Monday, December 7, 2015

Bravery in Increments

When you have mastered numbers, 
you will in fact no longer be reading numbers
any more than you read words when you read books. 
You will be reading meaning.

W.E.B. DuBois 

If I were to script a handful of scenes that were, for one reason or another, pivotal points in my life, one of those would certainly be an exchange I had with a nurse in the hallway of the St. Francis ER almost two years ago.

I was returning from nursing the then seventh-month-old Henry when a nurse stopped me outside the room where Reagan & Trey were waiting, waiting for me, waiting for answers. She asked me if Reagan had ever had blood work done, to which I replied in the negative. She then said that Reagan's blood sugar was abnormally high & thus they were going to run the blood work again. When I asked how high, she said, "six hundred & thirty."

I didn't know much at all about blood sugar then. I could tell from the nurse's face that six hundred & thirty was not good, but had I known then what I know now, I'd have fallen out on the floor.

I can't remember if they did run the blood work again. I think maybe they had to, for protocol, before officially diagnosing Reagan with diabetes. In the weeks & months after that exchange in the hallway,  I learned exactly how high six hundred & thirty is when it comes to blood sugar.

I read the above DuBois quote at some point in the last year; I love it. There are so many, many numbers you see & think about day in & day out when diabetes is a part of your life. Last Monday when we were leaving the endocrinologist's office, the receptionist asked us if we needed a second printout of the sheet with all the doctor's instructions for Reagan's new basal rates to take to her school. I shook my head no, & the receptionist smiled & said, "Yes, it would probably be Greek to them."

It used to be Greek to me. It's not anymore, which is why I was highly displeased, but admittedly not shocked, that Reagan's A1C was an eight point two last week. That's our highest yet, up from a seven point six three months ago. I was expecting it to be up; I was certain it would be, what with Reagan being away from me three mornings a week over the past three months (one of those mornings being Cookie Wednesday).

I know it's Greek to most of you, but what the eight point two means is that Reagan's average blood sugar over the past three months has been closer to 200, as opposed to closer to 140-150, which is what her previous A1Cs indicated. I had a Scarlett O'Hara, as God as my witness!, moment in front of the nurse who delivered the A1C news.

I've known for months Reagan needs more basal insulin in the morning. The doctor wanted to up the morning basal rate last time we were in Jackson, at the end of August, but Reagan was days away from beginning school. The doctor wasn't comfortable (& I wasn't comfortable) making drastic changes knowing Reagan would be away from me three mornings a week. Additionally, there was no way to know how any potential anxiety over beginning school might affect her numbers. 

In retrospect, I should've made incremental changes to her morning rate over the past few months, but I never did because I so greatly fear Reagan dipping too low while she's away from me. Maybe what I needed to summon the courage to give her more basal insulin in the morning was an eight point two A1C, or the doctor's approval to make the changes, or both. Monday night, I plugged in the new numbers the doctor suggested. Tuesday morning, Trey dropped her off at school while I drove to Delta, controlling my shaking by gripping the steering wheel.

With all the basal changes, Reagan's pump now dispenses a total of seven units of basal insulin a day, as opposed to the six she's been receiving basically since her initial diagnosis. Everyone needs a different amount of basal insulin, based on their size, weight, & other individual factors. Given that it's been almost two years since she was diagnosed & she's grown taller & gained a little bit of weight, I knew she needed more, but not being a pediatric endocrinologist myself, I wasn't sure at what time(s) to give her more (the doctor also upped her afternoon rate a smidge), & I was terrified of increasing it too much & sending her low in the hours she's at school.

If there is anything neat about your child having diabetes, it's that you know exactly when they hit a growth spurt (nighttime numbers skyrocket because the body demands more insulin when it's growing), & you also measure their growth not only in inches & pounds, but in the basal insulin they require. The adult diabetics I've spoken with take anywhere from twenty to upwards of fifty units of basal insulin a day, if that gives you any perspective on Reagan's current seven units per day.

I think Trey thought I was going to cry &/or have some sort of breakdown in the doctor's office. I did grip & squeeze his knee pretty firmly when the nurse read the verdict. The moment we walked through the door & headed back to the car he began giving me a pep talk that, frankly, made me want to throw something. I didn't cry, not last Monday in Jackson or since then. Honest. My mind is in March, when we return to Jackson & learn, again, the number into which I read & reread meaning as if it were a Tennyson poem.

When we were sitting in the doctor's office last Monday morning discussing exactly how much to increase the morning basal rate (the doctor & I were discussing, Trey & Reagan were taking selfies with my phone), I watched our doctor doing calculations over & over. At one point, she shook her head & mumbled to herself, "No, let's be brave."

And it does take a little bit of bravery, to instruct the manmade insulin pump to dole out more & more insulin, knowing what too much can do, with the eventual result of too little insulin always on your mind. How much insulin does a forty-five pound child need? It's a guess, it is, even for the doctor. Hers is an educated guess, but I learned soon after Reagan's diagnosis that dosing insulin is an art, not a science.

Reagan's former morning basal rate was .325 an hour (that's .325 of a whole unit). We jumped from .325 to .4, breezing right past .350 & .375. It's a big jump (in my world, okay), despite being a minimal increase in actual insulin. A few more drops of insulin an hour can make a one hundred point difference in her sugar reading when we pick her up from school. On Tuesday, my mom texted me at eleven thirty to let me know Reagan was at 153; when they sat down to eat lunch, & Reagan's breakfast insulin was all done with its work, she was at 129. When my mom texted me that number, I did cry a little. I know I said there'd been no crying, but these were *happy* tears; I never gave in & had a pity party over Monday's disappointing A1C.

