Maybe There's a Coupon?

Yeah, so, I had a little bit of a bad day. As you might recall from my post a few months ago, I had a somewhat successful visit to my endocrinologist a couple of months ago, but hadn't yet gone to fill my prescriptions. Looking at my dwindling supply in the fridge the other day, I figured it was time, because that supply was not going to last me until August when I start working. I filled them last week. I went to the pharmacist with about 6 prescriptions, and she came back with 2 that were covered by my insurance out of those: the Lantus and my test strips. When I read the copay, I looked at the Lantus and looked at the One Touch strips. "How much is the copay on each of those?" I asked. "The Lantus is $9. The strips are $70."
I sighed. The strips were obscene. So, I opted out of those (I can get them for cheap using a cheap meter on amazon) and bought the Lantus, which I couldn't believe was so cheap. Mind you - this was the first time I'd filled an actual prescription covered by insurance in almost 2.5 years. I was ecstatic, but a little confused. My insurance benefits didn't look like they covered that much of my insulin, but I didn't question it.
My short acting insulin (Humalog) hadn't been filled though. "It's not covered by your insurance. They prefer Novolog," the pharmacist said.
I called my doctor the next day to ask him to call in a Novolog prescription instead. I liked the Novolog pens a little better anyways. For once, I actually felt really... hopeful? I had not expected my insurance to make my insulin so affordable!

So imagine me walking into the pharmacy today, expecting the same great copay on insurance. I'm so naive! I walked up to the drop-off counter and waited for someone to notice me. A man looked up from giggling with some girl that looked like a student and asked if he could help me. I was still wearing my Mercer "student physical therapist" name tag. I know this pharmacy used a lot of Mercer pharmD students.
"Is there any way I can check to see if my doctor called a prescription in?" He looked at my name tag, then asked my name and DOB. And then that's where the frustration began. "Yeah, you've got a few..."
"Is there one for Novolog?"
He looked at the screen. "Yeah. Ooooh, but ouch," be sucked his breath in. "Wow, but it's expensive! Are you sure you want that?" He looked at the student and they looked at me and smirked a little, giggling.
"Umm. How much?" I asked, blinking, somewhat abashed. He told me the number. I swallowed hard. Was that funny? Was this a joke? I needed it to live. It's not like affording it was even an option.

It was a lot more than $9, or some test strips I didn't want to pay for.
"But... aren't they covered by my insurance?" I asked. "Yeah, well, maybe it's not preferred by them."
"It is. They said they preferred it over Humalog. Why is it so much more than the Lantus?"

"Oh, well, that was paired with a coupon that week. You just got lucky I guess. Normally that would have been... wow, $400 for you! Could be that your insurance just isn't that great."

"Oh." I said, my spirits falling. "Well, what about this prescription savings card?"
He looked at it. "Yeah, um, that's just a generic card."
"Check. Please. I don't really know how this works or what else I can do."

He typed it into the computer. "Yeah, it'd be a lot more than even with the insurance. Maybe there's a coupon online?"
Someone else walked up behind me to fill a prescription. I frantically pulled up my phone and searched for any coupon. I downloaded one and got back in line after the other person had finished.

"This one is just like the other card you handed me. You didn't get a Novolog coupon?"

"They don't have any. Um. Are the vials any cheaper?" I asked.
He typed some more into the computer.
"So what program are you in at Mercer?"

I looked at him, then looked down at my name tag with the big "student physical therapist" across it.
"Physical Therapy."
"Oh, cool. What year?"
"I'm finishing up in May."
"Wow, congratulations!"
I looked at him, with what I'm sure was exhaustion and frustration emanating from my face.

"So. Vials. They're $70 per vial."

"Per vial?" That's more than they would cost individually in the 5-pack. Why?"

"I don't know."

"Well didn't Novo Nordisk just partner with some pharmacies for cheaper insulin? What about that program for $25 insulin at CVS?"
"That's probably just coupons too."

"There are no coupons. It's not. Isn't there something?"
"Well, no, probably not. So, do you want me to go ahead and fill this?"

