while working, because there's nobody else around to take up the slack. As much as I love the hubby, he hasn't come around to helping more like I expected he would since I've been back at work, so I'm stuck doing everything I did while I was at home plus working during the day...which is pretty much impossible.  I'd never choose to work full-time if I had the choice. Part-time I could easily do (and would want to do), but I would LOVE to not have to come in Every. Single. Day...Forever.

I don't know what the solution to this dilemma is, and I know that there are tons of people who are much worse off than I am. In fact, I probably sound like a spoiled brat compared to a lot of people! But when you spend the little free time you have surrounded by people who are living the life you want to have, it's a constant reminder of what could have been. On the flip side, I'm sure that some of them wish they could do what I'm doing rather than staying at home...the grass is always greener, right? I completely realize we all idealize the other side of things, and I know I need to work on being happier where I'm at now instead of longing for what (right now, at least) is unattainable. I just hope that by the time Baby Girl is a little older (before she goes to school!), it will be possible for me to spend some time with her at home...


 ‎**Let me just say, it's not my intent to offend you moms who do get to stay at home by trivializing what you do in any way! I'm simply making the point that because of my health status, I'm forced to work rather than having the choice. And when you don't have a choice in what you do, it makes the "doing" so much more difficult...especially when all of the moms you hang out with are doing what you wish you could do! I feel like I'm missing out on a lot, both with my baby and socially, because I literally don't have time to do anything but work-both at my job and at home...

Patient Responsibility...And a Baby Update, Of Course =)

My last posts haven't had as much to do with diabetes as much as with my pregnancy and subsequent labor/delivery, so today I thought I'd go back to my roots for this one...although I'll preface with a baby update =)

Our little one is doing great--at five weeks old, she's growing and changing every day!  I was looking at some pictures of her from while we were in the hospital and right after we brought her home, and I was amazed by how different she looks already.  I also can't believe that she's already five weeks old...the time is already going by so fast =(  We had our first health scare last week when our baby girl started coughing at night, but luckily a trip to the pediatrician (an hour and a half away) relieved our fears--she just had a head cold, and the cough was from the accompanying drainage.  Nonetheless, I was glad to have answers since we were told that while sneezing in a baby was normal, coughing was not.  Not to mention that there's so much sickness going around right now...even though we've made it a point to stay home during these vulnerable first weeks, we still have visitors and can't avoid being in public for checkups and the like.

Even though I didn't think it was anything serious, I couldn't help but worry about her--especially since I'm at home with her most of the day by myself with only my thoughts to keep me company!  I know it's only the beginning of parental worry, but that doesn't make it any easier to deal with...even as we sat in the (sick) waiting room of the doctor's office, I couldn't help but think that if she wasn't sick to begin with, she might be by the time we left due to the older kids who were coughing around us!  Thankfully, though, everything turned out fine.  At the end of the week, I had to go back for my postnatal checkup where I had an IUD (Mirena) put in...as much as we love our little bundle of joy, I doubt we'll be ready for another one for a couple of years!

While we were in the waiting room, I had to buckle the little one back into her car seat since I'd just put her in there after feeding her in the parking lot before the appointment.  I quickly realized that was a mistake, because as soon as she was uncovered, a woman with her pregnant daughter and two-year-old grandchild came over to investigate.  I know it's a first-time parent thing, but it took everything I had to not go all "mama bear" on them as the grandmother kept pushing the toddler towards our car seat telling her to "look at the baby!"  I simply finished buckling her in while my mom answered their questions, and bundled her back up!  Let me just say, I have no problem with people I know getting close to or holding our little one (as long as they're not sick and their hands are clean!), but random strangers?!  I'll be the first to admit it freaks me out, and I won't apologize.  After all, how do I know that the toddler wasn't sick?  It may sound a little extreme, but pertussis (whooping cough) can kill a baby our little one's age, so until she can get her first dTap vaccine (at two months), she's vulnerable...and it's our responsibility to protect her.  For that reason, we're following our pediatrician's advice of keeping our baby girl away from public places (and other young/unvaccinated children) as much as possible until the two month point...which means no church, grocery store/Walmart trips, or hanging out with our friends and their kiddos.  It's hard, but at this point our social life is much less important than keeping the little one healthy!

