Sunday, June 21, 2009

On Being a Father

It is Father's day. A day of tie-gifting, card delivering and general grilling utensil accepting. Have you ever heard the saying, "Momma ain't happy, ain't nobody happy"? Well, the lesser known corollary is, "Daddy ain't happy, ain't nobody care". Father's day always seemed to be a holiday created to give some level of balance to Mother's having their own day the month previous.

I don't want to sound too cynical, because despite it's beginnings, I look forward to it. I've been a father for 8 years now and I hear it only gets more difficult/rewarding here on out! Here is a list of things men should be aware of before becoming a father:
*Kids are one of the major causes of gray hair.
*Childrens' need for attention rises in inverse proportion to the level of interest you have in what you are doing.
*In addition to those happy times of piggy back rides at the zoo, videotaping 1st birthdays, and attending recitals, there are also times of cleaning up vomit from the carpet just outside the bathroom door, trying in vain to remove a deadly splinter from a foot after telling him 10 times to put on shoes before he went outside, having to administer an antiemitic in suppository form because they can't keep down the liquid.
*No matter how weird it may sound before you take on the title, your favorite name will be Daddy.

I've been called lots of things (to my face, and probably lots more behind my back), but my favorite name is Daddy. I love my children unashamedly, without reserve, to the point my heart feels on the verge of bursting from the love it contains. If you want to get in good with me, really fast... dote on my children.

Being a father has been my greatest adventure. My children teach me things every day. One of my daily lessons is invariably patience, a subject I fear that I must continually learn. If you want to know how you are, look at your children. They reflect you. I'm glad to say that my children are fun to be around, kind and generous to others, helpful and creative, silly and yet profound. On the other hand, they all tend to have their moments of whining, disobedience, disrespect, and stubbornness. Maybe I need to rethink my assertion....

I don't think everyone is cut out to be a father. Anyone can have a child, it is shockingly easy to do. Being a father is a task on an entirely different level. Being a father requires a man to be at once both loving and stern, level-headed and impulsive, authoritative and collaborative, flexible and unyielding. Knowing when to exhibit which trait is sometimes difficult.

Being a father makes me appreciate my own parents a little more. It has been said that the only curse that truly takes is, "I hope you have children that are just like you!" Not that I was a handful. No, I was an angel, a piece of cake, no trouble at all. Just ask my parents, they are the ones in the corner of the rubber room in the tight white jackets. All kidding aside, it is a really tough job at times. However, God has graced most parents with the ability to let the trying times fade and focus on the moments of joy.

In a drawer upstairs, I have one of the gifts I was given on a past father's day. It is a cardstock tie, cut to size and colored with green crayon (my favorite color) and decorated with random stickers. It was attached to a piece of elastic band so it could be worn. Being a father means that you wear the cardstock tie to church Sunday morning. I got more compliments on that tie than any article of clothing I've ever worn.

Being a daddy means that I'm going to be really sad the day that Ethan figures out that boys don't kiss boys. I'll miss his "kiss attacks".

In my wallet, I have a paper cutout of a key. Mary Hannah was tracing things one day and she cut it out and gave it to me. I asked her, "What is this for?" She answered, "It is the key to my heart, daddy." It is one of my most treasured possessions.

Eleanor has a spring loaded bed. I mean, she must, because she is up and out of it so many times each night, it has to be the answer. For all the frustration with getting her to go to bed and stay there, I am convinced that she gets her night-owl habits from her daddy. Some nights, after she's managed to get to sleep and then is woken up by some trifle, instead of sending her right back to bed, I'll enjoy a cuddle in the chair in the living room. Ele is the best cuddler. It takes one to know one.

Newsong has a number that connects my role as father with my relationship with God. It is called, "Your favorite name is Father". I linked a YouTube video. Check it out.

Here are some things I do with my kiddos that make me happy:
wrestling on the floor*playing on the Wii*jumping on the trampoline*coloring pictures*making French Toast*going out for Sno-Cones*running errands*hugs and kisses*combing hair after bathtime*taking pictures*shopping for mommy*singing in the car*playing in the sprinkler*reading nighttime stories*giving piggyback rides*wearing matching clothes*playing tag*being appreciative of their crafts*listening to their stories*making them laugh*cleaning out the car*taking road trips*sitting down at the dinner table with them*getting help with household tasks*picking out flowers*attending their school activities*arranging for playdates*getting haircuts*surfing the web*more hugs and kisses*

Fathers: Enjoy this day, but remember to enjoy everyday. Being a daddy is the greatest job in the world.


Thursday, June 18, 2009

Initial Impressions about the Omnipod insulin pump

At the end of May, we switched Ethan's insulin pump out and have been trying out a new type of pump. Ethan was diagnosed with Type 1 diabetes in December of 2004 and has been using the Minimed Paradigm pump since spring of 2005.

All in all, we've been very pleased with the Paradigm pump. For those of you who are not familiar with insulin pumps, here is a brief description:

(image ganked from here) The pump is about the size of a pager (remember those?) or a flip phone (closed). It has a slot for a reservoir which is filled with insulin and the electronics which dictate how quickly the screw-driven pump will administer the insulin. A minimal amount of buttons on the face allow users to input blood glucose readings and adjust the dosage as needed. The pump itself is connected to the body via some tubing, through which the insulin must travel to reach the infusion site. The infusion site is a place on the body where a small canula is inserted using a disposable needle. Once the needle has placed the canula, it is disposed of, leaving the flexible plastic canula inserted in subcutaneous fat just below the skin.

