Pandamania 10k Training Log

[panda]

@TomH I think it’s a little of Column A, a little of Column B. I’m rural and I do live in a bit of a care desert (love that term!), and that may require @eric -style hacking of the system to get around. That seems to go hand-in-hand though with presenting my requests in ways that make sense to my provider and makes them feel comfortable to approve it. Getting to yes… just bought a book by that title in prep for law school!

Since I have to work with them as a team (hey hey @CarlosLuis!), it does makes good sense to present requests in a format that works for the doctor’s constraints (including pointing out where a refusal amounts to a liability risk for the doc, thanks @bkh!), in addition to working the angles if need be to get over the finish line. I hadn’t been really prioritizing the persuasion/presentation side, nor of reminding them of things like standard of care. All of these nuggets of wisdom seem like they can be put together into a strategy for successful management over time.

I booked yet another different provider for my upcoming appointment and will bring all these tricks with me! I am so lucky to have my little sugar family here with the wisdom and knowhow.

Onward! It’s a great day to be alive in the beautiful Pacific Northwest!

[TomH]

@panda Many people have tendency to put docs on a pedestal and bow to their wisdom and training, usually for good reason, “we” don’t normally have their depth of knowledge and training. Many of us here on FUD have stood that on its head. If you’re seeing a new doc, and obviously based on your comfort/read of the situation, and in your own words might consider starting your appointment by not doing that and instead interviewing the “new” person, telling him/her your purpose and previous experience:

1. This is an interview because I’m frustrated with my T1 experience since diagnosis. Some medical people I’ve seen since diagnosis don’t seem to include me in the decision process and seem overly conservative. I’m concerned some don’t seem to know or apply what I think are current standards of care; or appear to depend on outdated training. What’s your view on T1 treatment: Do you view yourself as safe, conservative, current, state-of-the-art, or willing to explore? What do you see as my role: Compliant and accept of your sole decisions, discuss like a team, explore the potentials together? Is there room to discuss or is it your way or the highway?

2. My current take on managing/addressing T1 “WITH” you is:
   A) We’re a partnership, but I live with the result, so my intent is to be in charge when I know enough. Determining when I know enough is a mutual decision between us; we can part ways when one of us is unwilling/unable to meet mutual decisions.
   B) You’re a valued primary source of information, when I don’t know enough and don’t have time to learn, you’re the authority. You’re also a source for scripts we both support and decide on. But, “we” have a give & take with the goal of me becoming more independent and you stepping back to a role of advice and scripts you’re comfortable writing. Does that make sense to you? If not, what does make sense to you?

Everything else depends on his responses and your discussion and feel of a fit. If it goes well:
3) I’m active, I intend to remain so. I think I need x, y, and z. What’s your advice?
4) Other areas: what BG goals, what treatment goals, future planning, pens or syringes/vials, use of an NP, CDCES, dietitian, (see @CarlosLuis’s one pager above), how often for appointments, how to share data with your PCP, etc. And if it isn’t obvious, “why” for each?

Obviously, you’re the “Captain” of your ship…lead away… Good luck no matter how you handle it, and may you have a better experience!

[CarlosLuis]

@panda Statistics show that often women’s health concerns are not taken seriously by medical professionals, even women doctors and nurses. I have hope that this is getting better, but is probably still an issue.

I think those who behave this way sense a reluctance to be assertive as a shark does blood in the water. This leads to the dismissal of valid concerns as hysteria.

I had to sooth the feelings of business women who were dismissed as idiots as they tried to report their telephone system troubles. This were business owners and CEOs, but they were out of the depth in explaining the issues. By the time it got to me, I would be getting that sharp edge of their tongues as they were losing money and opportunities.

I would listen until they ran out of steam. “Ms _______, I am sorry that you have been aggrieved. I know that you have tried to explain the problem several times. I am the one who can understand and get a solution. Please begin at the begining and tell me. I may ask for further clarification.”

My approach was the correct method.

Anyway, continue to educate yourself, have your facts in a row and don’t let them dismiss you. You are smart, determined and Captain She Elite!

[panda]

[panda]

A slight tangent, though I promise there’s a point. I try as a rule not to center my gender, but the point is well taken and true, @CarlosLuis. So the final straw for me on online dating was a series of guys who, upon finding out I was in the application process for law school, would stare at me with the kind of horror that might suggest I had sprouted an extra head.

