Introducing the Flourishing Approach at the Region Steno conference in Copenhagen

There’s little I enjoy more than sharing with health professionals the Flourishing Treatment Approach and training them, in less than two hours, in a few of its strengths-based skills – that often are the missing link to patient involvement and activation.

Screen Shot 2017-11-20 at 10.39.36 AM.pngIt is rich to see them work among themselves and gain new insights and skills. It is remarkable to see them nod in agreement when they hear, as if for the first time, things they have known intuitively all their lives: how people with diabetes being human beings, not machines, require a different way of engagement.

And it is sad that this more empathetic way of working has all but been trained out of health professionals in their medical education. And, it is reckless that safety, trust, listening and partnership’s ability to drive behavior is all but overlooked in our pressurized, standardized health system.

Wednesday, November 15th I worked with almost 100 diabetes nurses, educators, researchers and physical therapists at the Region Steno National Konference in Copenhagen. I had them practice beginning a conversation from a solution-focused perspective rather than a coping perspective.

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Health professionals typically find it difficult to start a dialogue looking for what a person with diabetes is doing well; it requires a new way of seeing and developing a new muscle. They, like other providers I’ve trained, also found it hard, and eye-opening

I also had them work in pairs listening for and then sharing the strengths they heard in their partner after she had told a particular story. They were struck by how close you can become to someone you don’t know in a matter of minutes, just by listening with your whole being, listening empathetically. How valuable this would be working with their patients.

On the Thursday I ran another workshop, this one at Steno and gave a keynote presentation on the theme of the previous day’s conference – Patient Involvement. My own view is that pulling patients into the medical world asking them to take on greater responsibility will not activate them more in their self-care.

We must have providers step into their patient’s world – to see how they live, learn about their challenges and resources, and meet them where they are. That is the connection through which people feel that they are not alone and become more confident, able and desirious to take better care of themselves.

We should be changing Patient Involvement to Provider Involvement.

I recited a quote during my keynote that when I first read it spoke completely to this idea. It was in an article by MD Atul Gawande, a surgeon at Brigham Women’s Hospital in Boston and Professor Harvard School of Public Health.

“In the 1990’s we replaced medical paternalism with the belief that we should activate patients by giving them options. But in the real world they ask us, “What would you do?” Because you are the expert, you still know better. This is for you to decide we say. And that is when people feel completely abandoned.”

Gawande goes on to say that palliative care clinicians also offer patients options and then they do something more. They ask, ‘What matters to you?’ And then they do something more, they listen.

And this is when patients feel connection and capability, two powerful motivational forces.

It is difficult to experience, myself, and to watch people with chronic illness suffering. In part because many providers lack the training and understanding how to effectively treat people with chronic illness. It is also tragic to see providers suffer from burnout and frustration, and leave the profession because they lack these skills.

This is why every time I get to change this landscape, to strengthen providers’ skills and the bond between patient and provider, I know I am just where I’m meant to be. How tremendous this time it turned out to be Copenhagen.

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Photo by Mathias Løvgreen Bojesen

 

Afrezza does it for me first time out

IMG_7438.JPGI know a lot of type 1s have waxed poetic over the amazing effects of Afrezza-particularly it’s quick onset and just as quick exit from the body. That always appealed to me, but I couldn’t fathom how I could use it when the smallest dose it comes in, in its little colored blister packs as seen above, is 4 units. Eating low carb I rarely take more than 1 unit of rapid acting insulin for a meal.

That said, when I went to my endo last month something made me ask him if he had any samples he could give me so I could just try it. And, with unusual foresight, I packed it last night into my luggage for a two month trip I have just embarked upon overseas. While my blood sugar is pretty predictable when I’m home sticking to my routine, it’s all but that when I travel and have little influence over what I eat, jet lag, what my body’s biorhythms are doing, etc, etc…

So right out of the box, or I guess I should say gate, landing in Amsterdam at 9 AM Dutch time, 3 AM NYC time, being met by the husband, we sat for a cappuccino. Boom! My blood sugar began climbing from 102 to 194. I got out my insulin and began dosing single units until I’d taken 5. I daren’t do more. Even though my blood sugar was 264 and didn’t seem to be budging, I knew eventually it would. And that’s the crux, it takes so dang long to come down.  Two hours later it was slowly sliding back down.

Now 1:30 PM Dutch time, 7:30 AM NYC time, we went for lunch. I had mushroom soup and a stir fry with just vegetables and beef. I didn’t take any insulin because I figured I had enough on board to cover this meal. I didn’t. Boom! It started climbing again. Now, at 200 again, I took one unit of insulin and we walked around the corner back to our hotel so I could try Afrezza. No way I wanted a repeat of the morning’s runaway blood sugar train and wait hours to come back down.

A short search through my knapsack revealed the little box. A quick video on YouTube showed me how to load the inhaler and take a drag. Then I put Pinkie’s (Dexcom CGM), receiver and my iPhone both, in my pocket, and said a little prayer. I had no idea if I’d inhaled properly and would see results and I was scared if I did, how low would I go?

