Infusion Site Review: Right Arm

I managed to find 5 infusion sites on my right arm which saw me through about 2 weeks.

Not completely related to diabetes... one day I became startlingly aware of how little upper body strength I have when I tried to do push-ups and failed miserably.  Since then, I've been doing them everyday before my shower, systematically increasing the number each time they seem easier.  I do them with my arms on the bathtub so they are easier because the angle is lesser (Yes, I realize that this means I'm doing girl-pushups, but I'm fine with that!).  Within a few weeks, starting at 5 pathetic ones, I can do 25, and still increasing.

I'm certainly not buff, but I'm realizing that my arms have more muscle mass in them than most other areas of my body.  Because a lot of the infusions sites hit muscle, a lot of them resulted in 'pooling' where it takes a few hours before the insulin is absorbed and works.  I only had one out of the 5 sites that did not have pooling, and that site was problematic for completely other reasons: adhesion!

The site that had no pooling and had really good absorption didn't even last 2 days.  It dislodged overnight and I woke up with ketones.  That site was on the back of my arm, close to the armpit.  I don't have problems with adhesives, so I'm thinking that this problem was because my antiperspirant was interfering - each time I applied, it would hit the plastic nub on the site.  Or, it could be due to sweat, which is also quite likely.

In general, comfort was ok.  The tubing has a way of creeping upwards, which can feel a little tickly when you have a bunch of tubing conglomerating at your armpit.  Because the tubing is so long, I have to wear an undershirt at night to keep it in place, otherwise arms and legs and other appendages might get caught in it .

In general, the arm went well.

I put in a new site last night in my right upper back.  I imagine I'll be able to get at least 6 sites out of my back, so here goes another few weeks or a month.

Hitchcock's Birds - in real life!

What words might you associate with this picture?

Pretty, stoic, birdly, feathery?

Perhaps...

I call it EVIL!!!!!!!!!!!!!!!!!!!!!!!

One of these little bastards attacked me today as I was walking by a creek.  It swooped down and hit me with feet or wing right on the top of my head.

It didn't hurt, but it shocked me - and those who know me, know that my reaction was not silent.

I let out a loud "FU@&" and expressed my dissatisfaction on my cell phone to the person with whom I was talking.

I was hung-over and all I wanted to do was lie down and sleep on the grass in the sunshine, but I couldn't do that with this evil little monster flying around!

This evening, I was able to identify the species of bird online and discovered that I am not alone in my experience.  Apparently, it is well documented that these are malicious birds and they like to defend their territory by swooping down on people often!

In other news, today was my last day at the ballet school I have been playing at in London.  It was a great part-time job to have this year, but I'm glad the year has come to an end.  I've long known that ballet-piano is not something that musicians can do for a long time without a certain embitterment and general disdain for the world; I'm finding that I'm getting close to my saturation point.  It's good to have it as a back-up or part-time job, but I will be happy to not have to play for dance classes next year in Vancouver.

I think I will still play for some exams because it is contract work and I've already learned the music, so the investment has already been made!  

Not to say that I can't still improve in my playing for dance classes, but I think I've learned about as much as there is to learn from ballet classes about the relationship of dance and music.  I am looking forward to exploring that relationship more through a creative process - working more with choreographers and professionals.

Life seems to be going pretty well these days.  The summer is already slipping by and surprise, surprise, I've done nothing.

I'm working, that's it.  The people at work are great and we're having lots of fun both in and out of the office.  The downside to that is that I'm spending a lot - too much money.

Part of me wants to be doing lots of great, worthwhile things this summer - reading books, listening to loads and loads of music and writing piece after piece so that I am really prepared to start a doctoral program next year.  The other, more powerful part of me, senses that after spending the last 7 of 8 years in university, I am about to embark on another 4 years - I need a little break.  I liken it to those weeks of summers growing up where there were no activities planned, your parents were working and you just had to amuse yourself - it was like recess all day long!

That's not to say that I'm completely wasting my time.  I'm still playing some piano, though the practicing has lessened.  I'm still learning the Scriabin piece as well as a Shostakovich Prelude and Fugue in B-Minor.  There are actually a lot of pianists at my office job, so it's fun to talk about piano rep and that kind of piano-nerd stuff.  

