How Answering Your Door Will Make You Fat

I think I’m turning into the weirdo recluse cat lady of the neighborhood. This worries me.

I’ve gotten to a point where I rarely answer my door unless I’m expecting someone, and I often don’t answer the phone either. I just can’t be bothered.

Somehow though, a few weeks ago, a neighborhood kid caught me on one of my rare door-opening days. She was selling stuff for a school fundraiser. Now, I applaud the kid who will actually go door-to-door in their fundraising efforts in an age when most parents just take the catalog to work and hit up their coworkers. So, even though I didn’t really want anything, I ordered a tub of cookie dough to reward the kid’s efforts.

Fast forward to last Thursday. I’m home after work and getting ready to go to yoga. Ding dong! Damn doorbell. I sneak to where I can peek to sort of see who’s there and decide not to answer. After the person walks away I look out the window and pat myself on the back – whoever it was came in a group and was carrying a clipboard, probably wanting money for something or other.

About ten minutes later: ding dong. Again! Well, I’m wise to these guys, so I don’t answer, but certainly do my peeking routine after they’ve gotten back to the sidewalk. Huh? It’s a completely different person, pushing some sort of cart, and --SHIT! -- she sees me spying out the window and starts back up to the house. I dive into hiding and ignore the doorbell once more.

By now it’s really time to leave for yoga, but I feel trapped. I don’t want to be seen leaving two minutes after I’ve hidden from this person. As I stood there contemplating my quandary, the phone rang. And I, in full recluse mode now, ignore it. The machine recorded the following message:

“Hi this is (whoever) from the school fundraiser. I’ve got your cookie dough, and um, tried to deliver it, but – uh – I guess you’re not home…” And she leaves a phone number.

Well, that explains the cart: the poor kid is hauling eighty pounds of dough around the neighborhood, and I – idiot that I am – am hiding from a six-grader. Now I really, really don’t want to be seen leaving so I delay as long as possible (can I get to my class in four minutes? Maybe, if all the lights are green...) and then sneak out into the dusk.

When I get home, instead of behaving like normal adult and calling the kid back, I decide to add that phone message to the list of things I’m ignoring. I’m completely embarrassed by my hiding behavior and I don’t really want the cookie dough, so (I rationalize) maybe the kid will just keep it and enjoy it herself. But I also decide that I’ll be willing to answer the door for the next few days in case she makes another attempt to deliver.

A few more days pass. I delete the message. Now there’s no possible way of claiming that bucket of fat from the kid. Until, last night:

Ding dong!

I heed my resolution to answer the door and open up. And there she is, in all her cute blonde glory, carrying my bucket of peanut butter chocolate chunk cookie dough with Dad a few feet back for support. I think they’re relieved to see me, so I cheerfully take the dough and make some smart remark about getting out a spoon. Blondie and Dad both look horrified. “You’re supposed to bake them. Thaw it and bake.” I seriously worried that they’d snatch the bucket back and make me vow to prepare the cookies properly. I reassure them that I’ll bake as directed, say thanks, and close the door.

Then I got out a spoon.

New blog!

After several months of writing mostly about Isabella, the wee diabetic cat, I realized I had a problem.

What is this blog about?

Mostly, it seemed to be about feline diabetes, but sometime I have other things I want to say. So I've decided to split the blog in two. The new blog will be devoted to the topic of the cat and her diabetes. This one will be for whatever else I care to comment upon.

Stage IV

Last week I got the news that a good friend has metastatic breast cancer. Stage IV. There is cancer in her lungs, liver & bones. And I suppose it’s in her breast too, although no one ever found it.

My friend is one of those “how can that happen?’ stories. She saw her doctor for her annual exam, including a manual breast exam, last September. She had a mammogram in November. When she started experiencing seemingly random symptoms in December, she saw doctors several more times – and had at least one more breast exam. By this point the cancer was well on its way, completely undetected and wreaking havoc throughout her body. No one ever found her breast tumor. It was a CAT scan taken when she presented to the ER with shortness of breath and general discomfort that finally revealed the diffuse tumors.

Stage IV.

