Three Months Later

Sitting next to Joseph on a bench painted like a black and white spotted cow, my mind is racing.

We've worked so hard... the testing, adjusting, the basal rate changes... so many long nights...

It has to have come down.

A knock at the door, and into the exam room steps a young woman with wavy blond hair and a slightly nervous smile.

A resident.

"Hello, Dr. C wanted me to meet with you before she comes in."

The resident takes a seat in the swivel chair opposite us and stares for a few moments at Joseph's file.

"Let's start with the basal rates-- what are they right now?"

Joseph leans back a little, pulls out his pump and gives her the numbers.

"Now," she continues, "do you correct a high blood sugar?"

Joseph and I look at each other.

"Umm, yes-- usually we do," I tell her. "Joseph's insulin sensitivity factor is 1:175-- we use that as a starting point and then adjust depending on activity level, insulin on board... "

The resident looks puzzled.

"What I mean is-- " she begins, shaking her head, "most families will do a correction starting at a blood glucose of 200, and then give a certain amount of insulin for every 50 points above that. So how much do you give him in that situation?"

And now I'm confused.

"It sounds like you're talking about a sliding scale-- we don't really use one. One unit of insulin typically brings his blood sugar down 175 points. So we calculate his correction based on that formula... "

I pause a moment-- suddenly annoyed by the woman's blank stare.

" ... but again, we only use this as a general guide, while taking many other factors into account-- like food, activity, insulin on board, and so on."

"Well, but you always correct a blood glucose over 200, right?"

"Again-- it depends. For example, if an hour earlier he was 300, then he's coming down pretty fast. In a situation like that, no-- we wouldn't do a correction. I guess what I'm trying to say is that there are no hard and fast rules here-- there are just too many factors."

She pauses, clearly frustrated with my answers.

"Do you have diabetes?" Joseph asks her.

I shoot him a look.

"Uh, no-- no, I don't."

After taking a cursory look at Joseph's sites, she finally leaves the room.

"Well that was weird," Joseph says. "Why do they send in people who don't really know what they're talking about?"

Stifling my own frustration, I take a breath before answering.

"Well, Bud-- I'm sure that's why they do it. It's probably the best way for new doctors to learn."

Just then, there's another knock at the door, and in walks Joseph's endocrinologist.

For a split second, my stomach is a mad frenzy of butterflies.

"I am so pleased," she says with a broad smile.

"Joseph you're doing beautifully. You're growth is perfect. You're all doing a wonderful job!"

I look at her, hopefully-- willing her to go on.

As if reading my mind, she nods-- still smiling.

" ... and yes, the A1c fell-- from 8.5 to 7.9."

With those words, Joseph jumps up and flings his arms around his endo.

Sitting still, so relieved-- I watch the two of them celebrate.

No more butterflies.

Just a huge lump at the back of my throat, and two eyes clouded with tears.

"Don't Be Afraid"

She's smiling.

Which seems a little surprising-- given the number handwritten in black ink on that sheet of paper sitting on her desk.

"Joseph, you've gotten so big!" she says enthusiastically, "I wonder if you can you see over my head now?"

Immediately, my son leaps out of his chair.

Standing directly in front of her, it's clear that Joseph is now several inches taller than his endocrinologist.

"Oh my!" she says, red-faced and laughing. "I think we can safely say you've begun the adolescent growth spurt."

With these words, Joseph throws his arms around his endo -- giving her a huge bear hug -- then, grinning, returns to the seat next to mine.

He's growing. That's the most important thing.

I tell myself this over and over while smiling at the two of them.

But then my eyes wander back to that sheet of paper.

To that number.

"Yes," she says with a nod, "we did see an increase in the A1c."

Joseph's head snaps up.

"From 8 to 8.5."

And now the only one smiling is Joseph's doctor.

"I'm not worried about this," she says, noting our somber expressions.

"A number of things are going on here. First, it's obvious that Joseph saw periods of rapid growth since his last appointment. This is probably the most significant factor."