 

Diabetes control is pretty damn good.

I've been extra good about writing all the details of my infusion sets in my calendar book so that I keep a good record and can track patterns.  I've actually found more spots on my arm than I would ever have thought - half of them have had some trouble with pooling the insulin before absorption, but I am fine with using my insulin pen to avoid the BG jump.  I will use one more arm site and then I'll move to my lower back.

The life of an infusion set

Funding for insulin pump supplies is based on the perfect world assumption that an infusion set will last for 3 days, which is also the longest that one is recommended to wear a single infusion set.

I wish mine were lasting for that length.  So far, I have gotten an average of 2 days out of the first two sets.  After the 48 hour mark on my first Silhouette set, I had elevated sugars which would not come down.  I switched the set and it was better.  I remember moving in my sleep last night - I shifted to sleep on my right side, but that cause some discomfort on my right arm, where Silhouette #2 was placed.  When I woke up, there was no discomfort, but also no absorption - it had dislodged sometime during the night and my sugars were yucky in the morning.  That was just a few hours ago and I still feel like shit getting rid of ketones and waiting for my sugars to come down to a comfy level.  I'm about to take a shower and then I'll put in a new Quick Set in the front of my arm.  It's one of my few more muscular areas, but there's still some extra fat there...

Let's see how it goes!

Things are looking up!

The weather is beautiful and downtown is bustling with people!

I picked up my personal copy of my thesis today.  It looks so professional and perfectly bound and all that.  I am very happy with it.  Oh yes, did I mention I got it bound in orange!?!? I LOVE IT!

I'm sure you noticed, but I was getting very upset with my pump and infusion sets.  I actually called the pump companies tech support line; I was at the end of my rope and if they didn't have a good solution for me, I was ready to go out and buy a bottle of Lantus right after the phone call.

I didn't get either, really, but I got a supportive dose of reality and a wonderfully friendly voice at the other end of the line. 

I had asked my nurses and doctors what the problem was with things, but they had no answers.  One nurse said she'd look into it, but I never heard back. [I'm not impressed with Ontario's Health Care, yet again.]  When I explained my symptoms to the tech support nurse, she definitively told me that I must be shooting into scar tissue.  She was patient with me and explained it over and over again until I understood and let down my stubbornness enough to accept it.

She explained: the reason the new sites don't work is because the insulin doesn't work in that area and it take a while for it to pool enough to spill over into a new area that accepts the insulin; steel needles vs canulas will not make a difference; site rotation needs to be my main concern.  She suggested a plan that will maximize the time that areas of my body will have to heal before being injected into again.  

Rather than going back and forth between left and right like I have, stick with one side of the body for a month and a half - if I can find about 15 different spots (at least 2 inches apart from each other) on each side of my body, then it will take a month and half to make it through each side, working logically like top to bottom.  By the time I go through the other side of my body, each site will have had 3 months since it was last punctured-more than enough time to heal.

Her logic was impeccable and that is the best way to appeal to me.  She pointed out that this is not an immediate solution; it will take a while to get into this and it won't cure previous scar tissue, but it will minimize the appearance of new scar tissue and work out for the best in the long run.

She said she would send me some samples, encouraging me to go back to the newer canula infusion sets.  I was overjoyed the next morning to realize that she had sent me 30 sets... that's 3 months worth!!  Now I'm in it for the long haul again.  I will stick it out for another 3 months from now and see if things are any better.

Of course, I will update as we go along!

I feel like I've been doing nothing with my summer so far.

I'm working so at least I'm making money, but I can't get motivated to do any writing - the story of my life!

The Scriabin piano piece I'm learning is coming along quite well.  I haven't spent too much time on it, but I only have 3 more pages (of 10) to learn before I've learned the whole thing.  It's intended to be a quick study, so I won't spend time memorizing it, but I think I'll record it so I can listen and see what needs improvement.  

I feel that I'm close to finishing with this piece, I don't intend to spend more than a month on any piece this summer, hopefully less so that I can learn a fair number of pieces.

I'm starting to wonder what my next piece will be.  Perhaps I will learn some Kurtag - I love him and there are lots of miniatures which would be fun to learn.  I played a selection of miniatures in undergrad, but I did a major research paper on him in my first year of grad school so it would be great to play some more with a broader knowledge of how he composes.