Okay, now that we've got all of that covered, down to business =)

I placed an order for glucose sensors for my CGM (Continuous Glucose Monitor) on February 10th, but never received notification that it had shipped.  On Monday, I called Medtronic and found out that the holdup was that my endocrinologist hadn't faxed the certificate of medical necessity back to them.  After having Medtronic re-fax the form, I called my endo's office to confirm they got it and let them know that I needed them to fill it out and return it ASAP...our new insurance year begins March 1st, so I needed to have my order shipped by today in order for it to be covered under this year, for which we'd already met our (ridiculously high) deductible.  They said they would get it taken care of, so in the meanwhile I checked the status of my order online on a regular basis.  By today, I was starting to get nervous.  I called Medtronic back to find out why my order still hadn't shipped, and found out that my endo hadn't checked the CGM box on the prescription form, so they were going to have to fax it to them once again to be signed.  This afternoon, I called the endocrinologist's office to make sure they received it and to give them the instructions on properly filling it out and sending it back.  A while after that, I called Medtronic (again...thankfully you get to talk to a different person every time, otherwise I'm sure they'd be tired of me by now!), only to find out that it would take 24-48 hours before the prescription certificate would be reviewed and scanned into their system.

As a result, I was forced to cancel my order...there was just no way, with the medical bills we're fixing to have to pay from the c-section and hospital stay and my husband's taxes that will be due in April (on top of our usual bills, baby stuff, and my insulin pump supplies, which run $492.80 every three months), that we need another $1,000 (the rough amount we'd be responsible for with the 20% insurance discount for my three boxes of glucose sensors) to worry about paying.  My parents offered to help, but I don't feel like that's their responsibility.  So right now, I'm disappointed and frustrated.  Disappointed that I'll soon run out of sensors, because even though I only use them occasionally now, they're super helpful in keeping an eye on my blood sugars as well as in adjusting insulin rates.  Frustrated (extremely) that everything was finally resolved to get my order out one day late, which is just my luck--a day late, a dollar short!

I'm mostly frustrated with my endocrinologist, because I suspect that the reason my form wasn't filled out and returned sooner is because he was on vacation (several members of my family also see him, and their stuff was just taken care of yesterday as well).  I have nothing against vacations, of course, but it would have been nice for his office to have called and let me know so I would have known why my order was delayed for more than two weeks.  Now I'm stuck with no sensors, which admittedly aren't as much of a necessity now that I'm no longer pregnant, but are still an integral part of my diabetes management...unless we end up meeting our deductible elsewhere, which is unlikely since my insulin pump supplies for a year don't come close to that amount, or I order a smaller quantity of supplies at a time.  I guess we'll see what happens!

Probably the suckiest part about the whole ordeal is the realization that I wouldn't have even known why my order was held up had I not been persistent about getting to the bottom of it.  As if living with diabetes isn't hard enough, I hate, hate, hate having to deal with the financial and political parts that come along with it...and on the spectrum, I'm very active in my health and d-management.  I sometimes wonder how people who aren't as involved in their healthcare do it, because I have to be very on top of things to ensure I get the care and everything else necessary to manage this disease.  It certainly begs the question of how much responsibility a patient should have in their healthcare, especially when a disease like diabetes (and insulin!) is involved...I can't help but question whether all PWD have to deal with the same things I do, or if doctors simply evaluate how much freedom (and therefore responsibility) to give their patients on an individual basis.  I honestly believe it's the latter, because I know that my endocrinologist has been pretty laid-back as far as how often he sees me (every quarter, even during my pregnancy, whereas he saw my sister every month or so during hers, and my next visit will be five months from the last...) and the level of control he gives me over my own d-care--I make the necessary changes to my insulin rates based on my blood sugar logs, and contact my CDE (rather than my endocrinologist) if I run across any problems.

I know from reading other diabetes blogs and from other PWD that I know personally that the level of control patients are given varies greatly, but sometimes I wonder if some of us are given too much responsibility when it comes to making sure things happen the way they should regarding our healthcare issues...I know in this instance, I would have rather not had to taken so much time and put so much effort into finding out why my supplies hadn't been shipped!

The Great Vaccine Debate

I decided yesterday that it was time for a change, so I revised the design of my blog and even got a new profile picture to match-and it actually looks kind of like me, so I thought that was pretty cool!  Every time I decide to embark on a blog makeover, I end up all tense with achy-shoulders from trying so hard to find the right html code to change in order to get the look I want, because the templates rarely work 100% for me.  Anyway, I somehow managed to get it decent-looking, so now I can finally relax!

I had another OB appointment on Tuesday, mainly to do the blood work for the quad screen prenatal testing that we decided to go ahead with.  Long before I was pregnant, I was undecided on the issue of finding out the risk level of having a child with a genetic defect or disorder (like Down's Syndrome or Trisomy 18), but since then I came to the conclusion that IF there was something wrong with our child, I would want to know before birth so I could be prepared for the challenges we'd have to face and get somewhat more mentally/emotionally adjusted to the fact, if that's possible.  A big needle stick (like I'm not used to that...), and 10 days later we should have our results.  They said no news is good news, so that's what I'm hoping for!

Prenatal testing, as I've discovered, is just one of the many difficult parenting decisions you have to make before your child is even born.  From breast/bottle feeding to the circumcision issue for little boys and even pacifier use (or not), there is plenty of controversy surrounding all of these choices.  People on both sides of every issue are passionate about their position, and few are willing to modify their ideas.  None of these debates, however, is quite so polarizing as the issue of vaccines.