She pauses a moment, thumbs through Joseph logbook, and then continues.

"Now, according to the log, you had a problem several weeks ago with a leaking cartridge..."

"That's right," I say, remembering that awful night.

Blood sugars in the 400s, followed by corrections that had no effect-- injections, a site change...

And finally, the anger and shock at finding his meal and corrective insulin clinging to the sides of a soaking wet, almost empty pump cartridge.

Our son hit a diabetes milestone that night-- moderate ketones.

"Keep in mind," the doctor continues, "blood glucose over the last month will have a greater impact on the A1c-- so this 8.5 is partly due to that incident."

Joseph says nothing, but listens intently.

"So what can we do?" I ask.

"You increased Joseph's basal rates three weeks ago-- and those new rates worked well for a while, but the highs are returning. So I've raised them again-- overnight and early in the morning. That should help."

She hands me the sheet of paper with Joseph's new rates-- and his A1c.

"Understand," the endo goes on, "you're probably going to need to increase his basals every two weeks."

And now my head snaps up.

"Don't be afraid. You need to do this, Sandra."

"But every two weeks- "

"He's going to need a lot more insulin now that it's clear he's entered puberty in earnest. And the amount he'll need is going to keep changing as he grows."

I know she's right.

The ridiculously frequent, insulin-resistant highs we've seen over the last three months made that perfectly clear.

Walking out of the clinic an hour later, carrying his new basal rates -- and the weight of that number -- I can still hear her voice.

"Don't be afraid."

But, I am afraid.

Not of making changes, nor of working harder.

No.

I'm afraid of that damn number.

I'm afraid of what it means might be happening inside my son's body.

I'm afraid that -- no matter how hard we try -- it won't be enough.

Our Wishes

"Hey, I call the wishbone!" Joseph announces-- before anyone takes their first bite of turkey.

And then a little more tentatively, "Is that okay?"

Everyone is smiling-- and no one objects.

"Sure," I tell him, "but only if I get a shot at it too."

"Mom," he says, eyes rolling, "you'll just wish for a cure for diabetes."

We all look at him.

"I can live with diabetes," he continues, laughing. "No. I'm wishing I have a good regionals on Saturday."

"Joseph-- a card tournament?"

"Oh, yeah," he says, beaming.

I pick up my wine glass, take a sip of Cabernet, and remember something that happened only two weeks before...

------------------------------------------------------------------------------

We'd just left his endo appointment-- our first in the new clinic building.

Though Joseph's A1c had gone down (from 8.1 to 8), I was really hoping it would have gone down further.

That we'd have gotten it below 8.

Standing in the elevator, I kept hearing his doctor's reassuring words:

"Yes, we want him in the 7s, but this is still good-- most kids we see in middle school move up into the 9s, sometimes higher. And Sandra, his growth is excellent."

His growth is excellent. His growth is excel-

"How about McDonald's?" Joseph broke in.

"Huh? For lunch? Ahhh... no."

For the next few minutes, we talked about food options while making our way down several long, shiny new corridors, on and off yet another elevator...

And that was when everything around us began to look less new-- and uncomfortably familiar.

We'd taken a wrong turn.

And just like that, we were standing in front of a fountain I hadn't seen in over three years.

A wall of large, rough-hewed stones-- water, pouring in ripples over the face of it.

And at its base-- a shallow pool, littered with coins.

We're back. In the hospital-- just outside the cafeteria.

The conversations with Ryan, the crying-- the desperate throwing of every piece of change I had into that pool.

The wishing.

The praying.

It all came back in waves.

For a moment, all I could do was look at the thing.

And then -- stubbornly -- I walked forward, shoved a hand into my right coat pocket, pulled out two coins-- and handed one to Joseph.

"Here you go, Bud-- make a wish."

He paused, holding the quarter for about two seconds while looking thoughtfully at the falling water-- and then dropped his coin into the pool.

