Old Hat, S.W.A.K.

Happy Valentine's Day!

I just had a nice talk with Yudi on the phone. We wrote and sang a spicy new song called "I Think We Should Get Together Now," surely an instant classic! That's about it for Valentine's Day romance. My mom did give me a cute card and gift, which was much appreciated.

I'm spending this afternoon at an orthopedic doctor's office to get my right knee looked at; I have psoriatic arthritis (diagnosed at the ripe old age of 28) and fell down hard on my knee twice (thanks, ice!) and have noticed that when I do steps or other exercises, my knee protests something fierce. I hope the doc can help me without putting me on drugs! To top off the romance tonight I'm attending at a pump and CGMS session with a Minimed rep (weather permitting--we're expected to get loads more snow!) and topping it all off with my weekly Weight Watchers Weigh-In and meeting, then out to Applebee's with my (girl)friend for dinner. Sounds awfully romantic, eh?

I had a wonderful appointment yesterday with Mary Lou, whom I now refer to as "my little angel." She's a part-time CDE (Certified Diabetes Educator), a type 1 diabetic for 43 years. I shared my frustrations with night-time hypos and exercising highs and she totally got it, and agreed whole-heartily with my insistence of going on a pump ASAP.

In fact, she just called with wonderful news: I have an appointment with a new endocrinologist, Dr. O'Shaughnessy, a woman who also speaks German, like my beloved previous endo, Dr. Sonnenberg. In addition, the insulin pump nurse will be calling me this week to schedule a meeting about my pump options. My Endo appt. isn't until April 15th, but she said I will be on a pump before then! Things are falling into place. Ironically, I originally had my appointment yesterday with "Sue," a different CDE, who had called in sick that morning, so I ended up seeing Mary Lou, which was a true blessing from God, of this I have no doubt. I've never had a CDE with type 1, which I really appreciated. I told her it was the best Valentine's Day gift ever and that I was near tears with happiness, to which she remarked that it was rather unromantic, but we both agreed that sometimes practicality wins out over romanticism. So, before my birthday in May I should be well trained on my Paradigm 522 and my insulin pen method will be strictly old hat!

Hooray!

A New Vision

My earlier rant over at d365 provided a much needed outlet for my frustrations this morning, which I know came, in part, from my wrecked nerves leading up to my 2:45 appointment today at The Eye Institute. Like fellow blogger Kerri's nervousness last week over her eyes, I've been a wreck, anxiously awaiting my follow-up appointment with my ophthalmologist, simultaneously dreading the news yet secretly hoping for the best--yet afraid to let even the smallest glimmer of hope enter into my consciousness for fear of the devastating disappointment I'd endure if the verdict rendered would be worse than I'd hoped for.

Already emotional and nervous, my bloodsugar skyrocketed as I waited over an hour for my appointment, going from 143 mg/dl to 304 mg/dl in less than sixty minutes. Sheer adrenaline pumped through my veins as I tried to relax myself by reading gossip rags, deciding to set aside my book, Sweet Invsible Body, in favor of People and Star. Did you know Katherine Heigl was a Mormon?

Luckily, the news is good. The spot the doctor saw a few weeks back is completely gone. Nothing showed up on the many scans and retinal exams. Poof! Gone! Just like that! Sometimes that happens, he said. Could it be from more exercise? Greater vigilance? Less highs? Perhaps. All I know is that the pesky spot is gone, and I'm going to do all I can to make sure it stays that way.

I feel like I've been given another chance to get things right, further asserting that my decision to leave Taiwan in favor of better health care and peace of mind was the right one. Stress, the doc says, needs to stay at a minimum, and after I shared my desire to continue losing some of this excess weight, we challenged each other to drop a few more pounds before our next visit in six months. He is very down-to-earth (and short! and stout!) and shared with me how he wants to drop a bit, too, but then told me to go out and celebrate with pizza. I laughed and told him that pizza was the diabetic's worst nightmare food, and that I'd head to the gym and sweat it out instead.

So while I still live with the very real possibility of further complications in the future, for this moment I'm good. My retinas are healthy and clear of any hemorrhages or leakages. My eye pressure is great. My A1C is going down, down, down. A pump is on the horizon. For now, I have what is known as "Background Diabetic Retinopathy" (Non-Proliferative). The only symptom I have are a few very small dots (5 or 6), visible only upon elaborate testing, that are microaneurysms, or scattered red blood cells in the retina where tiny, weakened blood cells have ballooned out. The microaneurysms are not serious, not themselves a danger to my vision, but a warning sign that damage could occur in the future if things progress in the wrong direction. I can handle this, as diabetes and the host of complications it can bring are forever in the background of my vision, and always will be. I can live with that.

Tomorrow is my follow-up appointment at the Diabetes Clinic, meeting with the dietitian and a new CDE. I look forward to a serious discussion of the pump with the CDE. The time is nigh. I am blessed to be surrounded by supporters, though the burden of care is, and always has been, my own. It is a blessing and a curse to have full responsibility for a disease I cannot always handle on my own.

That said, today renewed my faith in the goodness of some medical professionals. My doctor at the Eye Institute is competent and compassionate. He is a kind man. My eyes betrayed me, welling up with tears, after he told me he was proud of me and that he can only imagine how difficult it is to manage type 1 diabetes 24/7 for nearly 20 years, beginning in childhood. I thanked him, letting him know that was the first time a doctor has ever acknowledged and validated my struggle and the accomplishments that go along with living life as a type 1 diabetic. That is both sad, in that it took so long, and comforting, for the fact that the moment occurred at all.

So a big (((hug))) to each of you who read my blog, and especially those of you who comment with some regularity, as your support and validation fills a void in me that has been empty for far too long. What a gift you are to me, and I thank you from the bottom of my heart.

The Eyes Have It

Retinopathy. Eleven little letters I've tried to hide from for the last twenty years. Eleven little letters that carry with it possible implications that I'd rather not think about. After all, what purpose does it serve to think in terms of what-ifs and worst case scenarios?

My life is good now. Very good. I am getting back on track and taking good care of myself. I am doing what I can. I start each day now by looking myself in the mirror-peering directly into my own eyes and reciting the serentity prayer:

God, grant me the serenity
To accept the things I cannot change
Courage to change the things I can
and the wisdom to know the difference.