Every time I come across an interesting article on vaccines, I post it to Facebook.  I am absolutely pro-vaccine, and passionately so...therefore, whenever I encounter these articles online, I opt to share it with my friends because I think everyone should have the best information possible to base parenting decisions on.  The first was an article about pediatricians who refer kids that aren't vaccinated to other physicians--as the article says, "no shots, no service."  The American Academy of Pediatrics stated that by instating policies like this, these pediatricians might be preventing unvaccinated children from receiving proper health care.  The bigger issue in my eyes, though, is that these children aren't being vaccinated in the first place-is that not considered "proper health care" too?  After all, babies can't decide whether or not they receive vaccines; it's the parent's choice.  And with so many rampant rumors and misinformation on vaccines, more and more parents are making the decision to not vaccinate their children or to delay their shots based on invalid information and anecdotal evidence from parents who claim that their children were injured by vaccines.  The thing that saddens me most is that these children aren't receiving the recommended health care because their parents either do not have access to accurate information, or simply choose to believe that the vaccine schedule is part of a big government/pharmaceutical conspiracy.  What they fail to realize, though, is that vaccines offer very little profit for the manufacturers (especially compared to other pharmaceutical drugs), and that the government has little to gain from children being vaccinated other than an assurance that the threat of disease outbreaks in the country is reduced.  I am not saying that politics do not influence medical issues and vice versa; I am just saying that given the current situation, I do not believe the vaccine conspiracy theory that anti-vaccine advocates are so quick to force.

In all honesty, I think that vaccines should be required by law in all children who aren't allergic to them or have compromised immunity for whatever reason.  The reason I believe this is very simple: the more children who aren't vaccinated, the greater the threat to herd immunity.  The second article I posted regarding vaccines on Facebook was a story about a little boy with leukemia who could not be sent to day care because his parents could not find one in which all of the children had been vaccinated.  The reason this was of such great importance was because this little boy, whose immune system was compromised due to chemotherapy, could not receive vaccines during his treatment--therefore, he (like many others, including young infants and other immunocompromised individuals) relies on herd immunity to protect him from the diseases that vaccines would ordinarily offer protection against.  The problem that scientists and doctors are seeing, though, is that in communities where so many parents are making the choice to not vaccinate their children, herd immunity is compromised so much that diseases that were once thought to be basically eliminated from the modern world are gaining a foothold once again.  As a result, children (both those who are too young or cannot receive vaccinations due to compromised immunity and those whose parents choose not to vaccinate them) are dying of preventable diseases.

Regardless of your views on vaccines, you only have to look at recent news stories to know that this is true.  Last year, the pertussis outbreaks in several states were devastating.  The numbers of children affected by the disease were disproportionately higher than previous years, and many investigators believe that it is at least partially due to the anti-vaccine movement.  It's pretty simple, really: the more unvaccinated children in a given population, the lower the percentage of vaccinated individuals; the lower the level of herd immunity, the greater the chance of disease outbreak.  What scares me the most about this is that the diseases that are emerging in epidemic proportions again are so threatening to babies who are too young to receive the vaccines that would protect them.  The first shot for pertussis, for example, isn't given until 2 months as part of the DTaP vaccine.  Before then, babies are vulnerable to the disease, which can kill an infant in a very short amount of time.

What I've encountered in posting these articles is that anti-vaccine proponents are quick to say, "Well if vaccines do such a great job of protecting your child, you shouldn't be worried about my unimmunized child making them sick."  No matter how often I get this reaction (and it happens surprisingly frequently), it still frustrates me to no end.  First of all, who are you to tell me that I shouldn't be worried about my child's health?  Of course I'm going to worry about my little one getting sick, and I absolutely worry about them being exposed to unvaccinated children for this very reason.  Secondly, if you know ANYTHING about vaccines, you know that they aren't all given on day one...so until they're given the vaccination for a particular disease (which may be months down the road), they're vulnerable to it--it really is that simple and obvious.  The more I've thought about it, the more I realize that this reaction is just part of anti-vaccine advocates' self-affirmation toolkit--the more that they can convince themselves that their children aren't going to be infected with and/or spread diseases, the more they believe they're making the right decision in not vaccinating them. 

