Monday, August 23, 2010

School Nurse Blues

I often used to read with pity the woeful wails from parents whose children went to a school with a clueless nurse or even no nurse at all. Truthfully, I didn't give it a lot of thought because that was the one thing we seemed to have well under control. Amy had trained Emma's first nurse and teacher well, and they had a pretty good handle on things. There were a few bumps and hiccups along the way: Emma wandering alone outside during a fire drill, her pump wailing away all the while, screwed up sensor numbers from poorly-excecuted calibrations, etc. But at minimum, they could look after the diabetes basics. We were pretty distressed to learn the nurse was moving, but we remained optimistic that a week of training ought to do it.

And then today came. The first day of school. The first day of school with a new nurse. The first day of school with a new nurse and Amy's business on the cusp of booming success.

There is another T1 1st grader in Emma' school. He came to the nurse's office with Emma before lunch so he could be tested and given his injection. The nurse read the results and triumphantly proclaimed "You don't need insulin, your blood sugar is fine!"

Hallelujah! The school nurse has cured type 1 diabetes! At least until the test that comes 2 hours after this little boy ate his lunch. Fortunately, he is smarter than the nurse, and informed her he needed insulin before every meal. (To tell the truth, I'm not sure Emma would have said that).

Poof! There goes our misplaced optimism and excitement about the first day of school with the new nurse, and I'm completely torn as to how to address it. I know my wife won't want me to say anything, but this is just as much (if not more) about her as it is about Emma. I mean, she didn't want to give him insulin!! Where do you even START when someone is THAT incompetent? Clearly, someone failed to ask a pretty important question during the job interview, so do I hassle the principal? Hunker down and work extra hard to train the new nurse AND the new teacher?

I wish it were as easy as telling the school "You've got one week to figure this out." But this isn't McDonald's, it's Emma. If they can't do it, we will have to. Perhaps a better title would have been "Starting Over."

Thursday, August 19, 2010

The Stuff I Miss the Most

When I was first diagnosed with type 1 diabetes, at the tender age of 26, I had to make a very rapid lifestyle change that included giving up eating trainloads of stuff that I like to eat. Because I was 26, the ER doc assumed I was type 2, and after a couple of hours on IV insulin I was sent home with a prescription for glyburide (and a Winnie the Pooh sticker 'cause I only cried a little when they started the IV). After another doc tried to kill me with oral meds, I finally got on insulin and started to get the hang of this D nonsense. I quickly learned that being new to type 1 meant no more:

Oh how I miss you dear friends! Boxes upon boxes of donuts, with your various frostings, fillings, and delightful variety of sprinkles! And my dear Count Chocula, you and your cousins Frankenberry and Booberry haunted my every Saturday morning until the final cartoon went off the air at 11:30. Old friend, triple-meat, triple-cheesburger; I still call upon your delicious existance on the Ides of March, and yet your high fat content stays with my blood sugar for a fortnight.

These days, a donut here or there can be managed with an aggressive bolus timed just so. Cereal is a blood-sugar bomb. If there's a way to bolus for it, I certainly haven't figured it out yet. I cannot deny my indulgences in cheeseburgers, although my days of the triple-meat are fairly well passed. To be clear, I was not overweight when I was diagnosed, and NO, these things did not cause me to have type 1 diabetes. They just happen to be some old friends that don't understand diabetes and so I just prefer not to play with them anymore. They're that weird kid on the street that wore swimming goggles year-round.

I miss a lot of other stuff too. Like being able to roll over at night without a pump jabbing me in the ribs, or being able to sit through long meetings without whipping out a juice box. (Seriously, how many grown men still have to carry around juice boxes with "Big Bird" on them?) Mostly, I just miss being....normal?

Tuesday, August 17, 2010

Oh Yeah, Him!

Emma obviously captures a lot of time and attention. Actually, she demands a lot of time and attention! The really great thing about Emma (among many others) is that she's simply the happiest kid I have ever known, even though she has more to gripe about than any adult I know. I think Amy and I have done a pretty good job with her, but it takes team effort when there's a little one in the house with type 1. It's easy to take it for granted when a D sibling is as good a kid as her big brother, Brenden.

The true bottom line, in my completely un-biased opinion, is that Brenden has really taken to heart two very important things: always look after those who cannot always look after themselves, and that family comes first. Brenden is transforming, right before my very eyes, from a kid into a young gentleman.