"Your turn, Mom."

Just as I was about to release mine, Joseph grabbed my arm.

"Wait! Mom- you're not gonna wish for a cure for diabetes, are you?"

"You bet I am."

"C'mon, Mom-- there are a lot worse things. What about AIDS? People are dying of AIDS. Or cancer?" he said, almost pleading. "This isn't so bad-- I can deal with this. Please, Mom - don't waste your wish."

I turned away from him, tossed my quarter, and watched it bounce off two stones before landing at the bottom.

"So what did you wish for?"

"What do you think?"

"Oh, Mom..." he said, shaking his head.

But then, he wrapped his arms around me.

And I'm not sure if he was thanking me or trying to make me feel better...

---------------------------------------------------------------------------

"So really, Mom-- what are you gonna wish for if you get the wishbone?

Wine glass still raised, I look meaningfully into my son's large brown eyes.

"What do you think?"

Finding the Words

It's funny how sometimes you just can't find words. No matter how hard you try.

That's been me over the past week. Maybe it's because this disease is suddenly feeling more relentless of late.

The highs, the lows-- they continue.

And the exhaustion, too.

I realize I'm not alone-- thus, even writing this has me feeling somewhat sheepish.

So I'm just gonna launch into something more specific-- and hope a decent post emerges...

Joseph's endo appointment.

While his A1c rose (from 7.4 at his last visit to 7.8)-- his growth was amazing.

"This is the biggest growth spurt we've seen in a while," his doc tells us enthusiastically.

And when Joseph stands in front of her -- sure enough -- they literally see eye-to-eye.

"You're going to pass me by your next visit," she tells him with a smile.

But then, the downside of the appointment, after Joseph and Evan retire to the lobby. When I ask a question that's been on my mind for a very long time.

"I know I've told you that Joseph never wakes up when he's low overnight-- but I've been wondering if this is something that will change when he's grown?"

His endo pauses, looking sympathetically at both me and Ryan. And then answers my question:

"Well, we've found that as children get older they actually become less sensitive to overnight lows. This is why I worry about many of my patients who are going off to college. They tell me that they always wake up when they're low. But that is really quite rare. Most people will sleep through a low blood sugar.

"I tell these kids that they have to come up with a plan."

A plan.

God.

I swallow this down. Hard.

And feel grateful that I'm not hearing it alone. That Ryan's hand is right there.

"All right, then," I say, struggling not to cry.

And then I remember something:

"Have there been any new developments on the continuous glucose monitor front?"

"A number of kids in my practice are wearing the Guardian with a lot of success. We're even finding that they don't need to change the sensor every three days.

"In fact, the device appears to be more accurate if they wear the sensor longer-- as long as two weeks."

While this sounds so very promising, I remind her that Joseph wears an Animas pump. Thus he'd have to wear the (rather bulky) Guardian receiver, in addition to his pump-- versus Minimed's all-in-one pump/Guardian combo.

"Joseph has seen the device on another child," I tell her, "and he's just not ready to wear that much equipment."

"It's still worth exploring," the doc continues, "I think that Joseph could gain a great deal of benefit from it."

Then, of course there's the money-- insurance coverage for a CGMS is still not there yet. As we leave this visit, I'm doing the math in my head and it's not coming out right.

There's just too many things: diabetes supplies, preschool for Evan, braces for Joseph...

So I'm left with a mixed bag of emotions:

Sadness and frustration over the fact that we can't get this thing RIGHT NOW for our son;

Impatience, because I desperately want this technology to improve SOON;

And hope.

Because even if we can't jump on this right now, by the time our son goes to college he'll be wearing (or implanted with) something that will take our place during those long nights.

Something that -- I have to believe -- will keep him safe.

Speechless

I'm sitting in a hard gray chair, sliding my hands up and down its chrome armrests.

Trying very hard to stay calm.

The kids, meanwhile, are having a blast.