I've also found that anti-vaccine supporters tend to surround themselves with people who think the same way they do.  My husband was raised Mennonite, and although he received all of his vaccines and believes the same way I do, there are a lot of people within that group who are part of the anti-vaccine movement due to all the popular horror stories and rumors of vaccine injury.  As Seth Mnookin points out in his book "The Panic Virus", being around other people who support your way of thinking seems to validate your decision: "[...]sustained encounters with a small group of like-minded people almost inevitably lead to the conclusion that everyone thinks the way you do." (pg. 141, Nook version)  Never mind that 90-95% of the population in almost any given area of the country vaccinate their children; being around other anti-vaccine advocates (who are part of the other 5-10%, mind you) confirms that you're making the "right" decision, even if it goes against what the majority of the general public does.  I'm not saying that the majority way is always the right way; it's simply that on this particular health issue, it's logical to assume that if virtually everyone else is vaccinating their children without ill effect, you can be reasonably confident that your child is not going to suffer any adverse reaction from being vaccinated as well.  In fact, the chance of contracting one of the vaccine-preventable diseases is about 20 times greater than being injured in any way from the vaccine.  To further break those numbers down, if the risk of being infected with disease X is 1 in 1,000, the risk of having any ill effects from the X vaccine would be 1 in 20,000.  Furthermore, the transmission rate of most of these diseases is anywhere from 80-100%, so that gives you a 0-20% chance of NOT contracting the disease if you're not vaccinated against it.  Given those odds, I don't see how anyone would willingly not vaccinate their children without a valid medical reason.

Anti-vaxers also like to make the argument that if their child is sick, they're not going to expose them to others.  However, this is a simple statement to refute as well.  Many of these vaccine-preventable diseases have incubation times that are such that you could go days or weeks without realizing your child has been infected before they start to have obvious symptoms.  Pertussis, for example, first appears as a normal cough/cold before turning into full-blown whooping cough.  What parent keeps their child home from school (or any public place) every time they have a simple cough or cold?  I'd wager that it's not many. 

I've had this debate several times on Facebook, and one person even asked me point blank what the chance was of their unimmunized child giving a vaccinated child one of these diseases.  Never mind that the point of the article at hand (the one about the boy with cancer) was the danger posed to children who couldn't be vaccinated (yet), or that the occasional immunized child who for whatever reason does not get full protection from the vaccine(s) they receive also relies on herd immunity; this is what I replied:

[...]Therefore, the disease transmission rates (percentage of susceptible individuals who will become infected by an infected individual, where the susceptible individual is a person with a compromised immune system or one who has yet to receive the vaccine due to being too young) vary based on the particular disease. For pertussis, the transmission rate is 80%+. For measles, it's nearly 100%. This means that when a non-immunized child becomes infected with one of these diseases, the chance that they will infect a susceptible child they come into contact with is 80-100%.

As mentioned previously, there have been many recent cases in which a non-vaccinated child contracts a disease and in turn causes an outbreak. Most notably, there were 21 cases of measles outbreaks in Minnesota in April this year, of which 85% or more were linked to one unvaccinated child. In Utah, another child may have exposed up to 1,000 different people in two different events to the disease. The pertussis outbreaks last year have been linked to the large percentage of children who were nonimmunized, infecting infants who were too young to receive the vaccine and for whom the disease is often fatal. So clearly, it's a very real issue, especially when it comes to the recent epidemics of vaccine-preventable diseases in the U.S.

I also linked to two more articles (here and here) about how recent disease outbreaks have been linked to the anti-vaccine movement and how it is fast becoming a social health issue.  Never mind that the original "study" linking vaccines to autism, conducted by Andrew Wakefield in 1998, has been found to be fraudulent (and, in fact, clearly should have never been published if you read chapters eight and nine of Seth Mnookin's "The Panic Virus") and completely baseless, emerging from his illogical connection between the measles part of the MMR vaccine and bowel disease (yes, bowel disease), leading ultimately to autism.  Even after hearing about the Wakefield study being invalidated, I never realized the full ridiculousness of his claims until reading Mnookin's book.  No matter how crazy and unfounded, however, it is easy to see how claims like Wakefield's can so quickly influence the public's perception and how difficult it can be to undo the damage once it is done.  The media loves a good public health scare, and articles confirming vaccine safety aren't as newsworthy or attention-provoking.  Therefore, once the public is sufficiently enraged over a perceived issue, the retraction or correction barely registers in the collective psyche.

More recently, a review of the current literature on vaccines was completed by the Institute of Medicine (a division of the National Academy of Sciences) and confirmed that vaccines are generally safe.  Before anti-vaccine advocates can shout bias or conspiracy, it is important to point out that this study is unique because it reviewed over 1,000 existing studies on vaccines.  So unless thousands of scientists are publishing falsified research in legitimate, peer-reviewed journals (unlike the some other "scientific" publications, which will admittedly publish any article, even those that appear to be questionable at the onset), it would be hard to refute these findings.  On a Facebook page for Pregnancy and Newborn Magazine, which posted a link to this article after I did, Organic Baby University commented on the link that "I would love in just one article or news piece from someone to provide the actual studies they used to determine no correlation. Never seen a link or attachment or anything to provide the public with the ability to read those studies that prove it. Just that they exist. As educators we would love to read the scientific studies!"  Another person and I both replied with the link to the bibliography from the study.  Perhaps after reviewing 1,000+ research articles, some anti-vaccine advocates will feel more comfortable with the conclusion that vaccines are, in fact, safe. However, there will always be those that dismiss any evidence in favor of vaccines as part of a conspiracy, even though this review was completed by an 18-member committee and included research by thousands of scientists!