I'm on my second Sure-T infusion set.  So far, I've had two situations where my sugars were super-duper high - the infusion set is a suspect, but I'm not sure yet.  I will change the site today and find out if I am actually having the same problems as before.  

On the positive side, the Sure-T is incredibly comfortable!  I don't like the fact that there are two adhesive patches, because that's more bandaid-ish pain when I remove it, but other than that, it's fine.

It's actually just as comfortable as some of the canula ones I first wore.  

Anyway, I will keep you all updated on how they continue to work.

Yesterday I started on a new infusion set - the Sure-T.

I love it much more than the Polyfin already.  The Sure-T has it's own adhesive patches and the release mechanism is one-hand-manageable - it's actually the same type as the Silhouette which I used earlier.

I was running high through most of my shift at work last night, the timing says it could have been the new site, but it also could have been underestimating the amount of jujubes I was eating.... Oh so irresistible!

Eventually they came down.  The time it took to come down was eerily similar to the problem I was having before with the cannula ones.  I had no problems with the bent steel needle Polyfin ones, so I'm hoping that I will have a clean run with these ones too.

Physically, I love this new set much more than the other one:

-integrated adhesive patches means I don't need to use bandaids anymore

-the tubing is MUCH shorter and is the perfect length to just sit in my pocket, or be clipped onto the top of the pocket.  The previous set had a really really long tubing set- 43 inches compared to the current which is less than 24 inches.  

It's been a slow week for blog-worthy news.

Switching to the steel needles has been good and bad:

The sugars have been more stable.  Changing the sites has had NO effect on sugars or absorption.  There was one site change that didn't take, but one out of twenty is not bad odds!

My stomach, however is not looking so hot.  I've been bad at remembering exactly when I last changed the site.  If I get too close to the 2 day mark, or over that, the site gets really inflamed.  Because I need to change the site so often, and I can only use my stomach due to needing 2 hands to disconnect, my stomach looks a little like a battle zone.

I ordered a different type of steel needle infusion set - I am expecting them in the mail tomorrow.  Hopefully, they will be manageable with one hand so that I can use my arms and lower back again.

I am actually starting to evaluate the insulin pump's presence in my life.  I honestly don't know how I feel about it yet. 

I HATE HATE HATE having it connected to me.  I thought that I would get used to having it at my side, but it drives me insane.  I can't even fully describe how it makes me feel; words aren't enough.  

Ok, I do know how I feel.  I hate the insulin pump and I want to rip it off of me and out of my stomach and throw it out of the window.  Fuck all these diabetics who talk about the freedom that they get from the pump.  Freedom is being able to take ONE Needle a day and know that even though your sugars won't be perfectly stable, you can survive for 24 hours without eating or bolusing.  The insulin isn't just a piece of technology that is attached to you, it is a manifestation of how diabetes takes up every waking moment of your life.

Ignorance was bliss.

Before the pump, things were going fine.  There was room for improvement, but I was doing well.  Now, this type-A diabetic personality has been introduced into my life - the people who are finiky about every moment of their day and their sugars.  I do not do well with that lifestyle, so the pump makes me aware of how delinquent I am as a diabetic.  

I've grown accustomed to the ability to lower my basal rate for exercise and other forms of strenuous activity.

Long story short, I will not switch off the pump just yet...

Why?

Spite and Money!

It was too much effort to reach this point, that I'm going to make it worth my while.

I have no coverage anymore, so I really just can't afford to go back to my old insulin.

But also, mostly spite.

In conclusion, I hate being diabetic these days.

Back to Piano

I've wasted the last few days away completely.

Other than starting back at my job, I've not done anything productive.  I need to start thinking about what I want to do with my summer.

I printed out, and have started learning Scriabin's Vers la flamme, a piano piece.  It will be both musically and technically challenging, but not overly so.  It's been a while since I've actually LEARNED something properly.  I want this to be the starting point of my summer piano adventure - learning post-romantic repertoire to a near-performance level, but not memorized.  The idea is that I want to play more when I'm in Vancouver, collaborative and solo-ish stuff, so I need to get my chops back.  While I still enjoy baroque and classical stuff, I need to focus on modern/20th century music, techniques, and style.