I looked at him, swallowing back what were the familiar hot tears of years of frustration, underinsurance, exasperation, exhaustion, sadness. God, I didn't want to be diabetic anymore. I never asked for this.
"Um, no. No. I'll check back later," I said, turning away, holding back the tears again. The same old tears I'd cried for years, remembering these hard years, grateful at least that they were almost over.
I went to my car, let some tears fall down my face, looked up some patient assistant programs.
And you know what sucks about this all? I looked at the patient care assistant programs. They don't help you pay for your insulin unless you don't have insurance... which I was forced to get. Sighing, I put my phone away and drove home, giving myself a pep talk.
It was going to be okay. God had provided for me for years, through all of this hardship. Somehow, despite all of this difficulty, I had had insulin, whether through luck, the generosity of others, the foresight of doctors... somehow, I had had enough through all these years. And I'm frustrated, especially by the insensitiveness of the tech at Kroger today, but I'm thankful that I'd had enough. Here's hoping the blessed end to this struggle finally comes soon. It can't come soon enough,

Stress, School, Work, and Staying Positive.

Sitting in the white coat ceremony that afternoon, I kept pinching my leg not to fall asleep. My eyes opened and closed. They became dry from staring intently at the podium in front of me. I tapped my foot against the floor, trying every trick I could think of to not doze off.
I left the white coat ceremony in a hurry. Shedding my coat and placing it on my back seat, I donned a colorful tutu, shirt, and hairband and made the hour and a half trip in traffic to Stockbridge for a ninja turtle party. Pasting a smile on my face, I face painted and balloon twisted everyone's share of Leonardo and Michelangelo turtle faces, and then hopped back in the car and drove an hour and a half north to Cumming to do another party that Friday evening.

I'd just gotten back from Florida two days prior, then turned around at awoken at 6 to get to my first day of PT school Wednesday orientation at 8 am. I had a long stretch of 3 years ahead of me. I was excited but it seemed like a mountain I had yet to climb, and I wasn't even at the base of it yet. I was staring at it in the distance, not even knowing what I was fully in for...
I finished my second gig, stumbling out at half past 10, wiping the sleep from my eyes.
Suffering from an intense lack of sleep, I pulled my car into the side lot of the QT at the nearest exit I found, pushed the seat rest in my car back, and passed out for 2 hours, still in princess garb I'd changed into at a stoplight between parties that evening. It was almost 12 am when I awoke in the lot. I was exhausted. I somehow made it the 30 minutes south to my new home in east atlanta with the cold air blasting, windows down and music blaring.

It was only my second day of PT school orientation. The weekend was ahead of me, but I had 4 parties the next day and one on Sunday. I sighed. My first party was at 10 am in Macon, so I would have to wake up at 7 am to get ready...

School and work. Work and school. Tired, tired, tired. I have climbed that mountain for years now. I had nights where I cried from the sheer overwhelmingness of it all. Afternoons I'd come home from school and I'd fall asleep in my car the moment I turned it off, not awakening until it was dark out. I remember one afternoon during my first semester of PT school where it all felt like too much. I had too much personal stuff going on, my ex was badgering me, I couldn't handle it. I started sobbing at my locker before cadaver lab. I remember crunching it in spring, clenching my teeth, hoping I'd skin by in classes and make it through the hardest semester. Someday, this was going to be worth it, I hoped. Even if I didn't feel like I was "getting" it and I struggled more than everyone else. I could do it. I stayed up a little later at night to finish homework during the week because I didn't have the time on weekends. 5 hours of sleep was lucky for me. Rare Sundays I had off, I savoured like candy, soaking in the sun at bright, warm coffee shops, feeling normal for a second. I put myself through that, yes. Part of me likes the struggle, running a business, working. Honestly, I loved what I did - I still do. When I felt like I failed at all things physical therapy, I knew I was good at parties. At being a princess. It made me feel empowered and good about myself. Able bodied. Someday, I'd have enough experience as a therapist that doing physical therapy would be as comfortable to me as doing a party. Besides, I like to do things. I like to stay active. I have a very hard time staying still. I should in fact, be better about living in the moment instead of planning every little detail. I don't regret any of it - working and doing school. I've hated and savoured all the moments of the past 2.5/3 years. I've learned so much about myself. I've grown more confident. I've learned better communication. Better responsibility. Become a harder worker. Perhaps more importantly, I have more of a hunger to go farther, to learn more, I realize I've only reached the tip of the iceberg in what there is to know so far.