Evan sits on Joseph's lap, his arms wrapped tightly around her waist, as he propels the two of them all over the exam room on the doctor's wheeled chair.

Evan cannot stop giggling.

What if it's like the last time? Or worse?

Finally, the door opens-- and there she is.

And my God, she's smiling.

Before she opens her mouth, I want to cry.

And then:

"How does 7.4 sound?"

I can't talk.

"Sandra, I really like what you're doing with Joseph's basal rates -- this is just beautiful. And Joseph, you've grown so much-- over an inch in three months."

"My goal is five feet," Joseph tells her with a grin. And then he jumps up off of her chair, puts Evan down next to me, and stands in front of the doc.

"Let's see if I'm as tall as you now."

She laughs, telling him: "Not yet, but really close-- by next visit for sure."

7.4

I know that he is so much more than what this number indicates.

But still.

7.4

I'm so happy, I could cry-- and though I didn't at that moment -- I'm crying now.

The Rebound

No, not Joseph's blood sugar-- just my attitude.

Last week was tough. Increasing one's humility quotient always is. But it's inevitable, I guess.

The nature of this disease.

Anyhow-- first off, I need to thank everyone who commented on my previous post. Your words of support -- along with your willingness to help -- meant a great deal.

More than I can express here.

Now, you people also raised many excellent points, and I was going to respond to everyone's comments in a comment. But I'm afraid that comment was becoming post-size.

Thus, this post.

{Deep breath}

Many of you gave voice to what my gut was telling me as I sat silent in that exam room.

This was huge.

For example, a number of you took issue with the whole "basal insulin needs to be at least 50% of the total daily dose (TDD)" concept.

I'm right there with you.

You see, we've done basal tests before and found that Joseph's basal insulin could keep him steady (even when making up only 30% of his TDD). Unless of course, he was very active. In which case he would need even less basal insulin.

We've never subscribed to the idea that one formula fits all. What works (or at least, used to work) for Joseph may be out of the question for many others.

But we're not trying to create something that works for all diabetics here.

Just our son.

Now, of course insulin needs change. And because they do, more basal testing is needed.

Especially since his doc raised his afternoon basals by 33%.

That's right-- 33%.

Typically, I would have taken issue with such a dramatic change in Joseph's regimen. I would have asked her to take another look at our Smart Charts -- this time, with me (as I've done at all previous appointments), showing her why this move might not be wise.

I would have pointed out other factors that might have contributed to the rising A1c (i.e., excessive highs on our recent road trip, and time disconnected from his pump during baseball games-- games in which Joseph's adrenaline was surely through the roof).

But typically, Joseph's A1c didn't move so dramatically upward.

In that moment, I felt as though I'd failed-- as if I had no right to suggest an alternative.

Well, that moment is done.

The last time Joseph's clinic set his basals, insulin-to-carb ratios, and insulin sensitivity factor was a year and a half ago-- at his pump start. Since that time, we've drawn on information from books like Smart Pumping, Pumping Insulin and Think Like a Pancreas, and tested a ton-- 12-14 (sometimes more) times per day.

But mostly, we've learned from our son.

We've seen how he responds to insulin at night (i.e., he's very sensitive-- during the day, one unit will usually bring his bg down 175 points, but at night that's way too much insulin); how his blood sugars go haywire with pizza or pasta 5-6 hours after he eats; how just 30 minutes playing catch in the backyard can bring down his bgs 100 points or more.

Unless, of course, he's just had ice cream.

You get the picture.

Further, a number of you suggested that Joseph's increased A1c could be connected to the fact that he's growing -- thus we're "aiming at a moving target"-- and that he is on the verge of puberty.

Agreed.

In fact, from where I sit it looks as though this boy is not simply on the verge of puberty-- I'd say he's in the thick of it.

{Heaven help us}

So what am I saying here?

Well, I'm still feeling overwhelmed. Still coming to grips with the fact that Joseph's bgs have been drifting upward and that we may not be able to gain significantly better control until he's through puberty-- (though, that doesn't mean we won't try).