'Nuff said.

Cash in Hand: Day 70

What would you do with NT 4000? That's over $125.



If you're a type 1 diabetic like me, you'd be forced to choose between spending that money on something fun like a much needed new pair of winter shoes or spending it on your diabetes: prescription co-pays, little out-of-pocket expenses for diabetes that add up like glucose tablets, juice, that $40 flu shot, insoles for your shoes, etc. I figured it out and I spend about $500 a month or about $125/week on diabetes related costs.

That does not include the cost of insurance, mind you, which I currently have through COBRA (from my last employer) and my father, who has spent more than $6,000 keeping me insured while I've been teaching abroad and between jobs with good insurance in the US. Most of that cost is just "in case." I haven't used my US insurance here in Taiwan at all, except to get a few prescription supplies sent to me such as insulin and test strips. But being left without insurance is too damn risky for a type 1 diabetic, and often times future employers have a mandatory one (or two) year pre-existing clause attached to their insurance policies, which precludes covering any diabetic-related costs.

When I was a substitute teacher in Wisconsin, I was without insurance and had to pay out-of-pocket for all expenses, and even though my father did reimburse all costs eventually, the wait time was often long enough that I had to face a choice--spend $100 on that box of test strips, or go without testing enough. I always paid for my insulin (Humalog/Lantus), but sometimes the staggering cost of test strips was too much to afford making a mere $85/day as a substitute teacher (before taxes), and I had to go without.

While I do admit that my personal life choices (quitting my stressful inner-city teaching job with good insurance, substitute teaching, teaching abroad and working for a non-profit) have made it much more challenging to manage and pay for my diabetes care, there's something inherently wrong about our system of health-care in the United States, and I really hope that whoever the new president is will initiate much needed changes in the American health care system.

Looking Well.

I met with my boss today to discuss my leave. We met in the morning and he hadn't seen me for about three weeks (being a teacher I have a boss but it doesn't mean we meet often). The first thing he said was "You look well." Having issues with diabetes is hard to explain to an "outsider." I am well, yes, but then, also not. I look good yes, but you see the bags under my eyes? Those came from a low at 3:00am that woke me up (thank God). Then, I rebounded in the high 200's this morning, causing me to feel like crap. That look on my face? That's from the pounding headache I have. You see my hair? How bad it looks? That's because I didn't have time to do it because I was so exhausted and opted to stay in bed 45 minutes past my alarm. Oh, and you see the tiredness in my eyes? That's from the the needling worry in the back of my mind, the imbalance. You see that little wound on my left hand? It's hard to notice, but it's not healing so quickly. It's been there for a while now. It looks like a cat scratch or a little scrape, but it hurts and worries me. And you can't tell of course, but I see this little spot sometimes in my line of vision causing me to fear blindness or retinopathy. See my feet in my Birkenstocks? The heels are hard and calloused and I am thankful every day that they still tickle so much. You see that lump on my arm? That's from years of injections. So yeah, I look well. But if you only saw what I saw, things would look quite differently to you, perhaps...

During my internal diatribe, I explained my situation to him--my fear of things progressing in the wrong direction with my diabetes, my desire for a pump and tighter control, the frustrations with doctors, health care loopholes, hypo/hyperglycemia, food issues, etc. I tried to educate him a bit but also genuinely explain what goes into nearly twenty years of living with type 1 diabetes. I may have done the wrong thing by revealing "too much," but at the same time I really wanted him to know the struggles. After all, this is a new program they have and they're dealing with foreigners and they need to know what may push someone to go home--someone who looks so well on the outside.

To his credit, he took copious notes during our conversation, noting how much an insulin pump costs if you live in Taiwan and have to buy it and all the supplies out of pocket. I showed him my glucometer and the strips, explaining how much I test and how each strip costs $1 and are not covered in Taiwan. I told him how I inject insulin six times a day. He asked me if I did it myself. I said yes, of course. We discussed my contract and he said everyone understood and health is the most important. He knows because his wife had cancer a year and a half ago, and that changed their lives. He gave me a hug--something Taiwanese men rarely do to women or employees, I am sure. He let me cry a little without making me feel embarrassed. I really hate to be one of those women who cries at work, but I couldn't stop myself. And technically, we weren't at work. We were outside on a bench. Hah.

I felt like a chump, but he really seemed to understand, which caused me to become quite emotional, as this is rare. He told me I could come back any time after my health improves and sign a new contract. He told me other teachers could take my teaching hours if I need to go home in December for my brother's wedding and decide its best to stay. He said he wishes the school could pay for my ticket to and fro, but they can't, so it's up to me. If I want to stay come December, just let him know. This was a big relief as I have no idea how I'm going to pay for another ticket home if I come back after my brother's wedding at the end of December. He was very kind and full of empathy. Whether he was just making me feel good or would really have me back I cannot say, but it made me feel good anyway. I was, in short, relieved. And yes, a little sad because it felt like the end. Meeting with him gave my decision a finality it was lacking. I can't help feeling like I failed, just a little bit, and that I'm am letdown, disappointing a lot of people. This is not to say the decision is wrong--just that its difficult, which is, in fact, quite an understatement.

The Allure of Better Care

Today started off quite nicely, but quickly went downhill. I awoke to my new soft little kitten asleep at my feet. He was curled up around my glasses, which I inadvertently left on my bed last night after falling asleep watching a bad movie (but it had Pierce Brosnan in it, so really, who cares?). My sugar rang in at 150, a tad high for my tastes, so I injected two units of Humalog to bring it down. I planned on eating a breakfasty snack after my 8:30am class.
No, no, diabetes said to me this morning. We have other plans for you, my friend. There will be no snack, no teaching, no fun today. As I was running a tad late as usual, I did my powerwalk to campus, only to make it about halfway before I started to feel really strange. I actually saw stars. My head was spinning and I started sweating and could feel my hands and arms pulsing. I knew I was hypoglycemic, but I couldn't really think straight. I sat down on a bench in a kind of shock, as I usually don't have such bad reactions that come on so suddenly. I was afraid to test my bloodsugar--afraid that seeing the number would freak me out even more. I didn't test. I rooted around in my bag for glucose tablets, but was too out of it to find them. Luckily, Taiwan has a zillion 7-11's dotting every corner of urban landscape, so I ducked inside and went right to the OJ aisle, as it's my defacto treatment choice. The candy aisle is too much for me when I'm really low, so I grabbed two juices, somehow managing to pay and get a receipt. I sat on a campus bench and guzzled the entire juice in seconds. It was awful. When I finally got up the gumption to test, nearly 30 minutes after the initial hypoglycemic reaction, I rang in at 49. I guzzled more juice and did the only thing my semi-functioning brain could think to do--I went to the hospital.