In addition to piano, I will write lots of music this summer.  Some projects are:

-Soprano/Mezzo duet for two wonderful London singers

-Bassoon/Tenor duet: I need to verify with the bassoonist and singer, but I got a really exciting idea which I would love to pursue - the bassoonist had mentioned that she would love a piece written for her, and I think this piece would be great for her.

-Piano Solo anything.  This is a medium for which I have not written enough, barely any actually... There are some techniques I've touched on in my concerto and some songs, and I'd love the chance to develop those a little further in the solo medium.

-The Song Cycle that I put aside a while ago... I want to do it, but I have a feeling this is officially a long, long-term project.

Je l'ai tout fini!

After all of the hold-ups in the process, I finally had the meeting yesterday with the thesis coordinator.  It went swimmingly - I was in and out in about 5 minutes.

The day involved lots of walking around and errands, but the moral is that I got everything done and my thesis was officially submitted.  I'm not sure about the process, but I think that officially makes me a master, but maybe I have to wait until I get the diploma - who knows?!?

I'm back at my summer job from last year - lots of people are back, so it's good times!

I'm not very happy with Canada Post right now.

I had revisions to make on my thesis before my adviser could sign my Certificate of Examination.  Because he had to head back to Toronto right away, I was to send a PDF of the revisions and then he'd Xpresspost it to the school.  That was all done on Friday, so it should have arrived on Monday.  I called this morning to check that it had arrived, and it hadn't.

I had an appointment for 1pm today, in 20 minutes for my meeting to submit, but I can't have that meeting without the form.

I cancelled and rebooked for tomorrow.  There were only 3 fifteen-minute slots left.  Thursday is the absolute deadline, so if things don't go smoothly tomorrow, I will be very unhappy and very stressed.

I start training for the new telemarketing campaign today at 2pm.  I would have been late with the other meeting, but now I'll be on time - at least there's one thing on the up-side...

I passed my thesis examination/defense.  As usually is the case, there are some minor revisions that I've needed to make.  I'm almost finished them and I will be submitting it at the beginning of next week.

Just as I knew it would, this month has just flown away.  It really does seem like just yesterday that I was writing about how it would seem like a blink of the eye before the performance and the accompaniment work would be over.

I will also be starting back at my telemarketing job next week.  I don't really have any plans for the summer.  I want to move to Vancouver earlier than September, but I don't know exactly when.  It's expensive, so I sure can't pay rent in both London and Vancouver, but we'll see what happens.  I already have a roommate lined up, so I'll have to talk to her about when she wants to look for a place.

http://www.myspace.com/mikeyjpark

I just uploaded my thesis onto my myspace website so it's available for listening!

CLICK HERE to listen, it will load and start playing automatically.

While you're there, you can listen to the other pieces that have been there for a while already.

Lots to blog about!

There is a lot going on these days, so I'll address different points of interest as we go.

Today I will blog about diabetes related things.

I've been working 9-5 ish days with a lunch break, early to bed and early to rise lately.  I hate it, but my diabetes doesn't mind.  The thing I've realized about diabetes and life in general is that regularity is key!  I never practice this, but I realize the benefits when they fleetingly touch my life.

The other reason my sugars have been good recently is that I have switched to steel needles rathe than canulas.  My body has a love/hate relationship with this new phenomenon:

-They work! And right away, too!  This has effectively solved the problem I was having with the canulas not working for hours after they were inserted.  I'm thinking that all along this has been a problem with the end of the previous one's life rather than the new infusion set, but I'm not sure.  Eitherway, I can't afford to change the canulas more often than every three days, so that option is out as long as I'm in Ontario.  Here's the math:

-the Assistive Devices Program pays about 200 dollars a month.

-Canula insertion sets cost just under 200$ for 10 of them.  I can afford this only if I use them for the max of 3 days each

-The current one (Polyfin Quick Release) is much cheaper; you can get about 20 of them for less than the other type.  This means I can afford to change them as often as every 1.5 days, though I can wear them for 2 days.

