diabetes management

Believe in yourself to manage diabetes

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I’ve been doing an ongoing Thursday shot-in-the-arm of inspiration from my book “The ABCs Of Loving Yourself With Diabetes.” 

Emotional strength and resilience is critical to keep on keeping’ on managing our diabetes. Here’s today’s powerful thought for reflection.

Excerpt:

How you feel about yourself influences how well you will take care of your diabetes. Do you treat yourself with the same regard, kindness and compassion you reserve for a friend?

When you believe in yourself, you live life expecting the best. When you believe in yourself and feel confident, the world responds to you with a very special magic; things seem to just go your way.

If you have spent much of your life saying “yes” to everyone around you, leaving you little time and energy for yourself, practice saying “no.” You can’t truly take care of anyone else when your own energy is depleted. And if your past has not reflected your greatness or your ability to manage your diabetes, remind yourself with love, that today is a new day; today you will take a new step.

Reflection: Today write down three things you’re good at and three good qualities you have. Look at the list throughout the week and allow yourself to take it in. 

Also, before you jump out of bed and when you’re drifting off to sleep, take a minute and see yourself at your best. Remind yourself, you always have this fantastic person inside you.

Your history doesn’t have to be your future when managing diabetes

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Here’s my Thursday d-lesson – a little reminder that no matter what we’ve been doing, we can do a little better today if we decide to do so.

My kangaroos, by the way, were inspired by the year I lived in Sydney, Australia. Here’s today’s excerpt from my inspirational D-book,

“The ABCs Of Loving Yourself With Diabetes.”

Excerpt:

Whether you’ve spent years ignoring your doctor’s advice, or even avoiding your doctor, today you can decide to be the master of your diabetes. How? Begin by shifting your thinking.

If you’ve been seeing your diabetes care as something you “have” to do, see it as something you “choose” to do. You’ll feel more in control. 

Then see the benefit of doing the task. For instance, “By testing my blood sugar, I can keep it in target range and reduce my risk of complications.” Focusing on the benefit helps remind you why the task is important.

The truth is everything we do in life is a choice. Changing your mindset from “have to” to “choose to” gives you more energy. With all there is to be gained, isn’t it time you hopped to it?

Reflection: Right now list on a post it note 3 diabetes tasks you perform and how they benefit you. Keep this somewhere you’ll see often. 

Create a personalized pill card

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My husband was just cleaning out his piles of papers, and amazingly found an interesting sheet titled, “Patients Don’t Remember Doctors’ Instructions.”

Shocking as it sounds between 40 and 80 percent of what doctors tell patients they forget – immediately! Only half the information they tell us do we remember correctly, and the more information they give us, the less we remember correctly. Well, frankly, that doesn’t surprise me.

There is, however, a useful tip offered on the sheet if you need a little reminding what pills you take, when and what they’re for. It’s a tool called a “Pill Card.” And the best thing to do is create one for yourself based on what you’re taking. 

The card includes the name of each medicine you take, how much, what it does and then uses pictures to remind you of these things. You can find instructions, graphics and templates at the Agency for Healthcare Research and Quality.

Have fun. Turns out 94% of people who were given a pill card said it helped them remember the information their doctor gave them correctly.

More tips for timing insulin

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A few posts ago I extracted some very valuable information from an article CDE and dietitian, Hope Warshaw wrote titled, “Rapid-Acting Insulin, Timing It Just Right” and I’d like to share a little more of her knowledge.

 Fine-tuning the timing of your premeal boluses or injections is important, but no more so than knowing how to count the carbohydrates in a meal or snack. If you don’t know how to count carbohydrates or to match your insulin dose to the amount of carbohydrate you plan to eat, speak to your health-care provider. Many people find themselves in a reactive mode when it comes to dosing insulin, taking it in response to high blood glucose rather than using enough of it before a meal to cover the rise of blood glucose in the hours after a meal or snack. Experts agree that it’s much harder to bring high blood glucose back down than to control blood glucose levels with sufficient insulin in the first place.

Glycemic Index: The glycemic index of foods as well as the fiber and fat content dramatically affect how quickly or slowly blood glucose level rises. (The glycemic index ranks foods based on how quickly they raise a person’s blood glucose.) One tip since most people’s blood sugar rises most quickly in the morning is to eat low glycemic foods at breakfast like yogurt or a bowl of oatmeal with a piece of fruit rather than foods with a higher glycemic index such as some cold cereals, pancakes, or muffins.