Still out of it, I walked to the subway (MRT) and went the five stops over to NTU Hospital, the best hospital in Taiwan (err, so they say). I was scared. Only once in my 30 years have I ever felt that bad during a hypo. I knew I couldn't teach, but my brain didn't think to call my employer. I just wanted help. I wanted to take care of myself. I wanted someone to tell me it was going to be okay. I wanted to feel less alone. One of the worst feelings in the world is having hypoglycemia and knowing no one around you really knows, no one can feel what you're feeling and in those moments, I feel utterly alone. It's scary. I have never passed out or fully lost my ability to function, but the way I felt inside today was pretty awful. Here I am outside the hospital, testing my bg, which was 190 after overtreating my terrible low. Somehow, it helped to document the ordeal at the hospital today. At least with photographs I got something out of the time I wasted there.

I tried to check-in, and took a number, but later realized I was waiting in line not for registration, but for the pharmacy. D'oh! I then made my way to the waiting room for the Internal Medicine department (they have no Endo/diabetes clinic here), only to be told that these patients already had checked in earlier and I'd have to wait in line to register first before taking a number. D'oh! Foiled again. I called my Taiwanese friend to help me out, since I was getting frustrated and confused. As I approached the registration clerk, I simply handed her my health card and cell phone, and my friend talked to her in Mandarin, explaining my situation. She kindly informed him that diabetes is "too common a disease" and there are too many people who want to see the doctors on staff, so she refused to give me the piece of paper I needed in order to wait and see the doctor. D'oh! Foiled again. At this point, I asked my friend to come to the hospital with me to help me see someone for my diabetes. I was tired of waiting, and didn't want to go back to the diabetes clinic with the doctor who confused my A1c results, made me pay out of pocket for my tests and whose secretary told my friend that if I was his girlfriend, he could do better. Oh no. I was not going back there. So I waited. And waited. And waited...and during my wait, I noticed this oddball sign, pointing me in the direction of the "Operating Theatre." I doubted I could get tickets, so I passed. It piqued my curiosity, though. :)

After my friend arrived, he suggested we go to the urgent care department. I wanted an A1c and DKA check and to talk to someone about my bad hypos and crazy numbers lately, as I hit 366 late yesterday afternoon for no apparent reason and have been waking to different numbers daily. I wanted reassurance that I wasn't spilling sugars, wasn't dehydrated, etc. I have sprints of really good numbers, but they seem to be turning on me lately, and I feel like I'm out here navigating it all alone, since I don't have any good docs or nurses here in Taiwan. I honestly think it is, in part, hormonal. As a woman, these hormones are no joke, especially around this time of month. (Sorry, TMI). To be honest, I am sure my A1C is quite a bit better than the last time, but the thing is, it doesn't capture all the highs and lows. It's just an average. It can't show the doctors what I see each day--peaks and valleys and the ebb and flow of the glucose tides that are making me feel tired and lousy. So, in order to get some help (TODAY!), I checked in to the non-emergency section of the ER (it's an oxy-moron, I know). Again, I waited. And waited. And waited...At this point I felt nauseated and ravenous, an odd combination, since it was lunchtime and I had only consumed mass quantities of juice. But one whiff of the urine that some man walked by with (in one of those disposable chamber pot thingies) made me want to gag. That, and there were sick people on gurneys and makeshift hospital beds all along the corridors and in hallways. No privacy. Overcrowding. Old men and ladies with sickly body parts hanging out. Loved ones sleeping by their side on rickety metal chairs. Standing room only in the ER. Loads of sick and hurting people everywhere. It was madness. I didn't take any pictures because it would've been quite rude, but it was like nothing I've ever seen before. And this was at the best hospital in Taiwan. I asked my friend if we could just leave because it was obvious I wasn't going to get quality care in an ER, but he said no, we couldn't do that. We had wasted all this time and might as well see the doctor. So after about 2.5 hours at the hospital, I finally saw a doctor.

Unfortunately, she could do nothing for me. Since it was urgent care, they refused to do an A1C and only offered to do a glucose check, which I can do myself, of course. I told her I was at 117 mg/dl and she remarked that this really isn't an emergency and I seem fine. She was very surprised to hear I tested my bg 7-10 times a day, looking at me like I was nuts. I really think people in Taiwan don't check their bg often. She did offer to check for DKA, but I'd have to wait for that, and suggested (after I bawked at having my blood drawn multiple times) I go to another department at the hospital where they could do my A1C, CH and ketone check simultaneously. So, my friend paid the 700NT ($25) for the ER visit and tried to get an appointment for bloodwork. Unfortunately, the only time available was Friday morning, and I have to teach. The woman suggested I come to the hospital at 6:30am to wait for one of the "free" slots for the doctor. Eiey! It was 1:00 by the time I left the hospital with nothing more than a headache, a growling stomach and a handful of photographs.
I realize my impulse to get help was a good one, but that, with diabetes, often times the burden cannot be shared so easily. The responsibility is mine and mine alone. There are good, caring doctors out there, but they're overworked and overbooked and under pressure. I feel like I'm floundering a bit here, so I wanted some help reigning in my diabetes, but I'm up against some tough battles here. I've had this beast for 19 years, so I'm not new to diabetes. That said, it never ceases to amaze me how it changes and throw me off, just when I'm getting cocky and feeling good about things. Logging and maintaining reasonably consistent food, exercise and insulin amounts lets me know that there's more at work here affecting my blood sugar values. That low this morning really scared me.

