Archive for August, 2010

A Different Perspective on Seeing the Light

August 31st, 2010

I like short magazine tidbits not only because I can power through them without realizing it, but now also so that I can share them with everyone who reads this blog.

Today’s little tidbit came to me as I ate breakfast and paged through Diabetes Forecast.  They asked readers what made them take diabetes seriously

My favorite response was from a woman in Atlanta who answered “when my eye doctor wouldn’t write a prescription for new glasses until I brought my blood glucose down.”

Reading that made me almost jump up and give her eye doctor a standing ovation.  I find that doctor rather remarkable.

(For those of you who do not know, eyesight changes with glucose levels in the body.  Some people with diabetes get blurry vision when they are low or high, some people have trouble seeing before they are diagnosed.  The small capillaries in eyes are damaged by higher blood sugar levels and can eventually lead to blindness if diabetes is untreated.  Retinopathy is another complication of diabetes that leads to problems with vision.  Most of us with either type of diabetes get our eyes checked at least annually and have our eyes dilated and checked for early signs of damage.)

So this eye doctor knew her patient has diabetes that the patient wasn’t paying much attention to and she knew that her patient’s eyesight was only going to deteriorate if the patient kept going as is.

So this brave soul said to her patient: Okay.  I’m not going to help you in the short term because that is a band-aid where you need some real, honest to goodness, help dealing with a real underlying condition that is hurting you in the long term.

Gee, what do you think the reaction was to THAT?  Probably not a big squeezy hug from the patient.

But when you look at the situation, that doctor did I think the absolutely correct and right thing.  She helped her patient take diabetes seriously by taking a serious look at the disease.  She helped her patient get to a more stable spot with her blood glucose levels through that frank discussion and then addressed the patient’s vision needs from that spot.

I think that is a real doctor.  Not everything in life is rainbows and roses as we all know on some level—but we still wish it were!  So the fact this doctor was honest with her patient in a way that helped her patient get to a better healthier spot is simply fantastic

Not only am I happy for the patient, I’m happy for the doctor; I know it wasn’t easy for that doctor or for her patient. 

As one of my doctors would say: It’s Your Time.

August 30th, 2010

I had a dream my blood sugar was 1, 172.  I remember the screen had “11172” displayed, but in dreamland it was one thousand, one hundred and seventy-two

Wacky.

Because not only was I over a thousand (which I think has never happened in my real life) but I was in a weird blue bathroom and about to run a half marathon.  Since the half marathon was going to start whether I was ready or not, I just had to figure out what to do.  In my dream, I stood there a while and I don’t know what happened because I woke up then and said aloud “Weird!  I have to blog about that today!”

I rarely dream about my diabetes.  I rarely dream about much of anything from my close daily life, either, so it was weird to dream about my blood sugar.

I wonder if it has anything to do with my miserable run on Saturday.

I have to wake up for bootcamp every day at 5am.  This means I am reluctant to set an alarm on weekends.  Last year when I trained for my marathon I woke up one day of the weekend and did a long run before most people woke up.  This summer I haven’t been able to do it—I set the alarm, wake up, hang out in the bathroom staring at myself in the mirror, ask the dreaded 3-letter question one should never ask at that time of the day (“why?”), and head straight back to bed.

This on its own is not a problem.  On Saturday, however, it was a problem because when I woke up at 8am for my planned 16 mile run I ran out of cereal and turned on the TV.

Of course, I’ve been trying to bolus 10 minutes before I eat, so when I got to the bowl my insulin was already delivered.  Yikes when I opened the box and saw a literal tablespoon of granola at the bottom of the bag.  (I’d love to have shouted “who did this?!” but I’m the only one who eats that cereal.  All me.)  This meant I had to fudge it a little with some raisins and a gulp of Gatorade.

But the real culprit was Mike Holmes.  Now, in hindsight I know it was an hour-long show that was only part one of two.  At the time, though, I thought he would have built a beautiful home within an hour and I’d be able to see his magnificent work. 

So I kept continuing my reduced temporary basal and watching the show.

Which all meant I was 3 miles into my run and checked my blood sugar: 372.  Whoops.  Dang.  Small bolus, keep going.  Checked again 5 miles in, 330.  Looking better.  Keep going.  Checked again, 7.5 miles in, 220.  Phew. 

I was having a completely miserable run, though.