In general, foods and combinations of foods that have a low glycemic index and high fiber content will raise blood glucose more slowly. Conversely, foods with a high fat content tend to cause a delayed rise in blood glucose. The extent to which the glycemic index or fat content of a meal speeds or slows the rise in blood glucose following a meal varies from person to person. 

Meticulously timing your rapid-acting insulin dose and carefully calculating your dose according to the carbohydrate you will eat is usually best for blood glucose control, but it may not always be possible. There are times when you know exactly when and how much you will eat and times when you don’t. The following  tips may help you adjust for the realities of daily life:

High blood glucose before a meal. If your blood glucose is high before a meal, use how much your blood glucose level falls in response to one unit of insulin to calculate a dose of rapid-acting insulin to cover the high, then wait until that insulin begins to lower your blood glucose before you eat. 

Claudia Shwide-Slavin, a dietitian and certified diabetes educator in private practice in New York City, advises the following: “If your blood glucose level is between 140 mg/dl and 180 mg/dl, take the rapid-acting insulin and wait half an hour before eating. If it’s between 180 mg/dl and 200 mg/dl, wait 45 minutes. If it’s higher than 200 mg/dl, wait at least an hour.”  If a person is hungry or must eat at a specific time, Shwide-Slavin recommends limiting the amount of carbohydrate at the meal by eating mainly protein and nonstarchy vegetables.

Low blood glucose before a meal. If your blood glucose is low before a meal (below about 80 mg/dl), “Wait to take your insulin,” says Shwide-Slavin. “Let the food have 15 minutes to raise your blood glucose before taking your insulin.”

So, a few few more helpful hints to put your management “in the zone.” 

 

 

 

Learning more about timing insulin

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I know a lot about diabetes and working with my insulin. But recently a friend sent me an article, “Rapid-Acting Insulin, Timing It Just Right”, written by well-noted certified diabetes educator and registered dietician, Hope Warshaw. It helped confirm some of what I know and helped clarify some of what I didn’t know about timing insulin with your meals. Here are some of the article’s highlights.

Warshaw points out that even when you think you’re doing everything right with your diabetes care regimen, your blood glucose levels can seem hard to control. One potential source of difficulty is how you time your injections of rapid-acting insulin with respect to meals.

Most diabetes experts recommend taking meal-time insulins (Humalog, Novolog and Apidra) within 15 minutes of starting a meal. This advice is based on the belief that rapid-acting insulin is absorbed quickly and begins lowering blood glucose quickly. However, this may not be true for everyone. 

Howard Wolpert, M.D., editor of the book Smart Pumping and Senior Physician and Director of the Insulin Pump Program at Joslin Diabetes Center, cautions against blind-faith acceptance of insulin action curves or standard advice about when insulin works, noting that insulin can show “a lot of variability…between individuals and even within the same person from day to day.” The time ranges given for an insulin to reach its peak action are averages, so they may not fit everyone or every situation. You may find through blood glucose monitoring and experience that rapid-acting insulin typically reaches peak effectiveness within 45–90 minutes or possibly sooner or later. In general, people with normal stomach emptying can expect some glucose from the carbohydrate they’ve eaten to start raising their blood glucose level within minutes of starting to eat. Blood glucose level tends to peak about one to two hours after the start of a meal and gradually drops over the next three hours.

If rapid-acting insulin always started working almost immediately and peaked one to two hours later, injecting it anytime within 15 minutes of starting to eat would work well. But newer observations suggest that rapid-acting insulin doesn’t get absorbed and start working that quickly in all people. John Walsh, P.A., C.D.E., coauthor of the book Using Insulin, for example, believes the maximum blood-glucose-lowering effect of rapid-acting insulin may occur much closer to two hours after an injection rather than 45–90 minutes. If this is the case, the optimal time to take rapid-acting insulin is 10 to 15 minutes before eating rather than with the first bite or 15 minutes after starting a meal. Walsh’s belief is based on research suggesting that insulin may be measurable in the bloodstream before it begins actively lowering blood glucose.