That's the thing that has been the most striking about this debate for me--no matter what evidence you provide to anti-vaccine proponents, they would rather believe anecdotal "evidence" from people who have no medical background (not that I claim to have any medical training; I simply rely on facts from those who do to guide my decisions) over scientific fact.  Controlling for any potential biases, I just can't understand why anyone would believe that every single study confirming vaccine safety and neccessity is somehow "not real," or not to be trusted, or that peer-reviewed studies should not be used as a legitimate basis for decision-making.  Just last week, one of my closer friends (who does not vaccinate her child) deleted me as a friend on Facebook because she and her husband were offended by my posts on the subject.  She also took issue with the fact that my husband and I are choosing to not expose our baby (which will be born in February, the height of cold/flu/RSV season) to unvaccinated children until he/she can be immunized, because once again, she posed the question "If vaccines do what they say they do, why should you be concerned about our child?".  After I refuted this claim (again), I told her that my husband and I have every right to do what we feel is needed in order to protect our child.  I would rather take extra precautions to protect him/her and risk stepping on some toes rather than our little one getting sick when we could have prevented it.  I will choose protecting our baby over hurting someone's feelings any day, end of story.  I also told her that while I agreed that being a mom is a job that takes heart, I didn't see how my making educated decisions based on facts would make me any less of one.  I told her that if she chooses to believe other things over scientific fact, that's her decision-but it certainly isn't mine, and never will be. I simply could not make a decision about my child's health that goes against everything I know, simple as that.

I know that all of these people who choose not to vaccinate their children do so out of legitimate concern for their child's wellbeing and feel that they're doing what is best for their children, but it saddens me to know that they do so without accurate information to base their decisions on.  I believe that parenting decisions should be left to the parents until those choices affect my child's wellbeing-or theirs.  There is a reason why you can't get a religious or philisophical exemption for drunk driving or illegal drug use-it's an issue of public health and safety...The thing is, I don't know how many more children are going to have to die from preventable diseases until something is done about the issue.

What I've Learned in Six Months

The day before yesterday marked six months since I was diagnosed with diabetes.  In a way, I can't believe it's already been six months; on the other hand, I've learned a lot in that short amount of time.  One thing is for sure: it's been six months of disbelief, anger, and heartache; reflection, self-assessment, and hard work.  I would be remiss to say that I haven't had any d-related joy or happiness, though, because it's a wonderful feeling to know you're getting your numbers (and, therefore, your health) on track.  The day-to-day victories over your blood glucose are hard-won and fulfilling, and the knowledge that you're leading a healthier life is the bright spot at the end of the tunnel.  To sum it up in 420 characters or less, here is my Facebook post from February 23rd:

Today marks six months since I was diagnosed...I can't believe it's been that long already & how much I've learned since then. My life has changed so much, but it's given me the chance to become the healthiest I've ever been, & I'm thankful for that. I'm also thankful for such an amazing husband, family, & friends...You have all been such an amazing support through it all, & I love you guys! ♥

I've learned a lot in the past six months, both about diabetes and about life in general.

1)  I'm a lot stronger than I thought I was.  When one of your biggest fears becomes reality, you learn a lot about what you can really handle...and for me, it was more than I expected.  I came across a quote that says, "You never know how strong you are until being strong is the only choice you have." and it's so true.  Diabetes doesn't give you a break--it's a 24/7, 365 & 366 on leap years kind of responsibility.  Sometimes I don't want to be strong...I'd rather just be normal!  But unfortunately, I don't have that option.  I just have to do the best I can to try and stay positive and motivated, and not let this disease take over my life.

2)  It isn't as bad as I initially thought it would be.  When I was first diagnosed, I thought finding out I had Type 1 instead of Type 2 would be the end of the world...but it wasn't!  The first month or two, I wore my incorrect Type 2 diagnosis as a badge of honor, telling anyone who asked that I was "just managing it with diet and exercise" (thank you very much).  Then my numbers kept creeping up, and I started on oral meds (Janumet).  I did feel the sting of failure then, because I couldn't claim the "diet and exercise only" treatment medal of honor anymore.  Fast-forward to a month later, and I chose to begin insulin therapy to gain better control of my still upward-trending numbers.  Not even two weeks after starting on insulin I got my pump, and the rest is history!  The pump has made my life so much easier, and a little more normal (whatever that is), which is huge for a PWD.   