It wasn’t until I had returned home after forcing myself through the 16 that I started to wonder why it was so terrible.   (I finished with a blood sugar of 105 for those of you who are interested.)

Now it seems so obvious, but it wasn’t that obvious when I was out there!

Usually, at that 3 mile spot I have something to eat.  And usually, I’ve had an entire bowl of ceral.  And usually, I eat again after 9-10 miles.  But on Saturday I didn’t eat at all because I kept checking and seeing numbers that started with 3s and 2s. 

This isn’t how I normally run, and I haven’t seen a 300 in a while.  I’m glad, because I don’t like to see them when I’m out running.  Just like that 1,172 in my dream, I’m not always sure what to do when they are so high mid-run—my gut reaction is “insulin!” but when I’m running I know I need to moderate my gut response with something that makes better sense for my current situation.

Let me tell you, though, on Saturday I was one UNHAPPY camper.  I haven’t run that plainly unhappy in a number of years—and I’m glad I haven’t.  It sucked.

It brought to mind a comment Jerry Armstrong said once about running and nutrition: he said you know who did it right if they cross the marathon finish line and ask where the sign-up is for the next marathon.  If someone crosses the finish line and says they’ll never do that again, they haven’t taken care of their nutrition for the long distance.

That Jerry is a smart guy.

So the next time Mike Holmes builds a house for a sweet 63 year old lady with 5 grandchildren whose house was destroyed by Hurricane Katrina, if I decide to watch that instead of going out on my run when I planned to go, I’ll remember to eat on the run—even if I’m high—because if I don’t fuel my body, how can I expect it to perform?!

Do You Believe in Fate?

August 27th, 2010

To me, all of the information that various physical attributes are genetic makes me approach them differently than if they were somehow random.

Sure, I believe the science—it’s the predestination angle I think about.  If you knew what you were going to look like in 15 years would you do something differently now to change that?  If you knew growing up you’d have white hair by the time you graduated from high school, would you start dying your hair when you turned 15? 

Isn’t this information about obesity genes the same thing?

When scientists first discovered it in certain chubby mice, they called it simply the fatso gene. Years later, when they scoured the human genome for markers that increased vulnerability to type 2 diabetes, the fatso gene (now more politely called FTO) showed up there too. Turns out, people with two copies of the gene were 40 percent more likely to have diabetes and 60 percent more likely to be obese than those without it. Those with only one copy of the gene weighed more too.
Scientists now suspect that there are lots of fat genes. “There could be as many as 100 of them,” says Claude Bouchard, PhD, executive director of the Pennington Biomedical Research Center at Louisiana State University System, “each adding a couple of pounds here and a pound or two there. That’s a noticeable difference when it comes to how much more fat we need to burn off.”
As much as 16 percent of the population has two copies of the FTO gene, and half of us have one copy. So far, scientists suspect that the other possible obesity-promoting genes have a small effect compared with FTO. The good news? “A genetic predisposition isn’t necessarily a life sentence,” says Bouchard. Exercising regularly can offset the risk.

I’m absolutely sure that many people will read this, believe they have the obesity genes, and never try to change their habits to affect their outcome.  The same way I think people deal with fate: why try if they know the end result?

Well, my response is twofold:

  1. What told you that YOU were in the percentage that actually developed obesity?  When it comes to statistics, it only matters if you’re on one side of the equation.
  2. Even if you don’t control the specific outcome (obesity) you seek to avoid if you try, you still benefit in a multitude of other ways.  You can climb a flight of steps without feeling winded.  You can sleep better at night.  You can eat a meal without sweating.  You can say “excuse me” rather than “I’m sorry” when you’re passing someone in a narrow space.  You know that you faced your genes and decided to not passively let them determine who you are or what you do.

Why try?  Because you can.  Because you deserve to give yourself a fighting chance

You really do!

Diabetics Are Above Average (we already knew that)

August 26th, 2010

I get several magazines every month despite how many times I think I have let the subscription go.  It is confusing to me but it only comes up once a month, so it’s low on my priority list to figure out. 

One of the ones I swear I haven’t paid for in more than a year is Self magazine.  The thing I like about Self is their little sentence-long blurbs of healthy eating, beauty, and fitness news.  Today I read one that said that Americans see about 19 doctors during their life, and have about 200 pieces of paper in the form of medical records spread in 19 locations.  The point was to keep a medical history close by to reference should you ever need it.