The downside to the steel needles is:

-not as comfy

-they don't come with adhesives (I've been creative with bandaids)  This is actually a positive as well because the adhesive removal doesn't hurt as much, but it's not as stable, so again with the comfort...

- disconnecting the pump is trickier, which means it is not at all easy to do with only one hand.  I'm resourceful and made it work ish(see below) for a few days, but I'm not hopping on the bandwagon to use my arm sight again...

-changing sites more often causes more skin area to be used, meaning more likeliness of scar tissue.

So far, the needles have caused some situations to arise...

Story 1) New underwear is a wonderful thing; if I have my way, I would only wear brand-new underwear and socks forever and just throw the old stuff out.  Unfortunately I can't afford that yet.  Anyway, I got new underwear the other week - 3 pairs and I was working them into my wardrobe slowly.  They are wonderful.  The third and final pair was a beautiful pair of white underwear - so pristine and clean and crisp... I felt like a king just putting them on!

Note to self - do not wear brand new white underwear on a day when you have a steel infusion set in your left outer thigh which proceeds to gush blood at some point that day, unbeknownst to me until I check to see why my thigh is somewhat sore.

SO MUCH BLOOD

SO MUCH RED

SO little white

So Sad

Story B) As mentioned above, the new disconnect feature is a two-handed job.   I learned this moments AFTER I had inserted the needle and needed to connect the pump...  I was a little pressed for time, so my roommate who is extremely squeamish had to help me.  I covered any needle-ish parts up and made sure only the tubing bits were visible... STILL he could barely look.  I just don't get how people can be so bothered by medical things.  It's not like I was bleeding or anything.

Anyway, the next morning, I found a way of disconnecting myself by wedging my arm against my dresser so it held the one end stable enough-ish(see below) to disconnect and reconnect it.

Fast forward an hour.  I was on the 401, driving to Waterloo for my first day of Exams.  All was well, I bought my Timmy's Ice Cap and I was enjoying it as I drove.  I had boulsed a few minutes earlier and all was well in the world.

"Bzzz Bzzz" (vibrating), says the pump

"No delivery", says the pump

"Disregard, resume", Michael presses the buttons

"Bzzz Bzzz" (vibrating), says the pump

"No delivery", says the pump

"Fuck you!", says Michael

Driving 120 Kph on the 401 and realizing that I had multiple layers of clothing between myself and the infusion site.  This was not good.

Conveniently, the 401 has emergency stopping areas, right when I needed them. I drove by the first set, hoping that things would magically be fixed, they weren't.

I stopped, I took off my jacket, my shirt, and my undershirt.

I looked and saw that I had not fully connected the tubing... Silly Michael.

Where was my dresser?!?

The steering wheel helped me out in my hour of need, but it was tough and it took a lot of fandangling.

Moral - these sets are not a 1-handed set!

Other moral; I'm tired!

I'm going to bed right away.

It feels so early, but I have to wake up tomorrow morning so SUPER early.  I need to drive to Waterloo and start working for 9am.  I need to be there half an hour early and it takes an hour and a half to get there, that means I need to leave at 7am.  That means that I need to wake up at ...yuck!

I practiced a lot over the last few days, so I should be ready to play the exams.  I still feel a nervous and unprepared, but I know that things will be fine!

I'm staying at my uncle's tomorrow night in Cambridge- it is considerably closer to Waterloo, so I will save at least an hour of driving time by staying there.

I'm worried about my ability to navigate using the google map while driving.  I've only been through Waterloo on the bus, so this will be new and I'm limited to whatever google tells me to do.  I hope I don't miss an exit or make a wrong turn...

Well, my family has headed back to Manitoba.  It was great to have them all here to visit, but it is nice to have my own space back.

It's now just a few days before I start playing for dance exams in Waterloo.  The day after those finish is my thesis defense.  The rest of this month is going to just fly by!

I'm excited to have a rented car for the next week.

I am not excited that I will be having to wake up so early for the next week, but it is work and I think it will be at least mildly enjoyable!

So much to tell!

This has been such a busy week, and it's only been a few days since I last posted.

Family is still here and it's wonderful!  We've been eating out way too often for our own good, but oh well.  My dad had made an agenda, but we've barely done any of the stuff on there.  It has nevertheless, been a very family-heavy week.  I've discovered that my couch is much more comfortable than an old camping air mattress.