I saw her two months ago at an annual girls’ weekend getaway. We now know that she was having some weird discomfort (sharp pains, burning, and numbness in her arm) during that trip, but I don’t recall her mentioning it. If she did, it was probably offhand and dismissed by all of us as one of those random things that comes and goes benignly.

Not so benign, it turns out. Not benign at all. Stage IV.

I keep reminding myself that they do amazing things with breast cancer these days. And they do! I do medical research for a living, so of course I am all over the literature looking for hope. One article from 1992 stated that the survival rate for Stage IV patients is “appalling.” (That’s the actual word chosen by the author: Appalling.) However, 1992 was a lifetime ago in terms of breast cancer treatment. So I dismiss that prognosis and turn to more recent writings.

18 to 24 months is the median survival stated by the National Cancer Institute. Liver metastases are bad, though. And the type of cancer my friend has, HER2/neu positive, is bad. Aggressive.

On the plus side are the recent trials of monoclonal antibodies, which show very positive results as far as extending survival. JAMA – a venerable journal not given to exuberant language – featured an article titled “Monoclonal antibody therapies shine in breast cancer clinical trials.” That may not be exuberant by National Inquirer standards, but it’s positively giddy for JAMA. My friend is enrolled in a clinical trial of two monoclonal antibodies, Herceptin and Avastin. Herceptin specifically targets the HER2 receptors (good!) and Avastin strangles blood vessels feeding the tumors (also good!). Both of these drugs have been shown to lengthen the lives of women with breast cancer.

So I guess that we have to rely on modern medicine, which utterly failed in detection, to do something right now that my friend’s cancer is out of control. I don’t really blame medicine, nothing is perfect after all, but she did do everything right. Which leaves me with: “how can that happen?”

Pray for her.

Across the Golden Gate

I'm a swimmer. It’s what I do for fitness and for sanity. I’ve accumulated thousands of water-logged miles over the years, mostly confined neatly within the walls of one pool or another. A few of those miles, though, were earned in the open water of lakes, bays, and the Pacific Ocean.

Summertime open water swims are a tradition among year-round swimmers. Getting out of the pool and away from lane lines can be rejuvenating. In northern California the variety of open water swims available is impressive. Distances range from a short mile or two to marathons of 10 miles or more. The course may be marked by occasional buoys or not marked at all. Water might be warm, or not. A handful of people might enter an event or nearly a thousand.

One September I joined a couple hundred others to swim across San Francisco’s Golden Gate. The narrow channel that marks the transition from the Pacific Ocean to San Francisco Bay can have treacherous currents and heavy shipping traffic. The crossing is not long, but it should be attempted only in coordination with currents and the Coast Guard. The event I entered was meticulously organized, but I didn’t give much thought to all that. I just wanted to say I did it.

We gathered at Baker Beach, facing the ocean south of the Golden Gate Bridge. Our task was to swim a diagonal line north and slightly east, under the bridge to a small yacht harbor just inside the bay at the north end of the span. Our course was not marked; navigation was up to each individual. The distance was estimated at less than two miles. The water temperature was about 58 degrees. The weather was cloudy, drizzling rain.

The race director pointed to the hills north and somewhat west of the bridge. We should swim toward those hills, he said, not toward our final destination to the east. Slower swimmers should aim even further west. The incoming tide would sweep us eastward and under the bridge. Miscalculate, and risk being pushed past the harbor and into the bay. Swim west, he emphasized.

Race time now. The starting horn blew and swimmers rushed to the water, running awkwardly in the shallows before finally gaining enough depth to plunge in and swim. The cold stole my breath. Icy, shocking cold. Though 58 degrees was actually rather warm for these waters, it was still too cold to swim gracefully or breathe rhythmically. But swim I did. The first shock of cold shifted to an all-over numbness. My breathing settled and I began to swim more purposefully. To the west, deliberately to the west.

To me, the pace of an open water swim is similar to the pace of each year. January, like a swim, starts in a frantic rush. Resolutions, newness, fresh resolve. A rhythm is soon established as the newness wears off. Late winter and spring plod along. February, March, April. I stroke and stroke, Will summer – the halfway point – ever arrive? It does, and the middle of a swim is relaxed and easy. By fall I’m getting weary. The end, like the holidays, is visible in the distance, but is so far away. It’s too early for my finish-line sprint, but time to start planning. Then, suddenly, it’s Thanksgiving and the finish is just ahead. The December rush passes in a blur and the water is now shallow enough to stand and run across the line. Looking back across the water, it seems I just started, but another year --another swim -- is done.