I couldn’t find the study that came up with these numbers, but that shouldn’t matter.  I’m still trying to count how many doctors I’ve seen in my relatively short life!

Seriously.

So we’ll skip anyone who cared for me as an infant and just go for doctors I can remember.  There was my pediatrician who diagnosed me when I was 10.  I saw a dermatologist before diagnosis because my skin was so dry, but I won’t count that one.  And I won’t count my CDE I saw for several months after diagnosis.  And I won’t count my eye doctor, although maybe I should because he always sang “Once in Love With Amy” to me and I really should honor him on my list someplace. 

So, I’m at two doctors and I’m not even eleven years old yet!  I’m not counting dentists or orthodontists, either.  Or dieticians.  Or CDEs

Nope, you need an MD to get on my list.

So there is pediatrician.  And eye doctor.  And my endocrinologist after my pediatrician.  And then my other endocrinologist, after the first one seemed nonchalant I had passed out from a low blood sugar and said “meh, so you lost a few brain cells” when I was 16.  Do I count the surgeon who took out my wisdom teeth?  He probably had an MD, so I will count him. 

So I think now I’m maybe at five.  Right? 

And then college brought on another round of doctors since I moved.  And then I moved back and started over with all new doctors.

So here I am at 33 years old and I have absolutely seen more than a lifetime’s allotment of medical doctors.  Keeping in mind, I’m only counting those people I saw more than twice and who have an “M.D.” after their names.

I really also have to giggle at the thought of how many pages of records I must have strewn about the state.  If each visit to my endo generated at least five pages (1 regular notes, 4 blood sugar records or what have you) and I’ve gone to an endo four times a year for 22 years… I’m way past the average, and still only 33 years old.

It’s a good thing so many medical charts are going paperless.  It’s also a good thing most places destroy records after seven years.  Can you just imagine how many pages and pages and pages just the blood sugar records alone would take??  And I don’t even keep records!!  

Yow.

So yet again those of us living with diabetes are above the national average.  Go us!

How Joslin Suggests You Start Running

August 25th, 2010

Joslin Diabetes Center lists their 8 Tips For Running with Diabetes below.  I kind of think they are good tips for people without diabetes, too.  Not everyone who has a cardiovascular, orthopedic, or other problem has diabetes… so just be smart about your body and your physical conditions before you go out and try to win that gold.

Now, I want to repeat that I don’t think running is for everyone.  Some people simply hate running.  If you hate running, I don’t want you to spend time crafting your running skills—you’d hate the time and you’d hate me.  No need for that.  Only invest in learning what you need to keep yourself running, safe, and happy if you enjoy a few minutes of the run.  Those minutes will grow and grow as you keep at it.  (I know you won’t believe me when you’re out there, but it’s true.)

When I started running outside and no longer on a treadmill, I had been run/walking for about a year.  I never kept a log of my running and blood glucose readings—although I frequently checked while running.  I kept a log in my head, though, and one doctor asked me why I would think I could do it that way (meaning, I think, that he wanted me to write the numbers down so he could see them too).  Probably because I was stubborn.  (ya think?!  Still am.)  He made a good point, though: no need to make a point if making that point complicates your life.  Keep track so that you learn what your body does.  That knowledge will help you in all areas of your life with diabetes.

Now get out there!

“Walking is for everyone and provides tremendous health benefits,” says Michael See, M.S., R.C.E.P., a clinical exercise physiologist at Joslin. “Jogging is a great form of exercise for individuals who prefer to participate in a more vigorous exercise program.” Here are his tips to get the benefits of a healthy running program:

1. Get your doctor’s clearance. People with diabetes should consult their doctors if they want to go beyond purposeful walking, to make sure that they are not at risk from cardiovascular, orthopedic or other problems.

2. Walk before you run. Go from walking to running in a gradual process. Begin with purposeful walking (for half an hour or so), then combine walking and jogging, and then increase the jogging.

3. Wear the right footwear. Consult with an expert when you buy the shoes. Make sure that they fit well and are appropriate for running.

4. Dress appropriately. Dress in layers; wear absorbent materials close to skin to wick away perspiration and an outer layer to protect you from the wind and other elements. Wear a reflective vest if you’re out at night.