I find that people just don't get it--they think you're either in control or uncontrolled, but diabetes doesn't quite work that way. There are many shades of in-betweens, and a good A1c, though a tempting reassurance, can't possibly tell the whole story, of the scary lows, the draining highs and the balancing act that goes along with it all. Diabetes is a manageable disease, but one that is a continual work in progress. It's whims don't arrive on our timetable, and the choices that worked so well yesterday may not wield the same results today or tomorrow. I realize the allure of better care is one of false hope here in Taiwan (and perhaps elsewhere). Even the best hospital in Taiwan is limited by its own inadequate staff and sheer volume of patients. The smaller clinics have appointments, but you seem to really get what you pay for when it comes to medical care, and most docs at the privately owned clinics are out to make money, so they see as many patients as possible for as little time as is needed. The universal health care system here is good in many ways, but I suspect there are a lot of "uncontrolled" diabetics here in Taiwan, paying out of pocket for each test strip and shuffled along like parts on a conveyor belt, no one really taking the time for them. I certainly feel that way, and it's not an ideal place to be. I am concerned. I am weighing my options carefully. I will not sacrifice my health for a job or life in a country that can't give me what I need. I've been down that road before. Today reminded me, yet again, that I need to take care of myself very well because no one else can or will do it for me.

Day 33.

Navigating the health care system as a type 1 diabetic in a foreign country is not easy. This photo was taken today at NTU Hospital in Taipei, the largest, most prominent hospital in Taiwan, which means long lines, too few staff, bureaucracy and frustration. I waited in the wrong line, only to wait in another line and be told that no doctor would see me today because "diabetes is too common a disease" and there were too many people waiting. Had I been in the correct line (I wasted over an hour), I may have made the cut for non-appointment patients. I jealously spied patient #33 going into the room with the doctor. After a particularly bad hypo this morning, I wanted reassurance. I wanted my A1C done and wanted to talk to someone about my needs. Alas, it was not to be. I wasted three hours.

There is no cure for diabetes.
Yet.

See more diabetes 365 photos here.

Nanu Nanu, NaBloPoMo'ers!

Greetings, earthlings! While the rest of my American compatriots are still celebrating the best bits of Halloween, I have begun my own strange foray into the depths of NaBloPoMo! That's right, mofo, I'm on the crazy train, posting to my humble blog every day for the month of November, and I'm not talking just the photos for the diabetes 365 project. Kudos to my fellow writers who are embarking on NaNoWriMo to complete the writing of a 50,000 word novel before December 1st. I admire you. And while I'm not writing a novel, I will try to post decent stuff here this month, and not just blubbering nonsense. I will do my best.

It's a dreary grey and white skied morning, drippy with rain. This kind of day highlights the drabness of many of the ugly, runddown buildings in Taipei. The uninspired architechture made for the masses and dirtiness from smog, overcrowding and bad design makes much of the urban landscape around these parts rather blah. I certainly can find the hidden gems in much of the world around me when I'm looking for them, but today, waking up and peering out of my picture window, this is what I see ------------>

and it makes me want to curl up on my chamois sheets, hide under my fluffy down comforter and rest my head again upon my pillow and wait until I can awaken to sunshine and butterflies, damn it! :) Instead, I've got drippy rain (not the good stuff, just the pissy little drops), the din of traffic, and five classes worth of homework to correct and enter. Nooooooooo! I did wake up at 75 mg/dl, so that felt good.

I also had a chance to talk with my dad, who's out visiting my sister and nephews in NC. They just got back from trick or treating. I wish I was there to go around the neighborhood with them. My sister, sensing my homesickness and need for goofy photos, sent me this photo taken earlier today: my sister, the nun, Elliott, the Shark, and my dad and Max as pirates. My dad's perhaps the first pirate I've seen in shorts, but hey, coming in from Wisconsin to trick or treat in balmy North Carolina weather, I'd don the shorts, too. I think the hook hand is a nice touch, no? Sometimes I feel sad that I'm missing out on all this stuff being here in Taiwan. I know that I am experiencing a lot and that living and teaching in another culture, another country, another world, really, is valuable and exciting and something I'll look back on and be really proud I did. And yet, there is the proverbial BUT that always comes to the surface...but, I missed my best friend's wedding. I missed my nephew's birthday parties. I missed my grandpa's 88th birthday. I missed all the festivities leading up to my little brother's wedding. I missed celebrating my 30th birthday with my twin sister. I missed my dad's Barn Dance and Musicpalooza extravaganza. I missed many, many things. And while it's true that most of the people I love and miss will be there when I come back, those moments, those chances are gone, replaced by other different experiences that are not to be compared, I know. Not every day promises sunshine and blue skies, and I know that when I'm away from my life in the States, away from my family and loved ones I can easily idealize it and nostalgia bubbles to the surface in that luring way it has, beckoning me back to times long gone, but the truth of the matter is somewhere in between. Each choice has consequences. Each decision made leaves other choices in the dust. Each moment I experience here leaves others untouched. So it goes. This I know. But when I see that photo of my sister, nephews and dad, I can think of no other place I'd rather be than right there by their side.

Instead, on Halloween I spent the afternoon at the hospital. I went back for a check-up with the doc who prescribed the Lexapro (staying at 10mg, another appt. in 3 weeks). I was proud of myself for finding my way to the hospital (by taxi) and back home again, navigating the registration, check-out procedures and pharmacy by myself. Not knowing Chinese makes it challenging, but I was happy I could do it alone. I often times feel like a little kid here, dependent on others for the simplest of tasks. I lose quite a bit of independence living in a country where I don't speak or understand the language well. I need my friends and even strangers to help me make my way through simple parts of my day. So, yesterday was a milestone for me. I learned I could navigate the health care/hospital system here in Taiwan by my lonesome. It was the first time I wasn't accompanied by a friend, and my doctor even remarked about this. "Ooh, you came alone?" He seemed genuinely shocked that I would make it there solo. He even marked it down on my chart. I didn't know what to make of that. Maybe it was progress in his mind? Or he wondered what happened to my friend? I've no idea. All I know is Halloween has been and gone. I went to bed early with a pounding headache. It was just one of those days. I'm saving up my energy for Friday night when I go pick up the new little furball in my life! Hey, I'm still polling for names for my new feline friend. Vote now by leaving a comment!