As I worked in clinic today, I had the privilege of going out into the waiting room and calling my patient back. He lept up as soon as he saw me...with a cane in his hand. A cane! He had been walking with a rolling walker the past few weeks with a horribly unsteady walk, one leg crisscrossing over the other in a pattern that was sure to cause him to fall if he wasn't careful. He looked so proud, and I was proud, too. He hand't just gained the safe ability to walk back. This was the demeanor of a man who looked confident and strong. And if I helped facilitate that a little bit, then I was blessed to have done my job. I was working with a woman somewhat less than ecstatic about being in therapy today. Her hat fell off revealing a head full of newly curled hair, which I told her I loved. She beamed at the acknowledgement, her face lighting up. "I just went out to get it done," she said. "I haven't been able to get out and get my hair done in a while, but I'm more comfortable about walking now," she said. (Sometimes it's not just about the physical therapy. People need to feel good about themselves).
There's a poem by Emily Dickinson that goes, "if I can help one bird into his nest again, I shall not live in vain."
These past few years have been hard, but they have not been in vain. I have discovered a lot of keys to staying sane, to using every moment wisely, to still finding things to love in life. Setting aside time for hobbies such as my dancing. Going on little day or weekend trips - to the mountains, or to Asheville, or Charleston - that breath of fresh air out of the city enlivens my soul and helps me breathe again. Those escape days to the mountains refreshed me and made me feel at peace and ready for the next day. And the nights I laid alone, feeling alone in a big city where I hardly knew anyone? I wrote them down in journals, and now I look back on them, at a time that now feels like it ended almost as soon as it began. You don't stay alone forever. Things fall into place. They all fell into place when I met my husband, and so much of my crazy, sometimes overwhelming life made sense. The world I'd tried very hard to learn to love alone became one I could share with a second person. The places I learned to love with the spirit of adventure on my own, simply for the sheer joy of loving them - became fond memories with the person I loved. The sadness of my past became things I chased away as we talked late into the night. And I had a helping hand to guide me through the difficulties as they still unraveled.

Wow, these past few years have been crazy. But as I'm nearing my final two weeks of clinic as a student physical therapist - man, have they been worthwhile. My life is still going to be full of struggles, but I'm here now. For a little while, I can start to breathe.

2 More Months!

Reality is setting in around me as I am in clinic for the last 4 weeks. Next week will make 3 more weeks until I'm back at school and getting prepared for graduation. I CAN'T BELIEVE IT! In little over two months I will be Doctor Lacy Mason, PT, DPT. I couldn't be more thrilled. Everything I've dreamed of the past few years is coming to fruition. The struggles of endless nights staying awake trying to study, the nervewracking competencies, staying at school until 11 pm (even when I desperately didn't want to be there) practicing this one last skill or that one presentation... this time in my life is coming to a close. My days are filled with seeing patients, documenting, clinic life. The work is hard, but I much prefer it to the rigours of school and the endless pounding out of assignments. Studying for boards is something I am imminently nervous of, but I plan to study over the summer so I'll be ready in July. Until then, I've filled my time looking into part-time jobs to make extra cash over the summer, made plans with friends to see them, and checked out my heart's content of books at the library to last me all throughout the upcoming months.

On the flipside, my husband recently started school this Spring to pursue his dreams of becoming a doctor. It's weird, having our roles reversed. When I first met him, I was a PT student just barely beginning my third semester of school, tired and frazzled and overwhelmed. My husband gently accompanied me through all of those difficult months. He was a patient practice subject for my friends and I, and he didn't laugh too hard when I did an evaluation component wrong or asked him to act as though he had a flaccid arm during an evaluation. He would brew me coffee late and night or in the early mornings, or make breakfast for me before leaving for school. He'd share lunch breaks with me in between class and keep me company while I studied at coffee shops. He drove me to work so I could study in between jobs, or drove us to hiking on Sundays off to allow me to finish my assignments and still have fun with him. My husband got me through my difficult coursework and some of the hardest semesters of my life, and it's in such huge part to him that he gave me the patience and confidence I needed to flourish both and school and as a significant other.
The roles are reversed: I drive to hiking now while he does school work. I keep him company at coffee shops while he studies! He's up late doing schoolwork and juggling classes while I am learning the finer points of working life. I don't mind the role reversal. I don't envy him - I'm glad I did my time and I'm also done. But I'm glad that it's my turn to mentor and encourage him, to let him know that the payoff will be worth it. The payoff is worth it - it's incredibly hard to juggle school and life and take risks for your future and apply to schools that dictate your future that you aren't sure you'll get into. It's hard having your entire life pretty much come down to a transcript. But we'll get him there.

