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Archive for October, 2013

Oct 29 / Caro

How to Make Friends In the Playground

Working in any branch of frontline healthcare brings you in to contact with a huge variety of people. Thankfully most of them are lovely, polite and straightforward to communicate with. But there are plenty of “difficult patients” too; the kind that won’t listen, or that want to tell you their irrelevant life story; The demanding and downright rude; The drama queens. I seem to attract more than my fair share of “difficult” dental patients and it’s not gone unnoticed by my colleagues.

My manager gave me a rueful smile a few days ago when she commented that the only way I’d stop getting quite so many of them in my surgery if if I were to stop making them like me. “And that’s not going to happen” she laughed.

She was winding me up. But it was also a massive compliment. The truth of the matter is that one of my huge strengths in my profession is communicating with people on their level and making them like and trust me. As a result one of my biggest daily challenges is that too many people want to see me and I just can’t keep up. I suppose you could say that I’m popular.

Outside of my professional arena, however, things are a bit different. I’ve never, ever been one of the “popular” kids. Although I might not seem conventionally shy, I’m plagued by a deep lack of confidence in meeting new people. Despite liking myself, I tend to assume that other people won’t, which probably in itself doesn’t help, but at the ripe old age of thirty-three I still have no idea how to translate an acquaintance in to a friend, even when I really want to.

This, of course, is why work is different. There, I know how to make people like me, and I have confidence in myself and my skills. But more importantly, I’m not investing anything personally in these relationships. I don’t want them to be friendships and I don’t care whether I like the person back or not. Perhaps it’s easy there because it doesn’t actually matter so much.

I don’t want to give the impressions that I don’t have friends. Of course I do. I have some wonderful people in my life who I know that I can depend on to be there for me, and who I will always be there for in return. These are friendships which mostly date back years and are tested and true.

What I seem to be increasingly hopeless at the older I get is making new friends, which matters, so I am discovering, when you are a (relatively) new mother. New motherhood obviously turns your world upside down and it can be a confusing and indeed isolating time. I’m not sure many people would dispute the value of “mum friends”, who’ve been there too, to help them get through it. Yet despite the fact that I often see the same faces over and over at toddler groups, at the swimming pool, at nursery pick up and at the playground, and despite the fact that I smile, that I interact and that I even initiate conversation, I’ve never been able to cultivate any of these chance meetings as friendships.

It may, of course, be nothing to do with me. It is far more likely that these mums are simply just as clueless and just as shy. Or maybe they simply don’t need any more mum friends in their hectic lives. But I can’t help but wonder why this doesn’t seem to be the case for other people. My closest friend throughout my university years was the sort of girl who could strike up a friendship in the bus queue. Walking across a crowded bar was always a challenge because she knew everyone and everyone wanted to stop and chat. I always wondered how she did it, but even our years of friendship haven’t taught me the secret. And now, my closest mum friend (met through an ante natal group) is similar – she is the one who has collected a string of new friends from the toddler groups she has attended and a simple coffee always results in her bumping in to someone who wants to arrange their own coffee date soon.

So I can’t help but feel that I’m doing it wrong.

Even online I struggle to make the friends that everyone else seems to celebrate having made through social networks and the like “without having ever met in person.”

In my deepest crises of confidence, I tend to assume that I must be unlikeable. Or perhaps embarrassing. Odd. Too intense. Too quiet. Or maybe talk too much with too many opinions. At other times I just wonder if I seem too comfortable in myself and as if I don’t really need anything more.

Inside, though, I worry. I’m already aware that my lack of friendships is limiting the number of relationships that Thomas is forming with other children outside of nursery. And whilst that won’t be a problem just yet, I wonder whether this will affect Thomas in future – if my inability to form friendships with the class mums at school will stop him being invited for play dates. And how on earth will I go about arranging things like birthday parties?

I watch children playing in the playground and the ease of their friendships. Young ones, like Thomas, who are content to simply play alongside one another, and are unequivocally happy just to see again the toddlers they see most often, but have no expectations and no real emotional attachments. I see the older children who form friendships as quickly as they exchange names, and all because they have a shared love of the same colour, or they ride the same type of scooter.