This race was no different. After the rush and chaos of the start -- 200 sets of thrashing arms and legs -- the swim up the beach to reach to mouth of the bay lasted every bit as long as a cold winter. I spent the spring and summer crossing the Golden Gate. At first elated to be close to -- and then under -- the bridge, soon I just felt tired and alone. The sea swells, while not terribly high, effectively hid the other swimmers. Not even a pilot boat was in sight. The incoming tide did its job, and by fall the mouth of the harbor was visible. I was on course to go in, not past. The overall numbness, so welcome earlier, was long gone, leaving a creeping, bone-chilling cold in its wake. My hands were blue. I kept swimming. All of a sudden I was beyond the harbor breakwater and caught up in the excitement of the finish. I reached shallow water, then dry land, and a glorious warm shower. Done.

I don’t swim these events competitively. I’m not fast enough to win awards so my motivation comes from elsewhere. For the Golden Gate swim that motivation was the novelty. It was the opportunity swim under a landmark most people see only through car windows or in photos. The distance wasn’t challenging. I wasn’t afraid of sharks or ships. Nor did I fret about the current, though perhaps I should have: Swimmers the next year were caught in troublesome tides that threatened to carry them to sea. This swim that I approached as a lark with carefree naiveté is now an infrequent event, rarely open to the public, restricted instead to elite members of private clubs.

I’ve done many open water swims, but this one, the Golden Gate, is the most memorable. I’ll carry with me forever the sight of the bridge far above, the swells all around, and the sensation of solitude in that place between the ocean and the bay. And I can say I did it.

Part-time pancreas

I have a great deal of respect and admiration for people living with diabetes. Type 1, Type 2, no matter. If you’re coping with that disease, day in, day out, along with going to work and raising your kids and doing the laundry and all the other crap that comes with a normal life, then I bow at your feet.

You, my friend, are amazing.

I don’t have diabetes but I do live with it. Diabetes has reshaped my days. In my case it’s not a family member (exactly) – but my cat. My cat, Isabella, has this chronic and frustrating disease. Incurable. Expensive. Exasperating. So exasperating that I make oral pleas to her pancreas. I make bargains with God. I have a vial of insulin in the fridge that, administered in the proper dose will make her feel better. (For a while.) The improper dose, on the other hand, can kill her – either slowly or within hours.

Every day, twice a day, I choose a dose and inject my cat. Twice a day I hope I’ve chosen right and that she’ll feel better for a few hours until her next injection.

Before Isabella was diagnosed, diabetes was just one of those diseases warned of by earnest actors in dramatic TV ads. I knew it vaguely. Bad feet, sugar substitute, might go blind. But it was nothing for me to worry about. Now, well it’s a different story. Now, I am Isabella’s part-time pancreas. I know about beta cells and islet cells and glucagon and Somogyi rebound. I understand the action profiles of various insulins, both human and veterinary. I know what normal blood sugar is for a healthy cat (60-90 mg/dl). I know – and furthermore, I care! – about the carbohydrate content of various canned cat foods. I know where to get cat food on sale.

When Isabella was diagnosed, her vet showed me how to inject the insulin and instructed me to give her 2 units, twice a day and to change her food to lower carb. And to keep a bottle of Karo syrup handy in case she started acting funny. I thought that was simple enough. But that was before I started reading. And learning. And obsessing.

How could I just blindly inject my cat with a substance that could kill her if I didn’t know her blood sugar reading? Human diabetics don’t do that, and neither would I. So I got a glucometer and learned to get blood from a cat. (Not easy – particularly with a bad-tempered beast like Isabella, but that’s a story for another post.)

Now that I had the numbers, I assumed I’d just learn how the numbers and the insulin dose interacted and we’d be home free.

Not so fast, little bucko.