This spring has got me thinking, "what's next?" I'm 23 - I'm married - I'm about to graduate. I've nearly met my "big" life goals. We aren't really thinking that we want kids. What kind of things do you do when your accomplishments have been met, when you've met the big goals? How do you fill your days? I've done a lot of soul searching these past few weeks to try and figure this out. We've attended church regularly. Made plans to hang out with old and new friends. Got library cards. We take weekend and day trips. We swing dance. I write. We still go on dates. I'm nerdy and I make 5, 10 year financial plans. I guess what I've found from this is that you need to continuously pursue growth and hobbies and passions. Do things that excite you, whether it's coffee once a week, biking, working out, dancing, seeing friends, visiting new places. Enjoying the here and now. For so long, I have had my eyes on the future. "When I graduate..." and, "when I'm done with school I'll do this, or this", or "If only I wasn't in school".
Those what-if's and when's are here now! Now I'm faced with their reality and I'm learning what to do with it all. I can't complain, though. I could certainly have worse problems than figuring out what to do with all of my days. Maybe my plans will involve more school in the future - I'm not really sure - but for now, I'm excited to begin job searching and beginning my career as a physical therapist. The future isn't without it's stressors, its ups and downs and trials, but it's looking bright.

Why I'm Glad I Went to a Women's College

Women are a popular topic in the news lately! Women's protest, women's empowerment, the birth control/abortion/etc./etc. debate... it's been interesting to watch. It started me thinking on how going to an all-women's school gave me a very unique perspective on what it is to be a woman.
I want to preface this by saying that my decision to attend Wesleyan was never actually because it was all girls'. In fact, this was almost a downside for me when I decided to attend, although I found it interesting and unusual for most colleges of today. I chose Wesleyan because they had wonderful scholarship opportunities, amazingly small class sizes, the faculty and staff was warm, personable and easy to get in touch with and, to be totally and fairly honest, because Wesleyan was in the same city as a guy I was dating at the time (judge as you desire haha).
I heard a lot of mixed things about Wesleyan prior to attending. "It's for Lesbians," and, "There's so much drama! Stay away!" and, "It's a really amazing school." "I can't see why it wouldn't be your first choice." And, from Grandpa, a solid nod of approval, "I like that it's all women. No men to bother you!"

Honestly, it's been the years following my graduation that I've really started to garner a deep and abiding appreciation for the education I received in undergrad. I have come to love Wesleyan more and more as the years have gone on. Wesleyan was full of its ups and downs. It's true, it was very small (less than 700 or so students) meaning fewer fancy amenities, so-so cafeteria food, and not really your "traditional" party or fancy college experience. It was quiet, downright ghost town-ey sometimes, and the weekends even more so. Geese wandered around campus and you could take quiet walks in the arboretum. Foggy mornings walking to class and quiet hallways. The dorms were cute and old and kind of retro, the library was no bigger than many small public libraries. The gym was tiny and no frills, the pool literally looked like something that belonged at the Biltmore estate, and forget Chick-fil-a or Starbucks on campus.

But Wesleyan gave me something a lot better than fancy amenities, quite honestly. Being a female majoring in science, my class sizes were never bigger than about 20-30 students at any given time. Some classes had only 8-10 students. This meant incredible one-on-one time with professors, and it meant we got to do hands-on techniques that some schools with bigger class sizes couldn't do (such as breed real fruit flies and hook up still-beating turtle hearts onto EKG's). It meant, if I had a problem with financial aid or classes, I could just walk in to see who I needed to without having to take a ticket and wait 2-3 hours. And I knew those people personally. They cared about my problems. My professors knew me by name. If I skipped class and they saw me on campus later, they'd hound me about it. The people in the cafeteria knew you and what you usually ate.

And other really unique things: class dynamic are just different when there are no males in the classroom. I'm not saying that having males is a bad thing. But honestly, it was such a safe and comforting space to be surrounded by nothing but other fellow, driven, hardworking females there simply to better themselves. There was less pressure to focus on looks, more space to excel academically. There was a sense of camaraderie and willingness to help your fellow women out. Women felt safe walking around campus - and it was a welcoming environment to really focus on education, not just boys or parties or whatever. There was a sense of empowerment that I think you can only get by interacting with other strong, focused, driven women.