 

Some other factors that may cause insulin action to differ from the action curve given in product literature or to vary from person to person include thickness of the subcutaneous fatty layer at an injection site, temperature, blood flow, exercise, and dose size. (The choice of injection site—abdomen, thigh, arm, buttock—does not seem to affect the absorption rate of rapid-acting insulin as it does for slower-acting insulins.) Injecting into areas that have more subcutaneous fat tends to slow insulin absorption. Widened blood vessels (caused by higher temperatures or exercise) allow insulin to be absorbed more quickly; constricted blood vessels (caused by colder temperatures or smoking) can cause slower absorption. Large doses of insulin may also be absorbed somewhat more slowly than smaller doses.

Thank you Ms. Warshaw. Since this is a lengthy article there’ll be more from Hope’s article over the next few posts.

Counting down to the holidays

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My Omron pedometer

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As I sail from Thanksgiving into the merriment of Christmas, Hanukah, Kwanzaa and New Year’s Eve, counting how many sweet potatoes and marshmallows I just devoured and how many cookies and glasses of champagne await me, I have one eye on threatening extra calories. But I have my other eye on a different set of numbers.

Diabetes comes with so many numbers. Our pre-meal blood sugars should be between 90 and 130, our 1-2 hour post meal blood sugars should be between 120 and 140, our A1cs should be below 7, our HDL over 45, LDL under 100, oops no, for us it’s under 70, our triglycerides under 150… you get the idea. But here’s one measurement I find truly encouraging, rather than discouraging. Counting my steps.

I know how I eat and how I move affect and create all the numbers above, but here’s one value I feel I have immediate, visceral control over; how many times I lift my foot, stretch it forward and put it down again. And, I am rewarded (not just with my blood sugar going down, my insulin sensitivity going up, my calories going away,) but with the instant knowledge and immediate gratification of seeing the results of my labor. 

These 9,183 steps on my pedometer are yesterday’s count from a one hour and 15 minute walk. On this late fall day I was strolling through a nearby neighborhood peering into new restaurants and kicking the leafy foliage underfoot. Since these 9,000 plus steps occurred between 11:30 AM and 1 PM, I know my ambling around my apartment before and after certainly put me over the 10,000 steps a day recommendation for physical activity.

There’s something truly motivating in seeing such immediate results of your efforts. Every time I give a diabetes presentation and show my pedometer someone will ask me where they can get one. Maybe they like the “gadget-ness” of it, but seeing things in black and white makes a big difference — it gives you a feeling of control. And as we all know, diabetes feels pretty uncontrollable a lot of the time.

So while you’re counting how many holiday parties you’re going to, slices of pumpkin pie you just ate, mini hot dogs and mushroom tartlettes you’ll be sidling up to at the buffet tables yet to come, remember, you can always count your steps. Getting them up to 10,000 a day, I guarantee you will put a holiday smile on your tiramisu-stained face.

Are your systems helping or hurting you?

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In my last post I touched briefly on the importance of the systems in your life to support your diabetes management.

Systems-talk is generally heard relative to companies seeking ways to improve  processes in order to increase profits and save time and waste. But doesn’t it make perfect sense that the same holds true for managing diabetes? Our systems either make us successful with less cost in time and energy, or foil us. Back to the company analogy, no matter how dedicated employees may be, if they’re working within a system that doesn’t support their intentions and efforts, they won’t accomplish their aim. Similarly, no matter how good your intentions, if your systems do not support your best efforts, success will evade you.

What does this really mean? We all have some kind of system we work within for the daily or weekly tasks we perform regarding our diabetes management. For instance, you have a system for feeding yourself – it may be skipping breakfast, eating a yogurt for lunch, then a candy bar in the mid-afternoon, and having dinner at fast food drive-ins half the week and pulling frozen entrees out of your freezer the other half. This system doesn’t support having your best health, let alone a desire to lose 10 pounds. A better system would be having a healthy breakfast, a larger healthy lunch and skipping the candy bar, and, going to the supermarket once a week to bring home nourishing foods. You might cook a week’s worth of dinners on the weekend, freeze them, and one day a week greet the loud speaker at Burger King, McDonalds, KFC or your fast food joint of preference.

Trust me, you have a system for everything. Take refilling your meds. It may be you open your pill bottle and you notice it’s empty, you grumble or shriek and then go to the pharmacy or call your doctor. Here’s another system that might be less stressful: when a new bottle of pills come into the house, if it’s for a 90-day supply for instance, write on a calendar 75 days from that day, “Reorder meds.”