I see the easy interactions of children and look at the other adults around me, wondering just when it all got so complicated.

Frosty football game

Oct 23 / Caro

Photography For Bloggers Course

It started, as so many things in the life of a dentist do, with teeth. Back in May, when he was one week past the eighteen month mark, Thomas finally got his first tooth. A few weeks later, I wrote this post and a few weeks after that entered it in to a Twitter competition. Winning that competition was not only the best thing to come out of Thomas’s late teething, but also the best thing to come out of my blog so far. The prize was a place on Emily Quinton’s Makelight Photography For Bloggers Course.

The weekend before last saw me joining nine other bloggers at Emily’s husband’s studio space in Shoreditch for a day of talking photography and creating photographs. I tend to be quite nervous about meeting groups of people in general, and I’m especially nervous about blogging related events, I think mainly because my blog is so small and I frequently lack confidence in it! But the day was super relaxed and I felt at ease straight away. The other bloggers were friendly and easy to talk to, and Emily herself was every bit as lovely as her beautiful blog will have you believe. Her creative energy was apparent from the very start, with beautiful name badges and thoughtful goodie bags. Plus, in the afternoon, home made cake!

If I were to pick a single word to sum up the day, it may be predictable, but it would have to be inspiring. As we chatted early on in the morning, I admitted that I sometimes struggle to find inspiration for photographs for my blog – especially to accompany posts that focus on emotions or concepts, rather than on, say, days out or directly on Thomas himself. I also think I may have been in danger of becoming what Emily described as a technical bore – someone who knows quite a lot of the technical principles of photography – such as the elements of exposure and how to control them – but creates very boring images with little aesthetic appeal.

As a result of this weekend I think, or hope, that both of those things have changed. We talked a lot about the things that have been puzzling me, such as inspiration and also making time for photography amongst hectic schedules. We also covered lots of basics about composition, lighting, exposure and lenses. Whilst much of this information wasn’t new to me, it never hurts to have your knowledge refreshed. But the bulk of the day was devoted to practice using all the available space in the studio and a fantastic collection of props provided by Emily – everything from boxes and baskets to bottles, bunting, flowers and fruit.

As a result I’ve definitely developed a new found enthusiasm for still life photography. Most of my photography to date has been of places or of people. I’ve always been a bit intimidated by staging shots, or setting them up using props. But now I can’t wait to building my very own prop collection!

Here are some of my efforts from the day.

Flying saucers in paper cup

Autumn leaf and fruits

A hat and a squash... just because!

My milkshake brings all the boys to the yard...

Dahlia

Dahlias against blue background

Prop shot

Flowers on the piano

Gin

Gin & milk

IMG_8963

Love Hearts

Saucers

Hamper

(Credit for the setup of this last shot must got to Ruth at www.ruthlgarner.com I just snuck in and took a picture of her lovely scene. I would be quite happy to have her as my stylist!)

 

The name of this blog came about because I began writing it as a record of a diabetic pregnancy. It was a play on the old rhyme “Sugar and Spice” but given that I was pursuing the best control of my blood sugars possible, sweeteners were largely preferable to simple sugar! (And no, I didn’t know I was expecting a boy!) I’m hoping now, with my new found inspiration, that I may be able to add a little more of the “All Things Nice” to this blog. As I believe is common, I may have lost a little bit of my old self in the transition to parenthood. Things that were once important seem less so, and with more demands on my time more prioritising has had to happen. But I’d like to get back some time for more creative pursuits in my life. Doing more things for which the primary motivation is my happiness and enjoyment. Emily’s insights, as a mother of four, have been really helpful in setting my determination for this. I’m hoping eventually to add an “All Things Nice” category to this blog, with posts covering some of my creative and artistic pursuits. It’s probably a lofty goal, given that I already have a huge number of half-written and unpublished posts, and I can’t promise what I create and share will necessarily be worth waiting for, but I’m excited to put some new ideas into practice nonetheless.

And in conclusion, I would highly recommend Emily’s courses. If you’re just starting out with photography and want a good grounding in the basics, along with lots of practice, this ticks all the boxes. And if you’re more confident in using your camera, but looking for ways to refresh your approach or develop your style, she has this covered too. And whatever else, I can guarantee you’ll have a good day!