Honestly, while I was going to Wesleyan, I wasn't really big on feminism. I never really have been. But over the years, I suppose I've come to realize that I do support feminism of a kind - recognizing the glass ceiling is there. Supporting fellow women in their endeavors. Supporting women who seek high level professions. Striving to rise up in a career of my choosing with no limitations. I'm a person that seeks success because I want it - not just a woman seeking success. I recognize that women from all different walks of life have different goals and ideals, whether it's stay at home motherhood, doctors, lawyers, CEO's, small business owners, travelers, you name it. There's so much beauty and freedom to pursue what you want. And it's all thanks to brave women in past decades who fought to help make the workplace more welcome for people like me who want to have successful careers. We aren't striving to simply catch up to men. We are equals who will not be held back. Feminism doesn't have to be what you think of it at its extreme: it can just as much be, being thankful for how women have fought for us over the years to change the workplace and give women all the opportunities that any person should have or want. That's why it's important.

Wesleyan helped me see the importance of femininity and womanhood all while empowering me to simply be the best person I could be. It built my focus, drive and confidence and helped provide an atmosphere that felt safe to grow as a person. It encouraged a good balance of femininity and grace, while encouraging drive and passion. Looking back, I had a really special experience, being empowered by fellow women of all races, nationalities and walks of life, striving for their own version of greatness in their lives, striving to be the best they could be. No, it wasn't the typical college experience... but to me, it was the only one I would have wanted. Yes, I had to get used to all-male classes again when I went to grad school (lol).
But Wesleyan was one of a kind, and it made me who I am today: a career-focused, proud, passionate woman who learned so much through having caring professors who took the time to really teach and push me. It was a comfortable place to let myself grow during the transition from a teenager to an adult.
It made me the kind of woman I always wanted to be, and I will always be proud to say I went to an all-women's college!

Starving in the Midst of Plenty.

Let me tell you a little something about Diabetes.

It makes you lose weight. Well, sort of. When you picture Diabetes, it seems almost counter-intuitive to think that. You think of sugar and the obesity epidemic and it doesn't seem like that would mesh with weight loss at all. Would it?
Insulin is so great because prior to it, diabetes - type 1, anyways - was a virtual death sentence. Kids would be ordered on bed rest with 200-400 calorie a day diets, while they wasted away slightly less slowly because they weren't taking in any carbs. The carbs that break down into sugar, unable to get inside of cells to give the body energy, caused the body to burn anything else it had for energy. They would waste away until there was nothing left for their body to burn, skeletons of who they once were.

They called it "starving in the midst of plenty".

That's poignant and sad. It always has been to me. It humbles me to think that, if it weren't for modern medicine - that could have been me. I thought my life was horrible when I was diagnosed. And it was a mountain to climb, that's true. But at least I had a chance at life.

I have done a lot of research on Diabetes over the years. They always said to choose research projects and topics that you found interesting, and Diabetes was something I always wanted to know more about. Diabetes was something I could talk about. Educate about. Learn something else about.
That's how I learned about Diabulimia.
(Wait, is that a made up word? No. See the above link). It's not a made up word. It's a new term, not yet recognized as a medical or psychiatric condition. But I found it important as soon as I learned about it. Why? Because diabetes effects a lot of teens. Insulin makes it easy to gain weight. And I know this condition can effect many a person with T1D, especially young women. And the concept of purposely witholding insulin for weight loss seemed crazy to me. But it made so much sense. You see, chronic illness is hard. It's impossibly hard. I probably don't need to tell any of you that.
Invisible chronic illnesses are hard in ways that noninvisible illnesses may not be. Why? Because people brush them off. They don't take you seriously. They don't see the waking up low in night sweats and shakes at night. Crawling to the kitchen for food. Feeling low in the middle of talking to people and having your world just zero in on how awful you feel while you try to find the least obvious way to take care of your low and still let life go on. The cotton mouth from the highs. Trying your hardest to make your blood sugar great but still failing... the bruises... the insulin injections... the pharmacy bills... feeling as though no one understands but yourself and others like you. Feeling, even if just a little bit, isolated from humanity because of an illness you never asked for. Feeling cheated out of something you should have had (such as a healthy pancreas). Diabetes is hard too, because of the stigma. Did they cause it themselves? Their A1C is high. They're noncompliant. It's because they're lazy. Clearly they're trying to kill themselves. They just don't try hard enough.
You don't try hard enough.
You.
Aren't.
A.
Good.
Enough.
Pancreas.
Even though you should have had one that worked in the first place. Even though you never get a break... ever. I even did a presentation on diabulimia once. "The eating disorder no one knows about."
What point am I trying to get at here? That... you'll rarely, if ever, see anyone with a chronic illness that doesn't have some kind of underlying mental issues because of it. Myself included.
I would like to say that I would never purposely skip insulin as a coping mechanism or to lose weight or hurt myself in some way. I'd like to say that, as a healthcare professional especially, who sees the result of not caring for your diabetes almost everyday in patients of my own, that I know better.
This would all be a lie though. A couple months back, I wrote a blog post about how, at my lowest, I weighed 93 pounds because I purposely worked out and restricted my diet to 600 calories a day. I'd be lying if I didn't say that things like that - even if you recognize you have a problem - are still disorders, or problems, of some sort, and they stick with you. Forever. In the back of your head. Diabetes wasn't always the hardest transition for me diet-wise because I was already eating healthy in the first place. My past history and love/hate relationship with food has always remained with me.
I fell into a couple of difficult months this past/last year due to life - and I'll admit, part of my coping mechanism was not caring for my diabetes properly. Just not caring. Not giving insulin for this, or not counting it right, or waiting until the next morning to correct, or forgetting to give insulin for hours, or going a day without checking my blood sugar...I just stopped caring. I did it on purpose for 2 weeks. "To lose 5 lbs. Then I'll be done." And then I tried to fix it, but 2 weeks turned into burnout. "I'm tired of this disease anyways... I'm over it." 2 weeks turned into months of burnout... and then I tried to fix my levels. But I just couldn't seem to get them back to normal. It turned into months of horrible control that I never meant to happen... all because I wanted to lose a few pounds.