This is a cat. I don’t know about human diabetics, but cats are notoriously hard to regulate. The dose that one day takes her from the mid-300s to the lovely low-100s might just do nothing the very next day. Nothing. Or, it could take her low and keep her up all night. (And Isabella’s clueless caretaker might just spend the night yelling at her to go to sleep, only to realize – when 49 mg/dl pops up on the meter the next morning – that the poor little cat was probably very uncomfortable and trying to tell her something.)

She can go along happily on one dose, hitting highs of the mid-200s (not too bad) without restless-night lows. And then, suddenly, double digits. Or 400s. What?? WTF?? Just when you get complacent, something happens to shake things up. The cat starts drinking a lot again and lying like a lump by the front door. Pre-diagnosis behavior. Doses need adjustment. Frustrations run high. Pleas to the pancreas become more frequent and more sincere.

I operate on hope a lot. I hope I’m choosing a good dose. Hope I’ll get blood to test. Hope – every day – that when I get home from work, Isabella will greet me at the door. I hope I’ll never see a hypoglycemic seizure, and if I do, that I’ll cope with it and get her fixed up. When her numbers are high, I hope that ketoacidosis won’t strike her down before I can get her glucose under control. I hope to keep urinary tract infections and pancreatitis at bay. I hope I’m not making my cat miserable with all the poking.

This, for a cat. It’s not my disease; it’s not me that feels lousy. But because of this cat and my role in her disease, I have a tiny glimpse into the life of a person with diabetes. And you, my unseen friends, are remarkable.

Pain & Swelling in the South Bay

I sprained my ankle two weeks ago. It's still swollen. Is that OK? Or should I have it X-rayed?

The Writers Club

As I said in an earlier post, I read somewhere that the test of a real writer is "to try to stop." By that definition, real writers have an undeniable urge to say what's on their mind. I imagine it similar to the need to push in the final stage of labor.

Imagine.

I use that word deliberately, because I don't feel an urge or a need or a hunger or anything else that drives me to write. My personal driver is a deadline, and there are very few of those for this freelancer who does not actively seek work.

And yet, I have come to realize that I consider myself a writer.

It feels very naked and bold to say that. Who am I, after all, to count myself among the ranks of the talented? It might be that I've reached a sort of critical mass of encouragement:

• I had a writing class in the 7th or 8th grade. Years later, when I was in my 20s, the teacher of that class ran into my mother and asked if I was doing something that involved writing.

• I took a "what the heck" community college comp class in the evenings one semester. The teacher told me I should submit my work to magazines.

• I once actually had a job where writing a web newsletter was part of the responsibilities. There were four of us, and the lead said I was the best writer of the bunch. (This stuns me. My coworkers are a talented group and I surely did not stand out.)

• I send a goofy "year in review" letter with my holiday cards. People respond with "you oughta be a writer!"

OK, OK, I get it. I oughta be a writer. And as I just said, I consider myself to be a writer. But a real writer? Does any writer consider themselves to be a real writer?

I typed “real writer” into Google. (Because everyone knows Google has all the answers to life’s questions.) Apparently there are many tests to determine the realness of your writerness:

• Idiot Programmer presents us with a quiz:

• Susan Taylor Brown has a list:

• Denis Ledoux asserts that choosing to write makes one a real writer:

• Aaron Lazar agrees that writers have an urge:

• Answerbag offers an interesting variety of opinions, from the thoughtful to the obvious

My favorite? Moira Allen debunks all of the myths and makes it seem possible that I, too, am a real writer. She asserts that a writer must reach some level of competence to question that competence and doubt his place among real writers.

In my circle of writer friends and acquaintances, all of them – every single one – question their talent. They are sure that each piece they submit is the one that will reveal them as the hack they believe themselves to be.

I recall a conversation with a writer married to a writer. I confessed my fear of being found a fraud, that today was the day (I was, at that time, writing regularly) the editor would sit up and say, my god, we’ve been paying her? She admitted the same fear and confirmed that her husband (a stringer for a national publication) also suffered these doubts. Suddenly, I felt a part of the club, because I certainly counted those two among the real writers. And they felt that same as me!

No one can admit you to the real writers club. It’s up to each individual to step up and embrace his identity as a writer. My membership is shaky, at best. But I’m hanging on.