Think about how diabetes fits into your day, or doesn’t? Is it the last thing you always seem to contend with? If so, your systems are not very efficient or supportive for managing your diabetes. How about your emotional system? Do you let loved ones help you in some way or shoo them away? Do you do enough of what you love to replenish your energy and positivity? If not, can you schedule that into your week?

The good news is you designed your systems, consciously or unconsciously, and can change them with a keen eye, some creative thinking and practice. Look specifically at what you’re having trouble with and then look at the system behind it. For example, if you forget to take your pill before lunch because you’re always stressed at work, or running into a meeting, how can you remedy this? Can you put a note where you’ll always see it just before lunch? Dan you keep an extra pill in your wallet if you carry your wallet or  purse into meetings? f you’ve been trying hard and not doing terribly well, don’t blame yourself, blame your system and then revise it.

My Systems

My system for taking my blood sugar approximately 5xday includes keeping my meter always in the same place, on my kitchen counter, my test strips always in my meter case, my lancing device  always on my kitchen counter. I work at home and this works for me. If I’m out of the house, I take my smallest meter with me so I can always test.

My system for eating is to buy mostly fresh vegetables, fruits, chicken and fish and do most of my own cooking. Every morning I make a bowl of steel cut oatmeal. Almost every lunch I have a spinach salad with an assortment of veggies, beans and some feta cheese. I mostly steam vegetables and broil or saute meats and fish for dinner. I eat beans in replacement of higher carbs, for instance, rice, pasta, potatoes. The few freezer products I use don’t have any added butter, cream, etc. I use vegetables a lot as foods to fill up on, and crunch on, when I need something crunchy. I like nuts for this too, and yes, I have to be careful not to sit down with the whole jar. I notice when I run out of healthy foods, I begin to reach for less healthy foods (my husband’s stock of crackers, licorice, etc) so part of my system is to always try as I can, keep an adequate supply of healthy foods in the house. I make sure I have 85% dark chocolate in the house and cocoa powder so when I need a sweet I can satisfy my sweet tooth and not go crazy. If I don’t do this, I’ll eat everything in my house and still feel unsatisfied.

My system for exercise is to every morning take a one hour walk around my local park typically from 9:30-10:30 A.M. Just after checking my email and before getting into any major project. If I miss my walk because I have an appointment, I try to fit it into the late afternoon. If my appointment is in the city, I’ll walk 40 or 60 blocks when I get out of my appointment to a subway station so I fit my walk in that way.

My system for emotional health includes doing lots of things I really enjoy that make me feel purposeful, and I get the rich reward of serotonin, the feel good brain chemicals from helping others. I spend time with friends who nourish me. I love reading and movies and indulge in both. When times are tough, I reach out to my partner who always listens and then see how much good I still have in my life. If all else fails I do something guaranteed to bring a smile, look at the pictures in my wedding album, call a dear friend across the country or just leave my house and go somewhere else from where life looks different.

I’m only telling you about my systems to give you an idea of how systems work. Admittedly, I have a lot of lattitude working for myself and working at home. I don’t want you to compare what you to what I do. I want you to look at your systems and your life and see if your systems support your best efforts and if not what can you do to improve them?

Here are some questions to stimulate your systems-thinking:

Q: Where are my supplies? Are they handy? As I said my meter is always on my kitchen counter making it easy to find and grab, no searching that might lead me to say, “oh what the heck, I’ll test later.”

Q: Am I always running out of my meds or test strips? Why? Can I guesstimate when it would be time to order more and work out a system for this? Is my husband or wife always at me about this and so do I put off reordering my meds just to bug him or her? Can I remedy this by having a heart to heart talk with my loved one and then do better for myself?

Q: How can I avoid all the tempting foods always at work from parties and meetings? Can I keep a healthier replacement treat at my desk, or give myself a reward when I pass up temptation like a movie or little trinket?

Q: I only seem to be getting to the gym a third of the time I’d planned because work or family obligations get in the way. Can my family help pick up some of the load by taking over some simple chores?

Looking at your systems, start with the assumption that it’s possible to refine them. And remember, to improve you can’t do what you’ve always done and expect different results. Sounds like common sense, but many people will often spend their energy trying harder in a failing system than change their system.