That's why going to the doctor was important for me last week. I guess I needed that talk. "Those levels are deadly," I remember him saying, holding up my glucometer with the number "436" flashed on it from the night before. I had burst into tears. I knew they were deadly. This disease was deadly. To your body. Your health. Your happiness, sometimes.
Sometimes, you just get tired. Or you get upset. Sometimes you do dumb things to lose 5 pounds. Sometimes you slip up and your best efforts seem like they get you no where...

You're human. It's going to happen. I'm human.
But I knew I needed to change. Not giving insulin is stupid. Not trying is just as stupid. Yes, Diabetes, managing it properly, takes a lot of effort. It sucks some days. But you know what else sucks? Not just being cheated out of a health pancreas, but a healthy rest of your life. And I don't want to be cheated out of that.

Anyways, I guess the purpose of this post is just to say that I've learned a lot about myself in the past few months. It's not easy to share my struggles, but I hope it can be used for a purpose. I've gotten burnout, recovered, and I'm back on the road to trying to manage my Diabetes well again. But for all the people out there, that also struggle with diabetes - or hell, with something - any problem - I write this because... I think it's important to understand that it's never just a matter of "oh well, you've got things under control now though, right?" People always ask me that and I hate that question because diabetes isn't static. And no problems are static. It's always a careful scale, a balance, that you have to create...and work hard to maintain. And no one has it all down perfect. You're going to slip up. Hey, I slip up. It's a constant journey, a give and take, and you're going to burnout and want to give up sometimes, but you need those moments to come along and snap you back into feeling ready to push through again. It's not easy. And you can spend a lot of time feeling upset at yourself for messing up or not doing things right, and dwell on the negatives, sure. But I think if you realize that we all as humans struggle too, with all our own problems... then hey. It's going to be okay. You're going to make it through this. Maybe a little more beat up than before, but you'll have learned something and come back stronger for next time. Keep on pushing on, or waiting for those moments to give you the shove you need to push again. Don't give up. Persevere.
Even when I go through rough times, which I am apt to do... I'll always keep trying to do this. Persevere. I hope it will make me a strong and wise woman when I am older. And, I hope I will be a healthy one, for having learned the hard lessons now that I need to take care of myself, no matter how hard the struggle. We're all learning more, each and every day. Embrace it. Mistakes and all.

An Important Day.