Over the past year, on nights he and I do the grocery shopping, I noticed a couple of things that may not seem like a lot, but that I thought were pretty darn cool. To start, he saw an elderly couple obviously struggling to get out of the store with their groceries. Brenden asked if he should go carry their bags to their car for them. Tonight, as the checker was scanning our items and putting them into the plastic-bag merry-go-round, Brenden stood at the end putting the groceries into our basket. After every bag went into the basket, Brenden peeled the plastic apart just a few inches. He was doing it so the checker would not have to peel each and every plastic bag. Sounds silly, but that is how a gentleman would act, and its how a gentleman treats any employee of any business. I could not have been prouder.

My little gentleman is starting middle school this year, which by default adds another layer of gray hair. But if I never lived to see another day, I would know that my little gentleman would take care of his mom and his sister for as long as he needed to.

I'm proud of you dude.

Like Sands Through the Hourglass

Whoa. I am a TERRIBLE blogger.

I am good at impersonating Disney characters, accurately predicting arrival times to any destination when embarking on a road trip, and making computers do all kinds of things they were never intented to do. But I am a lousy blogger. A true poster-child of the Lazy Bloggers Club. Sorry about that, I'll try to make it up to all 4 of you.

Typically it would be expected that I would provide an update on what's happened since I last composed a blog, so here goes:
  1. Alaska became a state.
  2. Pluto was kicked out of our solar system.
  3. Global warming went away, then came back, then went away again.
  4. The Berlin Wall fell.
  5. Courtney Cox either starred in or had cancelled at least 5 TV shows; but she's still married to David Arquette. (His sister still awakens everyone in the house each night on "Medium," which has changed networks..twice.)
  6. Atari game systems were discontinued.
  7. Luke learned that Darth Vader was his father. (I'm still in shock)
  8. Someone apparently developed a device known as an "insulin pump."
  9. At least 3 cast members from "Saved By the Bell" have successfully shed their "squeeky-clean" images. I also hear the cast from "Diff'rent Strokes" has also endured some form of turmoil.
  10. The Lubbock Avalanche-Journal, my hometown newspaper, stopped advertising jobs in the help-wanted section as "Jobs for Men," "Jobs for Women," and "Jobs for Either." (Yes, they really used to do that).

Many other exciting things have happened, but because I am OCD and would love to travel to Europe, I like to keep my lists to multiples of ten. It's been one heck of a whirlwind the last several months to be sure. I know you are all screaming at your monitors begging for more, so I promise to provide a little more of an update very soon.

In the meantime, if you haven't seen it yet, here's a link to a guest blog I wrote for Kerri.

Monday, February 15, 2010

Layla Grace

I don't know why, but I cannot stop thinking about this precious little girl from the Houston area. She is 2 years old and has a terribly aggressive form of cancer. She is, sadly, in the last days of her precious little life as we speak. I cannot imagine what her family is going through. I have posted the link to her family's blog below, but be warned that it is not easy to read.

May God ease her pain now, comfort her family tomorrow, and rejoice with them when she is whole again soon.

Sunday, January 31, 2010

Why the Self-Checkout Doesn't Save Companies Money

This doesn't have anything to do with diabetes, at least it doesn't yet. By the time I get through it I may manage to tie it in, so we'll just have to see how it goes.

Before I went to work for The Scooter Store, I ran carwashes during the day and taught college courses at night. One of my favorite topics was the concept of the self-checkout aisle at The Home Depot. Tonight on the Children with Diabetes forums someone was complaining about the lack of service available on the floor at The HD. My theory is that the drop in business from the profitable contractor's business is causing cuts on the less-profitable sales floors. But then I thought for a moment about it. I've never been a fan of self-checkout at home improvement stores. By definition, these stores are for schlubs like me that are trying to do stuff ourselves; the last thing I need is the stress of trying to scan a 10mm hex nut with no barcode.

But I digress.

You see, the problem is that people need accountability. People are imperfect creatures, and we simply must be held accountable to someone or something. If you think about it for a moment, who exactly holds the kid in lumber accountable if he brushes off a customer? Is it the computer that helpfully reminds you to put that 6 foot picket on the scale so it can be weighed? In business, virtually every business has one chance to get a customer's feedback and either build on a positive experience or salvage a poor one.

That no longer exists at places with self-checkout lanes. If you were the 19 year old making $8 per hour, and you knew no one was going to ask that lady you just blew off if her experience was a good one, would you go the extra mile? Conversely, if you knew you wouldn't be recognized for extraordinary customer service, would you bother? For sure, some would. But most won't.