Getting Back to Myself

This is a difficult post to write, but one that I feel is important. I like to keep my blog full of mostly happy thoughts, stories and fond memories. I like to share the good stuff, and hope that those of you who do read it will feel good after visiting. That said, this blog is about life. My life. As a 30 year old woman. As a type 1 diabetic. As an expatriate in Taiwan. As a teacher, sister, friend, all that good stuff. It's now also the blog of someone on anti-depressants.

I'm generally a happy person and most who know me think of me as silly, funny, sweet, kind, patient, loving, laid-back and relatively level-headed. Yet I have been struggling here in Taiwan with unexplained emotions of sadness, hyper-sensitivity, lethargy, alienation, change in sleeping habits (more sleep but less well rested), and a general sense of malaise. It has been going on for many months, but after returning from my one month hiatus in the States, I've really been having a terribly tough time. I'd say abnormally so. It's interfering with my teaching, my relationships, my ability to function well and enjoy my surroundings. It's made me rather hobbit-like and just not the woman I feel I really am, deep down under this heavy sullen cloud. Today was the day I could no longer stand it.

I had a bit of a meltdown this morning, feeling like I couldn't go on this way any longer. I wanted to go home and end this charade knowing that my love affair with Taiwan has ended, but knew I'd kick myself if I didn't try my best to resolve things here and now rather than taking the easy way out and hop the next jet home (Jill and Scott, I pondered this, but still wouldn't have made it in time for your wedding tomorrow!). Luckily, I have good friends here, so my dear friend spent all day with me, taking me to see a doctor to see if it could help things. I did a quick websearch for psychiatrists and clinics, not wanting to go to the famous but way too big NTU Hospital, and found the Psychiatry Center at Taipei City Hospital.

I've got to say, for taking a stab in the dark here, it was the best experience I've ever had at a clinic or hospital in Taiwan. From the white gloved taxi cab driver in his Lexus who drove me there to the no-wait registration and the friendly and prompt service from a young Taiwanese psychiatrist with excellent English skills, it was as good as it gets here. I don't know why they have to weigh me at every appointment, though. Oh, and family--if anyone out there knows my blood type, please tell me because it is the very first question they always ask new patients, and I never know the answer and forget about it later. Everyone in Taiwan seems to know their blood type except me. Does "red " count?

The doctor and I met for about 45 minutes, taking a thorough history which left me feeling vulnerable and exposed but also relieved that someone was there to help. He was utterly shocked to hear that I tested my bloodsugar ten times a day, which people don't do here, probably because Taiwanese need to pay out of pocket for every single test strip, so that would amount to $10 a day. My friend told me "six times is probably normal. Well, I never said I was normal. We discussed treatment options and we decided (yes we, which was nice for a change) to have me try 10mg of Lexapro. He also prescribed a sleep-aid, as I've had such restless sleep lately, but I'm a bit reticent to take it. I'm going to try it tonight and see how it goes since it's the weekend. I paid my 400NT (about $12) for my appointment and two weeks worth of medication. The doctor said he'd help me find an English speaking counselor if I wanted one, as well. Thank you, Taiwan health care system! Now if we could only get them to cover test strips and insulin pumps, I'd be all set. I have a follow-up appointment in two weeks. I know anti-depressants are not a panacea, but it's a place to start, and I'd like to stabilize my mood and get back to myself again.

* * *

This is an already ridiculously long post, but I've got to do a quick commentary on what I noticed today at the psychiatric center. First off, the place was dead quiet. Not a soul in there. This is highly unusual for a hospital in Taiwan. Secondly, the hospital was set way back in the mountains on the outskirts of town, and when I asked my friend about this, I was told that because there is a psychiatric ward there (impatient clinic), people didn't want the crazies mingling with the normal folk, so they placed it out of the way. Thirdly, it's rather shameful to be seen at a psychiatrist's office or at a psychiatric hospital, so people tend to avoid them, preferring to go to a big centralized hospital like NTU instead.

I also had an interesting glimpse into my medical chart today. It was empty, of course, since it was my first visit, but the receptionist gave me the chart to give to the doctor when I saw him. I had some time to waste, so I, of course, looked through the paperwork. Since it's a psychiatric center, they have to carefully monitor the patients state of mind. I get this. I am not crazy, nor do I consider myself feeble-minded, weak-minded or a danger to myself or others. That said, I did go to the clinic seeking support and an anti-depressant, so I wasn't in my best state of mind, either. The interesting thing about the chart was the kinds of things they had listed in the check-off boxes for the doctor. Now some of it may be a Chinese-English translation problem, but there were definitely some different cultural views of mental health, as well. Among the things to look out for, doctors should note if the patient exhibits or mentions any of the following (this is not an exhaustive list):

• Dreamy Sleep In my mind, dreamy sleep sound romantic and lovely, but in Taiwan most people believe that dreaming in your sleep makes you tired and is a sign that something may be wrong. We're not talking bad dreams and nightmares here, just persistent dreaming. I know that I've become much more aware of my dreams and therefore, tend to remember them more, and (Western) experts say that we dream every night, whether or not we remember them and that we fall into a deep "REM" sleep every night. I guess in Taiwan, they'd think my father and his psychoanalytical friends are crazy for taking part in a Jungian Dream Group once a month where they share and help interpret each other's dreams.
• Inappropriate Dress
  Do my Birkenstocks and wrinkled shirt count? When pressed, my friend gave the example of someone wearing a black dress at a wedding or wearing red at a funeral. By this standard, both Kerri and I (and probably most of American women) are nut jobs!
  
• Homosexual Desire
• Sexual Orientation
  Gay and lesbian couples do exist in Taiwan, of course, and I've seen same sex couples holding hands, etc., and I'm pretty sure my former Taiwanese flat-mates were lesbians, but in general, Chinese and Taiwanese culture still considers homosexuality wrong and taboo. Stories of lesbian lovers committing suicide like something out of Romeo and Juliet abound, and most families find it shameful if their son/daughter is homosexual. Apparently, it's also grounds for psychological treatment.
  