Still damn scared of what all these highs might mean for Joseph down the road.

And still just trying to figure out the numbers-- knowing that what we figure out will be lousy with caveats.

But unlike last week, I feel like our best just might be good enough.

And really, it has to be.

Moving in the Wrong Direction

When Joseph's endocrinologist enters the exam room wearing a serious expression, I know I'm about to face the reality behind a growing fear.

It was all those damn highs, of course-- no matter how hard we tried, we just couldn't seem to get on top of them.

"Hello-- well, Joseph's A1c has gone up," she says as she holds out a white sheet of paper with a number handwritten at the top.

8.2

"Now, we're going to make some basal changes. Joseph's been getting far less basal insulin than he needs-- he should be getting at least 50% of his total daily dose as basal, and that hasn't been the case."

I want to say that it's been this way because when we've raised his rates before, he's gone low.

But I say nothing.

"While Joseph still takes in far less insulin than is typical for a child of his age, height and weight-- normally that would be between 35 and 45 units per day, and um... looks like he's taking in about 17 -- we really want to get him to where he should be with his basals. I think that will help smooth out some of these highs."

I nod in silent agreement, but my mind is still grappling with that number and what it implies.

He was 7.5 at the last visit.

"Sandra, I'd like to increase his rates at noon, 2 and 6 PM."

I stare down at the sheet of paper listing Joseph's new basals.

My God, she's got him at .300 from noon to 2pm. And .225 at 2pm? That's so high... and he's always so active then.

But again, I say nothing.

"I want you to try these rates for the next few weeks, and then we may want to increase them some more until we get that basal up to at least 50% of his total daily dose."

A few weeks? But he's going to camp at the end of the month.

Feeling utterly helpless, I suddenly remember something vital.

"Doctor Connor, how was Joseph's growth?"

"Oh, it was terrific, let's see," she says as she pulls out the percentile chart. "He gained over a pound since the last visit, putting him in the 50th percentile for weight-- which has always been his curve. And he grew over an inch-- which is wonderful. So he's right between the 50th and 75th percentile in height. Oh, and he's got a lot of lean muscle mass-- just what we like to see."

Relieved that Joseph's growth is on track, but still shaken by the rise in his A1c, I ask questions about the Dexcom CGMS and Exubera (the new inhalable insulin). By the time we begin discussing my concerns about diabetes camp, I begin feeling that I can still do this.

That I really can take of my son.

And so we leave our appointment and implement Joseph's new rates starting at noon. At 2:30 PM, his blood sugar drops to 65, we treat, and fifteen minutes later, he's 62.

The rebound later peaks at 344.

On Tuesday, his afternoon blood sugars are definitely more in range-- in fact, four hours after his breakfast bolus, he's 78.

But it's raining, and he's not being active today. At all.

And still he has a low at 8:30 PM.

His numbers are good again early on Wednesday, but only after I decrease his insulin to carb ratio, and have him eat some extra carbs during the day. But then, he goes low at 6:40, 9:30, and 10:40 PM. The latter bg was 57 -- prompting a rebound in the mid 300s for several hours.

And now, I'm feeling so unsteady here. Like I'm no longer capable of really knowing how to respond to all of these numbers.

You see, I was afraid that his A1c would rise, and it did.

But I really thought we were doing all right.

Now I just don't know anymore.

Year Two

Yesterday was the one-year anniversary of this blog.

It was such a busy day, what with Joseph home for spring break (weird, because you know, it's not even spring yet... and we're expecting a snow storm here tonight... sigh). And Evan has been sick with a fever and a nasty, wet cough since Sunday night.

You get the picture. The day went by, and here I am this afternoon, posting my first entry for Year Two.

Wow.

So, where to begin?

How about if I give you the low-down on Monday's endo appointment?