Thesis Performance - come and gone.  I was stressed to have been part of the performance process, other than attending rehearsals as the composer.  Things were not quite coming together as I hoped they would leading up to the fateful day.  The day of the performance, we had our last dress rehearsal and it was just plain not good enough.  I wasn't sure what to do.  I took some time to myself and convinced myself that I needed to do my best and be positive no matter what.  I did an interview with Rogers TV and I felt great.  Somehow, the performance came together and it felt great and went spectacularly.

 I watched the DVD today.  I didn't want to, but the family did and there were people that weren't there for the performance.  I should have left the room.  I was so self conscious.  My voice sounded so super-gay, and I hate it when people sound super-gay!  The video was also focused in on me the entire time, and I hate watching myself.  Watching the DVD so soon after was possible one of the most horrendous experiences of my life.

When I got home from celebrating the thesis being performed, I had an email from UBC in my inbox.  Long story short - it was an offer I couldn't refuse; I have, since then, accepted it.

Next year, I will be living in Vancouver, working on my Doctorate.  Without going into details, let's just say that I will not have to worry about finances anywhere near as much as I have in the past.

I still haven't heard from the DAAD people, but I have already made my decision.  It feels good to know what my future holds.

Ok, family is here for a few days more so I will make the most of it!

Goodnight.

Excitement

My parents and sister are in town and things are good.

I went with my parents this morning to the tourism centre.  As they were learning the excitement of London, I was excited to read the London Free Press and discover that my program cohort was featured in an article, and that I was also mentioned in it!

If you want to see the article go here.

They also contacted my pianist, mentioned in the article, so hopefully they got some more information from her today so that they can print another article tomorrow.

Most importantly, I'm hoping that the concert will be reviewed and that we will have good press!

Nevertheless, I'm very excited to see that we're getting advertising for the concert, and it's always nice to see one's name in print!

I'll admit, I'm nervous because I'm now part of the performance, as narrator!  The rehearsal today was a bit stressful, but it will be phenomenal tomorrow!

YAY!

I don't quite understand...

Now that I've finished the thesis, it feels like I'm the busiest I've been all year.

I've been cleaning all weekend.  My roommate was showing the place for next year, we had a birthday party for a friend, and my parents are arriving for the week on Monday.

I've been learning dance music all week.  I have literally hundreds of pages of music that I will need to play rather well for the Royal Academy of Dance exams starting on the 15th.

I've been sending lots of emails back and forth for many reasons, outlined below:

The performance of my thesis is now going to involve me.  In order to  get the strongest performance, we've split the solo part into separate pianist and narrators.  Because it's so close to the performance, I'm pretty much the only one who knows the text well enough to pull off a performance.

I'm trying to decide on what to do next year.  I'm still waiting to hear back from one institution; I cannot make a decision before I hear from them.

I need to decide what to do this summer.  I've been offered a job as a summer camp counsellor specializing in Musical Theatre.  I'm not sure if I want to take it or not:

-the decision will be influenced by what I'm doing next year

-pros = upstate New York in the Adirondack mountains would be gorgeous, I would be able to make a difference in the lives of children

-cons = the schedule leaves little to no time to myself, so I would get NO writing done, the pay is not as good as I had hoped

At the moment, I'm leaning against doing it.  I'm thinking of spending the last month or two in Winnipeg.  I need to decide quickly so I can start looking for summer work in Winnipeg if that is what I decide.

I'm leaning more and more strongly the more I think about it.

I'll likely be moving semi-permanently so I want some time this summer to spend with friends and family.

I just realized how hectic this month is going to be.  

Family is in town from April 6-13th.

By April 15th, I have to have decided where I will be going next year.

April 16-21st I'm playing dance exams in Waterloo - that means I'm driving there daily for 8:30 or 9am.

During that time, I still have to play regular dance classes in London.

I defend my thesis on April 22'nd.

Another set of dance exams on April 23'rd in London.

I'm supposed to know by now if I've been accepted to some programs, but I'm still waiting for the word.  I need the full picture so I can make my decision.  Here's hoping that I won't have to wait much longer.