• Childish (I would qualify many Taiwanese adults as "childish" by American standards, but I'm not sure of their definition.)


• Word Salad (Love this one! Apparently, jumbling your words and not being able to form coherent sentences)


• Abstract Thinking (Apparently, my suspicions are correct--abstract thinking is not only not encouraged, but the sheer lack of it is a measure of ones healthy mind.)
  
• Common Sense
  Seriously, I'm not making this one up. I'm not even going to say it. Perhaps this box would be checked if common sense was missing, same with the above (abstract thinking), but that goes against the format of the form.)
  
• Religious Delusion
  This leads one to wonder what exactly this consists of. Are overzealous Christians wrongfully targeted, or would J.C. or the Buddha have been locked up? Who knows where to draw the line here.
  
• Impoverished Thought Content (Again, no idea here, really)
  
• Pressure of Speech (not sure how they're defining "pressure")


• Suspicious (Again, not sure. Meaning I look suspicious, or I am suspicious of doctors. Is this wrong?)


• Inappropriate Smiling and Laughing (Uh oh. Looks like Kerri, Super G , half of the OC and I might be guilty of this one, as well.)


• Self-talking (Darn. I talk to myself all the time. Maybe I really am nuts!)


• Ingratiating (Really? This seems to be the status quo here, so I wonder where they draw the line).

There you have it. Different culture. Different viewpoint. Different medical system. Different treatment options, but at the end of the day, I got the same kind of medication I would've gotten in the States, and I'm happy with that. I may even be able to buy it over the counter here, since they don't have the same regulations on such things, but I'd prefer the Rx since it's cheaper. It's been a long day. Rather draining, but good, nonetheless. Good because I was well enough to know how unwell I felt. I am proud of myself for that. There is no shame in mental illness, at least there shouldn't be. Like diabetes, mental illness is often a silent but deadly disease if left untreated. I wish the stigma around it would be lifted so more people would seek the help they need. I almost didn't post about this because I feel a little embarrassed about it, but why should I? Some of the most wonderful people I know were/are on anti-depressants, and I certainly don't think any less of them. If anything, I'm more proud of them for having the courage and inner-strength to look within, ask for help, and accept it, in whatever form it comes.

From Typhoon Visits to Hospital Visits.

Taiwan has a population of about 23 million people living in approximately 32,000 square kilometers of land. That's nearly 70% of the population of all of Canada, in a land area slightly smaller than Maryland and Delaware combined. We're talking precious little space here. I can't walk down the sidewalk without being forced to walk in the street due to my American bulkiness and even then have to slink past masses of people and scooters. So how does it happen that so many hospital rooms are empty? Is it because they're all so healthy? Doubtful. Is it because they have a lot of hospitals in Taipei? Perhaps. It's certainly not because people don't have insurance, because they all do, myself included. I visited my friend and former ESL student in the hospital the other day and was surprised to see all the available beds. She happened to be in a double-room, but had no roommate, although she did have one for a few days. Looking around the floors, there were more than a few empty rooms. Maybe this is normal. I'm not sure.

It was interesting to get another look at a Taiwanese hospital, and this one was originally an Army General Hospital. It was in the Neihu area of Taipei, and was rather nice. I was surprised that her room was on the fourth floor, though, because Taiwanese are superstitious folk, and the number four in Chinese(四) sounds like the Chinese word for die (死), so most hospitals either omit the fourth floor or designate it as office space. Not this one, though. Apparently, if you want to use the National Health Insurance without paying extra, you get stuck in a room with five other people. If you want to pay a little extra, say about 1,000NT/night (roughly $32) extra, you can bunk in a bed with only one roommate. And if you want a single room, it'll cost you about 3,000NT/night, or roughly $95. Not bad considering the entire surgery (and this was a serious operation) and hospital stay is covered Taiwan's National Health Insurance. In fact, my friend's family tried bribing the doctor to let their daughter leave the hospital early by buying him an expensive bottle of imported wine.

Now I'm not saying that the doctor accepts bribes (though he graciously accepted the wine) or that medical professionals in Taiwan are unethical (though there are a lot of for-profit clinics in Taiwan, including the one my "diabetes doctor" operates), but I was, frankly, a little flabbergasted that people even consider such things, because in the States we really seem to have the opposite problem: skyrocketing co-pays and medical debt for hospitalization and insurance companies wanting you out A.S.A.P. My sister had to fight hard to stay in the hospital more than a day or two after her C-section, and this is a woman who has Type 1 diabetes and a difficult pregnancy to boot. She gave birth to her second son in a New Orleans hospital, post-Katrina, where she got a serious infection from unsanitary conditions in the hospital, and antiquated equipment and hospital rooms were rather lacking, not to mention limited staff. Luckily, both boys were born (and remain) healthy. This is in America, people!

I know my friend is bored because they don't have wireless internet or TV's in personal rooms, but she has really good care. Oh, and they have at least four TV lounges with flat screens and cable on each floor, as well as ample nursing support. And don't even get me started on the cafeteria. When asked if I wanted to eat dinner at the hospital, I quickly told my Taiwanese friends that I don't eat hospital food because it usually tastes terrible. I stuck to my guns, but let me tell you, I have never seen a cafeteria like the one in this hospital. It rivaled any mall food court you've ever seen, not that malls have gourmet food, but you get the picture--a lof of choices for quick eats. Right next to the "BMI" information on the wall was a Burger King. Ironic. They also had hot pot, Teppanyaki, curry, Japanese restaurants, Taiwanese noodles and traditional snacks, just to name a few. Perhaps not some of the healthiest choices for patients, but then again, who says hospital food in made purely with health in mind? But I digress...

In unrelated news, my glucometer battery died this morning, and I was running late, hadn't had my coffee or time to review my lesson plans, and didn't change it. I couldn't find my spare, and I didn't know where the hell my spare batteries were hiding in my disorganized bureau designated for medical supplies and other oddities, so I went the day without testing. Eight hours without so much as a fingerprick. It sucked. I'm not doing that again. I think I ran a little high today, because I was afraid of not being able to test and going solely on feeling. I didn't want to go low while teaching and have no easy exit strategy. I've taught during hypoglycemic reactions before, and it's not pretty...or fun. I was meeting one group of students for the first time today, as well. Things felt very tenuous, but I did okay and tested in at 103 when I got home. That made me very happy.