We arrived for Joseph's visit exactly on time-- an amazing feat given our more typical difficulty just getting out of the house. Despite Evan's reluctance to leave the warm couch, and the warm glow of the television-- PBS Kids beckoning -- we made it out the door in record time.

And, before we could take a seat in the waiting room, a nurse with long gray hair, a broad smile, large clipboard in hand, called out:

"Joseph?"

"Yes."

"Don't sit down."

Immediately, she brought us to the "pre-" examining room. The room where his finger is pricked for the A1c. The room where height, weight, and blood pressure measurements are taken. Where I'm always craning to see the numbers on the scale. Only to be frustrated by those damn kilograms; I can never figure out the conversion.

Too nervous, I guess.

Then, off to the examining room. Where we waited for nearly 45 minutes.

Given last month's visit, you can understand my anxiety as we sat there-- Joseph reading Eragon; Evan insisting that I help her come up with names for the characters in her latest story.

And all the time, my mind racing.

I just couldn't relax. Because, despite knowing that all of those extra tests his endo ordered last time came back negative, I was afraid that again, he might not have grown.

That really, I was screwing up here. Because the only other explanation for a failure to thrive would be poor blood sugar control.

Well, I needn't have worried.

The very first thing Joseph's doctor said when she walked in (smiling, mind you), was:

"Wonderful to see you all again. Joseph's growth is beautiful, just beautiful. He's between the 50th and 75th percentile in weight and about 75th percentile in height. Back on his normal curve. "

Upon hearing these wonderful, wonderful words, a tremendous wave of relief swept over me.

Until, that is, I remembered the A1c.

"Well, it's gone up slightly-- from 7.3 to 7.5. After looking at his logs, I think an increase in his basal rate from 8 am to 10 am should smooth out that spike he seems to experience between 10 and 11 am. That should help bring his A1c down to 7, which is really our target for high school kids. Joseph is actually right where we want him to be for elementary kids."

Hmmm.

"Well," I began, "I'm not sure that changing the basal rate during those hours is such a good idea." Then I pulled out the logs, flipping to the Saturday and Sunday entries.

"If you look here, there's no spike on the weekends-- when Joseph sleeps in. His bg stays steady, in the low 100s, all the way until as late as 11am. If we increase the basal in the morning, he's bound to go low."

The doc agreed.

Instead, we're going to give him more insulin for his breakfast bolus, and actually lower his basal between 10 and noon (to try to prevent the lows he's experienced when we've increased his food boluses in the past). We'll see...

So, it's all pretty good.

But still, I'm exhausted. Thinking about the never-ending bg checks, site changes, endo visits.

The endless worrying.

I'm just in a funk about all of it right now.

Maybe it's because we're seven months into Year Two with diabetes, and I'm surprised by the fact that our ability to integrate this condition so well into our lives makes me both proud and more than a little sad.

Maybe because I'm still fighting this new reality of ours.

Maybe because really, I just can't accept it.

The Good, The Bad, and The Not-So-Good

When last I posted we were pondering the question of whether or not we could (or should) get the Guardian RT Continuous Glucose Monitoring System for our son. As I said before, this would be a huge financial hit, requiring some sacrifices. But if it could make things a whole lot better for Joseph, then yes, it would be well worth it.

So, can we swing it?

Maybe.

That's the best we could come up with so far. There's still a lot of financial dust that has to settle post-Christmas before we can make a final determination. In the meantime, I do like the suggestion made by some who commented-- that we should try to become some kind of test case for Medtronics. Not sure if that's even an option, but definitely worth exploring.

Which leads to the second question: Should we even do this right now?

Again, maybe.

I think the pros of getting the Guardian are illustrated quite nicely on Printcrafter's site.

But what about the cons? Well, a few things came to mind as Ryan and I reviewed Medtronic's literature (oh, they were fast-- emailed fact sheets within minutes of our phone chat; brochures via "snail" mail the very next day!).