Oct 13 / Caro

On the Flip Side…

A couple of days on, I’m concerned that my last post may have come across as unnecessarily negative or self indulgent, and that perhaps it requires some balance.

For starters, I’m acutely aware of how many alternative scenarios I could be facing that are infinitely worse than anything I’ve ever experienced or am facing now. It may be a big deal to me in this moment, but in the grand scheme of things, it’s a minor blip.

I’ve spent my entire life refusing to be someone who says “It’s not fair”, because, frankly, that is only stating the obvious. Life is intrinsically unfair.

Perhaps the most difficult part for me is the lack of control. I’m used to working to get what I want and holding no one accountable but myself if I don’t get to where I want to go. And whilst I’ve made changes to my lifestyle and devoted hours to monitoring and recording my “fertile signs”, doing everything in my power to optimise our chances of successful conception, ultimately there is only so much that I can do. At the end of the day, much of it is out of my hands and comes down to chance, or to good old-fashioned luck. It’s hard for me to get my head around that.

I feel sometimes like my body is saying “no” to me, which is not something I find easy to accept. As someone who has met a lot of narrow minded prejudice in my life, I’ve learned always to be clear with people that they shouldn’t tell me not to do something that I really want to do. Not to tell me “no” based on their own assumptions of what they could, or would, do if they were me or in my position. The greater the barriers people raise, the higher I will jump, or the further I will go, to get around them. I  generally set a limit on my limitations rather than letting my limitations set a limit on what I can achieve. I can assure you that without this attitude I wouldn’t be where I am now, doing the job that I do, living, and having lived, the life that I do.

But none of this works when then problem lies in the way that your body works. Or doesn’t. I can’t go any further or work any harder, and my passivity is translating in to negativity.

On the flip side, at least I’m used to things not really working how they should. I’m used to unexpected twists to the journey and I’m used to getting bad news about my health. Even a commonplace broken leg for me had to be complicated by the simultaneous rupture of my achilles tendon which led to three surgeries and a total of more than six months in plaster. I never do things by halves, and perhaps my biggest mistake is allowing myself to be surprised that this isn’t going smoothly.

The positive side of all of this is that I’m built to cope. If I can’t direct my strength and determination into actually making it happen myself, at least I can direct it into re-setting my expectations and coping with the journey.

And not giving up.

Flowers on the piano

Oct 9 / Caro

Broken

I’ve been a bit quiet lately, both online and off. It’s not for a lack of things to write about or share. It’s not even as simple as a lack of time, although things have been exceptionally busy. It’s more down to a lack of motivation and a slide in to reversed philosophy of not doing today what can be put off until tomorrow. That, and every time my thoughts turn to my blog, or to other parenting blogs – and hence Twitter too – with so many sibling tales and happy pregnancy announcements throughout, they can’t help but turn to the baby we keep failing to conceive.

I never meant for this blog to turn in to a “trying to conceive” blog. And I certainly never dreamed it would become an infertility blog. When I first wrote about trying for a second child back in February, we’d already been trying for a number of months and I made the decision to share because I wanted to touch on the subject of the extra stresses that are associated with the experience when you have diabetes. I honestly thought at that time that we wouldn’t have too much longer to wait, so it seemed like the best time to cover the topic.

But here we are, eight months down the line, no nearer to having another child but with the newly acquired diagnosis of “secondary infertility”. The cause, if any, is as yet unknown. And I’m starting to really feel the strain. Even Ian’s attitude of calm, relaxed patience is starting to falter. Time and again he’s been the one to remind me that it’s “normal” for this to take up to a year. But just this week he has conceded that though this statistic is often bandied about, we know very few people who have waited that long and then suddenly conceived without fertility treatment. In fact, we know far more people who have experienced accidental surprises, or fallen pregnant on their first try.