3)  Life (and diabetes) is a rollercoaster, and sometimes we're just along for the ride.  Any PWD will tell you that this disease is unpredictable even in the best and most stable of conditions.  You could eat and do the exact same things two days (or even meals) in a row and get completely different results.  This can be difficult and very frustrating at times, because just when you think you have things under control, diabetes rears its ugly head again and you're in the 300s.  The days when you start low are often the most challenging because you find yourself chasing highs and lows for the rest of the day. 

Today is a prime example of this phenomenon for me.  I woke up at 68, corrected, and was at a respectable 106 before breakfast.  I bolused for my meal, then two hours later ended up at 209.  Breakfast was, admittedly, an unusual one for me since I normally only eat something light--this morning, my mom and I went out for breakfast and shared an omelet and some biscuits and gravy.  I ate a reasonable portion and set part of my bolus to be delivered over 30 minutes to cover the fat content of the meal, so I thought I would be in my normal range afterwards. I'm not sure if it was a rebound high, or if I underestimated the carb content of my meal, or if it was just because I'm not used to eating those types of foods for breakfast...or a combination of those factors that led to my post-meal high.  Either way, I did a partial correction since I still had insulin active in my system, and was at 176 before lunch.  I decided to eat a chef salad with a few crackers and some dressing since my BG was higher than normal, and bolused on the generous side for my meal.  Two hours later, I feel the familiar symptoms of a low, and sure enough, I'm at 68 again.  I ate a slice of strawberry cream cheese pound cake (20g of carbs, first ingredient: sugar), and 30 minutes later I'm sitting at 84 and hoping I'll stay there for a while.

I haven't started using my CGM (Continuous Glucose Monitor) yet, but I'm pretty sure today's BGs would look something like this:

4)  Blood glucose numbers should be just that: numbers.  As anyone who knows me personally or follows this blog knows, I'm a perfectionist through and through.  I had one "B" in high school, and graduated with a 4.0 from Texas Tech in August '09.  Some call it a type A personality; others, a control freak.  Call it what you may, that's who I am.  I don't like situations that I don't have some level of control over; I loathe last-minute plans.  So you give me a blood glucose meter and tell me what my range should be, and I'm all over it like white on rice.  The biggest challenge of my first few months with diabetes was trying to see those numbers as information for treatment rather than a grade.  No matter what I knew logically, those numbers were a measure of my self-worth.  If I had a "good" BG day, I owned my diabetes.  If I had a "bad" BG day, however, diabetes controlled my life.  I've had to work long and hard to change my way of thinking, because I knew it was flawed.  I would like to think that I now have a much healthier, more balanced way of managing my diabetes, but I know there's always room for improvement (and there's my perfectionist side coming out again!).  I found this sign the other day, and sooo wanted to buy it...But I didn't know where I'd put it:

Ahh, how great it will be when I truly start believing it, rather than just trying to move in that general direction!

5)  I'm not alone through all of this.  Even though my Dad has Type 2 and my sister is a fellow Type 1, I felt completely alone when I was first diagnosed.  It seemed like no one in the world around me had a clue what I was going through, so nothing anyone said really sunk in...after all, who were they (all normal and healthy) to tell me I would be fine?  It didn't seem fair that everyone else got to go along eating whatever they wanted, not giving a second thought to a food's carb content while I analyzed everything that went into my mouth.  I went through the "it's not fair" thing so much in the beginning that I could smell the corn dogs and funnel cake.  "How come I (the one who always ate healthy and tried to stay a healthy weight) ended up with diabetes when there were clearly so many people around me who lived much unhealthier lives than I did?"  "Why does everyone else get to have babies and not worry about how their body is going to affect their baby's health and wellbeing while I have to go through months of hard work just to get to a point where I can safely become pregnant?"  "Why do my friends get to stay home with their kids while I'll have to keep a full time job the rest of my life just so I'll have insurance to afford my medical care?"  It's not fair, not fair, NOT FAIR.  Then (as my perspective returned) I realized that while I had a chronic illness that wasn't going to go away, there were plenty of other people who were dealing with much worse things.  One of our friends just went through their little one having open heart surgery to correct a congenital abnormality, and another has a baby who has gone through lots of kidney issues.  All of it makes me see that each of us has something to deal with; a cross to bear, if you will; and in the end, it's all about how we deal with what we're given.  Life isn't perfect, we're not perfect, so why should we expect everything to be that way?