A bargain isn’t one when it comes to your health

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Now that the hazy, crazy shopping days are over, I recall an incident that occurred three years ago and seems apt to this story. On the brink of winter, I bought a bargain-priced pair of ear muffs off one of those typical tables of cheap goods on the streets of Manhattan. A month later trying to maneuver the cheap plastic band of the muffs over my ears on an absolutely arctic day, a few hours later I realized my bargain ear muffs had knocked my very expensive, designer earring out of my ear. Mind you, this is not how I typically dress, but I was on a job interview that day. The point is my $5 ear muffs cost me big time in the end. Bigger point? While shopping is a fun sport, and the odd bargain a real coup, quality is enduring and you usually get what you pay for. So now that the din of 2007 is quieting and 2008 is revving up, don’t forsake quality when it comes to your health.

I thought of our shopping behaviors and how we regard our health and our treatment regimen because a pharma rep. recently shocked me with the news that many doctors don’t prescribe insulin to their type 2 diabetes patients for fear their patients will shop for another doctor. Call me naïve, but it never occurred to me a doctor would prescribe less than the best treatment for his or her patients for fear of losing them. 

If insulin will better control your blood sugar and is the best treatment for you, yet you’ll shop for a doctor who’ll just tell you what you want to hear and, as many seem to be doing, become your pill pusher, that to me is the worst bargain – a Faustian bargain – a deal with the devil. 

The rep gave me a specific incident where he was talking with a doctor, a type 2 himself, who finally after having so much trouble managing his own blood sugars, “threw in the towel,” in his words and went on insulin. When the rep asked him how insulin was working for him, the doctor said, “It turned out to be the best thing I could have done. My blood sugars are much better and I feel so much better.” “So,” the rep asked, “now you prescribe insulin more often for your patients?” “No!” he replied, “If I did, they would leave me and go to a doctor around the corner who will give them the pills they want.”

Let’s face it, that great sweater in Filene’s basement may make you the toast of the party circuit but how many seasons is it going to last? With a sweater, who cares? With your health, I’m betting you want to see a lot more seasons ahead. Choose quality – in your doctors, your treatment, and in general, your quality of life. While I’m not much for New Year’s resolutions, the new year seems the perfect time to explore what options will give you the best outcomes for your diabetes, both today and tomorrow. 

Looking for a bargain, a short cut, the easy way can cost you dearly in the end.     I know. I really miss those earrings.

As diabetes month ends what did you learn?

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UnknownTake just one new step today

Today marks the end of Diabetes Awareness Month. What did you learn? Of course the notion of naming a month ‘Diabetes Awareness’ is in part to draw the public’s attention to diabetes. Yet, ask yourself what you learned this month, or this year, that you didn’t know before?

Did you know that approximately 21 million people in the U.S. – 1 in 16 – have diabetes and one-third of them don’t even know it? Out of those 21 million, 19 million have type 2 and 2 million have type 1. Did you know that 54 million more people have pre-diabetes? That means their blood sugar is slightly elevated, yet not enough to be considered diabetes. However most of them, if they don’t change their ways, will get diabetes within five years.

Did you know it’s predicted that one in three people born in 2000 will get diabetes? Did you know that every 10 seconds someone in the world dies of diabetes, and two more people get it? Did you know that diabetes is the fifth leading cause of death?

What did you learn about taking better care of yourself? Did you know that insulin controls blood sugar more effectively than pills, even if you have type 2 diabetes? Did you learn doctors hesitate to prescribe insulin because of patient resistance, and that it takes more of their time to educate patients and because of their own ignorance?

Did you learn that taking care of your diabetes is up to you, not your doctor? I guarantee you, he or she is not the one who’s going to wake up with complications down the road. Did you know that there’s a new insulin pump called Omnipod that has no plastic tubing and it’s controlled via a remote control? Did you know that if you have type 2 diabetes and you’re overweight losing just 10 – 15 pounds or 7% of your body weight could eliminate your need for medication? I have two friends with type 2 who just lost weight and both no longer require their pills.

Did you know that exercise is as important as diet to control diabetes because exercise not only burns sugar but makes you more insulin sensitive. This is particularly important for type 2s almost all of whom have insulin resistance. Did you know that?

Did you learn something about managing your head? For instance, it’s normal to feel overwhelmed, frustrated, fearful and crazed at times with all there is to do managing diabetes. You may also feel like your life’s falling apart at times taking care of a child with diabetes, but there is help.