Writing this post isn't easy. As you'll hear is a general theme for me, it can be hard to open up and admit your life isn't perfect. Mine certainly isn't... it's far from it. And I'm as far from a good patient sometimes as I can be.
That being said, today was an important day for me. Today was my first endocrinologist appointment since August 2014. Yes, you read that right. It's been two and a half years since I have seen a doctor for my condition. My last endocrinologist appointment ended in tears. I waited months to see a doctor, only to be berated for my 7.0% A1C and for not having seen a doctor in the last 6 months (I lived in a different state for college and I waited 3 months to see that doctor). My endocrinologist made my cry, told me I was a terrible patient, and forgot to prescribe me insulin. I never went back to her. It was the following month that I aged out of the Medicaid system. Paying out of pocket for a speciality doctor was expensive, insulin is more than $200 a bottle, and the school insurance, which didn't cover a great deal of the medications I needed at all, was so expensive that I'd have had to take a second, private loan out just to pay for it because it exceeded the amount of federal loans that I could take out (school is expensive, just fyi). So... I decided to just use the insulin I had saved up from the past few years. My pediatric endocrinologist always let me fill the maximum prescription I could, and it was thanks to her that I had enough insulin saved up from the years to last on. I just handled it all with self management... I've always been a pretty compliant diabetic.
Yes, I understand that some people might read that and say, "well if your health was really a priority. You'd have just taken out the loans and gotten the school insurance." And I understand that. I guess I just figured that I'd be okay to use what I had and keep doing what I'd always done. Maybe I didn't prioritize enough. Maybe I should have spent the thousands to better care for myself. Villianize me or no, I just didn't want to take out all of that money in extra loans. Doctors are great, and doctors are there for you. If you have the right insurance and you can afford it.  I figured that if I worked hard, I would be fine. I always knew that getting through graduate school would be a long haul and a dry spell of very little to no health care. But I ate healthy for a diabetic, stuck to my sugar free diet, and was sure to take my insulin every day. I kept my A1C below a 7 at least, which is all I could hope for for not being under the care of a doctor, I suppose.

Fast forward time. I opened the fridge after getting back from Europe. My insulin stash used to fill an entire fridge drawer, a shelf, and a butter compartment. It barely took up a corner now. I'd calculated how much insulin I would have to last me when I started graduate school, and I had calculated (roughly) enough to last me until May. I guess I had forgotten that I would need to account for waiting until August when I actually passed the boards and got a job with insurance. I didn't have enough to last me that long. I had finally bent and taken out the loans to get the school insurance this semester, and I had made an appointment back in November for the soonest I could be seen (February). So I waited the long haul until then. I had, honestly, begun to have a lot of problems. For starters, I had a lot of personal problems going on that led me to be a stressed/upset the last semester. And I had burnout... bad. For those that don't know much about burnout: basically, there just comes points in your life when you get really damn tired. Please, set your judgement aside before you think of me poorly for that. I don't really know any diabetics it hasn't happened to, I just didn't ever consider it would happen to me. But damn, if I wasn't tired. Tired of this disease taking its toll on me day in, day out. Controlling so many aspects of my life. I hated it. And so I became lax on my treatment. For seconds, I found myself giving the right amount of insulin for my food sometimes, only to have my blood sugar still be high afterwards with no clue as to why. Was it because it wasn't as potent? My insulin by now had all expired. It wasn't cloudy, but I'm sure it was less potent. I just wasn't doing great with my care, in short.
So, this morning I woke up, full of fear and apprehension that I would get yelled at for my bad blood sugar control - full of hope that I could get more insulin and perhaps not struggle these years as much as I had - and I made the drive to Emory to see the endocrinologist. I filled out paperwork and found myself waiting in the treatment room, a place I often sat in the rolling stool of myself at clinic seeing my own patients, but a place that perhaps I was never at as a patient enough. I felt a special kind of shame, being in the health care field and knowing I should take good care of myself but having failed to do so. I stripped away as much pride as I could. Part of me was worried that this endocrinologist visit would be as bad as the last one.
The doctor walked in, an older man. I hadn't been sure who to expect.
I told him how long it had been since I'd seen an endo. "Well, are you doing ok?" He asked.
"I guess...." I said, overwhelmed by all of the things I felt I couldn't express. How hard and sort of heartbreakingly difficult the last 2.5 years had been. How frustrating the health care system was. How tired I was. My meter ended up in his hand, and he flipped through my awful numbers. "I wouldn't call this ok," he said sternly. I felt ready to cry. This was going to be my last endo appointment all over again. I would have to try and find a new doctor again. I hated this. He left the room to try and get my glucose log downloaded from my cheap glucometer. I burst into tears with my husband in the room, who had sweetly come for emotional support. I hated this disease. I hated everything about it. The doctor came back to me blowing my nose into tissues. I told him the truth: I didn't have health insurance. I hadn't since I started school. I was using insulin that had been expired for 2 years. He asked me what I did. I told him I was in my last semester of PT school. "You're good, then." He typed some info into the computer. "Your job," he said, "Is to graduate, and get a job. And then get health insurance. And never let it go. And you'll be golden. Now don't be like that about this. It's going to be okay." He left while I tried to dry my eyes, and came back with his arms full of insulin samples and a new glucose meter. "This should last you a little while."
He gave me some advice about my injection sites (I wasn't rotating sites enough and the absorption was likely poor where I was injecting - try switching my sites even more and that should help me actually have the numbers to show good control when I give the right amount of insulin for my meals). And he told me that I should be on the pump.
I looked at him. "I... I don't want to be on the pump," I told him. "I really don't." He shook his head. "It's always women that say no to that," he looked at Kris as he replied. He didn't push it any further though. He had me set an appointment up with the dietitian 3 months from today and told me to try his advice. "Your job, is to take care of yourself as perfectly as you can for the next 5 years. Listen, I've never actually been able to say this before - it's always just been talk. But it's a good time to be alive. Changes are coming... and it's going to be much easier to manage this disease in 5 years. There will be closed loop systems. You're 23. Keep yourself perfect, and your life will be much easier in 5 years. It's going to be okay," he told me again. "You had a bad few years, but you're my patient now. Next time you come in - you'll be perfect."