Somewhere along the line this has stopped being about a desire for a nice tight age gap – although the number of Phil & Ted’s pushchairs at the local park is still a stark reminder of what we now won’t have. But these days it’s about desperation to complete the family I aspire to, whilst slowly losing hope that it will happen at all. I feel as though I’m surrounded by pregnancies, or families with more than one child. I know it’s partly because I’m focused on it, but it’s hard to do anything else when you want something so badly. It’s hard not to wonder why it seems to be working out for everyone around me.

I’ve tried to be positive about this. I’ve tried standing the typical questions on their head and asking not, “why us?” but instead, “why NOT us?”

I think it’s probably selfish to believe that we’re somehow more deserving of an easy ride than any other couple and I know just how lucky we are to have one fantastic child. But yet I can’t help but think that I’ve already dealt with enough crap and, in particular, enough of my body’s failings. Whilst no one else may deserve to be in this position either, I think I’m justified in wishing for a break.

My entire medical history, not mention life story, is too long and too boring to share here. Besides, I don’t care for the medical one-upmanship that abounds across the internet – there is no competition or prize for the longest list of bodily ailments. I prefer to focus on living well despite limitations. But here are some of the important facts of the matter: Diabetes pre-dates my earliest memories. I literally do not know what it feels like to live with a body in full working order, to not be reliant on an external supply of an essential substance that most people barely even know about, never mind take for granted. Then, following a run in with meningitis as a teenager, I’ve dealt with a life altering diagnosis which severely limited my freedoms and opportunities at precisely the time of my life I should have been seizing them. Instead, I was seizing in an entirely different way. To this day I live with brain circuitry that is dependent on medication for its proper function. And whereas many people couldn’t tell you where their pituitary gland is located, I’m intimately familiar with each of the hormones it produces and what can happen when their function goes haywire too.

I live with a broken body. Bloody hell, I live well – a good life – with a broken body. But I think it’s understandable that just sometimes I wish my body would do what it is supposed to do, without the need for medical assistance, without any hiccups. I’d like for things to simply work.

I’m not normally one for reading horoscopes (I mean, come on, can those little paragraphs really each be so applicable to one twelfth of the population?) But at the hairdressers earlier, the page in the back of a magazine caught my eye. Under my own sign, it included the statement “eventually life runs out of ways to torture us”.

Today, feeling down as I do, I couldn’t help but wonder when that time might come for me.

Oct 3 / Caro

Why I Believe Fertility Support for Women With Diabetes Needs a Rethink

Like a lot of women with diabetes, I spend a lot of time ensuring that people see that it doesn’t have to interfere with life and that there aren’t very many things that I can’t do. We don’t want or need special treatment in most ordinary circumstances in life. That said, it certainly complicates life at times, and many things need a little more thought and planning. Pregnancy is an obvious example. Women with diabetes can, and frequently do, have happy healthy pregnancies with happy healthy babies at the end. But it does take a lot more planning and effort to achieve than for many women without diabetes.

Pregnancy prep, for a diabetic, begins many months before “trying to conceive”. Current available evidence suggests that the risk complications is reduced if blood glucose control is at optimal pregnancy levels for some months prior to conception. Most experts seem to recommend a minimum of three months of good control. And this has benefits for the mother-to-be too, as very rapidly tightening control after learning about an (unplanned) pregnancy is associated with a greater risk of worsening any pre-existing eye complications, or bringing new ones on, as well as a much greater risk of hypoglycaemic unawareness and severe low blood sugars – potentially dangerous for both mum and baby.

Pregnancy standard of control achieved for the requisite time, you get the green light to start “trying” in the normal way in the hope that a positive pregnancy test will soon follow. Except, obviously, sometimes it doesn’t. In the presence of good control and regular cycles, there is nothing to suggest that this might be related to diabetes. But all the while that tight control needs to be maintained.

Unless you live with it, it’s impossible to truly understand what that means, but here is a small flavour: Testing blood sugars frequently (up to ten times per day) day-in, day-out. Counting every carb that passes your lips and calculating the corresponding insulin dose. Restricting dietary choices in pursuits of better post-meal blood glucose levels. Aggressively correcting high blood sugars whilst trying to avoid too many lows. Dealing as best as possible with the hormonal ups and downs of each cycle and their effects on your carefully calculated control. And doing that over and over as each month your period arrives and your pregnancy hopes fade.