InternetDude1: So law school huh? How come you wanna do that?
Me: explains my reasoning and motivation
InternetDude1: Ahuh, ahuh, well you’re so pretty, seriously why would you wanna do that?
Me, to waiter: Check please.

Later that week…

InternetDude2: So you’re heading to law school? How long does that take?
Me: It’s a three year program.
InternetDude2: Oh. Well that’s not too bad, I guess at least you’ll probably still be young and beautiful when it’s over.
Me: And if it was longer than three years I’d be what, old and ugly?
InternetDude2: sputtering
Me, to waiter, again: Check please.

And then I deleted all the apps and got on with my life

I sometimes feel like this is not a bad analog for the amount of credit I get from some medical professionals: some doctors feel like they’re ignoring everything I say, making assumptions that put me in some predefined box that isn’t applicable, and we end up totally talking past one another. Let’s hope the hunt for the right doctor goes better than my foray into online dating did! I am optimistic, now that I’m armed with some strategies to get to yes!

[Eric]

The best “dating app” is gonna be at your post-race gatherings.

My goal is to get you to the finish line fast enough, before all the good ones leave.

[panda]

Guess I better lean in on those workouts if I wanna catch one - literally or figuratively!

[Eric]

But on a side note, something I wanted to ask you.

So law school huh? How come you wanna do that?

jk!

[panda]

Well @eric to tell you the truth Plan A was that one of these Tinder charmers would swoop in and take care of poor lil me before the last of my youth and looks withered, but I teed up law school as Plan B just in case

…even if that were true, let’s just say the above Plan B would have been the move regardless

[Eric]

@panda

before the last of my youth and looks withered

I think you got 3 good years left.

Seriously, try to use a dating app that doesn’t have stupid men on it. Those dudes have absolutely no game.

[panda]

Oh buddy I have got stories, these were among the more successful dates how about the one where we were supposed to meet up at a common raft launch point, theoretically to go to a swimming hole (in itself not too weird, common activity here in summer and most spots are busy with lots of people around). Broseidon here however asks me to leave my car at the meeting point and he will drive us to his “secret spot”. I ask why I can’t just follow him in my own car if it’s so hard to find, and if it has cell service… the answers were not satisfactory so I’ll skip to the end: I wasn’t in the mood to get Gabby Petitoed that week so I literally just ghosted him, didn’t even cancel. Block, delete, do the Homer Simpson into the shrubbery. Hard no there

I have higher hopes for race corrals and law school: all Tinder and Bumble did was convince me that a large swathe of humanity is the equivalent of a sentient open sewer, with a higher than average concentration of excrement on dating platforms guess I better get my 10k game up to speed so to speak!

[Eric]

I am out of my depth on dating apps, sorry!

But I think the race corrals will be your best bet! The problem with law school is that’s it’s just gonna be a bunch of laywers…

Sorry! I am just zinging them at ya, today!

[panda]

As a future lawyer myself, I could hardly agree more no lies detected

[CarlosLuis]

You two had me in stitches, Thanks

[bkh]

I just read TomH’s ideas for interviewing a physician. I believe I understand the intent, but I also think that if I were a physician on the receiving end of this, I might just say that I’m probably not a good match, and let the patient search elsewhere. It sounds to me like an aggressive problem patient.

I’d go in and concisely explain my situation, what I’m currently doing about it, my goals, and what I’m looking for, then ask for their thoughts. Something like this:

I’m an athletic recently-diagnosed Type-1 diabetic. I’m used to taking good care of myself for high physical performance, and want to keep my body in excellent condition. I’m inspired by my discussions with other athletic Type-1’s who are safely achieving low A1C’s with high time-in-range and no severe hypoglycemia through a combination of CGM, closed-loop insulin pumping, and expertise in dosing insulin under widely varying circumstances. I’m not looking for a physician to teach me how to do that, I’m looking for one who is comfortable supporting a patient who is doing that. What do you think?

[Eric]

Tough week!