First, the psychological factor. How will Joseph feel if he has to wear yet another device; insert a second catheter? Will alarms going off at school draw unwanted attention?

Second, this is a brand spanking new technology. Do we want Joseph to be one of the first few children actually using it? Would we rather wait for all of the kinks to be worked out before making this leap?

This morning, armed with these questions, head swimming with the possibilities of this device, I took Joseph in for his three-month endocrinology visit.

First off, the good news. Joseph's A1c was 7.3.

Given all of the insane highs of October and much of November, I was surprised and pleased that he was up only slightly from the previous visit. Joseph's endo reviewed our logs, and thought our recent basal changes were just the ticket. Joseph's late November/December bgs (with a few exceptions on the weekends) have been looking really, really good. She suggested we do an at-home A1c test in six weeks, saying "I think you'll see an even lower A1c."

Next up, a bit out of order here, the not-so-good:

When Joseph took Evan out into the waiting room, the doc and I chatted about the Guardian. And at first it seemed a no-brainer. Joseph's endo thinks the device is phenomenal-- well worth the out-of-pocket cost. That, despite how it's being marketed, it will essentially replace finger sticks. She also thought that Joseph could truly benefit from it, since we need to test so often.

But then we discussed potential problems with the device, and she agreed with my concerns about the psychological issues of wearing the Guardian at school. She then added that the inserted wire could very well jeopardize the integrity of his already limited infusion sites (Joseph is very lean and can really only use his hips and abdomen). This could be a BIG problem for him in the not-too-distant future.

Now, the endo did say that Medtronics is working on a way to use one catheter for both insulin infusion and glucose sensing.

But who knows when that will be available? Clearly, we need to do more research here.

Okay – a bit of a breath here.

Now for the bad.

Joseph's height and weight have pretty much leveled off from three months ago. He's still in the normal range for his age-- between 50th & 75th percentile for height and 25th & 50th for weight. However, the leveling off is not good. I asked if two months of outrageously persistent highs might be responsible.

"Yes," she said, "that could be the case."

"However," she went on, "there could be something else going on here. Something involving another endocrine function."

"Oh."

She then asked me to bring Joseph back within the next month for a first-thing-in-the morning blood draw in order to: test again for celiac; check his thyroid function; measure his "insulin growth factor;" and test for some other things I didn't catch because I simply couldn't hear the words anymore.

I wanted to cry because this is my son. And I can't just provide him with food every day, and know that he'll grow.

And we can't just be glad that we're doing all right. That he's doing fine. No, because now my son is not growing.

I just don't know how this can be.

One, Two, Three . . . HbA1c!

Yesterday, Joseph had his three-month endocrinology visit. I'm always anxious about these appointments, often wondering if the doc will take one look at our "smart charts" and ask, "Do you people know what you're doing? What's with the highs? And don't get me started on all of these lows. You might as well pack it in right now, because, hell if you know how to take care of your son."

Er, well, something like that.

Anyhow, it never quite plays out the way I imagine. But let's backtrack a moment, shall we? Because yesterday was one of those days when the tiniest of efforts seemed to morph into something almost Herculean. What was the problem, you ask?

Just getting there.

Shortly after waking, it became very clear that a conspiracy was afoot. I had a plan, you see. I'd stayed up late the night before doing the final preparations for, what looked on the surface to be, a pretty straightforward morning:

• Review notes with questions for endocrinologist, while drinking soothing cup of tea;
• Take refreshing shower so as not to offend said endocrinologist with smell of anxiety-induced sweat;
• Wake and get breakfast for the kids;
• Dress Evan;
• Inform school that Joseph would not be in;
• Pack supplies for our outing;
• And then, off to our 9:45 appointment.

Easy enough.

Problems was, too few people got the memo.

I got up, and just as I began filling the tea kettle, I heard Evan calling from the top of the stairs, "Mommy, mommy" she sniffed, "I want mommy."