I hoped so. My ears burned a little from the sternness I knew I deserved, but for the first time in a long time - my hands were full of samples and my heart (or pancreas?) full of hope. I had started the appointment ready to bolt out of there, but ended it actually really trusting my new doctor and actually really respecting him. I hope that this is a new leaf for me - and an end to the struggles of the last few years. I left feeling more inspired to control my blood sugars than I had in a long time. I think my burnout has officially ended, and I feel ready to work hard again. Today was a big step for me. I look back on the last few years with frustration. It's hard, being a diabetic with no health insurance. Using insulin and praying all the time you have enough to last you until you graduate and get a job with health insurance. It's hard feeling as though you're alone with a disease you never wanted. Diabetes is hard... which is why I always try to be understanding with my own patients. It's hard mentally, physically, financially. In every way. I hope today was an end to some of those especially hard times for me. Even if it just means having a little extra insulin to make it through, or a helping hand to give me advice about controlling my levels better. There's light at the end of the tunnel, and these difficult past few years? They're almost over. They're finally almost over.

One More Semester.

This is almost it.

We're in class for one of the last times - finishing up fall semester, the last fall semester of school that I'll ever have. About to present our case reports on Friday. Applying for graduation. Applying to take the boards. Taking pictures tomorrow.
I'm surrounded by my fellow classmates, and it's weird. We've all come so far. 3 years ago, I was freaking out about whether I'd be accepted for an interview. Now, we're all preparing to go to our last clinics in January and exchanging stories about treatment and clinic sites and life in between. The 1st year physical therapy students buzz around us, the second years are practicing for their big musculoskeletal competency, and we are practicing skills that a year ago may have made me scratch my head. Talking updated CPT codes, funny ICD-10 codes, how annoying (or helpful) FOTO can be, and gait training with crutches versus gait training amputees. "Have you learned A-P mobs yet? What about strain counter strain?"
It's all delightfully familiar, and fun, and relaxed. My days have some classes and paperwork to do, but for the most part, the stress of exams, of competencies - is over. We have a clinic full of high expectations ahead of us, but we are ready for the challenge. We are making that transition from student to clinician and preparing ourselves to go out in the real world and be independent, practicing doctors of physical therapy. Next semester we will hear our names called at graduation and then we will go out into the world and live our separate lives as professionals.
My life is so much different now than it has been in the past years. I find I have more time for life skills - for every day things, such as going to see movies or play trivia in the evenings. I can paint during semesters, instead of leaving my canvas untouched for the months of classwork. All of those scary classes and long lists of requirements that I used to stare at, wondering how in the hell they were ever going to get done - they are done. I've finished them. I've run the race. I've jumped over the hurdles. PT school has sucked, it's been hard, but it's changed me. It's made me a professional. It's taken my quiet self and, yes, I'm still quiet, but it's taught me how to talk to patients and act confident and teach and to heal. Soon, I'll have a real paycheck. Soon, I'll have decent health insurance. Soon, I'll have student loan payments. Soon, I'll be managing my own caseload of patients.
It's not "eventually" anymore, or years from now. The future I've been building for years now is soon.
And it's been a long wait. It couldn't come soon enough.