I apologize for this long entry in my diary of basal rate regret. I do have what you want.

Here's Reagan reading to me while we waited on the doctor:

Reagan smiling for me while we waited on our lunch at Another Broken Egg Cafe in Jackson. 

After I ate my lobster & brie omelet & drank a lot of coffee, I left Trey & Reagan & stole away to Ann Taylor Loft, where I purchased only one turtleneck. It's navy & gray striped; I bought it to wear with these navy slacks I typically only wear when I teach because they just scream, "Teacher Pants!" 

I saw this in Barnes & Noble. I didn't buy it because, if I'm honest, this blog serves basically the same function. 

Monday's A1C news was the low point of the week.

In fact, something magical happened on the way home from Jackson.

When Trey asked me what I wanted for Christmas, I told him I wanted XM radio in my car. We had this conversation at some point on Monday morning. On the drive home from Jackson, Trey spent about half an hour on the phone transferring the XM from his truck to my Highlander. He said he never listens to it, so he gave them some ID number for my car, & POOF!, it was up & running before we crossed back over the Mississippi.

I could write an entire blog about how this is changing my life. I don't want to oversell the XM, but IT IS CHANGING MY LIFE!.

There are many channels, & maybe I'll eventually check them all out, but right now I go back & forth between 80s on 8 & 90s on 9. It's like my life flashes before my eyes every time I get in the car.

I forgot, you know? I forgot how many, many amazing songs were a part of the 1980s. Another thing Trey did recently was clean up my phone, making room for me to take another 2,500 pictures. I am so excited to once again be able to take thousands of pictures, & here are a few gems from last week:

(I realize you can see my reflection (as well as the reflection of my long, kind-of-creepy-looking fingers) in the pics, but I want so much to share my musical joy with you that I don't care)

(These were taken at night, so no creepy fingers)

Did you forget that Amy Grant & Peter Cetera sang this amazing duet?! 

A walk through my teenage years:

Ahhh! Janet Jackson's "Again"

I can't adequately express what a joy it is to drive right now. Between Michael Buble's Christmas album, my recent purchase of Adele's new album, & my constant connection to the epic musical decade that was the 80s, I am searching for reasons to go somewhere in the car.

I've yet to take any pictures of our Christmas decor, with one exception. On Tuesday, my mom picked Reagan up from WEE school & took her to Hobby Lobby. They'd discussed purchasing some small trees, one for Reagan & one for Henry.

So that is the story of how I came to have sparkly pink & blue tree debris all over my house. Henry climbs in the bed with me at night,  blue tree in tow, & wants to sing "Jingle Bells." I know, Awwwwww!

You know what else is fun in bed? Reading Jane Eyre & drinking hot chocolate. That's awesome too. Oh, & not having blue tree trimmings in my sheets? Also awesome. 

I had a moment of reckoning on Wednesday. Henry & I picked Reagan up at school. I'd already decided I wanted to eat lunch at Cracker Barrel; I wanted Wednesday's lunch special (chicken pot pie), & I needed some new lipstick. 

Trey couldn't meet us for lunch, & so I found myself chaperoning the kids all by myself in the middle of  a crowded Cracker Barrel so I could eat my chicken pot pie & buy more Burt's Bees, which is the extent of my lipstick wearing at this juncture in my life. I had a little chat with myself on the drive home about how I felt about purchasing my lipstick & my favorite pot pie from the same establishment.

Yesterday was Trey's thirty-seventh birthday, an occasion I was able to photograph thanks to all the newfound space on my iPhone.

Once again, I'm signing off despite feeling I've a good deal more to say. I continue on Jane's journey, which is not short!, but things are picking up considerably. In fact, the book club is meeting this Friday, & thus Jane & Rochester's courtship is going to pass so quickly for me Jane would blush. 

I shouldn't even be writing this; I should be reading (or grading). I have two looming deadlines on Friday. My final grades are due at noon, & then the book club meets that night. Pressure mounts on all fronts. 

In addition to all the tedious end-of-semester rot I have to get done, I need to finish reading Jane Eyre AND prepare a list of book suggestions as we're going to make a 2016 Bookclub Agenda Friday night after we've thoroughly discussed Jane & Rochester. We're also doing a blind book exchange, so I have to figure out what book I want to foist on some unsuspecting member of my book club. Obviously the temptation to wrap up Twilight is strong.

Here's where you can help. If you have book suggestions, by all means, share. At present the only book I'm going to suggest we read in 2016 is All the Light We Cannot See by Anthony Doerr. So, if there's something you think the book club needs to read, let me know. I'd consider suggesting The Bronze Horseman, however two members of the group have read it (& its sequels) at my urging (& they loved it . . . looooooooved it).

Also, if you have a suggestion for the book exchange, that'd be great too. I don't know who'll end up reading the book I bring, but we're all educated, fascinating women who drink coffee, read widely, & enjoy sarcasm, if you need a few guidelines.  

I'd like to tell you that the clouds of busyness will all part Friday, but that's just not the case. I want so desperately to feel I have the luxury to talk endlessly about Jane Eyre, to take countless pictures of my Christmas tree & share them with you, to talk more about the music of the 1980s, to write a lengthy critical essay on the abysmal & frightening failures of President Obama. 

I can't promise you any of the above next week, for the upcoming weekend will be spent celebrating Reagan's fifth birthday. It's likely next Monday's post will be another expose on Bravery: the Children's Birthday Party edition. 

(p.s. I know I keep whining about deadlines & responsibility, but I could easily be persuaded to take a road trip, provided I can bring my Yeti & you enjoy riding shotgun while a woman with a (fairly) clean driving record & a revolver in the glovebox sings loudly)


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