So let's pretend that Lowe's will save $20 million this year by eliminating 6 full-time cashier positions in each of its stores across the country. Somewhere some operations executive is very proud of that number; and I would also bet that a sales executive in that same company is scratching his or her head as to why their consumer business is suddenly flat or dropping. The reason is that what made the home improvement business such a raging success will now be the reason they fail.

I happen to think this is a perfect example of why the free market shouldn't be tampered with. There are lots of people opposed to "big box" retailers and their impact on "mom and pop" businesses. Sooner or later, the market will correct itself, and my suspicion is that the mom and pop hardware store will make a raging comeback as a result of the self-check lanes. I'll be interested to see if anyone notices it happening.

Sunday, January 17, 2010

Random Musings from the Sunday Paper and Other Tales from San Antonio News

When we first moved to the area, we tried our best to assimilate. Included in that was to watch the local news and read the local papers. First, we have to exclude the New Braunfels newspaper; any paper where the adventures of Nancy and Sluggo appear alongside the letters to the editor. And the Austin-American Statesman is out because it's a rag. The Statesman would make Beijing proud.

Primarily we get the San Antonio news here, and the television news always includes one of each of the following topics: a fire, a stabbing, and a robbery. Generally, whomever can get all three in the lead story will win "sweeps."

"A fire breaks out at a local bar after a man stabs his friend who had just robbed their mutual ex-wife." This is usually followed by an ill-prepared reporter with hundreds upon hundreds of emergency vehicles behind them. I think that robbers actually start fires in San Antonio because they know EVERY cop in town will be at the fire. Maybe the want to be on TV. You can practically hear the director whispering in the reporter's earpiece "OK, you're doing great. Now see if you can squeeze the phrase 'sex offender' somewhere in the story."

The young reporter, hoping to move to the big leagues, thus offers the viewing public:

"That's right Dan, behind me you can see that the entire city is awash in flames. Police suspect that a sex offender robbed a veteran just home from Afghanistan and started a fire hoping it would distract the police. Police have been unable to locate a suspect, presumably because they are all here looking at the fire."

Director: "Don't say that part."

Reporter: "Oh....uh...LOOK! They got him, right over there by the burning strip club."

Director: "Score!"

The newspaper is actually a little better. I'm more interested in the subtleties of newspapers. And since I'm just naturally inquisitive, I'm prompted to offer these observations and/or questions.
  1. Whoever decided to attach the eyeglasses ads to the funnies should be shot.
  2. Are trucks ever NOT on sale?
  3. I hadn't read "Parade" magazine in a long time, and boy have I missed newsy nuggets like "studies suggest a link between going to Wal-Mart on Sunday nights and complete stupidity." I used to think Marilyn vos Savont was a genius, now I think she's Milton with Wikipedia.
  4. I get that there isn't really a sole pro football team here, but one page out of 40 devoted to the NFL playoffs compared to 27 for the Spurs' loss last night seems a bit....confused.
  5. Does Academy actually sell any sporting goods, or just $100 shoes and $40 t-shirts?
  6. I love the Target ad. I always read them, and become disproportionately excited by them. "Look honey, Target has loofahs on sale! 3 for $7.99!" If I saw that ad for Dollar General, this would be a completely different blog.
  7. I also always look at the office supply ads and the Radio Shack ads. I guess I like to look at out-dated, over-priced technology and then label and file it.
  8. When you think about it, $1.50 for the paper is a pretty good deal. It takes an hour to read "People," and it costs $4.95. Or so I hear.
  9. Newspapers would be much, much more popular if they were the same size as a magazine. Airplanes should be a newspaper publisher's best friend, instead they go together like cookies and Calista Flockhart.
  10. I don't really have a #10, but I'm a fan of the metric system.

Tuesday, January 12, 2010

The True Cost of Diabetes

Type 1 diabetes is expensive. Two people in one house with type 1 diabetes is really expensive! We are lucky and have really good insurance, but that doesn't necessarily mean that it costs any less. Plus, there are lots of other costs that can't be expressed in numbers. But since I'm a numbers kind of guy, let's start there.