The darn stuff works! Within 15 minutes my climb reversed and I was coming down. Within 45 minutes I was at 120, In an hour and 15 minutes Pinkie was telling me I was at 84 with the arrow going straight down, then 70, arrow still straight down, then 55. I felt fine, but who knew. Checking on my meter I was 86. I remembered when your blood sugar’s going up or down rapidly, Pinkie needs time to catch up and straighten herself out from the roller coaster. I took 2 glucose tablets to create some cushion. Within 2.5 hours I was 105 and I felt Afrezza had left my body

If I hadn’t already taken the 1 unit for lunch, and just taken the Afrezza, I think it would have worked just great. As I’ve been told, 4 units of Afrezza, the smallest dose, works like 2 units of rapid acting insulin in the body. I can definitely see the value of heading off skyrocketing highs and getting back in target range much faster than with injected insulin. That is always my frustration, how slow insulin is to get working.

While I can’t use Afrezza often because I am insulin sensitive and do eat a low carb diet, I’m going to want to have it around when what’s around me is not my norm.

So, listen up everyone in Copenhagen, London, Abu Dhabi, Singapore, Sydney, San Francisco and Portland where I’ll be coming through, Afrezza is in my backpack and if you see me taking a drag I’ll probably have a smile on my face. Rest assured, it’ll be the insulin I’m toking on, not a souvenir from Amsterdam ;-).

My father passed away sunday

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My dad above at my wedding 16 years ago. As you can see, I tend to be a controller. But I think in the end, he controlled when he left us.
He died peacefully early Sunday morning after four years of Lewy’s Body Dementia and two years in a nursing home. He would have been 95 this month. The service was yesterday. It was a lovely day. The husband and I got a ride up to the nursing home from our friend Geri, she also carried in her car two other friends from the city.
It’s funny; at first I hesitated to invite people. I didn’t want anyone to feel obligated, but when friends began saying they wanted to come, I realized how special their gift to us was: their presence, love and kindness, and the history we’ve shared.
The husband and I printed cards Sunday night from my old greeting card designs. We picked two of my inspirational designs that were meaningful to my father. We handed them out at the service as a celebration of a life, and they told the story of a man always looking to get and give love.
My mother read the lovely poem I leave at the end, “Gone from my sight,” which she has always loved, and I do too now.  I spoke about my complex relationship with my father, thanked all the nurses and aides who had taken such good care of him these past two years and told them, “he died at home,” for the nursing home was his home. My brother shared his own remembrances. Then the husband moved everyone with his tearful and heartfelt tribute and gratitude to the people who made me, my parents. Gadget guy has a very tender heart.
About 23 people attended, which amazed us. Some friends of mine and my mother’s, my mother’s mah jong partners, some of the nurses and aids from my father’s unit. It felt rich and full. And, it brought home how moving it is that we rally round each other, gather and give solace when sorrow comes.
There was one surprise when several of us went to my mother’s apartment after the service and lunch. We brought my father’s belongings, which the nursing home had packed for us, into her apartment. Opening the first box we fingered sequin blouses and half used mascara. My mother laughed that maybe my father had a secret life. In fact, half the boxes were the life remnants of a fellow nursing home resident who must have died this same week, named Alice Greenberg. I’m sure it was the first time Alice left the home in years. This morning someone came and took Alice’s belongings back.
Today we donated much of my father’s clothes and the left over lunch from yesterday to the neighborhood homeless shelter. My mother said as we turned the goods over to a lovely young man, “Maybe I could volunteer here when I’m ready.” He welcomed her anytime. She is blessed with a year’s bereavement counseling sessions, which will take her back to the nursing home where she’s spent the last two years and loves the people.
My mother is remarkably strong. At 87 she is still feisty as a friend called her, walking, talking, laughing and exhausted. Since my brother and I have been here for days, reality has not yet set in. She also fell in love with my father these last few years and it was noticeable to all who knew them. It will hit, it will come, and go, and come……
And I am fine. My father had a long life, as I wrote two years ago, I fell in love with him these past few years, and he was so well cared for in the end. With my brother’s quick wit, humor brought us together this week as well as sadness. We’ve laughed a lot as we huddled around my father’s bed this past week. In fact, it often felt like we were in  episodes of Seinfeld or the next hit episode of Norway’s Slow TV.
If there’s any lesson for me it might be the renewed realization that
our shared humanity is paramount
you never know what’s going on for anyone else
be kind
just showing up is a gift you give
and I’ll discover what’s coming as it comes.
If you’ve been following this blog with me, now and then, thank you.

Gone From My Sight

I am standing upon the seashore. A ship, at my side,
spreads her white sails to the moving breeze and starts
for the blue ocean. She is an object of beauty and strength.
I stand and watch her until, at length, she hangs like a speck
of white cloud just where the sea and sky come to mingle with each other.

Then, someone at my side says, “There, she is gone.”

Gone where?

Gone from my sight. That is all. She is just as large in mast,
hull and spar as she was when she left my side.
And, she is just as able to bear her load of living freight to her destined port.

Her diminished size is in me — not in her.
And, just at the moment when someone says, “There, she is gone,”
there are other eyes watching her coming, and other voices
ready to take up the glad shout, “Here she comes!”

And that is dying…