Well of course you do. So I picked her up and carried her down the stairs. Trouble was, she didn't want me to put her down, she wrapped her legs about my waist like a baby monkey, determined to stay where she was, indefinitely. Okay, deep breath. Obviously, she was upset, and needed some time RIGHT NOW with mommy. Change of plan, sit down, read a book to Evan, and try to coax her into eating something, and then, on to the tea...

During implementation of the revised plan, Joseph stomped loudly down the stairs. Apparently, he'd "gotten up on the wrong side of the bed." Actually, I hate this expression, and because Joseph sleeps on a top bunk, against a wall, he hates it too-- pointing out to me that he can literally only get up on one side of the bed.
But I digress.

"How long do you think this appointment is gonna take? Because it's really boring sitting there while you and the doctor talk. Can I bring Evan out to the lobby during the appointment?"

Now, regular readers know that Joseph is a smart, sensitive, awesome kid. But, there are times when he can be, well, difficult. Unfortunately, because I still had not had my tea, I was a bit difficult myself.

"Joseph," I said, exasperated, "I don't want you to be rude at this appointment. No saying 'I'm bored.' I'm tired of hearing 'I'm bored.' Sometimes we have to sit through things that are not particularly interesting to us, but are important. This is one of those things. We see this doctor four times a year. You can tolerate being bored for those few visits."

"And another thing" my voice rose an octave as I was picking up steam, "if things go faster than I expect, then we'll just bring you to school afterward instead of going to lunch, since school lets out at 1:45 today."

"No, no" he said in a panic, "We don't need to do that." The fear was palpable.

Just as I was ready to come back with how this isn't a vacation day, the phone rang. It was Ryan.

"Honey, on my way to work, I noticed a lot of people in the neighborhood have their recycling bins out for pick up . . ."

Suddenly, Evan started pulling at my shirt, saying quietly, "Mom . . . mom. "

". . . I'm not sure if our street is scheduled for a pick up today or not, but our bin is pretty full."

More shirt pulling. "Mom . . . mom . . . mom."

" . . . could you check the new pick-up schedule? I think it's in the drawer by the phone . . . and put out our [huge] bin if the pick-up is today."

Clearly, Ryan had not gotten the memo.

When I hung up the phone, I turned to Evan, feeling guilty that I had been ignoring her attempts to get my attention. I said, in that soft, mommy voice:

"What is it, honey?"

She looked up at me with big brown eyes, and a somber expression.

"I'm bored."

"What?"

"Mommy, " she sighed heavily, "I'm just bored."

Dear. God.

Two phone calls later (the first from a friend who wanted to arrange a playdate for our kids, and really just wanted to "chat," and the second, a much-longer-than-intended conversation with the school secretary about Joseph's desire to play the cello in strings class), we were back on track.

The shower was quick. The tea never made. The recycling pick-up schedule never found. But the kids were dressed and fed. When we got to the hospital parking ramp, it seemed that everyone had a 9:45 appointment. We drove to the top of the ramp, before I decided to go wild and ignore a "Wrong Way" sign, in order to nab a just-vacated spot. We were in.

At 9:50, we ran to the parking ramp elevator, then on to the clinic elevator, and just as we approached the check-in desk, I realized that my notepad, filled with carefully thought-out questions, had been carelessly left behind-- still lying on the passenger seat of our van . . . a million miles away.

I was going to have to wing it.

Thankfully, I remembered all of my questions, Joseph successfully beat back boredom, and Evan only mildly freaked out in the examining room, until she realized that her brother would be the doctor's focus. And, when Joseph did eventually retire to the lobby with Evan, his doctor commented that "He's really a very bright kid, and so well-mannered."

I simply smiled.

Oh, and his HbA1c. It was 7. Down from 7.5 three months ago. "He's definitely ahead of expectations for adolescent children. As a matter of fact, our goal for high school and college kids is 7 or below. You really are doing a terrific job here," she said.

Again, I smiled . . . but this time, with a huge sigh of relief.