My husband, mom, family, and friends have all been an incredible support system during the past six months, and I am incredibly grateful for all the kind words, encouragement, and reality checks they've given me.  I try to do a lot on my own, but once I realized that's not always the best way, I've come to really appreciate and welcome help from others, even those without diabetes who have "no idea what I'm going through." =)

6) Diabetes doesn't have to control your life.  This was another tough one for me.  Being the perfectionist I am, things are often "all or nothing" in my mind.  With diabetes, I soon learned that it's all a balancing game, and that you can stay somewhere between obsession and neglect most of the time.  At first, my life revolved around managing my disease.  I was constantly thinking about it.  Now, especially after getting my insulin pump, I'm able to forget about it until it needs attention (which we all know is frequent enough).  Diabetes is still a huge part of my life, but it doesn't define who I am.  I'm more relaxed about the higher readings I get every now and then because I know that overall, I'm doing a good job.  One big lesson I've learned is that when I'm not so worried about my numbers, they're a lot better.  Go figure.  Since I've been on the pump and not stressed about my numbers so much, I've brought my overall average down to somewhere around 116-120.  Now if I can just continue that trend, I'll make my goal A1C (6% or less) in May...and hopefully get the go-ahead for pregnancy!

As with all chronic illnesses, diabetes is tough.  It's not only a physical disease, but an emotional and psychological one as well.  If you're not careful, it takes over your life one way or the other.  But with enough balance, humor, and support, I've learned that it is possible to not only live, but live well with diabetes.  As with most things in life, perspective is incredibly important when dealing with this disease.  Yes, it is a chronic illness, but thankfully it's now a treatable one.  And hopefully in the future, it will be a curable disease.  In the meanwhile, I'm going to just try to live the best I can with it.

World Diabetes Day

Week 2: ACT
Sunday, November 14

World Diabetes Day – Today is World Diabetes Day, recognized by the United Nations, so across the globe people are taking an action to raise diabetes awareness. What about you?

I'm so glad that diabetes awareness has taken on the global scene in the form of World Diabetes Day...Hopefully there will be a World Diabetes Month before too long!  My involvement in diabetes awareness really began in full force with American Diabetes Month at the beginning of November.  I decided that the best thing I could do to participate would be to share my experience with being newly diagnosed with the disease with the masses through this blog.  My hope is that I can help someone somewhere live better with diabetes, or at least feel like they're not alone in dealing with it.

If you've been reading my posts, you probably know my story; however, since we're halfway through the month, I thought I would share a little bit about my situation for those who may be new to the blog.  So...I'm Ashley. I'm 22 years old, an August 2009 graduate of Texas Tech University, and a newlywed since January.  A couple of months ago (August 23rd to be exact, and ironically, our seven month wedding anniversary), I was diagnosed with diabetes.  I saw an endocrinologist at the end of September, and was told that I had Type 2 diabetes that I could most likely control through diet and exercise.  Since then, I've seen a CDE (Certified Diabetes Educator), attended a Diabetes Education Class, and gone to a Diabetes Health Fair.  Through all of these things (and the 10 or so books I've read since my diagnosis), I've learned a lot about the disease and living with it.

I've been able to control my blood glucose relatively well so far with diet and exercise alone, but more recently, I've been dealing with some unexplained high readings that have led me to consider that I may, in fact, be in the "honeymoon" stage of Type 1 or "Type 1 1/2", or Latent Autoimmune Diabetes of Adults (LADA).  With this phenomenon, blood glucose is normally fairly well controlled with diet and exercise and perhaps the use of oral hypoglycemics (drugs that help lower blood glucose) for some time (sometimes months or even years), but eventually, the pancreas completely stops producing insulin and injectible insulin is required to avoid high blood glucose and the resulting complications.

At the Diabetes Education Class and Health Fair I attended this week, several of the health professionals commented on the unusual nature of my diagnosis--I'm not overweight, I'm young and in relatively good health otherwise--in other words, not their typical Type 2 patient.  They seemed unconvinced that that could be the case, and that I should really keep an eye on my BG readings in case I am in that honeymoon stage and Type 1 or 1 1/2 is just around the corner for me.

When I was first diagnosed, I would have given anything to be Type 2 instead of Type 1.  My younger sister was diagnosed with Type 1 Diabetes at 16, so I knew what a struggle it was for her.  My dad, on the other hand, found out he has Type 2 Diabetes a couple of years ago, and he was able to control his through a strict diet, weight loss, and exercise.  I suppose for me it's a control issue...I don't like not having control over situations, so finding out I have diabetes brought out that part of my personality even more.  In my mind, at least with Type 2 you still had some control over what your body did, whereas with Type 1 you're dependent on insulin to stay alive.

That was my thinking originally, but since I've had some time to deal with the shock of my diagnosis, I've come to accept a lot of things that are beyond my control.  If it turns out I have Type 1, so be it.  LADA/Type 1 1/2, ditto.  I would just like to know so I can do something about it.  Yes, I'm very much a Type A perfectionist.  And if I'm one of those two types rather than Type 2, I want to go on insulin sooner rather than later, simply because scientists believe that this may save some of your existing beta cells (the cells that produce insulin in your pancreas) and make the disease easier to control in the long run. 