As I mentioned earlier, we were pretty content with the pump, as it offered us greater control and less hassle in managing Ethan's diabetes. The high points were:
1) Typically, we only had one injection (the infusion site) every three days, which is how often we had to replace the site and reservior. Before the pump, Ethan got at least 5 shots of insulin each day, more when needed (which was frequently).
2) Whenever we did have a problem with the pump, the company, Minimed was FANTASTIC about helping us solve it. The most extreme (and impressive) case was one Friday morning, when the pump inexplicably shut down. Although we had backup supplies and were prepared to weather the weekend using syringes, Minimed jumped through all kinds of hoops to get a new pump there by the following afternoon. Unable to find an overnight delivery option, they purchased a commercial airline seat for the pump, put it on a plane and had it flown into Abilene regional airport, picked up by private courier and delivered to our doorstep within 24 hours. This was all without us pitching a fit. We were perfectly okay with waiting until Monday, but given Ethan's fragile medical history, the company decided on this action on their own.
3) Online ordering and billing was easy and we never had any problems getting supplies.

The downsides of the Paradigm pump for us were:
1) The infusion process. We tried using the quickset infusion set, but the springloaded device didn't work well for us and we had a lot of misfires that resulted in unusable supplies (when you use three sets to do one infusion, it adds up quickly). Also, it was a little painful for Ethan. So we switched to the Silhouette inserter, which worked better but required us to stick Ethan by hand using an inch and a half long needle every three days. For various reasons, the angle and depth of the infusion was different everytime, affecting the absorption of the insulin, and thus, it's effectiveness.
2) The tubing. Anytime we had a high blood glucose reading, the first culprit was the tubing. Air bubbles, kinks, and even outright disconnection from the pump while not common, were also not uncommon. Also, even though it didn't happen very often, there always remained the chance that the tubing would be caught on something and damaged or get pulled out. Admittedly, this only happened twice in the four years we used it.
3) The canula. Again, it wasn't common, but it was also not uncommon to have the adhesive wear off a bit and the canula work it's way out, delivering its payload of insulin on the surface of the skin instead of underneath. This also tended to be painful for Ethan and a source of great discomfort.

Soooooo.... when we heard about the Omnipod, we were pretty jazzed. It addressed all of the main concerns we had with the Paradigm pump. It was self-contained (no tubing) and the infusion process was precise (always delivering the canula at a 45 degree angle 1/4 an inch below the skin, every time. It is spring loaded and instead of the two-three second process that happens by hand, it happens in 1/250th of a second, minimizing the pain). Also, the pump has a window on it so you can see for sure that the canula is inserted in the skin.
(image from here)

So, after using it for almost a month, here is my review:

Overall, I'm impressed. Ethan's blood sugars have been more consistent and lower than we were able to typically manage with the Paradigm pump. The process of changing sites doesn't take as long nor is it as complicated. It seems to be less painful, according to Ethan's reactions and recovery time after site changes. He's been to Karate and been swimming with it and it functioned as promised.

Here are my concerns:
1) Adhesive. The backing that attaches the pod is not adequate. I understand that it is probably difficult to find a balance between something strong and durable enough to last for three days but weak enough to be able to remove easily and painlessly. However, it is just not up to the task of keeping up with a 6 year old boy... We've had to use medical tape (the type they use to secure IVs in hospitals. This works, but is annoying for several reasons a) we shouldn't have to take an extra step to secure it and b) the edges of the adhesive attract lint and when we remove the tape, the remnants stay on for days, despite attempts to use alcohol, acetone or other adhesive removal liquids.

2) Pod malfunctions. In four weeks, we've had two malfunctions that have required replacing the pump. Not only is it distressing to have to put Ethan through the process before the three days, but it is expensive, as well. In addtion to the expense of the pod, we are also out the insulin that is in the reservoir. Even when insurance covers it, insulin is EXPENSIVE.

3) Canula. I am glad that the window is there, but the combination of a poor adhesive and a pod malfunction left us in a high blood glucose situation for two days before we figured out that the canula never went in. After almost 24 hours of inexplicable high BG numbers, I finally gave Ethan an injection with a syringe and treated his ketones. Amelia was the one who noticed that the canula wasn't in.

4) PDA device. I know they're trying to keep expenses down, but this is just poorly engineered. The buttons are clunky and not very intuitive. The interface is too multilayered. Although it is designed to communicate wirelessly with the pump and displays the last BG reading when you activate it, that feature only works when you are within a foot of the pod. If Ethan is in another room and I'm just looking at his numbers, it takes four menus to get to his latest BG reading. Also, one of the times we had a malfunction - a communication error, the PDA instructed me to change the pod immeditely. However, my more immediate concern was to check Ethan's glucose. Because the PDA is also his glucometer, I was unable to bypass the ERROR screen and simply check his sugar. I had to dig a spare glucometer and check him (and then dose him, as he was high) before I could change the pod. There should be a manual override so you can use the PDA as a glucometer regardless of pod malfunctions. The PDA includes an onboard library of common food items and their nutritional information. This is just gimmicky. Any competent diabetic (or caregiver) will know this stuff by heart or will have access to a better source of information. Remove this function and save space, memory, or ... something.

So, am I happy we switched? So far, I think it is almost even between the two pumps. They both have strengths and flaws. I haven't interacted with Omnipod's customer service, but I need to call them and address my concerns and find out what our options are for recovering some of our expense when their product malfunctions. I'll try to keep you posted. Cheers!