5. Find a partner or role model. Look in your community for running groups or clubs. Invite your neighbor or colleague to join together during lunch. If you’re interested in going the distance and even maybe running a marathon, pair up with someone who has done it.

6. Keep a goal in mind. You may want to set your sights on an event such as a five-kilometer road race for charity.

7. Have a plan for managing your diabetes. Measure your blood sugar before and after the activity (and during it, if needed). Carry juice, a sports drink, a piece of fruit or glucose tablets. Keep a training log, recording your miles and your blood glucose readings.

8. Listen to your body. Starting gradually and being consistent are the secrets to improving your health and fitness, avoiding injury and managing your blood sugar levels.

Me and Numbers

August 24th, 2010

I don’t read a lot of other blogs—diabetes-related or others—but I have been more interested in them as I continue to write my own.

One thing I see on nearly every other diabetes blog is something I thought about before starting Diabetes Outside’s blog: posting my latest meter reading or yesterday’s blood glucose numbers.

I opted against doing it, and when I see it on other blogs I know why it isn’t for me.

It’s the same reason I never answer the question “how are you?” or “how was your day?” with a number.  It’s just a number; and a random, relatively imprecise one at that.  (Meters can be up to 20%+/- of an accepted lab result to be considered accurate.)

But more than the randomness of a number, it would seem to me to heighten the importance of my diabetes if I equate my emotional status with a number day in and day out.

Don’t get me wrong; I absolutely will answer by saying: “I feel like crap; I’ve been over 300 all afternoon” or “I’m exhausted I was 43 and now I’m 245 30 minutes later” or what have you.  It’s the response of simply “I’m 180” or “I’m 120” that gets me.

Think about when you were in school and being graded.  Think about getting a grade in every subject several times every day.  Would you want to answer the “how are you?” question by saying “C” or “B” or even “A”? 

I hope not.

I have my own emotions separate and distinct from my blood glucose.  Sure, I get irritable and uncomfortable and exhausted and desperate with different levels of sugar in my blood stream.  But that isn’t who I am.

I don’t let my diabetes define me.  I never have—and after seeing the picture of what I used to imagine diabetes looked like in my world, I’m very glad I skipped any definition as I’m sure it would have had devastating results.  It works for me to know that I’m me and any number that comes after it is properly in its place: AFTER. 

Me first.

If I didn’t have that, I would feel like my diabetes had won. 

I’m not going to let it win like that—at least not without a very good fight—because I am worth more than any random number that pops up after five seconds. 

I cannot express how much I hope you feel the same for yourself.

Anger and Fear

August 23rd, 2010

I had a Facebook conversation the other day at Diabetes Outside’s page about anger and diabetes.  I understand anger is a big emotion many feel toward the disease.

I rarely do.

Sure, I get frustrated at my numbers, I watch others eat food without thinking, I check my blood in line at the grocery store, I run 5 miles carrying 6 things in my hands.  I know these things make me different than most everyone around me.  I know my life has different challenges and that I need to work harder all the time than nearly everyone I see every day.

But I just am not angry about it.

This conversation the other day included a very solid question: “Amy, do you mean you aren’t angry at diabetes?!”

Well, shoot. 

No, I’m not really angry. 

And me being me, I immediately wanted to know WHY NOT?  I see many people online writing and commenting about their diabetes and I can’t say many of them aren’t angry.  So why aren’t I angrier at having diabetes than I am

Now, the simple answer is true and somewhat superficial: being angry takes a heck of a lot of energy.  I choose to spend that energy producing positive changes in my life and hopefully in the lives of others.

But, of course, I continued to think about it.  And I kept flashing back to a picture my therapist told me to draw when I was in high school.  She asked me to draw my diabetes.

Now, this is when I was about 15 or 16 and had had diabetes for 5 or 6 years.  I was still in a lot of denial.  A ton of it, in fact.  I remember drawing the picture, and I remember showing it to her and crying.

I'm the one in purple; my diabetes is black; circa 1993.

I’m kind of nervous to post my re-created picture, but I’m doing it to kind of show you who I am and why I think Diabetes Outside is so important.  I think it’s critical for everyone to acknowledge how frightening it is to learn about having this crazy disease, to learn we are in charge of it every day forever, and to know that despite our best efforts we’ll never get it “right”.  I think when we are diagnosed with diabetes it comes without warning and the disease has so many facets it is overwhelming.  For each and every one of us.  So for me, anger is only beneficial when we can use it to help us figure out a way to make our lives as great as they can be.  As I never was able to benefit from being angry, I have let go of much of the anger in favor of tools that I can use.