Per Month:
  1. Medical Insurance: $800 per month. Why is this so significant, you ask? Everyone needs insurance don't they? Not necessarily. Let's pretend for a moment that I am a healthy adult with an otherwise healthy family. $800 per month works out to $9600 per year. If I were healthy, I might have chosen a bargain plan at work at a cost of $4000 per year, or I might have chosen a major medical plan for as little as $40 per month ($480 per year). Then I would pay out of pocket for office visits (assuming I even went if I were healthy) and prescriptions. I've learned that you can negotiate a pretty decent cash price, and I figure a family of four paying out of pocket would spend $600 per year in office visits. Prescriptions would be pretty typical, antibiotics and such, and would run another $1000 or so to estimate on the high end. So, very roughly, diabetes costs us $7200 per year.
  2. Life Insurance: $58 per month. I was lucky (and smart) enough to grab a life insurance plan while I could. If I weren't diabetic, I would just use the group life provided at work and buy the increments there. That's $700 per year.
  3. Right now, I put $5000 per year into our HSA account. If I were healthy, I would probably do it anyway to balance the risk of having a major-medical plan, so that's a wash.
  4. We spend $1440 per year on mine and Emma's pumps. That's just the pumps.
  5. Pump supplies are nil (thank you A Plus), but batteries, Tegaderm, etc. are not. I put their cost at $300 per year.
  6. Most of our diabetes prescriptions are covered at 100%, but insulin is not. $240 per year.
  7. Office visits...yikes. Specialist visits are $50 a pop, and between Emma and me, that's $1000 per year.
  8. Hospitals, labs, etc. $2000 per year.

So that's a pretty rough estimate, but it costs my family $12,880 more per year than it could potentially cost.

If you talk about the word "profit" with an accountant and a finance analyst, you'll get two very different answers as to what defines "profit." To an accountant, if your revenues exceed your costs, then you're profitable. To a financial analyst, profit only exists if the revenue you receive is the highest revenue possible AND it exceeds your costs. In other words, if I earned $500 making calculators, and it cost me $300, then an accountant calls that profit. If I could have made remote controls for $300, and sold them for $600, then the financial analyst says I have LOST $100. Makes perfect sense, right? They call this obtuse concept "opportunity cost."

There are lots of "opportunity costs" associated with diabetes:

  1. I will never be an entrepreneur in all reality. I will be a slave to group health insurance. What is the cost associated with that? What if I could open a dog-grooming business and profit $100,000 per year? Not going to happen. I can't assume the risks of a start-up like most can. What if I was able to develop my big idea (a Lysol-type sanitizer in fogger form), and it ended up saving millions of dollars per year in costs associated with kids that get sick at day-care centers, in ball-pits, etc.? How much money is lost to parents staying home with those sick kids? You get my point.
  2. What if my wife wasn't forced to give up her career to take care of a diabetic baby? Let's assume she earned $40,000 per year, and Emma's been diabetic for almost 5 years now. That's $200,000 in lost income, and a reversal of $60,000 in costs for a net $260,000 swing. That's big money folks.
  • What are the emotional costs?
  • What are the costs in terms of the morale of the caregivers? And in some cases, what are the costs associated with the loss of a marriage?
  • What are the costs of parents that can't always attend their "healthy" kid's games?
  • What if that third child that we might have had otherwise was the one that found the cure?

So in strictly financial terms, it's cost our family roughly $300,000 in cost and lost income. In emotional terms, it's been far greater.

Thursday, October 8, 2009

The Best Big Brother Ever

Today my big brother Billy would have been 40 years old. Much is said about a man turning 40; they say men leave their wives for younger women in short skirts, buy expensive cars, start to dye their hair, or all of the above. Billy's physical limitations would not have allowed any of those things of course, although he did usually favor one lady over another at the State School, and he did have a certain twinkle in his eye when he got his new wheelchair.

I knew Billy as well as anyone. He and I were very close in a way that only a few people can really understand. Those with mental and physical handicaps very definitely develop bonds, and the bonds with their siblings are very strong. I see it often in Brenden and Emma. How many 10 year old boys will happily play with their little sisters, or quickly stand strong to defend them? I also see it in my wife's cousins, Holly and Haley. Their brother, Britton, is profoundly locked away by Autism, but he knows and loves them and vice versa.

That was how Billy and I were. And I know him well enough to know that if he were "normal," he never would have been any of those things that some 40 year olds become. His spirit, strength, and courage were too strong to be overtaken by higher indulgences. He preferred Hee Haw on a little TV to "Baywatch" on a wide screen. The Price is Right won out over "Lifestyles of the Rich and Famous."

Those who know how to cherish and appreciate the simple things are the truly powerful ones, and that will be the gift he left all who knew him.