I've lost my point here. I have a lot I want to say, but I'll save it for another post, another day. It's Friday night here, and it's been a long day. A typhoon is headed right this way, slated to arrive this weekend. Thus far, any typhoon action in Taipei has been extremely disappointing--we're talking a windblown rainstorm. Yes, windy days with drippy skies, but nothing that conjures up images of any typhoon I've ever imagined. After seeing firsthand the devastation of Hurricane Katrina, I had imagined the worst when typhoon season arrived here, but so far I've seen nothing major. I feel a mix of excitement, nervousness and curiosity. I don't really want the typhoon to be serious, but at the same time I'm anxious to find out what a real typhoon is like. After experiencing some little earthquakes (love that Tori Amos album!) here in Taiwan, I know that I don't want to experience a serious quake, but a fierce typhoon (that isn't deadly and does no major damage) would be okay, so long as I'm nestled safely in my cozy apartment, holed up with a good book and a good cup of tea. I know I'm romanticizing it, but what can I say? I'm a romantic at heart.

I'll keep you posted on the progress of Typhoon Krosa. She sure is pretty, isn't she?

P.S. Check out the new graffiti across the street from my apartment. It's located on the campus of NTU, Taiwan's premiere university. I've gotta hand it to the Taiwanese--they are neat and tidy. They even stencil in their graffiti.

Pumpin' Loophole

******************Warning: This is a frustrated rant.*****************************

I want an insulin pump.
I have insurance through COBRA and what is not covered by that is covered by my father.
I see an Endo in Taipei at a diabetic clinic, whom I don't really like, but does the basics.
I spoke to the folks at Medtronic.
On hold 30 minutes, transferred 3 times.
I need a Rx from an American doctor.
My wonderful Endo in WI has moved to NJ, so I have no contacts here in WI.
My most recent Endo in ME just quit the clinic, so I can't see him, either.
I can't get an appointment with a new Endo until January 2nd.
I can't get an insulin pump without an appointment.
I can't make an appointment on Jan. 2nd because I will be in Taiwan.
I can get a Rx without an appointment.
I can't take that Jan 2nd appointment because I'm not living in ME.
I can't get a pump without an Rx from an American doctor.
I can't use the pump without training.
The only people who will train me are the ones who want the comission from the pump sale, so I have to get the training in the same state where my doctor who prescribed the pump hails from, even if I'm in a different state.
My doctor moved from the state I'm in, so I have no contacts here anymore.
If I try to get a pump from Taiwan I have to pay out of pocket for all expenses.
Even if I pay out of pocket for all expenses for the pump in Taiwan, I can only get an older model pump, which I don't want.


I feel so annoyed and frustrated.

I want to take good care of myself.
I want to start on the pump.
I have the means to do it, but I can't get a prescription.
I feel like these loopholes are killing me. Perhaps quite literally.

It seems like the only way I can get the pump therapy I want is to come back and live in America. And that's only because I'm paying an exorbitant amount for COBRA, which runs out in 9 months.
I don't want to wait two years to go on the pump.

I'm just frustrated. I woke up with a bs of 332. I corrected for a high after dinner. I took Lantus at bedtime per usual. I checked my bloodsugar before bed and once around early morning, and still ended up with a terribly high reading. That probably wouldn't happen on the pump unless there was a kink or air bubbles or I forgot to bolus. I can handle that. This, on the other hand, is very frustrating. I take up to 7 shots a day for good control, if I need to. I'll take a shot for one unit if it will help. All that sticking is pretty shitty, though.

I spent the last 2 hours on hold on the phone and talking to the folks at Medtronic (very, very nice), to the folks at my secondary insurance coverage (very, very nice) and to the folks at my old Endo's office (very, very unhelpful and rude). Why is it so difficult to get a good Endo and good diabetes care? I go to the doctor when I should. I get my AIC's. I test incessantly. I do my best. Why is it so hard to find someone in the field who will take the time to listen to you? Why is it so hard to find someone who gives a damn and is willing to go a little out of their way to help you? Why is it that the nicest people are the ones without the power to help? Why is it that a diabetic is denied an insulin pump when she needs one, is willing to pay out of pocket for the best model? I have insurance that is paid for. I pay for national insurance in Taiwan. I pay for coverage in the States while I am in TW. I pay the co-pays and all the little out of pocket expenses for diabetes care. All of this is paid for, but I still can't get anyone to agree to give me a pump. I will keep fighting. I will try other avenues. I will call other doctors. But it just shouldn't be this damn hard.

I ended up in tears yesterday after a conversation with a family member about my diabetes care. Said I had a cavalier attitude. Said my priorities are screwed up. People seem to think it's a breeze to handle these things and that I'm being irresponsible for not being on a pump, but don't know how hard and frustrating it is trying to navigate all of these loopholes and rules. How I test up to 10 times or more a day and take injections 4-7 times a day and am constantly thinking about how what I do or eat will affect my body. My bloodsugar has been running high all day even after taking 3 correction injections, and I'm sure it's because of stress. Those stress hormones make my bloodsugar do wacky things, usually resulting in high readings.

Thanks for letting me vent. I hope to update you with a happier end-result later on.

The Good Life.

It's 5pm on Sunday evening and another weekend in Taipei is coming to a close. It was 99 degrees today, and 102 on Saturday with 70% humidity. This weekend I had to do a little 'TCB (takin' care of business), including a trip to NTU Hospital (pictured on the left), which looks lovely on the outside (photo on left), but was anything but.

The doctor didn't even try to speak English to me (perhaps because I brought a Chinese speaker with me), even though I was assured NTU is an international hospital, the best in TW) and he refused to write me a prescription for my Humalog insulin, declaring that the hospital is still investigating the drug, even though it's been on the market for years and years and certainly poses no risk. He did no exam, no check, took no A1C, and I would've left totally empty-handed, were in not for my Chinese speaking compatriot who at least insisted the doctor give me some Lantus insulin (apparently, Lantus is ok, though it's been around for fewer years than Humalog). The ironic thing is they probably had Novolog insulin, which is just a different brand name for the same fast-acting insulin, but due to the communication gap, there was no real way to push the issue.