So you can probably see my answer to the question a little differently now:

No; I was never very angry about being diagnosed with diabetes. 

I was too busy being scared.

What Food Do You Miss Most? Is a Confusing Question For Me

August 20th, 2010

I was reading a FaceBook page about diabetes and they posed the question: what food do you miss most since you were diagnosed with diabetes?

Hmm.

This question confuses me.

First of all, this particular site shall remain nameless since I’m about to be critical.  Most of their questions seem to focus on what I would say are the more negative side of living with diabetes: what do you miss, what is the hardest, how often do you want to curl up in a ball and cry kinds of questions.  These are all good questions that facilitate camaraderie and discussion, but it doesn’t often work for me and they have a LOT of these questions; I’m not sure many positive things result from this type of camaraderie.

Secondly, to me this may be a question for people with type two diabetes and not type one.  I expect type two diabetics need to mold their eating choices to fit the disease more so than type ones need to in an effort to keep their bodies working at maximum insulin efficiency.  Type ones have zero insulin efficiency on our own, so we need only try to keep our blood sugar levels even and in range.  (Also incredibly difficult, just in different ways and for different reasons.)  Limiting or managing how many quickly-absorbed carbohydrates is one of the best ways to do this, and since candy is a “quick carb” it usually is better managed than, say, a carrot.  (Although both have carbs and both need management.)

Reading the answers, though, it seems like a lot of type ones answer with what a person not well versed in living with diabetes would expect: “my daughter misses eating candy” and “I miss those sugar straws” and so on.  One particular answer was “I miss almost everything.”

Alright.  Here’s where I need to climb on my box yet again: 

IS THIS A PITY PARTY, OR IS THIS YOUR LIFE?  YOU DECIDE.

Yes, there is absolutely a time to feel sorry for your loss.  Of course you miss the now-rose-tinted carefree days where the word “carbohydrate” didn’t mean anything to you and certainly didn’t strike fear in your heart.  Of course you need to eat differently after you have been diagnosed with diabetes—either type.  Of course your food life was simpler then.

But to say that you have nothing now, no options, you miss everything, your world is over… that smacks of a temper tantrum to me: high drama, little reality.

There are ways to eat anything you want to eat when you live with diabetes—yes, the ways you used to eat without thought are gone forever, but that doesn’t mean you need to not eat something in particular ever again.  If I have an undeniable craving for a Coke Slurpee, I can figure out a way to make it work.  I don’t have to miss a thing.

I know I’d rather figure out how to make something work than throw myself on the floor and cry. 

I hope you agree.

Are You a Routine Type of Person or Do You Fly By the Seat of Your Pants?

August 19th, 2010

I was brought up in a family of planners.  We planned everything.  I can’t tell you anything that happened that wasn’t planned.  We talked about plans before they were plans, we planned out when to plan, we discussed the current plan, we anticipated what the next plan would be, and we thought about what the plan was for tomorrow’s plan.  And we had a tentative plan for next week, too.  And the plan for next week included plans for the following week.

The Plan Ruled in my family.

Which probably explains why I married a guy whose family never planned.  If you showed up on time, good job!  It’ll just be a few more minutes before I’m ready; where are we going again?

This is incredibly entertaining to me, incredibly frustrating, and always fascinating.  Either the plan or the non-plan; I’m often amazed anyone can make it through the day.

I was thinking about this because I was reading a Runner’s World magazine from last year (I’m working my way through them, I swear) and saw a blurb about a man who has run every day since December 20, 1964. 

Yeah, you read that right: he has run more than 16,000 days in a row.

They had a photo of him sitting with his seventeen running log books spread before him.  It’s pretty impressive.  I thought about one of my bootcampers, who reports that her dad has a journal that chronicles every workout he’s done for the past four decades.

Wow.

I think that would be so cool to have for myself.  I just know it isn’t going to happen.  At least, not without my undergoing a massive personality shift.

It’s hard to see any log book and not think of blood sugar log books.  (I asked for a copy of my printouts the other day from my doctor, so now I at least have something to look at!)  How crazy would that be, if I had blood sugar records from every check I ever did??  Can you even imagine that?  22 years, 4-14 checks a day, with insulin and activity records?  For more than twenty-two years?