Day:	Date:	Workout:
Monday	Apr 15	4 mile run, easy pace
Tuesday	Apr 16	30 min tempo run (around 6.3 mph, 9:31 pace)
Wednesday	Apr 17	4 mile run, easy pace
Thursday	Apr 18	3 mile progression run. Mile 1 @ 9:30 Mile 2 @ 9:25 Mile 3 @ 9:20
Friday	Apr 19	Rest
Saturday	Apr 20	5 mile run (2 mile warmup, last 3 miles at sub 9:40 pace)
Sunday	Apr 21	Rest

[TomH]

@bkh I think that’s a good option also! You’re right some would be turned off by a more direct/“in your face” approach, others as a challenge or intimidating. It all depends on what one is comfortable with, how it’s phrased/presented, and a read of the situation.

[panda]

This is quite a detour from training stuff exactly, but…

All great observations! I had an appointment yesterday with yet another doctor - it’s like Goldilocks with doctors instead of breakfast cereal! - so I was looking at this thread and thinking about it a bunch. I ultimately concluded that a doctor who would have a problem with me being direct, probably is not a doctor I want on my team. Especially because as @CarlosLuis noted, women get the short end here as a rule anyway. When it comes to “pushy”, “problem patient/child”, “bossy”, “demanding”, or “difficult”, those terms often get applied in gendered ways. I have experienced this personally before, and I don’t want to select a provider who would prefer me to consistently shrink myself or soften my tone or otherwise code-switch on what are perfectly reasonable requests to a professional providing healthcare… seems like an invitation to a strained relationship overall. I think it’s best to try to find a doctor who is OK with me being myself and being a vocal advocate thereof.

In other words I thought about every viewpoint shared here and decided I should approach this more like I am interviewing candidates for the role of provider on my team. I set some criteria for what constituted no hire vs proceed. This thread actually gave some great litmus tests up front, so I used those in the hope of finding someone I can work well with. That doesn’t mean being mean or nasty about coming on strong, but I decided that being businesslike and direct, with some specific goals that I could clearly explain (and maybe not mentioning how recently diagnosed until a little later on?) is the path to finding the right provider for me.

With all that in mind yesterday I had an appointment with a female GP who has been T1 herself for over 40 years. I brought my new strategies and it’s hard to say what exactly was the difference, but this was the only appointment I have had since this started that I didn’t leave feeling like : she’s the first medical professional who said “you are doing a great job”, she asked how I was coping with the diagnosis and if I wanted a referral for mental health support about it, she talked to me about how we might make some changes to my birth control to make sugar control easier, she basically was all over it and just got it in a way that was such a relief to me.

She immediately jumped on glucagon (mildly appalled I had been denied it), and when asking about my insulin use, she said “tell me how much you think you use, and then let’s round that up to make sure you’re never running out”. The number is around 30u/day on the pump: I rounded up and said around 35-40u and she says “Cool, in that case I’m going to write this for 50u/day, that should give you some margin, it’s never perfect math anyway and you lose some to priming your pump and not every day is the same and whatnot. If you’re using more just let me know and I’ll update your Rx”.

I couldn’t believe it!!! I didn’t have to make a case for why I wanted certain things, she actually asked me questions about my training plan and sports, we actually talked about range targets which no other doctor has bothered to do with me (except one guy who told me I should never go over 140 ever )… She even said she didn’t know enough about the sport side and was going to go do some research of her own about athletics and T1 before our next appointment. She said other diabetics are her favorite kind of patients to work with, and that she was excited to see me and work with me to manage it and “empower me to lead my best life” (her words not mine) - total 180 from everyone else. It remains to be seen if this is “the one”, but I think Dr T1 so far is feeling like a great fit for primary care. Thanks for helping me start off with her on the right foot: I am really optimistic that Dr T1 might be a permanent addition to the team I’m assembling.

[Eric]

Somewhat of a tangent to some of the things you mentioned here.

@panda

she talked to me about how we might make some changes to my birth control to make sugar control easier,

For a 10k it is probably not a big deal to stress about too much. Especially if it is not a target race, but is more of a training race.

But at some point, when you get into longer races that are more of a “target” event for you, there are some things we can discuss that will help you with making sure the race date fits well with your hormones.

That’s down the road though. Nothing that needs consideration right now.

[John58]

@panda

It remains to be seen if this is “the one”,

She sure sounds like a great endo…. if you are still looking for help, the consulting provided by Gary Scheiners office has received awesome reviews:

Integrated Diabetes Services