All in all it cost me $6 for the Lantus co-pay, about $9 to "register" at the hospital, and about $3 for the actual doctor visit, which is quite cheap by American standards. The cool thing is that you don't need any appointments in TW, you just go during business hours and wait in line (see photo to right), but you can schedule appointments online at NTU Hospital after you register in person, so that's a bonus. I waited over an hour to see the doctor. I have to go back on Tuesday for an A1C test and to meet with a real Endocrinologist who speaks English.


The clinic is next to the "Center for Human Appearance," which is an apparent bad translation for the Plastic Surgery Department. It cracked me up, so I had to take
some photographic evidence (pictured right). Perhaps the most frustrating part of my hospital visit was that I found out that although Taiwan has National Health Care, which is great, they don't cover the cost of diabetic test strips for glucose monitoring, which run about US$1 per strip even in TW. This means that if you test your blood sugar at least five times a day like I (and most type 1 diabetics) do, you have to pay at least $5 daily (NT 150) just for the privilege of pricking your finger to determine your glucose level so you know how much insulin to take.


I was indignant and am highly annoyed by this gap in coverage and couldn't believe that Taiwanese diabetics have the money to pay out of pocket for all their testing supplies, but the less than helpful doctor kept insisting this was the case, so I suppose it's true. They'll cover insulin (for a nominal co-pay of about $8), but refuse to cover the testing that is 100% necessary for type 1 diabetics. This sent me into a bit of a tailspin, and by the end of the whole frustrating experience at the hospital, I was in tears.


This is a quality of life issue for me, and although the health care system in America pretty much sucks unless you have top notch insurance or extreme wealth, I feel more than a bit uncomfortable at the notion of diabetic care in Taiwan. Luckily (or unluckily), type 1 diabetes is a highly self-regulating and self-monitored disease, and I need doctors for support and the occassional test results. I realize just how blessed I was in Milwaukee with the top notch doctors and diabetes educators like Dr. Gabrielle Sonnenberg (the best doctor ever) I had at the Medical College, Froedert and Children's Hospital. It's hard enough to trust doctors these days, but you add in cultural difference, language barriers and many lesser quality hospitals and clinics and it makes the whole thing rather tenuous at best, even if the price is right.


I shouldn't complain too loudly since the co-pays alone on my last insurance plan were a huge cut in my income, but I was disappointed by NTU, by the gap in coverage and by the lack of empathy on the part of the doctors and nurses. It seems empathy is not valued too highly in this culture, which is quite unfortunate for someone like me who values and appreciates it very much. Hopefully, I'll fare better on Tuesday.

P.S. On a happy note, I had my first hair-washing experience in Taipei today. It cost me NT 120, or less than $4 for a hair wash with a good 10 minute scalp massage. They wash and condition your hair, massage your head and blow dry and style it for you all for under four bucks! It's heavenly, and my hair has a healthy sheen to it that wasn't there before. I'm definitely going back for more!

Feels Like Home

I went to the Chinese Medicine Clinic again on Saturday. I must admit that my body feels better now, one day later, but at the time, I felt like I had taken a severe beating. I again had acupuncture (on my right foot and knee) along with some electro-therapy to stimulate my back and shoulder muscles which are really tight and sore. They put some scalding hot towels on my lower back and shoulders, but I had to insist they add another layer of towels because it was literally burning my skin. After another towel, it felt good. The acupuncture was good, but I can't bring myself to look at the needles in my foot and knee. They were in for about 25 minutes or so. They patched up my knee and foot with some herbal medicine wrap, and then did some cupping on my shoulder. The cupping left a large round red mark on my left shoulder, but it did relieve some discomfort. I think the mark will last for a week or so, which is normal, since it brings the toxins up to the surface, and if the area is damaged or needs help, it will become red.

By far the most painful part was the 40 minute massage. The first five minutes were spent hitting me with a metal broom like contraption. Non-stop hitting (to activate the flow of qi or energy that is blocked in some areas, I believe). The massage was anything but relaxing as he flogged me and worked so hard on my shoulders and back, at one point I started to cry because I couldn't endure the pain, and I have a fairly high pain tolerance. Actually, toward the end of the massage this little Chinese man was fully on-top of me with his whole body, bascially leveraging his body as a tool to help relieve my tightness in areas that wouldn't budge. It seems as though it was successful in many ways, but OH MY GOD...it hurt! I never experienced something like that before, and I kept thinking that if any of my friends or family had a similar massage experience, they'd probably flip out and insist on stopping the whole thing. Actually, sometimes really strange things like that will happen to me and I have to stop and remember that just a little while ago, I would think the whole thing was totally wack, but now, I've already started to assimilate so I have to remind myself of it.

I've mastered the squatty potties. I love Stinky Tofu. I can handle being flogged and cupped and needled and taking mysterious smelling and tasting Chinese Medicine. I'm used to showering without a tub or any separation of shower and the rest of the bathroom. I broke myself of the habit of actually flushing my dirty t.p. down the toilet. I now nicely place it in the trash receptacle (Taiwan's sewers can't handle the paper). I drink warm water almost exclusively now. I know a common question for choosing a meal is "rice or noodles?" I've become a pro at riding on the back of a scooter through the streets of Taipei. I can jostle with the best of 'em shoving my way out of the subway. I am learning many things and slowly life is becoming normal and familiar. I have my own little flower shop that I frequent behind my apartment building. I have my local grocery store and fish store. I have my lovely neighborhood Starbucks down the block and my drugstore. Now I have my clinic and doctor that I see regularly. I have my favorite Japanese restaurant and even found a decent American breakfast and bagel store as well as Mexican food. The picture above shows my daily walk to work from my apartment (you can see the bldg. in the background), through the NTU campus, where I stroll during my 10 minutes past many bikes, couples holding hands, I pick up my daily coffee from the local coffee shop, pick up at newspaper, bottled water, or snack at the 7-11 and head off to class. Things are becoming nice and normal, which is good for me. It makes Taipei and Taiwan feel more and more like home, and I am grateful for that.

Signing Off...