Not that I’m competitive or anything, but I bet I’d fill up waaay more than seventeen books.

A plan involves both looking ahead and looking back.  Plans can either complicate or simplify life; it depends I think on the planner involved. 

I’m sure I’d make more changes to my insulin if I had record books and could look at patterns on paper.  I’m just not sure if more frequent changes would be better for me.  I’ve been considering writing my numbers down again, just to see if I feel better doing it than not doing it.  I’m sure I’ll tell you how it’s going if I decide to start.

I will say this: I started logging my workouts in an online workout calendar this past year and I like it.  I like knowing what the past month looks like in terms of my days running and doing weights and yoga.  I look at that to help me decide what would be good for me to do next. 

I guess I learned something from growing up in a Planning Family.

My Doctor Report

August 18th, 2010

I feel a need to share portions of my doctor visit yesterday with you.  It’s a little bit bragging on my part because I felt like I handled the situation better than most of my visits.  If you read something you might be able to put to use in your life, please take it and try it out.  If not, it’s only 863 words.

So I have this new doctor.  I changed doctors this year because of some changes in my insurance plan and because I felt I needed a doctor who could be more aggressive with my management of my disease.

I kind of got what I asked for. 

This, of course, stressed me out.  (Hey, it’s how I roll.)  The first visit I felt like I was arguing with her and I felt like she was judging me and telling me that I was doing a bad job managing my diabetes

Not good.

I brought my husband to the second visit to hopefully defray some of the negative vibes I had at the first visit. 

It worked somewhat, but I was still uncomfortable having a doctor that I didn’t want to see alone.

I considered changing doctors again.

Yet they called to confirm my appointment and I confirmed.  So 9:30am yesterday I approached the desk with a new plan.

I was my typical nervous and chatty self, trying to make friends with the office staff.  I chatted with the guy who took my weight and blood pressure, even asking him how long it took him to commute to the office.  And I was in the clinic room posting on Facebook.  Maybe you saw me? 

Like I said, I was nervous.

So my doctor came in and asked me how I was.  Test time.  I tried a new strategy.  I told her how I was.  I told her that I felt like I should have a lower A1c and was somehow not doing something right because I’m always 7.1-7.4.  I asked for her help.

My new approach was rewarded almost immediately by her response: she looked at my printouts and said, almost meekly, “it looks like you’re doing really a pretty good job.”

We talked through a couple issues, and when she asked me if I had done midday basal testing I tried my other new strategy: I told her the truth bolstered only by a truthful reason, not an excuse.  I told her I haven’t been able to figure out how to fit in a midday basal test: I would do it on a weekend day, but I run 15+ miles on Saturday morning and that kind of negates any basal test results over the next two days. 

She took it in stride.

I felt like it was a good visit.  I was feeling so good I decided to ask her for what I initially sought her out to provide. 

I thought about how I would feel if a doctor came into my law office and told me that she had been dealing with a legal issue for 22.5 years and was only seeing me so that I would sign a form as her attorney.  I thought how that would feel if I had been practicing law for 25 years. 

I thought about how dumb that doctor would sound to me.  I’m trained as a lawyer to know the law and although I don’t share all of my knowledge with each of my clients, they come to me so that they have help with their legal problems and expect me to apply my knowledge to their situation. 

Why should I be any different in my doctor’s office?  She sees patients every day and knows so much more about type one diabetes than I do simply because she sees so many people, while I only truly know portions of my own disease. 

So I asked her for her gut response when she saw my printouts

And she gave it to me. 

And I asked her about portions of what she had said, and we changed my pump settings.  I asked her where she thought I should tweak if the first round of changes didn’t work out very well.  I asked her a number of questions assuming that she trusted me and my knowledge like I trust hers.

See, what I have known for months is that my issues with my doctor were coming from ME and not at all from HER.  She has no skin in this game; I’m the one to lose out if I don’t trust my doctor and benefit from her expertise.    

Yesterday when I tried out this theory, it felt like a successful visit.  I tried to be as honest with her as I could be, and I tried to really use her and her experience.  I tried to trust that she was bringing her experience and her training and knowledge to the visit and that she wasn’t telling me that I wasn’t doing something right or wrong or bad or good.  I tried to share my emotions and worries with her in a more analytical way so that we could get to a better place.

And I think it worked.