It may seem like I've accepted my diagnosis fairly well, and in some ways I have.  BUT, I still have days where I'm overwhelmed by the disease and everything that goes along with it.  The constant finger sticks, worrying, watching everything that I put in my mouth, and exercising in a furious effort to keep my BG under control...It's a lot to deal with.  Thinking about the future gets to me too, because I worry about health insurance and starting a family, with all of the extra attention that comes along with being pregnant and having diabetes.  I try not to worry myself too much about complications from the disease, because I know that they're largely preventable if you keep your blood glucose under control...And that's something I fully intend to do, whether that means taking medicines that have unpleasant side effects or injecting myself with insulin several times a day.  And hopefully, my insurance will pay for an insulin pump so I can have better control over my BG.  But that's for another day...=)

Election Day

WEEK 1: SHARE
Tuesday, November 2nd
Election Day-What issues are important to you? If you could tell your representatives one thing about diabetes, what would it be?

First of all, I'm writing this on a blood sugar low. I'm shaky, hungry (the reason I'm low in the first place), but at least I caught it before I got to the heart racing, hot all over, confused-feeling point...I think. I'll give my fast-acting glucose tablets a few minutes to work, then eat the apples and peanut butter that I was going to eat 30 minutes earlier (but instead got preoccupied with exploring my new laptop.) Incidentally, I left my blood glucose meter at home today on accident, so I'm just having to go by how I feel. I think this is the first time I've forgotten to put it in my purse before leaving for work since my diagnosis!

This is just another example of what it's like to live with a disease that doesn't let you forget about it. You can't exactly "go with the flow" or be spontaneous, especially when it comes to what and when you eat. I bug my husband incessantly when we're going out to eat about where we're going so I can look in my purse-sized calorie/fat/carb guide and decide what to order ahead of time. Sometimes, though, I still end up standing at the counter (i.e., Taco Bell, on Sunday), book in hand, trying to decide what I can fit into my carb limitations. It doesn't embarrass me, but it does add an extra dimension of time-consuming complication to what are supposed to be fun times.

Now on to the theme of today's blog: Election Day

There are a lot of issues that are important to me for this election...I consider myself mostly conservative: pro-life, -traditional marriage, -capitalism, -personal responsibility, -limiting federal powers, etc. HOWEVER that is not what is important to the central idea of this blog. Healthcare is a huge, debate-provoking issue right now, and for good reason...It's our lives that are at stake.

As a person with Diabetes, this issue hits somewhat closer to home for me. As I mentioned in my previous post, one of my greatest long-term fears is the loss of insurance coverage--I had always planned on being a stay-at-home mom in the future once we have kids, but now I'm not sure if that will be possible. Right now, one of the benefits of my full-time job as a CAD Drawing Technician is health insurance. If it weren't for that, I would have already spent over $350 in Diabetes testing supplies alone in the last two months. Test strips cost over $1 apiece, which adds up quickly...Especially if you're testing as often as you should. At a minimum, that's $365 in test strips over a year, if you're testing once a day. For more intensive Diabetes management, I test an average of four-five times per day, sometimes more. That adds up to $1,825 in a year at five tests daily...and again, that's just the cost of the test strips. There are also lancets, alcohol swabs, glucose tablets, doctors' visits, lab tests, extra dental and eye exams, more nutritions (and expensive) food...The list goes on. These are the things a relatively healthy person managing their Type 2 Diabetes without medications will have to deal with. For a person with Type 1, you can add to that list insulin, syringes, a possible insulin pump (which is a several-thousand dollar piece of equipment) along with all of the supplies it entails, and more. And if you have complications from the disease (kidney, heart, neuropathy, vision problems, etc.), there is another whole list of doctors' visits, medications, and even potential surgeries to expect.

The bottom line? Having Diabetes is expensive, if you're taking care of yourself like you should. Of course, if you just ignore the disease (not testing, going to the doctor, dieting, etc.) it's a lot cheaper, but you probably won't live very long! In a way, I feel as if I'm being punished for paying attention to my health and doing everything I can to make sure I don't develop complications from my Diabetes. It definitely isn't fair, but it's the way our system of managed care works. And I have insurance. A $40 specialist co-pay is bad enough, but I can't imagine how much the costs would add up without insurance. It is truly scary (and sad) to think about having to weigh your health against what you can afford.

Therefore, the one thing I would tell my representatives about Diabetes is that the current system works to penalize those who take care of themselves with preventative measures, and that has to change. It's hard enough to find the motivation to take care of yourself with this disease on a day-to-day basis without having to worry about finding the money to do it. I'm no political expert and I don't know what the solution to this problem should be, but I do know that people with Diabetes should be able to effectively, efficiently, and affordably manage their disease without having to fight against a system that is designed to exclude and neglect them. Insurance also has to be available and affordable to those with Diabetes--it's simply inhumane to deny coverage on the basis of preexisting conditions (after all, what else is health insurance for?) or to make it unattainable by radically inflating premiums and deductibles specificially because of them.

There's my soapbox for today! What's yours?