Did you learn that you can do exactly the same thing two days in a row: eat the same foods at the same time, get the same exercise, take the same amount of medication and get completely different blood sugar numbers? Why? Hormone interaction, variable rate of insulin absorption, getting sick, lasting affect of exercise yadayadayada…Big message: it’s not your fault!

Did you learn that it’s actually advisable to take “diabetes vacations” from time to time – skip a blood sugar test or allow yourself dessert here and there, just make sure you prepare and don’t put yourself in peril. Did you learn – and this is my personal favorite – that if you shift your focus from the tiresome tasks of diabetes to why you’re doing them – to have more energy, be able to travel in your retirement years, continue a hobby you love or still be here to dance at your grandson’s wedding – that you’ll have more motivation, resolve and pleasure as you go through every day? 

Here’s a big one: did you learn that diabetes is not a death sentence? That today, unlike decades ago, we have incredible research going on, and the tools, information and know-how to control diabetes, and that if you keep your blood sugars as close to normal as possible much of the time, (an A1c < 6.5) that you can prevent or significantly reduce your risk of complications? Did you learn that this is within your control by getting educated at your local hospital, at a support group, online, joining a diabetes organization, or subscribing to a diabetes magazine. In other words, step up to the plate. Oops, you may also need to step away from the plate. Try controlling portions by using smaller plates, upping yourphysical activity in small everyday ways like climbing a flight of stairs, parking further away, dancing to the radio, and a big way — get busy on living your dream.

I hope you learned a lot this month. Finally, did you learn that you have to put what you learned into action for it to make a difference? And that if you do, it will.

Notice your thoughts – it will help you

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I write this blog for several reasons. One, I love sharing my knowledge and helping others. Two, I want you to know that managing diabetes involves emotional resilience not just meds and counting carbs. Three, it keeps my mind checking in on how I regard and manage my diabetes.

Truth be told, my diabetes-life began poorly. My early years were spent in denial and ignorance. Then after developing a few minor complications, I found my way to the top of the learning curve and shifted my vision — from seeing diabetes as a burden to creating a healthy life. And how I deal with my diabetes has given me that. Over the years I’ve maintained a thirty-pound weight loss, I eat sweets only as a treat, I’ve wiped refined carbohydrates out of my diet, I use smaller plates and so eat smaller portions, I’m always taking food home from restaurants (usually it’s mine), I power-walk almost daily and watch my head for incoming negative thoughts. Today diabetes is just part of my routine, and I’m healthier for it. I believe we’re all capable of finding a gift in our diabetes, and for some, it will be better health. Frankly, though, you have to be ready to look for it.

Here’s a Zen sort of exercise that may help you do better: notice your thoughts about diabetes. How do you feel about it?  What do you do to manage it? What don’t you do? Do you resent it? Is it friend or foe? How do you manage it: peacefully or combatively? Do you keep diabetes a secret? Why? Checking in with yourself on these issues may help create some new thinking for yourself, and prompt new actions. How you hold diabetes in your life impacts your entire life.

I’m always curious why we think what we do, do what we do, expect what we do. I’m intrigued by how when individuals face the same issues, we each exhibit different behaviors. And now I’m fascinated by how diabetes shapes our lives: why can some of us deal while so many are so stuck?

Noticing your thoughts can help you see the life you’re constructing every day — your whole life and the role diabetes plays in it. Often I hear my thoughts best when I’m out of the house, walking around the park. My mind seems more free to travel under the open sky. If you let yourself rummage about up there in your head and then capture your thoughts on paper, it’s a great way to glean some new insights and work out frustrations. Both are powerful means for coping with diabetes. 

If you’ve read a few entries here you may think I’m schizophrenic. I report about feeling pride and celebration living with diabetes in one entry and then exhaustion and disgust in another. But, you see, I believe living with diabetes is all these things: the good, the bad, the ugly and the proud. And, our emotions are a significant part of what we need to manage along with our blood sugars.

I hope you find these entries fulfilling in some way. Maybe they validate your own feelings, provide connection with others, expand your learning or peak or satisfy your curiosity. Mostly, I hope they spur you to think about your diabetes-life, and try something new if you need to. I know it helps me to write them. Here’s where  all those thoughts walking around the park go.

You can take a stab at writing your thoughts here too to see them more clearly. You may find you notice something valuable in the process. If so, let me know. Sometimes it’s good for me to test my own theories.