Vibe CGM Graph

Trying to conceive can be trying for everyone, but trying to conceive with diabetes is a double whammy of struggle.

If you’re under 35, like other women in the UK, women with diabetes are expected to endure 12 months of this roller coaster of trying and waiting until basic fertility investigations are carried out on the NHS. By this stage the obsession over blood sugars has already been going for at least 15 solid months. You then spend month 13 of “trying to conceive” getting blood tests done on appropriate days. And possibly month 14 having these repeated in the hope of a different result. Then you might wait anything between six and eighteen weeks to be seen by a fertility specialist (unless you opt to pay privately, of course). All of which adds up to over 18 months of super tight diabetes control. Two pregnancies worth, before you’re even pregnant.

It’s easy for outsiders to dismiss, to tell you to take a break and that it won’t hurt. Even my GP suggested to me that I stop trying quite so hard to keep my control so good, and if I did happen to fall pregnant I could quickly “sort things out” then. It’s easy to say if you won’t be the one unable to move on should that pregnancy end in miscarriage, forever wondering if those weeks of slacking were the cause. It’s also easy to say when you don’t understand that “sorting it out” isn’t always as easy as it sounds. Because where blood sugars are concerned, stability breeds stability and chaos breeds, well, chaos. Keeping on the level is hard work, but comparatively easier than creating good control out of a mess.

I’m well aware, as someone who wants to minimise the impact of diabetes on my life and health, that we should all be striving for tight control for our own sakes, not just our unborn children. But there is a difference in the level of control required long term to reduce the risks of complications and the extra level required to really minimise the risks to a growing baby. The difference is that just two weeks of terrible control in a forty week pregnancy is a relatively long term. Two weeks in the three decades of diabetes behind me and the many, many years still stretching ahead of me is comparatively tiny. I can slip up for a few weeks, slack off and only test a few times each day. I can take a break between CGM sensors if I so choose and I can be lazy and let my pump infusion site run on for four days because I don’t feel like changing it. In the grand scheme of things it won’t make much difference, unless you throw a potential pregnancy in to the mix. A baby is the biggest motivation for good control ever. But it’s also the biggest fear factor.

I can’t say it often enough that people with diabetes on the whole don’t want to be treated any differently than those without. For the most part there is no need. But sometimes it’s essential. Our pregnancies aren’t managed in the same way as pregnancies which aren’t complicated by diabetes, and I don’t believe that the assessment of our fertility should be either.

I wouldn’t for a moment suggest that women with diabetes should somehow jump the queue for fertility treatment and I fully understand and support the general need to wait a while before testing fertility, as most often all that is required is time. But for some people all that time will turn out to be a waste, because pregnancy could never have been achieved without some form of intervention. That is sad, and hard enough to bear for any couple. But for a woman with diabetes who has driven herself to burnout in all the months of obsessive control, it’s even harder.

The basic fertility tests offered to women who’ve been trying for a year are relatively inexpensive in health service terms and I believe that they should be offered sooner to women in this position. Even if it’s just reassurance that all the effort is worth while because there is nothing obvious going on and pregnancy is as likely as for every other couple. If the news is less good, then at least it’s possible to make informed decisions about diabetes management moving forwards. Because what is the comparative cost to the health service of managing pregnancies in women who have tired of all the hard of work of diabetes and burned out long before the successful conclusion of a pregnancy? These women are at increased risk of miscarriage, need even closer monitoring in pregnancy, have increased risk of needing a caesarean delivery, and increased risk of birth defects or still birth.

Obviously this is something about which I’m very biased, impatient as I am to have another child and as burned out as I am by controlling diabetes right now. I know that every women who is trying and failing to conceive is desperate for answers and wants them as soon as possible. What I’m trying to illustrate is how dealing with an all-consuming chronic medical condition makes this process harder. I’m constantly baffled by how we are left to struggle yet the moment the second line appears on a pregnancy test, there couldn’t be more help on offer.

I could certainly have done with a bit more support on this journey. It’s amazing how much better I’m beginning to feel now that we’re finally getting it.

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